New research article explains the history of human-centered design, and why it matters for health equity

isaacholeman · October 23, 2019, 12:18am

TLDR: new research paper on human-centered design for health equity. Great insights! It’s open access; download the paper for free here.

I was first exposed to human-centered design in 2009, in the early years of Medic Mobile’s work in Malawi. At the time I was living out of a suitcase, traveling from health system to health system designing and implementing digital health projects. I had some training in qualitative research methods and great enthusiasm for tinkering, but I lacked any proper formal training in design or engineering. It was hard work and I encountered many surprising setbacks and challenges. I learned through practical experience that these complexities are an unavoidable part of the digital health process, and I learned to appreciate human-centered design as a way of grasping and responding to these complexities.

IDEO’s human-centered design toolkit and a few other practitioner resources proved enormously helpful, and yet after a couple years I also started to feel like I had reached a limit. These guides typically didn’t cite other sources or provide much of a pathway for how to dig deeper. And this was becoming a problem, because while I and the team at Medic Mobile were investing in human-centered design and finding great value in it, we were also seeing it become a buzzword. As with any buzzword that soars too quickly in popularity, we started to see sloppiness, and the tendency to talk about design just to impress funders, rather than to start a conversation about how we might better accompany patients, health workers, and other partners in a digital health journey.

I wanted to dig deeper and answer what I thought should be a relatively simple question: where does human-centered design come from, and how might it matter for global health equity? Before long, my interest in the question had turned into something of a personal quest, and I enrolled in graduate studies at the University of Cambridge to pursue this question with greater focus and academic support. I completed my thesis in 2017 and finally, just a few weeks ago, published a paper that presents what I learned. This paper was many years in the making, and I’m super excited to share it with this community. It’s titled Human-Centered Design for Global Health Equity, and it’s open access so you can download it for free.

Throughout the process I worked with Dianna Kane, who led Medic’s design team for the last seven years. I conducted a deep and wide-ranging literature review—this paper synthesis insights from 128 sources. And I worked with Dianna and our wider community to gather reflections on our shared experience with human-centered design. The literature review and reflections on a decade of design work in and around the Community Health Toolkit offer a degree of depth and nuance that I can’t boil down into a few bullet points. That said, if a research paper isn’t your speed or you can’t find the time, here are four key points:

Human-centered design is an approach to innovation that puts people at the center of activity, prioritizing their needs and concrete experiences in the design of complex systems. Great design work involves certain skill sets, mindsets, and a robust innovation process. It’s not only for building technologies or solving technical problems; it’s a way of making sense of complex challenges and designing a better world for and with people.
Design approaches differ from conventional global health research and innovation methods in two very important ways: an emphasis craft skills, and iterative methods that reframe the relationship between design and implementation.
There’s ongoing debate about what the ‘human’ part means, but three themes come up again and again: stakeholder participation or co-design, augmenting human skills rather than using tech to replace or control people, and attention to human values in practice. By values in practice I mean that many HCD studies investigate the dark side of tech projects gone awry—so HCD isn’t just about having good intentions, it’s about iterating to adapt to people’s ongoing needs over time.
At Medic Mobile, we like to describe HCD as a way of accompanying people in a digital health journey. As we put it in the paper:

To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end. While the term accompaniment is somewhat elastic, it is also clearly different than a paid consultancy, a one-off project or a short-term visit. Accompaniment typically implies staying the course until the person or people being accompanied consider the journey completed. As designers with niche expertise in digital technology, accompanying a community in their struggle for health equity affords us an active role in an ongoing process of social change. It highlights the quality of our relationships with community members, without taking for granted that everyone will share fully in our motives and optimism, or be able participate on equal footing.

We finish the paper by arguing that design matters for global health equity, and also that equity in global health matters for human-centered design. For anyone who is new to human-centered design, especially if you have more of a health background, I think this paper is a good intro. We tried to convey that human-centered design has a long and complex history, and that there’s a large and vibrant design research community that continues to push this practice in new directions. For our part, we’re still learning how to foster a more human-centered design practice, and we’re trying to learn in an open way alongside this community. So if you have a chance to read the paper or just want to share your responses to the points I’ve summarized here, I’d love to hear from you.

