Zenbox


Research / cultural probes / interaction design / prototyping / Healthcare


Zenbox is a tool designed to bring alternative care to patients suffering with depression.



Read about the project below

About the project

Premera, one of the prominent healthcare insurance companies in the Pacific Northwest region, provided us with a problem statement which will help them broaden their learning about a niche area of users. We were given 11 weeks to research, prototype and build a final design solution.

Our problem area was to imagine a better means for caregivers to attain the right care, create a plan, and support their care recipients.




Team & Role

I worked with Nora Owens and Samantha Baker while being mentored by Audrey Desjardins and Michael Smith. I was involved in secondary and primary research, creating cultural probes, prototyping and testing, designing the architecture, user-flows, UI design and framing the final UI spec document.

Opportunity



During our initial few weeks of identifying our problem space, we performed a lot of secondary research. Reading scientific papers, articles, books, journals and interviews assisted us considerably. Moreover, all of us somehow had some interaction with depression. Consequently, we decided to dig deeper into the field.

What is depression?

Symptoms causing an individual clinically significant distress or impairment in social, occupational or other important areas of functioning, including:

  • Loss of interest or loss of pleasure in activities
  • Change in appetite or weight
  • Sleep disturbances and fatigue
  • Feeling agitated or feeling slowed down
  • Suicidal thoughts or intentions



Response to a cultural probe placed in the streets of Seattle. Read more about these probes below.



Our initial research showed the immense scale of depression in adults around the US. 16.2 million adults in the United States experience depression each year, making it the leading cause of disability.

65% of U.S. adults with depression did not receive treatment last year. And of these, less than 36% sought treatment of any kind in the first 90 days after diagnosis.

Understanding the problem



We dug deeper to understand the underlying issues which prevent such a huge majority of diagnosed patients aren't receiving treatment.


Patients often many time doubt the diagnosis

Most people are diagnosed by their primary care practitioner, often making an appointment for other reasons (such as fatigue, pain, or sleeplessness). Because they have yet to self-identify that they are suffering from depression, they often do not believe their doctor’s diagnosis. Lack of accurate information (combined with stigmatizing social perceptions) about depression leads people to be hesitant to recognize their illness. Additionally, many people typically relate depression to sadness.

“I used to keep realising [my symptoms of depression] every now and then...because [I have Bipolar II disorder], there would be periods of few days where I couldn’t sleep and then be extremely normal for a month. there was only one person I trusted who didn't take me seriously, so I kept questioning it..”
Interview with Bipolar II & depression patient for the past 4 years





Social stigma permeates all aspects of the experience

  • Those who feel internalized stigma are found to be less likely to engage in help-seeking behaviors.
  • Patients feel like a burden to their family and friends so are hesitant to discuss their illness and often reluctant to seek help.
  • Patients often feel scared and embarrassed to talk to a doctor. They can also be uncomfortable sharing painful subjects during talk therapy session, for some, even causing a reluctance to seek help.


We placed the cultural probe shown below asking “Who do you know with a mental health condition?” on the University of Washington Campus. We found that people were most likely to select ‘You’, ‘Friend’, or ‘Significant Other’, with ‘Sister’ and ‘Brother’ ranking close behind.

We surmise that due to societal stigma, the closest relationships are those in which mental illness can be discussed.



A board was placed in the streets of Seattle. People responded to the question using stickers placed along with the board. A lot of these relationships were also written by them.



The most common stigmatizing perceptions are that “Patients who have a mental illness” are: weak, crazy, failed at dealing with life’s problems, or lack will power/are to blame for the problem.

This kind of negative self-talk was mirrored in responses to our “What does depression look like?” probe, placed at the University of Washington.

According to the literature, people who hold these negative self-perceptions are found less likely to engage in help-seeking behaviors.



The responses we received made us surmise how different depression is recognized as in society.





Fear of medication keeps people from seeking treatment

  • Especially due to stigma, many people don’t like the idea of taking medications or have the perception that they’re weak if they do so.
  • In an interview with a Californian social worker, she mentioned many barriers her patients encounter when trying to get onto a steady medication plan including: cost of medication, stigma leading to a denial of the diagnosis, the time and commitment it takes to adjust to medication
  • In an interview with a soon-to-be doctor in India, who is researching issues of mental health treatment in the United States, “It is a [little known] fact that [talk] therapy is better than medicines, but again, therapy is costly and a privilege. In most cases, insurance doesn’t cover it.”


