Persuasive Design

Stabylize.com

The Stabylize persuasive information system aims to help trauma survivors stabilize their life in three main ways. First, it changes their mental focus to activities they have control over. Second, it seeks to engage them in constructive behaviors that give them greater actual control over their life. Finally, it provides a framework that rewards accomplishments by providing a visually rewarding personal report card of their accomplishments.

To reach a wider audience, a trauma survivor will be defined as anyone who self-identifies as such. This could be a patient rated as 15 or higher on the Injury Severity Score (ISS), a victim of a crime, or a person who is in recovery from suffering long-term abuse. All of these users have the commonality of feeling a perceived or actual loss of control.

Trauma recovery is an important issue simply due to numbers of people impacted. 60% of U.S. adults have encountered a traumatic event sufficient to cause PTSD (Kelly, Merrill, Shumway, Alvidrez, and Boccellari, 2010). Over five million Americans actually suffer from PTSD each year, and in high-risk populations such as soldiers returning from Iraq, the PTSD rate is 19% (Wiederhold & Wiederhold, 2008).

Stabylize can benefit users in several ways. A great many recovery programs focus on the typical Western psychological focus of examining feelings. Stabylize draws its concept from traditions such as Japanese Morita therapy and Csikszentmihalyi’s Flow theory in being centered on taking actions that will actually improve the user’s daily life (Csikszentmihalyi, 2008). Additionally, it steers the user away from any element beyond their immediate control. Actions speak to our psyche louder than words ((Reynolds, 2002). While traditional trauma therapy may have a place in the survivor’s recovery, Stabylize supports the user to gradually build strength in practical and personal segments of life, creating an upward spiral of empowerment.

User Needs Analysis

One of the primary experiences of trauma survivors is the perceived or actual loss of control (National Crime Victims Research and Treatment Center, n.d.). Survivors can feel psychologically adrift because of the trauma. They may be experiencing factors that impact their ability to physically direct their life, such as physical injuries, economic losses, or a loss of control over their environment due to loss of their home or place of employment. Whatever the source of the trauma, people cannot recover until they stabilize their life.

Their main information needs are the specific constructive steps they can take to positively impact parts of life they have control over. While they may have been exposed to this information in a disparate fashion, people under stress are often not able to structure their thinking. Additionally, they need to learn that taking constructive action will lead to both feeling increasing control and regaining actual control.

There are countless factors that could prevent the target users from engaging in the behavior structure provided for them. People who have experienced trauma may have lifestyle habits that do not support consistent behavior, such as erratic sleeping patterns, poor nutritional intake, or a lack of healthy emotional support in their social network. They may experience regular nightmares, which can impact sleep quality and duration, and increase the likelihood of depression. This particular system may not engage them because of its tone, aesthetic, or design.

This needs analysis relied on previous research on trauma survivors and informal interviews with potential users of the system (Bayles, 2015). Potential motivators included an increasing feeling of personal efficacy, positive feedback from people perceived as understanding the user’s mindset, and the feeling of reward experienced by graphically tracking progress. Potential de-motivators included an inability to overcome depression about the user’s condition, pain management issues, and a lack of physical or mental energy to engage in self-help activities.

Potential users all expressed a desire to be able to interact with the system on multiple platforms and appear to use all platforms with equal ease. Full-scale keyboards on computers provide more ease of use than touch screens on phones or tablets. They would like to see more content to keep them engaged in the long-term, and more information about the two information systems meant to follow Stabylize.

Description

The first main feature of Stabylize is a series of achievement groups, each with its own set of related tasks (See Figure 3). Tasks vary in difficulty, allowing the user to select those that suit their present energy and motivation level. Within each group, tasks generally begin with those that require fewer resources (time, energy, money, etc.) and progress to those that require more.

The second main feature is a collection of accomplishment badges that draw together related tasks according to particular themes (See Figure 5). For example, a task may be part of an achievement group, but several tasks from various groups could combine to qualify the user for a badge. Groups have a broader span than badges (e.g. physical, financial, etc.), whereas badges are earned with a more specific focus, such as insurance or home security.

The third main feature is a set of engagement activities to deepen the users involvement with the process and the community. These include a journaling feature (which can be posted publically or shared privately), a leaderboard of people using Stabylize (with an option to see what city and state they reside in should they opt-in to share this information), and the ability to connect with other members or share achievements with the public (See Figure 6). This allows users to either utilize the service in an entirely confidential format, or connect with a group of their own choosing.

