Since its creation in 2008, the Portail VIH/sida du Québec has been using innovative approaches to produce and share information related to HIV and STBBIs across the Canadian province of Quebec, and beyond.
As a fairly young organization, the Portail has never been afraid to explore the use of mobile and social media platforms to reach its objectives and so when the right time presented itself, the organization jumped on the opportunity to develop one of the first sexual health mobile apps in Canada.
At the time, the Portail had been developing a directory of resources for people living with HIV in Quebec that included testing, support and treatment services, as well as other useful contacts such as shelters. Though undeniably useful, keeping the information in this directory current and up to date proved a constant challenge – organizations would close, new ones would open, and phone numbers would change.
When a revision of the directory came up during a board meeting, one of the members asked “Why don’t we develop an app?” What as initial resistance soon gave way to an enthusiastic consensus. The idea made sense: the app would allow the organization to fulfill its promise to service users (and funders) by making information about services available, while seemingly making it much easier to update the information than in hard-copy or PDF format.
With everyone on board for the development of a mobile app, the Portail launched into what was to become a challenging and enriching learning experience, the development of Sexposer. Initially created as a French application for use on Apple products, Sexposer is now available in English and French, for iOS and Android, and a Spanish version is forthcoming.
In the process, the Portail has learned some key lessons on what it takes for a community-based organization with limited means to create a mobile app from start to finish:
In order to develop an app that would meet the needs of its audience, the Portail began its conceptual process by looking to its own data, metrics from its website. Online, it seemed that service users were particularly preoccupied with risks related to the transmission of HIV and other STBBIs through oral sex. From this, the Portail decided to build an app that could help users better understand and measure the risks related to various sexual practices and configurations and to find testing services near them. At the time, their website metrics also indicated that most users were accessing the information via Apple technologies. With a limited budget and choices to make, the organization decided to begin with the development of an app for iOS.
The Portail has always attracted employees with a certain degree of knowledge and comfort when it comes to social media and ICT (in fact, this is one of the specifications that they include in their hiring process). While the employees were comfortable enough to develop ideas for the app, they would require external help to build its architecture. With a budget of CAD$9,000 (a small amount when it comes to app building, which usually warrants at least thrice the amount), the Portail hired a company to assist with the technical side of things. The IT consultants developed a mechanism based on an Excel spreadsheet: the Portail would create the content via the spreadsheet, whereas they would create the structure to allow users to access and read the spreadsheet in a interactive and stimulating manner.
One of the advantages of this approach lies in the fact that users can use the app whenever and wherever they want.The budget wouldn’t allow for the creation of a “live” app that could be updated regularly (this would have required access to a server, another considerable expense). The Portail therefore opted for a more “static” app format, whereby the app can be downloaded onto a mobile device and used independently, whether or not the user has access to a wireless network. One of the advantages of this approach lies in the fact that users can use the app whenever and wherever they want. Conversely, the app needs to be updated manually, which can be a costly process.
Over the years, the Portail has come to realize that in addition to requiring a significant amount of funding up-front, maintaining an app in the long run also requires considerable resources. In the first place, mobile technologies are ever changing and evolving, such that an app that works on an Apple or Android device at any given time may no longer be compatible eight months later. Sexposer was thus updated on several occasions, to adapt to changing technologies (including variable screen sizes). Housing an app on iOS also requires a yearly subscription, an additional cost of US$100.
Technology is a moving target, as is information about sexual health and risk reduction. With new discoveries coming down the pipeline, the Portail also had to make modifications to Sexposer’s content, adapting the information to changing notions about HIV transmission (including new knowledge surrounding the negligible risks of transmission associated to undetectable HIV viral load). Because every update requires modifications to the entire app, which needs to be done by a specialized IT person, the organization collects new information and comments in a file. When they have reached a critical point, they request the update.
Presented with important challenges and unforeseen expenses, the Portail still succeeded in furthering the development of its project, adding an Android version and an English version to its repertoire (such that updates now require changes to four different apps, the French and English versions in iOS and Android – again, more costs!) Were they to repeat the experience, the Portail might opt for a different approach, for example the development of a mobile site that could include a similar interactive format and feel, but which would be easier to update. This would also allow the organization to gather more information about the app and how it is being used. Because communication ceases once Sexposer has been downloaded onto a mobile device, it’s much more challenging to assess how and how often the app is used, beyond the quantity of downloads.
More and more, we learn and hear about the many benefits of using social media and ICT in public health interventions. This being the case, it seems that the funding hasn’t been as quick to catch up with the enthusiasm for these approaches. The Portail has always been committed to offering all of its services free of charge, and there was no question that access to Sexposer would have to be free. Initially, the organization was able to redirect some of the funding for the directory into the development of the app, finding some additional dollars here and there. However, as the process progressed and the Portail started to realize that maintaining and expanding the app would require significant expenses, they had to become creative around fundraising.
