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PLUSH

An Innovation in Transgender Healthcare

Role

Principal UX Designer and Researcher

In searching for different ideas to take on for my final capstone project for my UX design diploma program I had decided to veer towards the area of transgender healthcare. I wanted to focus on the difficulties transgender women have finding different providers, accessing reliable resources for surgeries and surgeons, and finally build networks within the trans community. 

 

I began to think about developing a problem space to accurately frame this issue and develop a research plan to tackle this space. From using my knowledge of the subject and after speaking to people in the trans femme community I had formulated a problem space:

“There are not many options available for trans women to gain resources on health-care providers or surgeons in California. Most trans women find it difficult to not only locate a provider in their network, but to also be able to see that provider within an appropriate amount of time. Even when finding a surgeon it is difficult to connect with a community of trans women who have undergone similar procedures.”

I had found that there is significant difficulty in finding a provider, surgeon, or doctor for many trans women. This is true especially in preparation for surgery. I have understood that there is room for a technological intervention in this space. My goal is to provide accurate, accessible, and community-driven information to my users.

PHASE 1:
Research

I will do research via various methods of information collection and source evaluation, we aim to create a product that joins communities of trans women from all over California to share resources and reach their transition goals.

Using these different milestones in my research process, I decided to push forward and begin my secondary research about the topic. I know that this is an issue, but how can I validate my claim and know the true extent of this issue?

 

By using secondary research! I began to look at different search engines to gather some information on transgender women, surgery preparation, and community connection. 

 

First and foremost, gender affirming surgery is a lifeline for many trans people. Gender affirming surgeries have a direct relationship to trans people’s mental health: 

“people who had received [facial feminization surgery] reported higher scores in seven of 11 measures of psychosocial health -- anxiety, anger, depression, global mental health, positive affect, social isolation, and meaning and purpose -- than those who had not yet had the surgery.”

Gender affirming surgery includes a variety of surgeries, any of which help tackle gender dysphoria and aid in affirming gender identity. This can include breast augmentation, facial feminization surgery, body contouring, and gender affirming vaginoplasty to name a few. In addition many doctors present participating in gender affirming surgery as an option to address gender dysphoria.

In addition to many of these affirming procedures comes talking to and dealing with different people from the medical field including surgeons, providers, psychologists, therapists, and endocrinologists to name a few. In dealing with these doctors, many trans people found that they had to walk the doctors through their own care plan:

“A 2015 survey of 28,000 trans people in the U.S. by the National Center for Transgender Equality found that 24 percent of respondents had to educate their own providers in order to get the care they needed.”

 

Additionally, there is not a lot of planning for trans inclusive health care to be taught in medical spaces and to different providers unless they themselves specialize in trans competent healthcare. Additionally, studies found that most medical residents scored an average of 57 percent, in knowing how to address a trans person’s questions regarding sexual health and gender minority health. 

Research Objectives

Why even conduct research? What is the point?

I want to know how trans women are navigating the healthcare field. I am looking at different facets of their transition including surgery and finding providers.

What do I hope to learn? 

I hope to learn why trans women chose certain providers. It would be integral to learn how trans women relied on their communities in order to find out which doctors and surgeons worked for their needs.

And how do I consider my directed outcomes? 


Our desired outcome is to help provide a solution to the difficulties that trans women have to face when approaching the medical industry. Our outcome is to understand how to better help trans women connect with their community.

These stats are pulled from a minor list of research I had compiled into a research plan. There are a variety of different resources available, and this is what made up a large portion of my secondary research. I was ready to expand outwards to continue my journey of solidifying my project and undertaking it. Afterwards there needed to be a list of not only assumptions but a projected outcome of what is to happen via my research and findings. I will now be instating an interview with my key demographic to justify and cross-reference my secondary research with the participants in the interview stage. This is important because we need to know that this research has practical and real world implications; enough to set a problem space for a technological intervention. My research is prefaced with a hypothesis for the results that I'm expecting from the participants in quantitative and qualitative metrics.

