How we scaled up user research in the NHS App at speed

The service is rapidly gaining momentum. Its usage has soared as we add more features and services to it – in June 2024, people logged into the app more than 33 million times, an increase of more than 50% compared to the year before. Nearly 9 million messages were sent via the app and people used it to view and manage their secondary care appointments 7.5 million times.

Success of the NHS App is partly rooted in user-centred design (UCD) and comprehensive user research conducted at every stage of the service lifecycle.

In the NHS App user research team, one of the many challenges was to enable a vast amount of high-quality user research to happen in an extremely fast-paced delivery environment.

Our team expanded rapidly to meet demand: we went from 3 user researchers to a team of 20-strong in what seemed like overnight.

We work in multidisciplinary agile squads that are developing a huge array of features in the app, such as messaging and notifications, prescriptions, new design systems and third party integrations.

With our user researchers spread out amongst the larger NHS App team, it was important we provided them with central support to help deliver best practice.

The NHS App has a central user-centred design (UCD) operations team which supports all UCD professions in the squads. This is incredibly helpful in linking up the UCD professions, but we still needed more tailored support for the user research profession – we needed to create effective research operations within the NHS App team.

To do this, we:

• designed the right team structure, including assigning 2 people to focus exclusively on research operations
• established clear ways of working for peer review processes, Confluence and Jira, and ways of working checklists
• created guidelines and processes based on NHS England’s guidance and policies
• built an effective insights management process and user research repository in Jira
• created inclusive participant recruitment processes
• created consistent reporting practises
• collaborated with other national digital channels, such as the NHS website (NHS.UK) and NHS login

This research operations gave us clearer ways of working, allowing our team to concentrate on delivering high-quality user research in their area of the NHS App.

We're asking ourselves things such as, how do we approach and apply more face-to-face contextual research on a large scale to engage with more diverse groups of people both patients and clinicians?

How do we implement effective automated feedback mechanisms and data analysis?

And how do we ensure we are continuously finding and recruiting participants from diverse groups of people at speed, including those who have barriers to accessing digital services or have different access needs?

No matter which user research project we work on in the NHS App, our main goal is always the same: to identify and understand user needs, experiences, challenges, pain points and opportunities. 

We conduct both primary and secondary research, employing various methods in our research. For example, this includes:

• face-to-face and remote user interviews
• moderated and unmoderated usability testing
• observation
• focus groups
• heuristic walkthroughs
• contextual inquiries
• pop-up research
• card sorting
• desk reviews
• accessibility testing

A significant aspect of the NHS App's recent development is the return to face-to-face research. This shift not only signifies a methodological change but also presents an opportunity to be more inclusive and engage with more diverse range of users. NHS England has just recently finished building fantastic state-of-the-art usability and accessibility labs, which we are actively using.

We also use automated feedback mechanisms such as surveys, live in-app feedback surveys, A/B testing and analytics. The live-in app feedback survey alone brings us approximately 7000 responses from our users each week! We have been developing our feedback processes to be able to understand and help our users even better.

To make the user research insights actionable and meaningful we are committed to sharing and collaborating with everyone across our UCD squads and UCD operations team.

In participant recruitment, we apply inclusive design principles. We aim to hear the voices of user groups facing barriers to digital transformation. We use many methods to reach out and engage with diverse users. This ensures we have a sample for our research that represents them.

We have created our own NHS App User Research Participant Panel which has now over 40,000 registered NHS App users. We are grateful for the people in our panel who have volunteered to be part of ongoing user research efforts. Anyone is welcome to join the panel.

We also use many other ways to engage with users. These include participant recruitment agencies and community networks. Also, other NHS England participant recruitment panels and many other organisations, networks and social media campaigns.