DiaryDiet

Empowering dietitians to deploy a food diary more easily

Info
Interaction Design Capstone Project
5 Months, 2020-2021

My capstone project is an individual, passion-driven, and self-discovered journey. I was responsible for the whole design process, from exploring a huge problem space, finding the unmet need, to creating a solution with hi-fi mockups. I received feedback from the instructor team and all talents of my cohort.

Problem

The photo-based food diary is an effective method for dietitians to understand their clients' eating patterns. The act of doing a diary can also help clients be more mindful of what they eat. However, dietitians seldom use the method in their practice because of the time of preparation, analysis, and getting a client to engage. So, how might we make a food diary easier to deploy and help dietitians to raise their client's interests?

Solution

The final design tackles this problem by improving the tool dietitians use. I created a new feature of deploying a photo-based food diary within their current workflow. Dietitians can deploy a diary, review the input from clients, and utilize the review notes in online sessions, all in one tool.

Background

When studying abroad, I started to prepare my meals every day. The process was playful and challenging, so to make it even more fun, I captured my meals for a record purpose. Eventually, I accidentally realized that the behavior of capturing my meals made me mindful about what I ate and enhanced my relationship with food. It is so-called a food diary.

My experience with food diaries resulted in my interest in the topic of healthy eating. Healthy eating is sometimes challenging and involves many different tools or stakeholders, like my friends and family members, or nutrition experts. To meet my personal goals below, I approached the topic with a focus on professional experience.

My underlying goals of the project:

→  Continue to figure out my career interest
→  Gain knowledge around designing for workflows and professionals

Breaking into the problem space

Because recruiting dietitians is hard, I chose to start reading existing works of literature (notes) to gain a better understanding of the area. A few key insights I gained from literature reviews are:

1 –
Dietitians play an important role in supporting healthy eating behaviors.

Many apps integrate the ability to track our meals and provide nutritional information like calories, which sometimes misleads people to focus on the numbers too much rather than the diet with balance and various intake. On the other hand, when a dietitian intervenes in a behavior-changing process, it involves discussion, reflection, and education.

2 –
Many dietary assessment methods help dietitians to understand a person's eating behavior.

The photo-based diary is not the only method a dietitian practices. 24-hr recalling, frequency questionnaires, or text-based food diaries are commonly used. There are pros and cons of using each method. The photo method has a more visual representative and richer contextual information.

3 –
Photo-based diaries are an effective way to create mindfulness for general people.

The photo-based approach encourages healthier choices by increasing people’s in-the-moment awareness. Also, people find it easy to use compared to writing down food items in a notebook. Its combination with mobile apps like Ate, MyFitnessPal makes tracking more effortless.

4 –
Dietitians can gain more contextual information from a photo-based, which is also more beneficial.

A photo diary provides much contextual information about a meal, like how foods are prepared, whether and what types of additional condiments or dressings are used, or context of eating (e.g., occasions, locations, or time). They provide dietitians with a whole picture of a client's eating behavior and patterns.

Later on, I approached 9 dietitians, from outpatient to inpatient professionals to learn more about their workflow and their experience with photo-based diaries. 6 of the interviews were conducted along with the other two researchers because we also worked on a dietitians' project with Dr. Chung that address a similar problem space. Some key insights from the interview are:

5 –
Dietitians want to know a client's meal pattern, eating context, and if they have sufficient and balanced food.

Photos become useful because they provide information beyond calories. Yet, photos cannot show the items hidden in a burrito, but dietitians can ask for clarification. The colors in an image easily show the different food groups and the background indicates where and who a client had their meal with.

6 –
‍Dietitians pay much attention to education to a client's goal.

The photo-based food diary is also a great vehicle for expert-client collaboration. Diaries create a space for nutrition education, context exchange, and further action discussion by visualizing the areas for intervention.

7
‍The diary engagement from clients matters.

Due to human nature, a client's fatigue and easy abandonment to doing diaries happen. Also, people often omit some taken items that are nutrient-poor or high-calorie, which results in a biased picture. It requires higher motivation so a dietitian can gain better results from a food diary.

8 –
The poor result and analysis work of photo-based diaries keep dietitians from using the technique.

In some clinical contexts, data oversimplification of photos may not capture details like nutritional content or calorie intake. It may also introduce extra effort for experts as they have limited time to review diaries, especially when a dietitian has to manage 10-20 clients.

Design Opportunities

Based on all the insights above, I concluded that a photo-based diary is a crucial role not only in supporting a person's healthy diet but also in building up a good relationship between dietitians and their clients. I decided to address the burdensome of deploying practice. Therefore, I asked:

How might we encourage dietitians, mostly an outpatient or in private practice, to use food diaries in their practice, which is with less effort and more effective?