Research Hypothesis 

I believe that trans women have a difficult time finding the right surgeons and providers. I will know I am right when I see difficulties communicated to me via user interviews and an increase in vetting surgeons via community input. This will be indicated to me if 2 of the 3 interviewees relied on a mix of primary and secondary research methods when considering surgery.

Along with the hypothesis, I wrote a list of assumptions to see the limitations which may affect the outcomes of my research. Out of the 17 assumptions I had written, 4 were selected:

​My List of Assumptions: 

  1. My initial users are trans women who are looking to change providers 

  2. Users have difficulty finding appropriate providers

  3. Users  have difficulty finding surgeons for their needs 

  4. There is a lack of information regarding finding surgeons 

  5. Users vet surgeons and providers via community 

  6. Users can use the internet to find reviews of surgeons

  7. The motivation for seeing out trans healthcare is to address confirmation in gender identity

  8. These needs can be solved by providing community input and reviews for providers 

  9. The user can get additional benefits by looking up review and comments for providers

  10. The user can get additional benefits by having a surgery complication rate for display

  11. The user can get additional benefits by looking up images of the surgery process 

  12. The user can get additional benefits by getting research tips and information for surgeons and surgeries 

  13. My biggest hurdle will be preserving privacy for users

  14. I believe my users have a right to vet healthcare providers

  15. I will make money by implementing a small subscription fee for users 

  16. I will make money by asking providers to pay a fee for certification and endorsement 

  17. The #1 value a person/user wants to get from my product or service is confidence that their provider is reliable.

To conduct and cover all our bases for our research plan it was important to establish the research methodologies that I would be using for my problem space exploration. I had found that I would be using:
 

  • Qualitative and Quantitative Statistics Collection 

  • "Informal Research" via review sites

  • Secondary Research via medical databases

  • Decontextualized User Research in the form of User Interviews and research.

In establishing these methodologies, it was also integral to set up a participant criteria so that I would have a more direct way to weed out potential participants and avoid unhelpful information which may not be specific to my problem space.

Interview Process

Participants must:

  1. Live in California 

  2. Must have had at least gender confirmation surgery

  3. Must be on HRT

  4. Must have been medically transitioning for at least one year 

  5. Must be 22-35

  6. Have been qualified for surgery 

  7. Have worked with their provider to plan surgery 

  8. Have had a pre-op and post-op appointment regarding surgery

In this development of my participant criteria, I had made a list of qualifications, characteristics, and demographic information to fulfill

After establishing a set group of attributes, demographic information, and medical history I connected with my trans community to find a few friends to interview. ​

Since this was one of my first recruiting options I had turned to my direct friendships and first-hand relationships to support during this process. I had tried to recruit participants via different methods: Instagram, word of mouth, and finally text. I had found that not many people were responsive over social media and that I would have to reach out to them individually to try and schedule something. Also, given the limitation of time (about one week to come up with, compile, and process data.) It was difficult to schedule appointment ahead of time. Working around peoples schedules was one of my biggest hurdles during this time, as it was not possible to get all the participants interviewed on the same day due to their prior commitment. Processing and moving through the research took longer than I had thought and had to be done in segments. 

However, before interviewing participants I had to set up an interview guide so that I could get consistent results on subjective questions and answers. I wanted as much of an unbiased and blank questionnaire so that participants could fill in their emotions, journeys, and experiences regarding transgender healthcare. 

Interview Guide

Here, I compile a list of interview questions meant to keep the results consistent and without as little variables as possible. I begin with a series of open ended questions and slowly work my way into the topics which pertain to my research. The goal is to show interviewee's that they are in a safe space to be able to divulge their authentic and raw experiences pertaining to their navigation in the transgender healthcare space. 

Hi! My name is Aliya Parashar and today I’m going to be asking you a few questions regarding your healthcare experiences. I am a UX designer doing some research into how trans women’s needs are addressed in the medical field. 

 

Firstly, do you consent to being interviewed? 

 

Secondly, may I use your responses for my interview research? 

 

Lastly, do you mind if I record our conversation? All recordings will only be used for my personal research and will not be played for other people. 

 

Let’s begin. A reminder that there are no right or wrong answers. Speak your truth! 

 

If at any point you are confused about a question please let me know.

