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CHRONIC(LING) PAIN

THE PROBLEM

This was my final thesis project for my BFA in Graphic Design at the Rhode Island School of Design. It combines
my interest in digital health and my experiences with chronic pain.

I wanted to use this opportunity to explore the ways in which design and technology could be used to address the issues that I have dealt with and still deal with now as a result of living with chronic pain. These issues include accurately describing pain symptoms to healthcare professionals and keeping a pain diary, motivating myself to adhere to exercises I was prescribed, and discussing my condition with the people around me.

TIMELINE

18 Weeks

January—May 2021

TEAM

This was a solo project, and was the final thesis project for my undergraduate degree.

KEY GOAL

Develop a language 

and a system to help people with chronic

pain to describe and manage their symptoms.

AREAS OF
INQUIRY

I began the project by devising five main areas of inquiry, which I used to anchor my research and thinking. These areas were:

  • Visualization - How can different types and levels of pain be expressed through a collection of commonly understandable symbols, and how can these symbols be used to aid communication between medical professionals and patients?

  • Public Education - How can design and technology be used to raise awareness of chronic pain, including the different types, causes, symptoms, treatments, and long-lasting effects?

  • Motivation - How can design and technology be used to encourage adherence to prescribed exercises when patients are in pain, which also affecting their mental health and motivation?

  • Communication - How can design and technology be used to facilitate effective monitoring and communication between medical professionals and patients?

  • Rehabilitation - How can design and technology be used to relieve pain and the negative effects of chronic pain on one’s mental health?

INITIAL
RESEARCH

My initial research began with a series of readings about how to design for people with chronic pain and how to communicate complex medical information to laypeople. 

Based on my own experiences with chronic pain, I then created an persona/empathy map, before proposing my intitial ideas for the final deliverables.

Readings (Key Takeaways)

  • Being able to visualize and map pain onto the body makes it much easier and more engaging for laypeople to describe and understand their condition

  • Information is easier to digest when it is immersive and interactive (sound, motion, VR etc.)

  • Active verbs should be used

  • Flexibility and adjustability are important - giving people options improves accessibility

  • Reward processing and positive feedback are good for motivation

  • Showing a user their progress visually is good for motivation

  • Use language that does not draw attention to pain

Persona/Empathy Map

As a warm-up exercise to help with idea-generation, we were given an assignment to collect/list a series of items in different categories, e.g. 5 hardware store items,

5 abstract feelings, etc. I decided to use this as an opportunity to create a persona/empathy map and start to think about what someone with chronic pain would think, feel, say, and do. I used the items I collected for inspiration. For example, "My body feels like I'm lying on a bed of nails," with nails being one of the hardware store items I collected.

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Pain Rating Scale and Icon Analysis

In order to explore ways to describe abstract pain sensations, I analyzed existing pain icons and rating scales.

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ANALYSIS:

  • It's difficult to standardize intensity/numerical ratings.

  • Scales do not indicate the TYPE of pain.

  • Many existing icons are generic representations of adjectives and do not accurately capture the actual sensation.

  • Pain mapping/showing pain on the body is very effective and provides a more comprehensive picture.

Final Deliverable Proposals

  • After considering the key takeaways from my various forms of research and ideation, I proposed three main deliverables:​
     

    • Icon Set

      • A set of static and dynamic icons representing different pain sensations that could be used to describe pain to a healthcare provider
         

    • Poster Series

      • A series of posters describing various chronic pain stories to help the public better understand the condition

      • PIVOT - I later changed this idea, and instead proposed a series of videos with voiceovers, as this would allow the inclusion of motion and sound in describing the pain symptoms discussed​
         

    • Paired Apple Watch and iPhone Apps

      • A pair of apps allowing users to record their pain symptoms, receive advice and prescribed exercises from their healthcare providers, and communicate with other users

BREAKING DOWN THE PROCESS 

The full design process is detailed below. In order to skip to the final presentation video which demonstrates the final iteration of each deliverable, please click here.

ICON SET: Pain Diary

 

In order to build up a visual language for describing pain and to begin generating ideas for the pain icon set, I created a visual pain diary over 5 weeks. 

