Co-designing youth testing experiences and measuring impact of interventions

How might we increase access to STI testing and normalize testing for Baltimore youth (15-24) through sustainable structural change?

Photos from observational research, community shareouts and ideation sessions.

Challenge Context
Baltimore youth aged 15-24 experience an infection rate of chlamydia and gonorrhea that is more than three times the national average (CDC, 2015). In Baltimore City, the highest rates of chlamydia and gonorrhea are found among young Black females between the ages of 15 and 19. A decade of research in Baltimore has shown that individual-level STD risk factors and behaviors alone do not explain increased risk for STDs experienced by specific groups. This suggests that larger social determinants of health are at play and that successful interventions will require structural-level change.

With funding from a 3-year CDC grant, the Johns Hopkins Center for Child and Community Health Research, Baltimore City Health Department, and the Center for Social Design at Maryland Institute College of Art worked collaboratively to design, implement, and test design solutions to increase access to STI testing and normalize STI testing for Baltimore youth. Through additional collaboration with  collaboration with UChoose Youth Advisory Council and Wide Angle Media we explored youth attitudes toward STI testing and testing clinics, synthesized findings, and co-designed interventions with youth to test on youth audiences.

Project Team
Matt Barr, Jaynie Chartrand, Maria Isabel Garcia-Diaz, Devika Menon, Patricia Natalie, Rachel Serra, Irina Wong, and Molly Reddy with Faculty Advisor Becky Slogeris.

Approach
First we mapped our own testing journeys, learned from experts in the field, conducted a literature review, facilitated ideation workshops with youth and adults, prototyped ideas, and presented them to stakeholders for feedback. We also spent time co-designing with youth to identify their ideal STI testing experience, exploring dimensions such as information delivery, location, access, staff, and space design.

Our initial phase of research identified the issue that despite the high availability of options, the fear and anxiety about what happens during the testing process, how to navigate it, and potential outcomes can prevent youth from accessing these resources. So we asked, how might we create transparency around the testing process to reduce fear and anxiety in patients?

Icon design by: Devika Menon

Proposed Interventions
I co-designed an initial mockup for a web-based application that would replace paper sexual health history forms in a format that youth feel comfortable using. Additionally, the forms would include personal interest questions that would serve as rapport-builders between doctors and patients. This evolved into Tap It, Test It, a group effort to design a web-based application that accompanies youth throughout their entire testing journey.

App prototype design by: Rachel Serra

Outcomes
Our successful first phase of research resulted in funding to design and implement an improved patient intake process, which included a redesigned intake form, a new waiting system that streamlined expeirence for individuals who were testing and waiting for results, clinic way finding signs, and provider relationship building tools.

I was funded to conduct in-clinic observation, surveying, and experience tracking to collect baseline data and intervention evaluation. Initial evaluation found the interventions show a statistically significant improvement in experience, as reported by youth patients, as well as across all age groups. Interventions were implemented in additional clinics across Baltimore and articles sharing process and results were published in the peer-reviewed journals AIDS Patient Care and STDs and Progress in Community Health Partnerships Research Education and Action.

2020: “Exploring the Sexually Transmitted Infection Testing Experiences of Young People through Creative Visual Mapping” Progress in Community Health Partnerships Research Education and Action 14(3):371-380; Grieb, S., Reddy, M., Griffin, B., Slogeris, B.

2018: “Identifying Solutions to Improve the Sexually Transmitted Infections Testing Experience for Youth Through Participatory Ideation” AIDS Patient Care and STDs, Volume 32. Grieb, S., Reddy, M., Griffin, B., Marcell, A., Meade, S., Slogeris, B., Page, K., and Jennings, J.


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