Entrust

Graduate Researcher / Designer / Developer

What is Entrust

Entrust was one of my graduate school projects. It was our entry into the student design competition at the Computer Human Interaction (CHI) conference. We focused on addressing the issues faced by low income HIV+ individuals.

The Problem

Getting infected with HIV no longer means a death sentence. Today about a million people live with the virus in the US (https://bit.ly/2ncxBcK). However, these individuals are on a strict daily medical regimen - the only way to keep the HIV viral load at low levels and prevent it from attacking immune cells (https://bit.ly/2x8hSzj).

Adhering to this regimen is challenging. Many experience side effects from the medications. In addition, the treatment is really expensive. All of these issues are compounded for low income individuals with HIV. We learned first-hand about the challenges they are facing through our visits to HIV care and treatment centers.

Ethnographic research

At the start of our project we conducted several ethnographic visits to an HIV care and treatment center in Des Moines, Iowa. We wanted to hear about the major challenges faced by the community. We learned that the most vulnerable group serviced by the center are low income individuals. I was particularly stricken by stories of people who had become homeless and lacked the basic necessities to cope with their condition. Case managers, professionals who meet with HIV+ clients to identify and meet their individual needs, described this group as the hardest to track and motivate to follow prescribed treatment.

Armed with this information, our team met for several brainstorming sessions in which we ideated on ways to improve the lives of the members of this low income group. Our goal with the proposed solution was to increase their adherence to their treatment plan, increase communication between case managers and clients, and improve the group’s overall well-being.

Service design

We developed an idea for a service that incentivises these individuals to adhere to their treatment plans via use of prepaid cell phones. The service would provide a low income client of a case manager with a cell phone loaded with prepaid minutes. The individual would be able to use these minutes to talk to family and friends but call her case manager for free as part of her treatment plan. If she adheres to her treatment plan, she would be awarded more minutes to use for personal calls.

With this service design, which we called Entrust, we aimed to incentivize low income clients to maintain contact with their case managers. In our research we discovered that cell phone communication has had positive effects on other treatments involving disadvantaged groups, e.g. assisting low-income individuals to quit smoking (https://bit.ly/2qaqW3r). Moreover, we designed the reward - free minutes to talk to friends and family - to be beneficial for the mental well being of the individual by preventing isolation. Isolation has been linked to anxiety and depression, mental conditions that could have detrimental effect on the adherence to a medical regimen.

Low cost phones

Entrust serves two user groups: clients and their case managers. The service would provide low income individuals with feature phones. This type of low cost basic phones would have lower risk of theft or unauthorized resale. Feature phones would also require less maintenance, keeping the overall cost of Entrust low. Case managers will communicate with their clients via text and calls. Automated text messages would remind clients of appointments and community announcements. The cell phones would come preloaded with the case manager’s number and other practical numbers such as pharmacy, physician, employer, landlord, or emergency contact.

Entrust Management System (EMS)

Case managers would manage their clients and cell phones via the Entrust Management System (EMS). We designed EMS to allow sending, receiving, and tracking text messages between case manager and clients. Case managers can also set and change client’s free contacts, add incentive minutes, add client specific notes, register new phones, and review phone usage statistics.

Designing and testing a prototype

I led the EMS design effort and collaborated with another member of the team on the development of a functional prototype. Our goal with the functional prototype was to test the usability and feasibility of the system with potential end users. We tested the prototype with several case managers and graduate students. The system was met with a lot of enthusiasm. Case managers saw a lot of potential in the service and saw how EMS can be beneficial to them as a client management system.

We described Entrust in a paper (https://bit.ly/2yZ42QP) which we submitted to the 2011 CHI conference, the premium conference for academic research around the topics of Human-Computer Interaction (HCI). Our submission was accepted to the student design competition and we were invited to present our project at the conference. We presented Entrust to a panel of CHI judges representing both academic institutions and industry. We were honored to receive fourth place in the competition.