Normalizing Youth STI Testing in Baltimore City

(This is a complete full-length process blog for the Youth STI Testing project. If you wish to read a shorter version, please visit here.)

“Normalizing Youth STI Testing in Baltimore City” is a four-month collaborative design project focused on lowering the barriers to STI testing for Baltimore youth. This is a pressing social challenge because Baltimore youth aged 15-24 experience an infection rate of chlamydia and gonorrhea that is more than three times the national average (CDC and MDHMH, 2015). The project is enacted in partnership between the Baltimore City Health Department, the John Hopkins Center for Child and Community Health Research, the UChoose Youth Advisory Council, and the MICA Center for Social Design.

The following is a blog that captures our design process and my key takeaways from each sprint.

Thank you to Rachel Serra for her impeccable recordkeeping in the original STI Intervention process blog (password protected, but WordPress will allow you request her permission upon arrival).


Sprint One : 30 August 2016
Discovery Part I

Immediately, our cohort hosted two Baltimore STI experts from the Johns Hopkins Medical Institute, Sophie Meade and Dr. Suzanne Dolwick Grieb. They provided insights into the status of their current CDC-funded research grant for Community Approaches to Reducing STIs (CARS) and shared their lessons learned, their best practices, and their vision for the future.

Takeaway: I readily admit I entered Sprint One with only a very rudimentary understanding of the state of STIs in Baltimore. Dr. Grieb and and Ms. Meade gave me a wealth of information to help me build a foundation of knowledge on which I could begin to enter this space responsibly.

Sophie explains the public-health challenges of STIs.
We map the landscape of current STI interventions.

Sprint Two : 06 September 2016
Discovery Part II

The Baltimore City Health Department presented to us their current efforts to address STIs among Baltimore youth. Also from the Health Department, Brittany Griffin led a presentation and a game-based workshop to teach us the medical facts of gonorrhea and chlamydia.  We also learned of a current case-in-practice under the guidance of Dr. Arik Marcell: Y2Connect, an information-rich, indexed database of STI health facilities in Baltimore City.

Takeaways: I dove deeper into understanding the scope Baltimore youth STI health. The Health Department insights and case-in-practice complemented the shareback from Johns Hopkins last week; together, this began to create a more complete picture of our pathways forward for our intervention this semester.

Brittany uses games to teach us the STI lexicon.
Maria and Jaynie enjoy “Thanks Birth Control” and its relentlessly positive message.

Sprint Three : 13 September 2016
Immersion

As an independent assignment, we each sought testing for chlamydia and gonorrhea.  For the most relevant experience, I chose to be tested at one of the two free STI testing clinics offered by the Health Department.  I illustrate a mood map of my experience below.

Takeaways: While the inefficient, convoluted testing experience frustrated me for five hours, I gained a strong sense of empathy for those who have no choice but to work within a very broken system. I acknowledge my privileged position as a student simply completing a curricular exercise; I understand the stakes are much higher for someone who must sacrifice school or work hours to undergo the same testing.

My mood fluctuated widely during my STI testing experience at one of Baltimore’s free clinics.
Jaynie opts instead for the mail-in STI testing kit.

Sprint Four : 20 September 2016
Research

This week, we assembled in pairs to explore four topics of research to present to the cohort:

  • Comparative analysis of chlamydia and gonorrhea infection rates across geopolitical/socioeconomic/racial/gender lines
  • Survey of current landscape of STI awareness campaigns in the country
  • Social-ecological models/personas of STIs
  • Catalog of available STI testing locations across Baltimore City

Takeaways: By understanding STIs through multiple lenses, I continued to broaden my knowledge of the social challenge beyond a medical issue.  I started to see different domains in which interventions can be enacted.


Sprint Five : 27 September 2016
Social Literacy

Diamond James, a professional social design facilitator, presented a lecture on social literacy, participatory design, and the responsibilities of those who choose to ally with underserved communities.

