Case Study: Helping pregnant women achieve a safe lifestyle

A UX Research & Design project aimed at understanding the behavioral journey of pregnant women to come up with relevant solutions | Fitness Application

Overview

This case study aims to understand the behavioral changes that women undergo during their pregnancy to help create a healthy and safe experience for them. It is a detailed account of how I provided the user (in this case; pregnant women) with relevant solutions keeping her frustrations, objectives, and motivations in mind. The solutions have been formulated and executed in the landscape of online health and fitness. This project has been done for educational purposes and is in no way made, owned, or affiliated directly with any application

There is a distinct and profound change that women go through which is drastically different from what they have been accustomed to. When a woman is pregnant for the first time, it is an experience that she has never had before, and that in itself makes the experience surreal. That is why I decided to take up this problem statement.

Role

Role: UX Researcher, UX Designer
Scope: UX Design, Online Fitness
Timeline: 6 Weeks
Context: Personal project under the mentorship of Anudeep Ayyagari (UX Designer, Amazon)

The Problem Statement

Business Problem Statement
Women have to be careful with their health during their pregnancy. An online fitness app wants to help pregnant women achieve a fit, nutritious and safe lifestyle.

Research Problem Statement
An online fitness app wants to help pregnant women with their health during their pregnancy. As a UX Designer, you want to understand the behavioral journey of a woman during the pregnancy. Plan a research to help identify the requirements for the business.

In short, a fitness app wants to extend its services to pregnant women. As a UX Designer, my goal is to empathize and understand the needs, mindset, experience, decision making pattern in order to identify gaps so that an ideal seamless experience can be delivered which ensures that all the objectives of the user are met. Moreover, there are not just a lot of physical changes but a lot of emotional and psychological changes.

Plan of Action

1. Understanding the Business and Research Problem Statements

• Framing 5Ws questions to understand the context of the problem
• Understanding the overall design thinking approach for this project

2. Secondary Research

• Gathering Statistical & Behavioural insights revolving around the problem statement.
• Defining the target audience.

3. Primary Research

• Sending screening forms to recruit users.
• Creating a session guide.
• Conducting user interviews.
• Recording key insights from the interviews.

4. Research analysis

• Empathy Maps
• User Personas

5. Reframing user challenges into ‘How Might We’ questions

6. Ideation and Wireframing

7. UI and Prototype

8. Testing

9. Refined Prototype

Understanding the Problem Statements

To understand the problem statement, I had to look into different aspects and possibilities of study so that there is a particular streamlined direction to work towards. For this, I framed the 5Ws — Who, What, When, Where, Why, which helped me understand the different aspects of the topic but also gave me a particular direction to point my research towards. This stage helps establish what needs to be researched.

WHO

Who are the users of this product? To find out about different types of pregnant users that would benefit from such products. Look at women from different fields, backgrounds, age groups, and family structures

Who within the target users requires this product the most? To find out who are the most at risk while being pregnant. Look into different situations such as women having health complications, conceiving at a higher age bracket, lack of awareness, lack of external support. Also, look into urban lifestyle and busy schedules to see whether it has an effect on pregnancy.

Who are the people that are indirectly involved? To understand who is a part of this process, (such as family members). Also research about people who are not in immediate contact but are part of the pregnancy process in some way or the other (doctors, trainers etc)

Who is more likely to use a fitness app during their pregnancy? Find out about users who have had prior experience with fitness apps and see whether there is something common among them. Also research about millennial mothers.

WHAT

What is the ultimate goal of this product? The goal is to provide physiological and psychological assistance to women during their pregnancies and ensure a fit, safe, nutritious, and happy pregnancy. The ultimate goal is to ensure a smooth pregnancy and a healthy mother and baby.

What role do parents and partners have during this process? I will find out how parents and partners affect this journey of a woman. Would also try to understand the relationship between the user and her immediate family and how it influences her decision-making.

What external factors have an impact? Find out about different spheres of their lives such as work, family life, financial situation and see whether they have an impact on existing patterns of nutrition, health fitness, health complications

What are the main segments of health that undergo change? To research about Physical, psychological, and emotional health. Find out about symptoms such as nausea, back pain, fatigue, and emotional factors such as stress, frustration, mood swings, anticipation, and worry about the baby’s health. Look into postpartum depression and anxiety

What are some of the common practices followed? Find about change in diet, medication, change in fitness, and nutrition patterns.

