Sexual health for women is a topic that is rarely spoken about in both public and private spheres. It is seen as taboo for women to be overtly sexual creatures, and therefore educating young women on the topic is avoided and replaced with messages of abstinence. It is usually the hope that teaching no sex at all will lead to women avoiding all the complications that come with sexual intercourse. However, there are consequences to the lack of discussion for women around sexual health. Without this knowledge and awareness, women are unable to prepare themselves to have safe, pleasurable, consensual and destigmatized sex.

I aim to educate young women in high school on their sexual health through a mobile application that will serve as a resource to substitute the abstinence only education they are getting from their religion and parents. I will be focusing on young women growing up in religious households whose parents are against their daughters being sexually active.

Focus of Project

Interaction Design
Undergrad Capstone Project

Tool Used

Figma
Keynote
‍

Timeline

1 semester

Research

Academic Source Research

I first turned to academic resources from online articles and databases. I turned this research and more that was conducted into an affinity diagram to analyze it. That is shown to the right.

In a memoir about her experiences, Linda Kay Klein described how she escaped Evangelical purity culture, and how it had a lasting influence on her sex life as an adult. She said:
As it turns out, incessantly telling girls that their bodies are a turbulent, unpredictable minefield of sin can lead to an unhealthy sex life when they’re adults. As I was developing as a sexual person, I was experiencing a tremendous sexual fear, shame and anxiety. But I was taught that that was OK, because sexuality was shameful, and something I should be afraid of and anxious about. So I thought that if I was having anxiety, it was because I was sinful. Even after I became an adult, left the evangelical community and rejected the sexual shaming messages in my early 20s, I was still haunted by a deep and life-controlling sexual shame and fear.

In another article published in the NCBI titled “Pathways from Family Religiosity to Adolescent Sexual Activity and Contraceptive Use”, the researchers found that once religious teenagers engage in sexual intercourse, they have lower odds of using contraceptives consistently. The researchers suggested that this may reflect their desire to avoid sanctions associated with publicly acknowledging sexual activity (for example, by purchasing condoms at a pharmacy), personal discomfort or ambivalence about being sexually active, or disapproval of contraceptive use in some religious communities. I think this theme can be reflected in all sexual activity, not just contraceptive use. Teenagers from anti-sex households hold desires to avoid sanctions associated with publicly acknowledging sexual activity for fear of disapproval in religious communities and also the cognitive dissonance they feel. While some adolescents can separate their parents beliefs from theirs, it is hard for people this age (women in particular) to not feel guilt and shame from going against how they were raised. 

‍Another article by David J. Ley, Ph.D in Psychology Today dove more into this concept of guilt and shame surrounding discouraged sex. They discussed how abstinence-only education from parents and schools comes with concept of “purity,” and the morally-based belief that remaining pure from sexuality until marriage is a good, moral and desired choice. They also mentioned how the purity movement heavily focuses on female sexuality, which sexual constrictions that leave young women confused and often feeling that they must reject even normal, healthy sexual urges. David explains that these messages lead to one of the most destructive emotions a person can experience - guilt. Despite this, guilt does not make people abstain from forbidden sexual activity, instead it just makes them feel embarrassed and shameful.

Main Takeaways from this research:

• Overwhelming feelings of guilt and shame while being sexually active that need to be actively disproved
  
• Difficulty separating their own views from those of their parents/religion
  
• Difficulty accessing contraceptives and other safe sex essentials because of religious views
  
• Higher risks of conditions such as vaginismus
  

Reddit Research

I then went to Reddit to see if I could find information from people posting their experiences online. I was able to document some quotes around this subject:

• “My parents didn't teach me anything, and my gf's parents at the time taught her abstinence. The result? 14 year olds having unsafe sex because we had no idea about anything”
  
• “Sex was a silent, loaded topic in my family while I was growing up.”
  
