1 INTRODUCTION
The number of
deaths in Mexico due to breast and cervical cancer are shocking. In order to
prevent and detect these diseases on time, it is fundamental for women to
conduct gynecological studies periodically. Although there have been several
campaigns for making women self-aware of the importance of this problem, these
have not been enough. For this reason, it is necessary to have tools for
helping and boosting women to take care of their bodies and health.
This
paper presents the analysis and design of GynApp,
a mobile application that was thought for solving some of the needs detected
through a series of interviews. The application described in this paper aims to
increase the number of gynecological studies conducted by Mexican women, with
the objective of preventing and detecting breast and cervical cancer on time.
GynApp will try to combat some of the cultural barriers
described above, such as eliminating the taboo on breast self-exploration,
explaining the importance of it, showing how it is done and reminding women of
the days when they should do so. In order to avoid conflict with husbands who
do not allow another man to touch or see his wife, GynApp will provide options for clinics where care is provided only
by women. On the idea that gynecological studies are for promiscuous women,
there will be videos that explain what it is and in what cases each
gynecological study is indicated, making it clear that not only promiscuous
women can suffer from cancer.
The
rest of the paper is organized as follows. Section 2 describes three existing
applications that are similar to the one proposed in this paper. The
description of the problem is presented in Section 3. Section 4 introduces the
analysis performed to obtain the user needs and profiles for the mobile
application. Section 5 is dedicated to the design process of the mobile
application, which includes a brainstorm, a story-board, a paper prototype and
a digital prototype. Finally, Section 6 presents conclusions and further work.
2 EXISTING APPLICATIONS
This section
describes three existing applications similar to the one proposed.
iGyno [1] is a mobile application that helps to manage
different aspects of the female health, such as the menstrual cycle, fertile
days, body temperature, hormonal levels, among others. These are shown on the
mobile application by using a graph. Given that the main aim of iGyno is to prevent breast cancer, it
includes a video tutorial where it explains how to do a breast self-examination
appropriately. Some of the drawbacks of this mobile application are that its interface
is not very friendly because has saturation of information, and the graphs
shown are not understandable.
Breast self exam [2] is a mobile application that helps to register
the results of a breast self-examination. It provides a brief tutorial that
explains how to perform a breast self-examination through animated images,
which help women to have basic knowledge. The results are registered using an
animated image for its representation and there is also the possibility for the
user to upload a photo. The registration of these photos in the mobile
application allows the user to carry out a visual comparison of current with
past tests.
Breast cancer prevention [3] is a mobile application developed by Roche laboratories,
which main objective is the cancer prevention auto test. The test is divided in
three different stages: calendar, self-examination and tips. The application
requests the menstrual information with the start and the end date. Later, it
gives a recommended date for the self-examination. It also shows images and
instructions to carry out the auto examination appropriately. Finally, the
application offers tips to help on the detection of anomalies, advices for
prevention, and what to do in case of having questions.
Table
1 shows a comparison of features among the three previously analyzed
applications and GynApp. A1 corresponds to iGyno, A2 to Breast Self Exam, A3 to Breast cancer
prevention, and GA to GynApp. The tick indicates that the
application has the feature, and the cross indicates that the application does
not have it. A brief description of the features is also provided.
Gynecological studies agenda. This feature corresponds to the ability to manually
or automatically schedule the gynecological studies that a woman must perform
at certain time, such as pap smears, colposcopy, mammography and breast
ultrasound.
Breast self-exploration calendar. This calendar allows a woman to manually or
automatically schedule the days it is recommended to perform breast
self-examination.
Table 1 Features of the
applications analyzed.
|
Features |
A1 |
A2 |
A3 |
GA |
|
Gynecological studies agenda |
û |
û |
û |
ü |
|
Breast
self-exploration calendar |
û |
û |
ü |
ü |
|
History of
gynecological studies |
û |
û |
û |
ü |
|
List of
gynecological clinics |
û |
û |
û |
ü |
|
Video tutorial
of self-exploration |
ü |
ü |
ü |
ü |
|
Explanatory
videos about studies |
û |
û |
û |
ü |
|
Tips to
prevent or treat cancer |
û |
û |
ü |
ü |
|
Management of
menstrual cycles |
ü |
û |
û |
û |
|
Photo
registration |
û |
ü |
û |
û |
History of gynecological studies. The history stores information about each
gynecological study previously performed. This information indicates the study
performed, the date of completion, the clinic at which it was performed, the
result of the study, and where appropriate, the treatment that the doctor
indicated, as well as any comments that the user considers important to be
registered.
