Presentation
Senior Safe Case-Study: Examining a Conflict of Users and User-Centered Design
DescriptionIntroduction
User-Centered Design (UCD) emphasizes that a product, intervention, or system should fit the user, rather than making the user conform to the system. Involving end-users in research is critical as it ensures interventions will meet the needs of the population while cultivating intervention ownership that supports long-term sustainment. UCD provides strategies for collecting and analyzing these necessary end-user perspectives (e.g., participatory design sessions, stakeholder groups, and interviews) that span the entire design lifecycle. UCD can be applied in healthcare to solicit information regarding how patients’ environments influence their healthcare decisions and aid researchers in the design of patient-centered interventions that promote safe health behaviors.
Ultimately, however; patient end-users are not designers. Users may have difficulty articulating their wants and needs which leads them to generate unrealistic solutions. Our role then becomes managing discordance between end-user recommendations and feasible, research-backed interventions—translating feedback into actionable information that will satisfy patient identified needs while also interrupting current undesirable and unsafe behaviors.
Objective
The objective of this presentation is to share how our research team addressed discordance between UCD generated feedback and theory-based design principles. Presenters will share 3 examples from our Senior Safe™ intervention including: efforts to receive and utilize end-user feedback, design principles leveraged, and the ultimate design outcomes. The presentation will provide recommendations for others wanting to utilize UCD feedback to inform community-engaged research and interventions.
Senior Safe ™ Intervention
Senior Safe is a community pharmacy intervention that aids older adults in the selection of safe over-the-counter (OTC) products. Senior Safe includes curated products for sleep, pain, and cough, cold, and allergies and re-designs the community pharmacy to warn older adults that “What is familiar is not always safe.” The first iteration, Senior Section, was implemented in 2018 at a mass-merchandise chain and has since been adapted and tailored following the Exploration, Preparation, Implementation, and Sustainment Framework. Senior Safe is currently being implemented in 63 community pharmacies at a mid-western healthcare system.
Example 1: An Over-the-Counter Doorbell
During initial intervention development, we recruited 5 older adults to participate in a series of participatory design sessions. The older adult end-users were shoppers of a partnering mass-merchandise store. The older adults expressed that the OTC aisles were far away and entirely out-of-sight of the pharmacy. The distance prevented them from signaling pharmacy staff for help and required walking to the prescription area.
The stakeholders brainstormed solutions, including a doorbell button located in the OTC aisle that patients could press to notify the pharmacy when they had an OTC-related question. The doorbell would sound in the pharmacy to alert the pharmacist and direct them to the aisles.
Our research team was concerned that the doorbell would present new safety concerns for pharmacy staff by increasing interruptions. We extrapolated from the doorbell recommendation that older adults desired a “magnetic pull” between the patient in the aisles and the pharmacists.
Instead of a doorbell, we physically moved OTC products to be within pharmacist eyesight to facilitate counseling and conversation. The intervention included curated Senior Safe™ products as well as signage to prompt older adults to stop and talk to their pharmacist.
Understanding why older adults proposed the doorbell and then our team’s elicitation of the problem exemplifies how we addressed the tension between user feedback and design principles. End-users may find it easier to articulate potential solutions to their problems rather than the barriers they experience. This creates a critical gap for researchers to fill—assessing root causes then identifying interventions.
Example 2: Signage and Posters
After the initial Senior Section pilot, our team adapted the intervention (now called Senior Safe) to community pharmacies in a mid-western healthcare system. As part of this adaptation, we recruited a group of 7 older adult stakeholders and met with them at 4 time points throughout intervention re-design. While piloting Senior Safe at 4 community pharmacies, we also solicited feedback from 30 additional older adults via interviews.
End-user feedback guided the re-design of posters and signage to educate individuals about the intervention, how to distinguish safe and unsafe products, and to recommend older adults talk to their pharmacist. The stakeholders provided recommendations for engaging older adults with signage—tailoring language, size, colors, and imagery to know that “[Senior Safe] is for me.”
End-user feedback was combined with research-based principles to maximize engagement. For example, we integrated color heuristics by color-coding products as red, indicating older adults should “STOP, and ask your pharmacist” and green to indicate a safer alternative. Over time, we tried numerous iterations of signage including color coded strips above prices; floor signs leading to Senior Safe; stop signs in front of red products; eye-level signs; and large posters with happy older adults.