• “My parents never talked to me about it but I had to sign a chastity agreement and wear a purity ring to signal my virginity”
  

I then wanted to gain insights from those users to see what they wish they knew / had access to when growing up in a sex-negative, religious household. I posted the following post to those communities:

I kept the information vague and did not provide much context in order to let the Reddit poster interpret it as they wish and to maximize the type of responses I would get. I have identified the most useful responses, with the usernames removed for privacy reasons.

From these responses on Reddit, I identified features and parts of an application that they would’ve wished they had. This user input was very insightful in letting me know what my users want/need, and I followed this up with creating lo-fidelity prototypes.

Main Takeaways from this research:

• Reassurance that being sexual is your own individual choice and does not need input from parents
  
• Knowledge that “being sexually active does not make them a bad person”
  
• Reassurance that “sex is normal, healthy, and having it does not ruin you as a person”
  

Interviews

I interviewed 5 women ranging from age 17-21. I asked questions in 3 categories: Experiences, Concerns and Learning. In the experiences line of questions, I asked them to talk about their sexual health experiences with the following (and others they thought of): Sexual intercourse (women’s sexual pleasure, condoms, lube), STD/STI awareness, other diagnosed conditions such as vaginitis or cervicitis, vaginal pain, birth control, consent, and more. After describing to me their experiences with these, I asked about what made them feel prepared or unprepared, how they felt, what they wish they would’ve known and how they have learned more about this space. For the concerns questions, I asked them to describe an issues they have experienced with their sexual health (such as getting a yeast infection) and what they did. For learning, I asked questions about how they have received and seeked out information to questions they’ve had related to sexual health. Who/where do they get their information from? Who taught them about these things? To see my full interview protocol, see the appendix at the end of this documentation. From these interviews, I was able to collect major themes and more specific takeaways from my participants. The major themes are as follows:

• Parents and school never taught about any of these issues
  
• Consulted internet and more experienced friends for answers and what to expect
  
• Feelings of being “behind” peers experience wise, and being embarrassed about it so not wanting to ask questions
  
• Wanting to feel like their “weird” issues aren’t uncommon and wanting to know that other people experience them too - not wanting to feel isolated
  
• Retroactive question asking - example: won’t look up questions about having an STD unless they suspect they have one (after there is a problem)
  
• I want to know what to expect, but I don't want to ask my friends because I do not feel comfortable with this topic at all. It makes me feel behind and embarrassed.
  
• “There is so much stuff about my body that I always feel is unnatural or I don’t know what to do about it but it’s never addressed”
  

Sketching

I sketched within the following themes from my research:

• Feelings of shame and embarrassment for being sexually active
  
• Designs must counteract the information they are being fed from parents and schools
  
• Accessing contraceptives and resources without parental consent
  
• Educating on conditions they are more at risk for
  
• Language must be sex positive and encouraging to this user group, while also discrete
  
• Designs should provide a space to “escape” from their surrounding reality of sex-negative, abstinence-only talk
  
• Sense of community with other young women experiencing the same thing
  
• Protection and privacy to keep the app away from the parents knowledge
  

For shame, I ideated on the dichotomy between sex positive images (such as fun naked illustrations and images containing condoms, birth control, etc) and neutral images to not overwhelm this user group / not put them in jeopardy.

In order to counteract information told to them, I brainstormed a section of the app for debunking “myths”, with common statements and why those aren’t supported. People can comment their experiences with those messages. For education, I continued the idea of general topic education from my initial round of ideation (broad overview of topics).

For discretion, I played around with the idea of having a kill switch, or a “discrete mode” which hides all sex related images / anything obviously sex related in case someone is looking over their shoulder. I also ideated on a version of a kill switch which “changed” the app into some kid friendly game in case someone walks in.

In order to include access to resources, I continued the theme from my first initial round of ideation of a way to find planned parenthoods nearby. I also brainstomed aorund the idea of having a “safe sex plan” with ways to access those methods they want to use. Lastly, I played around with including telehealth into the app since a lot of this user group can’t drive / don’t want to be seen at a sex positive location such as PP.