 

Opening Questions

 

Okay,

  1. How are you doing today? What is your mood like and how are you feeling?

  2. What did you do today? 

  3. Do you feel okay being interviewed today?

  4. Tell me a little more about yourself?

    1. Age?

    2. Gender Identity?

    3. Where do you live?

    4. Do you like your doctor?

    5. How did you find your doctor? 

    6. Are you on hormone replacement therapy?

    7. How long have you been medically transitioning? 

    8. What doctor do you go to?

    9. Do you have insurance? 

    10. Have you ever had gender confirming surgery?

    11. What surgeries have you had?

 

Thank you for answering some of those general questions. Now we will move onto some more specific questions regarding your medical history and experience. Once again, please be as detailed as possible but feel free to exercise your boundaries. 

 

  1. So tell me more about when you started transitioning and why?

  2. What age were you when you started?

  3. How did you find out about HRT?

  4. When did you have your first surgery?

  5. What conditions would you need for you to have an ideal surgical experience?

  6. Did you have any complications when you had surgery?

    1. If so, how did doctors handle it?

    2. How did you wish doctors would handle it?

  7. How did you go about finding a surgeon?

  8. How did you go about finding a provider?

  9. What were some of your favorite parts about surgery?

  10. How did you do your research about surgeons?

  11. How many surgeons did you consult with?

  12. Did you have a pre-op and post-op appointment? What did you like/dislike about those?

  13. How did you do research about your providers? 

  14. Did you pay out of pocket or via insurance?

    1. How much did they cover? How much did you have to make up?

    2. How was that experience for you? Working with insurance or collecting funds?

  15. How did you handle recovery? Did you have any help?

    1. What do you think could have gone better?

    2. In an ideal situation what would perfect recovery look like to you? 

  16. What are the best ways someone can support you through this?

 

So, we are at the end of our interview. Is there anything else you wish to tell me about regarding this topic? 

Y/N

 

Thank you for taking the time to do this! I really appreciate you. Your responses will have a significant impact on my research.

 

If you have any questions for me in the future regarding your responses please feel free to reach out. 

With these final responses I was able to do some affinity mapping to figure out how to approach these statistics and data from the interview portion. All of my interviews asked between 35-75 minutes, and while the interview guide was comprehensive, I had found that people wanted to give a lot of insight into their experience being trans and dealing with the medical industry because of their plethora of experience and their want to contribute to bettering the way trans women are interacted with in the medical industry.

Before getting into the interview process, I had to gather my participants. Here is their background information:

Interviewee 1

Gender: Transgender Woman

Age: 26

Status: Single

Profession: Technical Recruiter

Income: Below Average Income

Ethnicity: Latine / Latina

Interviewee 2

Gender: Transgender Woman

Age: 26

Status: Single

Profession: Marketing Manager

Income: Average Income

Ethnicity: South Asian

Interviewee 3

Gender: Transgender Woman

Age: 27

Status: Single

Profession: Artist and Sales Assistant

Income: Below Average Income

Ethnicity: White American

Due to personal medical data being divulged I will not be sharing participant responses outside of affinity mapping. Doing so would be a violation of their privacy. This is especially important to note as it pertains to medical information. 

It was integral for me to interview a variety of people with an emphasis on trans women of color because of the aspect that race would have to do regarding their treatment in the medical field. In doing this interview I had found that to maintain a consistent line of conversation I had to avoid taking notes during the duration of the interview and decide to record it instead. Additionally, I had found that the best way to administer the interview was via video call, since meeting them in person was not an option. Using otter.ai I was able to transcribe the meeting without breaking the flow of the conversation, which ultimately made people trust me more and further continue the conversation.

Information Collection and Analysis Stage

When reviewing the notes I had organized the interviewee’s responses into three different sections: 

  • Pain Points 

  • Motivations

  • Behaviors

This is to help me better understand their experiences and develop a solution for them which utilizes human-centered design.

Participant Answers and Affinity Mapping 

Next steps included grouping the notes into different categories to find commonalities and patterns between the participants answers. 

