---
title: User Testing for Healthcare
teaser: 'How to navigate sensitive conversations during user testing in healthcare,
  health tech, and beyond!

  '
tags: user research,interview techniques,design,health tech
author: Kelly McCann
published_on: 2020-02-04
---

User testing a great way to supply your team with qualitative data that can
[prove/disprove assumptions] and breathe context into your team’s quantitative
data. The process involves one or two people on your team getting real-time
feedback as a user or potential user explores your product. There’s a ton of
content and resources out there to help you [get started with user testing] at
your company.

Some interviews involve sensitive topics and need special consideration before
jumping in. This is particularly true for healthcare projects, like the ones we
did for [Ieso Health] and [Healthify]. I was recently on a website redesign
project for [Seniorlink], a company that empowers caregivers with the tools and
resources they need to give exceptional in-home care. My team conducted user
testing to learn more about caregivers’ experiences. Before kicking off, we
recognized that our conversations would likely touch on sensitive topics, like
the health of loved ones, choosing in-home or out-of-home care, or quitting a
job to give care full-time. The below tips helped our team navigate topics like
these.

## What qualifies as a sensitive topic?

Sometimes as teams regularly talk about their product, sensitive topics can
become day-to-day business conversations. Try to consider the user testing
conversations you’ll be instigating outside the context of your work. Raymond
Lee's [_Doing Research on Sensitive Topics_] defines three types of sensitive
topics that come up during research:

- An inquisition into areas that are **private, stressful, or sacred**. These
  could include topics like marriage, death, sex, or illness.
- The study of **deviance** and/or **social control**. This could involve
  individuals revealing information that could be stigmatizing or incriminating.
- Exploring “**political alignments**, if ‘political’ is taken to its widest
  sense. This is inquiring about a person’s vested interests in the actions
  and impact of powerful persons/institutions, or how they view the use of
  coercion or domination.

Before your next user testing session, consider if you could be discussing
topics that match one or more of the above types.

## Writing your script/interview questions

Preparing a script or interview questions is always helpful in planning your
conversation. Use this time to consider your question phrasing: **open-ended
questions** empower participants to choose the amount of information they
disclose, and to dictate a vocabulary that feels comfortable to them.

Have extra questions planned should you need them, but expect most of your
questions to take more time than questions around non-sensitive topics.
Diligently prioritize which questions will be of the highest value to your
research, and plan to ask those first.

That said, plan your conversational arc to start with a lower-pressure
introduction. I usually open with “Can you tell me a little bit about you, where
you’re calling from, and what your day-to-day is like?” Often, participants’
responses to this question offer an ‘in’ to ask more specific questions:

- “What does caring for your child entail?”
- “What did that process look like?”
- “How many hours a day do you spend doing _(activity)_?”

![](https://images.thoughtbot.com/blog-vellum-image-uploads/b3MiN9ZPRvCOvyfJXpzG_UXT-Map.png)

On the Seniorlink project, my team initiated user testing by requesting a
participant explain what the word “caregiver” meant to them. In response, most
people self-identified as a caregiver; but some, who spent hours daily giving
care, revealed that they did not identify as a caregiver. Participants’ answers
to this question steered our language and phrasing as we progressed through each
session. Asking this open-ended question prevented us from assigning identities
to people that they didn't agree with.

## Preparing for the user interview

### Gather your materials and study up

Study the subject matter you'll be discussing in the days preceding the
interview. This way, you'll avoid needlessly asking participants to explain
sensitive topics. I like to print my script before interviews so that
participants can see me reference it, even if I’m conducting the interview in a
video call. If a participant looks distressed, I can make a point to look at my
script, say something like, “Thank you for sharing that. I was wondering about…”
This way, I can change the subject without a user feeling like they’re ‘failing’
the user test.

### Find a spot and an (optional) partner

To avoid overwhelming the participant, no more than two people on your team
should participate in the interview. If you are co-facilitating the interview
with someone, make a game plan: assign one person to ask questions and one to
take notes. This way the participant can focus on a single person during the
interview. If you are recording the interviews and/or conducting the interview
via video call, ensure your equipment is powered and working.

Reserve a quiet spot for your interview. If the interview will be conducted in
person, place waters and tissues in the room. Plan for the participant to sit in
a position with a clear view of the door, and for you to sit in a place that is
not blocking the exit. For remote or in-person interviews, if you are in an
office, explain to those in the surrounding space that you’ll be conducting
interviews about a sensitive topic, and ask that noise be kept to a minimum.
Place a note on the door stating that an interview is underway so that no one
accidentally interrupts your session.

### Send confirmation details

Send an email to participants confirming the time, date, and duration of their
interview, and who will be present. In this message, also state your reason for
speaking to them, and what your intention is for the conversation. Something
like, "to learn more about your experience and to see how _(product)_ could help
others with similar experiences." This allows the participant time to consider
what they are willing to share before the interview. When deciding on an
interview duration, allocate more time per session than you normally would. This
allows time for a slower-paced conversation or someone who has a lot to share.

## Start the interview

Take at least a few minutes before the interview to center yourself. Make
yourself some tea, meditate for a few minutes, journal - whatever will help you
channel receptivity and compassion.

If the test is being conducted via a video call, ensure that it is still a good
time for the participant to speak. If the interview is being conducted in
person, situate the participant in the room and check that they have everything
they need. Then, start the interview by thanking the participant for their time
and reintroducing yourself and (if applicable) your teammate. Explain who will
be taking notes and who will be asking questions.

