Taking user research into interface & interaction design.
Project Overview
Stigma has found its way to the very core of human existence. The deep-seeded nature of this concept severely impacts the well being of many and as such, individuals find themselves internalising negative misrepresentations generated as a result of social conditioning.

Young Australians aged 16-21 require a mechanism to foster autonomy by way of distinguishing personal identity from external perception in response to their changing behavioral patterns and highly stigmatized environments.

The final design concept is a platform designed to decrease feelings of alienation and dismissal of one’s own conditions and therefore increase care-seeking behaviours to effectively provide a mechanism to spark the improvement of public health.

Working collaboratively through group-based design, utilizing the varying strengths of each member of the design team, allowed Blot to be as effective and beneficial to the target audience as possible. 

My personal involvement included playing a key role in thematically analysing research, user journey mapping, low and high fidelity prototyping as well as the usability testing and evaluation of Blot at all stages.

Throughout the process, the design team was conscious of the potential impact that this platform could have on the mental health and overall wellbeing of adolescents and young adults, acting as a means to change the internal perception of external stigmas. 

The focus problem scenario the design team (Connie Ou, Joshua Del Rosario and myself) selected was public health. Preliminary discussions in this area brought up topics of sexual and mental health, with the heart of these problems being stigma and shame. Certain social contexts provide a breeding ground in which power is exercised to label and stereotype different groups of people. These stigma processes have profound impacts on not only the distribution of life choices such as medical care, but also have “consequent negative effects on mental and physical health” (Link & Phelan, 2006). Ultimately, it is the social nature of stigma that finds itself within the various facets of our everyday life which radically alter not only our own, but also the wider community’s exposure to protective factors and disease risks.
My individual focus in the discovery phase was the stigma surrounding sexually transmitted infections (STIs), how this impacts STI positive individuals and their internal shame, and the subsequent effect on related conversations. This area was selected due to its novelty and increasing social relevance. The topic of sexually transmitted infections (STIs) presents a modern example of the socially fluid nature of stigma (Rush et al., 2008). Conservative cultural norms of monogamy, where there is no physical mechanism for STIs to spread, effectively equate STIs with non-monogamy which is traditionally associated with promiscuity (Squire, 2021). Stigma in the medical industry has typically been applied to conditions whose causes were seemingly related to avoidable behaviours which the afflicted is responsible for (Kinghorn, 2001). The presence of modern medicine has enabled effective cures for bacterial STIs, with the general population perceiving these as less of a threat than viral STIs to overall health and are therefore less stigmatised. Psychological and emotional consequences of general stigmatisation are well documented, however there is limited research in STI associated shame and psychological distress. There is a need to confront stigma to better preserve not only physical public health, but the mental wellbeing of citizens following a diagnosis.
Establish a deep contextual understanding of existing social attitudes towards STI positive individuals; gaining a comprehensive contextual understanding, which will act as a framework to further identify challenges faced by both STI positive individuals and prospective partners when engaging in mindful conversations surrounding their sexual health.
1. What factors contribute to the stigma surrounding sexually transmitted infections?

2. How do the psychological impacts of being STI positive compare to the physical impacts? And how do they affect each other?

3. What are the tools needed to successfully engage in mindful conversations surrounding sexual health; with all parties able to make informed decisions?

Systems mapping was utilised to understand the networked elements and systemic relationships that contribute to the stigma surrounding STIs. In example, it was found that a limited sexual education and misinformed media coverage operated in a complimentary fashion to fuel the stigma surrounding sexual health. Engaging with a systems thinking exercise allowed for a holistic understanding of the complex context in which STI stigma resides.

A Literature review was then conducted to establish a deeper knowledge of sexual health as well as STI related stigma and shame. The gaps found in the research serve as a guide to direct interviews and other primary research. Beyond this, the review acts as a foundation to which findings can be compared and contrasted with. It is important to note that given the limited scope for this assignment, the literature review is not comprehensive, however operates suffiently in this space.

Following investigation into the context surrounding STIs and associated stigma, it was established that there is a lack of general understanding surrounding STI severity and treatment. This misunderstanding acts as a mechanism to further facilitate the existing stigma towards STI positive individuals, enhancing feelings of alienation and internal shame. The stigma itself contributes greatly to the prevalence of STI cases as many asymptomatic individuals who fear association continue the spread unknowingly. A passive internalisation of social stigma contributes to high levels of shame following an initial diagnosis. Female specific moral stigma plays a strong role in how women perceive themselves following a diagnosis (Nack, 2000). These gendered social morals are inherently difficult to progress beyond due to the subconscious nature of their uptake (Rush et al., 2008). The landscape which this research is conducted within is unique due to the associated levels of discomfort, which ultimately poses a barrier in communication and access to help, contributing greatly to psychological distress.
Australian teens and young adults aged 15- 24 were selected as the target group for this study. This is due to the fact that incidence rates for STIs in Australia are highest in 15-24 year olds (Bourchier, Malta, Temple-Smith & Hocking, 2020) and that young people are “often uniquely open to behavioural changes”, being more likely to respond to intervention methods (Pfeiffer, 2016) than other age groups. 12 individuals in this age range participated in this study, 4 of which had personal experiences with STIs. The reason participants who had no personal experience with STIs were included in the study is because the research also aims to examine the social stigma through an external lens. Additionally, a General Practitioner (Dr Mitchell Squire) interested in transgender and sexual health was included in the research to offer a medically grounded perspective.

