Hydro Functional
Brief
Hydro Functional is run by a group of aquatic physiotherapists and aqua fitness professionals with research experience wanting to bring the best aquatic programs to people with knee arthritis.
They developed and launched a 6 week online Knee Program and commenced the first field testing trial in mid-September, 2020. The trial was aimed at acceptability, usability and feasibility outcomes.
The client had about 50 expressions of interest to be involved in the field testing trial but only 16 ended up starting. This indicated to the client that there were potential issues with the program onboarding process and / or people’s understanding of how the program worked and possible confusion related to using technology.
Client defined business needs
Understand the user experience for online aquatic exercise programs, i.e. downloading the program, understanding the elements of the program, provision of the downloadable pdf of the program and how it was used.
Explore options for improving the experience for the user, i.e. content or visuals – timer, music, elements of the program and use poolside, any unmet needs that they have with the program related to safety, supervision, content, value.
Find a way that makes sense to users to explain how to download the program, how the exercise videos work and how best to use them.
Find testimonials / direct quotes related to ease of use that could be used to encourage others to join in further field trials.
The Problem
Hydro Functional wanted to improve quality of life for people living with knee arthritis through delivery of aqua fitness programs.
However, the means by which the therapy was being delivered to remove and (primarily) elderly users was not meeting their users’ expectations or needs.
Project Scope
I worked collaboratively with a team of 5 UX/UI designers across the four key stages of the design process.
In scoping the project, we uncovered two key assumptions we wanted to validate:
Understanding of technology made the program too difficult to access for some users.
Social embarrassment with using the program created obstacles for some users.
Discover
Research Objectives
Our research objectives were focused on gaining a deeper understanding of four key areas.
Identify behavioural patterns of users
Identify how the Hydro Functional program sits within users’ lifestyles and treatment plans.
Understand users’ experiences with the program to identify client frustrations and areas of improvement.
Identify the experiences of non-participants with knee osteoarthritis and alternative pain management options.
Surveys
We conducted an online survey about the Hyro Functional Program with program participants to get a better sense of their goals and needs. (Link)
Interviews
We conducted 5 interviews with people who use the Hydrotherapy programs to gain key insights into their feelings, motivations and frustrations.
Key Insights from Research
Technological competency
Issues with social embarrassment
Issues with overcrowding in public spaces
Trouble keeping up with the speed of video transitions
“I’m really impressed at how well you unerstand these people. You really understand what some of their issues and frustrations are.”
- Client
Competitor Analysis
We completed a competitor analysis to get a deeper understanding of the marketplace that Hydro Functional operates in and grouped the primary competitors into two distinct classifications:
Social Impact
The core mission of Hydro Functional is to provide aquatic programs that reduce the pain of people with knee osteoarthritis and:
Give people greater confidence in their body to undertake exercise
Facilitate and encourage people to undertake long term exercise
Provide education and reduce social stigmas around osteoarthritis
We have identified four key competitors to Hydro Functional in this space:
Surgery
According to clinical research, surgery or total joint replacement should only be used in the end stages of the disease, however it is often seen as the best solution to “fix” their arthritis. Surgery is potentially dangerous, expensive and is still unsuccessful in up to 20% of patients. Surgery stands as a competitor to Hydro Functional’s social impact goals of improving the long term quality of life of people through exercise. Example: Melbourne Hip and Knee
Medication
General practitioners have low confidence in finding the right exercise and lifestyle interventions for people with osteoarthritis. This results in a tendency to over prescribe medications and imaging and leads to an inadequate and inequitable uptake of high-value osteoarthritis care like the programs that Hydro Functional offers. Example: Arthritis Australia
(Non water) Physiotherapy
Land based physiotherapy for knee osteoarthritis can (of course) be beneficial for sufferers. However Hydro Functional have their main area of expertise in water based treatments. Potential clients opting to undertake land base physiotherapy may choose to not undertake water based physiotherapy in future. This may or may not be of any detriment to that individual’s health outcomes. Example: Australian Physiotherapy Association
Cognitive Behavioural Therapy
Cognitive behavioral therapy (CBT) is a form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional emotions, behaviors, and thoughts. The tools deployed in CBT—which include learning to identify and dispute unrealistic or unhelpful thoughts and developing problem-solving skills—have been used to treat a broad range of mental health challenges. CBT is now considered among the most efficacious forms of talk therapy, especially when clients incorporate strategies into their daily life. A patient choosing CBT to deal with pain management may not become involved with aqua therapy. Example: Positive Psychology
Business Viability
Hydro Functional needs to make enough money to remain viable and continue to undertake further research. We identified two key competitors to Hydro Functional in this space:
GLA:D (Good Life with osteoarthritis: Denmark), is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms. GLA:D programs are available in more than 400 locations across Australia. They have a stronger brand presence and tenure than Hydro Functional. They mostly prescribe land based physiotherapy courses. GLA:D Australia seeks to achieve similar social impact goals to Hydro Functional. The challenge they pose is in taking potential customers away from Hydro Functional.