The full citation:
Holeman, I. & Kane, D. (2019) Human-Centered Design for Global Health Equity. Information Technology for Development, DOI: 10.1080/02681102.2019.1667289

isaacholeman · October 23, 2019, 12:22am

@mballard Do you think this paper would be a good fit for an upcoming Community Health Research Roundup? It’s not focused on community health workers, but the empirical examples in Section 5 all involve community health programs, and earlier parts of the paper discuss these ongoing design efforts in terms of how they matter for the Community Health Toolkit.

bernard · October 23, 2019, 8:28am

I enjoyed reading this paper. It does help appreciate the human-centered design approach at Medic and especially as regards iterating on the initial understanding of a context. The perceived simplistic nature of an intervention seeking to validate an understanding can often seem “too simple” and not “complex enough” especially if coming from a highly technical background and almost always does not translate to a simple design process.

I have a couple of highlights from this paper but these two stand out for me, one of which @isaacholeman highlights above:

to paraphrase “human-centered design is to accompany the user in the actual meaning of the word and much more!”;

and secondly,

" … the process of making is typically complex, because the designer’s moves often have intended and unintended consequences. The direction of a design project emerges in practice, because the designer cannot fully predict or control how the materials will respond to her initial attempts to shape them."

markherringer · November 16, 2020, 3:06pm

Hello @isaacholeman

Thank you for sharing this research. Human-centered design for global health equity is what’s needed. We are all in position to share user stories based on our experience and what we feel is needed.

Do you think people could share these types of stories? I’m interested in exploring the potential to develop a localized application that could collect and prioritize these stories.

As a pregnant mom preparing for birth I would like to visit a facility with an ultrasound so that I can give my baby the best care possible.
As a pregnant mom I would like to know if a facility has a well staffed operating theatre should I need a C-section.

We’re building a baseline of health facility data in OpenStreetMap. Deciding how and what to gather for such a global dataset is a challenge. There are many stakeholders and many aspects of a given facility that could be collected. Healthsites is embarking on this with a user centered design approach. Our goal is to build a platform that collates data that is relevant to the questions that healthcare facility users need answered.

We are driving the development of the data with priority user stories.

Here is the method we’re working with to identify the OSM attributes.

I’d appreciate the opportunity to refine these stories with this group of health experts.

isaacholeman · November 19, 2020, 10:47pm

Hey @markherringer, it’s great to hear that you’re approaching the health sites design work with this kind of human-centered approach. And thanks for sharing it with the community here, I hadn’t seen that blog post before and I really like the focus on user stories.

I think people love sharing user stories when they have to do with a service or opportunity that they care about. Figuring out the right method mix can be challenging though. For me, qualitative methods are always the starting point - interview people, shadow them at work, do focus groups. It’s harder to do this during covid, and in one of my projects with the Medic and Living Goods teams we’ve been relying more on phone calls with households. It’s not the same as doing fieldwork in the community, but the feedback from the phone calls has also just been extremely helpful.

Designing in a user-centered way for the needs of lots of stakeholders when they have different and sometimes conflicting values and priorities - I think that’s kind of a timeless design challenge. There’s no sure way to address it, but in my experience openness to iteration is the most important principle, which is great because constantly iteratively improving is also fairly intuitive and it’s clear that you’re already doing that in the Health Sites work. Being strategic about how you pick your first field sites and design partners is also important when you’re trying to build with global relevance, and I’ve found it helpful to think about outliers. For example if you want it to work across the African Continent, make sure that some of your design work happens in really remote and hard to reach communities, not only in urban centers like Nairobi or Lagos. That may sound obvious but it can be hard to prioritize when fieldwork sites may be more expensive, slower, less convenient to work with, so I always find it helpful to be explicit about how designing with hard-to-reach communities is part of the strategy to make the design work scale.

Anyway, just a few initial thoughts! In the early months of covid my schedule was so slammed that i didn’t have as much time as I would’ve wanted to engage with the health sites work, but I’ve been talking about it with @lucas about it. If we can find opportunities to make use of what you’re doing and provide feedback on your user stories and design process, that would be awesome. In the meantime keep up the cool work!