Despite integrating end-user feedback and older adults’ confirmation that Senior Safe signage was beneficial and relevant, pharmacy simulations demonstrated the signs were often missed. Here a tension existed, not between design principles and user feedback, but by adhering to both and still finding limited utility. Our research team implemented UCD recommendations, yet a gap persisted that was preventing safe behavior change.
UCD emphasizes that changing behavior is extremely difficult with education and signage alone. To interrupt OTC selection behavior, we moved a subset of unsafe products for pain and sleep behind the pharmacy counter. This forcing function required older adults to ask pharmacy staff members for assistance, increasing the likelihood for consultations and deterring unsafe selections.
Example 3: Magnifying Glass
From the intervention’s inception, older adults in the participatory design sessions suggested the inclusion of a magnifying glass to use while shopping for OTCs. They emphasized that text on OTC packages was too small to read and a magnifying glass would help establish agency to make safe selections independently.
During our Senior Safe adaptation pilot (n = 30) and effectiveness trial (an additional 144 older adults across 20 community pharmacies), <5 older adults used the magnifying glass. When our research team presented the findings back to our stakeholder group and suggested its removal, the group insisted the magnifying glass should remain.
This is a UCD example where there is limited alignment between end-user recommendations and research evidence. Despite the limited use of the magnifying glass, it was important to the stakeholders that the intervention address a common limitation to safe OTC behavior, small print.
To address the discordant tensions in this scenario, our team made the decision to keep the magnifying glass as part of Senior Safe, placing it on the pharmacy counter next to the cash register. This low-cost tool did not take up a large footprint within the pharmacy and validated our stakeholders’ input. Despite not fulfilling its intended use, pharmacy staff indicated in follow-up discussions that simply having it on the counter spurred conversations and patients sometimes inquired about the intervention.
Conclusion and Takeaway Points
This presentation illustrates 3 examples from our Senior Safe intervention when UCD feedback differed from design principles and research findings. We also share how our team navigated these tension points and ultimate design decisions.
Key takeaways for attendees include:
1. End-users are not designers and cannot always vocalize their needs, it is the responsibility of the researcher to translate their feedback into actionable solutions.
2. When resources allow, it’s helpful to acquiesce end-user requests. These compromises not only demonstrate your commitment to the users but may have unintended positive consequences.
User-Centered Design (UCD) emphasizes that a product, intervention, or system should fit the user, rather than making the user conform to the system. Involving end-users in research is critical as it ensures interventions will meet the needs of the population while cultivating intervention ownership that supports long-term sustainment. UCD provides strategies for collecting and analyzing these necessary end-user perspectives (e.g., participatory design sessions, stakeholder groups, and interviews) that span the entire design lifecycle. UCD can be applied in healthcare to solicit information regarding how patients’ environments influence their healthcare decisions and aid researchers in the design of patient-centered interventions that promote safe health behaviors.
Ultimately, however; patient end-users are not designers. Users may have difficulty articulating their wants and needs which leads them to generate unrealistic solutions. Our role then becomes managing discordance between end-user recommendations and feasible, research-backed interventions—translating feedback into actionable information that will satisfy patient identified needs while also interrupting current undesirable and unsafe behaviors.
Objective
The objective of this presentation is to share how our research team addressed discordance between UCD generated feedback and theory-based design principles. Presenters will share 3 examples from our Senior Safe™ intervention including: efforts to receive and utilize end-user feedback, design principles leveraged, and the ultimate design outcomes. The presentation will provide recommendations for others wanting to utilize UCD feedback to inform community-engaged research and interventions.
Senior Safe ™ Intervention
Senior Safe is a community pharmacy intervention that aids older adults in the selection of safe over-the-counter (OTC) products. Senior Safe includes curated products for sleep, pain, and cough, cold, and allergies and re-designs the community pharmacy to warn older adults that “What is familiar is not always safe.” The first iteration, Senior Section, was implemented in 2018 at a mass-merchandise chain and has since been adapted and tailored following the Exploration, Preparation, Implementation, and Sustainment Framework. Senior Safe is currently being implemented in 63 community pharmacies at a mid-western healthcare system.
Example 1: An Over-the-Counter Doorbell
During initial intervention development, we recruited 5 older adults to participate in a series of participatory design sessions. The older adult end-users were shoppers of a partnering mass-merchandise store. The older adults expressed that the OTC aisles were far away and entirely out-of-sight of the pharmacy. The distance prevented them from signaling pharmacy staff for help and required walking to the prescription area.