In order to facilitate escape, I thought about including a part of the app that included comic relief, jokes and more sense of community. For example, an area for just memes / relatable content / relationship building.

For community, I continued my idea from my initial brainstorming with a section to ask, answer and interact with questions from other people this age. I also thought about the idea of having “groups” for different topics or just little pods of online friends that have the similar experiences as you to talk with.

In order to protect the women using the app, I ideated on the safety of notifications. Notifications would not pop up unless someone was using the phone to make sure the parents couldn’t see them if the phone was laying around. I would use discrete  language to not clue into the purpose of the app. If in “switch app” mode, the notifications would appear to be for that app (to clue the user in that there is a notification, but appear neutral to onlookers).

Also to protect the users, I decided that the app would require a login or facial recognition to get in each use, similar to banking apps. This would be a setting option so if the user feels this is not necessary, they don’t have to have it on.

Lo-Fis

Using Figma, I started to condense my sketching, ideation and input from users into one design. I created a lo-fidelity prototype, which just uses boxes and placeholder text to get an idea of the layout and features that I plan to incorporate.

Onboarding

The beginning of the app asks for state (to tailor information to laws in their state) and age/experience level/want to learn in order to better recommend information pertinent to them. The onboarding includes which settings they want to activate to protect themself, and then ending with creating their account. Important themes: privacy/protection, age appropriate information, access to resources

Community

The community page is for joining specific groups for content related to their unique situation, as well as for “escapism” (an area to share memes, jokes, relatable stories and more. Users can read through their “feed” and upvote things they like, as well as post their own content. They see a feed for each of their groups and also a community feed. Important themes: space to “escape”, sense of community, reassurance

Discussion Board

The discussion board is a question/answer space only, where users can ask a question to all the people on the app. Other users can leave replies and input on the question based on their experiences. Moderators will remove any trolling content and experts from the app can also leave their input. Important themes: sense of community, reassurance, education, counteracting information by parents

Ask an Expert

If users feel too shy to post a question to the whole group or want expert advice, they can submit a question to an sexual health expert. They can opt to have the question answered for the whole group, or keep it private. This section helps establish credibility and give them information they can trust. It also provides information from someone who understands their sex-negative background and situation. Important themes: credibility, reassurance, community, education, counteract, shame

Education

The Education page will divide general information by topics so that the user can read existing information on their own. These topics will inform on subjects such as: consent, STIs, protection, and more general sex ed/ sexual health topics. Important themes: education, counteract

My Sexual Health Plan

My Sexual Health Plan allows each individual user to plan how they are going to have safe sex and HOW. When they click on a type of protection they plan to use, it leads them how to get that method without the knowledge of their parents. They can find the nearest clinics to help them gain resources, sign up for an appointment in person or using a telehealth visit. They also can read about how to access resources based on their specific state laws using the “Sex in the States” website built into the app. Important themes: access to resources, education

Mid-Fis

From my lo-fis, I started to move into mid-fi prototypes to build out the pages of the app that I hadn’t flushed out yet in order to test with users. In these screens, I will focus on what changes I made from the lo-fis and overall updated design choices.

Onboarding

In the Onboarding section, I created a welcome screen with a picture of a Papaya to introduce users into the app, and then built out the other screens with stayed pretty much the same from the lo-fi. I moved all the onboarding questinos on to one screen with the relevant privacy settings underneath the password. I also changed the "sexual experience level" question to "I consider myself" to be more open ended and inclusive.

Community

In the Community section, I built out what the “feed” would be like, because in my lo-fi I just left placeholders. Using Reddit for inspiration, I created adding a new post and the profiles with their post headers and more information and pictures underneath. I also built the screen for when you click on one of your groups.

Discussion Board

Same as the community pages, for the discussion board mid-fis I built out what the questions and replies would like within this app. The first screen is a thread of questions people have posted, and when you click on it you can see other user’s replies to that question or type your own.

