Charlie: Millennial Caregiver Chatbot Concept

Problem

How might we improve the quality of life for a person with Alzheimer’s or their caregivers?

Process Overview

We put into practice a combination of research and interaction design principles we learned through lectures, reading About Face and Luma Institute's framework for Human Centered Design; capitalizing on its flexibility and combining methods to gain greater insight at every stage.

Discovery

Understand Alzheimer’s, Identify Problems and Opportunities

Our initial timeline for the project was two weeks. We immediately agreed that our first step was to learn more about the disease so, we identified the following questions to answer:

• What is early-stage Alzheimer’s?
• What resources exist for people with Alzheimer’s and their caregivers?
• How many people are affected by Alzheimer’s in the U.S.?
• What are the challenges faced by caregivers?

Stakeholder Mapping

Who is impacted by Alzheimer’s?

Based on our preliminary research, we used stakeholder mapping to identify the key people involved and impacted by Alzheimer’s. Our map included the following people:

• A person with early-stage Alzheimer’s
• Primary and secondary caregivers (a patient’s family)
• Health professionals such as physicians, nurses, therapists and neurologists
• Health advocates and policymakers.

Interviews

What are caregiver’s pain points?

We interviewed six people ranging from their mid-twenties to their late-forties, all working professionals and women. Below, a sample of our questions:

• What are some of the challenges of being a caregiver?
• Please describe what it feels like to be a caregiver.
• What kind of support do you have? How do you need assistance?
• Tell us [me] about your daily interactions with your [grandmother, mother, father …].
• Please describe what changes you’ve had to make for in your daily life to be a caregiver.
• Tell us [me] about any technology (apps, websites, devices, etc.) you use to manage your days and activities as a caregiver.
• What types of solutions have you wished for?
  

Voices

I wasn’t sure what to do or say when she keeps repeating herself. It’s frustrating.

Websites are helpful but overwhelming.

Facebook groups and Alzheimer’s support forums are depressing. Our support group wasn’t a good fit. They were too old.

I don’t have time to listen to everyone’s sob stories. I have my own to deal with; I honestly don't have the time to weed through it.

Synthesis

Key findings about caregivers

• Alzheimer’s is a progressive disease, affecting individuals in many unique and different ways.
• Associated stigma prevents caregivers from sharing their burdens; feeling isolated, lonely, and scared.
• Caregivers experience feelings of frustration, depression, confusion, uncertainty, and sadness.
• Communication is difficult and causes tremendous tension between loved ones and their caregivers.
• Information is available yet overwhelming and often not relevant.
• Medical, legal and financial services and systems are not caregiver-friendly.

Ideation

Identify potential users

The interviews served as a foundation for our empathy maps which informed the development of our personas. These personas helped guide the direction of content, design requirements and framework — all in an effort to gain clarity regarding user goals and needs.

A persona for an early-stage Alzheimer’s patient was developed to understand what it feels like to be diagnosed with the disease and what challenges are faced. Two additional personas for millennial caregivers were also developed: a physician and a granddaughter. The former was explored to help identify the unique advantage a physician may or may not have as a caregiver. The later persona was developed to understand caregiving in a multi-generational household and one where more than one person develops Alzheimer’s disease. 

Discovery + Understanding

Secondary research

In an effort to understand what products and services already exist for caregivers and Alzheimer’s patients, we looked at many types of products and services ranging from websites to physical products. While there were many products for caregivers in general (e.g. medical and monitoring apps) there were very few products that were targeted specifically for caregivers of people with Alzheimer’s. In fact, a review of mobile health apps found that “there is still an imperative demand for resources focusing on supporting the caregiver’s emotional well-being, including coping with stress, anxiety, and depression” (Grossman, Zak & Zelinski, 2018).

Several therapy apps led us to chatbots. Three notable chatbots: Replika, Woebot, and Tess. Replika and Tess are unstructured, highly sophisticated chatbots. Replika is designed to become a user’s best friend over time and Tess is designed to coach people through difficult situations. Woebot, a structured chatbot, uses CBT, lessons, stories, check-ins, and mood-tracking to support peoples’ mental health. A study by Fitzpatrick et al. (2017) proved conversational agents could successfully deliver CBT and significantly reduce depression in people. 

References

Fitzpatrick, K. K., Darcy, A., & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR mental health, 4 (2).

Grossman, M. R., Zak, D. K., & Zelinski, E. M. (2018). Mobile Apps for Caregivers of Older Adults: Quantitative Content Analysis. JMIR mHealth and uHealth, 6 (7).

Design

Conversational structure and flow

We taught ourselves and discovered the nuance of designing conversations was the most challenging aspect of designing our prototype. We used Amir Shevat’s book, Designing Bots: Creating Conversational Experiences, as our primary source in addition to several posts on Medium and voice interaction documentation from IBM Watson, Google, and Microsoft.

Chatbots require minimal user interface design so the words, the language, meaning, and context takes priority. For this prototype, we referenced language from various therapy chatbots but recognize that with further development, we need a licensed, CBT (Cognitive Behavioral Therapist) who is also knowledgeable about Alzheimer’s and caregivers to assist in the design of the interactions.

Visual Design

Color, typography & textures

The goal was to give the chatbot a neutral visual direction; one that wouldn’t be overly feminine or masculine. Another goal was to avoid the increasing female gender associations attached to chatbots. We discussed the qualities and emotions associated with therapy, counseling, and assistance—the ideals of what that relationship would feel like.

We decided to move forward with a direction consistent with the genre in conveying a sense of calm; a way to amplify the parasympathetic nervous system (e.g. looking at the lake or ocean or sky). Mixing serif and sans serif was a way to add some texture; to keep it modern but also serious in tone. The textures were selected for their organic, nature qualities.

First draft of high fidelity mockups.

Prototype

High-fidelity mockups

The UI for chatbot design is minimal so we skipped the wireframing process and placed special emphasis on the words, personality, and tone. Our plan included a presentation to get feedback so it was important to present a more polished “Charlie” as the visual design could impact the perception of our chatbot's personality.

Introduction screens to inform and reassure caregivers.

(From Left:Conversation design, caregiving guides initialize prompts in the chat, caregivers can track their conversations as a journal.)

Feedback Session (version 1)

Constructive criticism

We used Proto.io to create our prototypes. Proto.io was the best option to communicate the look and feel as well as interaction minus full implementation using natural language processing (NLP) and machine learning (ML). We considered creating a prototype made with Twine or using a Wizard of Oz approach but we felt it was critical to provide an experience as close to reality as possible.

This should be the first choice for a caregiver; not a website.

I also like that it is customizable to the user and hypothetically to the users’ unique experience with the Alzheimer’s patient.

I like the layout as if its a text message and I like the three options for aid, particularly option two!

It looks good. The color is calming. But the conversation is at first, a nice pace, then goes too fast.

Conclusion + Future Work

Reflection

Conversational design is the user experience. This article, Therapy via conversational design by Kathleen Varghese and the documentation for Google Assistant, IBM Watson, and various other sources were critical to learning about the design of chatbots.

Focus on the words and tone to give chatbots the appropriate personality for your target audience. Make accommodations for dead ends and users who wish to “test” the system.

Collaborate with a therapist. Ideally, we will partner with a therapist who has experience working with caregivers; ideally Millennials. We want to make sure the conversations are appropriate, responsible, and sensitive to the nuances and complexity of caregiving.

Additional UX research and usability testing. We would like to do more generative research and eventually design a more formal usability test with representative participants. More data is needed to inform the next iteration and before resources are devoted to development.

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