C-ARCHES: Addressing Reproductive Coercion in Heath Settings
In summer 2023, a team of scholars at the University of Michigan School of Nursing hired me as an intern to help develop an app aimed at addressing reproductive coercion.
The American College of Obstetricians and Gynecologists defines Reproductive Coercion as any “behavior intended to maintain power and control in a relationship related to reproductive health by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent.”
Given the complexity and severity of this social and public health problem, this project began with breaking down each aim of the larger R21 National Institutes of Health research project into a more scaleable problem. Aim 1 is the focus of this project. Below details the progress I’ve made so far.
Problem
How can we use ARCHES and the ADAPT-ITT framework to create C-ARCHES, a digital health tool aimed at reducing intimate partner violence (IPV) and reproductive coercion (RC)?
Target Audience + Persona
A second step was to identify our target audience, which our team agreed should focus on young adult women between the ages 18-25 years who are interested in learning more about reproductive coercion, as it relates to intimate relationships, health, (unintended) pregnancy, and education on prevention, as well as resources for anyone at risk.
Below is a persona I created of a woman named Rachel who says “He says if I really love him, I wouldn’t be afraid to have his baby, but I’m just not ready.”
While Rachel is not representative of all possible users of the ARCHES app, her experience speaks broadly to the experiences of people whom have ever felt pressured by a romantic partner, are unsure of their reproductive options, and/or are unsure about the what is appropriate versus inappropriate intimate relationship behavior.
Challenge C: Users may have a partner who monitors their phone use/ app history
Design Requirement C: Security features from the myPlan app should be added to the C-ARCHES app to help users minimize their digital footprint.
This will alleviate safety and privacy concerns users may have and restores patients with the power to seek out information for their own health and wellbeing.
The next phase of the project was to use recommendations and feedback made by the team to start an Interaction Map!
The interaction design takes on an educational style, addressing topics related to reproductive coercion, including, intimate partner violence, unintended/unwanted pregnancy, harm reduction counseling, and a place for users to access resources.
Existing Solutions for Addressing Reproductive Coercion
Addressing reproductive coercion is currently in the hands of healthcare providers and typically offered in health care settings.
Smartphone access offers access to apps that support the fostering of healthy relationships, family planning services, and support for survivors of IPV
Love&Learn
Paired
Healthy Relationships
Sexual Violence Prevention
myPlan
** I also conducted a competitive analysis of these apps as I began drafting ideas for how to design ARCHES.
These solutions are all fine, but. . .
Addressing RC in healthcare settings alone does not address structural barriers to consistent and quality service for patients equally, including access to healthcare and regular health screenings.
This also neglects social, psychological, and cultural barriers to patient self-disclosure.
** On a larger scale, this contributes to gaps in knowledge and access, and overall, health disparities between groups.
Existent apps do not adequately focus on reproductive coercion, a specific form of IPV, that has direct consequences on the health, wellbeing, and reproductive outcomes of women and their children.
Our Response
ARCHES – an educational digital health tool for anyone interested in learning more about reproductive coercion, as it relates to intimate relationships, health, and (unintended) pregnancy, as well as resources for anyone at risk of IPV, RC, or unintended pregnancy.
ARCHES is NOT a replacement for existent apps.
Our goal is instead to integrate top features and resources from these apps to ARCHES.
myPlan should be linked to the C-ARCHES app.
Essential Functions and Design Requirements of C-ARCHES
Challenge A: Health care providers have limited time with patients to address RC with patients.
Design Requirement A: C-ARCHES should be accessible on any mobile device so that users are free to use this resource on the go, and without needing access to a desktop/laptop.
Users should also not have to provide a username/password to use the app, and minimal information disclosure should be expected of users.
Challenge B: Sensitive nature of RC and IPV makes it difficult for patients to discuss these topics with health care providers.
Design Requirement B: C-ARCHES should maintain an educational interactive style, and one that does not require users to disclose personal health or relationship information.
More design suggestions from Michigan Relationships Lab to come!
At this time I have been giving split demo presentations of the ARCHES app to a few members of the research team and a time, and soliciting their recommendations for the following:
How can we enhance quality of content? (too much? too little? what is missing? what is unnecessary?, etc.)
How can we enhance the aesthetic quality and design of C-ARCHES? (color scheme, visuals, brightness/contrast, legibility and readability of text, etc.)
How can we enhance the information architecture and organization or C-ARCHES?
What are core goals of the C-ARCHES app, and how can we apply this towards enhancing the (1) functionality, (2) usability and (3) accessibility of C-ARCHES?
I then used this interaction map to guide the development of the ARCHES app. This has been an iterative process, where multiple versions of C-ARCHES have been made.
Below are some of the main screens of ARCHES-Version A.
Additionally, I’ve been working on getting more feedback from my research team and users on how to use the symbolic meaning of the word arches towards the design of our app logo. Additional areas of interest on this topic are related to color meaning and the use of colors we select for our final logo and overall color scheme used throughout the ARCHES app.
More Things to Think About…
As we continue conducting user testing and user interviews with family planning patients, healthcare providers, and topical experts, we will gather feedback from each of these populations about ARCHES related to:
Content
Design
Information Architecture and Organization
Functionality of the app
Perceived Usability and Accessibility
Pain points.
*Three content domains of ARCHES asked in interviews include:
1) IPV/RC screening and education
2) Provision of harm reduction behavioral strategies
3) Resources and referrals
