Nikki Knox joined Hinge Health—a digital clinic focusing on joint pain—as the first individual contributor (IC) user researcher. Nikki hit the ground running with a mixed-methods experience research approach to support a host of use cases: from exploring new patient care models to refining and improving the core chronic pain program.
We chatted with Nikki to learn about how she’s adapted research in the ever-changing healthcare space, how she used dscout to support a new product launch, and strategies for a mixed-methods UX approach.
dscout: You've been doing user research in the health and wellness space for several years now. What changes have you observed? How have you adapted your UX research approaches to meet the current moment?
Nikki Knox: Today's patient is very data savvy, aware of who is asking for their information, evaluating whether or not it's real, and then checking up on how it was used or not. Participants need to know we're both following the laws around both protected health information (PHI) and personal identifying information (PII), and that we are asking for responses for specific purposes.
In practice, this means being very rigorous with consent, storage, and security assessments. Given the sensitivity of the data we are working with, we carefully vet our user research partners, ensuring that their commitment to privacy and data security matches our own. Fortunately, dscout’s privacy standards take care of all of this for us so that we can stay focused on the participants and on how we engage with them.
Additionally, researching various forms of chronic and acute joint pain, as we do here at Hinge Health, is complex. For example, the perception of and communication about pain varies drastically by person: a person experiencing acute pain typically finds it easier to describe their pain, and it's often easier for the provider to explain and treat it. Chronic pain expressions are often complicated by depression and anxiety. Also, the pain may have become a part of their identity, their sense of self, and hard to differentiate.
These factors necessitate a qualitative, mixed methods approach. We're not just trying to capture UX experience feedback—we need to probe the emotional, cognitive, social, and psychological elements that drive behavior and decision-making. It’s hard to do all of this without expanding the scope of the user research work drastically, to the frustration of both our internal partners and ourselves.
Therefore, we've been integrating quick literature reviews into our user research reports to fill in gaps beyond interviews, as well as maximizing the knowledge and experience of our clinical and behavioral science teams. The temptation for UXR is to expand scope, but it's working smarter, not necessarily more.
How has using more mobile/remote UX research approaches impacted your insights?
Pain is tricky, it's unpredictable. I can use a diary study to offer flexibility to people, who can share painful moments when it's most relevant to them. Some share right when they get up, others just before bed, some after a specific activity. I can't predict these things and neither can they.
Doing traditional ethnography was the solution in the past, but in today’s world, it feels too intrusive and frankly, no longer necessary with the new tools we have, such as a digital diary mission. They give me—and the scouts—flexibility to share data when it's most relevant, which has improved the depth of insight we’ve been able to collect.
It's one thing to ask participants about how they might rate their pain on a scale and an entirely different one to have them describe it closer to the moment they experience it. To our continued amazement, people speak freely and honestly in ways they might never do in an interview.
"Actually, I'm doing fewer moderated interviews now that I have dscout. The studies let me capture so much more data—including very powerful and personal moments—that I can mine for insights. I'll ask a question or send a message to follow up here and there, but mostly the Diary missions provide my teams with a wealth of data to use for our recommendations."
UX Research Lead, Hinge Health
Access to and awareness of women's health is very salient right now. You used dscout to support a new product offering in this area. What was the goal and research design to support it?
Hinge Health continues to expand and support more patients' needs beyond acute / chronic pain. This initiative focused on a very pervasive issue for women—pelvic floor health—that isn't widely treated or socialized. It impacts one in four women, yet the resources available require hours of internet searching, numerous doctor visits, and embarrassing conversations.
Hinge Health has launched a new Women’s Pelvic Health program to better support people with female anatomy as well as raise awareness and provide education about the impact of these challenges with employers (our buyers).
Because the bucket of "pelvic health" is so broad and diverse—it can encompass pregnancy, menopause, sexual health—we wanted to conduct exploratory research to better inform the design and product launch. In this case, we needed to know more about their history with pelvic floor health, where they seek information, their knowledge of and experience with different treatments, and what they thought of this potential offering.
