Problem

How can sexual health services be made easier to access and use – and less stigmatised?

Response

Designers worked with local health services to identify people’s needs and design a user-centred local health service.

Result

The designers’ blueprint for an improved sexual health service is being implemented by Gateshead Primary Care Trust. The design team is now working on several similar projects with other healthcare trusts.

Similarities with Cornwall

The key to this project was Dott’s method of focusing on the user perspective to design a more effective sexual health service for the community. This model can be applied to sexual health care facilities nationwide.

The UK has worryingly high rates of sexually transmitted infections (STIs) and the highest teenage pregnancy rate in Europe, with the North East of England commonly topping national figures.

According to the Office for National Statistics, the number of new STI cases seen in Genito-urinary Medicine (GUM) clinics in England, Wales and Northern Ireland doubled from 669,291 to 1,332,910 between 1991 and 2001.

But the news isn’t all bad. There has been a downward trend in the number of under-18 pregnancies in the UK over the past decade. Nevertheless, 2005 still saw 39,804 recorded teenage conceptions, nearly half of which were legally terminated.

Figures published by Equality Strategy, a division of Kent County Council, indicate a 22% reduction in under-18 conceptions in the Gateshead area – a positive reflection on the quality of sexual health education and services available in the region – however local people still encounter problems.

Sexual health workers in Gateshead already take their contraception services out to the user – for example, workers make home visits or travel to schools and other public places to meet patients.

However, Newcastle or South Shields are currently the nearest places with facilities for testing and treating sexually transmitted infections. This is a long way to travel for those without personal transport, or with limited time or low incomes.

The result is that, often, the people who need the most help fall through the net. Ill-considered opening times, unwelcoming environments, a lack of information about the services available, poor transport links and concerns over privacy all discourage individuals from going to sexual health clinics.

The Department of Health’s National Strategy for Sexual Health and HIV is already aware of this problem and, as a result, has provided funding for a new sexual health service in Gateshead.

DaSH (Design and Sexual Health) was a design project set up to generate ideas and suggestions to make sexual health services easier to access and use for people in Gateshead.

The project was led by health service design consultancy Design Options, which worked alongside Gateshead Primary Care Trust (PCT) and the Centre for Design Research at Northumbria University.

The Response

The founding principle of DaSH was to make people’s experience of using their local sexual health service central to its design and implementation.

To understand the issues that a local sexual health service for Gateshead would need to address, the team began a period of extensive research to understand the daily lives of the people the improved service would eventually benefit.

Community research

To develop their proposals for an improved local health service, the Design Options team spoke to around 40 professionals and more than 500 Gateshead people. There was a particular focus on groups who traditionally find it harder to access and use public health services, placing them at higher risk of poor sexual health. They included young people, gay and bisexual men and ethnic minorities.

Through these discussions, the project organisers were able to make sure their final outcomes would match the needs and expectations of their target demographic.

At the discussion sessions, small groups would look at the ideas that the design team had developed so far and offer feedback based on their expectations and preferences of using sexual heath services.

Taking this information, the designers began to look at how practical their ideas were by working alongside the healthcare professionals that would eventually have to implement them.

Identifying issues and developing personas as they outlined and refined their proposals, the DaSH team began developing a number of fictional personas, based on the experiences of people they had spoken to in Gateshead.

This process helped them to consider the proposed sexual health service from various ‘first person’ perspectives, comparing and contrasting aspects of the new service against the needs and wants of each fictional persona.

‘The team now think differently, they consider all the five elements from a user perspective and are questioning every detail in terms of necessity and impact on user experience. This is entirely down to the understanding of a people-centred design led process they gained through being on the DASH co-design team’

PCT Team Leader

Identifying Issues and Developing Personas

Creating fictional characters that embody the thoughts and experiences of others is particularly useful when dealing with personal or confidential information such as sexual history and lifestyle. They allow the design team to discuss scenarios and situations openly without compromising the individual.

Stories and scenarios such as the ones developed for DaSH help to inspire designers and generate new ideas by giving everyone involved a better understanding of the people who will eventually use their service or product.

Ankur Chaudhary
Ankur is 23 and lives in a ground floor flat in Bensham with his best friend Sharif. He works as a mortgage advisor. He is gay and goes out every weekend and some nights during the week after the gym. He is very careful when it comes to safe sex and rarely takes risks, but to make sure he visits the sexual health clinic every six months to be tested for STIs.

Beckie Manning
Beckie is 15 and lives with her parents in Birtley. She has recently started seeing her best friend Emma’s older brother, Mike. Mike hates using condoms, so they haven’t always used them. Beckie is worried she might be pregnant.

