WeSmile
WeSmile is a web-based application that helps the patients with intellectual or developmental disabilities and their caregivers (Direct Support Professionals and families) to prevent dental diseases through knowledge/skill acquisition, risk assessment, action plan, and follow up materials.
Scope
Product Strategy
User Experience Design
Instructional Design
Client
Columbia University College of Dental Medicine
The Arc
My Role
Product Manager
Lead Product Designer
CONTEXT
More than 7 million Americans with intellectual or developmental disabilities (ID or DD) need spacial health care. Oral health matters as it is related to general health directly. However, maintaining good oral health or receiving dental care can be particularly difficult for the ID or DD population. To better serve the individuals, a research team from Columbia University College of Dental Medicine started educational and service initiatives, with funding from the U.S. Health Resources and Services Administration (HRSA). The key project is to develop a new dental special health application.
PROJECT GOALS
The team is building the WeSmile Project, a new initiative designed for individuals with Intellectual and Developmental Disabilities (ID/DD), by applying experience gained from the MySmileBuddy project, which focused on improving children’s oral health behaviors. The WeSmile Project aims to:
-
Enable people with ID or DD and their caregivers to use it in different scenarios
-
Help people with ID or DD to develop good oral health habits
THE CHALLENGE
To design effectively for individuals with Intellectual and Developmental Disabilities (IDD), it is crucial to understand their capabilities, daily routines, living contexts, barriers, and social interactions.
While direct observation and fieldwork would have been ideal for gaining these insights, significant time and budget constraints of this project made them infeasible.
​
To address this challenge, I adopted two alternative approaches:
​
Desk Research
to explore the barriers and challenges faced by individuals with IDD.
A User Research Questionnaire
for Subject Matter Experts (SMEs), including dentists and dietitians, to provide insights drawn from their interactions with IDD-focused NGOs
RESEARCH
Desk Research
Designing for individuals with intellectual and developmental disabilities (IDDs) requires understanding their unique needs, including varying skill capabilities, living contexts, and levels of support.
1. What are Intellectual and developmental disabilities (ID and DD)?
Intellectual disabilities are disorders that involve difficulties in mental tasks such as learning, reasoning, problem-solving, and so on. Developmental disabilities affect intellectual functioning, physical functioning, or both. Examples include Down syndrome, Autism Spectrum Disorder, cerebral palsy, Fragile X Syndrome, and more.
2. What are potential skill gaps?
Individuals with IDDs may experience difficulties in various skills, including reading comprehension, motor skills, speaking and understanding language, as well as hearing and vision.
ID in reading
Have difficulty in understanding relationships between letters, sounds, and words; have problems with reading comprehension
ID with motor skills
Have problems with both gross and fine motor skills
ID with language
Lack ability to speak and to understand spoken words
ID with auditory and visual processing
Have difficulty in processing the things they hear and see
*Sources: HealthyPlace
3. What are the severity levels of IDDs, how do they impact individuals' capabilities, and what specific support is needed at each level?
Most individuals with IDDs—80% mild and 10% moderate severity—experience developmental delays but can learn basic and safety skills, needing only occasional consultation or regular professional support.
*Sources: Understanding and supporting learners with disabilities, HealthyPlace
4. What are the living contexts and support settings for individuals with IDDs?
Individuals with IDDs typically live in day habilitation programs, IRAs, or home settings. This project focuses on day habilitation programs supported by Direct Support Professionals (DSPs).
Individual with DSP
-Outside home in the community
-DSPs assist individuals to improve their self-help, socialization and adaptive skills
Small Group Series
-Small group experiences take place during the courses to develop skills and community involvement
Day Habilitation Programs
Individual Residential Alternatives (IRA)
Supervised IRAs
-Traditional family-style group homes
-24-hour staff support and supervision for up to 14 residents
​
Supportive IRAs
-IRAs are limited to 3 or fewer residents
-Need-based support for those who are living in their own homes or apartments
Home
Individual with families
-Live at their own home with parents or siblings
A User Research Questionnaire
Desktop research indicates that most individuals with IDD can use the application with some professional support. To design an effective tool for promoting oral health behavior change, it is essential to explore the following key areas: caregiver roles and interactions, oral health risks, dietary habits, digital device usage, and caregiver challenges.
