Supportive Case Study: Audio guided conversations to strengthen friendships and love
The Problem Space
Mental Health x Communication
In 2018, news articles appeared reporting the increasing rates of college students diagnosed with mental health disorders and the shortfalls of current solutions on college campuses. Pushed by the media, mental health became a big conversation on college campuses.
The rising problem in mental health:
- In a 2018 study, the American Psychological Association reported 1 in 3 freshmen college students have symptoms of mental health disorders.
- According to a Harvard study, college students face an increased risk of stressful life events and mental health challenges. 3 in 4 students had at least 1 stressful life event in the past year. 1 in 5 students had at least 6 or more stressful life events in the past year. 1 in 4 students had been diagnosed with a mental health disorder in the past year.
For my project, we decided to focus on the intersection between mental health and communication. In that middle section, there are two problems at play.
One, mental health is difficult to talk about because of stigma and the risk of a negative reaction from the listener (rejection or lack of understanding) when in a vulnerable position.
Two, communication is difficult, for everyone. Have you ever heard anyone say communication is easy? No. Because it takes hard work to communicate well. To go further, research links social support to resilience to stress and good psychological health. And social support requires the communication of the problem or need for support.
The focus of the project then became how might we create spaces for college students where they can communicate about mental health? For the purpose of this case study, mental health is extended to anything to anything related to feelings and emotions.
The Vision
- How can we decrease stigma around mental health?
- How can we create safe spaces to be real and imperfect and human and help users feel like that's acceptable?
- How can we help students learn how to active listen and in turn feel heard?
- Ultimately, how can we help our users feel supported?
Designer Challenges
- Learn how to design a web app experience
- Rise to the challenge: design for a compelling and tricky problem space: mental health
- Develop greater comfort with interviewing skills and iterate on interviewing techniques
- Learn how to use online source analytical tools (google analytics)
Background
As part of my Senior Capstone ME 216B & ME 216C, I dedicated 6 months to a single project that tied in everything I learned in Product Design to create a single product from conception to launch.
⏱ Timeline
Jan – Jun 2018 (6 months)🎓 Courses
📱 Final Project
Responsive Web App: Supportive.app📈 Success Metrics
- Users (the conversational partners)
- To feel listened to and heard
- To feel supported
- To feel like they have a safe space to be share both positive and negative emotions
- To have equal talking space in a conversation
- Product Owner
- Discover a compelling need
- Translate need into a product
- Launch product
- Secure market interest: < 100 email sign ups
💻 Product Segments
- User Research
- Expert Interviews
- Extreme User Interviews
- Talk Aloud
- Design Research
- Paper Prototypes
- Wireframes
- Wizard of Oz
- Design Thinking Methods
- 5 Whys?
- Frameworks
- Post-it Note Theme Clustering
- How Might We?
- Like? Dislike? Improve?
- Visual Thinking
- Product Development
- Prototyping
- Usability Testing
- Storytelling
- Grassroots Marketing
👤 My Roles
- Co-founder
- User Researcher
- Recruiter
- Product Designer
- Marketing Manager
📊 Market
- College students
- USA - 20 million college students
- Stanford University - 16,520 students
🗣 Experts Consulted
- 12 experts
- Psychologists, Therapists, Doctors, Design Professors, UX Designers in Industry, Mental Health Advocates, Wellness Teachers, Design Director at Hedge Fund
👥 Research Participants
- 29 participants
- 18-24 years old
- College students
- With depression and/or anxiety
Product Evolution: From end to beginning
How it works: User Guide
Design Thinking Process Flow Chart
In 6 months, we cycled 7 times through the design thinking process. Design thinking helped guide the research and the design. Leaning on these principles of design thinking:
- Radical collaboration
- Build to think and learn
- Frontloading empathy
- Bias towards doing
With these in mind, we created prototypes to learn more about what we did not know which allowed us to be surprised when we discovered findings that we could only uncover by building to learn from our users and learn often. In the cycles, we transitioned from low fidelity paper prototypes to medium fidelity wireframes and later a responsive web application. We sought feedback often from users and from experts and these findings gave life to the grounded solution of Supportive.app.
Results
Before we finished our product, we outlined success goals (also listed above).