Ask an Expert

For the Ask an Expert page, I modeled it to be similar to the Discussion Board page in order to cue the users in that that format is for question asking. I built the answers to these questions differently, with an image of the expert and their answer in quotes with their name and credentials underneath to establish credibility. Clicking on the question brings up a longer answer by the expert and full explanation by the asker.

Education

In the Education section, I formatted the “my state rules” section from sexetc.org to fit the theme of my app and functionality. I also played with putting a card on the first screen, distinguished from the other topics, to cue the user into learning about their state first.

My Sexual Health Plan

For the Sexual Health Plan section, I ditched the “map” image for finding a clinic and opted for a list instead, as shown in the second image above. I built out the input for users selecting their birth control options and added buttons to sign up for an appointment with the free clinic. I also listed the address and availability information for the clinics to give the user more information, with the choice of chatting or telehealth still an option.

Testing

 I tested with the same 5 women ranging from age 17-21 that I interviewed with previously. I wanted to test both the usability and understanding of my app, but also the emotional side. Because I am creating for such a personal and emotional topic, I needed to make sure I was testing for how this app would fit into their own experiences and goals. Testing with users whose stories I had previously heard through interviews was helpful in accomplishing that, as was asking them questions about their emotions pertaining to the app. I also used desirability testing as a tool to understand how the app made them feel and what they associated it with. 

I framed up my testing with my users by having them “use” the app as if they were back in high school, and in a sex-negative household. My testing started with the participant walking through the app while speaking aloud, with some tasks as a guide to navigate throughout. I asked follow-up questions about what was confusing and how they understood the different sections of the app. I asked how the app made them “feel”, before moving on to desirability testing where they got to choose describing adjectives from a predetermined list. You can see my full protocol with the adjectives in the appendix. I then asked questions about why they chose those adjectives to get a better understanding of their interpretation of the app.

Main Takeaways from this testing:

• App sections were easy to understand, the functionality was clear to users
  
• Identity based question should only be asked so often or changed up
  
• Big emphasis on the education tab - all testing participants seemed to think this was important and one of the main features of the app
  
• One part of the app to build out more is the sexual health part of the app - when you select which birth control you want, and hit help me, need to be more specific with ways to get help with accessing birth control
  
• Liked the colors and simple icons / colors, seemed very welcoming
  
• Privacy options were very important to the people testing, seemed to keep the user’s needs in mind and create a safe environment
  
• Immediately having to sign up was confusing, participant didn’t understand exactly what the app was for - Add a screen before signing up to give an idea of what it is for
  
• The difference between questions and ask an expert is unclear
  

Hi-Fidelity Prototypes

From the testing takeaways I got, I wanted to iterate further, applying those testing insights to an updated design. I also revisted my research to inform as second iteration of these hi-fis, making sure I was connecting my designs back to my research I did at the beginning of the project. You can see the changes I made here:

Built Out My Sexual Health Plan

In the previous iteration, the second screen above didn’t exist. I built out the screen that the user would use to input information about their contraceptive, planning out how they would get that prescription each month (if one is required). This information is then displayed on the landing screen of the Sexual Health page (first screen above). This additional information ensures that the user plans how to get contraceptives to have safe sex, and if they don’t have a plan it allows them to create one.

Adding Page to Onboarding

In the testing, participants said that they wanted a page before sign up to explain the function of the app so they could know what it is for and if they want to sign up for it. I created that page as shown to the right. I played with the idea of that goes against the “discrete” nature of the app, but later realized that anyone downloading the app would be the person who the app is for, and therefore we can disclose what the app is in the onboarding.

Combining Questions and Ask an Expert

Originally, the questions and ask an expert sections were separate tabs. However, after testing, my participants expressed confusion on the difference, since both are asking questions. Because of this, I combined the two sections into one, a general “questions” area with ask an expert within in that page.

Education Pages Changes

Because in testing my participants emphasized the education page as the most useful and most important, I built it out a bit more as I transitioned to high fidelity prototypes. I created the page for what the information would look like when clicked on, and developed the state page further. I also added icons to the landing page to be more interactive and to allow the user to scan better.