This requires addressing critical questions such as:​
​
KEY FINDING
01/
Diverse skill challenges
02/
Many-to-many interaction
03/
Technology is not accessible to all
04/
Obstacles across multiple risk domains
05/
Challenge from DSPs' overloaded schedules
including reading, motor, auditory, and visual difficulties
individuals with IDDs and DSPs often have overlapping support networks
digital technology is accessible to all DSPs but not to all individuals with IDDs
individuals with IDD usually have multiple risk areas
hinder adoption of new initiatives
USER INSIGHT
User Needs
-
Diverse Skill Challenges: Users (IDDs) often lack foundational skills, requiring tailored learning experiences through diverse modalities.
-
Many-to-Many Interactions: The ecosystem involves complex relationships where one DSP may support multiple IDDs, and multiple DSPs may collaborate to manage a single IDD. This requires tools that enable effective coordination.
-
Technology Accessibility: Many IDDs rely on DSPs for guidance in using digital devices and accessing digital platforms, which needs assisted workflows.
-
Obstacles Across Multiple Risk Areas: IDDs face varied challenges across domains that require comprehensive educational training to address these diverse needs.​
-
Challenges from DSP Workloads: crucial for solutions to be intuitive, low-maintenance, and easily integrated into their work environment.
User Goals
-
Effective Learning Despite Skill Gaps: IDDs should be able to adopt positive behavior changes using accessible multi-modal educational tools.
-
Seamless Multi-User Management: DSPs need to efficiently manage multiple IDD accounts while ensuring collaboration among DSPs who support the same IDD, with clear visibility.
-
Support for Technology Use: DSPs should have tools to assist IDDs in navigating digital devices and accounts, ensuring they can effectively use the system.
-
Holistic Education for Risk Areas: IDDs need access to comprehensive, actionable learning content to help them address varied risk factors.
-
Simplified Information Access for DSPs: DSPs should have quick access to IDD profiles, progress tracking, and learning materials without adding complexity to their workflow.
CONCEPT AND STRATEGY
1. How to provide effective learning despite skill gaps?
Universal Design in Learning Principles
-
multiple means of representation
-
multiple means of action and expression
-
multiple means of engagement
Text
active voice
informative statement
one consistent tense
whole numbers
left aligned
larger font text​​​
Images
text below the visual
realistic details
facial features
Website content accessibility guidelines (WCAG) 2.0
-
Perceivable
-
Operable
-
Understandable
-
Robust
Videos
multiple means of representation
Audios
multiple means of representation
2. How to enable seamlessly multi-user management?
One design challenge is managing the many-to-many relationship, where a single DSP supports multiple IDDs, and each IDD receives support from multiple DSPs.
Paper-based task management (in person)
Provide DSPs with a printed group task sheet that consolidates the tasks for all IDDs in their group.
This allows DSPs to organize and assign tasks in person, bypassing the need for the application.
Idea
Why rejected--Lacks flexibility to adapt to changes in personnel and increases the administrative burden of tracking progress effectively​
Time-based task management (online)
Allocate daily tasks for each IDD to a single DSP or caregiver based on matching schedules. Tasks are assigned by aligning the IDD’s action plan time with the DSP’s working hours, ensuring efficient coverage
Why rejected--Rigid and difficult to adapt to schedule changes, requiring significant effort to re-coordinate, and costly to implement and maintain
​
Open DSP support model
Allow any DSP or caregiver to support an IDD without assigning tasks based on specific times. DSPs can access the accounts of the IDDs they manage and provide support as needed.
Why accepted--offers flexibility and efficient resource use
​
3. How can we ensure adequate technological support for individuals with IDDs?
-
Seamless support across stage: Enable DSPs to seamlessly support IDDs at every stage, from registration to task completion, using either their own accounts or the IDDs’ individual accounts. The DSPs will serve as the primary users of the application.
