Exploring empathy, framing, and the user experience of disease
So before you get too deep into this, I want to warn you that there isn’t any magic bullet or formula for this kind of result. To me and I’m sure to many other individuals, the changes I discuss might look fairly obvious in hindsight. The more important thing I learned from this kind of case study is understanding why this change led to such a monumental result.
Spoiler alert: it’s empathy.
Background
So, I was working as a User Experience something (because my role was too broad to be limited to just one noun) and marketing specialist for a telehealth startup. I won’t get too caught up in my title because my day-to-day was all over the place. One day I would be creating web page mockups, fighting with CSS and browsers, and the next day I was organizing analytics from our various paid marketing campaigns. The point: I had my hand in quite a few of the things going on in the realm of consumer/customer/user experience.
One of the main functions of my position was to synthesize and more importantly understand the mindset of an individual who was suffering from a chronic condition like diabetes, heart disease, or something else terrible and how they move from an individual who is totally uncommitted to or unaware of treatment options to a patient who has enrolled in a therapy program.
The Problem
Most people with chronic conditions and even most of the general population wouldn’t think to equate “therapy” with something like diabetes or heart disease, yet the company I was working for specifically targeted individuals like these because the therapy program the company had developed was designed, at inception, for these “silent sufferers” (a term that refers to individuals that experience stress, depression, and anxiety but aren’t clinically diagnosed as having either major depression or general anxiety disorder).
So how do you get a very narrowly targeted audience aware of their underlying symptoms AND convince them that therapy — with all its social stigma — can help improve their life?
It’s not easy. It certainly more difficult than convincing them to just buy a product. This task requires them to acknowledge their symptoms (or at least some discomfort or problem as manifested as stress, anxiety, and depression), then, acknowledge that they have some power over managing these symptoms, and that our company can provide a solution to that problem (better than anyone else who may offer a similar service).
Overall, my task included all the familiar issues marketers face in the buying funnel, but also had to take into consideration how this “funnel” was different.
This is where health communication really helps.
Health communication is a field within the humanities that examines how communication serves as a tool (and sometimes a hindrance) in the domain of health. For my purposes, it offers several conceptual models of how individuals move through stages of change, what considerations and issues they may face on the way, and what factors should be emphasized in order to move them toward healthy behavior change.
So back to the issue at hand.
How do you get individuals to acknowledge that they have stress, anxiety, and depression instead of just byproducts of their disorder?
I know this is difficult because my brother has type 1 diabetes and faces burnout quite often. The problem is that he doesn’t identify his burnout as stress (at least not in the diagnostic sense) and doesn’t acknowledge the subsequent feelings, thoughts, and appraisals he faces as causing anxiety or depression. To him, and to many silent sufferers, that’s “just the way it is.”
(Part of) The Solution
One of the tools we had at our disposal was the PEQ-4 and the DASS-21 — clinical scales for diagnosing levels of stress, anxiety, and depression. By offering a free assessment and more importantly framing it as a measure of how their main chronic condition was affecting them, we were able to increase the number of people we treated.
This is a critical point that I want to make. Part of being a user experience professional is empathizing with the user/customer/consumer/patient (whatever noun you want to use). In the realm of chronic disease, I know that I’m unfit to accurately capture the totality of their experience with their disease and I won’t try to say that I was able to in any complete fashion, however, what I was able to do was recognize the frames, language, and metaphor that individuals use when they describe stressful events, anxious feelings, and depressive thoughts.
Indeed, the metaphors and language we use to describe something can never fully capture the experience of that phenomenon, in that, language, as a delimiter, forces us to choose representations of experience.
As someone who suffers from major depression, I know that I sometimes have a pretty dark lens on things and that I often will position myself as someone who has depression or is depressed.
One thing I noticed about silent sufferers, at least from the scant research we had, was that these individuals identified with their symptoms in a way that was, although similar to my experience with major depression, was understood differently as a phenomenon. Silent sufferers don’t relate to their symptoms of stress and anxiety and depression as manifestations as such, but rather identify them as byproducts of their primary disease, e.g., diabetes, heart disease, etc.
I can best illustrate this by the following quote:
Diabetes is stressful, but I don’t have stress.
I think part of the reason for this distinction is — because they have not been diagnosed with stress, it isn’t recognized or identified as a disease. Hence, the name silent sufferers, or the way I framed this demographic — individuals who, through no fault of their own, have been boxed into categorical frames of disease — either being manifest or not — as a primary condition. If mental illness was seen or understood culturally as existing on a scale rather than such harsh dichotomies, individuals may be more likely to identify with these byproducts and thereby be able to make the necessary connection between the their disease, its byproducts, and the efficacy of treatment.