List of gynecological clinics. This feature shows a list of gynecological clinics,
prioritizing those in which medical care is given only by female doctors.
Video tutorial of breast
self-exploration. The
video tutorial shows the proper way to perform a breast self-examination.
Explanatory videos about
gynecological studies.
These videos explain the procedure that is followed for performing different
gynecological studies (pap smears, colposcopy, breast mammography and
ultrasound), and specify in which cases these studies should be carried out.
Tips to prevent or treat cancer. This feature consists of tips that women register in
the application to support other women who suffer from cancer or who wish to
prevent it. Tips can be very diverse, such as food, exercise, habits,
therapies, among others.
Management of menstrual cycles.This feature refers to different aspects of women,
such as the prediction of dates of the menstrual cycle, fertile days, body
temperature, hormone levels, reminders of contraceptive intake, among others.
Photo registration.This feature allows the possibility of storing photos
corresponding to a breast self-exploration, in order to be able to compare the
appearance of the breasts, in case of finding any anomaly.
3 PROBLEM DESCRIPTION
Since 2006,
breast cancer occupies the first place of mortality in Mexican women due to
malignant neoplasms, with a rate of 16.1 deaths for each one hundred thousand
women aged 25 years old or more. Concerning cervical cancer, it is the second
place of mortality in the country, with a rate of twelve deaths for each one
hundred thousand women aged 25 years old or more [4].
There
are several factors that contribute to the development of breast cancer, although
there is not a key factor alone that causes it, instead the combination of factors
are the cause of this disease. Regarding cervical cancer, there are also many
factors, but in this case, they are more precise, such as smoking, suffering
human papillomavirus (HPV), taking contraceptive pills for more than five
years, among others.
A
timely detection of breast and cervical cancer helps to get greater
possibilities of survival and total recovery, after having the necessary
treatment. On the other hand, in a late detection there are less possibilities
of survival. For this reason, it is of vital importance a timely detection. In
order to accomplish this, it is necessary to conduct gynecological studies
periodically, such as pap smear, colposcopy, mastography and breast
self-examination.
Several
studies [4, 5, 6, 7, 8] have revealed that Mexican women do not conduct
prevention studies, such as pap smear, colposcopy, or mastography. Mexican
women say this is because several reasons, among the following: they do not
consider it necessary, they do not have time, they forget to conduct these
studies periodically, they feel fear to the procedure, they feel pain or shame,
doctors do not ask for these studies, among other reasons.
There
are also cultural barriers, which influence on the late detection of cancer.
The report "Social process of breast cancer in Mexico. Perspective of
diagnosed women, her couples, and health service providers" [7] highlights
some cultural barriers:
a) Fear of the disease: cancer is synonymous with death.
b) Fear that her partner will abandon her.
c) Children and husband are always before the woman's own
health.
d) There is no culture of self-exploration: there are
many taboos about touching your own body.
e) Husbands do not want them to be touched by male
doctors.
f)
Gynecological
studies are for promiscuous women.
The
truth is that there are several campaigns to make women aware of their health
care, but then why the mortality rate for these diseases does not decrease? In
order to answer this question an interview with five women of different ages
and occupations was carried out. In this way, the next section describes the
analysis per-formed to obtain the user needs and user profiles for the mobile
application. The first part of the analysis was to design an interview, which
was carried out with five women. The user needs were obtained from the results
of the interview. Finally, the user profiles were based on the needs detected.
4 ANALYSIS
The following
work is based on the User-Centered Design (UCD) process [9, 10], which outlines
the phases throughout the analysis, design and development life-cycle while
focusing on the understanding of the user needs.
The
analysis phase was composed of interviews and an ethnographic study in order to
detect the needs of Mexican women. The ethnographic study implies the observation
as the main activity to analyze the users.
4.1 Interview
The interview
was composed of nineteen questions, which are shown in Table 2.
