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Visualizing Bipolar Disorder

Academic Research

Role:

Lead Researcher (2021-now)

Design Researcher (2020-2021)

Contributions

  • Built and managed research operations planned recruitment and screened participants.

  • Spearheaded semi-structured interviews with 10 participants.

  • Drove data analysis and insight building that guided academic research paper.

Timeline:

Systems Implementation: Sept 2021- Ongoing

Co-Design Study: June 2020- Dec 2020

Team:

1 Lead Researcher 

1 Principle Investigator/Advisor

Advisor: 

Dr. Jaime Snyder, Assistant Professor UW

Goals

  • Validate the themes found in the context study interviews. 

  • Understand which of the three themes do the participants resonate their experiences the most with. ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

  • ​Validate the visual motifs to the theme.

  • Understand how visual motifs reflect the participants lived experiences.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Visual Motifs derived from the first round of studies. a. Tension and Balance through rope, b. Circular growth and change through lichen, c. Water

Concept Testing through

Co-Design Workshops

The participants were presented with three visual motifs, based on the three common themes that came from the first round of interviews (context study). These were, 

  • Water

  • Tension and balance

  • Circular growth and change

Recruitment

The semi-structured co-design workshop was held with the same 14 participants as the last context study. This made recruitment easy but also saved time building context on the progress of the project.

Overview

Our research study focused on building a tool to support people to manage bipolar disorder by using image-making and data visualization as a form of social interaction. We aimed to create a meaningful association of their experiences with visualizations. By adopting a co-design method of design research to ground our understanding of the practices, experiences, and tensions of personal health data of the population.  

Our aim was to create a way for people to reflect on their experiences, communicate with their caregivers, and help them open a conversation with their family and friends about their mental health.

Goals

  • Understanding the medical perspective of BD.

  • ​Studies and research done on the experiences of people with BD. ​​​​​​

  • Recognizing the difference in lived experiences of an individual living with BD. 

Bipolar Disorder

Bipolar disorder(BD) is a Serious Mental Illness (SMI) characterized by severe and unpredictable mood swings(i.e., episodes of depression, mania, hypomania, and mixed states). People managing BD experience heavy mood swings and energy flux that can be difficult to control. 

While there are prescribed medications and therapies for bipolar disorder, self-managing bipolar disorder is essential. This involves documenting behaviors and daily patterns of sleep, exercise, and social interactions. Self-management involves not just self-reporting but also evaluating and recognizing shifts in your pattern that might happen. This requires a very personal and deep understanding of factors and its impact on oneself.

Experiences with bipolar disorder are classified into three types, based on the changes in mood, energy and activity levels.

  • Bipolar 1 Disorder: Person experiences sever manic episodes that last longer than their often, shorter and milder depressive episodes. 

  • ​Bipolar 2 Disorder: Person experiences a sever pattern of depressive episodes and hypomanic episodes but not sever manic episodes. ​​​​​​​​​​​​​​​​​​​​​​​​​​

  • ​Cyclothymia: Person experiences hypomanic as well as depressive periods that each last a long period of time. When a person goes through these in short periods of times, it's called rapid cycling. ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Onboarding (Secondary Research)

Understanding Bipolar Disorder.

Before engrossing myself into the project, I had to broaden my awareness of the spectrum of lived experiences, build an understanding of the medical treatments and assessments for placing an individual on the spectrum, recognize the different lived experiences of an individual living with bipolar disorder

Methods

I spent three weeks, on secondary research, grounding my understanding of my participant's experiences through bibliographies and books written by people with bipolar disorder and detaching my normative lived experiences from the project. My major sources of reference were, 

  • Academic Papers

  • ​Bibliographies written by people with BD​​​​​​​​​​​​​​​​​​

  • ​Context Study (14 interviews with people with BD talking about their experiences)​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Illustration: My Experiences, My Own Words (nami.org)​

Co-Design Approach

Co-design is a research based design method involves the end users at every step of the process starting from framing the problem space, design research to systems implementation. This co-creation approach helps researchers ground their insights and design decisions through continuous critique from the main stakeholder. We broke down the research process into three steps, 

1. Context Study (Foundational Interviews)

2. Co-Design Study (Concept Testing/ Co-Design Workshop)

3. System Implementation (Usability Studies)

Co-design is a research based design method involves the end users at every step of the process starting from framing the problem space, design research to systems implementation. This co-creation approach helps researchers ground their insights and design decisions through continuous critique from the main stakeholder.

Research Operations

Consensus Building through Prototype Implementation.

Recruitment Operations

For this round of studies, we are recruiting 10 participants for a 60 min session.

I started recruiting for the study through flyers and cold mailer messages to local communities and social channels. 

  • Flyers: I posted physical flyers across campus medical centers and counseling centers as well as UW Medicine. 

  • Cold Mailers: I sent out cold mailers to organizations and social communities (both local and online) like NAMI Seattle Chapter and Reddit ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Participant Criteria

For the usability study, I recruited indivisuals with bipolar disorder that, 

  • Are at least 18 years of age or older. 

  • ​Are willing to talk about their experience with bipolar disorder. ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

  • ​Have not been hospitalized for mental health issues within the last six months, and do not have any serious substance abuse issues.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

All participants were screened through a phone interview by me. I got verbal conset to conduct the phone screener, asked 5 yes or no questions that helped us decided if they qualify for the study or not. At the end of the screener, we set a time and date for the interview. 

In a 60 minute interview, I asked my participants to reflect on their experiences and activities through the visualizations presented to them and provide honest feedback. 

IRB Protocol Requirements

The study involved a systematic investigation, for academic purposes with a vulnerable population of human subjects. I filed the paperwork needed for approval from Institutional Review Board for conducting research with participants. 

The IRB protocol was approved without the need for any revisions to the study plan. 

After building our visual schema, we had to test the feasibility of the schema as a cadence mapping tool for our target population. We wanted to validate our conceptual and logical design we've created so far, we invited participants from o

Goal

The objective of this test research is to get a user feedback on the design and find out the following​

  • How do our participants visualze their personal data points in a lichen visualization? 

  • Do participants visualize themselves as a single lichens in an ecosystem or multiple lichens representing different data points in an ecosystem? ​​​

  • How important is the ecosystem in building emotional affinity towards the visualization?​​​​​​​​​​​​​​​

  • ​What mechanism of change represents change in data? time or locus or growth?​

To Investigate- 

  • The reflective symbolism of lichen. 

  • ​The degree of illustration participants consider lichen. ​​​​​​

  • The interpretation of change in variables.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Prototype Building

Understanding Implementation through Prototype

The low fidelity design vs the high fidelity design for the changing variables of a lichen.

To Investigate- 

  • The degree to which this modality can support an individual as they introspection.

What I saw was, participants at this stage would move the toggles to explain their experiences with the different experiences with bipolar disorder. This became a useful way for them to share their experiences.

Dynamic Prototype

Interactive Site with Toggle

For the dynamic model of the prototype, I collaborate with a software engineer to build a p5.js interactive model with toggles which the participants can change the variables. 

I treated the visual schema as my first iteration of low fidelity prototype. Those low fidelity designs then became my inspiration to create higher fidelity prototypes I can put in front of participants. 

To achieve the primary goal of this study it was important to let the participant interact with the prototype. I wanted to create a dynamic version that the participant can toggle and visualize the change in real time.

Throughout the interview, the participant got a chance to visualize change to toggle through a low fidelity dynamic prototype and then connect to the lichen imagery through the high fidelity static prototype.

Static Prototype

Digital Designs of Change

Using the visual schema as a skeletal, I designed digital drawings to represent the change in visual variables. 

The high fidelity prototype with different energy, sleep, mood and engagement levels.

I broke down the schema based on visual variables, representation of time and data control and access. 

  • Visual variables, the dynamic movements of the lichen based on participants reflection of the visual imagery. 

  • Locus of change, there were multiple ways participants visualized time and the changes through time in the lichen imagery. ​​​​​​​​​​​​​​​​​​

  • Data control and access, understanding the baseline direct access and manipulations participants require to personalize their experience.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Primary Analysis

Building a Lichen Design Schema

Once I had a clear visual motif, the next step was to create a design system around the visual motif. I went through the interviews again to focus more on participants reflection. The aim of this analysis activity was to build a design schema, first  ​

Design Space Matrix

The first step was to find all common themes, all metaphors, reflections and connections participants made into a spreadsheet to create an understand of the all the moving parts of the design system.

I created a design space matrix in collaboration with the PhD scholar.

Lichen Design Schema

After finding the common themes and setting them in a system, I went through multiple iterations of visual system designs, trying to understand the best fit.

Representation of time has consistently been an important parameter for this population. They do not associate to the normative linear understanding of time. 

For the visual schema, we focused on understanding the movement of different visual variables across different locus of change. The first two locus of change are based on lichen's lobes. A lobe is the flattened branch, that a lichen uses for propagation and growth. The three prominent locus of change being, 

  • Center of the lichen: Changes are reflected the center/ innermost locus of the lichen.

  • Edge of the lichen: ​​​​​​​​Changes are reflected the edge/ outermost locus of the lichen.

  • ​Lichen in relation to its environment: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Changes on the lichen are a reflection of its surroundings.

I synthesized and designed the visual schema that was the foundation for the prototype for systems implementation study and design system.

Image of a Lichen

Lichen sharing a symbiotic relationship with its surrounding.

Initial Sense-Making

Lichen and Bipolar Disorder

Out of the three visual motifs presented to the participants, most responded well to the circular growth and change pattern visualized through a lichen. This finding validated the insight from context study, participants don't see their time as linear, but cyclical between their two, manic and depressive episodes. 

Our participants heavily reflected on lichen's relationship with its surroundings, the sudden contrast between its dormant state and flourishing state and its resilience against conditions or factors that other species can't withstand.

Here are some common themes our participants gravitated towards when talking about their experiences in regards to the lichen imagery.

What is a Lichen?

Exploring Lichen in Nature

Lichens are not plants or animals but a partnership between, a fungus and an alga. They are living, breathing, growing, reproducing, complex organisms. They grow on tree barks, dead organisms and thrive in humid climates. Lichens are a very common site in the pacific northwest of the United States. 

There are about 1700 species of lichen worldwide. There are three main types based on their growth form, 

1. Foliose, flat, convoluted structure full of ridges.

2. Fruticose,  have a pendant or hairlike structure.

3. Crustose, crust over the surface it grows on.

For the visual motif, we chose the foliose lichen. The flat, convoluted structure with ridges imitates the circular growth imagery participants resonated with the most.

Lichen Imagery

Symbiotic Ecosystem and BD

Lichen shares a symbiotic, mutually beneficial relationship with the environment around it including the surface it grows on, the other plants around it, the insects, basically the symbiotic relationship with the whole environment. 

Participants reflected on their experiences and how their environment; both social and physical impacts the way they feel. (add example quote-ish)

"I see my family and two friends that as closets, but then it's everyone around me and everyone kind of falls into my ecosystem."- P6 

"My friends keep a check on me, sometimes when you are manic. You need someone to tell you." - P2

Lichen Imagery

Lichen Growth Edge and BD

Lichen are resilient, they grow differently in different parts of its form under a lot of different circumstances. It’s called growth edge. So, each of these lobes can kind of grow and change on its own and one side might be flourishing while the other is kind of lying dormant. 

Participants spoke about the different lobes or edges of the lichen representing the different parts of their lives. These different parts are never flourishing or dormant at the same time. 

"This almost feels like me, I wake up not wanting to talk to people but still wanting my family around." - PO

"The chalky side reminds me of my depression"- P3

Lichen with a Growth Edge

System Implementation

System Implementation is the activity of creating a blueprint of the new system. Through this part of the process, we would be breaking down the

  1. Conceptual Design: Defining how the information should be visualized, defining the baseline assumptions.

  2. Logical Design: Validating the design system created based on the two previous rounds of research.

  3. Physical Design: Validating the form of technology for the system.

I was the lead research for this iteration of the research. I was responsible for the entire process from building a research plan, applying for an IRB, managing research operations and participant recruitment to conducting interviews and data analysis with the principle investigator.

We ran three rounds of participant interviews and workshops, I joined during the second round and led the third round of research.

My Role

I joined the team as a design researcher during the co-design study, playing a major role in building the design schema. I led the primary research for systems implementation, from building and iterating on concept designs to conducting the concept validation studies. 

In this case study, I will walk you through my onboarding onto an already ongoing project and the work I did in the co-design  as well as systems implementations phase. 

Co-Design Study

This round of research derived insights from the visual elicitation activities and participant discussion throughout the context study to build three visual motifs that resonated the most to their lived experiences. For the co-design study, we invited the same 14 participants to evaluate the visual motifs and reflect on their experiences through the changes in the motifs. 

We are Currently Recruiting!

I am currently recruiting participants for this study. Please reach out if you are an individual living with bipolar disorder and, 

  • Are at least 18 years of age or older. 

  • ​Are willing to talk about their experience with bipolar disorder. ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

  • ​Have not been hospitalized for mental health issues within the last six months, and do not have any serious substance abuse issues.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

To qualify for the study, you can set up a 15 min phone screener with me by reaching out to me at nikita98@uw.edu

This would be a 60 mins virtual conversation and as a token of appreciation for your time, we would be offering a $20 e-gift card to every participant.

Next Steps

Current Progress

I am current actively recruiting and conducting testing with the low-fidelity prototypes. 

This round of research will inform the systems blueprint of the product. Our overarching goal is to understand,  

  • How participants visualze their personal data points in a lichen visualization.

  • Understand if participants see themselves a single lichens in an ecosystem or multiple lichens representing different data points in an ecosystem. 

  • Does the ecosystem surrounding the lichen(s) promote emotional affinity towards the visualization?​​​​​​​​​​​​​​

  • ​Through their continuous reflections, I also want to understand the mechanisms of change that represents change in their data. 

© 2022 by Nikita Nerurkar. 

Education

Other Projects

Design, Technology & Social Innovation Workshop 2020

MIT India Initiative | 2020

Inchin Hackathon

Makers Asylum, Mumbai | 2020

Master of Human Computer Interaction and Design (MHCI+D)

University of Washington, Seattle

Bachelor of Technology in Electrical and Instrumentation Engineering

Birla Institute of Technology and Science(BITS), Pilani

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