Human-Centered Service & UX Design to improve Healthcare Access for Migrants
Case Study: Anne Eli, a bilingual pregnancy app and related services for migrant women
- Problem: Pregnancies among migrant women in Austria pose higher risks compared to those of native-born women; utilization of care and prevention services is lower.
- Solution: Collaborating with migrant women and healthcare professionals, we developed new service ideas and a bilingual pregnancy app to enhance access to health information and healthcare services.
- Client and approach: I initiated the project with my business partner, Eva. With our team we embarked on an open-ended problem-solving journey, employing methods and tools of human-centered service design.
- My role: Co-founder, Design Lead
- My responsibilities: Design Research, Workshop Facilitation, UX Design, Service Design, Leadership, Project Management
- Outcome: Feedback on the beta version of the app from both migrant women and healthcare staff was highly positive. However, our attempt to collaborate with public healthcare institutions faced challenges for various reasons. More at the end of the case study.
A critical issue: Migrant Health
I met my business partner Eva at Impact Hub in Vienna, a co-working space for people interested in creating a positive social and environmental impact.
Eva had worked in the health sector for decades, and I was drawn to the field due to my family history. We both shared a common vision of improving healthcare services, especially for vulnerable groups.
Migrant health turned out to be relevant not only from a social perspective but also from an economic standpoint. In Austria, health literacy is relatively low within the European context, with emergency hospital services being overused, and general practitioner services being underused by both native Austrians and migrants. This situation results in relatively high healthcare system costs. With this rationale, we were able to convince a jury that our project proposal was eligible for funding dedicated to the Creative Industries (as opposed to traditional social funding).
Our dream was to collaborate with public healthcare institutions, and I vividly recall a jury member who, based on his own experience, cautioned us about the challenges and difficulties ahead. Undeterred, we started the project fueled by strong motivation and, perhaps, a touch of naivety.
Focus: Migrant Health During Pregnancy
We decided to focus on the health of migrant women during pregnancy due to both its relevance and practicality. Pregnancies among migrant women in Austria pose higher risks compared to those of native-born women, and the utilization of care and prevention services is lower. Additionally, the duration of a pregnancy would provide us with sufficient time to work with families and healthcare staff throughout the design process.
What does it mean to be pregnant as a migrant woman in Vienna?
Our first goal was to find out how women from other countries currently experienced their pregnancy to identify major pain points and opportunities for improvement and innovation. Therefore, we conducted in-depth contextual interviews with pregnant women and young mothers at their homes, workplaces, and in parks. For the MVP, we specifically focused on the Turkish community, a substantial migrant group in Vienna, where pregnancy health is a prominent concern.
A significant pain point was communication with the doctor. While our main target group for the MVP was young women who had recently migrated, upon deeper investigation, it turned out that the actual problem was not so much the language barrier itself but the lack of information regarding what will happen during a visit and what is expected from the patient. Most importantly, the fear of making errors and appearing stupid, partly grounded in previously experienced prejudices against migrants, kept women from asking important questions.
We gathered a wealth of information on user needs through our contextual interviews. However, health information can be quite dry, right? How can we ensure that women actually want to use our service every day? To gain inspiration, in addition to the ethnographic interviews, we collaborated with a German language school and asked migrant women to create a photo diary of what motivates and delights them in their everyday lives. This visual research was invaluable for generating ideas on how to make our service offering interesting and engaging.
What are the needs of healthcare staff?
The next important step was to understand the challenges from the service providers’ point of view. We interviewed healthcare staff and social workers. Additionally, we gained insights from a day of shadowing and observing in the hospital.
For example, it turned out that hospital staff is not seldom confronted with aggressive behavior when wait times in the emergency department are long. Nurses and receptionists felt that there was a lack of understanding of how an emergency department works in terms of urgencies. This led to the idea of offering “Staff Cards” in the waiting room, which introduce the medical staff and their jobs in a personal way to create more understanding and empathy (among other ideas).
How to address the problems found?
Service Design Thinking is characterized by its “outcome-open” problem-solving approach. The often-cited example ‘You don’t need a car, you need a way to get from A to B’ illustrates how focusing on the problem opens up space for generating diverse creative ideas on how to solve it.
When we felt that we had a good grasp of the problems to solve, we moved on to brainstorming: generating as many ideas as possible, mapping them, selecting the most promising ones, and visualizing them.
Which ideas work?
Design Speed Dating
We detailed several ideas in the form of storyboards representing , scenarios of use, and presented this material in a co-design workshop with migrant women. The first part consisted of Design Speed Dating to identify viable scenarios (see box on the right), the second of improving the most promising ideas collaboratively.
