Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya

Claudia L Leung,Benjamin Andama,Carol Horowitz,Rajesh Vedanthan,Peninah Kiptoo,Mackenzie Naert,Valentin Fuster,Jemima Kamano,Rae Dong,Esther Matini,Sarah Nyariki,Simon Manyara,Thomas Valente,David Edelman,Sonak Pastakia,Gerald S Bloomfield,Winnie Matelong,Violet Naanyu

doi:10.1186/s12913-020-05199-1

Abstract

BackgroundNon-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs.MethodsWe created a Design Team of health professionals, patients, microfinance officers, community health workers, and village leaders. Over 6 weeks, the Design Team utilized a four-step approach of synthesis, idea generation, prototyping, and creation to develop an integrated microfinance-group medical visit model for NCD. We tested the intervention with a 6-month pilot and conducted a feasibility evaluation using focus group discussions with pilot participants and community members.ResultsUsing human-centered design methodology, we designed a model for NCD delivery that consisted of microfinance coupled with monthly group medical visits led by a community health educator and a rural clinician. Benefits of the intervention included medication availability, financial resources, peer support, and reduced caregiver burden. Critical concerns elicited through iterative feedback informed subsequent modifications that resulted in an intervention model tailored to the local context.ConclusionsContextualized interventions are important in settings with multiple barriers to care. We demonstrate the use of HCD to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya. HCD can be used as a framework to engage local stakeholders to optimize intervention design and implementation. This approach can facilitate the development of contextually relevant interventions in other low-resource settings.Trial registrationClinicaltrials.gov, NCT02501746, registration date: July 17, 2015.

Highlights

Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources
We demonstrate the use of Human-centered design (HCD) to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya
We describe how we adapt a four-step HCD approach to guide the development of an integrated model of group care and microfinance for NCD care in rural Kenya

Summary

Introduction

Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. The Village Savings and Loans Association (VSLA) model, on which the microfinance model in this paper is derived, has improved food security and strengthened household income indicators in Africa [13, 14]. In this model, participants save money together through buying shares and can access loans by borrowing against their savings. Additional informal and formal group-based savings and credit models exist in Kenya, including microcredit lending through institutions and local moneylenders, savings via investment in livestock, and the Rotating Savings and Credit Associations (ROSCA) model, commonly referred to as merrygo-round, in which members take turns receiving a pot of shared savings over a particular time period [16]

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Conclusion