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"I Should Know, But I Dare Not Ask": From Understanding Challenges in Patient Journeys to Deriving Design Implications for North Korean Defectors' Adaptation

Hyungwoo Song, Jeongha Kim, Minju Kim, Duhyung Kwak, Minjeong Shin, Bongwon suh, Hyunggu Jung

Abstract

While it is known that North Korean defectors (NKDs) struggle with South Korea's healthcare system, the specific challenges of their patient journey remain underexplored. To investigate this, we conducted interviews with 10 NKDs about an 8-step patient journey and identified the clinical consultation step as a critical barrier for all participants, marked by three key challenges: expressing symptoms, managing social and cultural concerns, and overcoming language differences. In response, we developed Medibridge, a mobile prototype that allows users to rehearse with an AI doctor before a real hospital visit to generate a tangible ``Helper Note'' for their actual consultation. Our evaluation with 15 NKDs showed improvements in perceived communication capability, including greater expression clarity, reduced social and cultural concerns, and enhanced linguistic confidence. Our contributions include an empirical understanding of NKDs' healthcare challenges, a novel AI-powered rehearsal system that prepares users for real-world clinical communication, and design implications for inclusive technologies for displaced populations.

"I Should Know, But I Dare Not Ask": From Understanding Challenges in Patient Journeys to Deriving Design Implications for North Korean Defectors' Adaptation

Abstract

While it is known that North Korean defectors (NKDs) struggle with South Korea's healthcare system, the specific challenges of their patient journey remain underexplored. To investigate this, we conducted interviews with 10 NKDs about an 8-step patient journey and identified the clinical consultation step as a critical barrier for all participants, marked by three key challenges: expressing symptoms, managing social and cultural concerns, and overcoming language differences. In response, we developed Medibridge, a mobile prototype that allows users to rehearse with an AI doctor before a real hospital visit to generate a tangible ``Helper Note'' for their actual consultation. Our evaluation with 15 NKDs showed improvements in perceived communication capability, including greater expression clarity, reduced social and cultural concerns, and enhanced linguistic confidence. Our contributions include an empirical understanding of NKDs' healthcare challenges, a novel AI-powered rehearsal system that prepares users for real-world clinical communication, and design implications for inclusive technologies for displaced populations.
Paper Structure (75 sections, 10 figures, 7 tables)

This paper contains 75 sections, 10 figures, 7 tables.

Table of Contents

  1. Introduction
  2. Background and Related Work
  3. Background
  4. Related Work
  5. General Challenges Faced by Migrants in Healthcare Systems
  6. Existing Tools for Healthcare System Adaptation
  7. HCI Research on North Korean Defectors
  8. Research Gaps and Study Objectives
  9. Formative Interview: Understanding Patient Journey Challenges
  10. Method
  11. Participants
  12. Procedure
  13. Researcher Positionality
  14. Interview Protocol
  15. Thematic Analysis & Design Goal Formulation
  16. ...and 60 more sections

Figures (10)

  • Figure 1: Research methodology from formative study to design implications. The study progresses through formative interviews identifying patient journey challenges, design goal development targeting clinical consultation difficulties, MediBridge system implementation with AI-powered dialogue and "Helper Note" generation, and three-condition evaluation study (pre-test baseline, Simple Version, MediBridge) leading to design implications for marginalized populations.
  • Figure 2: 8-Step Patient Journey Framework. (1) Provider Search: finding appropriate healthcare providers, (2) Registration: completing intake procedures, (3) Wait Time: managing appointment scheduling and waiting periods, (4) Clinical Consultation: communicating symptoms and concerns with healthcare providers, (5) Clinical Examination: undergoing medical assessments, (6) Diagnosis & Treatment: receiving medical decisions and treatment plans, (7) Billing & Payment: handling financial transactions, and (8) Medication & Discharge: completing prescriptions and follow-up instructions.
  • Figure 3: System prompt defining the persona of an AI doctor. We instructed the model to maintain a businesslike tone to simulate realistic interactions in South Korean healthcare settings.
  • Figure 4: MediBridge Steps 1--3: (1) Users input symptoms and access previous "Helper Notes", (2) review essential checklists and psychological preparation content addressing patient rights and social concerns, (3) practice real-time AI doctor conversations.
  • Figure 5: MediBridge Step 4. After the practice session, the system provides integrated feedback, including Voice Analysis for communication reassurance, Socio-psychological Insights addressing social concerns, and Conversation Analysis assessing coverage of essential clinical information.
  • ...and 5 more figures