User Scenarios

Shane Riley is anthropologist in her mid-thirties. She spends roughly half her time out in the field on digs, and half the time in the office. She grew up doing many outdoor activities, and the work sites she is on usually follow standard safety protocols, so up until this point she has suffered only minor cuts and bruises. However, there was a cave-in at her most recent assignment and she was brought into the local emergency room with significant injuries. She was admitted with a complex fracture in her right tibia, contusions over her back and torso, and a concussion. She lapsed in and out of consciousness during her medevac flight, and the EMTs were concerned she might have internal bleeding.

Scans showed no internal bleeding, and the emergency physician was able to successfully treat her injuries. However, she now has a long recovery process ahead of her that will require a significant amount of physical therapy, and the full bill will not be covered by her limited insurance. Her co-workers have been helpful, but with rotating staff and constant fieldwork, she will mostly be on her own during the recovery process. It is not clear how well the tibia will heal, so her future in a profession that relies on fieldwork participation could be in jeopardy.

Shane’s insurance covers six counseling sessions. During these sessions her psychologist suggested she look at the Stabylize site. During counseling she learned that the number one challenge survivors have is the loss of control they feel, and that solely focusing on her emotions may make things worse. She learned that trauma survivor’s typically suffer a variety of prolonged stressors. With so much out of her hands she would like to have a practical framework to help her stay focused on those things she has control over during this drastic change in her life circumstances.

Sample Task Scenario 1: Choosing the Next Focus Task

The system keeps Shane logged on to all her platforms (laptop, tablet, and phone) until she chooses to log out. She reviews the tasks she has checked off in the achievement groups she is interested in focusing on (See Figure 1). She then switches screens to review her badges and see what badges relate to the task she thinks she would like to pursue. She selects her choice of task by clicking on the star to the left of the task, and this turns the star silver. This action automatically generates several triggers. These include a morning notification on her phone and tablet and a mid-morning email that provides an infographic of her weekly progress, as well as a link to the main interactive dashboard (See Figure 4). The dashboard allows her to chart weekly and monthly progress, and also shows her set completion bars for each accomplishment group (Nodder, 2014).

Sample Task Scenario 2: Changing Trigger Settings

Shane can change her settings by going to the main menu drop down bar and clicking on the Settings selection (See Figure 2). She can change her settings to provide her additional triggers at any time of the day she wants, using email, texting, on-screen notification, and a fee-based phone call service. She can set her notifications to include embedded links that will take her to the accomplishment group that her listed task is a part of. This shows her what she has accomplished in this group so far. She may also have the system send her triggers that place the task in the context of her overall achievements. For example, it might say, “Completing this task will take you half way to completing the physical stabilization group.”

Finally, she can create triggers asking her to do one of several reinforcing behaviors: making an entry in the journal feature to reflect on how completing or not completing the task impacted her progress, watching a video about a successful survivor’s story, or reviewing a system generated infographic (with the option to print it, save it to her laptop as a pdf, or share it).

 

Figure 1: Task and User Flow Analysis: Sample Task Scenario 1

Figure 2: Task and User Flow Analysis: Sample Task Scenario 2

Figure 3: Stabylize Homepage

Overview of functionalities:

Achievement Groups - Breaks down tasks into easily achievable segments

Dashboard – Provides user interactive graphics to track progress

Badges – Uses Fogg Behavior Grid to group tasks into those that fit consistent criteria

Leaderboard – Allows user to compete against other members of the Stabylize community

Journal – Allows user to record progress and provides sharing options

Community – Allows user to connect with other members of the community

Settings – Allows users to personalize triggers

Premium Service – Provides users with upgraded services

Next Steps – Explains the follow-on information systems

About – Describes the rationale behind Stabylize

 

Figure 4: Dashboard Achievement Review Features

Figure 5: Badges Screen

Figure 6: Leaderboard

Justification

Much of the research on trauma lists a lack of control as the primary concern for survivors (Lowenstein & Brand, 2014). SuperBetter addresses the recovery of trauma, but places the emphasis on psychological and mental concerns, and allows the user to provide a great deal of personalized input. Addressing practical concerns related to medical, social, and financial issues may be more important than psychological issues (Kelly, Merrill, Shumway, Alvidrez, and Boccellari, 2010). Trauma survivors need three key components to recover; safety, predictability, and control (Stanford, Elverson, Padilla, & Rogers, 2013). SuperBetter may not be the best course for someone who desires more structure and predictability in their life following a trauma due to this design feature that encourages personalized input. Trauma survivors should not be required to imagine what would improve their situation; they should be given a framework that can be followed.

