Rewind - A brain-training quiz platform for people living with dementia.

A Smart TV application to ensure dementia patient’s independence and wellbeing as well as reduce caregiver burden.

This is the report for my Major project when I was studying Service design at London College of Communication, University of the Arts London during 2017–2018.

Acknowledgement

Big thanks to my grandmother Panju, mother Euisuk, father Hosun and my sister Roselina for generous support to completing this project. I hope we could happily manage this tough journey.

0 — Introduction / Summary

Assistive technology for inclusive design to improving dementia patient’s experience
This graduation project has suggested a possible future solution for people with dementia and Alzheimer’s disease in the United Kingdom. In the UK, the service around people with dementia is well organised and easy to access. However, as technology advances, which offers an easier way, society should come up with a new idea for dementia care.

1 — Project Background

1.1 — Contextual Research

This project started with observing users gain an empathic understanding of the problem this project will try to solve. Shadowing their experiences allows us to be immersed in the user’s feelings, thoughts, issues and challenges, and this became the starting point of the project.

1.1.1 — Observation & Shadowing

My Grandmother and Me
My grandmother is looking for objects
  • She can do most of the everyday tasks with some directions from our families. Such as there’s a towel in front of you, the pink one. After then, she could find them.
  • She spends 30mins for solving math quiz book which designed for elementary school students. Afterwards, my mother checks the answer. This activity is for training her brain to slow down memory loss.
  • She sometimes walks around the park with our families. Also, it’s dangerous because she has a risk to get lost.
  • She has to take pills every day at the same time. Mobile phone alarms help her to recognise pill times.

1.1.2 — An Initial Interview

The initial interview was conducted with my families to figuring out what she is doing during the weekdays while she stays in her home.

  • In the care centre, they organise several activities such as music, art, exercising and so on. We registered the care centre because we need someone to take care of her during the weekdays and provide many activities for slowing down memory loss.
  • When she comes back to her house from the care centre, she usually spends her time watching TV and solving math quiz book so that mother could check it later. However, my mother is always wondering what she is doing in her house alone.
  • Every Monday, my mother visited my grandmother’s home for cleaning. Because she is not able to clean up the room by herself.

1.2 — The Five Whys

The Five Whys is asking questions using the user experience to identify the underlying causes and motivations of external phenomena. I asked myself with ‘The five whys’ based on my observation in the empathise stage to define the next research stage.

  1. Why it is important?
    - Because it is good for dementia patients to keep living in their home.
  2. Why it is good for them?
    - Usually, they have live decades before they diagnosed with dementia so they will feel safer and familiar in their home environment.
  3. Why they feel unsafe outside of their home?
    - Because of the dementia symptoms.
  4. Why dementia symptoms makes patients life more difficult?
    - Let’s find out in the next step.

1.3 — Research and Design Process

From identifying problems and desired outcome to develop the service

Design Process for Major Project

2 — Discover

Discover the target user group, as well as their needs and pain points, and gain insight from them.

2.1 — Desk Research

Step back from the previous stage; the first desk research focuses on specific background context, understanding dementia diseases, patients’ and carers’ current situations for discovering pain points, with the need to explore new perspectives around dementia.

2.1.1 — Dementia is a global issue.

However, being diagnosed with dementia doesn’t mean you have to give up your independece.

2.1.2 — Dementia patient’s independence

2.1.3 — Assistive Technology and Dementia

Technology appeared as a new solution for dementia patients. Assistive technology for dementia patients is a broad term that describes objects, products, devices, and systems that assist in ensuring patients’ safe life and well-being at home or in a residential care environment. (Icarehealth.com.au, 2014) In this context, Alzheimer’s Society highlighted the importance of assistive technology. It can maintain patients’ independence and safety and keep them socially involved. Also, caregivers found it offers them support and reassurance. (Alzheimer’s Society, n.d.) On the Alzheimer’s Society website, we can see the advantages of assistive technology. It can promote patients’ independence and autonomy, improve confidence and quality of life, manage potential risks around the home, maintain patients’ abilities and independent living at home for as long as possible, help with memory and recall, and provide reassurance to carers, helping them feel less stressed. (Alzheimer’s Society, n.d.)

Some assistive technologies that help dementia patients’ everyday life
  • Improve the quality of life for everyone involved. Promote independence, autonomy.
  • Manage potential safety risks around home.
  • Reduce caregiver stress

2.1.4 — What Makes Dementia Patients’ Activities of Daily Living (ADLs) Difficult?

