1. Adherence Case

Increasing adherence to medication for chronic patients Client: Dr Reddys

Domain: Healthcare, Pharmaceutical

Duration: 8 Months

Tools: Ethnographic Research, User Experience Design, Business Design, Service Design, Interaction Design, Rapid Prototyping.

Cardiovascular and metabolic disorders are ‘silent’ diseases with little in the way of visible symptoms, which leads to a reality where few people are motivated enough to adhere to their prescribed regimen. This substantially increases the risks of complications and of further attacks.

Through a process which began with deep ethnographic research and which was followed by an iterative phase of testing and learning in market, we designed a broad based technology platform to address the various behavioral issues we identified as the key drivers of patient behavior.

IN A NUTSHELL The Problem

The Approach

The Result

Our goal was to design and develop solutions which would encourage patients, with cardiovascular or metabolic disorders, to more closely and sustainably adhere to their prescribed therapies.

Through a combination of primary and secondary research, we identified key factors that contribute to the low level of adherence.

Then, following an iterative process, we developed, prototyped and piloted multiple interventions designed to address those issues.

We developed a broadbased technology platform designed to address multiple behavioral issues simultaneously.

THE OPPORTUNITY Cardiovascular and metabolic disorders are ‘silent’ diseases - i.e. there are no visible symptoms for these conditions. As a result, awareness about and urgency to treat these conditions is generally low.

The treatment of these conditions requires a multidimensional approach involving diet, exercise and medication. The treatment usually involves a significant behaviour/habit change for newly diagnosed patients. It is estimated that close to 50% patients drop-off therapy within one year of beginning treatment, despite the need to be on therapy lifelong.

Non-compliance leads to suboptimal outcomes potentially resulting in life threatening events such as heart attacks or chronic kidney disease in the long run.

We were asked by one of the top 3 pharmaceutical companies in India to help develop a low cost solution that would help patients adhere to therapy and lifestyle changes.

THE PROCESS

We approached the problem by first understanding the complex domain through secondary research. We looked at existing adherence efforts by other companies, their methods and their data. In parallel we also spoke to subject matter experts such as senior executives in the company, doctors and behavioral psychologists. Once we had a fair grasp on the domain, we began to learn about patients and caregivers. Over a period of 2 months we spoke to more than 40 different stakeholders out of which about 50% were patients. The patients and caregivers were interviewed in-depth at their homes to enable a deeper emotional engagement. We asked them about themselves, their families and relationships as well as about how they were first diagnosed and what had happened so far. These stories evoked emotions and other related stories and helped us understand their needs, desires and aspirations.

Based on a combination of secondary and primary research, we were able to map out a patient journey over five phases that took into account both the conscious as well as the subconscious aspects of their behavior. This model was then validated with psychologists and consumer behaviour experts. The model helped us appreciate and convey the full complexity of the problem.

Working with the client, we narrowed the initial focus to only one of the five phases.

After multiple rounds of iterative brainstorming and prioritization, we agreed upon three interventions to prototype. We created four groups of users for the prototype. The first three groups were exposed to one intervention each and the fourth group was exposed to all three interventions simultaneously.

Where possible, the prototypes were developed using existing tools. For example, we used WhatsApp to accomplish a messaging task. Every aspect of the prototype was mapped out and planned out in detail using scripts, flowcharts and journeys. We also defined clear metrics. In addition to daily data collection and tracking of quantitative data, we also conducted face-to-face conversations with participants to gather qualitative feedback on a monthly basis.

THE RESULT After four months of prototyping, we found that the fourth group which was exposed to all three interventions stayed most engaged and had the highest adherence rate. We also learned about the comparative eectiveness of the various interventions when administered individually. The company is in the process of developing an app and a technology platform to power the integrated solution and pilot the solution with a much larger set of users over the course of several months.