chatbot-cece-pelvic-health

Creating safety with a chatbot to drive better outcomes in pelvic health

The Brief

According to Renalis Health, “Pelvic health disorders are insidious and expensive, affecting one in three people in the U.S. with costs exceeding $100 billion per year.” 

These disorders are often emotionally fraught and complex. They are a progressive problem to solve for patients and equally challenging to treat for healthcare providers. Often, pelvic health patients must follow a comprehensive plan to manage their symptoms and improve their overall state of being, but many are unable to succeed.

Knowing how difficult this can be for patients and providers, Renalis wanted to build a tool that focuses and supports the patient on this journey. 

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 To date, they've had success with a conversational agent (sometimes referred to as a chatbot), CeCe Lite, which provided people with a five-day experience of interaction and education. 

When they came to us, the next step for Renalis was to do a proof of concept study for a full-digital therapeutic for Overactive Bladder and submit those results to the FDA. In this study, participants will fill out validated surveys through the CeCe conversational agent,  as well as keep a bladder diary (tracking fluids in and fluids out) for three days. 

After the initial diary tracking participants will receive ongoing behavioral therapy consisting of behavior modification, fluid management education and urge suppression for 7 ½ weeks. They will also engage in exercises to increase their pelvic health.

“Building the right digital app that was easy for our patients to use with an inclusive design, was critical for Renalis. The integrated team at TXI uncovered valuable insights and delivered an extraordinary product that was innovative, user-centric and secure.”

Missy Lavender, Founder, CEO

Renalis sought help from Table XI in two ways: to develop, in the short term, what was needed to facilitate the FDA study and, more broadly, to understand what the opportunities are to better serve this population beyond the immediate constraints of the study. 

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Our goal was to reimagine a better patient experience while increasing physician and care team capacity through the power of digital product innovation.

cece-diary-flow

Throughout our research and discovery process, we tested many different ways to add diary entries. The final product resulted in a mix of representative iconography and specific numeric inputs to ensure accurate and complete information. 

The Challenge

Renalis came to us with a strong understanding of the data that physicians needed to collect from their patients but desired a greater understanding of the patient’s needs, goals and priorities. 

For people experiencing pelvic health disorders, the symptoms can be intensely embarrassing, and many are reluctant to identify and investigate their issues.

The opportunity to capture adequate patient data and inform better avenues of treatment and education will come from an upcoming proof-of-concept study Renalis’ research partner, University Hospitals will lead. 

6 steps to getting better software for healthcare providers

The study will require participants to keep a bladder diary (tracking fluids in and fluids out) for three days. At the end of those three days, participants receive ongoing virtual behavioral therapy consisting of education and exercises to practice. There are two subsequent diaries at the four-week mark and eight-week mark, to show patients how and where they have improved over the course of the study. 

Table XI’s integrated team worked to answer the following questions through a series of workshops and prototyping:

  • How can a digital product help to make it as easy as possible for someone to add to their bladder diary?
  • Knowing that pelvic health is a complicated topic for many people, how might we address the emotional stress surrounding these symptoms?
  • How can a tool give users more control over their bodies and lifestyles?
  • How can we utilize a conversational agent to educate and engage with users in expert dialogue?

With the norms changing in work collaboration during the pandemic, we utilized digital whiteboard tools, like Mural, to create a collaborative co-working space for the team and client.

The Solution

Table XI’s multi-disciplinary team of strategists, designers and developers guided Renalis stakeholders and patients through an established double diamond process to deliver innovative solutions. This integrated team, imperative to the project’s success, provided the different perspectives required to effectively deliver an end-product that mattered.

The crux of the double diamond approach is the concept of divergent and convergent thinking. Being able to go broad but then narrow based on informed decisions allows us to understand the total scope, while also prioritizing the right problems to solve. This approach leads to more creative and innovative solutions that meet business and user needs.

Build the right thing with double diamond

Before you can define a solution, you must back up to understand that you are solving for the right problem.

Our four steps of Research, Map, Ideate, and Define provide a rich foundation for us to kick off all of our projects. Over the course of two days, we led Renalis through a series of collaborative sessions to gather insights and ideate potential solutions. That was followed by prototyping a mobile product that we then validated through patient interviews. 

Throughout our process we were able to explore ways on how best to:

  • Make the process of collecting data less of a burden for patients
  • Keep users engaged through an 8-week journey
  • Give users a sense of control over their experience and tackle feelings of shame and embarrassment

After our initial workshop, we developed an interactive prototype to test with our target users: women who experience symptoms like needing to urinate multiple times throughout the day, having leaks during the day or night and/or intense urges to urinate.

When testing with users initially, we represented liquids using icons. However, because of the specificity needed in measurements, we found users actually preferred having a combination of iconography and numeric entry.

Empathy is the most important factor to build during this research phase and will ultimately impact how valuable a product is after its release.

This user research unveiled common themes and insights that provided a consistent roadmap for design to follow, like interface simplification and language use that is sensitive to the emotional aspects of the symptoms and gender-inclusive to trans and nonbinary folks with OAB. 

In tandem with our research and design phase was a technical discovery to better understand HIPAA constraints, optimal technology for the conversation agent and how to unify that agent with a diary-driven experience.

“The only thing they've done is throw medication at me”

Feedback we heard in user testing supported our hypothesis that diagnosis and treatment must meet a user where they are to ensure adoption and success of treatment.

cece-urge-tracking@1x

The Results

Through our research and discovery process, we determined that an app that focuses on engaging patients in a trustworthy and flexible format would lead to stronger adherence to a voiding diary. That outcome, while meeting user needs, would also support Renalis’ business needs in validating their product in their first official study. 

Prioritized features based on research
  • Easy-to-navigate onboarding and diary flow, that reduces complexity by presenting questions one at a time
  • Flexible options in how to record diary entries, be in the moment or all at once in one sitting
  • Simple navigation with approachable, friendly illustrations that increase comprehension, while also meeting users going through an uncomfortable process  
  • Clear language that takes avoids medical jargon
  • Inclusive features like international phone numbers, password security and no minimum character limit on names to be inclusive of people from different regions and backgrounds 
  • An inclusive design, to support and resonate with people who are assigned female at birth, but also in consideration of trans and nonbinary patients
  • Receive with timely, relevant and useful content and recommendations 
  • Successful engagement of the app, receiving breakthrough FDA status, and additional development to become HIPAA compliant would enable Renalis to achieve their long term goal of having the app be prescribed as a therapeutic.

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