Case Study 03 NIH-Funded Research Health Equity Systems Design Longitudinal Study

Field Guide

Designed the digital field data collection system for a 700-household NIH-funded cohort study — turning fragile paper infrastructure into the operational backbone for a landmark study in dental disease genetics.

2×
Participation rate
82%
Faster completion
0%
Data degradation
Same
Day data availability
Field Guide tablet interface — voice-enabled survey system
Context
01 · Background

High-impact science.
Fragile infrastructure.

The COHRA1 Cohort Study was a multi-site NIH/NIDCR-funded longitudinal study examining oral health disparities across rural West Virginia, rural Western Pennsylvania, and urban Braddock, PA — collecting data across 700 households with children ages 1–18.

Role
Lead Experience Designer
Partners
University of Pittsburgh · West Virginia University
Platform
Voice-enabled tablet
Offline-capable · Bluetooth sync to central research database
Domain
Oral health disparities
Intergenerational stress · Genetic research · Health equity
Context
01 · Background

High-impact science.
Fragile infrastructure.

The COHRA1 Cohort Study was a multi-site NIH/NIDCR-funded longitudinal study examining oral health disparities across rural West Virginia, rural Western Pennsylvania, and urban Braddock, PA — collecting data across 700 households with children ages 1–18.

Role
Lead Experience Designer
Partners
University of Pittsburgh · West Virginia University
Platform
Voice-enabled tablet
Offline-capable · Bluetooth sync to central research database
Domain
Oral health disparities
Intergenerational stress · Genetic research · Health equity
Problem
02 · Discovery

The team said literacy.
The data said overload.

Paper surveys and manual workflows were creating random answer patterns beginning at the 34% completion mark, 60+ minute sessions, and families leaving before receiving the care they were promised. The research team assumed the issue was reading ability. It wasn't.

What they assumed
A literacy problem
Participants couldn't understand the questions
Rural populations were disengaged from research
Data degradation was random and unavoidable
Scheduling delays were an operational fact of life
What was actually happening
A systems problem
Postgraduate-level surveys created cognitive overload, not confusion
The 34% degradation pattern was statistically consistent — a signature of overload
20+ minute manual intake compressed clinic time and broke promises
Appalachian communities had warranted skepticism toward outside researchers — trust had to be earned operationally
Solution
03 · Design

A trusted guide,
not a digital form.

I designed a voice-enabled, tablet-based Field Guide that transformed dense research protocol into structured, human-centered workflow. The core design principle: every system decision must either build trust or keep a promise. If it did neither, we cut it.

1
Preloaded Family Profiles
Call-center staff captured household structure during scheduling, eliminating the 20+ minute intake bottleneck at the point of care.
Reduced protocol friction before participants even arrived
2
3rd-Grade Reading Level Rewrite
Every question rewritten for clarity while preserving NIH scientific integrity. Eliminated cognitive overload without changing what was being measured.
Halted the 34% random-answer degradation pattern entirely
3
Voice + Headphones
Speech-enabled interface allowed participants to listen instead of read. Private audio playback maintained HIPAA compliance in shared clinic environments.
Increased accessibility across low-fluency populations
4
Offline-Resilient Data Capture
Tablet-based system supported structured data collection in low-connectivity rural environments with Bluetooth syncing to clinic systems.
Preserved data integrity across all rural sites
5
Smart Workflow Transitions
System-guided participant movement between survey and exam spaces ensured families received the care they were promised — the broken promise that was quietly destroying trust.
Reduced trust breakdown tied to scheduling delays
Architecture
04 · System Design

From deterministic capture
to agentic orchestration.

The original system replaced paper with structured tablet workflow. A reimagined v2 explores how longitudinal research infrastructure evolves when agents can detect fatigue, adapt phrasing, reconcile contradictions, and coordinate multi-actor flow in real time.

V1 · Deterministic System

Field Setting Participants Researcher Examiner Tablet System Tablet UI Voice · Touch Survey 120+ items Validation Required fields Visit Memory Household state Offline Store Encrypted cache · Sync queue Data Platform Bluetooth Batch sync Research DB Central store Bio Samples DNA · Microbial Lab Data Fluoride · Env.
V1 — Deterministic capture: tablet UI → survey engine → validation → offline store → sync → research database

V2 · Agentic Evolution

Field Participants Researcher Examiner Clinic Staff Agent Layer Conversational Capture agent Trust & Engagement Fatigue detection Data Quality Anomaly · Contradiction Clinic Flow Operational coordination Research Orchestrator Policy enforcement · Routing Longitudinal Memory Structured DB · Vector store · Multi-year state Outputs & Oversight Research DB Central store Insight Engine Risk flags · Patterns Audit Layer Compliance trail Human in Loop Review · Override
V2 — Agentic evolution: multi-agent orchestration with fatigue detection, contradiction flagging, HITL review, and longitudinal memory
Impact
05 · Results

Field Guide didn't just improve UX —
it stabilized research infrastructure.

2×
Participation rate
Families returned year after year. Longitudinal cohort sustained across multiple sites.
82%
Faster completion
60+ minute sessions reduced to under 12 minutes on average.
0%
Degradation pattern
The 34% random-answer signature — a hallmark of overload — was eliminated entirely.
Same
Day data availability
Replaced multi-day paper processing. Data was analysis-ready by end of each clinic day.
NIH
Continued funding
The study secured continued NIH funding. Data integrity was no longer a risk to the research program.
GWAS
First in dental disease
Clean data enabled the first genome-wide association study of any dental disease.
Reflection
06 · What I learned

Three principles that inform
every system I build.

01
Question the frame
The team said "literacy." The data said "overload." The system said "broken promises." The real problem is rarely the stated problem — and the reframe is where the design work begins.
02
Design for dignity first
Trust compounds, or collapses, through operational follow-through. Every missed promise creates compounding skepticism. Every kept promise opens the door wider.
03
Technology serves relationship
The best systems feel like a guide, not a form. That philosophy — earned here in rural Appalachia — now informs every AI system I build, from coaching agents to enterprise decision tools.