Zócalo Health

Researched the experience of Latino millennials navigating the American healthcare system to support the improvement of Zócalo Health, the first culturally-aligned telehealth experience for Latinos in the United States.

Company: Zócalo Health
Domain: Telehealth
My role: UX Researcher  | Team: Fernando Suarez, Funke Alliyu, Kat Iberer 
Skills: Generative research, evaluative research
Timeline: 10 weeks [Ongoing project]

Zócalo Health is a virtual family medicine service specializing in culturally-sensitive care for the Latino community. They’re on the mission to eliminate barriers to healthcare access by offering same-day appointments and emphasizing long-lasting relationships over one-time transactions.

Our team conducted UX Research to better understand the problem space Zócalo Health is navigating, identifying opportunities for improved user experience and business outcomes.

Zócalo Health

I contributed as a UX Researcher designing a study plan with a mix of methods including semi-structured interviews and service safaris.

Made affinity boards, distilled insights and created personae and customer journey maps to better communicate our research findings to our stakeholders.

Presented the Zócalo Health team with actionable opportunities and low-hanging fruit to improve their current experience.

My contributions

The problem space

Zócalo Health seeks to improve the healthcare experience of Latinos in the United States through their culturally-aligned telehealth service.

In order to gain better understanding of the problem space, we began consulting academic research papers on the experiences of the Latino community navigating healthcare services in the United States. Our comprehensive literature review revealed the following:

  • Familism, a cultural value that highlights the significance of family connections and duties in Latino communities, plays a key role in healthcare. It provides Latinos with emotional and financial support when dealing with health challenges, aiding in reducing health risks and bettering health outcomes.

  • Cultural competency in healthcare entails behaviors, attitudes, and policies that facilitate effective cross-cultural interactions. This includes a diverse staff, language-specific services, culturally aligned materials, and culturally specific healthcare settings. These culturally competent services can enhance health outcomes, increase staff efficiency, and boost client satisfaction, while addressing barriers to various types of healthcare.

  • Patient trust in a physician is an expectation and feeling of reassurance or confidence in the doctor. It is a mutual agreement for both parties to perform agreed-upon activities without fear of change. Trust is especially important in healthcare provider-patient relationships characterized by limited choice or power imbalance. It involves the expectation that the healthcare provider will act in the patient's best interest and with goodwill, recognizing their vulnerability.

Research

Research questions

How do bilingual Latino millennials navigate and make healthcare decisions for themselves and their families in the United States?

  • How does culture and family dynamics impact the healthcare experience of Latino millennials?

  • What are the barriers and enables Latino millennials encounter when trusting healthcare services? What, if any, current solutions exist to this challenges?

  • What is it like to be a Zócalo Health member?

Research roadmap

Methods

We opted to conduct semi-structured interviews given their qualitative nature to learn more about the unique, subjective, experiences of participants. This research method provides reliable data and the flexibility to ask follow-up questions. The team conducted a total amount of thirteen interviews, all remotely through Zoom.

Goal: Understand how participants navigated decision-making in healthcare in the United States, within and beyond Zócalo Health.

Semi-structured interviews

We prioritized service safaris given their ability as a service design research tool that supports the development of insights and inspirations by experiencing a service in first-person, as if we were 'in the shoes' of a user. Four service safaris were done, two per each of the core user journeys Zócalo Health.

Goal: Understand the journey of incoming members enrolling in the service and identify potential user pain points and opportunities.

Service safari

Participants & recruitment

We recruited six participants. Our inclusion criteria included identifying as a Latino, being a millennial, living in the United States, and to have sought healthcare services in the past six months. We recruited participants designing a screening questionnaire and sharing it through social media in relevant Latino channels.

Latino millennials in the US (Non-members)

Latino millennials in the US (Members of Zócalo Health)

We interviewed four Zócalo Health members. In the first three cases, they had received care from Zócalo Health in the past one to three months. They were all women and identified with the millennial and X generations. Participants were recruited through an internal email sent by Zócalo Health.

We interviewed three female subject matter experts who are part of Zócalo Health. The roles they perform are the ones of Chief Medical Officer, Doctor, and Promotora de Salud. The outreach was done through Mariza Hardin, Zócalo Health’s COO.

Subject matter experts

Insights

  • Latinos have healthcare expectations embedded in their culture encompassing individualized care that integrates active listenings, probes for medical history, fosters a sense of familiarity and trust, avoids using complicated jargon, and answers follow-up questions. Integrating these characteristics in the care that is provided results in an increased level of trust, and enhanced sense of cared, an improved patient satisfaction, and overall better health outcomes.


    “I once went to the doctor and I was expecting the doctor to ask me about my diet, or if I was on birth control. Instead of asking me any questions, they immediately prescribed antibiotics to me. I remember feeling like they didn't ask me anything. How do they not know, other areas of my life aren't affecting my [health condition]. I think if a doctor takes a more holistic approach, I would feel more trusting.”

    -Latina millennial (non-member)

  • Many Latino individuals often experience overwhelming challenges when navigating the US healthcare system, tending to rely on family members for assistance, which places on an additional burden on them as they also lack understanding of the system. Zócalo Health effectively addresses this burden through culturally competent care; however, the remote nature of telehealth and technology barriers exacerbate the burden felt by patients and their families, particularly impacting older populations.

    “...about the older populations, sometimes I know they don't have family, they live on their own. And they usually say something like, ‘Oh, yo si soy bien malo para la tecnología. Yo nunca he tenido un teléfono, o iPhone, no sé ni qué es eso.’ And I'm like, okay, you're gonna need help with this.”