Any time I felt pain (whether related to chronic pain or simply things like sore throats), I spent a couple of minutes visualizing it in Illustrator, resisting the urge to ‘over-design’ it and trying to make it as organic and representational as possible.

 

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ICON SET: Case Study

 

While creating the pain diary and starting to look for ways to visualize abstract symptoms, I came across Bruises: The Data We Don’t See (Pentagram). This is a data visualization demonstrating the progression of the petechiae and bruises on a girl with a skin condition, with each type of mark being represented by a particular gesture. 

This visualization does an excellent job of storytelling and mapping out the patient’s journey in detail, and it’s nice to be able to see all of the data at once. It’s also nice that the final result is a beautiful image that feels positive rather than dwelling on the painful symptoms.

This case study gave me some ideas for how to bring together the different pain icons to show progression over time.

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ICON SET: Iteration 1 (Static)

Using the symptoms and gestures from the pain diary, I generated a set of static and dynamic icons for 10 pain symptoms using Adobe Illustrator, Photoshop, and Keynote. While the static icons are not as useful for describing symptoms as the dynamic versions (shown below), they are useful for representing pain symptoms in places where sound and motion may not be appropriate or possible, such as printed medical reports.

 

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ICON SET: Iteration 1 (Dynamic)

USER TESTING & USER RESEARCH

Google Forms Survey - 20 Respondents

After the first iteration of the icon set, I sent out a Google Forms survey asking participants to assess the accuracy of the icons. I felt that creating an initial set of icons before conducting the user research would increase the chances of completion by participants as suggesting edits to a reference image is a less daunting task than being asked to describe an image from scratch. 

 

The survey also solicited people’s chronic pain stories, to be used as the basis for the Public Education videos, and information pertaining to chronic pain management, to be used as the basis for the design of the Apple Watch and iPhone apps.

> Icon Set - Accuracy and Suggestions

 

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> HCP Communication - Describing Pain

  • Out of ‘Words/Adjectives’, ‘Visuals’, and ‘Sound Effects’, ‘Words/Adjectives’ was the most popular option by far, which I found interesting because the user testing results for the pain icons were highly inconclusive, both in terms of narrow majorities regarding accurate vs. inaccurate ratings of my initial icons, and the contradictory suggestions from people who voted ‘inaccurate’. 

  • I found that some respondents even used other categories of pain when offering suggestions for how to improve an icon; for example, one used the word ‘tingling’ to describe how they would improve ‘Numbness/Weakness’.

  • This lack of consensus is precisely why I decided to create icons that could describe exactly what a person meant by a particular adjective. 

  • As such, I think that visuals and sound effects are highly necessary despite being less popular in terms of preference. 

  • I therefore decided to have a stock set of icons to accompany words/adjectives, but also allow users to edit the icons provided, including the names, and provide additional written descriptions.

> HCP Communication - Exercises

  • Motivation and Adherence​​

    • Many respondents said they found it difficult to stick to their prescribed exercises for a range of reasons, including not having time, simply forgetting, feeling demotivated, or being in too much pain. 

    • The majority said they would be more likely to adhere to their exercises if they had reminders, with rewards being a less popular incentive.

    • I therefore decided to prioritize reminders and encouraging messages over rewards.​

  • Types of Exercises and Exercise Instructions​

    • Most people said that having a range of options, including dedicated workouts, and small movement tasks that could be integrated into their daily routines would be optimal. People also noted that certain exercises were not possible for them due to specific injuries they had. 

    • Respondents also liked having a range of options regarding how the exercises were dictated to them, including written, visually, and verbally. 

    • I therefore decided to increase accessibility by providing a range of options within the apps, as well as an onboarding questionnaire that would inform the user’s healthcare provider of their preferences and needs.

> HCP Communication - Pain Relief Techniques

  • I found that CBT, Sound Therapy, Mindfulness/Meditation, and Guided Imagery were all fairly popular psychological pain-relief techniques, with Games/Gamified Relief being hugely unpopular. 
  • I therefore decided to users with a choice of the former, in addition to a section with additional suggestions and resources, which could include external links to pain-relief games.

