Loneliness Epidemic
A case study and redesign of healthcare flows in the context of the loneliness epidemic.
Service design project
This project started with an extremely broad brief and a vague goal. Our project direction was determined by entirely by our own curiosity and research. This was my first service design project and the research rigor was far beyond what I was used to.
01
DISCOVERY
KEY QUESTIONS
Our first foray into this topic was without direction. We needed to establish an understanding of the landscape before we could begin to even think about what what form our ideations could take.
01
What is the loneliness epidemic and what are the contributing factors?
02
What are the key characteristics of loneliness and how do seniors live with it?
03
What are possible solution areas and what is already being done to help?
WHAT IS THE LONELINESS EPIDEMIC?
To understand the loneliness epidemic, we began with secondary research on the U.S. Surgeon General's report and related articles. This gave us a broad overview that recent years have seen societal increase in social isolation and feelings of loneliness.
As social animals, humans require social interaction to stay healthy. Loneliness has serious health and social impacts, leading to increased risks of mental health issues, chronic diseases, and a decline in communities and support systems.
Increased Risk
26-29% Premature Death
29% Heart Disease
32% Stroke
Additional Symptoms
Anxiety, Depression, Dementia
Viruses and respiratory illness
Looking at interviews, testimonials, personal accounts, and reflecting on our own experiences with friends and family, we hypothesized how seniors might consciously or unconsciously withdraw from social interaction.
Loneliness is a subjective feeling.
It manifests differently for everyone and there's a distinction between a positive state of solitude versus a painful state of isolation.
Loneliness is a negative spiral.
Physical or mental deterioration makes it more difficult to maintain or form social connections. Relationships can also dry up over time due to sudden circumstance or gradual distancing. In this way, a person's support network shrinks until there's nothing left.
Loneliness is a taboo.
As with mental health, loneliness is stigmatized. Individuals often fear being perceived as weak, emotional, or insignificant for expressing their feelings of isolation, discouraging people from seeking support or even acknowledging their loneliness.
There's no single solution that can account for all of these factors.
SCREENING METRICS
We needed to identify the segments of the senior population that are at an elevated risk of experiencing social disconnect and loneliness.
I spearheaded the development of a robust analytical framework centered around Activities of Daily Living (ADLs): key indicators of an individual’s autonomy and ability to seek social interaction.
These are questionnaires and checklists used by social workers and some medical professionals.
OPPORTUNITY
We determined that our solution couldn't address loneliness directly.
Our explorations into various strategies, ranging from awareness campaigns to leveraging social media and AI, all failed to address one or more characteristics or induced behaviors of loneliness.
Weighing our options, we decided that Healthcare was the most robust platform for reaching out to and assisting lonely seniors due to a number of factors.
Accessibility
Unlike other solutions that rely on the initiative of the individuals to seek help, healthcare offers a unique opportunity to reach seniors during regular checkups.
Resources
The healthcare system is equipped with the expertise, funding, and connections to implement comprehensive solutions.
Authority and Trust
Healthcare professionals are highly credible which makes their advice to patients and other organizations more impactful.
INTERVIEWS
Research Objective
Clarify the policies and practices of healthcare and other service providers that interact with seniors to identify and address social disconnect and isolation
Identify other formal or informal communities, groups, organizations and services that engage with seniors and can influence and impact their day-to-day lives.
Subject Matter Experts
Dr. Christiana Shoushtari MD
Physician, Oak Street Health
Kenny O'Neil
Healthtech consultant, Ernst and Young
Jennifer Noonan
Social worker, position leader for CVSHealth Behavioral Health
Diana Siebenaler
Director of Experiential Design, OSH
Justin Hunt
Digital health, Oak Street Health
Manika Kosaraju
Oak Street Health
Rebecca Murray
Clinical supervisor, Oak Street Health
Sean Gallivan
Advanced UX researcher, Aetna
Nikki Brussard
Service design principal
Nardo Manaloto
Technology, Kaiser Permanente
Sticky note exercise conducted with all of our experts to discover who or what seniors interact with in their daily lives. Experts would explain how seniors would interact with each as the team wrote them down for them to ensure uninterrupted thought.
We concluded each Miro session by appealing to aspirations with affinity images. Participants would choose 3 stock images from an image bank and explain how it resonates with them. This allows us to cut through the nitty gritty and speak directly to the fundamental values that will be the key to success.
PROBLEM
Loneliness manifests differently for everyone and is hard to identify.
Lonely seniors don’t speak about their loneliness or don’t know they should.
Primary care providers aren’t trained to diagnose loneliness or don’t consider it within their job scope.
Existing solutions are inaccessible or incorrectly applied.
Accessing mental healthcare is confusing and difficult.
Doctors aren’t always aware of available resources that can help.
02
PROJECT DIRECTION
CLINIC RECOMMENDATIONS
This is our solution for our subject matter experts, detailing measures which, if implemented into the clinical workflow, will allow doctors to better combat cases of loneliness.
Staffing and Training
Hire social workers and care coordinators, who are trained to handle these kinds of cases, to work alongside doctors. Train physicians in bedside manner to make patients more comfortable to share their feelings.
Implement Screening Methods
Create tools and protocols for screening loneliness in patients that can be used in various touchpoints throughout the patient experience during a patient visit.
Curate Helpful Resources and Connections
Curate a database of community organizations, public programs, and mental health support that we can form connections with and be leveraged to treat for loneliness.
