In March 2020, the pandemic stretched across Europe to the UK and Ireland. As the governments of Northern Ireland and the Irish Republic began reporting cases of a deadly new coronavirus strain, both health services began to organize expert teams to take on what would be the biggest threat to public health in generations.

At Big Motive, we have enjoyed the privilege of working with the health service as part of an integrated and multi-disciplined stakeholder team, charged with combatting the virus, breaking chains of transmission, and ultimately saving lives. This is our story about design in response to a pandemic over six months in 2020.

Starting with a First Response App

Anticipating a potentially rampant acceleration of new infection cases, the team, led by Dan West¹ established a 111² helpline, a number used to provide health advice to citizens across the UK. With up to 6,000 calls on pre-pandemic peak days, the team imagined a much broader scope for ‘111’… a more accessible and ‘always-on’ digital service that provided advice specific to COVID-19. 

Big Motive collaborated with software development firm Civica³ to align on a daunting challenge and define goals for 2 week-long sprints, before designing an emergency response service in the shortest window possible.

Rapid Insight Gathering

In the ensuing days, we engaged with a sample group of citizens in a rapid research study, gathering critical insights from our community of users. We organized a wishlist of features and content themes into an information architecture that could be prototyped fast. We tested the prototype incrementally and quickly, with designers and software engineers working in sync.

After 12 long days and nights, one of Europe’s first digital response services for the pandemic was launched to support the citizens of Northern Ireland. COVIDCare offers critical information to users, a ‘symptom-check’ journey that combines a series of inputs and conditions to give relevant advice to users and their families, and a chatbot that answers frequently asked questions and a series of links to relevant websites. 

A World First in 12 days

From launch, the app reached close to 200,000 downloads, resulting in a dramatic reduction in both calls and visits to healthcare professionals, freeing up medical staff to help critical patients in need of urgent attention. This new digital service was released as the first of its kind across the world, and while giving way to newer and more sophisticated services as the pandemic took hold, COVIDCare represented an immediate and effective response to a population in crisis. It delivered critical health advice and enabled the public health service⁴ to continue to serve the people of Northern Ireland.

Digital Strategy for Track and Trace

Following the success of the First Response app, we immediately turned our attention to a new priority area. As the pandemic raged across central Europe and the UK, Northern Ireland formed a ‘track and trace’ strategy to implement a range of services designed to break chains of infections.

Because of Northern Ireland’s unique geography and political reality, health leaders recognized the importance of aligning closely with Ireland’s Health Service Executive (The organization providing the health and social systems in Ireland) while balancing a need to align with UK health policy. But as summer drew near, the UK’s national response to contact tracing was looking increasingly confused.

Delays and Data Models

The digital branch of the UK Health Service, the NHSX⁵, was busy at work on a high profile contact tracing solution and beginning to garner negative headlines, with widespread reports of delays, poor performance on Apple devices, and increasing public concerns over centralized versus decentralized data models. At that time, Apple and Google’s announcement of joining forces and developing their own service led to ill-fated results from cohort tests conducted on the Isle of Wight and a concession by the NHS to rethink the UK strategy altogether.

Given the mounting pressure and increasing needs at home, health leaders made a decision in Northern Ireland to break from the NHS path and develop a unique contact tracing service of our own. In June 2020, Ireland was close to launching its own service, combining ‘BlueTrace’, the open-source API developed by the Singaporean Government, and the ‘Exposure Notification’ framework developed in partnership by Google and Apple.

Given its pace and proximity, achieving interoperability across the Irish border would allow both governments to share critical health data and present a significant boon for public confidence in light of the NHS’s well documented challenges.

A Citizen Centered Design Process

Big Motive again spearheaded a citizen-centered design process, working with enterprise software development firm, Nearform⁶ to create StopCOVID, the UK’s first functioning contract tracing app and the world’s first working cross-border solution.

The process began with a series of discovery workshops that would paint a holistic picture of deliverables and project milestones with a wide range of carefully selected expert stakeholders from across the public sector.

Findings from these workshops were used to form a starting hypothesis. This included updated personas, composed of ongoing user research and expert interviews with stakeholders across the project group. As we developed end-to-end journeys that illustrated specific goals for the myriad of actors interfacing with the proposed service, we began devising a system-wide service blueprint. This ‘wide lens’ view, aggregated from our fieldwork, would expose several bottlenecks and dead-ends, or moreover, opportunities to design-in efficiency and design-out avoidable complexity.

A Service Blueprint for Citizens

Having moved quickly to a ‘best guess’ blueprint of the service, we launched an expansive user research study. The design team facilitated two weeks of scheduled interviews with a sample group that started with high risk users, vulnerable members of the population and citizens with challenging circumstances and conditions or limited access to healthcare. With limited time, we deployed our tried and tested approach to fast track towards a better understanding of citizens’ needs. By starting with edge cases and working back, we could address the broadest possible range of issues and hope to create a more inclusive service.

From Insights to Launch

The speed and intensity of our work exposed a variety of actionable insights and anomalies. Digital contract tracing, it seemed, would only be as effective as its adoption rate allows. How willing might citizens be to notify a government-led service of a positive infection? And with boundaries delineating a ‘digital divide’ – how could a digital health app overcome population-wide challenges around accessibility and inclusion?

As we worked through the research study, we launched a parallel work stream to design detailed prototypes in rapid iteration cycles. This allowed us to test through continued engagement with a wide range of users, folding insights from daily interviews into new versions to be used as a stimulus in ongoing test sessions. As we probed further, we opened our research out to begin consultation with a wider stakeholder group.⁷ 

Following the conclusion of formal user research, we continued to iterate and align with the development team at Nearform. Locking the final version of the prototype, we created a design system that would accelerate successive updates upon initial release.

Following an intense series of development sprints, we worked with the Nearform product team to assemble our research findings, front end design concepts, platform backend, and nascent code base.

We launched StopCOVID for iOS and Android devices on July 30, 2020. The UK’s first digital contact tracing service, the app shares data with Ireland’s service, which also made it the world’s first covid app to achieve interoperability across National borders.

Contact Tracing for Teens

No sooner had StopCOVID launched, the health service began promoting the app. With growing adoption, we began to see users post positive test results to their app, triggering exposure notifications to people they had been in recent contact with, replete with advice on how and for how long to self-isolate and how to cope with isolation itself.

The app’s adoption gathered momentum through late summer, but so too did the virus, as the predicted second wave grew closer. 

As September arrived, young people across Northern Ireland started a new school year. Anticipating outbreaks across schools as teachers struggled to implement confusing guidelines; the team faced a new challenge. School-age children represent a significant percentage of the population, most of whom own or have access to a mobile device. What could be done to make the app appeal to a younger cohort of 11 to 17 year-olds? What barriers to adoption by this group could we get around? And how could we enhance the user experience to onboard and engage this user group in digital contact tracing?

Onboarding Digital Natives

Leaning into ‘Citizen Centered Design’, we facilitated workshops to deconstruct the experience, attempting to identify problematic areas for young people. The design team planned and launched a new research study, this time working with groups of young people. Building findings into wireframe prototypes, further rounds of research re-engaged select participants, who were asked to select a friend and participate in follow up calls to test updated prototypes. This time, interviewees were asked to provide feedback on an enhanced version of the app comprising a redesigned onboarding experience, additional illustrations to explain terminology, as well as useful prompts to enable curious teens to interact with health service goals.

Our approach helped us to build a body of user intelligence that informed incremental improvement of the user experience as we progressed through development to launch. As before, we worked closely with the public health service to interpret and build on the latest public health advice. Widening our lens to include 11-to-17 year-olds, we engaged in consultation with the Children’s Law Centre and the Commissioner for Children and Young People in Northern Ireland. This consultation generated buy-in and support from influential groups and validated a new onboarding process, including age-appropriate information and prompts throughout the app for younger users to communicate with parents, guardians, and teachers.

Making People a Priority

Our collaboration with the Department of Health on the region’s digital response to the pandemic continues with the latest version of the StopCOVID app. We also redesigned the COVIDCare app to be more suitable for teenagers based on the learnings from the StopCOVID app, another world-first, and an achievement we are immensely proud to have played a part in.

Like many other regions across the world, Northern Ireland has endured a challenging period throughout 2020’s global coronavirus outbreak. At the time of writing, there have been nearly half a million downloads of StopCOVID, representing just under one third of the population. The health service has leveled a highly effective response to the pandemic while demonstrating the power of digital technology to break chains of transmission, promote public safety and ultimately, save lives.

But we know that design has also played a significant role in our relative success. Moreover, a citizen-centered approach provided a direction for us to lead an integrated design team. The approach brought a number of benefits to the project, namely:

• Service-orientation enabled us to craft an empowering experience for concerned citizens in a time of crisis.
• Service blueprints helped us to develop an intuitive user experience rooted in an understanding of connected and adjacent systems.
• Being citizen-centered meant promoting the health and wellbeing needs of citizens from across the region.
• Agile co-creation with research participants enrolled in the design process enabled us to test and iterate in rapid cycles.
• Using research insights, blueprints, and prototypes to invite feedback from a wide set of stakeholders accelerated the process, work through bottlenecks, and ultimately, see around corners.

By orienting the design process around citizens, we amplified the voice of users when working alongside engineering partners, the public health service, and government stakeholders. With this approach, collective empathy for citizens informed experience design and technical development, resulting in an intuitive experience that enjoys growing adoption in a historically conservative region, not widely known for its progressive attitudes to digital.

Going International

Despite a number of world firsts, perhaps the greatest impact the project might yet have is the decision to completely open-source the project. The StopCOVID app’s code base, documentation, UX patterns, and research insights have been made publicly available.  Now teams across the world can build on the combined work carried out here to accelerate development and launch a contact tracing service of their own. The NHS in Scotland and in Jersey are just two regions that have launched services using the open-source code from these projects.

This is a story of progress against the virus, though, not success in defeating it. Northern Ireland hasn’t beaten the virus. Families have been ravaged by sickness and loss, but we have lowered the rate of infection and staved off potentially disastrous circumstances through behavioral change, influenced in large part by attention to design. Adapting the ‘evolved double-diamond’ method championed by the Design Council, into a citizen-centered approach to designing for health, we have enjoyed a truly unique collaboration. Our digital response to the pandemic has been the result of a major joint effort between a number of partners. Big Motive, Digital Health & Care NI, software firms Civica and Nearform, quality services consultancy Expleo and numerous government bodies⁸ all worked together in alignment and under pressure to create an exemplary digital service for our citizens and a vision of how health services will be delivered in the future.

---

Credits

1.  Dan West is Chief Digital Information Officer for the NI Department of Health & leads the Digital Health & Care team
2.  111 is the number UK citizens call when they need advice or treatments quickly, and can’t wait for an appointment.
3.  Civica is a global enterprise technology services firm
4.  The HSC (Health and Social Care) is Northern Ireland’s public health service and equivalent to the UK’s NHS, which operates in England, Scotland, and Wales
5.  NHSX is the digital branch of the UK Health Service.
6.  Nearform are the people behind the covid apps in Ireland and a number of US States
7.  Stakeholders included the ICO (UK Information Commissioner’s Office), Amnesty International (global human rights organisation), Northern Ireland’s Innovation Lab, and the Behaviour Change Group (also known as the ‘nudge unit’)
8.  Other government bodies involved included the NISRA (Statistics and Research Agency), NICCY (Commissioner for Children and Young People), and the RNIB (Royal National Institute of Blind People)

References

• UK may ditch NHS contact-tracing app for Apple and Google model, Guardian
• Coronavirus: Ministers consider NHS contact-tracing app rethink, Leo Kelion, BBC
• StopCOVID NI – Open Source, HSC Northern Ireland
• What is the Framework for Innovation?, Design Council
• The Digital Divide, Rebecca Walsh
• Behaviour change by design, Damian Cranney
• Photograph by Sarah Pannasch, Big Motive.