Together with a Master of Public Health student and an advisory panel of medical practitioners, I prototyped and built a conversational interface to help community health workers disseminate pelvic health content to women and girls. The CI's primary purpose is to parse complex information surrounding conditions like fibroids, endometriosis, and Polycystic Ovarian Syndrome into consumable bites to inform patients, facilitate a better understanding of "what's normal," and prompt the appropriate seeking of care. Conversational design is a new frontier, one which encouraged me to revisit and utilize user experience principles over established UX processes. 
The reality
Each year in the U.S., about 11 million girls get their first period. The start of menstruation brings with it an onslaught of other challenges for many young women who lack the resources and education they need to sufficiently adapt to the reality of their changing bodies. Beyond and before sex and STDs, girls as young as 8 begin experiencing disruptive pelvic health problems like endometriosis, urinary tract infections, chronic constipation, and excessive or abnormal bleeding. By adulthood, 1 in 3 women has a pelvic health disorder. In addition to the depression and anxiety, lack of physical activity, poor sleep quality, social isolation, and perpetual absenteeism experienced by women and girls suffering from health issues below the belt, pelvic health disorders cost the country more than 100 billion dollars annually.

A few stats from an infographic I designed for BYB. Check here for links to the studies.

The Challenge
Pelvic health is cyclical—not just because the female body is tied inextricably to menstruation, but also because below the belt conditions, patterns, and problems are passed down through generations of moms and daughters. 
Many pelvic health disorders can be managed, improved, or altogether prevented with education. That said, information alone cannot improve health. 
Below Your Belt + MY ROLE 
Below Your Belt is an early stage startup developing digital pelvic health solutions for women and girls+. 
There, I wore many hats. I operated under the as-inclusive-as-possible title of Product Designer which included writing, front-end development, user research, interaction design, user testing, project management, and a bit of visual design. 
As development continues, what I present below is mostly process and reflection. Unless otherwise stated, the work and thoughts displayed are my own. 
The Process
Part 1: Discovery
To many, women included, the female body and the problems that haunt it are the stuff of mystery and legend.

That said, the combination of the BYB team's non-profit past and membership in the healthcare tech community at Matter lent me a dizzying amount of access to patients, practitioners, payors, and other healthcare-oriented individuals. 

Because of this tension—lack of population knowledge paired with countless opportunities to gain insight from stakeholders—I made it my mission to catch every bit of information coming our way, whether it was a conversation in the office kitchen with an employee of Blue Cross Blue Shield, a call with an executive taken in the car by our COO, or a 20-minute chat in Little Village with a mom of three daughters. 
Left and right: excerpts from our affinity diagram (built from dozens of stakeholder interviews), middle: one version of a consolidated flow model meant to show system wide breakdowns within our space 
To meet the needs of our tiny team during the brief windows available for user research, I adapted some processes and exercises from contextual inquiry, including, but not limited to affinity diagramming and modeling. We built these documents incrementally as I snagged an hour of time from my co-workers here and there. 

In addition to the insight they provided, the exercises that resulted in the deliverables shown above had the effect of creating shared knowledge and generating a continual influx of fresh ideas. 

What We Learned

There are myriad reasons why women and girls+ live with less than optimal pelvic health. 
Many of the reasons are logistical: they don't have insurance; they don't have time to go to the doctor; they don't know how to voice their concerns with their care providers; they prioritize the health of their family over their own; they lack sufficient understanding of their own biology. 

Other reasons are more ideologicaldiscussions about the pelvic region in some families are associated with talking about sex, which is to be avoided; women are embarrassed about the problems they're facing below the belt; fear of difficult conversations keeps women from talking with their daughters about things like periods and hygiene before adverse behaviors start to stick.

And still other reasons are systemic: the health concerns of females have been historically suppressed; some women feel pressure to cope with their pain and discomfort; certain conditions like painful periods and overactive bladder have been normalized and women are told they must adjust to less than optimal ways of being.

Meanwhile, healthcare providers have countless obstacles of their own, all of which further complicate each woman and girl's access to care. 
I came across a term while doing secondary research that helped me to center myself in the face of the magnitude and complexity of the pain points associated with the female reproductive + healthcare space.
"Sufficient Capability" refers to the idea that individuals need both awareness and knowledge in order to modify adverse behaviors. It's a term borrowed from economic theory which seeks to tie together the concept of self-efficacy with measures of health literacy and well-being. 

While steep battles abound in changing the time it takes a patient to get a specialist appointment or confronting the politics that prevent health information from making its way into the classroom (both of which showed up as breakdowns during research), helping women to be more sufficiently capable is a manageable and measurable goal.

The aim was to create more sufficiently capable healthcare consumers by injecting knowledge and awareness into the relationship between mothers and their puberty age daughters and between women and their healthcare providers. 

We chose to focus on moms as a way to reach two users at once (mom + daughter) and because we heard over and over again during interviews and in surveys how focused and motivated moms are to support and maintain the health of their families, even if that focus doesn't quite extend to their own bodies. 
Talking to each other about tricky topics is especially tricky when our personalities, beliefs, relationships, and gaps in knowledge get in the way. Besides being tricky, conversations about puberty and periods and poop and pee make many adults squirmy, not to mention puberty age girls. 

As a result, unlike the ubiquitous "sex talk", productive conversations about puberty often don't happen at all. 
Our aim is to modify this reality using conversational interfaces.
Parts of the scripting process and shots of the interface on FB Messenger
I still have a million questions directed at every aspect of this project. Some of them can be found in this usability report from our first round of user testing. 
I've abstracted many details about this project to protect Below Your Belt's privacy. If you want to know more, feel free to reach out to me. 
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