“It is hard to argue with the kind of impact you can make with healthcare,” said Stacey Chang, Director of IDEO’s Healthcare Practice and our facilitator for the day through Health for America’s design thinking workshop. We couldn’t agree more.
Many people recognize the burden rising rates of chronic diseases, such as diabetes and heart disease, have on society. Few, however, know that the most common chronic disease in children is asthma. One in ten children in the United States suffer from asthma, and it is the leading cause of missed school days with an estimated 14 million days lost each year. In addition to the impact on a child’s academic performance and quality of life, the disease places a substantial burden on parents. The additional child-care burden is particularly tough on those working hourly jobs or with unsympathetic managers. Keeping children healthier and out of emergency departments has the potential to impact entire communities.
The prevalence of asthma has tripled in the last three decades with disadvantaged, urban, minority children experiencing a particular spike in diagnoses. Almost 13% of African American children have been diagnosed with asthma compared to less than 8% of Caucasian children. African American children are also seven times more likely to die of the condition than Caucasian children. There is an urgent need for solutions that can sustainably improve outcomes in these vulnerable communities.
So how might we help the 26 million Americans suffering from asthma? Health for America’s Summer Fellows are committed to identifying solutions to fill the communication, information, and data gaps between stakeholders to make managing the condition easier for patients, their parents, and healthcare educators and providers. As part of this process, we turned to our partners at IDEO for help.
A product and service design firm, IDEO has done everything from designing the first Apple mouse to an agricultural water pump that can be made with materials found even the poorest villages and the business model to get it in the hands who need it. IDEO’s not-so-secret secret to success is their use of design thinking or human centered design. Their theory is if you care about the human experience and focus on human needs, you will find something innovative. You have to develop the entire product experience by identifying what people want, finding the technology to make it, and then developing the business, not the other way around.
“Innovations are born from great observations.” That is the philosophy we took when starting off on our childhood asthma journey. Over the past three weeks our Fellows have traveled to Louisville, Kentucky, one of the hardest hit cities by the asthma epidemic, and met with patients, doctors, nurses, schools, venture capitalists, medical device developers, entrepreneurs, payers, and government officials. The Fellows listened to stakeholder experiences, asked questions, and watched doctors and patients interacting. They also had a chance to learn from the experiences of the team at Oakland Children’s Hospital where rates of asthma are three times the national average. The IDEO activities helped Health for America distill and synthesize weeks of notes and observations into a few of the key themes:
Build on existing behavior. If an intervention requires too much additional effort, it is probably not going to be used by patients or providers.
Hands-on learning is key, especially when it comes to children.
Leverage existing resources instead of creating new ones. Using the school as a health education hub may be possible.
Give patients a role in their disease, at any age. Make sure they have opportunities to have some sense of control other than saying “no” to treatment.
Incorporating these lessons into a practical and valuable solution is the goal. One opportunity for delivery is through technology, mobile phones in part
icular. Mobile phones may even facilitate reaching underserved and minority populations. In fact, in 2010, African Americans and Latinos were significantly more likely to own a mobile phone and send and receive text messages than Caucasians. Additionally, the higher cost of smartphones does not appear to be a major barrier. Households below the poverty line represent the fastest growing segment of smartphone owners, with ownership rates doubling over the past year.
mHealth applications, the use of mobile technology to improve health outcomes, exist for asthma management. In fact, there are already more than 130 asthma-related apps in the Apple Store, but, in general, have not made a substantial impact on how asthma is being managed by families. Developing one more medication reminder system is not what the childhood asthma community needs.
While adherence to medication, especially consistent use of controller inhalers, is a major obstacle to prevention of attacks, adherence doesn’t often have much to do with forgetting to take your medication. As Stacey Chang noted, “Patients forget to take their medications the same way you forget to call your mother. There are some deep emotional issues at play.” For children, using an inhaler and the required spacer, which is about the size of a bottle of water, makes kids feel abnormal. If it makes them feel uncomfortable in public situations, such as school, it is unlikely that something such as an app-based reminder system is going to inspire behavior change.
Medication adherence, decreasing stigma for school children, and increasing education for all stakeholders around attack triggers are just a few of the issues the Health for America is taking into consideration when developing a solution. At IDEO, we learned to encourage wild ideas because they might just hold the spark of true innovation and to defer judgment of ideas because you don’t want to miss out by being critical. It is too early to say if our prototype will target children, their parents, teachers, school nurses, or even their peers. Right now, we have hundreds of ideas and more are popping up each day. Nothing is off the table, and that is a good thing.
This post was co-posted by Disruptive Women in Healthcare here.