Insight from patients with breathing issue

Insight from patients with breathing issue

This project start from a design workshop with NHS and STEAMhouse. We had a research session with patients and physiotherapists to have a better understanding of their frustration in different situation. The aim of this project is framing a potential design approach to improve users problems.


Shadowing and Interview

We spent 2 hours shadowing with patients (who have breathing issue) and see their routine of dealing with their breathing issue. After that, we had an interview with a respiratory specialist physiotherapist to have another point of view about how they provide Instructions and how they manage their patients.

Patients need to do a breathing exercise called the Active Cycle of Breathing Technique (ACBT). We map out the process in detail of ACBT and compare it to their exercise instruction, and we end up spot some pattern of how they get into a misunderstanding.

Case Studies

There are three patients in different scenario of their ACBT progress. We have a close look on each one with the physiotherapist in order to get some specific insights from those particular user cases.

#1. The Beginner

User Case

“I am new to ACBT. I am still learning it based on the instruction but I am confuse when there are some optional steps when I get into the second round, I am not sure if I need to do that or not.”


🧑‍🦳 Anna (Patient)

👩‍⚕️ Amy (Respiratory Specialist Physiotherapist)


The reason of the confusion came from the instruction of ACBT. Patient can book a video section for learning ACBT but some of them might not be able to attend that. It is not clear enough for patient to just read the instruction for learning the exercise specially when there are no physiotherapist around to monitor them.

understanding monitoring

#2. The Special Case

User Case

“I am a special case as I cannot do a deep breathing as long as normal patient. I adjusted my exercise with Physiotherapist but sometimes I just not sure if I am doing it with the right timing or I would just forget to stop the action sooner, my chest would be in pain because of that.”


👨‍🦳 Joseph (Patient)

👩‍⚕️ Amy (Respiratory Specialist Physiotherapist)


It is hard for physiotherapist to track if patients are doing on time and if they are doing it properly when they are at home, specially some of them need a custom adjustments for the ACBT. Those special case needed to be monitoring precisely as patients might damage them self by doing the exercise in a wrong way.

monitoring communication

#3. The Frequenter

User Case

“I know that it is important to do the ACBT, which I need to do it 4 times per day. However, sometimes I just don’t know if I do it right or not unless I book a section with my Physiotherapist and she would tell me if I am doing it right.”


🧔‍♂️ David (Patient)

👩‍⚕️ Amy (Respiratory Specialist Physiotherapist)


Patients can book a video section with Physiotherapist to assess and evaluate their performance of doing ACBT. However it is a huge time investment for both patients and physiotherapist, as patients need to do ACBT 4 times (or more) per day while physiotherapist need to monitor multiple patients at the same time.


We observed the pain points from patients and physiotherapists in the research session in order to get more insight from both perspective for the context.

Based on the discovery from different perspective, we focus on how to capture the breathing data from patients in an affordable way.


The Problem

We choose to focus on monitoring as our first priority. The problem is patients cannot measure if there are any timing errors from their breathing actions. Furthermore physiotherapist can only spot errors from patients breathing actions by video calls, which is not specific enough.


We believe by recording and presenting the length of breathing actions (in an affordable way) will help patients and physiotherapists to improve the understanding of their ACBT performance, and also help them to spot mistakes easier from the breathing actions.

We know this would be true when we see

  1. Patients can evaluate their breathing actions their own.
  2. Physiotherapists can compare patients performance with the ACBT standard

There are professional machines, which can collect different breathing data from patients. However we found out that it is too expensive and too complex to set it up for most patients, as some of them would need to work as normal just like us. They need something simpler that they can use it without a heavy setup.


Pattern and Timing

The aim of the function that we design is capturing the breathing pattern and timing when patient is doing the ACBT. We simplify the breathing actions by breaking it down to provide a better focus while they are doing each breathing actions. At the same time, that would help us to collect data specifically in each steps.


Principal and Criteria

There are a lot of existing products provide guidance for users to follow a particular breathing pattern. However, we need more specific data so both patients and physiotherapists can analyse and evaluate each of the breathing actions. In order to achieve this goal, they need something which is:

Measurable - They need a tool that enable to present data to them so they can compare their performance to the standard.
Recordable - They need a tool that can record their breathing data in a way, which is specific but flexible.
Noticeable - They need a tool that can capture breathing data, which is significant enough for them to notice and spot the exact breathe timing.


We focus on collecting the data of how long for each of the breathing actions specifically. We need a trigger for patient to start and stop “recording” each actions. Based on our principals, we defined that mapping patients’ breathing actions to the affordances of using mobile device would be useful for collecting and presenting the data. This solution provides a more sustainable and affordable way for patients and physiotherapist to evaluate the breathing exercise.


We test the solution with patients and physiotherapist to prove our hypothesis. We made a quick prototype in order to see if the function is achieving our goal.

Based on the insights from testing, we evaluate our idea with them so we can see the impact of the function and what we need to be improved.


Breathe and Tap

We record patients’ breathing actions by their affordances. They tap on their screen and hold while they start taking action, then they release their thumb once they finish the action. Once they get used to the mechanism, this direct mapping help them to collect their breathing data and present it on the screen.


The Comparison

By comparing the breathing data with the standard, patients can spot errors from the exercise and evaluate their own performance. On the other hand, physiotherapists can based on patients performance to adjust the standard timing and reflect it with them right away.


The Results

Participants' impression of the function

Patients and physiotherapist can spot their errors from the ACBT exercise by comparing their data to the standard.

Participants describe the purpose of the function

I can see if there are any wrong timing or delay of the breathing action. So I can know how “good” I am.

Success Rate

3/3 patients completed the task (they need extra 10 mins to practice their muscle memory to synchronise their breath and their thumb)

Both patients and physiotherapist think this could help them to evaluate their ACBT performance

Increases of understanding

They understand their performance and they will know that they are improving when they see the reduction of errors.

Things to inform future design decisions

The mapping between breathing actions and affordance is working but it need some time for patients to practice their muscle memory to synchronise their breath and their thumb. This tell us that we will need to make sure we provide a clear on boarding instruction for users to “warm up” when we design the product.

Area for further research

How might we better present patients’ performance on their device?
How we can cooperate with their tools while they are doing ACBT?
How we can provide better management for physiotherapists to consult their patients?

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