The takeaway: Healthwise changed the vocabulary they use. The medical profession refrains from using the word “diet” because it is not medically advisable to restrict whole food groups or hop from plan to plan. But Healthwise finally sided with the humans who use that word all the time to refer to both a fad/fast thing and also their usual nutritional intake. Additionally Healthwise diversified the modules they created for three different audience types (thinking styles) trying to lose weight.

Healthwise is a nonprofit organization that licenses content to WebMD, as well as to health plans, care management organizations, and hospitals. Since the 1970’s Healthwise has followed a strong evidence-based method for writing and reviewing content. Around 2004, Healthwise began creating patient education and health behavior change solutions. To fully understand the process of how patients make health behavior changes, Healthwise formed a team that included people with a background in behavioral psychology as well as empathy research. I have mentored this team since the beginning. One of the team’s projects was about weight loss. The research they did showed them how different people trying to lose weight have completely different behaviors and emotions.The behaviors and emotions that fell into three general groups.

The Resigned – I feel stuck. I may as well accept the way things are, since I’ve tried everything and nothing has worked.

The Sidetracked – I have a lot going on. I don’t have a lot of control over my choices, especially when something (a stressful project, my mom in the hospital, etc.) gets in my way. 

The Inconsistent – I’ve tried a lot of diets, and sometimes I do really well for a while. But at some point I stop doing things right. I should get back to losing weight sometime soon.

The Healthwise content strategy team decided that to be effective, they needed to tailor content unique to each of the three groups. The unique content supports each behavioral group better than a generalized approach, even though the subject areas have some overlap (like exercise or food choices). These solutions were also founded on the principles of meeting people where they are, helping remove barriers, and encouraging relevant goals, rather than persuading people to change their habits with one set of prescriptive goals. The empathy research helped illuminate how a topic as straightforward as getting some exercise could be approached in three different ways that supported three specific types of people struggling with weight, rather than just covering the topic of exercise. As a result, there is a much stronger link between the person being supported and the material Healthwise created.

newsletter #24  |  16-May-2017

Building rapport with participants takes some skill and concentration. Here’s an explanation to help you become aware of what it takes.

First, the foundation: There are two types of empathy that I focus on in exploring the problem space. (Do you remember them? Quick mental quiz … take a second. Remember?) Read More

newsletter #23  |  18-Apr-2017

When I give workshops or short talks about researching the problem space, there are three things that audiences have a hard time wrapping their minds around. Each audience is different, and they all don’t react to the same concept. But here are the three concepts that consistently generate the most thinking and questions:

In problem-space research:

  1. No users
  2. No note taking
  3. Not a part of a product cycle

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newsletter #22  |  21-Mar-2017

Most organizations have several different products aimed at different market sectors. However each product or service is usually designed with one main user in mind. This product or service ends up only supporting a portion of the people it is aimed at. Real life scenarios are ignored because they’re deemed not important enough by the organization, or too complex, or not even recognized. (e.g. A memorable example of the latter is the 2014 release of Apple’s Health Tracker that omitted period tracking.)

The prevalence of these kinds of offerings reminds me of the episode from the 99% Invisible podcast: On Average. In that episode they point out that in WWII, pilots flying in cockpits designed for the “average man” experienced trouble controlling the planes. There were deaths, which lead to investigation and research, and in 1950 they eventually hit upon the solution of adjustable cockpit controls.

So, instead of designing for an imagined average user, you could design adjustable experiences. This, of course, puts the onus on the user, both in terms of attention and cognitive load. My opinion is that several elegantly- and specifically-designed solutions for different peoples’ thinking styles is a better approach. For example, Healthwise came up with three different designs to support three different thinking styles of people trying to lose weight. And the example below, from Caroline Jarret, who is currently writing a book titled Surveys That Work. Pay close attention to how Caroline refers to “average.” It’s called the “mean” or “arithmetic average,” and provides very little help to our design of a solution.

Here’s Caroline:

Back in stats class, you probably learned that a ‘mode’ is the value that occurs most frequently, and the ‘range’ starts with the lowest value and finishes with the highest.

So let’s say that I’ve done a little pilot survey with 100 responses to find out whether a recent campaign to attract families with children has worked or not, and I get these answers:

Number of children in family Number of respondents  
0 19  
1 28  
2 16  
3 15  
4 10  
5 7  
6 3  
7 0  
8 1  
9 1  
10 or more 0  
TOTAL 100  
Mode 1  
Mean (arithmetic average) 2.15  
Range 0 to 9

The average number of children per family is just over 2.

If you look at the range, you’ll see there are a couple of very large families, including one with 9 children – perhaps not that surprising when we think about life today with blended families. And perhaps even more surprisingly, some families are turning up with no children in tow at all. So maybe if you’d designed seating in a restaurant to allow for two adults and two children per family, you’d have a lot of empty seats at tables for four, but some much larger groups struggling to organise themselves.

If you look at the most frequent number of children, the mode, then you’ll see that the mode is 1 child, with the group of people who turn up with no children at all the next biggest So if you designed a ticket price that’s aimed at attracting families with 2 kids, you’d fail to cater for the two biggest groups in your audience (and not be all that helpful for the larger families either).

I didn’t learn a lot about modes and ranges in statistics class because they’re awkward concepts mathematically, whereas means have lots of very interesting mathematical properties that are very handy for statistical purposes. But for designers, my experience is the other way around: means can hide a lot of the details that we need for design, whereas modes and ranges can be much more informative.

