This is a guest post from Holly, who is part of Young People Cornwall is a youth work charity running activities, youth groups and centres across Cornwall. Here, Holly writes about her experiences with young people and mental health in Cornwall and their opinion on Doc Ready.
I attend a group run by the Hear Our Voice project, which is about promoting positive mental health for young people. I am also a member of the Cornwall CAMHS Young People’s board, which ensures young people have a voice in local mental health services.
We consult with lots of young people in Cornwall about their experiences of services and so I have heard many different views from young people about seeing their GP and how difficult this can be, as well as talking from my own point of view.
The average GP appointment is estimated to be ten minutes long and my own personal viewpoint is that this is a very short amount of time for anything, let alone if it is a young person trying to talk about their mental health or emotional wellbeing
Most experiences I have heard from young people have unfortunately been quite negative. Young people find it very difficult to get an appointment, and of course the appointment will have to fit around other commitments such as school or college and it may be difficult to negotiate a appropriate time with the local surgery, especially if you want to go without your parents and without missing school.
Other main worries are that GP’s don’t listen, that it is extremely hard to talk about mental health especially under the pressure of a ten minute time limit, and that young people are worried about confidentiality and safety. Young people are not told about their rights or about consent and often worry that doctors will just immediately go to their parents without permission.
We have looked at Doc Ready in development and now at the final version – it is really useful because it is a resource designed to help young people with GP appointments that will be based around their mental health and/or emotional wellbeing and will help with some of these problems.
We like the website as it is easy to access and navigate and the advice given about confidentiality, your rights and how to make a complaint is really helpful – it helps you to know what to expect.
Creating a checklist to take in to your doctor is a really good idea and I think it will help lots of young people who might be nervous to start talking about their mental health or about self -harm for example.
So far I have only met young people who have seen this resource after having already experienced their first GP appointment but they have all said how good a resource it is and how they wish they could have had access to it before they had their first GP appointment.
I think the Doc Ready site is well worth advertising more as it could be extremely useful to young people who are anxious or worried about going to the GP to receive help with their mental health.
I’ll conclude by saying that, as a young person who has previously been to see my GP about my mental health, I admire the DocReady resource for its goal to help young people feel less anxious and instead more prepared and optimistic about their first GP appointment.
Thanks for sharing your views with us, Holly!
Doc Ready was awarded for blogging the development of our app to help young people visit their GP to talk about a mental health problem.
The awards’ judges all had considerable experience of mental health, either as providers or users of services, and all were extensive users of social media in mental health in their own right.
Here are just some of the judges comments:
- “Massively practical, very necessary thing to have”
- “A dynamic and very professional site”
- “The resource I wish I had many years ago.”
Congratulations are also due to the runners-up Leeds Wellbeing Web, an “inspiring and innovative community blog” and Stranobambolina, praised as “helpful to anxiety and emetophobia sufferers to have a ‘me too’ moment”. Both sites are well worth checking out if you get a moment.
There’s more information on the award and other winners over on the Mentally Wealthy blog.
The Doc Ready team delighted with the news of this award and it’s already motivating us to keep up the blog and continue being open about the development of the app.
Make sure to subscribe to the Doc Ready blog or follow @docready on Twitter for more updates!
Since launching Doc Ready last month, we’ve had over 6,000 people visit the site and over 400 people have produced and exported a Doc Ready checklist in the first month since launch.
That’s a fantastic start, but the Doc Ready team were keen to get more feedback from the young people using the app. What did they like? What didn’t they like? Do they like the look and feel of the app?
We’ve been running a survey for the last month to gather this feedback (with the added incentive of a few glamorous prizes) and the results are in. We’ll be using this feedback to work out what bugs need fixing and improve Doc Ready for its users.
Thanks to everyone who gave their feedback and the competition winners will be announced shortly. You can still give your feedback even though you’ve missed the competition deadline – just use the Contact Us page to send us your thoughts.
Without further ado, here is your feedback Doc Ready, as told by the young people who use the app.
What do you like about Doc Ready?
“Fabulous idea! Since being involved in the Doc Ready process, I have now started to write letters to my doctor and take them in before my appointment and she thinks it’s great and the relationship has improved and I am now getting more of the help and support I want. I have been going to the doctors for 5 years to do with my mental health and only feel listened to now.”
“How useful it will be to use when i need to talk to the doctor about many things but may forget without writing them down, now i can use doc ready and talk about everything i need to when visiting the gp.”
