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Dr. Walter Bierbauer

Why did we contact them?

We reached out to Dr. Bierbauer, a health psychologist at the University of Zurich, to gain insights into the psychological dimension of our self-test. Specifically, we wanted to understand the motivations behind testing behavior, how such behavior can be maintained over time, and how test results should be communicated to ensure effectiveness while minimizing stigma and anxiety.

Stakeholder Name
Dr. Walter Bierbauer

Discussion

Barriers and Motivators for Testing

Dr. Bierbauer emphasized that motivation or intention alone is not sufficient to ensure regular testing. Referring to the Health Action Process Approach (HAPA), he explained that motivation must be paired with concrete action and coping planning. “It is not enough to want to test,” he noted. “You need specific plans - when and where to do it, and what will remind you to repeat it.” Already considering the development of a full product and its economic viability, he suggested that a subscription model could help users maintain consistent testing habits.

Figure explaining the HAPA model
Figure explaining the HAPA model [1]

He also warned against relying too heavily on risk perception, such as fear-inducing images of infections or shocking statistics about cancer probabilities, as this would not be very effective. Instead, strategies that boost self-efficacy and highlight positive outcomes are far more effective. For instance, knowing that “if you test every three months, you are much less likely to have an asymptomatic STI that persists” reinforces the behavior.

Education, he stressed, is central to promoting regular testing and reducing stigma. He argued that testing should be normalized as a routine practice for sexually active individuals, and it should be made clear that this is a screening tool, not a definitive diagnostic test.

Practical Recommendations for Test Implementation

Dr. Bierbauer underlined the importance of simplicity, a key driver of self-efficacy. He argued that if the test looks easy, people believe they can do it. He recommended that digital support - through a website and later perhaps an app - should complement the instruction leaflet. According to him, users need step-by-step video guides, pictograms, FAQs, troubleshooting help, and reminders to remove any uncertainty. He particularly stressed the importance of videos, noting that many users struggle to understand or follow written instructions

He argued strongly for clear, accessible language. He noted that many people struggle with percentages, so concepts like sensitivity and specificity can be confusing. Instead, he recommended visual representations or plain-language explanations, such as: “In 1,000 people without the disease, 50 may still get a positive result.” Such formats make the numbers more intuitive and easier to grasp.

Framing Results and Next Steps

A key challenge, Dr. Bierbauer pointed out, is ensuring that people act on their results. health psychologist, I see aftercare as at least as important as the testing itself,” he said. “People often assume that once a patient gets a diagnosis, they will automatically do the right thing. But they don’t. Not even when facing life-threatening diagnoses.”

To explain this, he referred to the Common-Sense Model of Self-Regulation, which describes how people’s actions depend on their subjective interpretation of the situation. He explained that patients construct subjective illness beliefs—about what the illness is, why they got it, how long it will last, what consequences it has, and whether it can be controlled. These beliefs then shape their emotional and behavioral responses.

Dr. Bierbauer introduced the Common-Sense Model of Self-Regulation (Leventhal), which explains how people interpret and respond to a diagnosis. He explained it in detail as follows.

The model, explained

The Common-Sense Model of Self-Regulation (Leventhal) describes how people respond to health threats by trying to understand and manage them. It suggests that individuals act as ‘common-sense scientist’ forming mental representations of their illness. These subjective illness beliefs are crucial in shaping their subsequent behavior.

These illness representations can be divided into five (sometimes more) dimensions:

Identity: What is it?

This refers to the label a person assigns to the illness and the symptoms they associate with it. For STIs, this is often challenging, as many infections are initially asymptomatic. Identity may then simply be the “diagnosis label” (e.g.,“I have chlamydia”). The person might ask: “What does this name mean? Am I now ‘sick’?”

Cause: Why did I get it?

The person looks for a cause. In the context of STIs, this is emotional and often tied to guilt and shame. Possible attributions include: “I was careless,” “My partner cheated on me,” or “This is a punishment for my behavior.” These causal beliefs shape both emotional and behavioral responses.

Timeline: How long will it last?

