Team SAT

Week 12-14: PREPARE, TRAVEL & APPROACH USERS

With a new field trip around the corner time was pressing. We scheduled various research activities for the upcoming trip. The second stay in Nigeria is divided into three stages: 1.Initial usability testing, 2.Reflect on designs & redesign, 3.Evaluation redesigns with user.

Our goals for testing are:
Obtaining recommendations for the service scenario, application and device
Getting insights in the requirements dealing the various stakeholders, such as: HMO's, Physicians and Patients.

Meeting those goals we created a research plan and build prototypes for both the app and the blood pressure device. For app-prototyping we use proto.io, an browser based tool that enables to run clickable prototypes on smart-phones.

WEEK 11: Conceptualising & prototyping

Hello everyone!

We are so sorry for not posting anything for the past couple of weeks. We have been very busy, but now we will tell you all about it!

To recap: the journey to Nigeria by two members of the team was done to map the different factors around the treatment of hypertension in Nigeria and gain insights for possible solution spaces. During this time, some ideation was done by the home team to simultaneously explore some solutions according to the results. This was partly a test for ourselves as well to see how well the team in Nigeria could communicate findings from the research to the home team. Some interesting ideas were developed, but without a clear design goal the focus was not there yet.

Upon coming back from Nigeria, the team has been defining the boundaries for the final solution. What we noticed is that we had so much information that it was hard to get a proper overview. After prioritising the information, coaching sessions and skype calls to Nigeria we chose to go for an product-application combination.

Then it was time to get to work. Hard work, since we spent too much time making decisions. Programmes of requirements, mockups, blueprints, process trees, scenarios, etc. all have to be developed before the second visit to Nigeria. So that is where we are now. Working as hard as we can to get everything ready before departure.

Week 6&7: 19 INTERVIEWS, 8 OBSERVATIONS, 2 CO-CREATIONS

For this two weeks, Tobias and Masako have soaked into the Nigerian context for the research for creating a better blood pressure control service in Nigeria. We visited 3 hospitals and 2 medical outreaches, interviewed with 6 doctors, 6 patients, 2 advisers, 1 nurse, 1 insurance company, and conducted 2 co-creation sessions. It was a quite hard schedule, but we surely grasped the current barriers and potentials for better healthcare. At the same time, Tine, Doenja, and Lenneart have created the first trial of the design concept based on the information from the field research in Delft.

HOSPITAL VISITS
It was a precious opportunity to stay in some hospitals in Lagos for a while and observed interactions between doctors and patients directly. We looked at a lot of barriers to the hypertension treatment in a public hospital, such as language barrier, lack of knowledge, fear of awareness of chronic diseases, and too busy doctors. On the other hand, in a private hospital, because doctors can have more time to talk with patients, the interaction was quite different.
In the interviews with doctors, we understand doctors’ great efforts to empower patients to comply with and take the initiative to treatment. For example, one doctor gives patients clear pictures, so they understand the seriousness. Another doctor told us that patients’ satisfaction during a physician meeting affects their dedication of self-treatment afterward.

PATIENT VISITS
With the introduction from Ibrahim’s mother, we were able to interview with 6 patients and conduct 1 concretion session with 3 patients. Through these activities, we have been emphasized with patients’ values and emotion towards hypertension. The most patients see the importance of patient-doctor relationship including clear information, quality of advice and diagnosis. Also, one patient told us in the co-cretion session that after the self-measurement in the home, she feels fear and unconfident if the result is not good because the blood pressure device just tells the reality rather than what she should do for improving the reality. To empower patients to initiate treatment, they need more connection to information, doctors in the best timing.

INSURANCE COMPANY VISITS
We visited the insurance company, “AXA Mansard,” and discussed our current ideas and the trend of health care in Nigeria. Their concerns were people’s unawareness on health care. Currently, only 7% of population join the health insurance and most of the contracts are for a big companies or organizations. But they start offering smaller health care package plan so that low-income group can reach the benefit. Also, the interesting thing is that they also offer the internet blood pressure monitoring service which connects patients and doctors remotely. We could have confident that our service direction is matched with the Nigerian context.

Week 4&5: RESEARCH PREPARATION AND ARRIVAL

To identify an opportunity for a design intervention for a better blood pressure control in Nigeria, we have been planning the field research in Lagos. On 20th March, Tobias and Masako arrived there for getting know the context of Nigeria!

RESEARCH TOOLS
To understand what is happening on the topic of hypertension care in Nigeria, we are going to visit all the stakeholders.The research includes interview, observation, and co-creation with patients, physicians, pharmacists, families of patients, suppliers, insurance companies and medical outreaches. Also, we will do some activities with the team in Nigeria, such as kick-off meeting, co-creation etc. To reach participants’ sub conscience values and activities in the interview, we made some tools such as a set of value cards, morphological chart and emotion curve chart.

KICK OFF MEETING WITH NIGERIA TEAM
We did the presentation about the team SAT and the Netherlands. Also, we shared the research plan during three weeks and what we have known so far through the research of papers, websites, statistics data, and interview with some Nigerians. After that, all the team discussed who is the target patients. We reached the consensus; we start to see with the low-mid income group working as artisans, civil servants, traders, or unemployed people. Besides, we were able to know what Ibrahim, a collaborator and health care activist in Nigeria, dreams in the future.

VISIT PHARMACIES, A MEASUREMENT BUS, AND A DOCTOR
For three days, we visited three pharmacies and one BP measurement bus, and two doctors. Sometimes the clinic visit is difficult because of its bureaucracy, but Ibrahim and his team members have made great efforts to arranged the interviews. We are gradually getting the understanding of the context around hypertension in Nigeria.

LIFE IN NIGERIA
Very hot weather, very vigorous city, so nice people!! We have stayed in Ibrahim’s home. It’s very nice to soak in the local culture. We experienced electric downs a lot, but most of the buildings have own generators, so they get returned soon.

Week 3: GENERATE RESEARCH QUESTIONS FOR THE INITIAL FIELD RESEARCH

The team SAT is in the goal setting phase where we are exploring what opportunities are underlying around hypertension in Nigeria. We have been collecting information and learning things from three areas; current Nigerian context, market, and technology. In this week, with our current understanding from papers, websites, statistics data, and interview with some Nigerians, we identified what we would like to see, who we would like to meet in the first field research.

CLOUD HEALTHCARE IN THE WORLD AND NIGERIA
Currently, healthcare service providers start making use of cloud/mobile. At the same time, cloud/mobile service providers (e.g. Amazon, IBM, Nokia) start healthcare service via the cloud. For example, patients can be informed by doctors with a text message on their mobile phone. Research suggests that these services are a good way of getting patients involved in their treatment. In Nigeria, although many people have mobile phones (some people have more than one mobile), power outages frequently occur. Therefore, most hospitals do not rely on the online medical record system (They store patient's medical history with papers). But how about cloud? If all the data is in servers outside of Nigeria and each device works with inside batteries, the cloud medical service should work despite constant power downs. We will see this interesting IT environment of Nigeria carefully.

PERSONAS
With the current information we have got, we generated the three personas. One is a 35-year-old guy, a hand‐to‐mouth existence, working as a hawker on a street, obesity, and smoker. He found his hypertension but has not visited a clinic and has not started treatment. Another is an elderly woman living in a rural area. She needs helps of her family when coming to a hospital. She is aware of her hypertension and trying periodical clinic visits and self-treatment, but difficult to do so. Last is a pregnant woman living in an urban area working as a researcher. She visits a hospital once a week and tries to cure hypertension herself for her baby, but her blood pressure has not still controlled well. We are going to refine the personas during the field research.

PATIENTS, PHYSICIANS, and DATA JOURNEY
We have communicated with Ibrahim, a doctor and activist in Nigeria collaborating with us, to get to know current activities and values of patients, physicians regarding Hypertension. With the current understanding, we have visualized the journey map. Although the information is still not enough and the map is unsophisticated, we could see what we would like to understand more, who we would like to meet in the first field research. These will be connected our research questions and the field research plan. We are going to refine the journey map during the field research.

NEXT WEEK
With the coach, JC, we are going to fix the research plan. We will be busy to make research tools such as interview sheets, observation sheets, generative session tools. At the same time, the interview with Dutch doctors dealing with hypertension will be conducted to know the general barriers of patients against controlling high blood pressure. In addition, technology research and context research will continue.

WEEK 2: CONTEXT and TECH RESEARCH

The team SAT stands in the goal setting phase now. To explore what opportunities are underlying around hypertension in Nigeria, we are learning a lot of things in three areas. One is the current Nigerian context; health care system, patient and data journey, cultural characteristics, etc. Another area is the market; what devices/services are available, possible target users, etc. The other area is technology; what is the state-of-the-art and minimum necessary technology, etc.

WHAT IS HYPERTENSION
All the members learned hypertension through papers, articles, and Khan Academy. Hypertension (High blood pressure) is considered as blood pressure greater than 140/90 mmHg. Because hypertension doesn't present with symptoms most of the time, people usually do not notice. The discovery is usually incidental e.g. when medical outreaches are conducted in offices or residential areas; some people realize for the first time that they are hypertensive and they’re advised to visit a hospital for further medical care. To improve hypertension, the regular, continuous blood pressure measurement is required.

NIGERIAN CONTEXT AROUND HYPERTENSION
Masako, Lenneart, and Dounja have tried to understand context around Hypertension in Nigeria. We made an assumption map and conducted the Skype interview to our partner, Iblahim, a doctor and activist in Nigeria. From the communication, we learned very insightful Nigerian situation.
For example, the insurance in Nigeria is still grossly underdeveloped, less than 5% of Nigerians have any form of health insurance. Presently, coverage is still considered to be less than 10% of the population, and it mainly covers people who have some form of formal employments - especially multinationals. People in the informal sector (artisans, traders, etc.) are largely out of the picture, and this represents more than 70% of the population.
Another example is concerning how people check their blood pressure. In the general community, there are individuals who carry BP devices around markets and residential areas and help people measure their BP, charging them ₦50 - ₦100 per measurement. (1€ = ₦331 on 1st March) We will continue the communication to generate the best research questions for the first visit.

TECH OF BLOOD PRESSURE MONITOR
Tine and Dounja are investigating the tech side. We got two blood pressure devices; one is the state-of-the-art appliance with a smartphone, wifi, and cloud, the other is with minimum necessary components. With these products and the internet research, we identified four type measurement, Korotkoff, Oscillometry, Pulse Transit Time, and Direct method. Each way has the different cost, accuracy,and levels of discomfort. Also, the components and parts of the blood pressure device were clarified. We will start prototyping and hacking products for further learning from next week.

CULTURAL RESEARCH
Tobias generated helpful insights we should keep in mind from cultural dimension research.
Main insights:
- The position of the physician should be clear in communication with the patient (POW)
- The people around the patient should be actively involved in the treatment process (IDV)
- Physicians should stress the benefits of treating hypertension regarding success (MAS)
- It is important that certain things have to be left to the patient, give the patient more responsibility (UAI)
- Focus on the short-term improvements when treating hypertension (LTO)
- Let patients be aware of the consequences of both options (treatment or no treatment) (IND)

GOT VACCINATION AND APPLY FOR VISA
The first field research is going to conduct from 20th March. Tobias and Masako got three vaccinations and applied for VISA at the Nigerian embassy in Den Haag.

NEXT WEEK
We are going to meet our coach, JC, and discuss all the research structures we set. We will try to define the research plan on the first visit and start tinkering BP pressure device.

THE PROJECT OFFICIALLY STARTED!!
In the past three months, we were busy to discuss with a lot of collaborators to find out opportunities for a collaborative project.
Since we met a doctor who was looking for designers to tackle the issue of the medical situation in Nigeria, we have prepared and set up this project. It started finally this week! We got a dedicated room for the project in IDE building. We are going to design our workplace as well through the course of our “journey” so that we can be creative and communicate smoothly!

SHARED SPECIALIZATION OF MEMBERS
The team has five students from different three master programs. We shared each specialty and strengths and discussed common and different perspectives. It seems that we have very good mixed expertises for the project! We will also share the result of Sixteen Personality Types Test on the Sunday unofficial team meeting!

OVERALL SCHEDULE
We have planned the three design phases in the project. First, in the goal setting stage, we will understand the current situation with literature research and the extensive field research in Nigeria, and set a design goal. Through the conceptualization phase, we will ideate solutions and then define one design direction through building low- and hi- fidelity prototypes. And last, in the detailed development phase, we will again go to field research with these prototypes to iterate designing further and create a final design.
We got positive reactions with this plan from the coaches and the local collaborator and doctor, Ibrahim. Also, we determined that Tobias and Masako are going to go to Nigeria on the first visit for the goal setting, Lenneart, Dounja, and Tine are going to go there on the second visit for the detailed design and evaluation phase.

ONLINE MEETING W/ IBRAHIM
We met a doctor in Nigeria, Ibrahim online. The team asked some questions and requests to Ibrahim for our visits. With weekly meeting, we are going to use Slack to communicate more frequently and casually with the team in Nigeria. Also, fortunately, he was very willing that we stay his place for three weeks of the field research.

RESEARCH STRUCTURE
In the coach meeting, we recognized the importance of having a good overview of research questions. This assignment involves a lot of research components, such as health care systems, patient Journey, DATA journey, local cultural traits, current/future technologies, diagnose methods, a way of distributing to the local market. We visualized the first version map and are going to change and adjust it through the course of the research. Tine started to do research about current technologies for monitoring blood pressure, Dounja also began the research about cause and treatment of hypertension. Others are trying to capture the cultural traits in Nigeria.

TRAVEL PREPARATION
Tobias and Masako are going to visit Nigeria for the field research for goal setting from 20th March for three weeks. To get visas, we are preparing for getting vaccinations, invitation letters, flight tickets and so on.

TEAM LOGO
Lenneart designed the cool logo mark of us!