Utilising multiple methods or data sources in qualitative research, known as triangulation, assisted in developing a more comprehensive understanding of phenomena (Patton, 1999). By obtaining information from multiple, varied sources, data collected can be tested for validity and reliability. An Online ethnography was utilised to gain a comprehensive understanding of broader social sentiments and attitudes, with findings becoming the basis for interview questions. The online ethnographic data collected showcased an array of individuals, who had varying opinions and sexual histories. From this research, it was deduced that a lack of education and maturity often leads to psychological distress in newly diagnosed individuals. This was particularly the case for chronic STIs. Interestingly, it was found that there is a heightened fear of STIs in the cis heterosexual community compared to the LGBTQI+ community due to the impact and relevance of HIV/AIDS. This suggests that a social awareness of impact and available treatment of STIs has the potential of reducing stigma related fears. This is also true of the response of potential partners to a disclosure, where it was found that limited education on the topic and little desire to learn contributes greatly to the likelihood of an insensitive response. Avoidant behaviours were seen to develop as a result of this anxiety. As disclosure is an emotionally draining and vulnerable act, where fear of rejection is often at the forefront, an insensitive response can have a significant impact on one’s mental health. A positive response to disclosure was seen to be relieving. Extremes & mainstreams was selected as a method to be used in the process of recruiting interview participants. Extreme users are those on the outer edge of a challenge space, in this case being the impact of STI associated stigma on individuals, their internal shame, and associated conversations. Two extremes in this scenario could be 1. a conservative individual who is heavily connected to religion, believing in abstinance or 2. a progressive HIV positive individual who has come to terms with their diagnosis and is very open about their status. The target user group of teens and young adults aged 15-24 are the “mainstream” in this scenario. By recruiting interview participants in these two extremes, along with mainstream participants, a more holistic understanding of the needs of people within the challenge space can be established. Interviews were then utilised to understand the needs of participants in the target age range, their existing knowledge and desire, with Expert Interviews incorporated to ground the research in fact and gain a systems level understanding of the problem space. It was found that in the target age range of 15-24 year olds, there was limited pre-existing knowledge of STIs and associated social impacts grounded in fact rather than stigma, particularly in the space of treatment and transmission. The prospect of intercourse with an STI positive individual, without previous social experience in that realm, was consistently met with aversion. Whilst appearing naïve at face value, the expert interview with Dr. Mitchell Squire (2021) revealed that the idea of exposing oneself to any disease, or risking any perceived harm is not desirable, regardless of the condition. Like the earlier online ethnographic research, it was seen that levels of stigma were much lower in acute STIs than chronic. In the LGBTQI+ community, for HIV negative individuals, there is much less concern towards HIV+ individuals (Squire, 2021). It can be deduced that this is due to the historic impact of HIV/AIDS on the community, which has equipped them with the social education to reduce stigma, as well as the efficacy of preventative drugs such as PrEP. The erratic nature of HSV flare ups, if on no suppressive medication, renders the transmission of HSV unpredictable (herpes is more likely to transmit when there are active lesions). Due to this unpredictability, as well as the permanency of the virus, HSV is arguably the most stigmatised STI, regardless of its minimal physical impact (Squire, 2021). It was further seen that HSV disclosure prior to intercourse is a difficult conversation to initiate due to fear of rejection and internalised stigma. Being “health-literate” and proactive with one’s sexual health means that the chance of permanent physical harm from any STIs, with regular testing, is very low, particularly in Australia. This is however under the presumption that one can afford costs of screening and treatment, which can vary in expense depending on insurance and healthcare providers. This was seen as a frustration to multiple participants.
A Thematic analysis was utilised to organise information found in qualitative research to discover meaningful patterns across the data (Joffe, 2011). It was found that:

1. Moral challenges are inherent when STIs are introduced into relationships, requiring vulnerability and transparency of all parts for positive outcomes.

2. Failure of the education system to provide relevant social and conversational skills to students has resulted in individuals who are ill-equipped to digest a positive diagnosis, effectively encouraging negative emotions.

3. Due to the lack of information provided in schools and limited social experience, youth are passively absorbing information through public media.

4. Access to care, initially physical transcending to psychological post diagnosis, is impacted by social traditions.

5. Awareness of the associated negative stigma affects an individuals ability to distinguish social perceptions from their own internal shame, subsequently impacting emotional growth and development, enabling movement towards acceptance and decreased negative emotions.

Four personas were developed for this project, grounded in the above research, each with different needs, goals and frustrations.

Journey mapping was used to better empathise with the personas in order to improve their experience later.

A flow diagram was created to model interactions that users would have with the platform, as previously defined  in the user journey map. This provides the design team with a mechanism to purposefully increase ease of movement across the platform. 