Using the insights from Diamond’s lecture,  we then collectively brainstormed for our upcoming workshop with the Youth Advisory Council (YAC). The YAC, composed entirely of Baltimore city youth aged 14-20, provides youth-focused guidance and feedback to the Teen Pregnancy Prevention Initiative while acting as peer health advocates.  Brittany Griffin, herself a member of the YAC, guided our brainstorming session. We sought ideas and activities that could harness the unique experiences, viewpoints, and energy of the youth.

Takeaways: To provide a truly effective intervention for the youth of Baltimore, we must include the voice and the leadership of the youth in Baltimore. I know I am not of the target demographic for this intervention. I can never assume I know their worldviews, methods, and motivators, nor can I assume I know the solutions to their challenges. I acknowledge this lack of shared experience and let them teach me what it’s like to walk a mile in their shoes.

Potential persona characteristics are added to our plans.
Devika and Jaynie continue to brainstorm.

Sprint Six : 04 October 2016
The Youth Advisory Council (YAC)

Our cohort facilitated four activities for our workshop with the Youth Advisory Council (YAC):

  • Persona crafting for a hypothetical friend’s outlook on sex, sexual health, and STI testing.
  • Survey for their opinions on the menu of testing options currently available to Baltimore city youth
  • Free word association to images of interior/exterior spatial design (identified as an activity to prepare for potential interventions which involve spatial design)
  • Whiteboard session on their perceptions of STI testing in general

Takeaways: The YAC’s responses challenged my assumptions for the “ideal” intervention. When the youth described for me their experiences and perceptions, I understood their unmet needs and their motivators more clearly.

A YAC member invents her persona and adds emojis to the characteristics.
YAC members complete surveys for our quantitative data collection.
Free word association in response to images of interiors.

Sprint Seven : 11 October 2016
Research Review Preparation

Our cohort took a step back and surveyed the hundreds of Post-it® notes we had scribbled and pasted over the past seven weeks. We began to categorize their contents into “buckets” (really, just larger post-it notes that we used as tackboards) and saw the groupings that organically formed. For each of these groupings, we formed an “insight”: the alchemy of fact and social tension.

Takeaways: By surveying the tableau of notes, I began to understand themes and draw connections.  Patterns started to emerge and urgent issues rose to the surface by volume.  I could understand the concepts caused by — or resulted in — social tension. Very clearly, the domains of intervention came into focus.

So many observations!
We continue bucketing on chairs because we run out of wall space.
Maria continues to identify themes.

Sprint Eight : 25 October 2016
Research Review with Health Department

Our midpoint milestone arrives: a research review to be presented to the Health Department.  We presented an overview of our research process to-date, the design principles which guided our journey, and the key insights formed from the work in the previous sprint. Participants gave feedback and asked questions on all the insights, then voted on those they wanted to see further developed in future stages.

Link: Research Review slide deck

Takeaways: Of highest importance to our audience were the insights on emotional barriers, wait times, and peer-to-peer networks. This informed our decision as we continued to refine the project.

Our audience gives us their votes, their questions, and their reactions.
Close-up of the feedback to one particular insight about peer-to-peer networks.

Sprint Nine : 01 November 2016
How Might We?

We unpacked the most resonant insights from the Research Review from Sprint Eight. In an intense ideation session, we synthesized the feedback for each insight and then crafted “How Might We…?” statements to lay the groundwork for the generation of design opportunities.

Takeaway: By crafting “How Might We” statements from the insights, we maintain a close connection to the youth and healthcare experts from whom those insights came.

We build on the previous insights to make “How Might We…?” statements.
We are challenged to not lose focus of the insights when we write our “How Might We…”s.
So many insights! So many themes!

 

Sprint Ten : 08 November 2016
Health Department Brainstorming Session

The final five “How Might We?” statements were:

  • How might we clarify the testing process to reduce fear and anxiety?
  • How might we design a safe and inviting clinic space that encourages youth to get tested?
  • How might we make the waiting periods before, during, and after testing a positive and comfortable experience?
  • How might we design a testing process that respects individual privacy?
  • When a provider and a patient meet, how might we include conversations about sexual health beyond infection treatment?