What are some of the myths that prevent pregnant women from having a healthy lifestyle? Find out about prevailing false information about a certain food or health practices. Look into Certain cultural/traditional expectations.

WHERE

Where do we need to focus the most? Research to find out the most crucial period, and also the most crucial aspect of health that affects women during their pregnancy.

Where does the user otherwise get fitness-related services when not pregnant? To understand what is the widely accepted mode of getting fitness-related information/content. Look into different apps, trainers, and classes.

Where do women get information relating to nutrition and diet? Research, whether they consult somebody or usually do their own research through blogs/magazines, depend on apps, or get guidance from family members.

WHEN

When is the problem occurring? Research about when during the pregnancy do women start facing issues. See how this varies in different periods. Research whether there are certain activities that trigger any sort of problem/discomfort.

When do women feel like they require information/support the most? Research about when women feel the most vulnerable, underconfident, and overwhelmed.

WHY

Why is this problem important to solve? Because women undergo a lot of changes during this crucial time and are not accustomed to these new changes.

Why is a fitness app important for pregnant women? It will assist them and keep them healthy since physical activity is very important during pregnancy (especially for women with health complications).

Why is being healthy during this period important? To understand why this period requires extra caution, care, and nutrition. Look into how a mother’s health is related to the wellbeing of the baby.

Why is it important to understand the behavioral and psychological, emotional changes? To understand how changes determine the mental state of the mother, negative mental state.

After formulating these questions, I understood what all I need to focus on during my secondary research. I was able to scope down to topics around which I would base my research, this made me feel more organised and confident.

Secondary Research

Desk research was conducted for my problem to understand the landscape of online health and fitness in the context of pregnant women. It helped analyze certain opportunities in this problem area and also formed the base for further user research. It allowed me to come up with the right questions needed for the user interviews and also in deciding the target audience.

Prevalence of happiness among pregnant women

• During the first trimester, new mothers are filled with a feeling of anxiety about losing their new baby as it is accompanied by symptoms like nausea, vomiting, dizziness.
• Mothers also begin to feel self-conscious about the weight they are putting on to support their baby, and these feelings can lead to low self-esteem.
• In case a woman fails at motherhood, it is a gender expectation that is not met. These expectations are cultural perceptions, and therefore, in the Indian culture, there is a sort of pressure on the woman.
• Maternal stress and anxiety often end up leading to premature births.
• A lot of importance in given to traditional cultures and stereotypes, which often affects happiness. It is seen as a family circumstance.
• The presence of people greatly reduces the emotional and social states of loneliness for pregnant women
• Familiarization with the expected changes is far more in the 2nd pregnancy.
• Anxiety, hopelessness, fatigue, anger, frequent mood swings and the constant fear that one will not be a good mother are few distressing states

Dietary Knowledge Among Pregnant Women

• 32% of the participants did not know about a balanced diet.
• 33% percent of reproductive age group women of India are underweight and 15% are obese or overweight. More than half of married women (56%) and pregnant women (58%) are anemic
• Participants knew that there is a requirement of additional nutrition during pregnancy but they were not aware of the balanced diet and right food choices.
• Most women do whatever is culturally and traditionally appropriate in terms of nutrition.

Physical Activity Patterns

• Overall, only 10.7% of pregnant women performed recommended levels of physical activity. Out of 10.7%, 8.7% without GDM, and 16.9% with GDM.
• Gestational diabetes mellitus (GDM) is a major problem. 1/7 live births are being complicated by hyperglycemia in India. Sedentary behavior is more common in women with GDM than without.
• Pregnant women spent 23% of their day at work, 33% in sleep, 21% in the general domain (daily living activities), 2% in transport, 11% in the recreational domain, and 11% watching TV
• Physical activity patterns vary depending upon different factors such as ethnicity, geography, socio-economic, literacy, religious, and cultural factors
• The most common activities reported by pregnant women are household activities like cooking and other domestic chores. This is followed by walking as exercise and going to places of worship. These activities are deemed culturally appropriate and safe during pregnancy