“This is fantastic! I have not come across anything like this before. I really like the idea of organising the topics and having them to hand. It is so easy to forget what to say or even get embarrassed so a patient could easily hand the document over as a conversation starter. It is also great to see the section on ‘rights’ and ‘confidentiality’ as I think sometimes this can be a grey area and people do not have the important knowledge they are entitled to know!”
“I think that Doc Ready will be awesome for people like me who don’t want to talk to the doctor about my feelings and also things that I forget to mention can be on there.”
“I think you have done a really good job at covering lots of issues. Any problem a young person might be experiencing can be covered in Doc Ready and taken to the GP. And even if it’s not listed, then you can add your own!”
What don’t you like about Doc Ready?
“More information of the actual health issues. If people are borderline on going to the GP they might want some more info on what is actually happening to them.”
“Links in the find a GP section didn’t work. Maybe have a forum or somewhere that they can post questions online? Maybe some information on the conditions? Some quotes or stories from previous sufferer of the diseases to help them feel though they are not alone.”
“The ‘Find a GP’ section didn’t work for me, the post code nor the location utility. Although clean-looking, I found the borders above and below the main body of the page slightly too thick, requiring a lot of scrolling to get around to reading.”
“It would be good to save your checklist. At the moment you have to make it all in one go and can’t add to it at another time.”
“I do not believe that my GP would really use it. I think it’s something he would just ignore and I would have to explain when I get there anyway.”
“Some parts may be a little wordy and intimidating.”
Tell us what you think of how Doc Ready looks
“Layout is nice but I find the questions rather text-heavy and unapproachable. The actual advice is good. The bottom ‘about’ bar limits screen space.”
“The layout is awesome and I really like the interactive dimension of it all. The ability to email/print/download is important so people from different backgrounds and with different resources can access the list too. I also love the fact there is a section for ‘notes’ doing the session. It is very easy to sometimes miss important information so jotting it down is a brilliant idea.”
“It looks amazing. That’s probably my favourite part about it. It’s like insanely less confusing than a .gov site or an NHS site, where there’s so much random information everywhere it’s so confusing.”
Don’t forget! You can give your feedback on Doc Ready by using the Contact Us page.
Today is World Mental Health Day, a day to celebrate the positive aspects of mental health. Run by our partners at the Mental Health Foundation, this year’s theme is around mental health and later life.
Although Doc Ready currently focuses on young people, we’re aware of the enormous problems that loneliness, isolation, dementia and depression can cause for older people.
In fact, on average people aged 55 and over have greater life satisfaction than people aged 25-54, so there is enormous potential that this phase can have in terms of enjoying a full and active later life, as well as maintaining a healthy social involvement in the community.
We know that lots of young people have already been using Doc Ready to get advice, prepare for an appointment, and to help ensure that everything gets discussed in their time with the doctor. But Doc Ready may also be able to help older people and those in later life.
So, we want to hear from people who are in this phase of life. What do you think of Doc Ready? Could Doc Ready be useful for older people and those in later life?
We’ve set up a survey to capture your comments. Although you won’t be able to enter the prize draw to win some fantastic prizes (that part is only open for under 25 year olds) your feedback will still be extremely valuable.
We’ll finish this post with a great example of older people who are enjoying their later life, to inspire us all on World Mental Health Day.
This is a clip from the film Happy Movie, which features older people in Okinawa, Japan, who are staying active and enjoying a strong sense of connection with the people around them. Enjoy!
Accessibility is extremely important to the Doc Ready team, so we were keen to take this into consideration from the outset of the project. All too often we see projects where accessibility is seen as an afterthought or a “nice to have” and this is exactly what we wanted to avoid. Our team of designers and developers have worked hard to make Doc Ready as accessible as possible in the time available to us.
Of course, nothing can be truly accessible to everyone, so we hope that the considerations taken into account (listed below) have addressed a wide range of people’s needs. Everyone has different needs and wants, so Doc Ready’s accessibility features can be supplemented by browser / device customisation to help tailor this further to the individual. AbilityNet’s My Computer My Way is a good resource that explains the accessibility features and settings (vision, hearing, motor and cognitive related) available on computers to help make them easier to use.
Read on to find out more about Doc Ready’s accessibility:
What good is a web page if you can’t read it?
One of the easiest ways to make a site inaccessible is by using a font size that is too small. Over 2 million people in the UK experience some form of visual impairment, so using clear typography at a generous size is a no-brainer.
In Doc Ready, the body text is set to 16 pixels, which should make reading the screen text similar in ease to reading from a book for most users. All web browsers set text to 16 pixels as a default (minimum) font size but web designers have a habit of trying to reinvent the wheel and often opt for a smaller font size to save space.
The article 16px Body Copy: Anything Less Is A Costly Mistake, makes a good case for why this intervention should be avoided.
Some users will find 16 pixels still too diminutive and are welcome to use their browser’s zoom function to increase the font size further. The easiest way to do this is by pressing CTRL and + together.
Web pages that have a “fixed” design become problematic when zooming because the design starts to get bigger than the screen, obscuring some of the text and imagery. Because Doc Ready is flexible, as the text gets bigger it reconfigures (or “wraps”) to fill the screen appropriately. This type of flexibility is often referred to as “responsive web design” because it makes the content “responsive” to the space that is available.
It is this design technique which also allows Doc Ready to be usable on different screen sizes, from Desktop monitors to different phone handsets.
In web design, the subject of contrast typically relates to the relationship between text colour and background colour. For instance, white text on a yellow background could be considered a combination that is too low in contrast to make the text easily legible. This is why we made the decision to change the text on the “advice” navigation link from brilliant white to a dark grey, as illustrated below.
Contrast becomes a more complex concern when you consider users who are affected by colour blindness, which accounts for approximately 4.5% of the UK population. While most users can rely on both hue (colour) and tone (shade) for contrast, some users will see little difference in terms of hue for certain colour combinations and have only tone to fall back on. For instance, green text on a red background of a similar tone may be readable to some but the text becomes almost invisible to others. The best way to test is to take a screenshot and convert it into a greyscale image in a photo editor like Photoshop. The result is often surprising! In the case of Doc Ready, we have tested for contrast but please contact us if you are experiencing difficulties in this respect.
Using the keyboard
It is easy to forget that not all users of websites and apps click on links and buttons using a mouse. Using a keyboard instead to navigate a web page is quite a different experience. Sometimes users experiencing neuromuscular conditions or tremor have no choice but to rely on keyboard controls because they are not able to achieve requisite accuracy when trying to point the mouse at objects on the screen. For the most part, such users will harness the TAB key to jump from one control to the next. When one of these controls has been “jumped onto”, it is said to be “focused”.
However, it is difficult to lose track of which control is “focused” unless it is visibly highlighted. Focused controls in Doc Ready’s “advice” section, for example, switch to a dark blue colour. This way, keyboard users have some indication about which subsection they will be opening when hitting the ENTER key.
Most HTML elements (or “tags”) are not designed to be focused at all, so it was important to code the controls correctly. Otherwise, keyboard users might expect to highlight what looks like a control only to find that pressing TAB has skipped over it entirely!
Aside from HTML form elements such as <input>, only the <a>, (hyperlink) and <button> tags are easily focusable without extra scripting.
Users who are blind or have very low vision and cannot easily interact with a website visually may choose to use a “screen reader“. Screen readers literally read out the contents of the web page using an electronic voice emulator. Most screen reader users are also keyboard users because they cannot see the screen to point the mouse cursor at controls.
Getting an impression of the overall content of a web page can be arduous for screen reader users because, while sighted users can glance and “take in” the overall design almost instantaneously, screen reader users must read it from top to bottom. To make sure that the content in Doc Ready made sense being read in this linear fashion, we had to be careful about the order of the controls and surrounding text. Sometimes special techniques were employed to reorganise the content just for these users.
It was also important to break the content up, so that different parts of each page could be navigated to directly using special screen reader keyboard commands. The simplest way to break up content for screen reader consumption is to use appropriate headings to introduce text.
The most important heading is usually “tagged” with the <h1> HTML element, which is read aloud as “Heading Level One” by the screen reader voice. Users of the JAWS screen reader can use the numbered keys (1 – 6) to skip to headings of the corresponding “level”. If you are testing a site with JAWS, here is a useful list of keyboard commands.
The latest version of HTML — HTML5 — comes with another way to break up content. An extension of HTML5 is the Accessible Rich Internet Applications suite (ARIA), which is a set of provisions to help define the roles, states and other properties of HTML code in an accessible way.
For our purposes, to define important “landmarks” in a web page one can edit the HTML code to include ARIA “landmark roles” for the appropriate areas. In Doc Ready we use a “banner” role to define the header or “banner” of the page. Inside this is a set of links that make up the main navigation for the app. This has a role of “navigation”. The tag that contains all the main content of the page gets a role of… “main”, of course.
Working together, these “landmark” areas act like continents to help describe the map of the page. Not only are they announced when you reach them reading normally but — like headings and links — are also available in a special “elements list” dialog. To access this using the free NVDA screen reader, one simply has to pressINSERT together with F7.
