This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy.
The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people.
In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team.
Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point.
This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues.
Young people’s increasing access to free web-based pornography has led to concerns over its impact on their attitudes and behavior [
Pornography is not homogenous, nor are its audiences [
Despite the evidence of the impacts of pornography on young people being underdeveloped, interventions to reduce its potential harms are being funded and produced [
Importantly, current literature is inconclusive about the effectiveness of pornography literacy to reduce pornography-related harms among young people [
Human-centered design and design thinking approaches involve prioritizing users throughout the creation of a product or service rather than at the start or end [
Despite the seemingly obvious alignment of design and health disciplines, recognized challenges for cross-disciplinary collaboration exist [
This study aimed to co-design a relevant, usable, and acceptable digital prototype to improve pornography literacy among vulnerable young people. The project involved a cross-disciplinary co-design, including vulnerable young people, service providers, public health researchers, design researchers, user interface designers, and web developers.
A total of 17 young people aged between 14 and 23 years participated in the multiphase co-design workshops. The participants included 5 young women, 1 gender nonbinary person, and 11 young men.
Young people were eligible if they were currently engaged with one of our partner youth service providers, were aged 14 to 24 years, and had experiences or identified with of at least one of the following: fragmented school attendance or disengagement from mainstream education (irregular attendance or participation in alternative curriculums such as vocational or applied learning); limited access to relevant education on sex, sexuality, and relationships (ie, for young people who identify as LGBTQI+); experience of family conflict or breakdown; and culturally and linguistically diverse (CALD) backgrounds.
We partnered with youth services, education providers, and primary health care providers to embed us in their existing programs for young people. This included youth groups and alternative education programs for young people disengaged from mainstream schools. A written information and consent form was developed and was accompanied by a short video to facilitate information and consent for people with low literacy skills. Project information was housed on a website to ensure that community members and potential co-designers could access further information about the project or contact our team. Informed consent was obtained from participants aged 16 years and older. For participants aged 15 years, we followed consenting practices for mature minors [
A total of 17 young people participated in the co-design workshops, including 5 females, 1 gender nonbinary person, and 11 males. Participants ranged in age from 14 to 23 years (mean 16.5 years). Furthermore, 6 participants were from CALD backgrounds (English as a second language), 5 identified as LGBTQI+, and 2 were living with an intellectual disability. Over one-third of our sample was disengaged from mainstream schooling and had experiences of fragmented education. A similar proportion had experiences of family conflict or breakdown.
We conducted a total of 12 co-design workshops across 3 groups. Workshops were designed across 4 phases adapted from design thinking [
The first workshop focused on introducing the process, building trust and rapport, creating shared boundaries and safety, and beginning the process of getting to know our users and their information preferences. Activities were designed to create opportunities even during the introduction and icebreakers to understand more about our user’s lives, aspirations, motivations, and challenges to help us walk in their shoes. The second workshop focused on creating opportunities for our participants to reflect on their thoughts, feelings, and experiences of sex, relationships, and pornography and to enable them to define key issues or problems, hence identifying information needs. We were conscious of creating space for participants to speak openly, using their own language about issues they may feel unsafe or embarrassed to talk about in the workshop setting. We designed activities that could be fully engaged with either anonymously or in the third person. The aim of the third workshop was to review young participants’ definition of the problem and position our participants as
During activity design, we considered our participants’ interests, abilities, and challenges and, our design practices. Activities prioritized creativity, shared understanding, empathy, and safety. In the first workshop, participants created personas of other young people that could be used for third-person discussions to avoid over disclosure. Across the workshops, each activity was built on the topics and outcomes from previous activities. This allowed participants to work into this complex issue and to increase trust and engagement as the activities progressed. Activities were generative to create spaces for participants to embrace creativity and to reflect on the issues [
Hot or Not? Collage.
Data generated from activities included (1) the products of these activities that were considered
An iterative human-centered design data synthesis using
Human-centered design practices guided our process for bringing together the needs and wants of our users with best practice in accessible design and health promotion. The multidisciplinary team of designers and researchers were involved in the final stages of the synthesis and then participated in a process called Design Sprints. The process included ideating solutions based on user personas (available on request), on participants’ design solutions created during co-design workshops, and on the response to the information needs and preferences of each user persona. Multiple rounds of ideation and design took place before a set of design recommendations for the prototype was developed. On the basis of the feedback from participants, key stakeholders, and external subject matter experts, these recommendations were developed into a functioning digital prototype of the solution for testing and evaluation (to take place in an independent study).
A summary of key design considerations (
Participants defined pornography as
In contrast to these claims, young men created scenarios in which watching pornography did impact their behavior. For instance, a pair of participants created a stop-motion Lego movie illustrating how a character watched pornography and, after viewing anal sex, decides to try it with his girlfriend who is uncertain about it (
Porn world vs. real world activity creation.
Stop motion movie scene and storyboard activity creation.
Activities revealed that our users lacked information and skills to be able to contrast problematic messages from pornography with alternative ways of thinking or behaving. For instance, although participants could identify that representations of pleasure and consent in pornography were limited, there was little consensus among the groups about how to make sex pleasurable for all people and what constitutes consent or ethical sexual practices. This was particularly problematic for LGBTQI+ young people who experienced even less access to relevant representations of sex and sexuality outside of porn. Specific information gaps identified across groups included pleasurable sex positions, sexual pleasure for young women and trans young people, sexual pressure, consent, safe sex, and healthy relationships. Without alternative information and frameworks to guide their decision making and preferences, our participants were concerned with their ability to navigate both the “basics” and the “grey” areas of sex and relationships.
Furthermore, our users identified how messages from pornography can be compounded by messages they are exposed to in other domains. For young women in particular, problematic messages that they are exposed to in pornography are not always different from those in popular culture and society. For instance, some talked about the messages they are exposed to on Instagram about the ideal female body and sexuality. Some young men also articulated concerns about unhealthy behaviors they had seen modeled by family members such as a “drunk uncle” who makes people feel uncomfortable with his behavior. These insights highlight potential problems with creating a resource centered on pornography as an issue without addressing the information gaps and underlying social norms that permeate young people’s lives.
In general, our users were unlikely to proactively seek out information, especially about sex, relationships, and porn, unless prompted by experience or contradiction to preheld knowledge. Rather, they wait until they have a negative or confusing experience or until their beliefs are contradicted to
Participant’s experiences of trauma affected their engagement with these sensitive topics. Some who had experienced sexually related trauma found overtly sex-positive sex education content retraumatizing. Other participants specified finding visual and descriptive content about sexually transmitted infections and detailed real-life stories of sexual violence to be traumatizing. As stated by a young man who said:
You don’t want to see like diseased bodies (sic). It’s just gross. But at the same time, you want to know about what happens. It’s the same with like stories about sexual assault. I’m sorry but they are just hard to read sometimes.
Although there was an understanding of the need to be aware of behaviors and consequences, young people’s personal and online experiences of this educational content sometimes resulted in them withdrawing from engagement altogether. The sentiments demonstrated the fine balance between being direct and positive about sex without traumatizing or downplaying the sometimes negative experiences of sex among our users.
On the basis of the results described earlier, a high-fidelity digital prototype was designed by a cross-disciplinary team of researchers and designers. A digital prototype is a way of creating a working example of a product that is tangible enough that it can be tested with a larger population and further developed based on new learnings. The design processes leveraged the solution designs (
A digital wireframe of a solution concept created by a young co-designer during prototyping.
The Gist (
The Gist web-based mobile application prototype home screen.
The Gist content provides alternative information that our users want and are not getting from porn, society, or mainstream education; it aims to develop healthy ideas about relationships, sex, and bodies. Drawing on concepts underpinning ethical sex, as described by Carmody and Ovendon [
The Gist ‘Debunked’ activity to challenge pre-held knowledge and attitudes.
The Gist brand is designed with a bold typography in keeping with our audiences’ desire for alternative and nonmainstream products, and a
The Gist web-based app does not include commenting features or social media integration other than sharing a quiz or an article directly with someone. This reduces the capacity for young people to interact negatively with each other and reflects our co-design research and previous studies suggesting that young people are unlikely to actively share any content relating to sexual health on social media [
The Gist article structure utilizing progressive disclosure to increase user control.
The findings of our co-design workshops identify unmet sexual health and pornography literacy information needs among our users, their information-seeking patterns, and preferences for a digital resource. Through this process, we were able to develop The Gist prototype with young co-designers. The detailed and revealing nature of our findings suggests that using participatory research methods such as co-design can overcome sociocultural and structural barriers to engaging vulnerable young people in research on sensitive health issues. Some notable findings from this cross-disciplinary approach are discussed in the following sections in the context of current literature and directions for future research.
Most formal pornography literacy programs focus on the critical awareness of pornographic content and the industry [
Few resources exist that directly contrast information about sex with messages from pornography and society [
A large body of the literature has identified the information deficit that young people experience as a result of current education approaches that fail to adequately teach about pleasure, sexual discovery, or self-representation [
Research has illustrated limitations to traditional approaches to intervention design, which involve engagement with target users in research to inform content development by subject matter or technical experts rather than by engaging end users throughout the process as equal partners in design [
These findings should be considered within the context of study limitations. Co-design with
The study findings include important recommendations for the conceptualization of online pornography literacy programs and opportunities for cross-disciplinary research to address complex and emerging health issues. If pornography literacy programs focus on pornography without providing young people with alternative information about sex and relationships, they may not be effective in reducing harm. This study highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The cross-disciplinary approach reported in this study demonstrates that it is possible to collaboratively co-design a pornography literacy resource combining the needs and wants of vulnerable young people with best practice in design and health promotion.
culturally and linguistically diverse
lesbian, gay, bisexual, transsexual, queer, and intersex plus
user experience
The project was funded by the Victorian Health Promotion Foundation, Melbourne, Australia. Prototype content was developed with technical expertise from Jenny Walsh. Illustration and production were delivered in partnership with Cat Wall and Bonnie Eichelberger. AD was supported by the National Health and Medical Research Council postdoctoral scholarship. CW, ML, PD, and MH were supported by the National Health and Medical Research Council fellowships. The project was delivered with collaboration between the Burnet Institute and Sheda and in partnership with Stonnington Youth Services, Hester Hornbrook Academy, and Star Health. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute.
None declared.