-
Simplified workflow design: Design workflows for both primary (DSPs) and secondary users (IDDs) to be as simple and intuitive as possible, minimizing complexity and ensuring efficiency.
Primary User
DSP
Secondary User
People With Mild IDDs
4. How can we deliver holistic education to foster meaningful oral behavior changes?
(1). Identify risk areas
(2). Develop key learning objectives based on risk areas
by collaborating with Subject Matter Experts (Columbia University dental professors, dentists, and dietitians)
​​
-
Week 1: Access dental care
-
Week 1: Oral hygiene
-
Week 2: Make healthy food choices
-
Week 3: Make water your go-to drink
-
Week 4: Thoughtful eating
(3). Facilitate behavior change
After conducting research on behavior change theories, we applied social cognitive theory and health belief model to the learning process design. The process includes four steps to support behavior change:
1. Risk Assessment
-
Perceived severity
-
Perceived susceptibility
2. Goal Setting
-
Self-efficacy
-
Cues to action
3. Action Plan
-
Health Motivation
-
Perceived benefits
-
Break barriers
4. Follow-up
-
Self-efficacy
-
Cues to action
Multiple choice questions to identify users' dental health risk areas
​Fill a form to identify responsible person
Educational guide and regular flyers to help users learn knowledge and skills
Reflect on action plan and work better on next goals
(4). Create behavior change strategies, learning experiences, and educational content based on the determinants of behavior change
INFORMATION ARCHITECTURE
As simple and straightforward as possible
USER FLOW
DESIGN DETAILS
Create an Account
Allow both IDDs and DSPs to create and register distinct account types.
Direct Support Professional (DSP) Dashboard
If logging in as a DSP, they can access each IDD's profile to guide and support their oral health behavior change journey.
​
If logging in as a DSP, they can access each IDD's profile to guide and support their oralIf logging in as an IDD, they will start with a risk assessment to identify key areas, followed by a tailored five-week program addressing comprehensive risk factors.health behavior change journey.
​
To facilitate many-to-many interactions and help DSPs monitor progress effectively, the platform enables printing and physical storage of key information for easy reference.
Manage Members with Intellectual or Developmental Disabilities
When DSPs add new members, they can either link existing IDDs with accounts or assist IDDs in creating accounts if they lack the capability, then add them as members under their care.
Risk Assessment
To enhance accessibility for individuals with IDDs, the risk assessment features larger text sizes and offers multiple representations of each question, including text, images, and audio, catering to diverse needs and preferences.​​
​
Program Introduction
During the learning process, DSPs and individuals with IDDs can conveniently access action plans, view task lists, and review risk summary reports to monitor progress. Additionally, individuals with IDDs can print these pages as educational resources for their families.
Goal Setting, Action Plan, and Follow-up
Provide multi-modal learning experiences and present a single key message per page to reduce cognitive load and ensure clarity throughout the process, from action to follow-up.
​
.png)
IMPLEMENTATION
Design Document
Break the whole application into three development phases. Wrote design documents to support developers.
FURTHER THOUGHTS
1. Work with limited resources for user research
Many projects lack the time or budget for comprehensive user research, even though it is critical. Ideally, securing additional resources is preferable, especially for projects starting from scratch. However, when that's not feasible, it's essential to make the most of existing resources within the team or online. This can involve leveraging secondary data, making informed assumptions, and presenting multiple solutions based on those assumptions. Sharing these solutions with the team can help refine ideas through feedback, and subsequent user testing can validate or adjust the approach.
​
2. Collaborate with Subject Matter Experts
In healthcare-related projects, Subject Matter Experts (SMEs) play a crucial role due to the importance of domain-specific knowledge. However, many SMEs may not have a background in design or technology, which can pose collaboration challenges. To ensure effective and smooth teamwork:
-Maintain regular communication to provide updates and gather feedback.
-Facilitate their understanding of the design process through educational initiatives like design workshops or knowledge-sharing sessions.
These practices help bridge the gap between design and subject matter expertise, fostering better collaboration and more informed design decisions.