Scroll towards the bottom of the About page on the TBD Health website and you’ll notice a few testimonials from customers. One reviewer said in part “I wish this service had existed years ago.” It doesn’t take an astrophysicist to glean at least some of the inference in that statement.
To wit, technology made TBD Health possible. Never before in human history could a person sit in front of a screen and, with just a few clicks, have something historically available only at hospitals and clinics shipped directly to their doorstep. Using the internet like this is not merely convenient; it’s accessibility too. Considered in these terms, shopping online suddenly becomes more a profound value proposition than sheer frivolous amenity. Especially when it comes to putting better effort into monitoring one’s health and wellness, TBD Health’s accessibility story becomes all the more apparent–and important.
On its website, the sexual wellness company states their intent loud and clear: TBD Health was founded to help people “live, thrive, and have great sex.” The startup specializes in providing at-home testing kits for sexually transmitted diseases. The Las Vegas-homed TBD Health was founded by two young women, alongside a third co-founder, after what the website describes as “lots of not-so-great experiences with our gynecologists.” Their conceit was to reimagine this part of the healthcare experience; the trio aspired to deliver a product that would “reduce all the stigma, anxiety, and inaccessibility” that are typically associated with STD screening. “We feel that, especially during this time when the rights of women and people with vaginas are being attacked, it is crucial for us to build a sex-positive healthcare company that makes it easy to prioritize your sexual health,” the company wrote of its mission.
In addition to its online service, TBD Health runs a physical clinic in Las Vegas wherein people can get testing, ask questions, and more.
Of course, the technological aspect of TBD Health is the easy part. As has been established, the fact people can order these over the internet and have them delivered directly to doorsteps everywhere is nothing short of a revelation. This can be especially true for people in the disability community, who, again, may not be able to venture out to a brick-and-mortar clinic for testing due to mobility or logistics or other condition. It’s the second half of the equation that’s the hard part. For everything TBD Health is trying to achieve in promoting good sexual health, their tests are only beneficial if someone can literally take the test. For a person with disabilities, success is almost always not guaranteed.
In an interview with me conducted earlier this week via videoconference, TBD Health co-founder Daphne Chen explained to me the crux of the matter lies in the company’s focus on what’s known as dried blood spot testing, whereby a finger is punctured with a lancet and a drop of blood is placed on a small piece of filter paper for testing. (This is the method used commonly for blood-sugar testing in diabetes patients.) According to Chen, pricking one’s finger is precisely the problem from an accessibility perspective. The fact of the matter is, not everyone has the visual acuity and fine-motor skills to perform the testing safely and accurately. Chen told me the team went through about “30 different design iterations” during development before landing on something she described as “fairly intuitive.” She reiterated the company’s ethos of making sexual health easier and more approachable for everyone, telling me accessibility is “really at the core” of everything TBD Health does.
As with accessibility in computer software, the work here is evergreen.
“I will be the first to say there’s more that we can do,” Chen said in recognizing where TBD Health can improve. “There’s a lot that we can improve upon. Any feedback we get is incredibly useful for how we think about the product [and] how we think about the end-patient experience. I think the short answer is [accessibility is] always top of mind for us.”
Chen said the team at TBD Health has been working closely with Alana Schreiber, a Seattle mom who has become an influencer on platforms like TikTok and Instagram as she chronicles her struggle with gastroparesis. Chen said Schreiber provided a lot of feedback on the STD kits, particularly in light of people who have chronic illness or are disabled. One of the “most eye-opening” things Chen and team heard from Schreiber is many doctors operate under the presumption that chronically ill and/or disabled people aren’t having sex. Chen added the whole healthcare complex in this country is predicated on such biases, which TBD Health is trying to counteract by advocating sexual wellness.
If the concept of inaccessible test kits sounds familiar, it should. About a year ago, I wrote about the Biden administration making accessible Covid tests available to Blind and low vision Americans. As I mention in the story, there was a lot to unpack about the news, but suffice it to say what constitutes accessibility for the White House left me dubious. Nonetheless, that these purportedly “accessible” tests existed at all is recognition that, like with TBD Health’s STD kits, not everyone is physically able to negotiate them as designed. In fact, Chen said the FDA-approved form factors that her company uses for its tests “presumes a specific physical ability that does seem incredibly problematic for a lot of populations.” What’s true for STD kits is true of Covid tests: just because it’s a DIY operation, shipped direct and doable from the comfort of your own home, doesn’t mean it’s accessible.
In other words, there’s accessibility in being able to procure either test in the first place. Actually taking the test properly is a whole other level that, Chen noted, expects a level of competency not equal in everybody.
When asked about feedback, Chen told me the response from customers has been positive. What TBD Health is doing makes good on the promise of digital health; it’s “able to reach everybody with an internet connection,” she said. People are increasingly becoming more aware of healthcare systems that are readily available online, with Chen saying they’re “thrilled at the prospect of being able to manage their own health care on their own terms.” Moreover, the ubiquity of the internet makes it such that people don’t need to take time off to attend doctor’s appointments. Not to mention the proliferation of what Chen called “healthcare deserts” across the country where, as with food deserts with limited access to grocery stores, it’s nigh impossible to find a provider.
“When we work with patients who might be experiencing one or a combination of those factors, the response is always, ‘Oh, this is amazing! Why didn’t I know about this before?!.’ Chen said of customers’ appreciation for her company. “It’s been really gratifying for us as a team to be knowing that we can support people like that.”
Looking towards the future, Chen said her ultimate desire is to see user-centric healthcare “become the expectation and the norm.” More pointedly, it’s her hope that companies start leveraging technology in an effort to build more experiences that are truly conducive to a person’s needs and tolerances. In sum, make healthcare easier to use and more inclusive. Chen conceded these sound like lofty goals at first blush, but she’s a believer in there being a “way forward in making things better if we can continue to prioritize listening to patients.” For TBD Health specifically, one of Chen’s goals is to push onward with dismantling the stigmas around sexual health. She cited a statistic in which 71% of primary care physicians are uncomfortable discussing sexual matters with their patients. “I would love to see that change. A big part of our mission is to de-stigmatize sex and sexual health care,” Chen said.
Reimagining healthcare is, like accessibility, a never-ending battle.
“There are a lot of structural things that need to change in order for that to happen,” Chen said. “I think fighting the good fight is important within startups [and] within the government and new legislation.”
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