This is the perceived duration of the illness:

  • Acute: “I’ll take a week of antibiotics and then it will be gone” (e.g.,chlamydia, gonorrhea). Some may believe it will resolve on its own.
  • Chronic: “I will have this for the rest of my life” (e.g., HIV, herpes).
  • Cyclical:“It will come and go repeatedly” (e.g., herpes).

Perceived timeline strongly influences hope and future planning.

Consequences: What impact will it have?

This involves imagining the illness’s effects on one’s life—physically, socially, psychologically, and economically. Examples: “I might become infertile,” “I’ll never find a partner again,” “I have to tell my partner and they’ll leave me,” “I’ll be judged by others” For STIs, fear of social consequences (stigma) often outweighs fear of medical effects.

Control / Cure: What can be done about it?

This reflects beliefs about whether the illness can be cured or at least managed. STI testing should be presented as a tool to regain control (“Take it into your own hands”). Questions include: “Is there a pill that solves this problem?” or “Do I need lifelong medication and precautions?” A sense of control (through screening or later effective treatment) is central to reducing anxiety and supporting psychological adaptation.

How the model explains behavior

Based on these five dimensions and associated emotional responses (fear, anger, shame), a person develops coping strategies. Examples:

  • If someone believes the STI is curable and consequences are minor (high control, low consequences), they are likely to see a doctor promptly (problem-focused coping).
  • If someone believes the consequences are catastrophic (social exclusion) and the cause is personal failure (high consequences, internal-stable cause), they may deny the diagnosis or withdraw (avoidant coping).

Conclusion

The Common-Sense Model shows that responding to a diagnosis is an active, cognitive process—not merely an emotional shock. For this project, communication around test results should address these five dimensions. Clear, simple, and reassuring information about identity, cause (destigmatized), timeline, consequences (realistic, not catastrophic), and control equips users with the knowledge to form accurate illness representations and promotes constructive coping strategies.

He also insisted on unambiguous next-step instructions for all outcomes—positive, negative, or invalid. After a positive result, users must be empowered and guided toward medical consultation. Even after a negative result, reminders for re-testing should be provided. While he said that a counseling hotline would be ideal, he acknowledged that it is financially challenging. Therefore, having a comprehensive website becomes crucial: because many people prefer to gather information before visiting a doctor - and value the anonymity this provides - it is essential that the website offers detailed and reliable aftercare information.

Design and Trust

Dr. Bierbauer underlined that anonymity and discretion are vital, particularly for younger people who may avoid pharmacies. He argued that stigma is less of an issue for home testing but still needs to be addressed through neutral, non-judgmental educational material. He stressed the role of transparency in building trust: providing clear information on sensitivity, specificity, certificates, and expert endorsements makes the test appear professional and credible while increasing user confidence. He warned against overly commercial marketing, arguing for a professional medical appearance. Testimonials or public endorsements, he added, could also help normalize testing.

Main Takeaways

  • Motivation alone does not lead to consistent testing; action and coping planning are essential (HAPA model).
  • Regular testing should be framed as a routine practice, emphasizing self-efficacy and positive outcomes rather than fear.
  • Test instructions must be simple and accessible; digital support (videos, pictograms, FAQs, reminders) strengthens usability.
  • Result communication should offer unambiguous guidance and support constructive coping (Common-Sense Model).
  • Transparency, professionalism, and credible information (specificity, sensitivity, certificates) foster trust.
  • Anonymity and discretion reduce stigma, especially among younger users.

Unanticipated Insights

Dr. Bierbauer emphasized that aftercare is just as important as the test itself. People do not automatically act on results, even in the face of serious diagnoses.

Integration

His input guided us in designing our test and communication strategy around psychological models. We implemented this by:

  • Creating our “product” page with comprehensive guidelines and information about every STI, with particular attention to aftercare and clear instructions on next steps.
  • Structuring the page according to the HAPA model and the Common-Sense Model, to encourage constructive coping and self-efficacy.
  • Adding myth vs. fact boxes to fight stigma and sharing them on social media.
  • Designing the wiki visuals to reflect clarity, accessibility, and user-friendliness.
  • Considering a subscription model for Entrepreneurship

References

  1. Schwarzer R. Modeling Health Behavior Change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology [Internet]. 2008 Jan 1;57(1):1–29. Available from: https://doi.org/10.1111/j.1464-0597.2007.00325.x.
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