Community Health Toolkit

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

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:

  1. 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.

  2. 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.

  3. 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.

  4. 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

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@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.

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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."

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