Case study
Home Hemodialysis 2.0
A mobile app prototype designed to enhance the home hemodialysis patient experience, using interactive games, AR-assisted needling training, and gamified learning to help patients choose and sustain home dialysis independently.
- Role
- UX/UI Design · UX Research · Human-Centered Design
- Timeline
- Academic project
- Tools
- Sketch · InVision · Adobe XD · Photoshop
- Outcome
- AR-assisted home dialysis training
- HealthTech
- Clinical UX
- Mobile
- AR
Overview
Home Hemodialysis 2.0 is a mobile app prototype for patients who dialyze at home. The goal was to give patients a safe, low-stakes environment to learn the full dialysis process before in-clinic training begins, using the waiting period on the home dialysis waitlist as a pre-training phase. Interactive games, AR-assisted needling practice, and step-by-step monitoring modules replace the existing instructional manual, which patients consistently described as impossible to use.
Problem & UX Research
Based on patient feedback and stakeholder interviews, the foundational problem was the existing instructional manual, not updated in years, dense with medical terminology, and impossible for a non-medical person to follow. But the manual was only the entry point. User research revealed the real problem space was significantly broader.
What Patients Were Experiencing
- Machine setup tube connections were manageable for experienced patients, but self-needling was consistently cited as the most challenging and anxiety-inducing step.
- Reading the manual while simultaneously connecting the machine was physically and cognitively impossible for most patients, the steps were not easy to remember.
- Troubleshooting guidance in the manual was incomplete: it did not cover all reasons an alarm might sound, leaving patients stranded when something went wrong.
- Cleaning procedures were taught once and rarely reinforced, patients felt uncertain about correct sanitisation steps between sessions.
Direct Patient Voices
"I did not find much difficulty in machine setup tube connections but as a newbie, I experienced difficulties in troubleshooting, needling, and cleaning processes. In particular, the self-needling was challenging." , John Brown, new home hemodialysis patient, St. Joseph's Healthcare Hamilton.
"I do the connections by reading the instructions from the manual. I find it hard to read and connect the machine simultaneously. Since the steps are not easy to remember." , MarieAnne, wife of in-clinic training patient Paul.
Strategy & Discovery
Design Thinking methodologies and Human-Centered Design principles were applied throughout. The analogies approach was central, structuring and developing insights from the patients' perspective to ensure the solution was relatable rather than imposing new complexity on an already-stressed population.
Stakeholder Map
Stakeholders were classified into two categories. Primary stakeholders, nurses, technologists, patients' family members, and programme coordinators, directly benefit from the project. Secondary stakeholders, nephrologists, OHIP, and psychiatrists, benefit indirectly.
Design Process
Analogies and Ideation
To explore the breadth and depth of the design challenge, analogies were used to ensure the solution was built from patients' existing experiences rather than imposing new mental models. Three analogies shaped the entire design direction.
- Trying a MacBook in an Apple Store, the application gives patients a safe space to experience the dialysis process before their actual training begins.
- Learning by Playing, interactive game levels replace passive manual reading, helping patients learn faster and remember steps more reliably.
- Training Wheels, a pre-training phase during the wait time prepares patients emotionally and mentally before in-clinic training starts.
Machine Setup
Machine setup was the foundational step in the dialysis process. The game presents patients with an interactive image of the machine and all required tools. Instructions appear step by step; completed steps turn green. Patients drag tools to their designated locations in the correct order, building procedural memory through repeated interactive practice rather than passive reading.
AR Needling
The needling process carried the highest anxiety for most patients. The design used augmented reality to give patients the felt experience of injecting themselves before they ever needed to do it for real. Storyboards defined the correct needling order, gauze, medical tapes, needles; correct arm locations, and stakeholders reviewed accuracy at every stage. Stakeholders were enthusiastic: AR could teach the real feel of needling and help patients overcome fear through repeated safe exposure.
Treatment Monitoring
Treatment monitoring covered two areas: pre-dialysis sanitisation protocols and what to monitor during the session. Patients could tap on signs, redness, swelling, heat, tenderness, drainage, to understand what might be wrong and how to respond. A second section showed key numbers to monitor during dialysis: blood pressure, fluid changed, fluid remaining, and blood flow.
Troubleshooting
The instruction manual's troubleshooting section was incomplete and misleading. The design replaced it with an interactive alarm response system: when an alarm sounds, a list of possible reasons appears. Patients tap the most likely cause; the list collapses to focus on that problem. They follow step-by-step resolution guidance from an in-app binder. A quiz game then lets patients test their knowledge by ordering correct resolution steps and eliminating incorrect choices.
Cleaning
Cleaning covered both patient sanitisation and machine sanitisation after each session. In addition to instructional videos, two interactive games reinforced the steps. In Game 1, patients drag tools toward a dustbin, the bin changes colour and opens for correct tools. In Game 2, patients work through situational scenarios to reinforce safety and health practices. Stakeholders confirmed that these games covered everything patients needed without requiring additional training.
Results & Clinical Impact
Wireframes were built and tested with patients across the machine setup and AR needling stages. Prototyping and testing confirmed that the interactive format significantly outperformed the manual for learning retention and emotional preparedness.
- 5
- Dialysis process stages covered: machine setup, AR needling, monitoring, troubleshooting, cleaning
- AR
- First application of augmented reality to home hemodialysis patient training
- ↑
- Patient confidence and readiness scores vs. manual-only training in prototype testing
Learnings
- The scope of a clinical UX problem is almost always broader than the presenting complaint. What looked like a manual readability issue revealed five distinct failure modes across the entire dialysis process.
- Emotional safety is as important as task completion in clinical contexts. The AR needling feature worked specifically because it addressed fear, not just procedural knowledge.
Conclusion
Patient experience in clinical settings is an education and trust problem. The instructional manual failed not because patients couldn't read, but because it asked them to learn complex procedures passively, in isolation, without repetition or emotional scaffolding. Stakeholders at St. Joseph's confirmed it: patients who arrived at in-clinic training having already practiced through the app came in prepared, not anxious. That's the goal.
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