Table2Questions asked to
women in the interviews carried out.
|
# |
Question |
|
1 |
Have you heard about breast cancer? |
|
2 |
Have you heard
about cervical cancer? |
|
3 |
Have you received
information about these topics through any type of media? |
|
4 |
Have you
investigated about these topics? |
|
5 |
Do you know the
reasons why a woman gets breast cancer? |
|
6 |
Do you know the
reasons why a woman gets cervical cancer? |
|
7 |
Do you know what
studies must be conducted to diagnose breast cancer? |
|
8 |
Do you know what
studies must be conducted to diagnose cervical cancer? |
|
In case of having answered YES
to any of the last two questions |
|
|
9 |
Do you know how
regularly these studies must be conducted? |
|
10 |
Have you taken any
of these studies? |
|
In case of having answered YES
to the last question, please answer questions 11 to 15 |
|
|
11 |
How often do you
take these studies? |
|
12 |
When was the first
time you took these studies? |
|
13 |
Where have you
taken these studies (clinic, hospital or laboratory)? |
|
14 |
What opinion do you
have about these studies (treatment of the staff, discomfort of the studies,
religion, among others)? |
|
15 |
Do you know when is
the best time to take a breast self-examination? |
|
16 |
Do you think there
is enough information about these topics? |
|
17 |
Do you think there
should have something to help improving the communication of this
information? |
|
18 |
What types of tools
or media do you think it should be? |
|
19 |
Would you say that
people around your environment are well informed about these topics? |
4.2 Detection of Needs
Based on the
results of the interviews a set of needs were detected, which are shown in
Table 3.
Table3Needs detected based
on the interviews carried out.
|
# |
Need |
|
1 |
Informative talks |
|
2 |
Informative
leaflets with images |
|
3 |
Explanation videos |
|
4 |
General information |
|
5 |
Sexual education |
|
6 |
Advice from experts
and other women |
|
7 |
Agenda for studies
already carried out and future studies |
|
8 |
Gynecological
studies card |
|
9 |
How to carry out
the breast self-examination |
|
10 |
Overcome fear of
conducting studies and their results |
|
11 |
Believe and trust
in the doctors in charge of the studies |
|
12 |
Trustworthy health
service and available for everyone |
|
13 |
Talk to someone
about these diseases |
|
14 |
Share experiences
with other women |
|
15 |
Family support |
|
16 |
Partner support |
Taking into
consideration the list of needs shown in Table 3, it was observed that it was
not possible to solve all of them but some, such as: advices, agenda, explanation
videos, studies card, and how to carry out the breast self-examination. Given
these needs and their solutions, it was decided to design a mobile application,
due to its easy access and mobility.
Once
the needs were identified, it was required to define a user profile, which described
precisely the features of the person that will use the mobile application. It
should be noted that the women interviewed comply with the user profile defined
in the next subsection.
4.3 User Profiles
In order to
analyze the possible solutions, three user profiles of different women and one
scenario for each of them were defined. Each profile takes into consideration
three of the needs mentioned previously. Only one user profile is shown in this
paper, due to space restrictions.
The
user profile presented defines a woman aged between 25 to 50 years old, with
active sex life, housewife, with high school or university studies. She has a
mobile phone with Internet access and has experience using several mobile
applications. An example of this user profile is shown in Table 4.
5 DESIGN OF THE MOBILE APPLICATION
This section
describes the process of designing a gynecological mobile application, which is
composed of a brainstorm, a storyboard, a paper prototype, and a digital
prototype.
Table4An example of the
user profile defined.
|
Feature |
Description or value |
|
Name |
Andrea |
|
Age |
45 |
|
Occupation |
Housewife and saleswoman |
|
Brief description |
Andrea manages her family's
home and sells catalogue products. During weekends on her free time she goes
out with her family, does exercise, goes shopping and goes to the cinema. She uses the following
applications: Whatsapp, Pinterest, Google, Waze and Youtube. She also likes to register
her product orders and appointments on the calendar of her mobile phone. |
|
Scenario |
Andrea receives a notification
on her mobile phone that indicates the date of her last study of mastography,
which was conducted a year ago approximately, and advises that she should
carry out the study again. The application shows her the catalogue of clinics,
that are close to her, that conduct the mastography study. Andrea chooses the
clinic and calls to make an appointment. Once Andrea has taken the
study, she registers the date in which the study was conducted and its
results. If there is something abnormal in the study, it will be registered
along with the date of detection, the treatment given and the indications;
this information will help her in future gynecological appointments. |
5.1 Brainstorm
The design of
the mobile application started with a brainstorm, this means the generation of
words, images, sentences and concepts that could help to get inspiration in
order to make an appropriate design according to the role of the mobile
application. Some of the ideas and words that came out in the brainstorm were
the following: healthy, colorful, easy, attractive, tranquility, feminine,
simple, wellness, and control.
