Communicating Risk for Obesity in Early Life: Engaging Parents Using Human-Centered Design Methodologies

ObjectiveHow we communicate about obesity is critical as treatment paradigms shift upstream. We previously identified parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. We engaged parents of children 0 to 24 months of age and pediatricians from Indianapolis, Indiana, USA in the co-design of messages and tools that can be used to facilitate parent/provider conversations about early life obesity prevention. MethodsFrom April to June 2021, we conducted a series of co-design workshops with parents of children ages 0 to 24 months and pediatricians to identify their preferences for communicating obesity prevention in the setting of a pediatric well visit. Human-centered design techniques, including affinity diagraming and model building, were used to inform key elements of a communication model and communication strategy messages. These elements were combined and refined to create prototype tools that were subsequently refined using stakeholder feedback. ResultsParent participants included 11 mothers and 2 fathers: 8 white, 4 black, and 1 Asian; median age 33 years with 38% reporting annual household incomes less than $50,000. Pediatricians included 7 female and 6 male providers; 69% white. Through an iterative process of co-design, we created an exam room poster that addresses common misconceptions about infant feeding, sleep and exercise, and a behavior change plan to foster parent/provider collaboration focused on achieving children’s healthy weight. ConclusionsOur hands-on, collaborative approach may ultimately improve uptake, acceptability and usability of early life obesity interventions by ensuring that parents remain at the center of prevention efforts.

BackgroundUsing a human-centered design (HCD) approach can provide clinical trial design teams with a better understanding of the needs, preferences, and attitudes of clinical trial stakeholders. It can also be used to understand the challenges and barriers physician stakeholders face in initiating and completing clinical trials, especially for using off-label drugs (OLDs) to treat unmet clinical needs in cancer treatment. However, the HCD approach is not commonly taught in the context of clinical trial design, and few step-by-step guides similar to this study are available to demonstrate its application.ObjectiveThis study aims to demonstrate the feasibility and process of applying an HCD approach to creating clinical trial support resources for physician stakeholders to overcome barriers to pursuing clinical trials for OLDs to treat cancer.MethodsAn HCD approach was used to develop OLD clinical trial support concepts. In total, 45 cancer care physicians were contacted, of which 15 participated in semistructured interviews to identify barriers to prescribing OLDs or participating in cancer OLD clinical trials. Design research is qualitative—it seeks to answer “why” and “how” questions; thus, a sample size of 15 was sufficient to provide insight saturation to address the design problem. The team used affinity mapping and thematic analysis of qualitative data gathered from the interviews to inform subsequent web-based co-design sessions, which included creative matrix exercises and voting to refine and prioritize the ideas used in the final 3 recommended concepts.ResultsThe findings demonstrate the potential of HCD methods to uncover important insights into the barriers physicians face in participating in OLD clinical trials or prescribing OLDs, such as recruitment challenges, low willingness to prescribe without clinical data, and stigma. Notably, only palliative care participants self-identified as “frequent prescribers” of OLDs, despite high national OLD prescription rates among patients with cancer. Participants found the HCD approach engaging, with 60% (9/15) completing this study; scheduling conflicts caused most of the dropouts. Over 150 ideas were generated in 3 co-design sessions, with the groups voting on 15 priority ideas that the design team then refined into 3 final recommendations, especially focused on increasing the participation of physicians in OLD clinical trials.ConclusionsUsing participatory HCD methods, we delivered 3 concepts for clinical trial support resources to help physician stakeholders overcome barriers to pursuing clinical trials for OLDs to treat cancer. Overall, integrating the HCD approach can aid in identifying important stakeholders, such as prescribing physicians; facilitating their engagement; and incorporating their perspectives and needs into the solution design process. This paper highlights the process, methods, and potential of HCD to improve cancer clinical trial design. Future work is needed to train clinical trial designers in the HCD approach and encourage adoption in the field.

BackgroundIncreasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders’ acceptability of interventions.MethodsA systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers’ behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools.ResultsTwenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants’ perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals.ConclusionThere is limited reporting of stakeholders’ experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants’ acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up.Trial registrationPROSPERO registration: CRD42019108658

Background Digital health interventions designed through human-centered design (HCD) have shown potential to impact health equity. This scoping review aims to understand how HCD approaches in digital health impact health equity. Methodology A scoping review was undertaken. Searches were conducted on PubMed, EMBASE, Web of Science, AMC Digital Library, ProQuest Thesis and Dissertations and Global Medicus Index databases. Results A total of 6169 references were identified, and 40 of them fulfilled the inclusion criteria for analysis. The application of HCD methodologies varied greatly as did the digital health interventions. The HCD methodologies had an impact on health equity for those individuals included in the development of the digital health tools, but beyond those persons, the impact was harder to establish. Conclusion There is optimism for the role that HCD in digital health can have in reducing health inequities; however, the evidence is not robust. Most projects failed to scale up to maturity or failed to apply evaluation mechanisms to assess the health equity impact. Recommendations include rigorous application of HCD methodologies, scaling digital health tools beyond pilot projects, and embedding evaluation to determine the impact on health equity.