Aqua Fitness classes like those run by Fitness First (as well as other providers) represent a business risk to Hydro Functional. Some people with knee osteoarthritis may seek to improve or maintain their fitness and wellbeing using Aqua Fitness classes, rather than finding programs that are specifically designed to help.
Arthritis Australia is a charitable not-for-profit organisation, and is the peak arthritis body in Australia. They work in collaboration with arthritis organisations in ACT, New South Wales, Northern Territory, Queensland, South Australia, Tasmania and Western Australia.
Noom is an American based Cognitive Behavioural Therapy app / website designed to help people lose weight. The user experience design with their website is fantastic. Could some of the learnings from their approach be adopted by Hydro Functional when attracting new sign ups?
Define
Affinity Map
We mapped the data collected from our user interviews and surveys to help define our focus.
Four Key Areas
What the Hydro Functional Program Offers
Attending the program 2-3 times a week
Provides pain relief
Increased motivation attributed to progressive program structure and social connections among peers
Exercises are very easy to follow
Behaviour Around the Pool
Most participants used tablets with ziplock bags to protect their device
Experienced difficulties with technology
The features of the video, e.g. the time displays for countdown and video length as well as the Get Ready Screen before video are useful
Hydro Functional Pros and Cons
Pros:
Values interaction with their peers
Knowledgeable advice from the HF team
Self-paced program
Cons:
Navigating a crowded pool
Confusion with downloading exercise videos
Hydro Functional Outcomes, Goals and Desires
Physical condition and motivation improved significantly with the HF program
Gained increased awareness about the benefit of exercise
Their goal was to be as active as they were before having arthritis with reduced/ no pain
User Persona
Judy has a long history with osteoarthritis and suffers from chronic pain in her back and hips. Judy has had to stop her regular activities due to her osteoarthritis. After trying various treatments, surgery is the last resort. Judy’s main motivation for joining the Hydro Functional program is that she is looking for a long term alternative to surgery.
Customer Journey Map
At the beginning of Phase 1, technology is a major pain point for users, whether it’s using the devices or downloading the videos. This validates the first assumption about technology being an obstacle for users.
As the users acclimatise to the mode of delivery, in Phase 2, frustrations were more about quick video transitions, micro-movements of the exercises not being explained as well as having to navigate around other people.
By Phase 3, users have made social connections which have helped them to stay motivated with the program, disproving the second assumption around social embarrassment.
How might we…?
Be less reliant on technology?
Have a simplified process?
Optimise program content to better serve users’ needs?
Deliver to the uers’ accessibility needs?
MVP for UX
With technology being a major source of frustration in the user journey, our solution aims to iron out these obstacles by providing alternatives to tech-based program delivery and by simplifying the way users can access the exercise videos.
Given the pain points users have around timing and lack of explanation, program content has also been adjusted to better cater to the users’ pace and level of understanding
User Flow
Given that technology was a major pain point in the user journey, it was necessary to explore other options for program delivery.
The key to our solution lies in allowing the user to choose how their program is delivered to them. During the fortnightly reviews the user is given a chance to nominate their preferred method of delivery for the next phase, whether it’s a physical copy of their program, or a link to their video playlist via email or SMS.
At each phase of the program, the user flow branches out according the different modes of delivery. Customised program delivery directly caters to the users’ individualised needs around access and use.
Develop
Protoype
Welcome Kit
Welcome Letter
Exercise Sheet
Waterproof Sleeve
Welcome SMS
Email Newsletter
Youtube Playlist screen
Video - Title Screen
Introduction to Exercise
Video - Get Ready Screen
Timer and Illustration
Video Screen
Timer and tips for micro-movements
User Testing
User testing of Getting Started webpage and Welcome Kit concepts
Usability Testing
Users felt that:
The exercise sheet was a great way to communicate the program in a physical form.
