Access to women’s health services can sometimes be hampered by bothersome realities of institutional administration: impenetrable websites, inconvenient office hours, hellish phone trees, out-of-the-way office locations. An everyday task like picking up birth control pills or getting treated for a common infection requires coordination between health care providers, pharmacists, and insurers. Any problems with this coordination can make accessing healthcare difficult or impossible.
For my thesis project I’m interested in increasing opportunities for women to self-care. To do this, I will need to discover what needs women would feel comfortable meeting on their own. In addition, I would like to find out if the women’s public bathroom can be a place to facilitate self-service health care.
Goals of the project
The goal of the project is to design a self-service women’s health care delivery method that replaces or augments a need now met only by structured, institutional care. In my research, I will attempt to identify regulatory, cost, or bureacratic restrictions that prevent access to women’s health care and design a solution to maximize access to the more valued products and services. I would like prototype and evaluate a self-care service for women who need quick access to medicine or products, especially those of an urgent nature or that may be difficult to obtain because of environmental or bureaucratic constraints. I would like to find out which every day items could be the best candidates for self-service, such as contraception, feminine needs, and common remedies. I will learn about what delivery methods could be possible for a public restroom and which women might respond to or reject.
One part of this project would revolve around the understanding the roles of the specialized players in women’s health institutions: from policy makers and private insurers to doctors and pharmacists. What is the original intent of these service providers in furnishing care, what are the unintended consequences of their part in the process? How do these personas protect and care for women in a way they cannot do themselves? How can they complicate access to treatment and medicines? Have any of the players become unnecessary “gatekeepers”? Relics of another social or political era? Are there institutions that profit from restrictions to products?
Once a woman has experienced and treated a common infection, or committed to a form of birth control, does she really need to seek medical attention regularly to access preventive services? What barriers to care could be removed if women were permitted to diagnose and treat themselves for certain, everyday needs?
There are potential risks if a woman is left to diagnose and treat herself during a time of illness, or that she may use contraception improperly if not instructed by a professional. Or, a woman might simply prefer to seek health care in a trusted, institutional environment over having to “go it alone.” Would having unrestricted access to medicines and products improve a woman’s health, or invite room for errors or abuse that would outweigh any potential convenience?
The idea for this project came from my own struggles to obtain birth control pills over the summer Boston. I had several things going for me: I have health insurance, I have a GYN, I have a pharmacy account at CVS, and I had money to pay for pills. Against me was the fact that my one-year prescription had run out, (Why not a lifetime prescription? Some women are on the pill for decades. My primary care doctor told me I could take the pill until I was 50), and that I was in a different town than my doctor. They refused to fill my prescription unless I came into the Richmond, Virginia clinic for an annual exam. My doctor’s office wanted me to have a full pelvic exam with Pap smear (to check for cervical cancer) before they would renew my prescription for pills. I’ve seen on the Planned Parenthood website that you can make an appointment for counseling (no exam) to get a prescription written for pills. This makes me wonder if the full annual exam is really necessary. When I arrive at CVS, the pharmacist “fills” the prescription by taking a pack of pills out of a box behind the counter, stapling some information to it, asking me if I have questions, asking me to sign a piece of paper, then ringing me up for $15. It seemed like such a rigamarole of bureaucracy that doesn’t really do me, the patient, any good. Was the inconvenience meant to protect me from something? If so, what? When I think about the layers of obstacles I encountered, I started wondering if other women had similar struggles. How many hurdles does a woman have to jump to get her hands on a pack of pills? Are there hurdles I don’t know about?
This project will question the current system around the female health care consumer and the products she consumes. The journey of a woman as she navigates interactions with her health insurance, doctor/provider, pharmacist and the product will be told as a story, then re-imagined in a self-service format. Could the system be simplified so that health care is consumed without the need for insurance, health care providers, or pharmacists, especially for everyday, preventive medications? What risks are involved in shifting the balance of responsibility for care from provider to patient? I would like to explore what existing knowledge women have about consuming these products and see how savvy they are or could become in a self-serve environment.
Consumer self-service interactions are becoming more common in our society: self-checkouts at grocery stores, ATMs, ZipCar, IKEA and fast-food service. The idea is to eliminate the “gatekeeper” behind the desk that stands between the consumer and what they want. Once a person is allowed to help themselves, a service employee’s role can shift from “keeper of the flame” to “on-demand assistant,” empowering the consumer to inform themselves and access their product or service of choice. Related books and articles on self-service may be found in the business sphere and IEEE journals.
Existing self-service health care options exist today in the form of over-the-counter medications, self diagnosis kits for pregnancy, infections, and HIV, blood pressure monitors, and online quizzes, health websites and literature. What other self-service health care experiences could make it easier for women to access care? Reading articles on functional health literacy and health education would help me design communication materials for women to understand and choose their care options. Existing surveys and studies on the self-service approach in healthcare would help me understand what methods have succeeded or failed in past research. The service design course I hope to take in the fall should provide me with a good foundation of readings. To better understand the existing environment for women’s health care, I will seek out background information on the current government policies and real-world practices of the U.S. system.
