Using Human-Centered Design to Develop, Launch, and Evaluate a National Digital Health Platform to Improve Reproductive Health for Rwandan Youth

Purpose: Private sector is the major providers of Primary health care for the poor in many low- and middle-income countries. In the public healthcare providers, the health facilities are built by the government and the healthcare workers, draw their salaries from government treasuries. In the private providers, the health facilities are owned by individual or a group of people and the salaries of the workers are paid from the resources generated in the facilities. They are either for profit or non-profit making. Enrollees are given freehand to choose either of the providers, but the information available to them is not enough to make decision on which of the providers to choose. This study aimed at determining the enrollee’s choice of private and public healthcare providers of community-based health insurance scheme in Edu LGA Kwara state.
 Methodology: The design was descriptive cross-sectional study. Sample size of 400 was used in each of the provider. The respondents were recruited by systematic sampling method among private healthcare provider while multistage sampling method was adopted in public healthcare providers. Data was collected using semi structured questionnaire. Focus Group Discussion was also carried out. Data collected were analyzed using SPSS version 23.0. Results were tabulated and logistic regression was adopted to determine level of significance. Level of Significance was set at P<0.05
 Findings: Nine- point-five (9.5%) of the respondents of the private healthcare provider and 5.7% of the respondents of the public healthcare providers had good knowledge score of community based health insurance scheme. The difference in knowledge score was statistically significant as the p=0.035. Mode of premium collection had Odd ratio 2.99 (CI =1.934- 4.622), P<0.001; Trust of the system Odd ratio 2.987 (CI = 1.884-4.733); Quality of health care Odd ratio 2.673 (CI = 1.757-4.065) P<0.001; Proximity to health facility Odd ratio 2.225 (CI = 1.412-3.506) P=0.001. Mode of joining the scheme Odd ratio 0.400 (CI = 0.290-0.552) P<0.001 and cost of accessing care Odd ratio 0.577 (CI = 0.42-0.779) P<0.001.
 Recommendation: It was recommended that private health facilities should be maintained which will improve access to health care for the enrollees. The government should also improve the quality of health care in the public healthcare providers.

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.

In Vietnam, as in many other countries, tuberculosis (TB) control has long been organized exclusively within the public health-care system. However, recently the private health-care sector has become more important and private health-care providers currently have a role in TB care delivery in Vietnam. Through a retrospective survey of patients at District Tuberculosis Units (DTUs) of the National Tuberculosis Programme in Ho Chi Minh City, we investigated utilization of private and public health-care providers among people with symptoms of TB. Eight hundred and one patients in eight DTUs were interviewed. For the current illness episode, about half of the patients had initially opted for a private health-care provider. Twenty-seven percent had been to a private physician and 31% to a private pharmacy at some time during their current illness. We found no significant association between socioeconomic status and use of private health-care providers. Utilization of private health-care providers among people with TB or symptoms of TB in Ho Chi Minh City seems to be similar to the general utilization of private providers in Vietnam, at least before TB is diagnosed. Since a large proportion of people with TB in Ho Chi Minh City across all economic and social strata consult private providers at some time during their illness, planners of TB control strategies need to consider both the health-care seeking behaviour of people with TB and the clinical behaviour of private providers, in order to secure early detection of TB, early initiation of appropriate treatment, and maintenance of appropriate treatment.

