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Discovery: Maternal Care for Preeclampsia in Rural Canada

Literature reviews, empathetic testing, and journey mapping to help discover solutions to limitations in maternal care in rural Canada.

 
 

project background

As a portion of my final thesis project, research was conducted to solve a problem-- one that significantly impacts the lives of those affected. The research presented is the first step towards a design proposal, and don't claim to address the subtleties of all of the challenges faced that would take years to deeply understand. The research is a thorough analysis of how design of new products or services can help women diagnosed with preeclampsia in rural communities, and what challenges may be presented.

UN Sustainable development Goals

This project was chosen considering the UN Sustainable Development Goals for 2030. As designers, it is our responsibility to move towards a more just, safe, and environmentally conscious world.

I was drawn in by Goal 3.1 of Health and Wellness: “By 2030, reduce the global maternal mortality rate to less than 70 per 100,000 live births”. In addition to this goal, this project will also focus on equality of access across cultural groups within Canada.

 
 
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Healthcare in rural canada

In Canada, access to healthcare disproportionately affects rural Canadians, with worse health outcomes by nearly all indicators. This especially impacts vulnerable groups such as new mothers and their infants, where the lack of accessible health professionals can have serious impacts on health outcomes. Only 3% of Obstetrician Gynaecologists practice in rural Canada, serving 22% of our population, with many general practitioners no longer performing births. Even as the most accessible health care professionals in rural Canada, only 18% of registered nurses provide care in these communities.

 

research goal

 
 
Identify solutions to improve the accessibility of diagnosis and monitoring of preeclampsia for women in rural and remote communities.

The challenge associated with distance for rural women led me to research conditions that are affected significantly by a mothers access to medical professionals such as obstetricians. One of the conditions that I became aware of was Preeclampsia, and its serious impacts on women all over the world.

 
 
 

Preeclampsia

 

What is preeclampsia

Also referred to as toxemia, is a condition that causes hypertension (high blood pressure) and decreased liver and kidney function past the 20th week of pregnancy. There are many theories for its cause, but it is currently only diagnosable by its symptoms. Preeclampsia precludes Eclampsia, which results in seizures, strokes, miscarriages, or death if not treated. The only way to fully relieve the symptoms of preeclampsia are birth and medicated treatments.

why is it important to address

Preeclampsia is the third most common cause of maternal mortality in the world, accounting for 14% of total deaths. It can also occur for women of all ethnic, geographic, and socioeconomic groups. In the western world, it is one of the most unpredictable events that can put a pregnancy at risk. Although in many cases it can be managed affectively, the time before diagnosis can directly impact the results of treatment and the wellbeing of mother and child.

 
 
 
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Literature Reviews

Persona Development

Using case studies of the experience of young rural mothers (such as Karen Campbell's The "Good" Mother), statistical information on risk factors associated with preeclampsia, and the stories submitted to the Preeclampsia Foundation , a persona was created to embody the risks of a rural women at high risk of developing preeclampsia. "Heather" helped to focus my questions of what is most important to the women being impacted by preeclampsia, and what is most important when looking at a solution for the challenges they face.

One challenge of this research is the limitations placed on the types of interviews and interactions students can have within a university setting. This persona was developed to help focus my further work in lieu of access to women currently or previously affected by this condition.

 
 
 
 
“I saw my doctor as scheduled. He said [my symptom] was ‘normal’. I could feel something deep down telling me it wasn’t normal.”
— Ariana's Story, of the Preeclampsia Foundation

One of the most formative pieces of information from the research was that many women who experience symptoms feel that their natural instincts are dismissed as general pregnancy symptoms. This in some cases is understandable- many of the symptoms to a lesser degree are related generally to pregnancy. This informed the decision to narrow the project to focus on giving women the resources to make educated health decisions independently, using quantitative data that could not be disputed.