Landmarks are not the only ARIA enhancements that we’ve used in Doc Ready. By using a combination of ARIA attributes (“aria-controls” and “aria-haspopup“) on the section headings in “advice”, we have enabled NVDA to tell users that the heading is a “clickable” control which corresponds to a hidden submenu.
One of our biggest challenges when making Doc Ready as accessible as we could was in handling navigation.
Traditional websites are made of separate pages and, when you click on a link to navigate to a new page, the screen reader starts reading that page on arrival. Doc Ready is a “one page application”, meaning that when you appear to be navigating between “pages” you are really just reconstituting the page that you are already on. This has its advantages: It can speed up traversal through parts of the app and it means data can be easily shared between parts of the app too.
However, it’s not quite so easy for a screen reader to know just when the content on the page has really changed, or where it should start reading from. To solve this, whenever the content on the page changes we use another ARIA feature called “alertdialog” to alert the screen reader to the change and instruct it to start reading the fresh content. So that the keyboard is ready to control the new content, we also manually refocus the box that we put it in.
According to testing, this measure has vastly improved navigation around the app, which would otherwise have been badly broken. However, it is an experimental measure and we welcome any feedback from screen reader users who have tried out Doc Ready.
Throughout Doc Ready’s design and development, we’ve been speaking to young people to test its design, functionality and usability, which includes its accessibility. We feel that we’ve come a long way, but we’re still extremely keen to speak to people to find out what they think and whether Doc Ready is accessible to you.
In case you hadn’t heard, Doc Ready – the app to help young people get the most out of their GP appointment when it comes to discussing a mental health issue – launched last week.
We know that lots of people have already been using Doc Ready to get advice, prepare for an appointment, and to help ensure that everything gets discussed in their time with the doctor.
So, we want to hear from you.
What do you think of Doc Ready? What have we done right? What works? What don’t you like? And what should be different?
To say thanks for your feedback, we are offering a range of great prizes. One lucky winner will get a brand new Samsung Galaxy Tab 3 (the one in the photo at the top of this post). We are also offering two runners-up £50 Amazon vouchers.
All you need to do is fill out this feedback form before 18th October, leave us an email address so that we can get in touch, and we’ll enter you into the raffle to win one of these fantastic prizes.
You must be a UK resident and aged 25 or under to enter. Will be in touch after 18th October to let you know if you’ve won.
Thanks for giving us your feedback and good luck winning a prize!
We’re delighted that Stephen Fry, English actor, screenwriter, author, playwright, journalist, poet and comedian (to name just a few of his many talents) has given his support for the Doc Ready Project.
Stephen had this to say about Doc Ready:
“The support that Doc Ready gives young people is vital to help them become the healthy and confident adults that they deserve to be. The teenage years are an important period to address mental health issues and Doc Ready is a great tool to help young people through a difficult time.”
Stephen is well known for his activism around a range of mental health issues and he often writes about his own experiences battling cyclothymia, a form of bipolar disorder (Only The Lonely is a particularly brilliant recent post).
His most notable work in the area is The Secret Life of the Manic Depressive, a two-part television documentary that explored the effects of living with bipolar disorder, based on the experiences of Stephen, other celebrities and members of the public with, or affected by, the disorder.
We’re gearing up for the launch of Doc Ready and Stephen’s support is a real boost to the team behind the project and the young people we’ve worked with in developing the tool.
Sign up to our email newsletter to make sure you’re the first to know when Doc Ready launches.
Failed by the NHS
Monday 29 July, 9-10pm, BBC Three
Doc Ready, a project to help young people who are worried about their mental health get more out of visits to their GP, will be featured as part of a documentary screening on BBC Three this coming Monday. The documentary, “Failed by the NHS”, is part of BBC Three’s It’s a Mad World Season that explores a range of mental health issues affecting young people in Britain today.
26-year-old Jonny Benjamin, who has schizoaffective disorder – a combination of schizophrenia and depression – investigates why many young people with mental illness are failing to get the right treatment from the NHS.
Make sure to watch the documentary to find out more about the issues faced by these young people and be one of the first to discover how Doc Ready will make a positive difference to their lives.
From the beginning, Doc Ready has run a series of engagement workshops, collaborating with young people from all over Brighton and Hove to develop its functionality, look and feel. We began with user insight workshops and followed this with paper prototyping to come up with a functional spec for a first technical development sprint. For this sprint, we were working with what we’d heard in these workshops, but wanted to make sure that what we were building was still correct.
This is where user testing comes in. The Doc Ready team took the first iteration of the actual digital tool back to the young people we have worked with. And this time we even invited a few extra people who have never heard of Doc Ready to get a fresh pair of eyes on what we were building.
We showed the group the first iteration of the app, so they could test its usability and functionality across a range of different devices – from mobile to laptops and iPads. We also ran a questionnaire to find out what the group thought about the design and how they would like it to look and feel.
To test usability and functionality, we gave the group a fictional character and scenario, asking them to use the product to satisfy certain user goals. For example, they had to imagine it was their first experience going to a GP alone and they wanted to build a checklist of things to remember to say, such as ”I’m not sleeping well”.
The group facilitators observed how each person worked through these scenarios to see how they used it. But we also gave each person a capture sheet so they could note down the good, the bad and the ugly as they worked through the scenarios.
For the survey on the design of Doc Ready, we asked the group what kinds of apps and websites they liked, which apps and sites they liked the look of, what they thought of the original Doc Ready branding and what they would like to change. We also sent the survey out through Twitter, email and the Doc Ready blog, so people outside of the workshops could feedback on our approach.
Through the user testing process, one of our biggest assumptions was challenged. We thought that people would print out their checklist to take with them to their GP appointment. But over 70% of the group said that they would take the checklist just on their phone or handwritten, rather than print it out. We’ve since changed the design of Doc Ready to reflect this.
The group of young people were very savvy about digital design, what they like and how it makes them feel. The original Doc Ready layout used lots of boxes, but they felt that this was like putting everything in its place, so that they were being pigeon holed into certain categories. If you are already stressed out or depressed and people are putting you into boxes around that, you don’t want to be put in a box when using a website as well.
The language of Doc Ready has also changed. The group described the language as very “Big Brother” and they weren’t sure who was talking to them on the site. They felt like the language should be softer, more straightforward and sound like something they would say to each other in everyday life.
We’ve now changed things around so that the language the app uses prompts young people to use their own voice, rather than being an authority figure telling them what might be wrong with them. We’d like the Doc Ready app to be used and taken by young people to their GP visits, putting the young person in control of what they want to talk to the doctor about.
The next steps for us are to take the feedback gained through the user testing workshop and integrate these notes into the second development sprint of Doc Ready. We’ve reworked the brand and language the app uses too, based on the young people’s feedback. After this sprint, we’ll take the digital prototype back to the group to make sure that we’re still on track before making Doc Ready available to use in September.
All this feedback has been fantastic and we’re getting ever closer to launch. Exciting times!
May was a busy month at Neontribe, when we were working on the first digital prototype of DocReady. We like to work in a series of short sprints to keep our pace of work high, and to hold ourselves to our ideal that we should be able to show a working product (even one which doesn’t do much) as early and as often as possible.
Officially the first Doc Ready sprint was about 4 weeks long, but we find it best to break that time down into smaller and smaller sprintlets. Each week we try to get together (usually over Skype, or in a Google Hangout) with as many people involved in the project as we can – to discuss what’s been done that week and try to make sure that we incorporate any feedback into the next week’s work. A week can seem like an awful long time though, so each day we hold a short meeting called a stand up. Each member of the team outlines what they’re working on right now and lets everybody else know if there’s anything they can see coming up which’ll slow them down. Stand ups are a great thing, and they really help coordinate our efforts, but only if they don’t go on too long… The name gives it away – we really do stand up for them because we find that cuts short any rambling
To try to get all these meetings moving along as fast as possible we make sure everybody can see what we’ve been doing. To help with that we’ve been using a nifty set of online services:
- GitHub tracks the changes we make to our source code
- Travis CI runs all our tests for us when we make changes, and publishes the app when those tests pass
- Heroku shows the work in progress at DocReady Staging
By wiring those together the work we do is visible on our testing server as soon as each little piece is complete. If this build button -> is showing green it means you can head on over to (http://docready-staging.herokuapp.com) to see how things are coming on. If not, well… Please excuse our dust, we’re working on it.
Since the first sprint of building Doc Ready, we’ve shared this initial version with a group of young people from Brighton and Hove, including some of the people who took part in the earlier stage research and paper prototyping workshops, to get their feedback on how it works, what they like and what they’d like to see improved. We’ll be sharing the outcomes of this session on the Doc Ready blog soon, so watch this space…
The geek bit – you can safely ignore everything under this line
If you’re curious about technical aspects of Doc Ready this section is for you!
DocReady is currently split into two projects:
- An API server built on Django using the excellent Django REST framework - you can find the code here: docready_api Looked after by@heidarb