The patients’ brains are impacted by dementia, which makes patients’ activities of daily living (ADLs) difficult, including bathing, cleaning, grooming, dressing, eating, and toileting. There are some reasons for difficulties in daily living. On the Verywell Health website, Esther Heerema divided the reasons into six categories. Firstly, executive functioning makes sequencing, planning, and organising — multiple-step activities — difficult. Memory loss is the most common symptom of dementia, and it makes patients forget to do their tasks. Poor decision-making skills make them forget to wear a coat in winter. A lack of attention causes challenges in completing activities. Also, dementia affects their behaviours and personality. Visual-spatial changes jeopardise their perception so that patients become uncertain as to which container is the toilet. (Verywell Health, 2018)

“Patient’s memory loss makes their Activities of Daily Livings more difficult. They start forgetting things they knew before.”

2.1.5 — How Can We Slow Down Memory Loss?

2.1.6 — Can brain training activities help delay memory loss of dementia?

2.1.7 —Caregiver Stress

Caring for people with dementia or Alzheimer’s is challenging and overwhelming. In an article from Alzheimer’s association, they categorised ten symptoms of caregiver stress: denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, lack of concentration, and health problems. (Alzheimer’s Disease and Dementia, n.d.) Therefore, there are many social organisations and services for dementia caregivers. Also, there are many Facebook groups for carers so that they can communicate their individual care journey, get some tips, or gain useful information, and they share their stories to stay strong.

326 comments from Alzheimer’s And Dementia Support Facebook group

2.1.8 — Insights from Desk Research

User group-Progression of Alzheimer’s disease

2.2 — Field Research

Field research is driven to observe their point of view and understand the context. By seeing and meeting people in their environment, insights have been reframed, and new perspectives from user experience have been discovered.

2.2.1 — Unforgettable Caregiver Club Event

Unforgettable website (https://www.unforgettable.org/) and Caregiver’s club newsletter
Unforgettable event
Guest speakers’ session
RemindMe Care (https://app.remindmecare.com/)
RemindMe Care: Features & Benefits (https://app.remindmecare.com/)

2.3 — Target User Interviews

Target user interviews are the best way to extract information from real users to understand their current situations and problems and figure out opportunity areas.

2.3.1 —Facebook Group Interviews

Facebook groups are important communities for dementia carers or people who are interested in dementia and Alzheimer’s disease. Members share their personal stories and photos, get feedback from each other, and share important quotes that encourage carers. The interviews were conducted to gain insights from specific target user groups so that new opportunities were figured out.

Dementia & Alzheimer UK Carers Group
Dementia & Alzheimer UK Carers Group
The Unforgettable Dementia Support Group
The Unforgettable Dementia Support Group

2.4 — Co-discovery

The co-discovery activity was conducted to gain a new perspective and explore opportunities about the way of slowing down dementia patient’s memory loss. This session is carried out with the caregiver of a dementia patient who was diagnosed with dementia four years ago.

Co-discovery session about the way of slowing down memory loss

2.4.1 — How can we measure memory loss?

Cognitive Assessment
This assessment covers a broad range of activities to measure someone’s cognitive function. This tool is conducted during a time-limited office visit, and during the screening, a doctor can detect possible cognitive impairments so that patients could be referred for further evaluation. (Alzheimer’s Disease and Dementia, n.d.) This stage is important in the dementia care journey because we can detect the symptoms earlier, which means we can get support, information and medication earlier. (Dementia.org.au, n.d.)

2.5 — Insights

  • Dementia products, digital services and brain training & entertaining activities divide carer’s work with caregivers in the dementia care journey.
  • Digitalised memory active program can be a possible solution.

2.6 — HMW Question

Framing the problem and challenge to explore an opportunity for the innovative solution, How Might We Question, was set up. On reframing insight statements as How Might We Question, current challenges turn into opportunities for design. This question includes a possible solution and the potential impact for user groups. (Designkit.org, n.d.)

Workshop session_17th July

2.7 Possible Solution — Digitalised Brain Training Program

3 — Define

Exploring opportunity areas based on problem statements and applying them to real users’ lives led to narrowing down ideas.

3.1 — Persona Creation

Dementia caregiving stakeholder map

3.2 —User Journey Map

Organising users’ daily activities with several touchpoints helped to find opportunities in the users’ lives and possible solutions that could be applied to certain touchpoints. Here are personas Linda and Jenny’s weekday and weekend journeys.

3.3 — Insights

  1. Applicable points
    What if use patient’s free time to remote care?
  2. Smart TV as a possible solution
    What if use smart TV as a delivery method?
  3. Digitalised
    What if digitalised dementia brain training activities?
  4. Reducing cost
    What if developing a personal cognitive assessment tool to reduce the cost of visit doctor?
  5. Inclusive
    Design service for both patient and caregiver

4 — Develop

Develop and iterate ideas that can be prototyped.