The link between engagement and player emotions has been extensively explored by researchers in recent years. Empathy, which is the innate ability to accurately perceive another person’s current feelings and meanings can be broadly categorized into two main human-centric design approaches - cognitive empathy and affective empathy. Certain forms of media especially time-based media have been proven to better exploit viewers’ empathy and provide a more engaging experience when a human-centric design approach is applied. The aim of this research paper is to explore if a human-centric design approach can provide the same level if not more immersive engagement when designing video game experiences. The initial research into a human-centric design approach in video games will be obtained through an exploratory research design involving six tertiary-level students in the field of game design between the ages of 20 to 24 over a period of two weeks. The exploratory research encompassing of a semi-structured interview process with eight key questions relating to the respondent’s experience with empathy in games determined the advantages of planning and designing a game using a human-centric game design approach. The research determined that human-centric game design focusing on affective empathy provides a high possibility of a more engaging game experience that is strengthened by in-game narrative elements resulting in increased time spent in-game. This can be attributed to two main factors – firstly, a stronger player connection through direct empathy to their virtual avatars or in-game characters, regardless of the player’s moral standings and principles. Secondly, an immersive narrative structure produces a deeper player attachment toward game characters and game worlds.

In 2021, the United States Department of Energy (DOE) awarded the Pacific Ocean Energy Trust a grant to act as the coordinator of a foundational research network, ultimately named the University Marine Energy Research Community (UMERC). The community aims to facilitate connection between U.S. university researchers, industry, and government research laboratories to close common gaps in foundational research that are prohibiting the pathway to commercialization. To achieve this goal, UMERC held a series of workshops to create a Research Landscape (Landscape), which identified current challenges, gaps, research capabilities as well as uncovering additional questions about where the sector is headed. A human-centered design (HCD) approach was used throughout the three-workshop series. 
 HCD is a problem-solving and design technique that uses human perspective and emotion to develop solutions. The stages of human centered design include inspiration, ideation, implementation and validation, or testing, in an iterative, or cyclical process that results in ongoing refinement. HCD is carried out with the acknowledgement that values vary from context to context and are subject to change as people and technologies interact over time (Zachry and Spyridakis).
 It is through this approach that we are able to identify the current gaps and challenges and through the HCD approach, we will continue to refine the Landscape as current challenges and gaps are retired and new challenges and gaps arise. This will help account for the fast pace of innovation in the marine energy sector, where human-technology interactions are changing as the technology develops, and there are new entrants into the market. With the current state of fluidity in technology design and application, what works at one location may not work at another location. Using HCD methods and sensibilities, workshop participants, including individuals from universities, private sector companies and the national laboratories, we able to bring in their individual perspectives to develop the Landscape.
 Through the HCD process, the workshops revealed a set of values, tools, research interests and gaps and challenges. These were synthesized into what is now the current Landscape that can be found on the UMERC website. The values are themes that should be considered when designing marine energy projects. These include community, innovation and new technologies or applications, education, sustainability, equity, blue economy, and collaboration. The main challenges were condensed into four categories that include creating markets and a trained workforce, management and logistics, understanding and protecting the environment, and marine energy engineering, research and development. The tools are actions that can be carried out to overcome the main challenges. Finally, a list of common research areas was identified under each main challenge area.
 Following our HCD methodology, our cycle of iteration will soon start again. While the current Landscape serves as a benchmark, the next steps include a series of industry-academic brainstorming sessions, with the aim of creating collaborative projects to address challenges, as well as come up with a list of common technology agnostic challenges, in hopes to push future research funding.

OBJECTIVES/GOALS: The use of Human Centered Design (HCD) to improve the quality of team science is a recent application, and HCDs benefits and challenges have not been rigorously evaluated. We conducted a qualitative study with health sciences researchers trained in HCD methods to determine how they applied HCD methods and perceived its benefits and challenges. METHODS/STUDY POPULATION: The University of Pittsburgh offered HCD training to three cohorts of research scientists (staff as well as faculty) over a three-year period. The training was provided by the LUMA Institute, a premier HCD design firm with a highly regarded training program. We then evaluated this training by conducting 1-hour, semi-structured interviews with trainees from three training cohorts. Interviews focused on perceptions of the training, subsequent uses of HCD, barriers and facilitators, and perceptions of the utility of HCD to science teams. Data analysis was conducted using Braun and Clarkes process for thematic analysis. RESULTS/ANTICIPATED RESULTS: We interviewed 18 researchers (nine faculty and nine staff) trained in HCD methods and identified distinct themes regarding HCD use and its perceived benefits and challenges. Trainees found HCD relevant to research teams for stakeholder engagement, research design, project planning, meeting facilitation, and team management. They also described benefits of HCD in five distinct areas: creativity, egalitarianism, structure, efficiency, and visibility. We also identified challenges, including tensions between HCD approaches and academic culture. DISCUSSION/SIGNIFICANCE: Our data suggest that HCD has the potential to help researchers work more inclusively and collaboratively on interdisciplinary teams and generate more innovative and impactful science. The application of HCD methods is not without challenges; however, we believe these challenges can be overcome with institutional investment.