> HCP Communication - Community Building

  • There was no overall consensus regarding community building/forums/chatting with other users, but I did find that most of the people who did express an interest in this feature already had access to it through another app or online support group. 
  • I will therefore keep this as a potential v2 feature, and instead decided to put the ‘Public Education’ videos in the iPhone app, which will provide users with a degree of solidarity and encouragement.

> HCP Communication - Sounds/Colors

  • Regarding pain-relieving sounds, suggestions included rain, train/railway, classical music, and calm music; I will incorporate some of these into the exercise and pain-relief videos within the apps in the future. 

  • Regarding pain-relieving colors, suggestions included pink, blue, white, gray, and green; these informed the branding of the apps. 

 

ICON SET: Iteration 2 (Static)

I revised the static and dynamic icon sets to accommodate some of the suggestions from my user testing survey, with the intention of still enabling users to edit the icons to suit their needs.

 

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ICON SET: Iteration 2 (Dynamic)

PUBLIC EDUCATION: Iteration 1 

The following are personas that I created using stories from the user testing participants. I will eventually be making motion graphics videos combining the respective pain icons with voiceovers to illustrate each story.

 

These videos will serve both as PSAs to educate the public about chronic pain, but will also live inside the iPhone app so that users can get to know other people with chronic pain and feel less alone.

 

The 'posters' next to the text demonstrate how the pain icons will be combined to create the imagery for the videos.

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HCP COMMUNICATION: Product Proposals

and Use Case

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Andrea is a 26-year old woman with suspected fibromyalgia.

 

She has a series of unexplained pain symptoms, which she finds difficult to describe and they seem to occur at random times. Her healthcare provider (HCP) signs her up to the 'Chronic(ling) Pain' iPhone and Apple Watch apps.

Onboarding & Settings

The onboarding questionnaire and settings page will allow Andrea to adjust the user experience to suit her preferences and needs. Options will pertain to things such as injuries, pain triggers, preferred forms of physical and therapeutic exercises, and accessibility. This helps to improve adherence and the reduce risk of further harm.


 

Physical and Therapeutic Exercises

She will be able to access both physical and therapeutic (e.g. meditation, CBT) exercises to help relieve her symptoms. While her HCP will be able to prescribe specific exercises based on her medical needs, she will also be able to select her own from the exercise bank or start an open exercise/workout.

The onboarding and settings sections of the apps will allow her to indicate her preferred forms of exercise, as well as how she would like them to be displayed (e.g. text and audio, just text, etc.)

The motion tracking technology of the Apple Watch will also allow her HCP to see if, when, and how well she completes the exercises. The apps will also warn Andrea if she is not doing the exercises correctly.

Reminders and Notifications

Another benefit of the digital interface is the ability to provide users with reminders to complete their exercises as well as inspiring them with periodic messages of encouragement. These features will help Andrea to stick to her plan, even when she is feeling less motivated.

Log, View & Edit Symptoms

The digital interface, as opposed to a standard paper pain journal, allows Andrea to log her symptoms using customizable icons, which utilize sound and motion to increase accuracy and give her HCP a clearer idea of her symptoms that pure text. She will also be able to add additional written notes. She will also be able to see a visual summary of the symptoms she has reported each day, either in a list view or placed onto a body. The ability to visualize previous pain symptoms in this will allow Andrea and her HCP to start noticing patterns.

Resources & Videos

The 'Public Education' videos will be available in the application as an alternative to a user forum. They will help Andrea to feel less alone as well as deepen her understanding of chronic pain.

There will also be additional links and resources available within the app, and Andrea's HCP will be able to flag those which they feel are most relevant.

Contact HCP

Although exercise progress and logged pain symptoms will automatically be sent to the paired HCP app, Andrea will be able to message her HCP directly, if necessary. Her HCP can adjust their suggestions based on adherence, though she can also expand on particular issues by messaging them. This will enable Andrea to flag any issues or ask questions quickly, without having to make an appointment, providing greater comfort and reassurance.

HCP COMMUNICATION: Competitor Analysis

Some Other Chronic Pain Apps and Their Features

  • Pathways

    • ​this is a mind-body therapy program with various videos and articles; users can also track their pain symptoms and other factors using verbal descriptors

  • Manage My Pain

    • ​this allows users to track their pain and activity using verbal descriptors, and generate graphs and reports, which they can give to their doctor

  • Care Clinic

    • this allows users to track their pain and activity using verbal descriptors, and share the data with their doctor

  • Pain Tracker and Diary

    • ​this allows users to visually record pain symptoms by mapping icons onto a body

What Makes My Apps Stand Out?

