Opioid use disorder (OUD) is a growing issue and leading cause of death in the United States.

Opilink is a research and design project to develop an opioid overdose prevention application that includes education and resources for individuals living with Opioid Use Disorder. My role in this project was as UX Researcher from concept through completion.

― Overview

I worked as a User Experience Researcher in the Healthcare Experience Lab at the School of Information at the University of Texas at Austin. Our team collaborated with Dell Medical Psychiatry to create a prototype for a mobile health (mHealth) application for individuals with Opioid Use Disorder (OUD). The mHealth application centered in opioid overdose prevention, as well as general support for individuals living with OUD.

― Problem Statement

Opioid use disorder (OUD) is a growing issue and leading cause of death in the United States. The healthcare system treats OUD as an acute condition rather than a chronic disease. Other chronic diseases, have benefitted from the use of mHealth applications, but there is a scarcity in mHealth resources for OUD.

― Research Process

― Literature Review

I conducted a literature review simultaneous with sensitivity training provided by a social worker at Dell Medical. This preemptive training provided me with the following insights:

• One challenge to working with this population is that participants can be used to facing extreme consequences for at-risk behavior, and therefore may not be forthcoming, or are otherwise not inclined to trust people outside of their very intimate social circles. Through this training, I learned how important knowing the appropriate language is, as well as how to take cues on language and tone from participants.

• A literature review of academic research articles provided insight into mHealth solutions, opioid use disorder, and further elaborated on specific terminology for working with a marginalized population.

• Studies showed that mHealth apps with the use of gamification incentives improved patient adherence to treatment, which was valuable information to pass along to designers who were developing the prototype in InVision.

― Competitive Evaluation

We used a competitive evaluation to determine what already exists, how it’s being used, as well as specifics about feature preferences. There are not many apps specific to OUD, so we looked at other apps targeted at addiction, (e.g. cigarettes and alcohol), as well as other mHealth apps for chronic illness. Researchers and designers worked collaboratively during this process to develop a preliminary set of features to begin wireframes for the first iteration of the prototype.

― First Prototype

Based on formative research, designers at the Healthcare Experience lab developed the first mHealth prototype for Opilink in InVision. The first prototype focused on Narcan education (an opioid blocker), journal entries, and emergency contacts, (e.g. clinic counselors or personal contacts). The initial design also contained settings that allowed emergency contacts to locate people on the app via geolocation.

The onboarding process of the initial prototype required the patient to enter their treatment location, provide contact details for one or more trusted friends, set a message that would be sent to the listed friend in an emergency, and enter personal goals and motivations. The Journal allowed the patient to log and track their opioid use and emotions. A summary of the information was displayed on the dashboard. The application provided support for three types of emergency situations: (1) the patient wants to use opioids, (2) the patient is currently using opioids, and (3) the patient or a bystander is witnessing an overdose.

We then explored the first prototype with research participants during our user interviews to receive feedback about how best to move forward with the second iteration of the application.

― User Interviews

User interviews were the best way to understand a new user group, and also get feedback on our prototype.

Interviews were conducted by myself and fellow UX Researcher, Hannah Levine, at a methadone clinic in Austin, Texas. Participants were recruited by counselors at the clinic. All participants received medication-assisted therapy (MAT) for OUD. Our stakeholders at Dell Medical were interested in participants who had a history of incarceration, and we wanted a mix of gender and age range.

The interviews followed the structure below:

1.General

• Demographic Information

• Tech Literacy & Access

2. History with Opioids

• Treatment history

• History of Incarceration

• Effect of incarceration on behavior, relationships, and at-risk environments

3. Overdose Education

• What do participants know about risk factors

• Knowledge, interests, and attitudes regarding opioid overdose and overdose prevention

• Perceived barriers and facilitators to resource acquisition

4. Prototype

• Feedback on strengths and limitations of proposed intervention

Due to difficulty with recruitment, the criteria was expanded. Six of the participants were male and three were female. The average age of a participant was 35-44 years old. All of the participants had been previously incarcerated. The average number of overdoses that each participant had experienced was five. Participants spent an average of 45 minutes a day to get to the clinic where they received their MAT.

― Results

After synthesizing the data from interviews, we were able to create a journey map of the experience of our participants.

The four phases of the journey are:

1. Illegal Opioid Use

2. Detox (often as a result of incarceration)

3. Recovery

4. Reintegration

It’s important to note that this journey is often not linear. We accounted for the potential for relapse at every phase of the journey. This journey map helped us to better understand the users of our product, and it also created a more precise picture of pain points and opportunities for our stakeholders at Dell Medical.

― Feature Suggestions

Based on results from our user interviews, we redesigned our prototype to include four approaches to decreasing opioid related overdoses and that improves the recovery process.

The four approaches are:

Support - Allows users to both receive and give support. Creating community is important because using alone is one of the greatest risk factors for overdose.

Journal - Participants indicated that they sometimes have to wait two weeks to see their counselors. Journals would be an effective method of accounting for time between counseling appointments.

Learn - Although most participants had a high-level of knowledge about overdose and Narcan (the drug used to reverse the effect of an overdose), it is still a high priority to educate users about what to do in case of an overdose.

Motivation - All users identified a motivation for sticking to their treatment plan. In some instances the motivation was the money that they would save. In other instances it was a family member. Motivation is a key factor in maintaining treatment.

― Second Prototype

We made changes in a second iteration of the prototype to reflect these changes, and presented this updated version to stakeholders at Dell Medical Psychiatry for a second round of testing. Dell Medical Psychiatry has continued the project and is actively progressing in testing for the application in tandem with their pursuit to acquire funding through grants to develop the app.

― Presentation

― UXPA Finalists

We were one of five teams selected out of hundreds of applicants to present our work at the User Experience Professional Association Conference in San Juan, Puerto Rico. The poster we presented can be found in the University of Texas at Austin Repository.

― Next Steps

1. Complete further testing to determine the usability of updated design, and iterate design as testing unfolds,

2. Expand user group by designing an interface for counselors that is linked to patient information.