“People try the meds, start to feel ok, then get off them. It’s a never ending cycle. With diabetes you can go get a blood test, but mental health is very subjective... People feel it is their own fault.”
Interview with a Social Worker from California





Issues with treatment options

  • One of the interviewees mentioned of her anxiety during scheduling calls, preventing her from taking the first steps to getting treatment. Her friends were able to assist her in making those phone calls and now her family and friends help her manage scheduling.
  • There’s typically a long wait to get a first appointment (2-3 weeks average).
  • The average appointment time with a psychiatrist is just about 22 minutes. Furthermore, at the appointment the patient needs to put effort in articulating the complexities of their mental state and well-being.
  • People are not informed of the full range of treatment options available to them


“[therapists] are trained to deal with different kinds of situations. but I was building myself up from scratch. I didn't have much to say when [she’d] ask why I was there, I didn't have a specific issue to work with. She couldn’t help me, and I looked for someone else.”
Interview with Bipolar II & depression patient for the past 4 years



“My psychiatrist [suggested I] join Yoga Therapy classes. It helped me calm down my nerves a lot.”
Interview with depression patient







What is the caregiver experience like



After understanding the entire spectrum of issues around patients, we now dug deeper to see what issues do caregivers of patients with depression face.

  • Caregivers of those with mental illness provide on average 32 hours of care a week, more than a typical U.S. caregiver.
  • These caregivers are an integral and often the only source of unpaid help for adults with mental or emotional health issues.
  • Mental health caregivers help with instrumental activities of daily living, including arranging or providing transportation, shopping, housework, preparing emails, managing finances, giving medicine or injections, or arranging services.
  • From primary interviews, we heard how caregivers can be vital in scheduling and arranging care, as adults cannot receive caseworkers to assist them.


Along with our probe asking “Who do you know with a mental health condition?”, we solicited stories about what it is like to support their loved one.


We found that many caregivers may be unsure of how to best provide support, and are even unsure of what their loved one’s want.



“Both of my ste sisters have mental health conditions, which is hard to support 2,000 miles away. I have tried really hard to simply listen without any judgement or giving any advice b/c I think that is what they want."







Iterated problem statement



Following our research phase we rethought our statement which gave us a better and clearer picture of what we wished to achieve with our design solution.

How might we support caregivers of adults with depression in finding the right care and supporting their care recipients?

The outcomes we hoped to achieve in our design response:

  • Educate caregivers about ways they can help their care recipient.
  • Provide caregivers with the tools to make an informed choice with their care recipient.
  • Assist the care recipient and caregivers in overcoming existing social stigmas*.

*Stigma includes ill perceptions towards taking anti-depressants, talking about one’s depression, going to a therapist, pursuing alternative medicines, a belief in self-cure or that one can “snap out of it”, and that people with depression are weak.

Ideation



In our ideation process, we utilized many methods including 4 x 4s, 8 x 8s, polar opposites, and braiding. We found several broad themes across our ideas. We came up with 90 thought-through ideas which were later down-selected to 20 and then to 3 final ideas.

Discussions with Premera representatives, other experts in field and various books helped us frame our criterias for down-selection.

We first looked at our twenty ideas through the Six Thinking Hats methodology. By examining choices with the perspectives of the process, optimism, emotion, creativity, facts, and cautions, we reached a more holistic understanding of the strengths of our ideas.

Following, we utilized a decision matrix for each idea, examining the strength of each with regard to the: caregiver role, consideration of privacy, ability to get the patient directly to a care provider, ease of use, requires little patient effort, and how innovative it is.

We then pulled our top options from our decision matrix, finding that they strongly correlated with their evaluation from the thinking hats. Results from our creativity perspective made us realize that our ideas are best combined. We negotiated combinations of our ideas to come to three proposed responses that can each comprehensively address our desired outcomes.



20 down-selected ideas. Along with each idea, we listed down all possible combinations which help build a stronger product.



Response 1 - Being There

This beautiful and well crafted object aims to provide an alternate care plan to patients, to complement their ongoing medical care.


This is a physical box, designed to counter the symptoms of depression by engaging patients in alternative hobbies and tasks. It contains informational cards, alternate action cards, communication aids, caregiver calendars and emeregency planning tools.

Storyboard made by me explaining the concept.





Response 2 - Getting Care

A platform for caregivers to educate themselves about the different options for treatments, understand what they entail, and read success stories from other patients.


This is a platform for caregivers to educate themselves about their options.Contains Online caregiver classes hosted by the insurance provider and transparently outlines the care options available/covered by insurance. Additionally, it also has personal success stories available for all therapies and situations.


Sam made this amazing storyboard about response 2.





Response 3 - Alternative Medicine

A platform for caregivers to educate themselves about the different options for treatments, understand what they entail, and read success stories from other patients.


This is a platform for caregivers to educate themselves about their options.Contains Online caregiver classes hosted by the insurance provider and transparently outlines the care options available/covered by insurance. Additionally, it also has personal success stories available for all therapies and situations.

This compelling storyboard, made by Nora, talks about response 3.







Prototype testing



Using the same criterias used in our previous down-selection and through initial user-testing with potential users we came up with a final concept. Through our interviews we realized that Response 1 stood out to be more impactful than others. However, there were elements from the other responses which could be merged together to build a more comprehensive and robust solution.

Hence we built Zenbox, a tool to providing caregivers with introductions to alternative care options, personalized to treat their loved one's depression.


One of the many tested paper prototypes of Zenbox




We tested the prototype with 6 potential caretakers and patients. They were recruited via various social platforms and UW communities. Our aim was to test if users understood what Zenbox was, how it works, its components and more importantly what brought them joy on using it.

We received a lot of constructive feedback and learnings. We needed to communicate on what Zenbox is in an understandable yet comprehensive manner. The website, which serves as a merketing landing page, needs to explain the interacies of what Zenbox is. At the same time, needed overall clarity on the relationships between the box, caregiver, and the patient. Some also requested for helper tips and guide to have a conversation with their loved ones.

You can find more about the results below.

Read more





Defining the architecture



While testing the early wireframes of the prototype, we started framing the architecture and user-flow of the product.

The primary user (caregiver) journey has three key paths: order Zenbox online, use the box, and return to the website to find a practitioner. This journey is represented graphically below. Users may select up to six treatment trials, in which case key path two would be expanded accordingly.

Journey of the caregiver while using Zenbox. Keypaths are explained below.




Sitemap




Key Path 1

The landing page (Zenbox’s website) contains information about the product, detailing how it works and featuring user testimonials. The a caregiver needs to provide a few details about the patient which enables Zenbox to suggest customized treatment options for the patient based on the survey. The user then submits a request to receive the Zenbox which contains exercises to try for each of these personalized treatment plans.

User flow for Key Path 1




Key Path 3

Returning to the Zenbox website, users find key information regarding their chosen course of treatment, including the average cost per month, details of insurance coverage, and the typical schedule for appointments.
Before booking an appointment they learn a bit more about what the first appointment will be like, and have the opportunity to download a support toolkit and practice with it.

User flow for Key Path 3







Developing the UI



During the process of refining our concept (following ideation), we began to articulating our visual schema. As we discussed the merits of each conceptual finalist, we determined that some of their best attributes could be combined into one idea which helped frame sime guiding principles. Our style-guide evolved during testing with users. We listened to the way they described and critiqued Zenbox, which reinforced our commitment to direct, personal design that puts the caregiver at the forefront.

Our primary color palette is shades of blue. Despite being blue it still has a warm feeling to it, something which echoes our design principles for Zenbox. A darker hue is used for emphasized areas.

Our secondary palette is vibrant and delightful with color applied thoughtfully and with restraint. The background shapes and illustrations use a low opacity of the color so as not to overwhelm the composition.

Both our website and Zenbox employ careful use of White and Sleeping Swan to put a touch of Zen into our product. The colors are each named to relate to yoga and meditation.

Color palette and type rules used for Zenbox



The Zenbox logo is derived from the traditions of Japanese zen rock gardens (karesensui) from around the 14th century. These gardens appeared in Buddhist Zen temples and are meant to inspire reflection. Across styles of gardens, rocks are often placed in groups of threes and have certain metaphorical meanings, dependent upon the tradition. Our stones symbolize (from largest to smallest): Premera (the insurance provider), who supports the caregiver, who in turn supports the person with depression.

One of the possible logo variations of Zenbox



Zenbox's detailed UI specification document can be viewed below.

Read more

Final designs

After weeks of prototyping, testing and iterating we built this final version of our design response. Our design solution caters greatly to the needs of Premera and Blue Cross Blue Shield in Washington since their patients have a higher diagnosis rate of depression as compared to the rest of the country. At the same time, Zenbox bridges the gap between the digital and physical world, presenting informational materials in a personal and accessible way.
 Furthermore, it makes life easier by connecting people with the right care and local practitioners within the convenience of their home.

Zenbox website showing Key Path 1. The caregiver visits Zenbox's website and places an order for the box.




The box contained customized and personalized treatment options, caregiver tips, delicious treats and hand-crafted gifts.

The Zenbox with 3 possible treatment plans and gifts.



The caregiver now returns to the Zenbox website to book a doctor appointment (Key Path 3).




Zenbox

Bringing alternative care for depression