Sketches were used as the first method of visualizing the screen designs for Blot. These were completed as a design team to efficiently explore ideas quickly (Tomitsch, 2018) to better understand how various interactions take place. This provided a foundational understanding of how various elements were to be visualized within the context of the phone screen and guided exploration into a streamlined process of individualizing yourself through blots..

Paper prototypes were built upon the sketched screen designs. These served as a valuable low-fidelity method of enabling quick conceptual exploration and visualisation. Furthermore, the low-commitment nature of paper prototypes allowed the design team to quickly gain feedback from users and elicit honest feedback due to their ‘sketchy’ look (Babich, 2018). The ultimate goal of these paper prototypes were to uncover early errors and pain points within the system.

The goal of the usability testing sessions for the paper prototypes was to let users navigate the various screens and ultimately let them view the various functions of the app. The user testing and evaluation of the paper prototypes allowed preliminary discovery into the changes to the system states to increase overall enjoyment and performance. This was beneficial in ensuring that the initial plan for Blots functionality, features and overall navigation corresponded with user needs, expectations and behaviours.

The think aloud protocol allowed the design team to gain the access to people’s thought processes (Tomitsch, 2018) while they interacted with Blot. Participants were asked to verbalize their thought processes as they performed the following tasks: create an account, find and external resource, show another user you care, compare orb changes over time. Once users finished the think aloud session, a short semi-structured interview was conducted surrounding their overall experience, efficiency and confidence levels whilst using the prototype. Participants were then asked to complete a System Usability Scale (SUS) survey. This provided the design team with quantitative data on actionable insights and the usability of the system. The minimal cost and ease of administration of meant SUS surveys were the most appropriate method of usability analysis to employ. To wrap the usability sessions with participants, a short, unstructured interview was conducted to probe further into some of the answers that participants put on the SUS survey.

Key feedback was implemented in the following wireframe stage.

Wireframing was utilised to show the fundamental structures and functionalities of the platform with a hyper-focus on content placement and user flow. Described as a way to “draft a structural and functional skeleton” (Tomitsch, 2018), wireframes are limited in their ability to visually represent certain aspects of the app. However, they are beneficial in implementing feedback from the paper prototype usability testing sessions and act as a precursor to the final high-fidelity prototypes.

High fidelity prototyping was useful in representing the platform in the closest similarity to the final design in terms of functionality and aesthetics. In the final round of usability testing, this enabled more thorough and detailed feedback on certain elements of the design that would otherwise not be recieved.

Over the course of the DECO2200 studio, the design team has been given the opportunity to design “useful products with usable interfaces”, with the chosen focus being the impact of stigma and shame on the wellbeing of adolescents and young adults. The intent of the final design concept was to create a platform that would decrease feelings of alienation and dismissal of one’s own conditions and therefore increase care-seeking behaviours. This would  effectively provide a mechanism to spark the improvement of public health. Throughout the process, the design team has been conscious of the potential impact that this platform could have on the mental health and overall wellbeing of adolescents and young adults, acting as a means to change the internal perception of external stigmas. 

Following ideation in task two, the design team began to further develop the selected design concept, drafting initial wireflows. These modelled proposed interactions, which would enable ease of movement across the platform. Utilising the wireflows as a space for reflection and re-evaluation created a platform for effective communication and collaboration within the design team in a visual space. This was further enabled through the sketching of interfaces, which increased consistency of each member’s mental models and provided a space to practice and improve on existing sketching skills. The development of early wireframes acted as a space to apply newly learnt skills in content placement and user flow, creating the groundwork for the paper prototypes. The creation of paper prototypes tested the design team’s low-fidelity prototyping skills, with a strong focus on consistency of elements across the interfaces. This consistency was seen to be successful in the initial user testing and evaluation. These paper prototypes provided a quick and inexpensive way to weed out major design errors and feedback received in the initial testing sessions. 

Participants in the initial round of user testing and evaluation sessions provided consistent feedback, being that they would prefer internal focus and insight to first deconstruct their own stigmas before gaining knowledge of other peoples. Further, it was seen that designing an interface to have a purposefully low cognitive load would be more impactful. This was of great benefit to the design team, as it assisted in developing a more focused direction for blot, honing in on the understanding and acceptance of internal stigma. This feedback was then adopted into the polished wireframes. The feedback received here consisted mainly of usability errors rather than conceptual flaws. High fidelity feedback from other designers was encouraging, with more minor usability issues brought to attention. Overall, the user testing and evaluation sessions proved to be significant in the evolution of Blot and its functionality. Further, this feedback sparked refinement of the design team’s high fidelity prototyping skills, particularly in the space of interactions. 

Working collaboratively through group-based design, utilizing the varying strengths of each member of the design team, allowed Blot to be as effective and beneficial to the target audience as possible. On a more personal level, the design team learnt that healing from stigma is not linear, more so tumultuous. As such, emphasis was placed on unpacking this misconception. As designers, we learnt that our knowledge is limited, and therefore it was highly necessary to include real people throughout every step of the process. 


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