A Circle of Friends:

Persuasive Tools to Improve Heart Health

From From October to December 2019, I worked with assistant Aqueasha Martin to conduct a content analysis for the non-profit Health Freedom Inc on their walking program Circle of Friends in Baltimore Maryland. The program is 6 weeks and has the goal of improving participants' cardiovascular health through achieving walking goals and making improvements to their health and lifestyle. Every week, participants also meet with a leader to help them stay on track. Participants are given a walking manual to track their steps and are rewarded with a fact about abolitionists history and their life traveling the Underground Railroad, a secret network of paths African slaves took to through the northwest United States. The narrative of the underground railroad represents the participants journey to health freedom

Role : Undergraduate Research Assistant

Task : content analysis, design research.

Publication: Link | Download

Goal : create the groundwork for future development for a functioning application base on the program.

Team : Aqueasha Martin-Hammond

Process & Analysis:

To begin the project, we collected scanned digital pages of the walking manual that the participants used to count their steps and receive rewards, roughly 60 pages. Our plan was to scan the pages and analyze each page to determine what are the motivating activities and interactions the participants use in the program. This was important in order to identify opportunities for future app design and development for the organization.

My process to execute our plan was to develop a coding system through my first analysis and organize each file into its designated code. So for instance, if a page was a reward fact, it would go into the “Reward” folder. If a page had multiple themes, I categorized it by the most relevant theme.

Then, I did a second analysis in each theme for sub-themes, and here I was looking for significant data that would clearly explain or identify the participants' interaction with the program. So in the “Reward” theme, “Slave Quilt” and “Boston, Mass.” were sub-themes because they were specific pieces of information the participant could learn about.

From the analysis, we discovered three motivational tools that could be used:

Setting goals and support for reflection

This is the main tool used in the program. Participants track their steps daily and record the on a map that they can reflect on later. The suggested goal is 10,000 steps per day to keep healthy. Participants also converted their steps to reflect miles traveled on the Underground Railroad.

Community engagement

The program uses peer and group accountability to encourage their participants, and participants meet with their leaders, or conductors, to report their total steps, wellness choices, and any health issues or improvements they’ve seen. At the end of the 6 week program, participants can choose to walk in a 5K walk where they visit historical sites related to the Underground Railroad.

Rewards

Rewards were given once participants reach certain step goals on their map. The rewards were various pieces of historical information that range from facts about African American history in Boston, to what runaway slaves would eat and wear along the way.

And finally, I took what I learned from my thematic analysis and did additional research online to determine how I would transfer theme elements into a digital design. My research had me look at various health and wellness products, mobile games, and social media platforms and how they used different methods and features to interact with their users. The goal was looking for the best features that were similar or identical to activities in the program.

Findings:

From these tools, we discovered 3 opportunities for design:

Reducing Tracking Effort

The most important design intervention was to insert an automatic tracking and performance calculation. This will remove miscounting, miscalculation, and reduce user burden.

Improving Engaging with Information and Rewards

While the current reward system was effective in engaging users, having additional incentives would further encourage users to participate in activities and events in the program. Gamifying some of the rewards, such as the quilt facts, would help with user engagement as well as real-time rewards such as discounts and coupons that promote healthy choices.

Improving Communication

Because leaders determine the day and time of meetings, communication with peers can be inconsistent from group to group. Peer-to-peer contact was also lacking outside of the weekly group meetings. To improve communication we suggested implying open messaging or peer support interactions to improve user experience.

Paper

Submission:

During the fall, we wrote and submitted a paper/poster for ACM GROUP 2020 about the findings and opportunities we discovered. We were accepted, published, and presented our findings in a poster discussion with 105 other presenters. Our poster received the best poster award courtesy of Microsoft Research.

Lessons
Learned:

For the future, we planned on designing an app prototype based on our findings to conduct usability design tests and to interview existing participants of the program. Our hope was to get feedback on the concepts we pulled from the manual and the designs. Our biggest challenges had been bridging the communication between the non-profit in Baltimore and figuring out the logistics and schedules for meetings and approval. With funding, we hope to achieve the founder’s dream of creating an app to continue the program’s legacy of improving heart health in the African American community.

Update:

In January 2021, the project was awarded $60,000 from the Google Award for Inclusive Research! The focus will continue to stay on "investigating inclusive digital strategies to improve culturally relevant content delivery and communication among participants and community-health workers involved in the program". Read more here!