The
sentences that stood out were the following: 1) illustrations are more
attractive than the text and easier to understand; 2) having reminders of dates
facilitates a better planning and control; 3) historical data would help to
have a registry of studies, diagnoses and treatments taken; and 4) a simple
graphical user interface would be easier to use and would demonstrate
seriousness and confidence.
A
point of view was also defined, which expresses clearly a problem and
opportunity, and specifies what a good solution should accomplish. The point of
view was defined as follows: With an application that reminds women to conduct
gynecological studies, they would not forget to carry out them on time and take
care of their health.
5.2 Storyboard
The design of
the mobile application continued with a storyboard, which is a technique
focused on producing rapid prototypes, by identifying tasks (actions) that will
help users to solve their needs. It should be noticed that users will always
appear in the process of prototyping.
A
storyboard consists of simulating a scenario where a task is required to be
done, it shows the steps to be followed to accomplish the task required, and
finishes when the task has been successfully completed. A storyboard helps in
the design stage to identify problems and also possible solutions.
Figure
1 shows one of the storyboards that were produced in the analysis stage, in
which a woman is making use of a mobile application to know how to conduct a
self-study. It should be noticed that the messages shown in the storyboard are
written in Spanish. The characters used in the storyboards were taken from the
drawings made by Agustina Guerrero, who is an Argentinean graphic designer and
illustrator [11].
Once
the tasks to be done have been identified, the next step is to design the user
interface in paper, in which it is easier to shape the ideas and make the
necessary arrangements before making a digital user interface. Next subsection
presents the paper prototyping carried out for the mobile application.
Figure1 Storyboard that shows a woman
making use of a mobile application to know how to conduct a self-study.
5.3 Paper Prototyping
Paper
prototyping is a technique that consists of creating hand drawings of user
interfaces in order to rapidly design them. The paper prototype should contain
the structure and organization of the information (text, images, buttons, among
other elements); the arrangement of those elements on the screen; the
simulation of the actions performed by the buttons with the execution of
certain tasks and their results, which is very useful for a first test with
users.
Figures
2 and 3 illustrate four of the screenshots of the paper prototype created for
the gynecological mobile application. The first screenshot of Figure 2 shows
the menu of the application, while the second screenshot represents the screen to
register a result of a study. The first screenshot of Figure 3 shows how
to register a treatment, and the second screenshot presents the registration
screen completely filled. It should be noted that all the texts shown in the
paper prototypes of Figures 2 and 3 are in Spanish.
Figure2 Paper prototype for the mobile application: menu and
registration of result for a study.
Figure 3 Paper prototype for the mobile application:
registration of a treatment and registration form filled.
The paper
prototype was tested with five women, the same that were interviewed, according
to the ten usability heuristics for user interface design defined by Jacob
Nielsen [12], which are the following: "1) visibility of system status; 2)
Match between system and the real world; 3) User control and freedom; 4)
Consistency and standards; 5) Error prevention; 6) Recognition rather than
recall; 7) Flexibility and efficiency of use; 8) Aesthetic and minimalist
design; 9) Help users recognize, diagnose, and recover from errors; 10) Help
and documentation" [13]. The results of the tests are shown in Table 5.
Table 5Results of the tests
using the heuristics defined by Nielsen.
|
Heuristic |
Person1 |
Person2 |
Person3 |
Person4 |
Person5 |
|
1 |
ü |
ü |
ü |
ü |
ü |
|
2 |
ü |
ü |
û |
ü |
û |
|
3 |
û |
û |
ü |
û |
û |
|
4 |
ü |
ü |
ü |
ü |
ü |
|
5 |
ü |
ü |
ü |
ü |
ü |
|
6 |
ü |
ü |
ü |
ü |
ü |
|
7 |
ü |
ü |
ü |
ü |
ü |
|
8 |
û |
ü |
ü |
û |
ü |
|
9 |
ü |
ü |
û |
ü |
ü |
|
10 |
ü |
ü |
ü |
ü |
ü |
The test
consisted first in explaining to the women what Jacob Nielsen's heuristics
consisted of, then the prototype was shown on paper and they were asked to interact
with it, and finally they were provided with a format where they should
indicate whether the heuristic was fulfilled or not, according to the prototype
shown. Additionally, they were asked to provide suggestions about the
prototype. The suggestions obtained are described below:
a) It would be good to have a history of studies carried
out in the past.
b) A message should be shown indicating that the
medication information of the treatment has been saved successfully. There is
no message and leaves uncertainty.
c) Events should be seen by clicking on the calendar
numbers.
d) The colors of the calendars should be changed, to more
alive ones.
e) The underline of some titles should be removed; it
gives the appearance that they are links.
f)
A
previously saved study should be able to be eliminated or modified.
g) The text "No events" should be changed to
something like "No studies registered".
h) An error should be indicated when the form is not
filled completed.