The Portail was able to secure a one-time funding allocation from a telecommunications company, allowing the organization to add an SMS component to their services, and to Sexposer. On the app, this allows users to click on a link that downloads the phone number into their phone. They can then send an SMS to the organization with any question related to sexual health. They receive a response promptly, via SMS.
Let’s face it: updates may be absolutely necessary, but they’re not particularly sexy.
While social media and ICT work may open up doors to interesting new funding opportunities, the biggest challenge rests in the difficulty of pitching updates as an attractive element to funders. Let’s face it: updates may be absolutely necessary, but they’re not particularly sexy. In order to make the updating of Sexposer more attractive to funders, the organization bundled the updates with other changes, such as the development of the English or Android versions of the app.
By way of recommendations to other organizations who may want to tackle the development of a mobile app, the Portail advises on the importance of carefully considering unforeseen costs and expenses in the long run, and on developing strategies to make the various elements of app creation and maintenance appealing to funders.
Another key lesson that the Portail had not anticipated upon embarking on its Sexposer adventure was the question of copyright. Early on in the development of the app, the organization decided to register the Sexposer name with Industry Canada – not so much to prevent anyone else from using it, but to prevent a situation whereby someone else might register the name, making it unavailable to the Portail. The process was lengthy (it took about a year) and required additional funds.
Upon developing an agreement with the IT firm that developed the architecture of the app, it was clearly detailed that all materials developed belonged to the Portail – from the content to the technology. The organization also asked the developers to use open source fonts. In fact, this is another recommendation that the organization makes: inasmuch as possible, they encourage potential app developers to use open source fonts, images and other elements, as these can reduce important, and often unforeseen expenses along the way.
As a community-based organization, the Portail works with a limited budget. The organization does have, however, a strong network of individuals and organizations supporting its work. Thanks to its openness to partnerships and collaboration, the Portail was able to expand Sexposer into English and Spanish versions.
The English translation of the app was carried out by a volunteer intern. Because the organization works primarily in French and has limited capacity when it comes to offering English services, they sought the support of ACCM, an organization that offers English language services to people who are living with HIV and/or HCV in Montreal. ACCM reviewed the translation and provided their contact information, such that any person who seeks additional information or uses the SMS service in the English app is referred to ACCM.
In the case of the Spanish version, the Portail was approached by Antisida Lleida in Spain, who was looking to develop a sexual health app in Spanish and Catalan. The Portail generously offered to share the content of Sexposer in exchange for the translated text. Sextat was launched in the spring of 2016, offering Portail some interesting visibility outside of Canada (they are credited on the app’s website, and they even created and sent a short video to accompany the launch of Sextat in Spain). As for the Spanish version of Sexposer, the Portail is currently seeking funding to be able to develop this newest version of their app.
For a small organization with a limited budget, the Portail was able to draw from its openness to innovation and collaboration to develop a very interesting and successful mobile app.
Sexposer has been downloaded more than 4000 times since 2013 (on iOS and Android)
INTERESTING FACTS:
- In addition to Sexposer, the Portail relies heavily on its web and social media presence to share information. They have a Facebook page, a Twitter account and a Vimeo account to share videos. People can reach them by email, phone, SMS and online chat, a service that they offer for several hours every week. In the last three years, they have started using SurveyMonkey for all their data collection and analysis.
- In general, social media platforms tend to be modest. This can be challenging for an organization that works in sexual health. When they first developed Sexposer, Apple did not allow the app to be available to anyone under 17 (even though it had been developed for an audience of 14 to 25 year olds). The organization requested a re-evaluation and was able to lower the access age to 14. A few days before the launch of the app, the background image was censored because it featured a pubic area (with hair). They eventually modified the image but had to launch the app without a background illustration. Some of their Facebook ads have a also been censored, a challenge also met in the development of the Yukon Condom Fairy campaign.
- The Portail takes the safety and wellbeing of its service users very seriously. Sexposer reminds its users that the app is not a substitute for going to see a health-care professional in person to undergo a risk evaluation and STBBI testing. The staff do not collect any information that could identify or in any way compromise the individuals that they interact with, and they always differentiate between services that are anonymous (where the identity of the person is not known) or confidential (where the identify of the person is not shared). Incidentally, the organization recently changed its platform for the SMS service to guarantee the anonymity of its users.
OF NOTE:
On September 13 2016, Apple launched iOS10, its latest operating system. An exciting moment for technogeeks in search of fast and more dynamic platforms, for a community-based organization like the Portail, this technological development represents yet another important, and expensive, hurdle. With several versions of Sexposer under its belt, the Portail has decided to abstain from updating the application for iOS10, as this costly process would likely have to be repeated upon the launch of the next operating system. For non-profit organizations, programmed obsolescence can be particularly challenging. Here is the message that they shared about this situation:
The Sexposer application is unfortunately experiencing compatibility issues with iOS10 for Apple products. We are sincerely sorry for this inconvenience and are working to find a viable solution. Thank you for your understanding. Unless otherwise noted, the app remains available and functional on Android devices. To ask any question about sex or relationships in English, you can also text SextEd at 514-700-4411 to get an answer within 24 hours!