Poor mental health is one of the most significant issues in England. Irrespective of age, income or background, we all know of someone who has, or have personally experienced mental health challenges ourselves. According to Mind, approximately 1 in 4 adults in the UK will experience a mental health problem each year.
We were recently asked to undertake user research for Every Mind Matters; a new national platform from Public Health England that “aims to support everyone to feel more confident in taking action to look after their mental health and wellbeing by promoting a range of self-care actions.” The task? To engage with various individuals impacted by mental health conditions on how they would benefit from using the website while also testing its usability.
Listening to peoples’ stories was sometimes very emotional, however the experience was positive and rewarding for all involved. Although it wasn’t the first time we conducted research with sensitive groups, we learnt a lot and wanted to share the following learnings.
Do we really need that lab?
We all know that people do not experience products/services in a lab environment, so why do we test and validate in one?
When you block all external influences of everyday life, you will influence the only variable left in the room: the final ‘user’. While creating the perfect situation might sound ideal, when testing with people with mental health issues it can be quite challenging or even undesirable. Remote testing should also be avoided since it may put the researcher in a position of limited control if a problem arises during testing.
Instead, be more creative with the choice of location. Consider places where people will feel comfortable but also confident to express themselves.
In our case, we found that public spaces such as libraries and community centres were particularly calming for our audience. Most of the participants had visited them before, they felt safe to disclose sensitive information and they weren’t associated with clinical services or authorities. In certain instances, we also asked people if they would prefer to be visited at home instead.
If you want to do some more reading on this, we thought this was a great study which calls into question the use of lab testing.
Consider regional differences
Life in a city is different to a life lived in rural areas and studies have shown that the risk of experiencing a mental disorder is generally higher in a city. Considering the diversity in city versus rural lifestyles and access to services, one can argue that there are regional differences in the ways people cope with mental health problems.
As we were undertaking research for a national campaign, geographical coverage had to be representative of both urban and rural areas.
After talking to participants from different areas, we started to identify patterns in the ways that people cope with mental health issues from spending more time in nature to engaging with family.
Tread slowly and carefully
Conducting sensitive user research is not about asking people to share personal information and stories but rather about translating their experience in a relevant way so that they can critique and provide feedback on the product/service you’re looking to test.
Ensuring participants feel comfortable is a hugely important part of building trust. To achieve that, allocate enough time for introductions to allow them to ease into the session. Allocate at least one full hour for each participant and avoid interrupting their flow. During these sessions, people will most likely remember periods and aspects of their life that aren’t pleasant, and they might find it difficult to control their emotions. Offer them a break if needed or pause questions until they feel ready to continue.
Do not overload your sessions
Depending on the participant, a topic might take a bit longer to explore or take on a different direction all together. To prepare for this, we usually run a pilot study to understand which questions demand more in-depth responses or how to redesign the discussion guide. However, when it comes to sensitive research, balance and personalisation is everything. Spending extra time on introductions and personal questions is key to building genuine empathy and eliminating faulty attributions but it also increases the risk of losing control of the conversation. Personal questions might also lead to negative emotions and reactions and you’re definitely aiming to not upset the participant!
To tackle this, we found that a flexible discussion guide was important. Flexibility doesn’t necessarily mean following the participant’s flow. In some cases, it requires further preparation such as creating a list of alternative tasks and questions or improvising and personalising tasks during the session. If you have some questions that you need to ask consider either swapping the order of the questions or iterating them between sessions.
When is the best time to do user research?
When we talk about accessibility, we need to think through three distinct categories: permanent, temporary and situational. Similarly, the state of mental health can be separated in these three groups to unveil different needs. While situational accessibility needs might be difficult to track for each person, there are ‘third party’ dynamics which researchers can take into consideration when creating a testing plan.
Think about the last time you were on holiday. And now compare it with the first day you were back at work. Mood is easily impacted by external factors. So next time you’re planning user research during the summer or holiday season, consider that this might skew your results. Instead, when you’re studying participants who are stressed, suffer from anxiety or low mood, ensure you consider the season and time of year.
If you are a user researcher (UR) or part of a team that has tried Guerrilla Testing before you’ll know how difficult is to catch someone’s attention, ask for feedback on designs or gather answers to short questions.
Approaching people on the street and asking them for their views on mental health can be quite upsetting and people are not always happy to engage.
‘Mental health’ as a phrase is negatively loaded and we learnt that some believe that talking about mental health may indicate that they are dealing with a mental health illness. To avoid this consider choosing different words or phrases that have more positive connotations such as ‘emotional health’ or ‘mental wellbeing’. Moreover, avoiding particular words such as ‘suffering’, which as mentioned here might indicate that individuals can’t successfully live with mental illness.
Attention must also be given to your tone of voice which should be crafted gradually throughout the process from organisational calls and emails to the day of the session itself.
Screening in a human way
Depending on the project, it’s important to include participants with diverse mental health states, ranging from people who have been dealing with mental illnesses for many years to people who have been recently diagnosed or who believe they are thriving. Having an equal representation of all the segments is important for success. As a result, applying the right screening is vital.
During this project we discovered that when it comes to mental health some people might struggle to indicate the state of their mental health; not because they are dishonest but due to their lack of awareness.
As a result, the screening process should allow people to describe the feelings they experience instead of providing categories and/or examples that might fail to reflect someone’s reality.
The key is to really listen to participants and ensure they have communicated different aspects that have influenced their mental wellbeing and then to classify them into different user groups.
It takes two to UX
Consider having someone with you during the testing session as undertaking user research on a sensitive topic can be quite challenging to take on alone. If there is another person with you, they can focus on taking notes which allows you to concentrate on the conversation with the participant.
As a UR, you are not a therapist and probably not aware of how to deal with certain feelings. Having a second UX practitioner in the room can provide some extra support that might be required if things get a bit uncomfortable.
Make sure that the observer introduces themselves and joins in the conversation whenever required. This way it will feel less like a clinical environment.
After the session
A digital mental health resource can be a great addition to mental health treatment, but no website is enough on its own. This is true in the same way that a therapist or medication alone is not enough to help someone with their mental illness. Often there are other variables like an exercise plan, a daily routine or a supportive group of friends that help someone further.
With that in mind, remember that negative experiences might surface post the testing session. Consider providing some additional support for people should they need to contact someone after the session. This can either be a dedicated therapist or a list of services that participants can reach out to.
Take some time to recover
Have you ever cried after conducting user research? Have you ever heard a story that made you feel so annoyed because you couldn’t help?
Although this part of user research is not really discussed, sometimes listening to people’s stories and experiences can be emotionally draining. As URs, we are required to be empathetic. Processing emotional information can be tough so remember to take care of yourself too during this process. Set up some healthy habits for distressing like taking longer breaks between sessions and making sure you have time to exercise or discuss the session with someone else.
Also, try to keep the number of daily sessions to less than you usually would and get involved in different activities between rounds. This will allow you to have some time to reflect and be ready to deal with the next round.
While our user research was for a particular mental health service, as a UX community we should be mindful that people experiencing stress, sadness or depression use tech products and services daily. When we’re designing a new system, we must remember the fluctuating life of feelings, moods and emotions. This project served as a reminder that we should aim to always create virtual spaces that are uplifting and designed for comfort.
Please feel free to get in touch if you have any thoughts or comments: firstname.lastname@example.org