Attitudes, Barriers, and Enablers to Physical Activity

• 95% of the participants felt that physical activity was important and beneficial.
• 294/500 women felt that group exercise session for pregnant women was an enabler for physical activity.
• Knowledge-action gap: physical activity participation rates for pregnant women are low despite positive attitudes to physical activity, this suggests a disconnect between the women’s intention about physical activity and her action.
• Majority of barriers to physical activity are intrapersonal (existing within the user): fatigue, lack of time, and pregnancy discomforts such as nausea, pain, and awkwardness due to weight gain.
• Another major barrier was lack of safety information regarding type and intensity of physical activity that is considered safe for the mother and baby.
• Lack of accessibility to safe and affordable places to be physically active also acted as a barrier
• Lack of social support- this leads to low confidence and lack of knowledge as well
• Wellbeing of mother and child, ease during pregnancy, labour are seen as factors that push women to exercise.

Major Pregnancy Risks for Indian Women

• Lack of nutritious diet, pregnancy preparation, infection, postpartum depression
• Age-related infertility has become common now, because of delayed pregnancy caused by financial instability, career aspirations, late marriages, or if one suffers from certain medical conditions.
• With aging, the quality of eggs also deteriorates. The chance of conception, therefore, lowers. As women get into their 30s and 40s, the risk of chromosomal abnormalities like Down’s syndrome increases because the eggs also get older

Defining Target User

After my secondary research, a target audience was set to give a certain direction to the study. I received a lot of valuable insights in my secondary research which helped me understand which points I would like to understand in depth during my primary research.

I have created two tables, one for demographic categories and the other for the type of users based on qualities and situation. For both, I have mentioned reasons based on which these were chosen (secondary research)

Primary Research

Primary research gives us insights that allow us to understand their attitude and behavior towards something, their triggers, pain points, and the gaps that stop them from achieving an optimal experience.

The users were recruited through a screener form. Link

I then prepared my interview guide (link). I started with questions that would help break the ice and make the user comfortable. I then followed up with questions related to certain topics that I wanted to know more about. This was followed by 1:1 interviews

Challenges During Recruiting and Interviewing Users

• Since pregnancy is a socially and culturally driven experience in India, a lot of women did not want to mention anything seemingly negative about their pregnancy. It was very interesting to see how all my users said that their pregnancy was smooth at the beginning of the interview but slowly they opened up about small details and I could identify moments where they were stressed, anxious or worried.
• Recruiting was tough as the study was targeted towards a very specific audience. Finding pregnant women who are willing to talk to you in itself is tough, further finding pregnant women that match your defined target audience makes it even tougher.

Insights from User Interviews

Below are some of the key insights from my 1:1 interviews

Users that were experiencing for the first time felt apprehensive and worried about what will happen. They did not know what exactly to expect and this made them want to be more cautious and learn as much as they could. This feeling of underconfidence also led to anxiety which affects the emotional state of the user. The biggest worry is the safety of the baby.

“Since it’s my first pregnancy, I feel like I’m checking my baby app every hour, I just want to have a smooth pregnancy.”

Few of the users had a high-risk pregnancy due to conceiving late (by choice and also delayed due to PCOD). 2 users developed GDM as well. It was interesting to see how cautious these users were, and were doing everything to ensure their baby’s health but also actively trying to be positive and not think negative thoughts. The user does not want to ignore any signs that are subtle but might indicate some problem.

“I was really scared because I have PCOD and I have conceived at 35, but I really tried to not think too much about it and keep myself occupied with household chores.”

For a lot of users, being in control makes them feel confident and in turn, reduces feelings of anxiety and stress. Stress is often seen as a big contributor to premature deliveries.

“Being in control keeps me calm. I am very organized and finicky, and like to be on top of things.”

Users that are aware of their own behavioral patterns are able to make decisions that work best for them. This also shows that what may be dominantly practiced may not work out for everybody during their pregnancy.

“I did not want to stick to a strict diet as I knew that I would not be able to handle it and would only follow for a short period.”

Some users tried to keep themselves occupied with work and other activities so as to not overthink and overwhelm themselves. For a few users, this was also a sort of coping mechanism to deal with the visible changes that their body is going through.

“I do not want to overthink and obsess over too many things. I have basically dealt with my entire pregnancy by not thinking about it”

Two users mentioned how in the initial stages they were alone but eventually, their families came in the final semester. The user felt more assured when she was surrounded by family, she also felt more relaxed, happy, and confident as compared to when they were not present.