Indonesia has a high incidence of tuberculosis (TB), despite the successful introduction of the directly observed treatment short-course strategy (DOTS strategy). DOTS depends on passive case finding. It is therefore important to identify determinants of patient delay and reasons for visiting a DOTS healthcare provider when seeking care. The aim of this study was to assess these determinants in TB suspects (coughing for at least 2 weeks). Cross-sectional data were gathered with a structured questionnaire in which psychosocial determinants were based on an extended version of the theory of planned behaviour (TPB). The study was conducted in five governmental lung clinics of Yogyakarta province. In total, 194 TB suspects that registered at the lung clinics were interviewed. The median patient delay was 14 days (range 0-145). Ordinal regression analyses showed that visiting a private healthcare provider when first seeking health care, reporting travel distance/travel time as reason for choosing a certain healthcare provider when first seeking health care, discussing the symptoms with family and a reported short travel time, but no factors of TPB, were significantly associated with a shorter patient delay. An important factor negatively associated with visiting a DOTS clinic was the reported travel time. Accessibility of the healthcare provider was the main determinant of patient delay, but the role of psychosocial factors cannot be fully excluded. Urban and suburban areas have relatively good access to (private) health care, hence the short delay. Thus, future studies should be focussed on extending the DOTS strategy to the private sector.

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 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.

Healthcare data is highly sensitive and must be safeguarded. Personal and sensitive data, such as names and addresses, is stored in Encrypted Electronic Health Records (EHRs). This paper proposes a Blockchain-based distributed application platform for Bangladesh’s public and private healthcare service providers. The proposed application framework enables users to create secure digital agreements for commerce or collaboration by leveraging data immutability and smart contracts. As a result, all stakeholders can collaborate securely over the same Blockchain network, taking advantage of their data’s openness and read/write nature. The proposed application is made up of various application interfaces for various stakeholders. The proposed solution employs Hyperledger Fabric and Blockchain to ensure data integrity, privacy, permissions, and service availability. In the application portal, each user has a profile. The creation of a unique identity for each user, as well as the establishment of digital information centers across the country, has greatly aided the process. This application collects health data from each user in a systematic manner, which is useful for research institutes and healthcare-related organizations. For this application, a national data warehouse in Bangladesh is feasible, and various healthcare-related analyses can be performed using the collected data, assisting the strategy and planning department in making informed decisions regarding the healthcare sector in Bangladesh. Because Bangladesh has both public and private healthcare providers, a simple digital strategy is essential for all organizations to accomplish their services. This study proposes a solution to achieve this goal.

Elderly choose between utilizing private or public health care providers based on their socioeconomic, demographic, and epidemiological condition. The purposes of this study was to evaluate how these factors affect the choice of health care provider and to compare the impact of their choice on individual and family income. Data from 7,920 elders interviewed in a study of the State Committee for the Elderly of the state of Rio Grande do Sul in 1995 was used to evaluate the impact of elders' gender, age, educational level, individual income, family income, family size, participation in the family total income, and health self-assessment when choosing private or public health care providers. The statistical analysis was carried out using logistic regression. To have access to private health care providers, family income had a much more significant impact than individual income. When family income increased in one minimum wage, the odds of using private providers increased by 20% while it was only 7% when there was a similar increase in individual income. Other variables had also a positive impact: female, age, schooling, and smaller family size. Elderly choices' on health care depend on the family's needs and resources and not on the individual's condition. Therefore, low-income elderly health is a lower priority in the family and it is disproportionately impaired by reduced family resources and deficiencies of public health care.