- Users (the conversational partners)
- To feel listened to and heard
- To feel supported
- To feel like they have a safe space to be share both positive and negative emotions
- To have equal talking space in a conversation
- Product Owner
- Discover a compelling need
- Translate need into a product
- Launch product
- Secure market interest: < 100 email sign ups
Not only did we meet all of the user and product owner goals, we exceeded the product owner goals. Within a month, we had 154 email sign ups for the mailing list when our goal was 100. 7 months later without any active marketing, we had 175 total email sign ups. We had a rapid adoption rate of over 1000 users gained in 1 month. We even achieved a global reach with users from 10 different countries. In addition, we had done an excellent job relative to our product design cohort group. Our project grade was an A+ and marked in the top 10% of projects in the class.
Top Findings
Our top findings fell into these 5 themes:
- Barrier to entry
- Stigma: A mark of shame associated with the term “mental health” and even “mental wellbeing”. That said, the term “mental health” cannot be mentioned in the product to encourage the product as useful for all. Prototypes introduced as being helpful for mental health created a coat of stigma that discouraged those not identifying with mental health from using the product fully. Those without mental health problems suggested that they would not ask for help on a product meant for those with mental health problems.
- Communication: In order for friends to understand a person’s problems with mental health, they need to be able to communicate the problem and the needs.
- Fear of negative reactions: The result of stigma is a cycle of endured shame, the distress felt from wrong behavior. Our society isn’t educated in how to react to a confession around mental health which can lead to a negative reaction by the listener (lack of understanding of mental health, not knowing how to react, rejection, confusion, etc.) These negative reactions cause the confessor to feel their feelings are wrong and feel shame. These fears of negative reactions are especially risky when a person is in a vulnerable position already when not in a mentally healthy state.
- Barrier to understanding: The repeated idea of being unable to explain one’s illness and symptoms, and about how the most hurtful moments are when close friends and family do not understand.
- Lowering the barrier to entry
- App design with a low barrier of entry: No download required, no login, website app to make it accessible on desktop for PC or Mac and mobile for Android or iPhone.
- Prescribed behavior: participants were more willing to try out the activity if prescribed by someone they trusted, otherwise it was difficult to prioritize having a facilitated conversation to work on the relationship.
- Making impact within the experience
- Concrete offers of what a person would be willing to do for the relationship that week made the other partner more willing to ask that something of the other person.
- Mindfulness: The mindfulness and 30 seconds of time to think about the questions were helpful in preparing for questions normally difficult to answer — it allows users to go “off-script” more easily and be genuine.
- Active listening: teaching users active listening and giving them space to put themselves in someone else’s shoes and tell them what they heard was gratifying for users to hear their friends try and empathize with them.
- Increasing vulnerability of questions: As the questions progress in the guide, the questions build in difficulty and allows for more vulnerability.
- Balanced conversation: both partners are equally important and both get time to answer the question, which is unusual in most conversations where one person might be driving the questions and the listening while another person talks.
- Designated talk time and space: Each user had 1 minute to answer each question and the ability to increase the time limit by pressing the pause button. This meant users were guaranteed at least a minute of someone listening without interruption which some remarked was novel experience for them.
- No space for negative reactions: The users do not comment on what each person has said. Rather each person gets to answer the questions and listen to the other and then summarize what the other person has said in active listening. The users learn how to just be there for someone.
- Tension
- Within the research:
- In-person conversations: Users expressed a desire for genuine in-person interactions which was surprising because people with depression tend to be more isolated and not talk with others as much.
- Communication is work: Users thought conversations were easy to have yet at the same time difficult to have a meaningful one. Culturally, we don’t prioritize in-person communication as a skill that can be taught since communication classes are not required in either high school or college. It is expected to be learned outside of school, so when we run into communication problems we don’t have a foundation outside of life experiences or friends as resources to lean on. On the other hand, after college, employers rank verbal communication as the number 1 must have skills. Clearly, there is a strange contradiction that communication should not require work but also require work.
- Cycle of apology: One user described to us the “cycle of apology” as codependency that can emerge from getting caught up in helping others and not taking care of oneself in the process and apologizing when they then cannot provide more help.
- Openness with strangers vs loved ones: A stand-up comedian who described his openness with strangers: “I'm not public about my disorder, but I will talk about it on stage to strangers who will never be associated with me after the fact I guess” which allows him to be open and have others laugh with him (relate with him) in a space he can feel there is no shame or stigma attached.
- Within the product:
- Silence: Users liked having silence after a person finished talking and had more designated time left to talk in the conversation to think about what was said but also felt uncomfortable when no one filled the time in the conversation by talking.
