In the CDC's Sexually Transmitted Disease Surveillance 2013, Cook County, IL ranked as the second highest county in the United States for cases and transmission rates of chlamydia, of gonorrhea, and of syphilis. To improve urban health, we propose offering a two-pronged service that will first do an online risk assessment and then send an STI testing kit for in-home use. The target population is women in Cook County who think they may have one or more STI. In 2013 alone, there were a total of 40,590 cases for gonorrhea and chlamydia.The conventional approaches to lower transmission rates are to educate in the school system and to promote the use of physical barriers, such as condoms. Our approach, however, enables individuals to learn their personal sexual health status and thus make informed decisions in practicing safer sex in their community.
Our concept is to develop an STI testing kit for high-risk individuals to use at home, affording them to conveniently get results without the fear of getting shamed. Through our research, it became evident that fear and shame become major barriers to getting tested. Rather than going to a clinic, many self-diagnose by searching online, which leads them to become overwhelmed without getting definitive answers. Our solution gives clear answers with tailored information that provides peace of mind.
Notice is an STI testing service that provides the support one needs before, during, and after taking the test. It helps individuals understand the potential risk of having contracted STIs, gives them rapid test results, and provides suggestions for those whom want treatment. For the end-to-end experience, Notice has an online risk assessment questionnaire, a testing kit, and a list of recommended treatment providers.
The online risk assessment questionnaire has four steps with short questions about relationships and behaviors. The testing kit is made for first time users and is received at home and allows individuals to get answers quickly in the familiarity of their own environment. As trials have shown, self-administered STI test results are as accurate as a medical professional administered test. Through our research, we found that the ease and comfort of taking the test at home could increase rates of getting tested. This approach could decrease the cost associated with diagnosing patients, such as staffing doctors and nurses, and would increase clinic efficiency because patients would come in for treatment only. Additional to providing clear answers, Notice seamlessly links individuals with appropriate treatment.
Recent developments show a trend towards testing for STIs outside of the clinical setting. With its novelty, it is being trailed on college campuses for students, including at Johns Hopkins University, though it has yet to be tried as a service provided by a city government or city clinics. This solution has great potential to increase awareness by giving individuals clarity about their situations and providing a way to get tested that has shown to increase habitual testing. Not only is the testing easy, but it can seamlessly link to treatment.
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Risk AssessmentRisk Assessment
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Checking ResultsChecking Results
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It was critical to this topic that we spoke with multiple stakeholders. We screened for individuals that have a variety of sexual habits, we interviewed experts in the field such as; sex therapists, professors of human sexual behaviour, sexual health educators, STI advocates, and individuals who are living with STI or who have been infected with an STI.
Using the dating application Tinder, research participants were intercepted and asked about their sexual experiences and to share specific stories about STIs or to share their opinions on discussing STIs with partners. Additionally, we posted questions to the on public forums such as Reddit and YahooAnswers. We frequented our posts and added probing questions throughout the discussion thread to continue engaging with the public.The team combed through discussions in a variety of online forums. Here, protected by pseudonyms, people would voice their concerns and ask questions around STIs.
Asynchronous Online Qualitative Study
Using Revelation® we created a discussion guide and did real time journal tracking with our participants. Individuals from Tinder, Reddit, and YahooAnswers were asked to participate and screened before entering our study. This was a very reflective study that allowed us to gain a lot of rich content and thick stories about the testing process. To have research participants speak openly about the otherwise highly stigmatized topic, the team used an online research tool to moderate the conversations. Doing so, the participants could answer at their own pace
We mapped out what the current experience was like from having sex, to going to the doctor for testing, to waiting for results, and then learning the results. It was clear where pain points existed in the user journey and become launching off points for concept generation for where to improve the experience of STI testing. Later in the concept development phase, we overlaid our new service to ensure that the holes we found were resolved.
Creating sacrificial concepts was a key driver for arriving at robust service concepts. We went through multiple scenarios and “…what would happen next” situations. Our sacrificial concepts were based off of hypothesis and developed rapidly so we could play out the scenario.
Low-Resolution Mobile App testing
The level of fidelity and resolution can make or break a prototype. We prototyped a low-resolution prototype of a mobile application on a high fidelity device. The focus was not on the aesthetics of the application, but rather observing the flow and how a user navigated through the application. MarvelApp was used to make a series of Illustrator artboards animate and become interactive.
Going to the doctor is a shameful experience. Although this is perceived by an individual, the tense and conflicting circumstance become a barrier to going and getting tested.
Booking an appointment to go to the clinic is time consuming and means commitment. It is natural human behaviour to procrastinate in situations where denial is prevalent. This additional step in going and getting tested poses as yet, another barrier to going and getting tested.
Online sources, although a wealth of information, are overwhelming and do not offer any clarity. Falling down the rabbit hole of endless searching does not result in any clear or customized answers. Additionally, this lag time builds up anxiety for the individual.
While purchasing self-administered kits is an option in-stores, there is no telling which of the multiple STI tests should be selected for testing an undetected STI. These kits are relatively costly and therefore selecting the accurate test for an unknown STI becomes a costly blind search.
Women are especially affected by fear and shame, which keeps them from going to a clinic. The team decided to design for individuals who are avoiding going to the clinic.Consequently, team developed a prescriptive user journey that shows the desirable user behaviour the service should support.
Based on the research insights, the team developed ideas and tested these with participants in the target group using sketched scenarios. Several rounds of iterating and refining these concepts lead to the final service concept.
Through the website, Notice can provide accurate
information on STIs and make an assessment of an individual's unique
situation and risk.
The algorithm uses two components to assess an individual's risk: user-provided information and stats from credible sources such as government agencies.
Using that data, Notice can asses an individuals risk, and, over time,
discover patterns and trends that can further increase accuracy in the risk assessment. In the delivery of the results, Notice informs which behaviors put an individual most at risk for an STI so that awareness will increase.
The at-home testing kit is taken at home, allowing individuals to get
an answer in the familiarity of their own environment and without the shame or fear of uncomfortable interactions with others.
Because most individuals do not know which STI they need to test for,
Notice's kit combines tests for most infections. All necessary
components for testing will be included inside the box.
The tools to get samples are made specifically for first time users and are supported by easy-to-follow instructions.
After the test is completed, individuals can input their test results on the site.
For those individuals whose test showed they have a condition, Notice
will provide a list of specialists for treatment. The doctors are selected
based on specialty, location and internet reviews.
To visualize the entire offering and how its components work together,
the team modeled all user actions, frontstage and backstage, as well as
supporting processes in a service blueprint.
The team modeled Notice's value exchanges, estimated the size of the
market and modeled its costs to prove its viability as a business.
Very creative use of existing technology
This is a really great example of thinking through a very compelling solution to a sensitive topic.