Design Contribution Square

BackgroundDigital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development.ObjectiveThe main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research.MethodsAn exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies.ResultsA total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41%), codesign (6/27, 22%), user-centered design (5/27, 19%), or a specific design method (5/27, 19%). Just over half (15/27, 56%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27% (8/30) of all the included studies explicitly mentioned the presence of designers on their team.ConclusionsOur results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research.

The main aim of this thesis is to study how employing a user-centric approach in architecture can affect the designers understanding of their requirements. It particularly focuses on a qualitative research using a human centred design (HCD) approach in a health care facility located in Petawawa, as an example. Whilst HCD has been applied in Industrial Design for years, architects claim to shape people's lives, yet the user is often not involved in the design process. The challenge faced translates to "how the application of an HCD approach can possibly be applied in an architectural project?" by proposing a method for architects to use, using three co-creation tools. Employing an HCD approach may decrease the gap between architects and users due to the end users hidden and unmet needs being identified, resulting in a user-centric design.

A lack of access to evidence-based, unbiased, and youth-friendly family planning and reproductive health (FP/RH) information and care limit young people's ability to prevent unplanned pregnancies and HIV and sexually transmitted infections. This threat-ens their health and is a significant cause of school drop-out, limiting young peoples' well-being, future potential, and employment opportunities. To address these challenges facing youth, YLabs used an end-to-end human-centered design (HCD) approach to create CyberRwanda, a digital platform aiming to improve the health and livelihoods of adolescents (aged 12-19 years) in Rwanda. From 2016 to 2020, CyberRwanda was designed and piloted using an HCD approach in partnership with more than 1,000 youth, parents, teachers, and public and private health care providers. During the problem recognition phase, HCD revealed participants' beliefs, behavioral preferences, and experiences as they relate to FP/RH specifically and their broader life experiences, motivations, and challenges. Several phases of analog, digital, and live prototyping with youth and key stakeholders were used to codesign, test, and refine the intervention for implementation. CyberRwanda is a direct-to-consumer platform where adolescents can learn integrated, age-appropriate health, and skills-building information through edutainment behavior change stories and a robust frequently asked questions library, order health products online, and be linked to CyberRwanda's network of private and public health care providers who have been trained to provide adolescent-friendly care. The HCD process resulted in significant pivots to the design of the digital platform and the implementation model. Using HCD provided a structured methodology to combine technical FP/RH expertise and visual and product design expertise to codesign and iteratively develop a digital health intervention with and for Rwandan youth.

BackgroundThe world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality.ObjectiveThis systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population.MethodsWe conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies’ qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed.ResultsEight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210.ConclusionsFindings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted.

Co-build is one of the four pillars of the Patient Engagement Framework from the Canadian Institutes of Health Research Strategy for Patient Oriented Research. Collaborating with Patient Research Partners (PRPs) using co-build approaches can enhance the applicability of healthcare tools produced. Human Centred Design (HCD), a problem-solving methodology focused on creating functional solutions for users, offers a promising approach to co-building patient engagement tools. To describe the process of using a HCD approach to co-build patient engagement tools with PRPs and to identify successes and challenges encountered. A HCD working group was formed from a Patient Advisory Council (PAC) that supports a research program to optimize laboratory test ordering in hospitalized patients. The HCD working group included nine PRPs, two patient engagement team members, and a HCD specialist. The working group employed the Double Diamond 4D design methodology: Discover, Define, Design, and Deliver, along with patient engagement principles of mutual respect, inclusiveness, support, and co-build. At the conclusion of the HCD process, we conducted a semi-structured debrief session to obtain perspectives on challenges and successes from all working group members. These were then summarized and collated iteratively with feedback from the group members. The working group met 31 times in 12 months and co-developed three patient engagement tools (an infographic, a video, and a website) to educate and engage hospitalized patients about the bloodwork process. HCD working group members valued the diverse and inclusive environment within the group, the available enrichment opportunities in HCD and qualitative research, and presence of patient engagement team members. Challenges noted included delays in timelines due to difficulties with consensus-building and redundancy in discussion topics. HCD approaches can be effectively combined with the principles of patient engagement to facilitate co-building with PRPs in healthcare. Future research is required to further the evidence for these strategies and their application in co-building processes, including use of clear project mapping and timelines and transparent consensus-building approaches. A PAC that consisted of nine PRPs guided this study. PRPs collaborated throughout the study. The current six PRPs were involved in the decision to write and are co-authors on this manuscript. PAC members had participated equally in the conduct of a prior qualitative study to understand patient needs about bloodwork processes in hospitals. With the guidance of a HCD specialist, PRPs contributed to decisions on content, wording, and imagery for the tools. The PAC members are currently collaborating on a study to implement these tools in hospitals and to evaluate the utility from a patient perspective.

Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. Healthy Beginnings is a nurse-led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6- and 12-month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6-month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%-65%) compared to those speaking English (70%-80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.

Home-based Intervention Among Non-Hispanic Black Families Finds No Significant Difference in Growth at 15 Months: Results from the ‘Mothers & Others’ Randomized Trial (P04-187-19)