The app used streaks, badges and red-marked missed doses. Patients who missed a dose disengaged entirely, and the population who most needed the product were the ones it drove away.
STUDY 25 / 30 · ANONYMISED · NDA · HEALTHCARE · US · SERIES C
HEALTHCARE · US Medication adherence without shame mechanics.
RoleLead designer + researcher
Timeline12 weeks
Team2 designers, 1 researcher, 1 PM, 2 mobile engineers, 1 clinical SME
VerticalChronic care companion · 340K patients
Removed all punitive mechanics. A missed dose renders as a neutral event with a clinically correct recovery instruction, which is the only response that changes an outcome.
Adherence improved most among the previously lowest-adherence cohort - the group every streak mechanic systematically loses.
+41%ADHERENCE · LOWEST QUARTILEvs baseline
84%RETENTION AFTER FIRST MISSED DOSEfrom 38%
3.1xCAREGIVER-LINKED ACCOUNTSvoluntary
THE ARGUMENT
Why the obvious solution was wrong.
The study matters because the product problem was reframed before the interface was polished.
Streak mechanics are borrowed from consumer fitness and are actively harmful in chronic care. A streak's motivational force comes entirely from the cost of breaking it, which means the moment a patient most needs the product is the moment it punishes them and they leave. The patients with complex regimens and comorbidities - precisely the clinical population that matters - break streaks constantly by definition.
A missed dose is now a neutral event with the clinically correct instruction attached, which differs by drug: take it now, skip it and resume, contact your clinician. This was the single highest-value screen in the product and it had previously been a red mark. Progress is shown as a rolling proportion rather than an unbroken chain, so a missed dose changes a number slightly rather than destroying an achievement. Retention after a first missed dose went from 38% to 84%, and the largest adherence gains came from the lowest quartile - the cohort the previous design had been quietly expelling.
THE INTERFACE CRAFT
The interaction, rendered as a working product surface.
The specimen below is code-native and uses the study's own design logic. The client interface remains protected.
HEALTHCARE
ALARM PRIORITYNeeds action
Room 408 · 02:14
DESIGN DECISIONS
Positions we would defend.
Each decision names the principle and the product consequence, not a stylistic preference.
No punitive mechanics, ever
In chronic care the moment of failure is the moment of clinical need. Punishing it removes the patient from the system that was helping.
Recovery is the product
The missed-dose screen is the highest-stakes surface in an adherence app and had been treated as an error state.
Design the caregiver view with the patient
A surveillance surface built without patient input destroys the trust the product runs on.
PRODUCT LEADER READOUT
What transfers, and what should remain specific to this product.
A case study is useful when its operating principle travels without turning the original interface into a template.
Read the operating condition
For Chronic care companion · 340K patients, the transferable lesson is not a copied screen. It is the condition the interface had to make legible: No red, no broken chain. The clinically correct recovery instruction for that specific drug, which is the only content that changes an outcome. Rebuild that visibility for your own roles, risk, terminology, and operating cadence.
Protect the design rule
In chronic care the moment of failure is the moment of clinical need. Punishing it removes the patient from the system that was helping. Keep that rule in the acceptance criteria, component states, and production QA record so later visual cleanup cannot erase why the interaction exists.
Measure behaviour after ship
The evidence record is +41% for adherence · lowest quartile, vs baseline. Recreate the baseline and outcome window before rollout, segment the result by role and context, and state clearly what the measure cannot prove.
RESEARCH RECORD
The work behind the interface.
These artefacts connect the final interaction back to the evidence and product model that produced it.
Disengagement analysis
Traced 4,000 disengagements; 61% occurred within 48 hours of a first missed dose under the streak design.
Recovery instruction sourcing
Built drug-specific missed-dose guidance with the clinical team across the 90 most-prescribed regimens.
Shame-mechanic literature review
Reviewed the behavioural literature on punitive mechanics in chronic conditions with the clinical SME.
Caregiver co-design
Ran three co-design sessions with patient and caregiver pairs to define what the caregiver should and should not see.
“The people we were losing were the people with the most medications. The streak was doing that.”
Chief Medical Officer, chronic care platform · under NDA
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