4.1 — Desk Research

As a possible solution, smart TVs could be used for dementia care. At this stage, this possible solution has been proved through desk research.

4.1.1 — TV Is an Important Component of Seniors’ Independent Life

The article ‘TV for Seniors’ highlighted some advantages of age-in-place without making any changes: 1. Is less expensive 2. Maintains freedom and dignity. 3. Enables them to remain in contact with friends, neighbours, and family members. As a result, they can improve their quality of life. (Independa, Inc., 2015)

My grandmother is watching TV and it’s her favourite time.

4.1.2 —The digital generation is not just kids anymore

Slowly, but surely, digital consumers are taking over the coveted media demographics. This means that opportunities for adults (65+) are shifting to the digital generation. Which digital product is the most familiar among senior citizens? In the report, ‘Adults’ media use and attitudes,’ by Ofcom, it asked elderly people to say, out of all the devices they use, which device would they miss the most if it were taken away?

https://www.ofcom.org.uk/__data/assets/pdf_file/0026/80828/2016-adults-media-use-and-attitudes.pdf
https://www.broadbandtvnews.com/2016/02/02/strong-smart-tv-growth-in-japan-us-and-europe/
http://www.smartclip.com/sites/default/files/content/case-studies/case-study-pdf/smartclip_Smart%20TV%20Insights%202015_UK.pdf

4.1.3 — Smart TV as a Delivery Method

When we think about our common living room, the TV is always at its centre. The TV is a simple-to-use device and is a favourite among older adults; they do not need to be trained to use it. (Seniortv-aal.eu, n.d.)

4.2 — Co-creation

Co-creation was conducted with users as advisers to create a value-rich experience to organise the contents of the brain training Smart TV application. The involvement of direct users and other external stakeholders allows for the creation of differentiated contents and unique and personalised customer experiences.

4.2.1 — In-depth interview: Involvement of caregiver

Interviewee
Caregiver (Age. 53) who is caring an early onset dementia patient.

Summarised In-depth Interview 28/09/18
  1. Entertaining Activity
    Reading news and simple exercise are recommended as an entertaining activity for brain training and the patient’s health.

4.2.2 —Co-Design Activity: Involvement of caregiver

Co-design activity Sheet 10/10/18
Co-design activity with family members

4.2.3 — Online survey: Involvement of community

To gather ideas apart from previous activities this online survey aimed gain insights about caregiver’s emotional opinion about what do they hope their loved one does not forget and what do they want to keep reminding to the dementia patient.

Online survey Screenshot 10/27/2018–11/2/2018
Online Survey Result

4.2.4 — Desk Research: Involvement of doctor

Based on the different type of Cognitive Assessment Toolkit, the contents were divided into four categories.

  1. Math > Calculation, Purchasing
    - Count backwards 20 to 1
    - Could you take 7 away from 100?
    - Serial 7 subtraction starting at 100
  2. Things > Recognise objects, Match name and photo
    -
    Can you tell me something that happened in the news recently?
    - Now can you name as many animals as possible? It can begin with any letter.
    - Place the paper on top of the pencil
    - Pick up the pencil but not the paper
    - Ask the subject to copy this diagram
    - Ask the subject to count the dots without pointing to them
    - Ask the subject to identify the letters
    - The similarity between eg banana — orange = fruit
  3. Memory Recall > Read & Repeat
    - Read the script / Repeat the script
    - Name of the current Prime Minister
    - Name of the USA president
    - Name of the USA president who was assassinated in the 1960s
    - Name of the woman who was Prime Minister
    - Address recall correct?

4.3 — Case Study — Digitalised brain training program

GameChanger
GameChanger app screenshots

4.4 — Prototyping

The flow of the screens was sketched out to narrow down ideas into the paper sketch. This session allowed the first inspiration for the layout of each screen and the flow of the functions. Paper prototyping screens lead to organised the main structure of the interfaces.

Paper Prototypes

4.5—Testing

To gain feedback from experts, the testing session with paper prototypes helped to gather valuable insights and allowed more user-centred design.

Dementia Friends information session 31/10/18
Feedback session with Jack Dementia friends information session organiser

4.6 — Insights

5 — Deliver

Implementation of ideas based on the previous research stages. Refine and design service delivery method.

5.1— Service Concept

Rewind is a digital platform that provides brain training quizzes for dementia patients. Five quiz sets are provided in one day, divided into five categories: time, math, things, mood, and love. The result of the quiz is sent to the carer’s smartphone through an application, and this result can be shared with the doctor via email. Due to the advantage of TV, external services can be connected with this platform with the use of a GPS tracker and Wii.