In short, the way they (silent sufferers) and we (socio-culturally/DSM) place silent sufferers is short of reaching the threshold of disease (diagnosis) and therefore don’t pursue solutions.
The Specifics
You’re wondering, “Okay, but how did you actually increase revenue by that much?”
We changed our information architecture and language.
“What? You mean you changed your nav bar and increased revenue by $5 million”
That’s part of the end product. But it was much more than that.
We did some card sorting, tree testing, but I had a feeling that this didn’t give us the whole picture.
Let me first say that I love card sorting and user testing. I like it a hell of a lot better than quantitative measures like surveys, however, I think it’s very difficult for individuals to communicate their wants and needs from a website. Assuming they can is predicated on them knowing what their goal is, and that’s not always so cut and dry.
Card sorts are a great way to help us organize, separate, and better understand our user’s mental map of how different items fit together. Open card sorts, furthermore, are great at letting users add to existing structures. However, if you’re trying to build something unlike anyone else or if you’re venturing into new territory, a user’s existing mental model of how something should work will only get you as far as the status quo.
If you’re doing blue ocean strategy, or you’re creating a disruptive or misunderstood product, your job is to venture out into the unexplored and figure out the best way to connect your offering to the tangible, real-life experiences individuals will have with it. If you’re offering a service, it’s even more nebulous.
User experience and marketing both require an understanding of current experience to better produce, frame, position, and communicate a beneficial future.
Here’s why I think it worked
We could have offered a free trial button above the fold. That would seem like a better offering, however, for our current infrastructure and resources, this wasn’t doable. Plus, I don’t think individuals with chronic pain or diabetes are ready (convinced) to start therapy. I think they want change in their life, yes, but I don’t think individuals have made the cognitive connection between therapy and something like a gastrointestinal disorder.
What I discovered from the scant literature is that largely, at least for individuals living under a Western medical paradigm, what happens to the rest of your body doesn’t necessarily have anything to do with your brain, much less your thoughts; this is a foreign, almost alien concept to some individuals. For our company, this is a critical goal — to break this misconception along with the strong negative stigma of “therapy.”
Technical details
In Q3 of 2017, page visits to our assessment were dismal, and although it had a prominent place above the fold, it didn’t seem to produce the results we wanted. It was around this time I began my investigation.
Let’s skip ahead to the end of Q1 2018, i.e., now.
Compared to Q4 of 2017, our overall web traffic increased 36% in Q1 of 2018, which was expected as we increased the number of individuals who were pre-qualified.
However, due to the change in wording — from “Take An Assessment” to something that paralleled the experience of an individual frustrated with their medical condition — page traffic increased by 852% which resulted in an 1810% increase in completion rate. This completion rate, multiplied by the value of each enrollment and other factors, gives you a difference of $5.1 million in yearly revenue.
It wasn’t just wording. There were other factors that led to this increase.
I had been testing several variables since the beginning of Q3 to optimize conversion. These included button size, button text, color contrast, button shape, button shadow, button location, the # of CTAs above the fold, headline text, background image, and wording.
After testing each element against the default page, it was necessary to test the totality of my results against the default page. This is important because in a simple A/B split test only one element is changed, and while it’s implicit that combining the results should produce a positive effect, it’s better to be sure.
Things to remember
It wasn’t one thing. It was many things: the navigation, the information architecture & taxonomy, the user interface, as well as the frames and metaphors that were employed to better relate to actual individual experience.
The most important thing to take from this is the one thing that all user experience and design thinking rest on: empathy. I read countless medical and research journals trying to find something that explained the variety of ways stress is identified and interpreted, and although most of the literature was sparse, putting together and synthesizing it with what I was seeing (or not seeing) in our web analytics helped me develop and test my way to a solution.
It’s important to remember that the way an individual experiences anything is guaranteed to somehow be different from your own personal experience. That’s why it’s critical to develop empathy, ask a lot of questions, test, revise, and test again. It’s important to recognize the limits of language and listen to the answers.
In the realm of healthcare user experience, it’s not easy to gain access to the kind of experiences that plague so many; it is deeply intrapersonal while rooted in socio-cultural paradigms. For me, being able to remember the times where it was dark and stressful and bleak helped motivate me to uncover part of the truth of their experience. It’s critical.
When a company doesn’t just sell you the language of your experience, wrapped up in marketing speak but actually celebrates your wins and shares in your loss and really talk about it, — then businesses are able to foster a more empathetic experience for all of us by offering solutions that are founded on the understanding of what it truly means to be human.