 
 
 

Diagnosis tools

To diagnose preeclampsia, the most important readings considered by physicians is the blood pressure of a patient, and the content of protein present in their urine. These tests do not always identify preeclampsia, but in conjunction to other physical symptoms can inform if a women needs to be examined pursue further testing at a hospital. Although not as reliable, home blood pressure testing and urinalysis provide an indicator if further testing should take place.

 
 

Blood Pressure

Testing for blood pressure above 140/90 mm Hg, remaining consistently high over at least 24 hours for women with typically regular blood pressure. Many women who are higher at risk for preeclampsia have chronic hypertension, so this can differ significantly.

Urinalysis

Testing for greater or equal to 0.3g/d in a 24 hour urine collection, or greater or equal to 30mg/mmol urinary creatinine in a spot urine sample (such as a chemstrip). 24 hour urine tests are preferred, but a spot urine sample can help inform if more testing should be done.

Physical Symptoms

Women can experience a number of symptoms for preeclampsia including headaches and migraines, edema (intense swelling), blurred vision, abdominal pain, and nausea. However, many pregnant women who do not have preeclampsia suffer from these symptoms as well.

 
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Empathetic Testing

"The suit" used for testing was sewn to simulate some of the physical constraints of pregnancy.

"The suit" used for testing was sewn to simulate some of the physical constraints of pregnancy.

a day in the life

The goal of this experience was to increase my understanding of the physical and mental challenges of pregnancy and address how conducting home versions of diagnostic tests could be improved. This included wearing a 15 lb suit for a day, while doing normal things like cooking and going to run errands in addition to conducting tests.  I did not have the opportunity to partake in other common activities such as driving, but I felt that my day generally represented a typical Saturday for a pregnant women. I also do not live in a rural location, however much of the testing took place at my home, which would remain relatively consistent.

 
 
 
The goal of this experience was to increase my understanding of the physical and mental challenges of pregnancy and address how conducting home versions of diagnostic tests could be improved.
 
 
 

test methodology

While wearing the suit, I measured my blood pressure using a typical blood pressure monitor and measured my proteinuria (trace protein in my urine) using lab testing urinalysis strips. I completed these tests on my own twice, with a four hour interval in between, which is the typical duration between tests when I women is in the hospital for screening. I have never used the devices for this testing before, so I learned during the testing through the manuals and graphics on the devices. All supplies I used are commercially available for purchase.

 
 
 

Journey Map and Storyboarding 

empathetic testing map

By mapping my experience, I was able to highlight areas that I experienced being more challenging and what areas things worked in. Most importantly, I wanted to map where I could map meaningful change to the experience, specifically through how the process could be better guided.

 
 
 
 

Areas of Opportunity

Some Areas of Opportunity that were identified included:

  • Help manage when testing should be done, and the results taken from each test.
  • Provide instructions in one place to facilitate accurate measurement.
  • The system should actively help calm and inform women, by using language that doesn't increase stress.
  • Make the interface for the Blood Pressure Monitor even more simple by eliminating any excess features.
  • Provide feedback and guidelines for what results mean in one place, dependent on the users medical history.
  • Decrease the bulkiness of the Nuns Cap to be more mobile.
  • Improve the colour matching for urinalysis process by making it less subjective to ensure accuracy.
  • Remove distractions from process, such as not providing results for other tests, to focus the results.
  • Provide actionable steps dependent on results, similar to how with a thermometer reading of 103 degrees over a prolonged time it would be recommended to seek a physician.
 
 
 

Heather's Storyboard

Based on this experience, I experimented with ways that "Heather's" experience could be improved by creating a better designed system of products. One insight I had while doing this process was that it would be important to record results for later recollection, either to see change over time, or to provide to a physician. This record, in addition to the possibilities of helping navigate the experience more directly, led to the concept of an app led experience to record and help navigate the process. 

 
 
First storyboards experimenting with how the design of the system and products be adjusted to improve experience.

First storyboards experimenting with how the design of the system and products be adjusted to improve experience.

 
 

Moving Forward

You can see how I applied this research to design a comprehensive preeclampsia monitoring home system for rural mothers in this case study: