QUALITATIVE RESEARCH: IN-HOME HEALTHCARE
Care coordination breaks down at the moment it should feel simplest, right after the doctor's appointment, when a patient is handed two or three next steps and expected to keep track of all of it. Working with Care AXL, an in-home healthcare startup, I ran five semi-structured interviews, a mix of solo participants and dyads, in person and remote, plus a card-sorting activity to understand how patients build trust in the people who show up in their homes, and where scheduling for follow-up care falls apart.
One story came up repeatedly. A doctor orders imaging, a specialist visit, and a follow-up. The front desk can only book the imaging on the spot; for the rest, the patient is told to expect a call within a week. No printout, nothing to hold onto. As one patient put it, "sometimes you don't even get a printout to help you remember which procedure needs what in order to get the ball rolling." When the call doesn't come, the burden shifts back to the patient to chase it, and the cycle can repeat week after week, each round a point where someone quietly drops out of care. Relief only arrives when two things line up at once: the scheduler calls, and the patient happens to be free to answer. By then, the appointment itself is often weeks or months out.
Research questions: how patients define their circle of trust in home healthcare; what they experience as positive or negative about care delivered at home; and what their actual scheduling preferences are, once someone asks instead of assumes.
How the study was built
Constraints: zero budget, four weeks, one researcher, recruiting through friends and family. HF780 Field Methods in Human Factors Research, Prof. Meena Kothandaraman, Spring 2025. Client: Care AXL.
The plan called for real-time, in-context observation of active in-home care patients, recruited from a broad and diverse pool, with a second person on hand to take notes as things happened. What I ran, working alone on a four-week timeline with no budget, was five semi-structured interviews, three remote and two in person, one of them a dyad, plus a card-sorting activity, recruited through my own network rather than a formal panel.
Five interviews isn't a compromise on depth. Prof. Meena Kothandaraman, who taught the qualitative methods behind this study, and researchers like Erika Hall argue that a small, carefully facilitated sample surfaces the kind of nuance that breadth alone can't reach; going deep with five is a deliberate choice, not a shortfall. The cost showed up elsewhere.
What was actually lost sits in two places. The sample skewed toward people already in my network, mostly one race, ages 35 to 78, all within an hour of their doctor's office, which narrows how far these trust patterns can be expected to generalize; a more diverse, representative pool was the ideal. And the method gave up what only real-time presence can provide: in-context observation of care actually happening in the home, a longitudinal view of how trust shifts over a patient's story, and a second observer taking notes in the room as it happened. Insights came through recordings reviewed afterward instead. Both are named directly below, because that comparison is the point of showing this work: not to defend the study, but to show exactly where its edges are.
Sample, ideal versus actual: for behaviors, the ideal was people who schedule their own in-home care at least once a week; the actual sample schedules any healthcare appointment fewer than once a month, which lost regular lived experience with in-home care scheduling. For demographics, the ideal was a diverse sample across race, age, and gender, urban and remote, drawn from a representative pool; the actual sample came from my own network, within an hour of a doctor's office, ages 35 to 78, predominantly one race, which lost a more diverse population. Abilities and psychographics stayed close to the ideal; the gaps sit in behaviors and demographics.
Approach, ideal versus actual: for context, the ideal was in-context, inside the home; the actual was in person for two participants and remote for three, which lost the immersive, first-hand context of where care actually happens. For dynamic, the ideal was longitudinal; the actual was not, which lost the breadth of a story arc changing over time. For method, the ideal was one researcher plus two observers, using interviews, ethnography, and a diary study; the actual was one researcher with no observers, interviews plus a card-sorting activity, captured through Otter.ai and Figjam, which lost real-time synchronous observation, replaced by insights gathered asynchronously, along with some of the depth and breadth the fuller method mix would have offered.
The People Behind the Data
Two patterns of trust showed up across the interviews, not fixed camps but a spectrum: the Utopian and the Skeptic.
The Utopian is an optimist. If a new specialist is recommended, they might phone a friend or just go with the flow. They believe doctors went into medicine motivated by a desire to help people. "I trust people right off the bat," one participant said. Their real challenge is that they rely on advocacy from their inner circle of trust to make decisions, and that circle isn't always available: "I realize that in our present healthcare system, you really need every patient to have a patient advocate. Often there's multiple doctors involved who aren't all getting together and having a meeting about you."
The Skeptic treats trust as conditional, never given without verification. They believe some doctors are motivated by an expected income as much as by care, and they research peer-reviewed sources before trusting a recommendation. Their bar is set high, very specific care providers are required to earn it, and they can sometimes overthink it, second-guessing a good match. That same scrutiny makes them an effective self-advocate, always looking for the truth.
The Shape of Trust
Trust in an in-home caregiver behaves less like a switch and more like a dial. It moves in through specific moments, and it can move back out just as specifically. Some of what builds or erodes trust held true across both personas interviewed; some depended on which lens a participant brought into the relationship, the Utopian's or the Skeptic's. The diagram below maps what moved trust in and what moved it out, alongside where each persona tends to sit on that spectrum.
Concerns and Openings
Participants raised real concerns about care delivered outside a clinical setting: a sense that in-home care ranks below an office visit, unfamiliarity with the tools and the space involved, a fear of isolation, doubts about what happens if something goes wrong in an emergency, worry about coordinating across multiple providers, and skepticism about how a caregiver is credentialed.
Those same participants also named what draws them in. In-home care can feel more personal. The tools involved, MyChart, ZocDoc, Healthgrades, are already familiar ground. It removes the travel burden entirely; participants consistently reported roughly 45 minutes one way to their usual provider. And it opens room for a pace that does not feel rushed.
Scheduling Is Emotional Work
For most participants, scheduling in-home care is not just a logistics problem, it is an emotional one. "We spend two to three hours per week calling the insurance company to see what is covered," one participant said. The two personas handle that friction differently. Skeptics tend to reschedule as a form of self-advocacy, pushing until an appointment works on their terms. Utopians are more likely to avoid rescheduling altogether, even when it does not suit them, to keep the peace. The journey map below traces where that friction shows up: a week can pass with no callback, and in that silence, a patient can quietly drift away from care altogether.
What Comes Next
The next phase should start with recruiting patients who are already using in-home care, not people who could imagine it, so the research captures lived experience rather than a hypothetical. In-context ethnography paired with a diary study would close the two gaps this round could not close: seeing care unfold in the home in real time, and tracking how trust shifts over the course of a patient's story. Before designing further around trust, a focused discovery study on what trust actually means in this context looks like the right next step. Two leads are worth chasing there: a kind of stranger danger hesitation about inviting someone new into the home, and the pressure some participants described to host, to present the home for a caregiver rather than treat it as their own space during an appointment.