More information about Design Speed Dating
Speed Dating: Providing a Menu of Possible Futures, Zimmerman and Forlizzi
Iterative Prototype Testing
Next, we created simple interactive prototypes of the top voted ideas for digital and non-digital service touchpoints: a multi-lingual pregnancy app, a health-related board game, and a coupon booklet for free complementary healthcare and social services, to be delivered with the “mother-child-passport.” (This prenatal care record is given to mothers by their doctors in the beginning of a pregnancy in Austria.)
After testing these prototypes several times with users and health care staff and revising them based on their feedback, we prioritized implementation based on expected customer benefit, technical and operational feasibility, and cost.
Fun fact about App Prototyping
We initially tested a digital greyscale prototype built in InVision. Even though we explained that it was just a prototype, women still thought the app already existed and asked many questions about the promoted services while wondering why the app had not been made available to them before. This prompted us to print out the screens and present them in a cardboard phone dummy. In this way we were able to get much more feedback for improving the app.
Outcome: A bilingual Pregnancy App and a Future Service Concept around Migrant Health
Based on our research findings, we developed a bilingual pregnancy app as our minimum viable product (MVP) that aimed to assist migrant women in each stage of their pregnancy through four key features:
- Daily Health tips: Relevant health tips tailored to the specific pregnancy stage in engaging formats such as videos, illustrations, quizzes, etc. The right information at the right time.
- Calendar of Exams and Complimentary Visits: A calendar and reminders for important medical exams and complimentary free social and health consultancy offers.
- Visit Preparation: Information on what is going to happen during a doctor’s or complimentary visit, why the visit is important and additional information.
- Phrasebook for Communicating with Medical Staff: A tailored phrasebook for each visit during pregnancy, allowing women to practice essential questions in German and listen to the pronunciation. It enables them to communicate more confidently with medical staff, and there is also a feature to record the answers given by medical staff.
The app was at the center of a larger service concept to improve migrant health, which also envisioned interventions directly at medical practices and hospitals and physical products like a healthcare services coupon booklet and a cardboard game.
Feedback
The migrant women involved in the project were very happy with the final result, and also medical staff, who initially had been skeptical, were looking forward to the launch since they felt the app would support them through better patient preparation.
Lessons Learned and Reflections
That was the fun part, now the difficult one….
As mentioned initially, a jury member of the funding commission cautioned us about the difficulty of getting public healthcare institutions on board. We managed to get informative interviews in the beginning but involving the institutions more actively in the process was unfortunately not possible due to bureaucratic constraints.
We were hoping that a collaboration would be easier once we had a fully functional beta-level prototype to offer, and the only thing to be provided from institutional side would be health-related content which already existed in the form of traditional paper brochures.
We had meetings with all important institutions, starting from different city departments and social security services to the Ministry of Health. The feedback was always “Amazing project, you should propose it to the other institution.”
We briefly considered collaborating with commercial partners or private hospitals but this was not really in line with our social vision and motivation to support vulnerables groups. So, in the end we could never launch the app and services to the public.
I’m still happy that we did this project. It was a great learning experience, we had a fantastic, extremely diverse team and also the participating women and healthcare staff enjoyed the project activities. It gave a glimpse of hope that things can change. At least the design process provided benefits for the participants albeit the final product could not be launched. (The photo diary study and co-design workshops also worked as art therapy activities and Eva provided a lot of information on reproductive health during our design workshops. After my art therapy education, I can now appreciate these process outcomes much more than before.)
I strongly believe that design can contribute a lot to social and healthcare innovation and would love to hear about your experiences, and maybe start a project together.
Acknowledgements
Thousand thanks to my fantastic team, composed of:
- Eva Westhauser (Co-Founder, Marketing, Business, Service Design)
- Nurten Aybar (Social Worker, Collaboration with Ethnographic Research and Co-Design Workshops, Service Design, Translations)
- Konstantin Wolf (Graphic Designer, Visual Design, Service Design)
- Stephan Petzl (Software Developer, Android App Development & Web Development)
I’d also like to thank my friends who provided feedback and support, especially Tamer Aslan, founder of City Games Vienna, who came up with the name “Anne Eli” which literally means “the hand of the mother” in Turkish and is also used to refer to something good or delicious in general (for example, food).
The viability study and proof-of-concept consisting of a fully functional Android prototype was financially supported by Austria Wirtschaftsservice (aws) and the Austrian Federal Ministry of Digital and Economic Affairs (aws impulse XS program) and by the Vienna Business Agency (departure pioneer program).
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