 

While my apps do share features with existing apps, they uniquely combine all of these features, with the addition of:

 

  • Customizable GIFs/icons that seek to accurately visualize pain sensation, instead of just generic pictograms

  • Live reporting and messaging to healthcare providers, allowing them to notice any issues and actively prescribe resources and exercises, as opposed to AI-driven care, which may not pick up on nuanced issues

  • iPhone-based exercises, which pick up on accuracy/adherence, and adjust accordingly, rather than just videos

  • Simplified reporting using an Apple Watch - users do not have to go through a long questionnaire every time they want to log pain; they can choose to go back and add additional detail

  • Videos of other CP sufferers discussing their stories, making users feel less alone

HCP COMMUNICATION: Color Scheme

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I wanted the color scheme to have a positive and relaxing feel, in order to promote healing and distract from the pain. The main colors I wanted to work with were pink, blue, gray, white, green, purple, and orange, as these were the colors that came up in the survey as having soothing properties, while also being the main colors that I used in my original pain diary. 

 

The Apple Watch app needed to stick to the watchOS design guidelines, which have more minimalist principles and a requirement for a black background; the colors are therefore used more sparingly there than in the iPhone app design.

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HCP COMMUNICATION: Typography

 

 

 

 

 

 

 

 

I generally wanted the typography to be bold and legible, so that a user could navigate the website easily if they were in pain or discomfort.

 

I therefore chose Work Sans as the main typeface of the iPhone app (the Apple Watch app uses SF Compact due to WatchOS guidelines), as it is bold and legible, but also has some character that makes it visually interesting.

Work Sans Semi Bold Sample

Work Sans Extra Light Sample

HCP COMMUNICATION: Iteration 1 (Apple Watch)

All prototypes were created using Figma, with assets made in Adobe Illustrator, Photoshop, and Keynote.

HCP COMMUNICATION: Iteration 1 (iPhone)

 

Balsamiq Wireframes

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Prototype

Iteration 1.png

HCP COMMUNICATION: Iteration 2 (Visual Design)

The main feedback from class critiques on the first iterations of the Apple Watch and iPhone apps was that the working app name 'Chronic(ling) Pain' was too "on the nose" and focused too much on pain and that the visual design of the iPhone app was a little too playful and visually complex.

 

The first change I made in response to this feedback was the name of the app, which is now 'sentoms CP'. I decided that the pain icons themselves should have their own brand name, which is 'sentoms' (sensory + symptoms), with each icon being an individual 'sentom'. As the icons are hypothetically applied to different products, the specific application of the product would be indicated. In this case, the app is focused on chronic pain, and so is called 'sentoms CP'.

 

I also updated the logo to reflect the new name and used the logo motif as the basis for the new visual design.

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HCP COMMUNICATION: Iteration 2 (Apple Watch)

HCP COMMUNICATION: Iteration 2 (iPhone)

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HCP COMMUNICATION: Iteration 3 (Visual Design)

The main feedback from class critiques on the second iterations of the Apple Watch and iPhone apps was that the visual design of the iPhone app was still too visually complex. I, therefore, decided to switch from using the four colors of the logo to one, and give the user to option to pick the color scheme they find the most comforting. I have also made other small edits to the visual design to make the user interface more effective.

HCP COMMUNICATION: Iteration 3 (Apple Watch)

HCP COMMUNICATION: Iteration 3 (iPhone)

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FINAL DELIVERABLES

The final presentation video, which demonstrates the final iterations of each deliverable, can be found below.

KEY TAKEAWAYS & NEXT STEPS

This project gave me an invaluable opportunity to broaden my human-centered design experience and approach a healthcare problem using a range of techniques and solutions, including motion graphics, icon design, print design, and UI/UX.

 

Moving beyond my Degree Project, the ideal next steps would be to build high-fidelity MVP prototypes using HTML, CSS, and P5.js, and validate the products with healthcare professionals, people with chronic pain, and laypeople. 

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