Reducing Barriers for Self-Testers
I was in a hurry to get to our office recently and forgot my transit pass. I searched every pocket — no luck. Panic set in as I could hear the train approaching. A sign on the wall reminded me that I could purchase one-off tickets via an app, and thanks to strong cell signal, I quickly downloaded the app and purchased my ticket — all without missing my train. It was fast, easy, and reduced my anxiety during a stressful moment. Through digital tools, the transit authority provided a variety of ways for people to access the public service and reduced a barrier for me and likely many others.
Accessibility, and the complimentary inclusive design methodology, have gained traction over the past decade, and for good cause. With over 7.7 billion people in the world with diverse needs and abilities, creating a variety of ways for people to participate with adaptive, personalized experiences just makes good business sense. But, this can feel like a daunting task. Microsoft’s Inclusive Design Toolkit is a great starting point - specifically Designing for Guidance built on the foundational research of Dr. Margaret Burnett, Distinguished Professor at Oregon State University. In full disclosure, inclusive design was my primary focus before leaving Microsoft in 2017 and has heavily shaped my thinking and approach. Microsoft identifies 3 different approaches to learning: trial and error (dive right in), semi-structured (following a “recipe”), and guidance (attending a class or watching a tutorial). Humans are complex, and the desire for guidance may shift in different scenarios, influenced by confidence level with or motivation to achieve mastery with a given task.
In the case of self-testing or testing a family member for COVID-19 — where the stakes are high, the process is new to many, and there may be an increased risk of cognitive impairment — digital tools can play a critical role. When designing these tools, it’s important to consider the experience, education, physical and cognitive abilities, emotional state, and barriers to care including stigma faced by those who are testing. To aid in accurate test administration, many rapid test manufacturers print crucial information directly on the face of the test cassette, such as test processing time or the number of buffer drops to add. While useful to some, these markings may not add value for people with varying levels of literacy, visual acuity, familiarity, and cognitive ability. So, how can we create a truly inclusive experience, increase access to powerful health tools, and yield consistent, quality outcomes? Effective digital tools will maximize comprehension with simple language and visual aids, yet enable guided experiences when desired, in the context where it’s needed, in a variety of formats. Let’s dig into this a bit more with some examples.
How can we create a truly inclusive experience, increase access to powerful health tools, and yield consistent, quality outcomes?
Maximizing comprehension for a diverse global population means that tools should be simple, eliminate ambiguity, and work in every environment, every time. Paper instructions that come packaged alongside a rapid test offer step-by-step guidance for test administration. Many times these instructions rely heavily on large, colorful images, incorporate a numbering system to clarify order of operations, and sometimes even map test kit components to the colored numbers on the instructions. This appears to “check the box” for a guided learning experience, however, for symptomatic individuals experiencing acute stress and anxiety, people who are blind, or those with limited mobility or dexterity — these paper instructions can seem overwhelming or completely inaccessible. A digital experience with animations, video instructions, and accompanying audio descriptions and navigation can better enable access to important content for guided learning.
If simplicity is table stakes, what about individuals for whom more is more? As I noted in an earlier post, building trust in the test result is crucial for public health outcomes — which stems from the confidence that an individual has in their own ability to administer the test correctly. In the case of a blood-based HIV self-test, the finger prick step can cause anxiety and confusion the first time around. A simple drawing or video demonstration may not be enough to build confidence, and this is certainly not a step most people would feel comfortable taking a trial and error approach! Providing contextual entry points for individuals to dig into progressively more detailed information, such as descriptions, FAQs, or reviews from people who have taken the test before, may provide a semi-structured, transparent way to demystify the process.
Successful designs are those which are useful — as indicated by breadth, depth, or regularity of use. But more importantly, chosen for repeated use with intention, not under duress. Retentive experiences provide ongoing value and make people’s lives easier, bringing them back the next time the function is needed. In the case of digital experiences for self-testing, retention may not follow a typical consumer app’s patterns. Active use may look spotty over the course of a month or a year — as an individual would test when symptoms arise or if testing is required for an event. This usage pattern should also inform our design choices, considering the confidence some people may build by administering numerous tests over time while many may lack mastery in the process as a result of infrequent use. This will look different from country to country, region to region, and person to person. Digital solutions must provide a diversity of ways for people to navigate the process in order to include everyone — critical for strengthening public health outcomes.
Digital solutions must provide a diversity of ways for people to navigate the process in order to include everyone — critical for strengthening public health outcomes.
IDEO.org shared perspectives on making the health system more equitable - the concepts of co-creation with vs. for communities, building trust, creating equitable access to information and tools, and centering the needs of underserved communities are resonant here. By creating digital tools with palpable value, which adapt to people’s changing needs and abilities, we will empower self-testers, many of whom lack access to high-quality healthcare or face barriers and exclusion due to inflexible, rigid, or inequitable experiences. As you embark on your next design challenge, I urge you to spend time with people who do not use your product regularly or at all - whether due to choice or those you may have inadvertently left behind. Explore the barriers they face, understand their goals, explore the diversity of learning styles across the population, and intentionally introduce ways for everyone to confidently use your product or service.
Have digital tools reduced barriers in your own life? I’d love to hear about your experience and any lessons that have influenced your own work.