We weren't even ready to think about design yet—we wanted to get some clarity on what was going on and how this impacts people as well as identify gaps in their care. Given the wide range of topics and user symptoms to address, I suspected a diary study was going to work best. As I mentioned earlier, it gives people the space and privacy to share what can be difficult, sensitive, and private information at a time of their choosing.
In addition, a diary study would help us paint an accurate and fuller picture of lived experiences. I didn't go into the study planning to do interviews, because Diary missions can capture so much detail, but it was confidence boosting to have that in the back pocket, so to say. We were able to conduct both exploratory work and vet some early ideas we had about solving for that need in one study.
Could you share any top-line takeaways that informed the development of this program and how the insights were shared with the wider team?
Using the dscout panel, we quickly recruited a diverse set of people, both demographically but also in terms of their pelvic health symptoms. The outcomes from this research helped our product and design teams gain a lot more empathy and context for how pelvic health issues impact people, as well as stressed the importance of education. Participants reported doing extensive internet research to learn more about their symptoms and to look for helpful solutions.
Unsurprisingly, we learned how medical professionals tend to downplay the person’s experience by not recognizing the impact these symptoms have on their lives. In addition, successful treatment programs such as pelvic floor physical therapy aren’t well known and easily accessible.
As for sharing, our internal partners were eager to see what I was learning and hearing, so I posted select video clips from entries as they came into a private group of internal partners. This generated a lot of excitement and energy for learning more. The video clips really drive home the human experiences that the recommendations and findings are grounded in.
Then, after the mission was closed, I posted participant summaries, the exportable scout entries, to build empathy and maintain energy while I took a few days to finish the documentation. These helped me package a user's journey or story in a digestible way. I'd post a top-level finding and then attach a PDF saying, "Hey, check out so-and-so's story for more context."
Our stakeholders really liked engaging with that format. I was sending those one-pagers several times a week, they were so popular! Again, when you're working in patient care or health and wellness, stories matter—they drive empathy which can create better experiences.
What advice would you give to others who are working with sensitive research subject matter?
Because you're not in the room with the scouts as they complete a diary mission, I really enjoyed collaborating with dscout's CXR team on fine-tuning questions. There is definitely a craft to phrasing a mobile study in a way that's clear and helps folks have the space to share what's relevant to them.
My advice is to keep it simple, as it’s easy to overcomplicate and make the mission harder for scouts to complete. Now that I’ve led several video-based diary studies, for people experiencing many different types of pain as well as those with weight-related issues, I’m impressed by how much participants will share when given a simple, clear prompt.
I also think it's worth mentioning—for people who have never used a tool like dscout—that video is more accessible than you'd think. At times, our internal partners expressed skepticism at how effective video entries might be for those who are less technology savvy or not as comfortable with this mode. Yet, we received powerful data from a wide range of people.
"We live in a culture saturated with video and I’ve seen how comfortable people are talking into their phones and sharing personal information. Use those video questions as your superpower, both to tell user's stories but also to collect the most impactful, needed insights for your work."
UX Research Lead, Hinge Health
What's next for this product and your work around it?
Right now I am leading the user research for the program, using a diary study as well as quantitative data collection methods.
I’m using dscout as a sort of always-on, rolling data collector, checking in with pilot participants after key moments in the user journey, following up with interviews when needed, and collecting continuous feedback that our product and design teams crave. Stakeholders are excited because they don't want to wait to make needed improvements, and with dscout I can deliver more of those as-they-happen insights.
With these user research tools and approaches, we can continue to identify and advocate for unmet user needs across the musculoskeletal pain spectrum. Healthcare UX and design without humans doesn't work, and we're committed to bringing empathy and mindful design where it’s most needed.
Ben is the product evangelist at dscout, where he spreads the “good news” of contextual research, helps customers understand how to get the most from dscout, and impersonates everyone in the office. He has a doctorate in communication studies from Arizona State University, studying “nonverbal courtship signals”, a.k.a. flirting. No, he doesn’t have dating advice for you.