Foursquare is perhaps the most popular badge-based system, and it does provide some badges for exercise goals or healthy eating. Stabylize offers badges for a wide variety of needs. Hospitalized physical trauma victims defined their primary needs as being related to physical health, work, finances, social issues, psychological concerns, medical issues, and legal factors. Acutely injured public-sector violent crime victims defined their primary needs as obtaining safe housing, food, medical treatment, and financial aid (Kelly, Merrill, Shumway, Alvidrez, and Boccellari, 2010). Stabylize is designed to focus the user on addressing these practical concerns. It also links mental and physical issues, which has been shown to improve recovery in such populations as martial artists sustaining traumatic injury by 16-28% (Slavia, 2012).

Stabylize badge requirements are designed using Dr. BJ Fogg’s Behavior Grid (Fogg, 2015). Some badges reward starting a behavior, some stopping a behavior, some continuing a behavior, and so on. Each badge should fall within only one grid space to keep the persuasive strategy consistent. Using the Fogg Behavior Model, the emphasis will be on simplifying ability rather than increasing motivation (Fogg, 2009).

As the user completes tasks and earns badges, they will have a visual representation of the many specific steps they have taken to aid in their own recovery. They will also be provided with periodic visual scorecards that will highlight these positive steps, serving as a touchstone and reminder of their accomplishments, similar to the psychological impact of Alcoholics Anonymous coins or Scouting Merit badges.

This step-by-step progression (using badges, a leaderboard, and progress bars) targets Yu-Kai Chou’s Accomplishment Need in the Octalysis Framework for Gamification. Stabylize will continue to grow and develop, targeting all eight of these quadrants to deepen user engagement. Those users who complete all the tasks in the Stabylize system, will be able to graduate to two additional systems; one targeted at maintaining stability over time (flourishing), and one focused at using the gains made to excel. Each of these three (stability, flourishing, excelling) are treated as separate steps with increasing energy requirements and greater payoffs.

User Evaluation Report

Some users liked the design, while others thought that the reference to military academy culture was too limiting or had too many negative connotations and might alienate a segment of the possible audience. People who had previous experience with earning badges, such as foursquare users or those who had been involved with scouting, saw the appeal of a visual representation of accomplishments. Those who had no previous experience seemed less convinced of the utility of virtual rewards.

Everyone understood the concept of regaining practical control over life following any type of significant stress, and most thought professional counseling had a limited usefulness for trauma survivors, UNLESS the counselor was a trauma survivor themself. They liked the idea that this system was meant to be the first in a series of three. Some feedback suggested that trauma was too unspecified a term and should be more narrowly defined.

The drop down menu interface was well-received, as was the opaque splash screen on the home page. The switching opaque mini screen that activated upon rollover was also commented on favorably. Users did not feel like they could comment on what would be of more use to them without being able to test a working prototype.

Lessons Learned

The primary takeaway from this project was how difficult it is to design a system that is truly going to help other people. Good design must get into someone else’s psychology if it hopes to impact the user in any meaningful way. Secondly, designing at the correct intersection between too broad and too specific is a significant challenge. Finally, it’s intimidating to design for people who have experienced or are presently experiencing pain and suffering. There are far more ways to get it wrong than to get it right.

These insights encourage caution in the work world, which is often at odds with the rapid timeline of a commercial product. However, going through the step-by-step process allows the designer to trust the method, even if they have to accept that any product created will be imperfect, and therefore may not aid users at all.

 

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List of Figures

Figure 1: Task and User Flow Analysis: Sample Task Scenario 1                                         

Figure 2: Task and User Flow Analysis: Sample Task Scenario 2                                         

Figure 3: Stabylize Homepage                                                                                               

Figure 4: Dashboard Achievement Review Features                                                               

Figure 5: Badges Screen                                                                                                        

Figure 6: Leaderboard