How might we facilitate a mutual relationship between dietitians and their clients, and thus increase a client's engagement with a diary?

Forming a deeper understanding of their current tools

I conducted an application analysis on the telehealth platforms dietitians commonly use. I investigated three platforms: Healthie, SimplePractice, Ate. My learnings focused on what makes them good or bad in terms of design.

Creating artifacts to guide my design

Since I have more time to design than I used to be (around 2 months), I created design principles and a profile of my target user, so I can refer to the need of dietitians while exploring solutions.

Design Principles

1.
Collaborative rather than arbitrary.

Even though nutrition experts play an important role in providing dietary suggestions with their knowledge and background, a client's story is also crucial in the context. Moreover, in my content research, most experts mentioned that they want to know more about a client's story, including their daily life, the reason to choose food, etc. Thus, the design should help to bring their stories to the table.

2.
Seeing the forest but not only the tree.

From literature reviews and my previous research experience, there is a theme that nutrition experts rely on the eating pattern, food variety, eating context, and sufficient intake to examine a client's diet and thus provide them with actionable suggestions. The design should help that information emerge from the conversation between a client and an expert.

3.
Supportive rather than creating articulation work

I don't want my design idea to become another case that happened in a hospital, where doctors have to use the extra time to make technology work. Dietitians are busy already. They can have only 15 minutes between sessions with clients. The design should fit into dietitians' workflow and take less effort to use than before.

Persona

On the other hand, I created a very straightforward persona—goals, pain points, and behavior patterns. I intentionally didn't include other information like pictures or demography because they are the noise against my empathy to a dietitian.

Stories behind ideation

When the idea of the web app was confirmed, I quickly sketched out the idea deeper and annotated the necessary elements in each step. I created these wireframes by myself and not with dietitians because I found it hard to recruit more people to participate in the co-design process. Therefore, I decided to do further testing after I have hi-fi mockups.

Introduce a new diary tool for a dietitian, Ellen

The flow of the new diary tool

As mentioned before, the proposed design focuses on a new feature on the existing platform. Here is how a dietitian navigates within the new system.

Mockups

❶  Create a new diary

In the current app Ellen uses, she can create a food diary through the action menu, and follow the steps to set the items she wants to know more and other details.

❷  Review photos

When her client logs food photos, she can see the images right on the client's page, where she can access the diet goal, session notes, and other important info together. When she wants to dive deep into an image, she can read the detail by clicking any images and even take notes to help her in the future session with her client.

❸  Utilize photos in a session

Ellen can access the diary photos and notes when she has an online appointment with her client. She can identify the important image by recognizing the little icon of the notepad below an image. By doing so, Ellen doesn't have to switch between many tools or pages and concentrate on the conversation with her client.

Mapping the needs with the new features

How might we encourage dietitians, mostly an outpatient or in private practice, to use food diaries in their practice, which is with less effort and more effective?

  • Integrating a diary with their current tool, from requesting to logging"
  • Focus" template that is reusable
  • Previewing what the outcome of a diary would be
  • Previewing a diary quickly with timeline and icons

How might we facilitate a mutual relationship between dietitians and their clients, and thus increase a client's engagement with a diary?

  • A friendly reminder from a dietitian
  • Keeping a client's goal on top of every step
  • Using a diary outcome in a session

Next

Due to time constraints, I focused on creating the mockups at the end of my masters. There are some actions I can take to make the design more desirable and feasible.

→  Conduct interviews to further gain dietitians' feedback on the proposed design
→  Design the diary instructions in the new process for the client-side
→  Discuss with engineers to understand tech issues

Takeaways

→  Reach out for feedback with an intention

Working individually allowed me to learn how to describe my problem and ask for feedback. Because the class has 20 people and each of us has different topics, I found that it is super helpful every time for me and all other people that I can give a little bit of context of my project and explicitly say the kind of feedback I'm looking for.

→  Love working on a complex workflow

Because of my passion for "work", I found myself very excited to learn a professional's day-to-day life, their tools and workflows in practice, and their needs and concerns to a task. Working on the design for dietitians also shows me the value of enhancing one's workflow and productivity. Most importantly, it's rewarding to see the design impact on a group of people who are passionate about what they're doing, because they can become better.

A big shout out to the instructor team, Dana Habeeb, Andy Hunsucker, Patrycja Zdziarska, and Oscar Lemus, and the most supportive 2021 HCId cohort.