    -Zócalo Health team member

  • Latinos with a reactive mindset tend to overlook telehealth, perceiving it as an inadequate solution during urgent situation, and considering as a potential supplement to their healthcare options. Zócalo Health’s monthly visits through a membership align with a preventative approach Latinos may not typically prioritize.

    Moreover, family plays a significant role in shaping the adoption of a proactive or reactive mindset towards health among Latinos. The reactive mindset observed in Latino families in the US can stem from a lack of trust in the US healthcare system, avoiding its use unless it’s strictly necessary.

    “I think I would try it [telehealth] initially but then I would want like a second opinion with someone face to face. I don't know why it just doesn't feel like enough.

    And I think even my partner feels the same way. We found like a rash app where you can take a photo, and then it tells you all these things about the rash. And I was like, I don't trust it. It's too complicated.”

    -Latina millennial (non-member)

Service Safari

After our team conducted service safaris on different user journey we were able to illustrate them on a map, as well as highlight positive and negative inflection points along it.

Journey maps

This user journey map illustrates the journey of a potential member from discovery until their first appointment with Zócalo Health.

Several pain points were identified, inspiring potential design opportunities to support Zócalo Health with.

Macro journey map

This user journey map illustrates the journey of a Latina millennial as she books her first-time consultation with a Promotora de Salud.

Some key moments of delight include:

  • Learning about the service Zócalo Health provides,

  • Having a call with the promotora de salud

However, I also identified points of friction:

  • Mismatch between the scheduled person and the one reaching out

  • Mismatch between the users language of preference and how they are reached out

  • Overwhelming marketing emails and the inability to unsubscribe

Scheduling a free consultation

Please access the full service safari results and high quality journey maps below.

Artifacts

We used several tools to communicate our research findings to our stakeholders.

Based on the qualitative information gained from our research methods, we were able to craft personas as a tool to better communicate the needs, goals, and barriers our intended users experience. These personas are the Latina Millennial and the Non-Tech Savvy Elder, and they both represent who will we be designing for.

Personae

Based from our research interviews, we created two word clouds to contrast the emotions expressed by Zócalo Health members while using their services in contrast with the emotions expressed by non-members when describing their encounters with various healthcare providers in the United States.

Word clouds

Experiences with the American healthcare system.

Experiences with Zócalo Health.

Outcomes

Design Priciples

As part of our research outcomes, we were able to come up with three design principles who will serve as a north-star for the upcoming ideation process.

In all aspects of our design process, we prioritize and celebrate the richness and diversity of Latino culture, ensuring that our solutions are thoughtfully crafted to resonate with and cater to the unique healthcare needs, values, and beliefs of Latino individuals and communities.

Placing Latino Culture at the heart of design

We prioritize sustainable growth, ensuring that any new initiatives or changes are implemented in a way that supports and empowers Zócalo Health’s team and maintains high-quality care for all members.

Building without overburdening

We recognize the desire for transparency in healthcare services among the Latino community empowering individuals to make informed decisions about their healthcare by providing clear and accessible information that promotes trust.

Fostering honesty and transparency

Through our research, we were able to identify several low-hanging fruit opportunities for Zócalo Health. These were presented to the team alongside actionable recommendations.

Low-hanging fruit & actionable recommendations

  • “If felt too good to be true.” Some potential members doubt Zócalo Health's offerings' authenticity.

    Recommendation: Inform users that they have the option to schedule their initial visit without any charges, emphasizing the absence of any hidden conditions or limitations throughout the process.

  • When potential members choose between wanting to learn more about ZH and having an immediate medical need, they might be unsure of which option to choose because their needs don’t align with the options.

    Recommendation: Include a third option in the sign up type form stating “I want to become a member and schedule an appointment with a doctor.”

  • Members have a preference on how they want to be contacted.

    Recommendation: Ask members about their preference on how to be contacted (text, email, call).

  • There are grammar and spelling mistakes in some of Zócalo Health’s messaging

    Recommendation: Fix grammar and spelling mistakes, use a script to copy/paste from if needed.

  • The ‘Unsubscribe’ button in the emails does not work and there is no physical address in the email footer, making all marketing emails not CAN SPAM compliant.

    Recommendation: Fix the button and add the correct physical address to the email footer template. Marketing emails must include the physical mailing address of your business and a link for contacts to manage their email subscription preferences.

Design opportunities

The generative research findings inspired the direction of the upcoming ideation phase. The design opportunity will be prioritized based on business and user needs.

1.

Match and manage expectations to continue building trust

HMW manage and match the expectations of members throughout the Zócalo Health journey in order to create a safe space that fosters trust?

Recruit and train culturally-aligned care providers for a better experience

2.

HMW help Zócalo Health recruit and train care providers to facilitate a culturally aligned experience for Latino members?

Support the technological onboarding of new members

3.

HMW minimize the technological challenges enabling members to easily access and fully use Zócalo Health services in accordance with their technological know how?

Promote the advantages of preventive care among Latinos without chronic healthcare needs

4.

HMW promote an awareness of the advantages of preventative care in order to change a learned reactive mindset?

Next steps

  • Define the Design Challenge in partnership with Zócalo Health’s executive team

  • Design and conduct an ideation workshop with the Zócalo Health team

  • Perform iterative design and prototyping

  • Evaluate the solution

  • Adhere solution to Zócalo Health’s product backlog