Data-Visualization-Portfolio

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Facilitating Telehealth to Promote Rural Health Project: Storyboard, Wireframes, and User Research

Storyboard

I created this storyboard to clarify how I anticipate the intended audience interacting with each of the key components of the story. By understanding these goals, I was able to better focus on the points I wanted to emphasize in my story as I built my wireframe. Additionally, this helped me get an idea of what I should look for in my user research. If these points aren’t being made clear to the reviewers, I may need to revisit my story content and structure.

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Wireframe

For my wireframe, I included high fidelity versions of the major data visualizations I intend to include in my final project. To connect these data visualizations to the larger story, I included brief headers for each of the major parts of the story, questions the audience may have about that topic, and a combination of the data visualizations and brief text that is intended to answer those questions. I kept the text elements brief to focus on the overarching narrative and the role the visualizations play in that story, so that my user research could help me understand how well the visualizations are able to support my main points in the absense of detailed text.

Title: Strengthening Digital Infrastructure and Telehealth Capabilities for a Healthier Rural America

I. Introduction

Get audience interested and prepare them for the rest of the story

II. Health Disparities

Why does something need to be done about rural health? Why should I be worried about the health of my community?

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Why are there poor health outcomes in rural areas? What are the barriers to good health?

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III. Telehealth as a Solution to Rural Healthcare Access

Why is telehealth particularly suitable for rural areas?

IV. Barriers to Telehealth in Rural Areas

How does the digital divide hinder the implementation of telehealth in rural areas?

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Rural providers have adopted telehealth more slowly. What factors contribute to provider hesitancy to adopt telehealth?

V. Addressing the Digital Divide

How do current policies work to overcome the digital divide and build sustainable digital infrastructure in rural areas?

What more needs to be done?

VI. Increasing Provider Adoption

How do current policies work to increase provider adoption of telehealth services in rural areas?

What more needs to be done?

VII. Call to Action: As a public health official or community advocate, you can work to improve the viability of telehealth in your rural community

What can you do to support telehealth in your community?

User Research

Research Methods

Participant Selection

The intended audience for my story is public health professionals and community advocates with ties to rural communities. Unfortunately, I was unable to test the preliminary wireframe with individuals that fit the description. Instead, I selected three individuals that had either a health or policy related background, as public health officials and community advocates tend to have an interest in both health and policy. Throughout the interviews, I asked the participants to imagine themselves as a local public health worker or community advocate and to reflect on the information from that perspective. Additionally, I selected participants with diverse interests and backgrounds to best understand how people may approach the information differently. Participant 1 had a background in mathematics and was well-versed in data analysis as well as health. Participant 2 works in a health-related setting and has a background that focuses more on art and design. Participant 3 compliments the health perspectives with a more general policy perspective, which is useful for understanding how this information could impact community advocates who may not focus specifically on health.

Protocol

To develop a relevant script, I first established what I wanted to learn from the interviews. Ultimately, I composed a list of the five things I was most interested in soliciting feedback on:

With these priorities in mind, I developed a list of questions that addressed the reader’s holistic perception of the story, each individual section, each visualization, and how well the visualizations and sections worked together. The questions are displayed in the interview results table below. To conduct the interviews, I recruited my participants and discussed my priorities for the interview, so that they had these key concepts in mind while reflecting on individual questions. I then asked the participants to read through the wireframe and think about it for a few minutes. Once they had an initial impression, I asked them my interview questions and recorded their responses. I allowed them to continue looking through the wireframe while answering the questions, so that they could directly identify the subjects of their critiques.

User Interviews


Questions
User #1

Gender: Male

Age: 23

Hometown Geography: Suburban near rural

Job: PhD student

Background\Interests: Bioengineering, mobility, mathematics, music
User #2

Gender: Female

Age: 23

Hometown Geography: Suburban near rural

Job: Healthcare customer service

Background\Interests: Art, music, psychology
User #3

Gender: Female

Age: 24

Hometown Geography: Urban

Job: Student

Background\interests: Policy, environmental science, the outdoors

General Questions		      

How would you summarize this story in 1-2 sentences?
If we want to improve healthcare for rural Americans, we need to make telehealth more accessible by building broadband and increasing resources to help them use telehealth.
Rural Americans have poor health, and we need to support telehealth, so they can have better access to healthcare.
Telehealth could help address many of the health disparities experienced by rural populations. We can grow the use of telehealth among rural populations by working to improve digital infrastructure and supporting providers.

Is there anything you did not understand?
Not really
No.
No. It was all pretty clear.

Is there anything in particular that you really liked?
I like the colors that were used. It was really easy to see the differences between things. Also, you kept the colors consistent, which is helpful. It is a pet peeve of mine when people don’t do that.
I liked that there were a lot of visuals. You might want to put some pictures in as well.
I liked the policy aspect and how you showed the reader how they could advocate for large scale policies or pursue more local level efforts.

Health Disparities		      

Why do you think the story includes information on health disparities?
To set up what the problem is, poor health in rural communities, and explain what causes that, transportation, economics, and lack of doctors.
To give you the motivation for the rest of the narrative.
It establishes the problem and the factors that contribute to the problem, so you can put the intervention in context.

What does this section make you think about?
Individuals in rural areas and the struggles they face. Specifically it makes me think about farmers and how they produce so much of the food and other things that help keep us safe and healthy, but we aren’t helping keep them healthy.
I feel bad for people living in rural areas. It is crazy how few health providers are out there.
It definitely reminds me of the broader public health and public policy context. You are looking at rural urban dynamics and there are many disparities that go beyond health itself. It just reminds me of how many little things play a role in health outcomes.

What do you think of the poor health outcomes visualization? How well does it fit in the section? Would you change anything?
The visualization makes a lot of sense and it looks nice. It seems like a mix of different topics though, so maybe they would work in separate plots.
It looks nice, but the scale for the bottom two is ‘soooo’ different from the top two, that it kind of distorts the interpretation. You could split them in two.
I would separate these out. The scales aren’t the same and they seem to address different types of outcomes. Maybe you could find data on a few more health conditions and pair that with diabetes.

What do you think of the provider shortages visualization? How well does it fit in the section? Would you change anything?
There’s a lot more specialists in the urban areas. So few primary care in the rural areas. And that’s, well that’s a big problem. The graph definitely makes an impact.
This one is really good. It gets the point across. I think I remembered it most of all the things in this section.
This one really shows you the huge difference in the amount of providers. It’s a good graphic.

What do you think of the health risk factors visualization? How well does it fit in the section? Would you change anything?
I like it. Is there any way to make the font for the axes darker. The trend of rural having higher risk is very clear.
It makes sense. Don’t have any recommendations there.
‘Obese’ and ‘smoke’ sound awkward. I get what you were trying to do with making the categories sound similar, but it would still make more sense with just ‘obesity’ and ‘smoking’.

Would you change anything about this section?
I would move the last plot above middle plot. It would make more sense in the narrative in my opinion.
Not really.
Change the order of the last two graphics, so the health risk factors are near the poor health.

Telehealth as a Solution to Rural Healthcare Access		      

Why do you think the story includes a section on telehealth as a solution to rural healthcare access?
In order to like tell us a possible solution to help people be healthier and reasons why to pick this solution.
Why telehealth is a good idea.
How telehealth overcomes the barriers in the previous section.

What does the section make you think about?
Makes me think of smart technology and how that could be integrated in rural areas.
That telehealth seems like a straightforward solution to health problems in rural areas.
Telehealth should play a bigger role in rural healthcare as we move forward.

Would you change anything about this section?
No, that looks pretty good. Its fine to me.
Is there any order of importance? If so you could include that.
Maybe make an infographic or something to make it a little more interesting. I don’t know. Like it’s fine, but if you want to make it more fun, pictures or something would help.

Barriers to Telehealth in Rural Areas		      

Why do you think the story includes a section on barriers to telehealth?
To make it clear why rural people can’t necessarily use telehealth right now.
To show that it isn’t as easy as just saying we are going to use telehealth now. That isn’t really practical for some people.
Explain from an infrastructure and provider side why telehealth can be challenging to use in rural areas.

What does the section make you think about?
It makes me think of how frustrating it can be even when you have pretty good internet and your devices are working slow or struggling to connect. Especially like a video call like telehealth stuff usually is.
It makes me sad that rural people can’t access telehealth.
This makes me think that we need to put more focus on telehealth policies that specifically account for challenges in rural communities.

What do you think of the traditional metrics broadband visualization? How well does it fit in the section? Would you change anything?
I like it. I am a little confused about what the colors mean because it says 0-50, but splits in the middle. Interesting take for the story though.
The caption was helpful. I don’t know much about broadband, so at first, I was like, why should I care? Then I read the caption, and it made sense even though I don’t know much about the topic.
It is great except for the legend. I definitely know what you are trying to show, but you really need that middle 25 on the legend. Same for the next map.

What do you think of the proposed metrics broadband visualization? How well does it fit in the section? Would you change anything?
Yeah, I like this one too, but same issue with the legend.
Same as before. Caption is super useful.
This wouldn’t be in the map itself, but could you also do a call out with how many counties flipped. I just think that would be really interesting.

What do you think of the slow adoption by providers visualization? How well does it fit in the section? Would you change anything?
Was confused by the title.

Recommended title change to ‘Urban Providers have been using Telehealth for longer than Rural Providers’
It’s fine. The colors are kind of weird and don’t fully fit with the rest of the sections.
I honestly don’t have much of an opinion on this one. I understand it, and the data makes sense.

What do you think of the provider concerns visualization? How well does it fit in the section? Would you change anything?
Maybe cut a few of the categories that aren’t of interest or something. There are a lot of things to look at here. For example, the ones like technical support that are close together for rural and urban could be taken out. But I’m not sure maybe that’s important.
This looks really neat. Is there a way to show the average percent too? If not, that’s fine. I just think it would be neat.
Can you space it out or make it a little bigger. It looks cool, but its kind of small which makes it harder to read. Other than that, I really like this one.

Would you change anything about this section?
Not a change really, but when you turn it into the final product, make sure to have clear subsections because there’s a lot of info here.
Nothing other than what I already said.
No.

Addressing the Digital Divide		      

Why do you think the story includes a section on addressing the digital divide?
To outline steps that help overcome the digital divide and show strategies that really work.
Tell you what some people have done to try to solve this problem.
To introduce the reader to ongoing policies that address the digital divide and show the reader what still needs to be improved.

What does the section make you think about?
It makes me think we are capable of doing something about these problems.
Big policies and how expensive it is to work on this.
I worry that many communities don’t know about these policies and don’t get the chance to take advantage of them.

Would you change anything about this section?
For thinking about what needs to be done – you could sort of split this into two subpoints. Limitations and next steps/future directions or something.
No.
No.

Increasing Provider Adoption		      

Why do you think the story includes a section on increasing provider adoption?
Steps to improve adoption of telehealth practices among healthcare providers.
Explain how to make it more practical for providers to incorporate telehealth.
To introduce the reader to programs and policies that help providers more sustainably implement telehealth.

What does the section make you think about?
It is frustrating to see how long it took them to put regulations in place and then learn a lot of them are going to expire.
I work in health insurance customer service, and this reminds me of a lot of the changes that have been happening during COVID, and we still don’t really know what is going to happen after all this.
These definitely feel like things a community advocate could get involved in.

Would you change anything about this section?
Same as the previous. Limitations of current policies and future directions instead of mixing them together.
No, I really like this one.
No.

Call to Action		      

Did the call to action seem appropriate for the audience?
Yes.
Yep.
Yes.

Did the call to action make sense in the context of the rest of the story? If so, how well did the story build up to the call of action?
Yeah, it made sense. The story did well in laying out the problem and how we are planning to address the problems, which leads right up to what I can do. Now I could do a bit more research and then go out and make things happen in my theoretical community.
Yep. It totally makes sense. You explain why there is a problem and what you can do about it. Then at the end, you make me feel empowered to actually carry it out.
For sure. Right away, you made it clear we were going to find solutions for our community in the intro. Then you gave a clear problem statement and potential solutions. Once you have the potential solutions, the logical next step is to figure out how to use them, which is what you help with in the call to action.

Would you change anything about this section?
It has been a while since you had a visualization. Could you use an infographic or something?
I would include some regular pictures. Just to keep people’s attention.
No.

Wrap-Up		      

Overall, how well did the visualizations fit in with the story? Did they make the story more impactful?
They did make it more impactful. I really like the consistent color scheme. It makes me happy.
I liked them. They were pretty and made sense. I liked that the titles actually explained what it was showing instead of just being ‘this vs that’.
The visualizations were really good. They emphasized your key points and were easy to understand.

Are there any other data you would recommend presenting or any visualizations you would add?
That last infographic like I said.
Not that I can think of. Just pictures like I said.
Some of the sections that are more policy based than data based could use something visual to help hold your attention. I really like infographics, personally. Like the kind that call out interesting facts. But you could also use pictures or something.

Is there anything else you would recommend changing?
Could you link to the policies, so the reader could learn more without having to go through too much effort.
Nope.
Not that I can think of.

Any last comments?
No.
Nope. That was pretty neat.
That’s all I’ve got.

Reflections on User Interviews

Alignment Between Interviews

Overall, the feedback from each user aligned with the feedback from other participants. In particular, positive sentiments were generally shared among respondents. Additionally, for several of the visualizations, there were shared or similar criticisms. These common themes are further explored in the two sections below. One interesting critique stood apart from the others as it was only held by one user, but that user felt very passionate about it. User 1 was very confused by the title for the stacked bar chart of length of telehealth use among rural and urban providers. The original title was ‘Rural Providers Have Started Using Telehealth in Their Practices More Recently than Urban Providers’. The user was very confused by the title and said it distracted from the data. Specifically, he thought the words ‘more recently’ did not make sense. I discussed this with him and tried to understand the source of the confusion. Working together, we developed a new title for the visualization: ‘Urban Providers have been using Telehealth for longer than Rural Providers’.