BackgroundFatigue is a highly prevalent and debilitating symptom of systemic lupus erythematosus (SLE), significantly affecting the quality of life and employment of those living with the disease. Nonpharmacologic approaches, such as physical activity interventions, have shown promise in reducing fatigue but are often resource-intensive and lack grounding in behavior change theory. Mobile health (mHealth) technology offers a scalable approach to delivering behavioral interventions.ObjectiveThis study describes the development of an mHealth app, grounded in behavior change theory, to support fatigue self-management in individuals with SLE by promoting physical activity.MethodsWe used a human-centered design (HCD) approach to develop an mHealth app grounded in the self-determination theory of motivation and the social cognitive theory of behavior change. The process included two phases: (1) inspiration and (2) ideation. In the inspiration phase, key user needs were identified from focus groups of adults with SLE. During the ideation phase, a prototype was developed and iteratively refined based on feedback from additional individuals with SLE who participated in multiple rounds of semistructured interviews and online feedback surveys.ResultsIn the inspiration phase, 12 individuals participated in 2 focus groups and identified key priorities for the mHealth intervention, including symptom tracking (fatigue, pain, sleep, and physical activity), reliable educational content, social connection, and reminders. In the ideation phase, a prototype was developed based on these findings and refined through 2 rounds of user feedback interviews with 12 additional adults with SLE. Participants rated the features and format of the prototype favorably, with average scores ranging from 1.4 to 2.1 on a 5-point Likert scale (1=highest rating), and 78% (7/9) of interviewees reported they were likely or highly likely to use the app. Several themes around preferences for the app emerged from the interviews, including the importance of: (1) community and social connection, (2) accessibility and inclusion, (3) options for customization, (4) integration of the app with existing digital health tools, and (4) notifications for reminders and motivational messages. Based on this feedback, the prototype was refined, and a digital messaging feature was created. A library of 154 reminders and motivational messages was developed with input from 10 individuals with SLE who took part in a third round of interviews.ConclusionsUsing an HCD approach, we developed an mHealth app tailored to the needs of individuals with SLE, integrating behavior change theory to support fatigue self-management. Through engagement with end users, we iteratively refined the app to address key priorities and enhance usability. This study demonstrates the feasibility of using HCD to develop an mHealth app grounded in behavior change theory and provides a model for creating rigorous digital health interventions for individuals with SLE and other chronic conditions.

Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China

Background Healthcare expenditures for HIV care pose a major economic burden on households in sub-Saharan Africa. While immediate initiation of antiretroviral therapy (ART) for all HIV-positive patients has important health benefits, it is unknown how this profound change in HIV care provision will affect patients' healthcare expenditures. This study, therefore, aims to determine the causal impact of immediate ART initiation on patients' healthcare expenditures in Eswatini. Methods This stepped-wedge cluster-randomised controlled trial enrolled fourteen public-sector healthcare facilities in rural and semi-urban Eswatini. Facilities were randomly assigned to transition at one of seven time points from the standard of care (ART eligibility at CD4 counts of < 500 cells/mm3) to the immediate ART for all intervention (EAAA). The primary outcome was total patient-borne healthcare expenditures during the preceding 12 months. We used mixed-effects negative binomial regressions adjusted for secular trends and clustering at the facility level. Results 2261 participants were interviewed over the study period. Participants in the EAAA phase reported a 45% decrease (RR: 0.55, 95% CI: 0.39, 0.77, p < 0.001) in their total past-year healthcare expenditures compared to the standard-of-care phase. Patients' healthcare expenditures for private and traditional healthcare providers were 93% (RR 0.07, 95% CI: 0.01, 0.77, p < 0.001) lower in the EAAA than the standard of care phase. Self-reported health status was similar between study phases. Conclusions Despite a higher frequency of HIV care visits for newly initiated ART patients, immediate ART initiation lowered patients' healthcare expenditures because they sought less care from private and traditional healthcare providers. This study adds an important economic argument to the World Health Organisation's recommendation for countries to abolish CD4-count-based eligibility thresholds for ART. Key messages This is the first experimental study to examine the impact of immediate ART initiation on patients’ healthcare expenditures and thus obtain a causal estimate of the economic benefits of immediate ART. Immediate ART initiation in Eswatini reduced HIV patients’ healthcare expenditures, at least partially through decreasing care-seeking from traditional and private healthcare providers.

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.

Design Contribution Square

A Concordat with the Private and Voluntary Health-care Provider Sector (Department of Health (DoH), 2000a) proposed a strategy to remove barriers between public and private health-care providers. The document set out a broad framework to enable the NHS to use a wider range of services more imaginatively to meet local health needs. It was recommended that decision-making be devolved to the local level to enable more tailored services to be available to the community. Primary care groups (PCGs) were therefore encouraged to commission services from the private sector. This was especially relevant to relieve pressure on hospital beds during the winter months (DoH, 2000b).

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.