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A holistic digital approach to heart disease management for women
HHF collaborated with Monica Parry, a cardiovascular nurse practitioner and lead of the at heart research team, on the conceptualization and design of a digital health intervention for women with heart disease. at heart is a chatbot-focused app to help women self-manage the pain and symptoms related to their heart disease and recognize when they need to seek medical care.
Client
Monica Parry and the at heart research team
Funded by
Canadian Institutes of Health Research (CIHR) Project Grant
Services
UX/UI Design, Usability Testing, Co-design workshops, Branding
Challenge
BACKGROUND
Cardiovascular diseases (CVD) are the leading cause of death worldwide, putting a huge strain on healthcare systems. Coronary artery disease (CAD) is the most common type of CVD, causing an estimated 8.93 million deaths each year globally. While cardiac pain is often seen as the main sign of CAD, the symptoms women experience can be entirely different from men. Women may have varying patterns and types of pain, making it hard to tell if it’s related to their heart. Instead of seeking immediate medical care, many women tend to discuss it with family and friends first.
Monica Parry, a cardiovascular care researcher, nurse practitioner, and professor at U of T’s Bloomberg Faculty of Nursing, aimed to design a digital tool to support women in self-managing their cardiac pain and discomfort.
HHF was tasked with creating a tool that provides evidence-informed symptom triaging and tailored education, ultimately empowering women to seek timely care and manage their health proactively.
Women tend to delay seeking appropriate care for their heart pain.
Heart and Stroke Foundation of Canada
Process
DISCOVERY
The client’s literature review and focus group interviews highlighted the underrepresentation of women in existing cardiac pain management studies and identified user needs: self-management, symptom triaging, decision making support, and holistic health. To address these needs, HHF conducted a co-design workshop with women living with cardiac pain. The goal was to engage participants in defining the functions and features of the web app. HHF presented a series of distinct concepts, each addressing the identified needs uniquely. Participants discussed and ranked these concepts, providing valuable insights into practical ways they wanted to interact with a digital self-management tool.
WHAT WE DISCOVERED
The tool must be practical
Women preferred a digital self-management tool that was conversational, accessible, and provided custom, timely advice, mimicking what they were already comfortable with. They wanted a tool that felt like texting a friend, which was a familiar and convenient way to communicate for them.
Storytelling is powerful
Storytelling stood out as an important element for this community. It created connections, helping women understand that they are not alone in their experience. By seeing themselves in others’ stories and learning from their journeys, they were more likely to prioritize their health and make informed choices.
Emphasize holistic health
Acknowledging and treating the Spiritual, Mental, Emotional, and Physical health of women was essential. Going beyond the physical helped reduce barriers to timely treatment.
DESIGN
The first major task was to develop a unique Clinical Triaging Algorithm in collaboration with 10 healthcare providers. This algorithm focused on cardiac symptom presentation and delivered appropriate care recommendations. The iterative process involved thorough discussions with healthcare providers.
The Clinical Triaging Algorithm was integrated into a chatbot named ‘Holly,’ which interacts with users based on their health history and symptom reports, navigating users through predefined flows based on their inputs. The chatbot, through a script written by our design team, delivers recommendations for self-management, directs users to relevant educational content within the app’s library, and alerts a user to symptom patterns that require medical attention.
After defining the clinical algorithm and conceptualizing a feature set, we designed the UX and UI of the app. Usability testing was conducted in two rounds on initial prototypes and the developed web app to refine the user experience.
HHF aimed to develop a platform focused more on the person than the pain.
Wellness Check
A holistic view of the user’s health is captured through the Wellness Check. This assessment leads to personalized self-management recommendations from the at heart Library, ensuring that the user’s psychosocial needs are met.
Heart Check
Regular Heart Checks pushed through the chatbot assess physical pain and symptoms. The chatbot then gives advice for managing or addressing symptoms.
The Library
The Library serves as the resource hub, containing self-management content, academic papers on women’s heart disease, and strategies for overall well-being, each summarized for easy reading. Additionally, the “Her Stories” feature, produced by our client, shared recordings of Canadian women’s experiences with heart disease.
Outcomes
The project delivered the at heart web app, which is powered by a unique clinical triaging algorithm and resource recommendation system. The web app’s features work together to empower women with heart disease to manage their health proactively and seek timely care, ultimately enhancing their overall well-being.
Monica and the at heart research team launched a study to examine the usability and feasibility of an at heart intervention. The study recorded the opinions of women who used the at heart web app for a period of 3 months. During this time, all women were to continue with their regular medical care. A survey completed at the beginning and end of the 3 months measured satisfaction and preliminary outcomes of using the at heart web app. Engagement was also tracked.
The mean age of participants was 57 years, with an age range from 30 years to 92 years. There were 198 Wellness Checks, representing 1 to 12 per participant.
This study found that at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative.
- 90%of participants rated the user-friendliness of at heart as good or excellent
- 100%of participants thought at heart was easy to use and efficient.
- 100%of participants completed 1 to 15 Heart Checks
- 78%of symptoms were triaged as low risk out of the total of 226 heart checks completed
"Her Stories" feature, produced by our client, shared recordings of Canadian women’s experiences with heart disease, illustrating how their lives have changed.