The waterproof sleeve was environmentally sustainable.
The video interface and flow would mean they would be less rushed and would also be handy when manouvering crowds.
The micro-movement tips on the video screen would be a great reminder to engage particular muscles.
The Getting Started webpage was a great design with lots of visual cues.
The Getting Started wepage was more functional than the current resources available.
Users felt that:
The exercise sheet needed to provide more details to users on how to download videos to their device.
The exercise sheet did not provide enough detail in general.
The waterproof sleeve needed to accommodate different device sizes, i.e. different mobile and tablet sizes as well as any protective device covers on those devices.
The term ‘playlist’ was unfamiliar and preferred the word ‘program’
The video playlist should be curated according to the participants’ current program.
The video screen design was too minimal.
Testimonials
Video Transition & Graphic Overlays
Current Experience
“Sometimes on the other videos you’ve got to do the jump really quickly and I’m halfway through doing something else and I’ve got to move to the next one. It means I sometimes have a tendency to rush.”
Future Experience
“It gives me an opportunity to get organized for the next exercise, conscious of who’s around me and to know how long the exercise is going. It’s got all of theinformation that I need to do what I’m doing correctly with just that amount of time. Excellent. Like it a lot. I just think it will makeit a little less rushed.”
Video Graphic Detail
Current Experience
“When I was at the pool I’d be thinking which leg should I be leading with? The one I’m trying to work with or the other one? Then I’d go back home and reread the information that came with my video, or I’d go through all the techniques that came with my email to see if I was doing it right.”
Future Experience
“I think the most useful thing is it’s going to be an easy reference to make sure you do the exercises effectively, so I think those little tips there are good.”
Welcome Kit
Current Experience
“Another useful tip might be to try and allocate time to it... like, three days a week or two days a week or whatever. It doesn’t say that anywhere currently and that could be written somewhere to remind you.”
Future Experience
“I like the way you can quickly glance and you know you’ve got three phases you have to do. And I also think (the laminated sheet is) important because some people don’t feel comfortable taking the device. I think it’s good to have both options.”
[About the device cover] “It’s a gift for those who are participating in this program.”
Video Features
Current Experience
“I could never find where the original Vimeo page was. My Android phone is connected to Youtube already and Vimeo not supported on my Samsung tablet - it does support Youtube.”
Future Experience
“Layout looks good. Looks clear to go through sections, pause or choose sections. Autoplay jumps to the next video.”
Deliver
Client Presentation
Some clips from the final client presenation
Next Steps
Phase 2
Simplified client interface: Client Dashboard on HF website; everything in one place.
Notifications: User receives links to relevant content when they arrive at the pool and useful reminders, i.e. “Make sure your device is charged before the next class.”
Improved video experience: Pop up text on videos, i.e. Affirmations (“Keep up the good work!”) and educational information about OA
Phase 3
Difficulty scaling: Option to play video at different speeds, i.e. 0.5x or 0.25x.
Sociability features: Access to a Chat group with others in the program via the HF website
Additional support channels: A ‘Help’ chatbot on HF website as an alternative method of getting in contact with the team.
Accessibility
UI Design: Iterate design to align with WCAG to achieve AA standards.
Design: Communicate information within the design and not just rely on text directions. Consider participants’ varying levels of digital literacy and physical ability.
Language style:
Acknowledgement of pain
Encouragement to continue
Congratulatory affirmations
Evoke trust
Conclusion
With technology being a major source of frustration in the user journey, our solution aimed to iron out these obstacles by providing alternatives to tech-based program delivery and by simplifying the way users can access the exercise videos.
Given the pain points users had around timing and lack of explanation, program content has also been adjusted to better cater to the users’ pace and level of understanding.
Limitations
Working with only 4 user participants, our sample size was very limited which risks skewing the data towards individual needs and personal biases. In order have a more accurate representation of user needs, we would need to conduct research with a much bigger sample size. It might also be helpful to conduct research with non-participants to gain a better understanding of higher level needs.
“There's lots of good ideas here, some of which we've already implemented in our second pilot. You really understood our users and what they needed and you understood the main problems we are having. You did a great job, well done!”
— Client