Groupings were split into 12 different categories:

  • Community

  • Information and Research

  • Care

  • Insurance

  • Scheduling

  • Recovery

  • Surgery Timeline

  • Assigned Doctors and Surgeons

  • Providers (PCP + Endocrinologist + Healthcare)

  • HRT + Transition 

  • Surgery

  • Uncategorized

Grouping is integral to finding different trends which can then be developed into a final How Might We question. Notice some of the key themes I have selected below are those which most participants had a lot of say about. Let's review them below. 

Click into the image to view it all!

All of this led me in being able to make my How Might We?  question, which shapes my research and app development from here on out.  Through iterating different types of questions based on my key themes I was able to come up with a strong and motivated question. 

All of this research leads me to ask: 

How might we provide trans women in California access to the right resources for surgery and providers in order to provide them with the right information to make a well-informed choice?

Say Hi to Nur!

After using the research that I had gathered and the information I had processed for this undertaking, I made a persona using all of my findings. 

Here, I invented a potential user for my app, all song with a list of her pain points, goals, motivations, behaviors, and apps used to give a well rounded perspective as to why and when she would need this app. 

After using the research that I had gathered and the information I had processed for this undertaking, I made a persona using all of my findings. 

Here, I invented a potential user for my app, all song with a list of her pain points, goals, motivations, behaviors, and apps used to give a well rounded perspective as to why and when she would need this app. 

Persona 2 (Light).png

Using different key elements from the persona page, I had used her experiences to construct a scenario or task fir her to complete. In this case it is researching different surgeons and their cosmetic results. I set this into 4 different phases which have an emotional scale attached to them in the form of a map. 

Each section is then separated further into touchpoints, channels, thinking, and doing. From here I developed different opportunities for our technological intervention.

Example.png

PHASE 2: 
Prototypying

Now, after gathering all of this information I am finally able to get into the prototyping phase of this project. This is where the app will come together in front of our very own eyes. However, before heading into the actual sketching and visual app development we must select a task flow via my constructed user stories. 

User Stories

What do your users need and what do they want? Actions and result oriented sentences are what user stories are complied upon. These user stories are going to be able to show me an isolated task flow that I can begin prototyping. 

Using the experience mapping and persona I was able to come up with a list of 23 user stories in the perspective of a surgery candidate, a new patient, and a potential patient. Below I will arrange a progression on images which will show the process of authoring user stories. 

Click through the gallery and into the images for further details!

Task Flow

Through selecting my final user story, I was then able to figure out a way to make it into a technological interaction. The user story led to the task of: Messaging Anonymous Patients to Connect with Through the App. This was under the epic of community, a core ethos surrounding PLUSH. 

Capstone Taskflow (Version 1).jpg

After ideating the task I was able to isolate some key pages that I would begin sketching. They were:

  • Chat Messaging Screen

  • Offline Messaging Modal

  • Home Screen

  • Surgery Selection Screen 

  • Messages Screen

This list will help to keep the main screens ideated without getting bogged down on the details of transition screens. 

I began to look at different user interface design inspiration and gathered my materials for my sketching process. Then, I created a board on InVision to further organize my ideas. 

Sketching, Designing, and Wire-framing

Working in different types of formats to sketch, I was able to come up with a selection of ideas. In this case I was making 2 "crazy-8" sketches, 12 exploratory sketches, and finally 6 solution sketches. 

Click into the sketches to see steps and descriptions

These then led to my wireframes for PLUSH, though at the time it was not called that. I began to make my wireframe on Figma. Below is a screenshot of what that looked like, feel free to click here to see the initial prototype!  

Screenshot 2022-11-06 at 5.08.54 PM.png

Prototype, Test, Prototype, Test, and Then? Prototype Again. 

Through a series of iterations and design prioritization matrices, I was able to arrange all of my information into a user output document. The issue that I had encountered here was that I could not get enough trans women to interview multiple times over a period of 2-3 days. Because my HMW affected such a specific group of people, it was difficult to conduct my timeline for prototyping and test simultaneously. While I did test with one trans woman, I will redo my testing in my next iteration solely with trans women. Below is a series of design outcomes and matrices, if you want a direct link to my User Output Document, click here. 

Click through the gallery below for a summary of results!