Veteran-centered Design of a Post-Traumatic Stress Disorder (PTSD) Tool: Qualitative Analysis of Interviews with Veterans

Many veterans from recent wars are suffering from Post-Traumatic Stress Disorder (PTSD). PTSD is a mental health disorder or an anxiety-based psychiatric condition developed after witnessing or living through distressing events along with feelings of fear, helplessness and horror. Technological interventions have been discussed as viable treatment alternatives in the recent literature (Henderson, Davis, Smith, & King, 2014; Majerowicz & Tracy, 2010), but only a few have been validated using formal human factors and usability engineering methods, and integration into clinicians’ work remains an overall gap (Rodriguez-Paras et al., 2017). The overall scarcity of literature on PTSD-supportive technologies or tools can be traced back to the complexity of PTSD care and lack of a systems perspective and user-centered design approaches. With a combination of coordinated and ad hoc efforts to meet the demands, the current PTSD care system has naturally evolved into a highly complex socio-technical system with multiple stakeholders. To design a tool to fit in the existing care system, it is imperative to first address the system’s complexity from the perspectives of both end-users, i.e., healthcare providers and veterans with PTSD. The lack of systems perspective in currently available tools, which could lead to a loss of potential opportunities for improvement, is partly due to the absence of clear understanding of the current PTSD care system for veterans to inform the design of such tools (Moon, Smith, Sasangohar, Benzer, & Kum, 2017). As an initial effort to address such a research gap, this paper investigates veterans’ perspectives on improvement areas in the current PTSD care system and how these areas can be addressed with potential technologies or tools. Findings from recent interviews with clinicians suggest that the current system lacks consideration of the unique characteristics of veterans with PTSD and lacks treatment control in-between sessions (Moon et al., 2017). Building on these findings, this research aims at (1) understanding the unique behavioral and attitudinal characteristics of veterans with PTSD, (2) identifying improvement opportunities in overall PTSD care processes or pathways (especially in-between sessions), and (3) deriving functional requirements for PTSD treatment-supportive technologies or tools. This paper documents our findings from an iterative qualitative data analysis (QDA) of iterative semi-structured interviews with 20 veterans diagnosed with PTSD. The interviews were transcribed, coded, and analyzed by two coders using MAXQDA-12, using the general thematic analysis approach containing three phases of sense-making which seek to refine themes and model relationships among interviewee responses (Bryman, 2015; Corbin & Strauss, 2015): initial coding, focused coding, and modeling relationships. A highlight of findings is presented as emerging topics pertaining to our three aims. (1) To be compatible with veteran world-outlooks and daily lives, design solutions must understand their unique behaviors or attitudes. Three topics emerged as follows: Topic 1: Social Isolation. Topic 2: Avoid/Leave Situation. Topic 3: Breathe and Calm (Refocus). (2) Interviews led to some holistic observations regarding opportunities in the “overall PTSD care process”. Findings can be categorized into two groups: those pertaining to a veteran’s regular psychotherapy appointment (i.e. “treatment”), and those during times and places between these appointments; and two topics: Topic 4: Disconnect from the Therapist. Topic 5: Hyperarousal Triggers. Findings suggest hyperarousal triggers inhibit quality of life by encouraging avoidance, high perceived value of welltimed alerts, and a need for closing a disconnect between clinicians and their patients. (3) Veteran feedback was used to explore functional requirements for potential PTSD treatmentsupportive technologies or tools. The word “functional” demonstrates our pursuit of an objective assessment that reveals “solution-neutral” functions, thereby informing design decisions about how systems or solutions can fulfill these functions. The following topics represent veteran responses to direct inquiries about what functions may be useful in a supportive technology: Topic 6: Warn/Intervene for Hyperarousal Onset. Topic 7: Peer-to-Peer (P2P) Connection. Topic 8: Clinician Support Function. Findings will inform the design of supportive solutions to connect patients to peers, report crucial information to clinicians between sessions, and leverage breathing or meditation exercises to encourage healthy refocus. The QDA topics synthesize veteran responses to interview questions and offer some valuable insight into their lives. Also, the exploration of behaviors and attitudes through modeling relationships between their responses allows creative insights to emerge, e.g., potential avenues for follow-up questions or refreshing new perspectives. This opens the design space beyond the boundaries of our requests for direct feedback. Findings are expected to inform the process of designing novel PTSD treatment-supportive technologies and enable them to be better integrated with the current care system. While the findings documented in this paper contribute to further understanding how to design solutions for those veterans afflicted with PTSD, future work must go towards exploring how these insights can be operationalized and evaluated.