- Active listening: Users enjoyed active listening in the product (gratifying to hear someone say what they heard you talk about), yet most users rarely use active listening skills in their own life as it’s not a norm.
- Timing: For initial adoption, users wanted the product to not take too much time because they felt very busy, but after finishing the product experience they wished it was longer.
- Two user groups: The product needs to encompass the needs of both those identifying with mental health problems and those not identifying with mental health problems because social support is given and received by people with and without mental disorders.
- Design: Using a web app is a lower barrier to access because it requires less storage space, open to different operating systems, accessible on both desktop and mobile, and no login is required. However, a web app requires a user to remember or bookmark the website for later usage.
- Role of technology: Real-time conversations are the focal point and the device is more a guide between interactions.
- Post usage
- Stronger relationships: Users found that the prototype deepened their relationship by asking questions that are normally given “scripted” responses to, and by providing opportunities after to deepen the relationship further with their conversation partner.
Future Considerations
- Silence: Silence was an interesting bonding moment (awkward) because if the user didn’t use up the 1 minute of talking time on their turn they could use it to think about what they said or the conversation partner could think about what their partner said. Silent moments should be explained earlier on in the product.
- Prescribed work: These conversations would work well if prescribed by therapists or during New Student Orientations as a resource. More work would need to be done in building relationships with college counseling and the college office in charge of student life on campus.
- Pause button: The pause button was not used as often as intended. This should be explained clearer in the beginning that users can press pause to extend the talk time if needed.
- Mailing list pop up: In order to reach our goal of 100 email sign ups, we designed a pop up to appear when accessing the conversation guide. Because there is no login required, we cannot design well for returning users. Because we are no longer trying to reach the 100 email goal, I would like to take down this pop up to ease the user experience while still keeping the option for sign up in the lower portion of the website.
- Behavior change: How might we design for users to want to use this product to improve their relationships? In the same way that wellness companies have a hard time motivating users to drink enough water or eat nutritious food, how can more research uncover how to best motivate people to work on their relationships? Culturally, I’m not sure if we’re at a place where we value self-care as highly as we should.
- Scalability: Each conversation has multiple components (meditation, psychology research quotes, new communication techniques) that need to be tested to see how useful it is. I think it would be an enormous task for this two person team to create multiple conversations in a short period of time for different scenarios that all require new expertise (for break ups, for increasing intimacy, for expectation setting, for talking about values, for mental health specifically, etc.)
Storytelling
Figuring out the right story to tell was an essential skill in this project – from finding mentors to getting feedback on a certain component to acquiring participants, each story being slightly different. Below, I've posted one way we used storytelling to gain a weekly design mentor who stook with us for 4 months.
Before we called ourselves Supportive, we branded ourselves as Offscript because we created spaces in conversations to go offscript from chit chat and create spaces to be real.
This was a pitch video that succinctly demonstrated what we had learned from our research and where we were in our prototypes to get a mentor on board with us! We successfully found a mentor who was a head designer at a design agency in SF.
Lessons Learned
Independence and collaboration exist in harmony and depend on the team.
In previous projects that were short term and had a larger group size, collaboration and individual work seemed to come together pretty easily. Given the team size of 2 and the complexity of the topic in this project, I learned to question my previous ideas for what works best for me in design sessions as well as individual work. Even during design sessions, I realized not all times needed to be discussion time. During design sessions, sometimes we would experiment with 15 minutes of reflection with a whiteboard and a prompt and quickly draw a mind map of connections or write down lists of new ideas or things to fix. This allowed spaces for independence even within collaboration. As the project developed, my partner and I took on more specialized roles and I took charge of usability tests and emailed changes and problems to my partner who made adjustments to the web app. Independence worked really well at that stage. I realized that there is a time and place for independent work and collaboration.
Documentation of prototyping as well as work logs is important in long term projects.
Design professors always insist on lots of documentation of the process. The extra step of documentation can feel like an unnecessary extra step among the hustle to do good design and prototype more, but having the documentation of pictures of whiteboards, post-it notes, wireframes, and notes along the way created space to reflect on where we were as we narrowed and expanded our thinking in the process to navigate ambiguity and find clarity. We also created a prototyping timeline document which helped to explain our process as we talked to professors and mentors. Later in the process as we became more specialized in our roles in the project, creating a shared work log was helpful in documenting next steps to be accomplished no matter how small the task and helped give greater perspective to how we shared the workload.
🎬