“I really wish my parents had come down to be with me sooner.”

Some users mentioned how because of their busy schedule, they don’t want to overdo things and often feel overwhelmed by too many apps or too many things to follow. This often irritates them.

“I don’t like to use too many apps as I don’t have the time for it.”

One interesting insight was that 2 users didn’t know they were pregnant until the 12th week, both with PCOD. This in itself shows that there is less knowledge about symptoms and different stages of pregnancy. The user was so habituated to symptoms of PCOD that even though there were few different symptoms, she assumed that it was regarding PCOD and not pregnancy

“I got to know I was pregnant after my first trimester”

Levels of physical activity varied from person to person to person depending on lifestyle. Users that have previously been physically active are more likely to explore different avenues of fitness during their pregnancies. Some women who were doing household chores considered that as well to be a part of physical activity.

I was quite active, however my frequency of walking reduced in the final trimester because I used to feel uncomfortable.

Validation and Invalidation of Secondary Data

New Insights from Primary Research

1. Users don’t want to be overwhelmed with too much information.
2. Users with PCOD are usually not able to tell the different between symptoms of pregnancy and PCOD.

Analysis of Data

After receiving insights from primary research, I decided to simplify all of the raw data so that it could be inferred to. 2 user sets were created with respect to all of the data acquired.

Since pregnancy is a socially driven concept in India, I could sense how the users would initially say that their pregnancy was smooth but over the course of the interview, they would open up and mention small incidents that would indicate otherwise. Because of this gap in what the user was saying and what the user actually felt, I realsied that it was important to articulate this and draw a relation between what teh user thinks, says, does and how she was feeling. It would help with the overall process of understanding the research data and scoping down to whatever is relevant to the study. Creating empathy maps allowed me to draw connections between what the user says and what the user does and thinks, and it also helped me see how the pattern of behavior of one user set varied from the other.

Empathy Map of Anxious-Cautious Mom

Empathy Map of Self Aware-Planner Mom

With the help of the empathy maps, I decided to create representations of my target audience as it would help understand their needs, goals, and motivations. This would further help arrange and make sense of all the data that was scoped down with the help of empathy maps.

Define: HMW Questions

Now that the research data has been analyzed and the user’s needs, goals, motivations have been determined, it is time to frame HMW questions which are basically problem statements that have been rephrased to convert challenges into opportunities. I wrote down the problem, followed by why this problem is important, and then formulated an HMW question.

• Worry about baby’s wellbeing and development- This constant worry and doubt can lead to feelings of stress which can have adverse affects on the baby and the entire pregnancy process. (Menta state of mother is very important)

1. How might we make the user feel more assured of her baby’s wellbeing?

• Since the user is experiencing this for the first time, there is this anxiety caused due to not knowing what to expect- New experience; she is not sure whether everything that she is feeling is common and this leads to overthinking and doubt which leads to the mother being in a negative state of mind.

2. How might we create awareness in the user’s mind regarding the different stages of pregnancy and its symptoms so that she can immediately identify if something is wrong?

• Having to visit too many doctors, or refer to too many websites/apps-This is a problem because instead of making the user feel in control, it can make the user feel very overwhelmed.

3. How might we ensure that the user does not get overwhelmed because of multiple platforms/sources of information?

• Negative feelings towards self- It’s tough for the user to suddenly come to terms with the changes in her body due to pregnancy

4. How might we help the user cope with physical changes that her body is going through?

• Lack of guidance, the user lacks support and a sense of belonging. -Since this is a novel experience and the user experiences a lot of changes, not having guidance/support only makes her feel less confident and this leads to overthinking which leads to stress. Stress leads to rise in cortisol (bad hormone)

5. How might we make the user feel supported, educated, and confident in the way she is dealing with her pregnancy.

• Lack of customized diet and fitness plan (wrt to health complication),- Since women have different preferences, a one fits all diet doesn’t work out especially if the user is self-aware and knows about her eating patterns and fitness patterns and what she can’t resist etc. similarly levels of physical activity also vary depending on their lifestyle and whether they are occupied with household chores, etc.

6. How might we help the user in maintaining a proper diet and physical activity with respect to her lifestyle as well as health complications

• Having to visit the doctor for every small doubt — This is a problem because the user does not have knowledge herself and wants to clear her doubts fast and not wait to schedule an appointment.

7. How might we create a way by which users could educate themselves and clear doubts faster in an efficient manner?

Ideation and Wireframing

All of the below ideas are solutions for the HMWs that were formulated in the previous section.

One thing that I realised is that the app must not overhwlem the user. Create different sections so that according to the need of the user, the user can go to that section.

Since each user may not use every feature, the basic idea is to personalise and bring info to the user instead of the user having to go through everything to find what is relevant to her. Try to create a space where women are assisted in multiple ways so that they don’t have to use multiple apps.

Weekly Updates

• How might we make the user feel more assured of her baby’s wellbeing?
• How might we create awareness in the user’s mind regarding the different stages of pregnancy and its symptoms so that she can immediately identify if something is wrong?
• How might we provide a way by which the user can educate themselves about different aspects and requirements during pregnancy?

Provide visual info about the baby’s development. Make the mother familiar with how big the baby is (with reference to real objects). Provide info about common symptoms during this week. Provide a log in which she can mention all the symptoms she is feeling to keep track. Tips and Tricks for the week. Can provide medical check-up reminders to be extra cautious.

Personalized Sections for Fitness, Nutrition, Wellness

• How might we ensure that the user does not get overwhelmed because of the high risk and multiple platforms/sources of information?
• How might we help the user in maintaining a proper diet and physical activity with respect to her lifestyle as well as health complications

Create a customized nutrition and fitness plan. Allow the user to choose whatever services they want such as tracking calories etc. Similarly for physical activity, recommend workouts depending on health complications, physical activity frequency, lifestyle, etc. Create different sections within so that according to the need of the user, the user can go to that section (and the user doesn’t have to use multiple apps)

Education and Forum:

• How might we provide a way by which the user can educate themselves about different aspects and requirements during pregnancy?
• How might we create a way by which users could be more independent and clear doubts faster in an efficient manner?

Showing articles relevant to the situation of the user. (PCOD, post partum depression, nutritional necessities, myths etc), provide articles about myth-busting. Having a forum and FAQ section where women can share their stories and get relevant answers.

Connecting solutions to Insights

Low Fidelity Paper Wireframes

I started with low fidelity wireframes before moving to high fidelity digital wireframes to come with detailed ideas and to decide the user flow.

Medium Fidelity Digital Wireframes

Wireframing was done to identify usability issues early on in my design process.

Home Page and Weekly Updates

From the main page, the user can access different sections such as nutrition, fitness, and community, depending on what they want to access (since users within target audience have varying needs). It has been explained in detail in the UI section

Personalized Nutrition

The idea is to assist women with their nutritional intake as well as knowledge. The user can also

Future Scope for Solution

Personalized fitness, based on lifestyle, frequency of exercise, preference of physical activity would be another solution. Another solution is creating a forum where women can share their experiences and learn from other women’s experiences.

UI and Prototype

For this project, the base app which has been taken is Cult.fit, mainly because it has more than just 1 segment of fitness, it has sections such as recipes, wellness, etc. The idea is to have a separate section for pregnant women, and this section will be shown on the main page.

Initially, I had decided that I would create a sub-app of cult.fit called preg.fit (similar to sugar.fit). However after my mentor’s advice I realised that it would be tough to draw traffic to another app, hence I decided to keep this section within the same app and make sure that it gets noticed by users in the main page itself.

Once the user goes to this section, the user would be asked questions about health complications, weight, last date of the menstrual cycle, due date, etc. (Information other than what has already been inputted while logging into the cult.fit app)

All of this information would help in providing personalized insights and updates.

Home Page

This is the main page that would come after inputting information such as due date, health complications etc.

There are three features, first is weekly updates, upcoming tasks (including reminders, upcoming workouts, and nutritional requirements), and a services section.

Problem Solved

• The home screen lets the user decide what pregnancy-related update/info they want, instead of having to see everything. This solves the problem of the user feeling overwhelmed with too much information as not everything might be relevant to her (as seen in behavioural differences in the personas).
• Since there are different categories of wellness such as nutrition, health, wellness, the presence of the upcoming tasks section helps the user be reminded of the tasks in the home page itself instead of having to go to the different sections.