  1. Release caregiver burden
    - Slow down memory loss & Prevent repetitive behaviour
  2. Store patient’s data
    - Utilise data for further dementia research.
Mapping insights and gathering information

5.2 — Stakeholder Map

Stakeholder map is the map which is visualised all groups of cooperators related to the particular service. This method allows users, companies, partner organisations & charities, and other stakeholders to be shown and the relationships between different groups to be schematically analysed.

5.3 — Value Proposition Canvas

To create more value, this service designed on the assumption that the Alzheimer’s Society provided the service. Due to Alzheimer’s Society’s participation, the service system could be circular and created more value.

5.4 — Rewind System Map

Rewind has a circular system. Alzheimer’s Society provides the service and the data gathered to the Society again. Through the circular system, the service will be improved and provide a better user experience.

5.5 — Rewind Features Map

Rewind has key seven features. This chart below presents the contents of the feature and the purpose of the contents.

Graphic Ideation Moodboard

5.6 — Graphic Design Guidelines

These sheets provide the guideline heuristics for designing accessible digital interfaces, services, and contents for people with dementia. Dementia and Alzheimer’s disease symptoms are diverse. Thus, it is important to consider different levels of digital literacy. This list can be used for evaluating digital interfaces. (Rik Williams, UX Architect, 2017) Rewind interface considered this accessibility. Therefore, Rewind can provide comfortable interfaces for the dementia patient’s digital experience.

5.6 .1- Service Elements

In order to deliver user-centred experience, logo, colour, visual system and font were built.

5.6.2 — Logo System

This logo’s centre is transparency to avoiding the user’s attention to the logo. It is pervasive to the background image. Therefore, when the user enters the screen, they can focus on the main content.

5.6.3 — Colour System

Vivid colour and high contrast
Rewind has five categories, so it has five highlight colours. Each colour represents the meaning of emotion to the dementia patient. Especially, violet is the colour which represents Alzheimer’s disease. Thus, this colour used in ‘Rewind your love’ category which is the question about the patient’s family members and their emotions.

5.6.4 — Typography

Source Sans Pro is google open san-serif font which has a simple shape and free from decoration. The simplicity of the shape is more visible and readable, digitally.

5.7 — Rewind

The following paragraph showed final design output of Rewind.

5.7.1— First touchpoint: Promotion

The early sign of dementia can be detected earlier. However, they usually think they will be fine, thus, they don’t visit GP. This behaviour pattern makes the proper treatment delayed. As the first touchpoint of the service. this poster can be a simple screening tool for elderly people.

5.7.3 — Rewind for Dementia Patient: Smart TV Application

Wireframing

5.7.4 — Rewind for Caregiver: Smartphone Application

Flowchart

5.7.5- Rewind for Doctor: Image file

The result of the quiz classified and exported to the image. The doctor can receive the result via email. In this image file, the doctor can access the history of quiz content, time duration for each section, the number of correct answer & category, the number of incorrect answer & category and the change of total result compared to the previous office meeting.

5.8— About Data protection

Rewind data protection
‘Remindme Care(2.2.1)’ was used as examples to assume Rewind’s data protection. Rewind encounters a variety of stakeholders. Users input their data, service provider and external medical service provider received the data. User’s valuable and sensitive personal and medical information will be responsibly managed and used with our data protection system.
The list below was referenced to the ‘Remindme Care’ website ‘Data protection & GDPR’ section. (Remindmecare.com, n.d.)

5.9— Service blueprint

5.10 —Business model canvas

5.11 — Impact

Related to the insights, Rewind create value for users, community and the world. The contents of Rewind provide the better living to users, the system of rewind offers community’s engagement, and the impact of Rewind can contribute to reducing the cost of caring and researching dementia and Alzheimer’s disease.

6 — Evolvement

Expanding to the Smart Home service
When the Internet of Things is commercialised then now, Rewind, the smart tv application, can be a hub that connected with IoTs to provide a better experience for patient’s independence and safety.

7 — Conclusion

The potential of technology assists people with dementia’s wellbeing. To create the value-centred solution, the involvement of various stakeholders in the design process is needed.

7.5 Service Design Symposium on Dec.2018

Can service design positively affect the future of health and biotech?’

8 — Bibliography

Ageinternational.org.uk. (2018). Dementia is global | Age International. [online] Available at: https://www.ageinternational.org.uk/policy-research/expert-voices/dementia-is-global/ [Accessed 18 Oct. 2018].

I’m a service experience designer who loves innovative technology, human-centred goodness and collaborative work. Currently based in Seoul, South Korea.

I’m a service experience designer who loves innovative technology, human-centred goodness and collaborative work. Currently based in Seoul, South Korea.