We presented these statements to the Health Department stakeholders. In five-minute lightning rounds, the participants brainstormed possible solutions as fast as they could.  We collected all the ideas and bucketed them according to theme. At the end of the workshop, the participants browsed through the gallery of ideas and voted on their top three.

Links: Insights & “How Might We…?'” slide deck

Takeaways: By maintaining a lightning-fast brainstorming speed, participants were encouraged to be fast and loose with their ideas. Some of the best ideas came from when they didn’t overthink.

Participants brainstorm with quick sketches on half-sheets.
Molly, Maria, and Rachel do lightning-round theming as quickly as participants are brainstorming.
So many brainstorm ideas!

Sprint Eleven : 15 November 2016
Wide Angle / Low-Fidelity Prototypes

The next week, we conducted the exact same brainstorming workshop from Sprint Ten to the youth at Wide Angle Youth Media, an organization that empowers youth with media education to tell their own stories and engage in their communities. (Full disclosure: we got a a lot of SpongeBob ideas.) Then, we brought together the highest-vote ideas from both the youth and the Health Department and prototyped those ideas roughly.

Takeaways: Both the youth and the adults expressed a strong desire to address the stigma and the wait times (for both testing and results). This commonality resonates with the core of the negative emotional experience of testing.

Wide Angle Youth brainstorm on the “How Might We…” questions.
There are a lot of games and SpongeBob brainstorming ideas.
We prototype positive messaging on context-appropriate vehicles.
Our first prototype of the Express Testing idea.
Prototypes of positive affirmation ideas.

Sprint Twelve : 22 November 2016
Prototype Shareback with Wide Angle

We brought our roughly made (but generously hot-glued) prototypes back to Wide Angle. After presentation, the participants were encouraged to play with the prototypes, then vote on their favorites.  Prototypes for positive messaging, web-based applications, an “Express Testing” window (like Dean Street Express in the UK), and games in the waiting room won the most votes by far.

Takeaways: Ludic interaction was important — when entering a stressful experience like STI testing, injecting a sense of fun, positivity, and brightness can make all the difference.

Jaynie and I roleplay the Express Testing window prototype.
Arcade ideas won many of the votes.

Sprints Thirteen and Fourteen : 29 November 2016  + 06 December 2016
Final Presentation Preparation

To prepare for our final presentation to the Health Department, we first built higher-fidelity prototypes of our positive-messaging ideas and the Express Testing window.  We also retraced our journey from Sprint One, identifying key takeaways that informed decisions later in the process.

Takeaways: After taking the retrospective view of the process, I realize the design thinking process alternates between expansion and contraction: there are moments when we brainstorm and get an influx of new ideas, then later work to focus and narrow when bucketing, synthesizing, and writing “How Might We” statements.

Jaynie turned a quote from the YAC (with SpongeBob!) into a prototyped message.
Higher-fidelity mockups of positive messaging within the clinic setting.
A higher-fidelity mockup of the (now unstaffed) Express Testing machine.

Sprint Fifteen : 13 December 2016
Final Research Presentations

The four months culminated in a presentation of the prototypes to the Health Department, the CARS research team, and the Youth Advisory Council. By presenting our prototypes in a narrative representing the testing journey, we captured the essence of the experience and demonstrated the value of our proposed interventions.

Based on feedback from participants, the ideas of positive messaging and express testing were chosen for the final phase of the project with a new team, which began in January 2017. You can follow their progress here (password protected but you may request permission from the website owner, Rachel Serra, from the link).

Link: Final 2016 slide deck

Final takeaways: Nobody said the human-centered design process was going to be speedy, but it certainly is more engaging, ethical, user-focused, and communistic. I understand the natural temptation to be wary of resource limitations of time and money when designing interventions, but I know in the end a slower, iterative, and thoughtful human-centered approach emerges with greater success. I look forward to more opportunities to continue this kind of work in the future.

 


August-December 2016.
Project completed within the graduate program in Social Design at MICA.

Project team: Matt Barr, Jaynie Chartrand, Maria Isabel Garcia-Diaz, Devika Menon, Patricia Natalie, Molly Reddy, Rachel Serra, and Irina Wong.

Faculty Advisor: Becky Slogeris.