These sorts of Zipf distributions are everywhere in UX, with the most familiar being the search terms. (by Caroline Jarret)

Caroline’s restaurant example is a good way of demonstrating how eager our culture is to design for the mean, and how much of a hassle an “average” design turns out to be for most people. If you expect several different groups at the restaurant (and assuming this is a restaurant that anticipates lots of kids), you’d design multiple solutions: tables for pairs of adults, tables for adults with one kid, and configurable tables pre-arranged in anticipation of adults with 2-4 kids and with 5-9 kids. (Ignore for purposes of this example the fact that it’s rife with assumptions around how a kid behaves and how to support a kid versus an adult. Focus on the average versus mode part of the example.)

thought provoking


Product managers have more and more resources, and since October 2016 Karthik Vijayakumar has hosted a podcast called Design Your Thinking. He invited me to speak with him last month, and produced two episodes about researching the problem space from our conversation. (Each episode is about 30 minutes.)

In episode066, we discuss the larger ideas that have nothing to do with what an organization is offering, and taking time to understand what’s going through people’s minds to see what the patterns are, measure the strength of your support, and map out your focus and priorities for the next few years. For example, it allows start-ups to focus and recognize when they are trying to solve the wrong problem and pivot. Our conversation continues in episode067 exploring the how to address the needs of what shows up in a tower in a mental model diagram, which is a representation of the stages of people’s thinking as they work their way towards an intent or purpose they have. (Karthik follows a specific format across all his guest interviews, so you can compare answers across many different experts.)

Also last month I got into conversation with the producers at the Wisconsin Public Radio show, To the Best of Our Knowledge, about the Against Empathy book by Paul Bloom. Paul did an interview with the host of TTBOOK, and it purported the opposite of what I practice. Paul said that empathy leads to bad decisions because you put the story of one person over the stories of the multitudes. Quite the opposite of what I do, which is bring the stories of the multitudes into the room with product managers, designers, and developers via the cognitive empathy I develop with participants and distill into mental model diagrams. Check out my interview, along with another engineer’s response, in the segment “Does Empathy Have a Design Flaw?” (21 minutes. Transcript available here.)

In the 10 minutes of my half of the interview, I cover the following topics:

  • We’ve gotten good at checking out our ideas & making sure they work. Now it’s time to understand implications first.
  • It’s not a deficit of empathy—it’s a deficit of breadth when we are designing solutions.
  • Ideas are sexy. You get a lot of credit for good ones. We gravitate towards solving as opposed to understanding.
  • Understand the different kinds of thinking and map out how we can support them over the next 5-10 years.
  • People design from their own experiences. I bring a whole lot of other people’s experiences into the room.
  • Ability to support other perspectives, beyond those they’re familiar with.
  • Focus on the lack of emotional education in our culture, the lack of ability to listen to & recognize other people.
  • A start-up has a short runway; they can’t solve everybody’s problem. I get them to focus down to a particular subset.
  • Single-minded design/function is bad in that it leaves the majority of people unsupported.

What’s our best fit?

quick research help

“We’re trying to explore the problem space, but we’ve run into problems. Can you double check what we’re doing?”
quick help

mentor the team

“We want to make sure we do the research right. And we want the skills in-house so we can keep exploring.”
mentor the team

custom research

“We want to explore something, but we don’t have the cycles to get involved. We want answers that are credible.”
custom research

training & coaching

“We want to do solid problem space research. We want a workshop or coaching to tighten up our skills.”
training & coaching

A book called Against Empathy came out in late 2016. Author Paul Bloom, a professor of psychology and cognitive science, has consequently gotten a lot of exposure for such an eye-catching title. I’ve found contradictions in what he says. (e.g. empathy means many things vs. empathy is feeling what the other person is feeling)  I got a chance to speak with Steve Paulson of Wisconsin Public Radio’s To the Best of Our Knowledge about using cognitive empathy in product design. Podcast: Does empathy have a design flaw? (21 minutes) Transcript below.

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ConveyUX is a home-grown Seattle event, produced by Blink UX. This is the one event that UX professionals can count on to bring a yearly stream of great content to the Puget Sound area. Over thirty UX practitioners presented 40+ educational sessions over the three days of the conference. Video of the talk. (68 minutes) Live sketch by Len PeraltaTranscript below.

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newsletter #21  |  21-Feb-2017

Figuring out what to explore in a problem-space study is difficult. For problem-space exploration, you ask participants about the larger intent or purpose; for user-research, you ask about your ideas or products. For example, in a problem-space study having to do with drive-through menu design at a fast food chain, we asked participants, “What went through your mind as you decided what to eat for a quick lunch over the past couple of weeks?” The purpose wasn’t to select from a menu, but to eat lunch.

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newsletter #20  |  17-Jan-2017

It’s one thing to say it, quite another to do it. You might agree that broader, deeper understanding of people will strengthen your product strategy and solutions. You might be open to the idea that diverse teams create more sustainable organizations. But getting your own organization to make this shift seems impossible. Because of budget priorities. Because the organization has to get out ahead of the competition faster-than-fast because the market is changing. Because time is money. Because the shareholders need to see profit.
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newsletter #19  |  13-Dec-2016

For a few years, Christina Wodtke has been speaking and writing about using stories in your work. When she says “story,” she means stories with characters and a setting and conflict and resolution. She says stories that develop your concern for the character’s outcome are memorable. And she compares stories with a climax to a typical product decision-making process where the focus is on what can be created or fixed–not why.

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newsletter #18  |  15-Nov-2016

Chances are that if you’re subscribed to this newsletter, you’re interested in techniques for understanding others–specifically in the context of supporting people in your work. Chances are you’ve heard what the U.S. president-elect has promised, and a notable part of it goes against the philosophy of understanding and supporting a variety of different people.
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