Track patient progress and ensure follow-up
Rely on the extra staff or create software tools to track the patient's recovery journey and collect metrics. Adjust treatment plans as necessary and use successful cases to advocate for further funding.
03
ECOSYSTEM
SENIOR MAPPING
In order to contextualize our recommendations, we created a series of tools and diagrams to help understand our target audiences and solution scope. Intended for internal use in the design team, some of these artifacts ended up becoming valuable to the stakeholders and subject matter experts in their own right.
Behavioral Continuums
Series of continuums designed to classify and score different senior archetypes, enabling care providers to get actionable insights on their patients.
Touchpoints
Map of the relationships and touchpoints that a senior interacts with in their day-to-day life.
Workflow Integration
Service blueprint of a typical visit to the primary care provider, highlighting opportunities for improvement and detailing how to smoothly apply changes.
Strategy Blueprint
Clear outline of our goals, required activities, and parties involved in our final design solution.
BEHAVIORAL CONTINUUM
Using our ADL framework, we placed the metrics on a series of continuums to identify patterns that can indicate someone who is vulnerable to social isolation. This allowed us to segment the senior population into distinct risk groups.
With this framework, care providers are able to get actionable insights for developing targeted interventions.
This system garnered enough positive feedback that one of our stakeholders, Dr. Christiana Shoushtari MD, incorporated parts of it into her academic thesis.
The blue dot depicts a senior who's largely healthy and not at risk of social isolation. They're physically healthy, maintain a good social support network despite not connecting well with neighbors, and are sharp in mind. They can take care of themselves and seek social activity on their own.
The red dot is a senior who is not doing well and is at risk of social isolation. They've experienced serious physical and mental decline, requiring someone in the house at all times for help for even basic tasks. They're distant with friends, family, and their neighbors. These should be huge red flags for a doctor.
TOUCHPOINT MAP
Additionally, we also mapped the relationships/touchpoints that a senior interacts with in their day-to-day life based on our findings from the sticky note exercise with our stakeholders.
This map paints a clear picture of how different parties impact a senior’s life. Each node presents a possible lead where our solution can be implemented. It also informs us on what community resources are most important to pursue when developing our database.
WORKFLOW INTEGRATION
I drew a service blueprint outlining a routine clinic visit. This gave me an understanding of the process, both from the perspective of the patient experience and the backend logistics. It also helped me empathize with doctors and nurses, knowing that there were thousands of moving parts for even a simple checkup.
Using this, I highlighted opportunities that a doctor could implement into their practice to better diagnose and treat for loneliness.
STRATEGY BLUEPRINT
This blueprint outlines the scope of our solution, detailing exactly what our goals were, how we wanted to fit into the existing ecosystem, and how we were going to leverage it.
Building this really made us see how many moving parts there were and that each one was something that needed to be accounted for.
04
DESIGN
A TOOL FOR DOCTORS
While creating a feature complete EHR is unfeasible, it's possible to incorporate features to detect and manage cases of loneliness into existing patient management software. This demonstration uses a questionnaire to perform risk analysis, but future iterations may change as more advanced detection methods are developed.
A DATABASE OF PUBLIC PROGRAMS AND RESOURCES
The resource search and patient matching functions tap into a database of vetted community organizations, charities, professional mental care, and other helpful groups that doctors can contact and work with. With this, it's also possible to prescribe social activity and keep track of patient recovery progress.
PATIENT NAVIGATION
While sign up can be handled by clinic staff, the patient can stay on top of their treatment plan with an accompanying app which, after partnering with rideshare programs, can handle travel and logistics.
REFINED LOOK
05
REFLECTIONS
This was the most complex and interesting project I've worked on in my time at design school. The first few weeks were confusing, but as our research took shape it became a delightful experience. I was especially excited to work with our subject matter experts and being able to catch their interest to the point that they decided to attend our final presentation.
I loved hunting down insights, mapping/diagramming complex systems, and being able to express my findings to both my team and our subject matter experts.
The most important outcome of this project wasn't our wireframes or UI design but rather a set of recommendations we developed for our subject matter experts. While the specifics of implementing our suggestions are up for debate, and could be entire projects in it of themselves, being able to put our solution into a succinct list is, I think, more impactful than the screens we made.
TAKEAWAYS
Your first instinct is probably wrong
It can be tempting to design according to your gut, but our assumptions were constantly being challenged each week. Beyond design iteration, I was surprised at how much our solution had to change based on a single new insight we might find each week.
Account for the system when designing
We're taught as designers to empathize our users, but it's equally as important to understand what ecosystem our designs exist in and what needs to happen in order for them to be built. This way our designs will be more feasible and can leverage existing tools.
Build your research tools
More than just reading and taking notes, our goal in research is to achieve understanding and hunt down important insights. However, not all insights are straightforward to obtain. Out of all the outcomes of this project, I think the research exercises and the ability to create and use maps/diagrams/metrics are what I want to walk away with.
Design your questions
In really complex topics, it's impossible to know where to even begin. Half of this project was trying to hone in on what solution space to work in and once we did figure that out, we needed to extract information that we didn't even know existed.
NEXT STEPS
Community Organizations
Research more on how community organizations and mental healthcare behave. See if they're receptive towards the idea.
Maps and Blueprints
Further map out the service blueprint and elaborate on how to create more channels between mental health and the rest of the healthcare system.
Target Audience
Extend this resource to other types of patients such as troubled youths.
Deployment
Look into ways that this solution can be implemented. See how to pitch this idea to a company with the necessary resources or perhaps how to launch this as a startup.