With the
feedback obtained from the tests carried out with users the digital prototype
was developed, which is described in next subsection.
5.4 Digital Prototyping
The digital
prototype was developed based on the suggestions of the users, once they tested
the paper prototype. The first version of the digital prototype was also tested
with users and new feedback was obtained to modify the digital prototype again.
Figures 4, 5, 6 and 7 illustrate eight screenshots of the final version of the
digital prototype.
The first
screenshot of Figure 4 shows a calendar for keeping track of the dates for
studies and results, the green circle means that a study has already been taken
and results have been registered; the yellow circle means that a study has been
taken, but the result is not ready yet. The second screenshot of Figure 4 shows
the menu that is displayed for the mobile application, where it is composed of
the following options: Home, Add Study, Add Result and History.
The first screenshot of Figure 5 is the Add
Result screen, where the user can add the necessary information for the
result of a study (result of the study, notes or comments about the study, and
whether the study requires treatment or not). The second screenshot of Figure 5
shows the Add Treatment screen, where
the user can add the necessary information for the treatment, in case it was
prescripted by the doctor (medicine to be taken, dose, and duration of the
treatment). It should be noted that these screenshots were designed based on
the paper prototype described in the previous subsection. The texts and
messages shown in all the digital prototypes are in Spanish.
The
first screenshot of Figure 6 shows the Add
Result screen after the result has been saved. The second screenshot of
Figure 6 shows the confirmation screen after a result has been successfully
saved. The first screenshot of Figure 7 illustrates the Add Study functionality, where the user can provide the necessary
information to register a new study (name of the study, date when the study
will be taken, and clinic where the study will be carried out). Finally, the
second screenshot of Figure 7 shows the View
Study screen, where the user can view all the information of a study, such
as the type of study, the date, the clinic where it was taken, the results,
some comments and the treatment.
Figure 4Calendar and menu screenshots.
Figure 5 Add result and add treatment screenshots.
Figure 6Add result and result saved screenshots.
Figure 7 Add study and view study screenshots.
The final
version of the digital prototype shown in Figures 4, 5, 6 and 7 represents a
functional gynecological mobile application to be used by women that fulfills
the user profile defined previously in this paper. It should be noted that the
tool used for creating the digital prototype was Axure [14].
6 CONCLUSIONS AND FURTHER WORK
This paper
presented the process to analyze and design a gynecological mobile application,
taking into consideration the users in every step of the process. This UCD
methodology was very helpful to develop such application, because the user was
involved in all the tasks carried out, and the final version of the prototype
was de-signed according to the real needs detected in the analysis process.
Further
work is needed to implement this mobile application for an Android platform,
because all the users involved in the process use this platform. It should be
noted that the implementation of the application would not be a difficult step,
given that all the screenshots have been developed and tested by the users. The
implementation would involve the translation of the screenshots to the
appropriate programming language and the creation of a database for storing and
retrieving data. The functionality and usability tests would be minimal,
because they were already done during the process of developing the prototype.
In
summary, GynApp will help to remember
the dates in which a study should be carried out, in addition to suggest
specialized clinics for its realization; clinics where the service is provided
only by women, a registry of the results obtained in each study and advice for the
prevention and detection of cancer, as well as advice from women who have
suffered cancer. There will also be an explanation in video format about how
each study is carried out, as well as specifying in which cases these studies
should be carried out.
7 REFERENCES
[1] iGyno Mobile
Application (2019). Retrieved from:
https://itunes.apple.com/mx/app/igyno/id479872013?mt=8
[2] Breast Self Exam
Mobile Application Web site (2019). Retrieved from:
http://breast-self-exam.appstor.io/es
[3] Prevención de Cáncer
de Mama Mobile Application (2019). Retrieved from:
https://appworld.blackberry.com/webstore/content/17842703/?lang=en&countrycode=CL
[4] Campero, L, Atienzo,
E., Marín, E.,Vara-Salazar, E., Pelcastre-Villafuerte, B., González G. (2014). Deteccióntemprana
de cáncer de mama y cervicouterino en localidades con concentración de
poblaciónindígena en Morelos. SaludPública
de México, 56 (5), 511-518. Retrieved from: