In Development

Open up access to interventions that support ageless sexual health.


Sexual health is a fundamental aspect of well-being and quality of life, both at individual and relational levels. However, several factors can affect this, and they can become obstacles and affect this fullness. Age and some chronic diseases, such as cardiovascular episodes or cancer, can often affect intimate and sexual lives.

Sexual health is still taboo, which can make it difficult to ask for help or support. Especially with age, the risks of experiencing sexual problems increase. Many people who need help or support do not seek it or do not know how to get it. Specialised support for this is limited, and the treatment of sexual health is often neglected or treated medically. While it is challenging to highlight the sexual health of seniors, it is essential for a good quality of life.


Fraunhofer AICOS Portugal, KBO-PCOB Senior Citizens Association, SexLab, Instahelp


Adults 55+


Anathema, the first smartphone delivered sexual health promotion programme that seeks to adapt traditional face-to-face interventions.


Increases patients' adherence and extends the number of people who can access highly usable, engaging, and non-stigmatising sexual health support through the benefits of mobile devices and interaction design.


How to overcome barriers experienced by older adults and people with chronic diseases who need sexual health support but currently don’t have it?

Anathema’s main challenge is to adapt traditional face-to-face sexual health promotion interventions to be delivered through mobile devices, tailoring them for older adults, including those with chronic diseases (and their partners), and to make them highly usable, engaging, and non-stigmatising so that users adhere to the intervention and potentially experience its benefits.


To address the challenge and guarantee that Anathema reaches sustainable business models, project partners are doing the following: – Joining complementary research on human-computer interaction with sexology; – Joining complementary online psychology services with interaction design; – Intensely involving three primary user groups: 1) Older adults (community setting); 2) Colorectal cancer survivors (clinical and community settings); 3) Stroke survivors (community setting).

The internet is not perceived to be a totally safe medium to receive sexual help. The idea of an app for sexual health support is only considered a bad idea for 12%. Being able to find reliable sexual health information and reaching a specialist in this field are highly ranked. Despite this, around 60% say they would not use an app for sexual health. Source: Questionnaire results (1.119 older adults), KBO-PCOB

Despite evidence of the efficacy and cost-effectiveness of internet-delivered interventions for several psychiatric and somatic conditions, literature focusing on sexual health online interventions is scarce. Most studies addressing such programmes focus on male and female sexual dysfunctions, and only a few target sexual difficulties related to chronic conditions. Cancer is the most frequently researched condition, with studies including gynaecologic, breast, prostate, and colorectal cancer patients. To the best of our knowledge, no studies yet assessed the efficacy of internet-delivered interventions to promote sexual health in stroke survivors or older adults.

Nevertheless – professionally guided-online sexual rehabilitation programmes were identified as highly consensual in a recent Delphi study involving stroke survivors, their partners, clinicians, and researchers. Evidence suggests that internet-delivered sex therapy effectively improves psychosexual outcomes in chronic patients. However, access to such programmes relies heavily on the delivery method, and the involvement of end-users in the design process is critical to ensure acceptance, adoption, and adherence.

A recent systematic review on mHealth interventions for sexual health among adults with chronic diseases reported no studies with interventions delivered through smartphones. All analysed studies used a website for intervention delivery, failing to leverage mobile devices’ advantages in this context, namely, “convenience, privacy, anonymity and more interactive treatment for sexual dysfunction”. Additionally, only one study adopted a Participatory Design approach. Thus, conducting Participatory Design implementation research to develop evidence-based smartphone-delivered sexual health interventions, such as Anathema, is crucial to overcome barriers to treatment-seeking and improve older adults and chronic patients’ Quality of Life (QoL).

At this stage in our workflow process, in close collaboration with our partners, we have discovered and defined issues and opportunities through stakeholder workshops, business model design, qualitative and quantitative user research, user- and stakeholder interviews, personas and user goals, competitor analysis and benchmarking, data inventory and technology exploration.


Speculating about how to scale up sexual health interventions.

Older adults, colorectal cancer survivors, stroke survivors, psychologists and sexologists, and managers of care and clinical institutions will be involved throughout the project, using a Participatory Design approach, which has led project partners to adopt an In-Action Ethics framework.

This way of working has three main implications: 1) co-creating the solution with main stakeholders; 2) the need to be open and prepared to work with plan changes, as close contact in co-design with end-users often causes priority shifts, which need to be made to reach a product that is accepted, adopted and used; 3) the need to go beyond normative ethics practices and to engage in continuous ethical discussions.

This co-creation will culminate in two waves of pilot studies, corresponding to two full-cycle intervention programmes to measure technology usability and acceptance, measure the efficacy of the intervention in promoting positive sexual health and test business models.

Interaction design, applied to Internet-connected smartphones, is the perfect tool to engage User eXperiences (UX) which can increase adherence to the intervention.

Interaction design for sexual health: In the scientific field of Human-Computer Interaction (HCI), designing for human experience, wellness or embodiment has become part of what is known as the Third-Wave HCI, which also includes a new set of studies and technology experiments on human intimacy. More recently, the field has come to reflect on sexuality and older age. However, while there are studies on design principles to address sexuality for adolescents, there are no similar studies for senior users. Anathema will seek to address the gap with technology for sexual health designed with and for older adults and people with chronic conditions.

Despite the shortcomings in HCI, we consider past work that can provide some guidance to begin our interaction design work. First, design/interaction principles are useful with other user groups, which might apply to Anathema. For example, in prior work with adolescents or with adult women, humour is used to address taboo issues as a way to engage users with the technology and create comfort in addressing otherwise embarrassing topics. Serious games are also used to assist with education. Another technique is the embodiment of interaction by reflecting/externalising parts of the human body, or emotions, in a screen or wearable so that users can deal with their bodies and emotions through new eyes. Secondly, research on Design & Emotion provides frameworks to design products that are appealing to users. An example is Jordan’s typology of pleasure with products: physio (delight of the human senses); psycho (positive emotions from cognitive processes, e.g. mastering a skill); socio (how a product influences sense of self); and ideo (product’s relation to one’s moral values). Looking specifically at product meaning, Schifferstein and Zwartkruis-Pelgrim have identified four facets relevant to person-product attachment: enjoyment, individual autonomy, group affiliation and life vision. Another example is Desmet and Hekkert’s categorisation of product experience in three types: aesthetic experience, the experience of meaning and emotional experience, followed by strategies to elicit such experiences. We note that enabling memory association with products facilitates attachment, as are surprise factors designed into the product. Another relevant point of view is that the consumer market has seen a shift in sex-related technologies towards luxury experiences with design concerns akin to other types of consumer products in terms of experience, quality of materials and interactions, and elegance of product image. An important part of Anathema will be the exploration of smartphone-smartphone interaction for couples engaged in the intervention.

Given the wide variety of expected abilities in the user groups (older adults, colorectal cancer survivors and stroke survivors), Anathema will follow an Inclusive Design approach. Inclusive Design aims at including the widest possible range of users, regardless of age, abilities, body stature or culture. Therefore, we will invest in redundancy in interaction using multimodality beyond bringing users themselves to co-design the solution. So, for instance, if a user struggles to read written information, they will have the option to have it in audio.

At this stage in our workflow process, we iterate through ideation sessions with end-users, creative strategy and positioning, concept design and visualisation, data analysis and storytelling, scenario and storyboard creation, (rapid) prototyping, data engineering, concept testing, and roadmap strategy.

Through iterative prototyping and testing in the pilot trials, we evaluate feasibility and intervention effectiveness. When evaluating user engagement, we will apply the Google H.E.A.R.T. framework, which will provide evidence on end-users Happiness, Engagement, Adoption, Retention and Task Success. This assessment is made through a tool for remote monitoring of smartphone and app use.


Anathema will include smartphone apps, a desktop app for psychologists to tailor interventions, a repository for the intervention modules and a tool for remote monitoring of technology used to track Anathema use during the pilot studies.

The final challenge is to get primary users in touch with sexual health counselling. Therefore, Anathema is building on an existing psychology/sexology service platform that can integrate with the smartphone app to extend service to include specific support for our primary user groups. This service, in turn, is activating its ecosystem to reach as many primary users as possible within and beyond the project duration. Finally, because users and their needs are very different, Anathema’s sexual health intervention consists of modules that can be combined depending on the person’s specific needs – from a business point of view, this modularity eases the product’s scalability to reach other user groups.

At this stage in our workflow process, we iterate through UI/UX design, front-end development, software development, app development, technical design, API specifications, and DevOps.

A delightful user experience is key to ensure the success of mHealth apps. Knowing SPRIGS’ portfolio, we asked them to join Anathema in order to design a mobile application that would engage users and encourage adherence to a sexual health promotion program. Accomplishing this will ensure positive health outcomes among users and enable the successful commercialization of the app. Ana Correia de Barros, Head of Human-Centred Design at Fraunhofer Portugal AICOS

The project started in April 2021 and will last for 24 months. During this period, pilot studies are planned – to be developed in Portugal, Austria, and the Netherlands – that will allow to evaluate and measure the usability and acceptance of the technology, the effectiveness of the program in promoting positive sexual health, as well as test business models and analyse the feasibility of transferring this solution to the market.