If you are recording the interview, ask the participant if it will be alright to
record the test for note-taking purposes. Specify if you are recording audio,
video, and/or screen interactions, and make sure you’re only recording what you
have permission to record. Then, restate your intentions for the user interview.
On the Seniorlink project, we said something along the lines of: “We’d love to
get an idea of what your experience has been caring for a loved one and how
Seniorlink might be able to help others with similar experiences.”

Finally, address the fact that due to the utility of the product that you’re
testing, topics that surface could be of a sensitive nature. Assure the
participant that they are under no obligation to answer any questions you ask
and that they may skip any questions they wish. Also offer them the option to
end the interview at their discretion.

## During the interview

Practicing [active listening] is 85% of an effective user interview. If you
haven’t, definitely look into exploring and building this skill!

### Go off-script

As with any user interview, some of the most valuable user feedback comes from
unscripted questions. Pay attention to the language participants use, and topics
they continue to bring up. I like to repeat those topics and words back to the
participant, then ask them to speak about them a bit more. Again, open-ended
questions empower participants to dictate both a vocabulary that feels
comfortable to them and the amount of information they are comfortable
disclosing.

### Allow for silence

Establishing a slower cadence in the conversation can diffuse loaded topics. It
also allows participants space to explore their thoughts and responses. During
longer silences, if you feel a participant has more to communicate, consider
asking a question like “Is there anything else on your mind?” Be sure to allow
yourself time for thoughtful responses, as well.

### Keep the focus on the participant

Periodically check in with participants to ask how they are doing, especially if
you sense any distress. Wrap up the interview if the participant becomes visibly
upset. Some people have a tendency to talk a lot when they are nervous; try not
to interject while they speak (you planned extra time for this!). If someone
really derails, wait for a pause, then reference something they said before the
derail to gently guide them back to the topic you’re hoping to learn about.

As you respond to the participants’ offerings, resist the temptation to share a
similar experience you may have had. ‘Piggybacking’ can sometimes register as an
effort to compete with an experience rather than to empathize.

Emotions are part of the human experience. If a participant appears upset in any
way, allow them the space to feel that emotion. Statements like, “Please don’t
cry. It will be okay," are better replaced with a simple acknowledgment of the
person’s experience: “That sounds really difficult. Thank you for sharing.”

## When things get tough

Take a deep breath. However things may have gone awry, remember that whomever
you’re speaking to has plenty more going on in their life outside of this
interview. Whatever is happening, there's a strong possibility that it has
little or nothing to do with you.

Keep in mind that you have no obligation to agree with a participant. If someone
makes a statement or tells an anecdote that you find disturbing or that
conflicts with your values, tactfully continue on. If the participant asks to
know what you think, do your best to deflect: “Sorry, I’d really like to keep
this conversation about your experience. Would you mind telling me a bit more
about... ?” Likewise, avoid offering advice to a participant. If you are
directly asked for advice, aim to present your ideas as possibilities rather
than prescriptions.

Sometimes people don't want to talk: your open-ended questions may be answered
with three words, or a participant may become unexpectedly defensive or shut
down. It's okay. When this happens, you can always thank the person for their
time and end the interview early. If it feels okay, you can also try switching
gears: sometimes asking which products a person most often uses can surface
valuable information about what is important to them. You can also ask what they
like or don’t like about the products they use and when during their day they
use them.

On the Seniorlink project, one participant seemed defensive at the beginning of
our user testing session. She worked long days to care for both her parents and
an elderly neighbor couple that her family had known for years. It was clear
that she cared deeply for all 4 of the individuals in her care. Midway into the
session, she revealed that her commitment to her parents and neighbors had been
questioned on occasion: some caregivers receive government stipends per
individual in their care, and the system was prone to abuse in her area. This is
a great example of how sensitive topics can arise despite planning.

## Wrapping up the interview

Be sure to allow some time for the participant to ask you questions, but don’t
worry about ending the session early if the participant has nothing to ask.
Graciously thank the participant for sharing their time and experiences,
regardless of how you felt the session went.

As you’re synthesizing and presenting your findings, aim to anonymize personal
details about the participants you interviewed, and be mindful of any public
records that could betray participants’ identities.

## Take care of yourself <3

Consider reserving some self-care time yourself between interviews: go pet an
animal, grab coffee with a colleague, journal, take a walk outside - whatever
helps. If needed, work with your manager to revise your approach so that it
feels more sustainable. Other mechanisms of support like counseling are a great
option if you are feeling emotionally impacted by this work.

## Final thoughts

Though this work can be taxing, user testing can also be deeply and wonderfully
rewarding. Through these types of interviews, I’ve had the privilege of hearing
the stories of everyday heroes: folks who manage full-time work and caring for
loved ones, survivors, devoted parents who make it work, and bleeding hearts who
are dedicated to a mission. Most people are eager to assist in building tools
that help others, and in my experience, that enthusiasm can be inspiringly
contagious. So go forth, learn, be inspired, and build some amazing products
that do the world some good <3

A **huge** thanks to [Eric Bailey](https://ericwbailey.design/) for his insights
on this topic! 🙏

[_Doing Research on Sensitive Topics_]: https://books.google.com/books?id=AVW_MGH5ZsIC&q
[active listening]: https://psychcentral.com/lib/become-a-better-listener-active-listening/
[get started with user testing]: https://thoughtbot.com/blog/tips-for-conducting-user-research-interviews-workshop
[Healthify]: https://thoughtbot.com/case-studies/healthify
[Ieso Health]: https://thoughtbot.com/case-studies/ieso-health
[prove/disprove assumptions]: https://thoughtbot.com/blog/test-driven-product-design#figuring-out-if-those-tests-have-passed-or-failed
[Seniorlink]: https://www.seniorlink.com/