Services: Solves the user wanting fast communication.

Your Body

This page helps the user be aware of the stage she is in and also provides information regarding symptoms that she may experience.

Problem Solved

• Since this is a novel experience and the user does not know what to expect (leading to anxiety and feelings of doubt), this section helps the user feel more confident and well-informed.
• The “your symptoms” button allows the user to log her symptoms so that she can see whether all her symptoms are okay. This helps the user immediately identify if something is wrong.

Familiarity leads to a feeling of reassurance. Lack of awareness causes the user to feel underconfident.

Your Baby

This page gives visual information about baby's development along with size and comparison with a real object. Each week, the development of the baby is mentioned.

Problem Solved

• The baby’s wellbeing is one of the biggest motivators of the user. This helps the user combat the fear of the unknown (by gaining more knowledge)which is often one of the leading causes of anxiety, especially in a high-risk pregnancy.

This also elicits feelings of excitement and admiration. Further some of the developments would help the mother understand why she is facing certain symptoms.

Your Log

This page allows the user to add tasks/reminders. The tasks are colour coded, and are indicated on the weekly calender (can be converted to monthly)

Problem Solved

• For high risk pregnancies, the user has to go through multiple checkups, blood tests to make sure that everything is going on track. This makes the user feel overwhelmed. This page helps assist the user so that she can get an overview of her week/month and plan accordingly.

Weekly Tips

This page provides info about weekly tips and personalised insights based on the needs of the user (determined by info added in profile)

Problem Solved

This solves the problem of the user not knowing what to do. This will help the user make decisions that are safe, which would also help boost her confidence and also help her stay cautious.

Here is the full prototype.

Testing

User testing was done with the real users to observe and analyze how the users were interacting with the application. It was done to see whether the solution is solving the user problems or not and if there are any usability issues.

User 1

Overall, this product is very helpful, I just found the log/reminder section a bit tough to understand.

• The user could not comprehend that she could add tasks.
• In the tips section, she thought that the personalized insights were articles that were already saved. She also thought that the articles were videos.
• Even though she felt that the update section was self-explanatory, she didn’t understand that the updates were clickable.

User 2

I like the personal insights section, I see that there is a saved section, but I am not understanding how to save the articles to read later.

• During the blood test checkup task, the user assumed that the slot for the date is fixed and that she needs to swipe to fit the right date into it, instead of just clicking on it.
• When probed about the “insight save” section, the user actually asked how she was supposed to save the articles.
• The user took time to understand what the log page was

User 3

I like that the app has a visual of the baby along with the new developments. Normally I would search all this on youtube but it is nice to have all this in one app.

• The user said that she would like to know what all she can feed in the log. Even though she understood the purpose of it, she didn’t understand the color-coded dots.
• She said that she would not always be able to log into the apps so whether reminders would come as a notification.

Revised Prototype

After the feedback that I had received, I understood some of the key points that I needed to incorporate in my design.

• Make the weekly updates section clickable by adding a chevron icon
• Write “Add Reminder/Task” instead of the plus icon
• Change terminology from “log” to something like “reminder”
• Add “Read More” in the personalized insights articles, also add a save icon.

Before and After

Chevron icon was added to indicate that these buttons lead to more information. This will make it easier for the user to comprehend that these are clickable.

Before and After

I added a bookmark/save icon so that the user can save the articles on this page itself (in case they want to read it later) instead of only being able to save it once the article is opened. The “read more” will indicate that these are articles and not videos (as assumed by the user during testing).

Before and After

On this screen, I changed the add button to add task so that the user can understand what the button is for.

Before and After

The user tried to swipe the dates as she thought she had to make the date sit in a particular slot instead of just clicking. Hence I solved this problem by removing the carousel scrolling and simply adding two arrows.

Learnings

One major takeaway for me from this project was that I need to unlearn to be perfect and that I can not try and solve each and every problem of the user. Initially, I tried to focus on multiple solutions in this project and then felt like I could have done justice to just one solution and create more iterations for the same.

I learned that research is extremely important to set the base of your entire design process, once the context is understood, the entire process of empathizing also becomes easier.

Thank you for reading! If you liked this article let me know in the comments! All feedback is heartily welcome and you can email me at kaavyajeevakumar@gmail.com