The first phase of my research will involve doing background research. By reading existing articles and studies on women’s health care, I hope to answer some of my early questions and prepare for my interviews. Conversations with women will be the starting point for my exploration. I hope to uncover current difficulties that women face in obtaining health care services or products. I’d like to know what they feel they can do to treat themselves, and what they’d prefer to see a professional for. I’d like to know what they do in times of urgency or crisis when they can’t get the care they need.
In addition I’d like to do observations of self-service spaces, health care spaces, and public women’s restrooms. I’m interested in seeing what mechanisms are effective for communicating to the self-service consumer. I’d like to document the flows and pain points of accessing services and products on one’s own.
After researching these women and spaces, I’d like to experiment with prototypes for delivering self-service care. Some ideas I have now include vending machines and installations in public restrooms. These prototypes could deliver information and products, and perhaps sync with existing data on the consumer or be totally anonymous.
Possibilities for further research:
Common purchases for feminine needs
Common reasons for womancare visits
Barriers to access birth control
Privacy and positioning in self-service enviornments
Sample interview questions for health care providers:
What do you wish women knew how to do for themselves? What problems do you see patients come in with that are preventable?
What needs should women really come to the doctor for, and not try to treat themselves?
Do women already know how to use contraception, or do they need to be taught? Can they be taught via packaging alone?
Do long-term contraception users need pharmacy/prescription to guard against dangers of misuse?
Sample interview questions for women:
Birth control stories: what do you use and how do you get it?
Have you ever been denied care because of bureaucratic or administrative problems?
Do you prefer to self-pay for care, as with OTC products, or pay for insurance and have insurance cover the cost?
Do you prefer to see the doctor or pharmacist for birth control or infection treatments, or would you prefer to handle it yourself?
Have you ever had a female health problem that was diagnosed differently than what you thought it was?
Possible players in current system of women’s health care:
Public (consumers and producers): health care providers, patients,
Policy Makers (politicians, lobbyists): local/state/federal lawmakers, drug reps, FDA,
Payer: insurance companies, patients
Program/Provider: health insurance, drug manufacturers/suppliers, pharmacies
Practitioner/Staff: doctors, nurse practitioners, pharmacists
Patient/Consumer/Client: women of childbearing age
Scope and Limits
I will focus on women’s restrooms on the Carnegie Mellon campus as the space for my self-service healthcare prototype. Through interviews and user research with female students, I will identify common contraception, treatment and diagnostic needs that could be offered in this space.
I am interested in the perception of public bathrooms and what might make them a trustworthy place for self-care. I will focus on the possibilities for package design and communication materials as a way to self-diagnose and self-treat. This is especially important with birth control pills because they come in varying varieties of hormones. For example, birth control pills could be charted so that women can more easily know their proper hormone level. Instructions could be simplified (current ones are incomprehensible and usually get thrown away). To keep women from smoking and taking the pill, a big “no smoking” sign could be integrated into the packaging.
My delivery method will experiment with removing administrative “gatekeepers,” such as insurance, pharmacy, doctor visits to deliver female health products. For testing purposes, I will use non-prescription products and paper mock-ups for controlled medications.
What makes this a feasible project is the large number of women and women’s bathrooms on campus, which could be outfitted with prototypes for testing. CMU has many female students in their childbearing years who are sexually active, and who are probably trying to avoid pregnancy and disease. They may be more likely to have a high degree of health literacy, making them good candidates for this project.
September to mid-October
- Literature review and research phase.
- Set up contextual interviews with women and care providers.
- Fly-on-the-wall observations.
- Posters asking for feedback on the public space.
- Develop interview questions, and conduct pilot interviews.
- Revise the questions if needed.
mid-October to mid-November
- Synthesize findings from interviews and literature reviews in a comprehensive summary.
- Conclude research phase.
- Idea generation for self-service experiences and interactions.
mid-November to mid December
- Service design blueprint.
- Packaging and communication materials design.
- Early prototyping of self-service product.
January to March
- Illustrate implementation with video sketch, scenarios, role-play sessions.
- Continued prototyping and evaluation.
- Evaluate model effectiveness.
- Finish core design work by mid-February, early March.
March to April
- Write thesis document.
- Prototype refinements.
- Final thesis document and product due May 14, 2012.
Further reading recommendations are needed in these subject areas:
- survey design
- package design
- information visualization
- participatory activities for ideation research
- service design
- design for women’s health care
- IEEE publications on self-service
Service design experts to research:
- Lara Penin, Parsons
- Birgit Mager, Koln
- Shelley Evanson, Facebook
- Todd Park, HHS