Lauren Connolly
Lauren is 23 and lives in High Spen with her three-year-old son and her parents. She doesn’t have a job. Lauren hasn’t had many nights out since the birth of her son, but she recently went to a party with her best friend. Around midnight she started feeling very drunk. She blacked out and came round at four in the morning on her own in one of the bedrooms. Lauren found she had been partially undressed. She felt terrible, but had no idea what had happened.

Alex Deacon
Alex is 20, single and lives with his mother in Sheriff Hill. He works as an agency construction worker. He often ends up taking a girl home (or being taken home) on a Saturday. He uses condoms most of the time, but not always. Recently a girl he’d slept with a while ago confronted him. She told him she had Chlamydia and that he gave it to her. He’s been trying not to think about it, but it’s been preying on his mind.

Linda
Linda is 46 and divorced. She has just begun a relationship with Adrian, her first serious relationship since her marriage ended. Adrian insists on using condoms when he and Linda sleep together, which she hates doing. She has suggested they both go for STI testing so that they can stop using condoms – he’s reluctant, but has agreed.

The Outcomes

The DaSH project was the first time that anyone had attempted to develop a sexual health service by using the principles of user-centred design.

This meant that, as well as creating a document outlining specific recommendations for improving the sexual health service in Gateshead, the design team produced a series of more general examples of service design methodology that can be applied to the redevelopment of other local health services, both nationally and internationally.

Service experience

The team created a Service Experience document detailing six key recommendations for Gateshead Primary Care Trust’s new sexual health service.

Each recommendation is divided into a series of specific design actions, encompassing everything from branding to service structure and suggestions for feedback channels to aid the service’s evolution.

1. Core service structure
   This section lays the foundation for the rest of the recommendations, outlining the service provision model. The designers place particular emphasis on supporting the city centre’s hub clinic by expanding the outreach work that has already proved successful in the Gateshead area. The introduction of a mobile laboratory as part of the outreach force would also allow for off-site STI testing. Systems like these would enable people reluctant or unable to travel to be tested locally.
    
2. Service promotion and raising awareness
   As with any product or service, branding, identity and marketing will be key to success. After all, no one will use the service if they aren’t aware of it, don’t recognise it when they see it, or can’t access it easily. This section of the document outlines various suitable awareness campaigns, including targeting the different social groups using the service in different ways.
    
3. Service gateways
   Service gateways are the means by which people make initial contact with a service. In this case, the four service gateways are the website, the telephone system, referral by third parties including other health services, and by other means such as text messages. Suggestions include online walkthroughs designed to help users feel less nervous about their first visit to the hub clinic and a telephone call-back service during busy periods.
    
4. Clinic overview
   This section gives an overview of the key features of the city centre hub clinic including its location, what other services could be offered in the same building, and how best to get feedback from users. Suggested services to run alongside the sexual health clinic include breast care, help with stopping smoking, drug and alcohol services and other primary care services.
    
5. Service user flow through the clinic
   To ensure that people using the service feel comfortable and get the most from it, it is important that they know where they are in the process, and what they should expect next, at any given time. This section gives a step by step explanation of a typical user experience, from arrival through registration and consultation to obtaining results and booking their next appointment.
    
6. Clinic environments
   According to the user research conducted as part of the DaSH project, users feel ill at ease in a clinic that looks and feels too medical or institutional. The more comfortable and attractive the surroundings, the more relaxed and positive users are likely to feel about their experience. This final section details a number of interior design techniques to achieve this aim, allowing for the fact that the clinic is unlikely to be purpose-built.

The service experience document also includes a number of scenarios based on the personas developed by the design team. Each one illustrates how the suggested sexual health service would cater for the specific needs of different people and social groups.

Service design blueprint
The Service Design Blueprint was written to sit alongside the Service Experience document as a guide for the health trust. It sets out the commissioning options and action points necessary to be taken to deliver the Service Experience demanded by the local people through the DaSH project.

Methodology document
Produced by the Design Options team in partnership with Gateshead Primary Care Trust, the Methodology document explains the user-centred approach adopted by the DaSH team.

By explaining the design techniques, consultation methods and social science research, which eventually led to a proposal for Gateshead’s new sexual health service, this document provides a guide for other local care trusts preparing to redevelop their existing services.

Since 2007

A new GUM service opened in Gateshead in July 2008 using many of the design recommendations made by the Dott07 team of designers. The service has performed well in the first quarter with it consistently hitting its 48 hour access target. More than 50% of users attend as a result of a friends recommendation.

Learning from the project has also been shared with the National Centre for Social Marketing and other health authorities in the UK have shown interest in the user–centred approach to developing sexual health services. Design Options is now working with several Primary Care Trusts across England.

Design Options provide assistance, consultancy and management services in health and the social sectors. http://www.designoptions.org.uk

Supplied by The Design Council http://www.designcouncil.org.uk