Other Changes

The final changes I made were aesthetic design changes to move up to a higher fidelity. I provided a few before and afters to show how the designs changed. These design choices were minor, personal decisions based on improving the look of the app. Above are the changes made to the onboarding screens.

Identity Questions: Onboarding

Previously, I had two questions in the beginning that asked what they need help with and what they consider themselves. That second question (“I consider myself”) was intended to allow the user to think about their own identity within seuxality and religion, and occasionally that question would reappear for them to reflect on if how they consider themselves have changed. After revisiting my research, I came back on the quote from my earlier research: “Help people struggling with sexual shame to overcome it by deciding who and how they want to be sexual”. That last part, decide who are how they want to be sexual, inspired me to redesign those identity based questions in the onboarding. I added the question of “how do you want to be sexual?”, built out the answers to guide them how to answer, and added a space for them to answer in their own words. I also added sentences at the top explaining the purpose for these questions.

Identity Questions: Reflection

Previously, I had these identity questions on the home screen sitting there for whenever the user wanted to reevaluate or reflect. With revisiting the research, I realized that I needed to facilitate the reflection more. I added a separate tab on the homescreen for “reflection” where the user could revisit old entries, and add more. I also decided to prompt the user to do so every so often (once a month) to keep them on that journey to see how their identity changes. You can see that onboarding prompt that would pop up on screen 1. Screen 2 is the new home page without the questions, and 3 is the tab they can go to to see their old entries or add new ones.

Moving forward, I will be conducting another round of testing and making final UI changes before the completion of this project!

Heuristic Analysis

In order to do further evaluation of my design, I decided to use a heuristic analysis to check my design. I created principles to ideate off of in the beginning of my ideation stage, I will revisit these in order to see how well my design meets them. The design heuristics are as follows:

• The design should counteract feelings of shame and embarrassment for being sexually active
  
• The designs should counter the information they are being fed from parents and schools
  
• The designs should be debunking church myths
  
• The designs should make accessing contraceptives and resources without parental consent easy
  
• The designs should educate on conditions they are more at risk for
  
• The language must be sex positive and encouraging to this user group, while also discrete
  
• The designs should provide a space to “escape” from their surrounding reality of sex-negative, abstinence-only talk
  
• The designs should establish a sense of community with other young women experiencing the same thing
  
• The designs should be private and protected from onlookers in all settings
  

In order to evaluate against these heuristics, I took each one individually and walked through my design to find problems and then rate how well the design stacked up. My rating scale was: meets heuristic, room for improvement, and does not meet heuristic. I will discuss the only the heuristics that were either room for improvement or did not meet heuristic.

Counteract Feelings of Shame

Room for improvement. There is no explicit section that meets this heuristic directly, instead indirectly the app attempts to meet this goal. Feelings of shame are attempted to be counteracted through exposure in communities, daily affirmations, reflection on identity and through education. Therefore, I designed upon the following idea: daily affirmations that are more than just words, instead the user has to repeat them out loud a few times before going into the app to actively fight against those feelings of shame.

Educate on Conditions

Does Not Meet Heuristic. This was one area that got lost as I was designing and iterating since the sketching phase of my design process. I somewhat cover this in the education section under articles about STDs and other conditions, but this doesn’t make it apparent what conditions they need to be aware of specifically or how to determine if they have one. This heuristic was something I lost throughout my design process, and in order to help, I designed a quiz that they could take to self-diagnose and receive a recommendation to go see a doctor.

Provide a Space to “Escape” (to the right)

Room for Improvement. I made a section called “community” to be a space where girls could make funny memes or share relatable content about their situation. However, is this really a space for escape if it is just continuing to talk about those issues? Instead, a space to escape should be any content, not just focused on sexual issues. In order to do this, I added random funny videos by moderators unrelated to anything in the community section.The videos appear in orange to call attention to them, and allow users like Julia to see lighthearted content unrelated to their situation or problems.