How do we optimize the COVID-19 testing experience?

Why is this issue important?

Rhode Island’s response to COVID-19 is driven by data. Understanding in real time how the pandemic is unfolding—how many people are infected, and where—is critical for decision-making about if and when to enforce or lift restrictions (such as opening restaurants or schools), and for efforts to isolate and quarantine potentially infected residents. To keep that data flowing, people must be willing and able to get tested.

But someone may be reluctant to get a COVID-19 test. They may have difficulty getting a test. To troubleshoot against barriers to getting tested, and reassure residents that the experience will be seamless, we set out to optimize the COVID-19 testing experience in Rhode Island. A particular focus was the K-12 testing experience, which is integral to reopening our schools.

What did we do?

To understand what barriers to getting tested might exist, you need to closely observe every step of the process—from signing up for an appointment, to traveling to the physical site, to getting the nose swab, to learning about the results. You need to talk to people who have been tested, and people who have failed to get tested. It’s user experience (or UX) research, to use some jargon.

Between May and December 2020, we conducted field observations of testing sites, collected 1,200 feedback surveys, and interviewed 90 Rhode Islanders. We asked people to rate their experiences being tested, and we invited them to share feedback on what went well and where improvements could be made. The one-on-one interviews went deeper still and allowed us to ask a suite of follow-up questions. We created process and user journey maps.

What did we learn?

The large majority (over 90%) of people who interacted with the state’s COVID-19 testing program had a positive experience. But there was (as always) room to improve. In the K-12 testing space, for example, we uncovered 13 key insights, leading to 5 core recommendations that are now being pursued (see the full K-12 report for details):

1. Offer a broad variety of options for where and when users can get an appointment—as well as who can qualify for one.
2. Send users more information leading up to their appointment, focusing on what to expect at their appointment and specific instructions on what to do when they arrive.
3. Provide public-facing state personnel with frequent updates on procedures, coupled with easy-to-communicate messaging, to create better consistency across work streams.
4. Pressure test new processes and systems for preventable issues by introducing a diverse set of users into simulated scenarios.
5. Assign a team member to collect user feedback and provide individualized support.

For example, Figure 1 plots over time how many people agreed it was clear where to go and what to do at a testing location. By September the overall rating was high (about 90% saying “yes” or “definitely yes”), but further reforms based on the recommendations increased those saying “definitely yes” by about 20 percentage points.

We show responses over time tied to clarity of information at COVID-19 testing locations. While overall public opinion was always high, new users' opinion of the process increased over time as the team actively adapted and implemented recommendations

What happens next?

In January 2021, we also released a series of user research toolkits. These can help other states replicate our learnings and also conduct their own UX research in the COVID-19 testing space. If you see gaps or have additions or improvements to suggest, please email us at thepolicylab@brown.edu.

Behind the scenes

Throughout our interviews, a common refrain was that people were grateful to the staff delivering tests, and they were also appreciative of the chance to provide feedback and be a part of making the process work better. An illustrative comment:

“I’m so impressed that Rhode Island got their act together to do this. It’s key to making school work at all. I want it to work and it's SO close to working.”

Occasionally, these conversations could become quite personal. People would share how they’re faring, not just on that testing day, but more generally during the pandemic and all its associated hardships. It’s a privilege of UX research to hear such stories.