Positive Feedback

Implementing Constructive Criticism

My user research interviews helped me identify unclear, confusing, and awkward aspects of my proposed story structure. Reflecting on these criticisms, I planned a series of changes that will help me improve the flow and impact for the final version of my story.

Split and restructure the poor health outcomes visualization

Problem: All three users commented on problems with the poor health outcomes visualization, which consisted of four bar plots, each of which demonstrated high levels of poor health outcomes among rural residents, in a chart grid. The users identified two major problems with the visualization. First, the top two charts are to a different scale than the bottom two charts, which makes the visualization confusing. Second, several of the charts seem to describe different aspects of health outcomes (diseases, vs injury rates) which might me more clear if they were separate.

Solution: I intend to find additional data on a few other health conditions in a format similar to diabetes. I will then use this to make a chart grid where the data is at the same scale and about the same topics, so I can show higher rates of common chronic diseases among rural residents. I will then separate each of the other charts into their own graphic. Each of the other charts addresses a concept that is important on its own. Injury deaths are a notorious problem specific to rural communities that corresponds with the lack of specialists and distance to emergency services. Preventable hospital stays can provide evidence for the economic burden of poor health outcomes. The percent in poor or fair health provides a good introductory statistic as it represents a higher-level view of health.

Reorder the number of providers visualization and the health risk factors visualization

Problem: Two users mentioned these visualizations could be more impactful if the order were switched because the current order slightly disrupts the flow of the story.

Solution: I will switch the order of the two visualizations. Currently, the story discusses health outcomes, then health infrastructure and provider shortages, followed by health risk factors. Health outcomes would flow well into health risk factors as the reader could connect the risk factors to health outcomes that may be related. Additionally, the next section discusses how telehealth would be a good solution for rural communities because it can help connect rural residents to providers outside the immediate area. By moving the provider shortage visualization to right above this section, the logical flow would be improved and the argument for telehealth as a solution would be more persuasive.

Making ‘Telehealth as a Solution to Rural Healthcare Access’ more interesting

Problem: While the users find this section clear and relevant, they recommend using a visual like a picture or infographic because there aren’t any interesting visuals to capture your attention.

Solution: Design a pictographic infographic that utilizes pictures to augment the evidence for telehealth as a solution to rural healthcare access. While I considered using regular images as a background, the list-like nature of this section seemed suitable for a pictographic infographic that utilizes a picture or icon to reinforce each point.

Improve the legend for the maps

Problem: Two users mentioned that the legends for the maps were unclear. They stated that it was not fully clear what number represented the division of categories in the legend, and they felt uncomfortable making assumptions. Additionally, they were confused by the upper limit as it changed between the two maps and did not seem to represent the actual top values present in the map.

Solution: Create a new, more clear legend. The divisions at 25 MBPS and 100 MBPS should be clearly displayed. Additionally, the upper limit will be replaced with the highest value present on the map.

Rename and recolor the length of telehealth use visualization

Problem: As detailed above, one user found the title of this visualization very confusing. Additionally, another user recommended a change in the color scale as the colors seemed somewhat off from the other colors used in the story.

Solution: Since this graphic focuses on digital technology, I will utilize the same teal color I used in the broadband graphic. To focus on this color, I will use a gradient scale with light to dark indicating longer use. This corresponds to the previous utilization of this color to maintain the same theme throughout the visualizations. Additionally, I will change the title to ‘Urban Providers have been using Telehealth for longer than Rural Providers’.

Declutter the dot plot

Problem: Two of the users found the dot plot of barriers to telehealth use somewhat cluttered and found the individual components to be somewhat too small.

Solution: While one user recommended taking some of the data out, each of the points is involved in a trend I plan to talk about. However, I agree that the plot feels cluttered and could be more clear. I intend to increase the vertical spacing and the size of the graphic components, so that they can be read more easily.

Helping the reader discover more

Problem: The wireframe discusses several policies that will be discussed in brief, and users mentioned that the audience may have a particular interest in reading more about these topics. They need an easy way to find more information.

Solution: I will include in-text links to sources about these policies, so that readers can more easily access more information on these topics.

Make the call to action visual

Problem: The final three sections are not very visual, and by the last section, the users indicated they were craving more visuals.

Solution: I create a checklist style infographic to provide a simplified overview of the steps the reader should take to begin helping their community work toward sustainable telehealth implementation. The checklist style of the infographic will connote a series of actions that should be taken which will help remind readers that this is where they get involved.

Include more images

Problems: Some sections, like the policy sections do not have many visuals. The users indicated that sections without visuals felt somewhat dry.

Solution: I will include images throughout the story. I will focus on including images that help establish a mood that focuses on rural communities and their health struggles. Additionally, I will choose images that feature people to emphasize the human and community aspects of this story.