The stakeholders brainstormed solutions, including a doorbell button located in the OTC aisle that patients could press to notify the pharmacy when they had an OTC-related question. The doorbell would sound in the pharmacy to alert the pharmacist and direct them to the aisles.
Our research team was concerned that the doorbell would present new safety concerns for pharmacy staff by increasing interruptions. We extrapolated from the doorbell recommendation that older adults desired a “magnetic pull” between the patient in the aisles and the pharmacists.
Instead of a doorbell, we physically moved OTC products to be within pharmacist eyesight to facilitate counseling and conversation. The intervention included curated Senior Safe™ products as well as signage to prompt older adults to stop and talk to their pharmacist.
Understanding why older adults proposed the doorbell and then our team’s elicitation of the problem exemplifies how we addressed the tension between user feedback and design principles. End-users may find it easier to articulate potential solutions to their problems rather than the barriers they experience. This creates a critical gap for researchers to fill—assessing root causes then identifying interventions.
Example 2: Signage and Posters
After the initial Senior Section pilot, our team adapted the intervention (now called Senior Safe) to community pharmacies in a mid-western healthcare system. As part of this adaptation, we recruited a group of 7 older adult stakeholders and met with them at 4 time points throughout intervention re-design. While piloting Senior Safe at 4 community pharmacies, we also solicited feedback from 30 additional older adults via interviews.
End-user feedback guided the re-design of posters and signage to educate individuals about the intervention, how to distinguish safe and unsafe products, and to recommend older adults talk to their pharmacist. The stakeholders provided recommendations for engaging older adults with signage—tailoring language, size, colors, and imagery to know that “[Senior Safe] is for me.”
End-user feedback was combined with research-based principles to maximize engagement. For example, we integrated color heuristics by color-coding products as red, indicating older adults should “STOP, and ask your pharmacist” and green to indicate a safer alternative. Over time, we tried numerous iterations of signage including color coded strips above prices; floor signs leading to Senior Safe; stop signs in front of red products; eye-level signs; and large posters with happy older adults.
Despite integrating end-user feedback and older adults’ confirmation that Senior Safe signage was beneficial and relevant, pharmacy simulations demonstrated the signs were often missed. Here a tension existed, not between design principles and user feedback, but by adhering to both and still finding limited utility. Our research team implemented UCD recommendations, yet a gap persisted that was preventing safe behavior change.
UCD emphasizes that changing behavior is extremely difficult with education and signage alone. To interrupt OTC selection behavior, we moved a subset of unsafe products for pain and sleep behind the pharmacy counter. This forcing function required older adults to ask pharmacy staff members for assistance, increasing the likelihood for consultations and deterring unsafe selections.
Example 3: Magnifying Glass
From the intervention’s inception, older adults in the participatory design sessions suggested the inclusion of a magnifying glass to use while shopping for OTCs. They emphasized that text on OTC packages was too small to read and a magnifying glass would help establish agency to make safe selections independently.
During our Senior Safe adaptation pilot (n = 30) and effectiveness trial (an additional 144 older adults across 20 community pharmacies), <5 older adults used the magnifying glass. When our research team presented the findings back to our stakeholder group and suggested its removal, the group insisted the magnifying glass should remain.
This is a UCD example where there is limited alignment between end-user recommendations and research evidence. Despite the limited use of the magnifying glass, it was important to the stakeholders that the intervention address a common limitation to safe OTC behavior, small print.
To address the discordant tensions in this scenario, our team made the decision to keep the magnifying glass as part of Senior Safe, placing it on the pharmacy counter next to the cash register. This low-cost tool did not take up a large footprint within the pharmacy and validated our stakeholders’ input. Despite not fulfilling its intended use, pharmacy staff indicated in follow-up discussions that simply having it on the counter spurred conversations and patients sometimes inquired about the intervention.
Conclusion and Takeaway Points
This presentation illustrates 3 examples from our Senior Safe intervention when UCD feedback differed from design principles and research findings. We also share how our team navigated these tension points and ultimate design decisions.
Key takeaways for attendees include:
1. End-users are not designers and cannot always vocalize their needs, it is the responsibility of the researcher to translate their feedback into actionable solutions.
2. When resources allow, it’s helpful to acquiesce end-user requests. These compromises not only demonstrate your commitment to the users but may have unintended positive consequences.
Event Type
Oral Presentations
TimeTuesday, March 268:52am - 9:15am CDT
LocationSalon A-3
Patient Safety Research and Initiatives