Human-centered Design Methodology Research Articles

Using Human-Centered Design Methodology to Maximize the Impact of Hospice and Palliative Care Research (ME303)

Using Human-Centered Design Methodology to Maximize the Impact of Hospice and Palliative Care Research (ME303)

Centering School Leaders’ Expertise: Usability Evaluation of a Leadership-Focused Implementation Strategy to Support Tier 1 Programs in Schools

AbstractAlthough there are a growing number of implementation strategies to increase the adoption, fidelity, and sustainment of evidence-based practices (EBP), they are often complex and bulky, which can interfere with their widespread application. To address these challenges, the Helping Educational Leaders Mobilize Evidence (HELM) strategy was created as an adaptation of the evidence-based Leadership and Organizational Change for Implementation (LOCI) implementation strategy to enhance elementary school principals’ use of strategic implementation leadership to support the adoption and delivery of Tier 1 (i.e., universal social, emotional, and behavioral) EBP. In service of its iterative development, a human-centered design methodology was employed to increase the successful uptake and use of HELM. The Cognitive Walkthrough for Implementation Strategies (CWIS), a novel mixed-methods approach to evaluate implementation strategy usability, was applied to identify and test HELM strategy tasks of critical importance. A sample of 15 elementary school principals participated in group cognitive walkthrough testing as either school principal recipients or HELM coaches. Both user types rated the strategy as acceptable (principal M = 77.8, SD = 15.5; coach M = 87.5, SD = 7.9). Five usability issues were identified using a highly structured common usability issue framework and provided direction for the generation of redesign solutions to be incorporated in a subsequent version of the HELM strategy. The evaluation of the strategy’s usability improved its alignment with user needs, expectations, and contextual constraints, rendering a more usable strategy and broadly applicable information surrounding the development of psychosocial implementation strategies in real-world settings.

Fostering Community Empowerment: A Human-Centered Approach to Designing Clean Water Solutions in a Jakarta Slum

This article presents a case study of the application of human-centered design (HCD) as a codesign approach to address complex problems in slum communities in Jakarta, Indonesia. Through a review of relevant literature, we examine how the HCD methodology embraces a participatory framework but retains a certain degree of control not found in pure participatory approaches. We explain why HCD was selected for this study and describe the methods used, including sort cards, solution cards, in-depth interviews, focus group discussions, and product usability interviews. These methods were employed to generate a solution that addressed the issue of sourcing clean water in Jakarta’s slums, which was then prototyped, tested, and implemented. The study contributes to the development of a cohesive and applicable methodology by integrating codesign and HCD in designing solutions for people at the Base of the Pyramid.

Pilot Implementation of a Nutrition-Focused Community-Health-Worker Intervention among Formerly Chronically Homeless Adults in Permanent Supportive Housing.

Food insecurity is a known health equity threat for formerly chronically homeless populations even after they transition into permanent housing. This project utilized a human-centered design methodology to plan and implement a nutrition-focused community-health-worker (CHW) intervention in permanent supportive housing (PSH). The project aimed to increase access to healthy foods, improve nutritional literacy, healthy cooking/eating practices, and build community/social connectedness among 140 PSH residents. Validated food-security screening conducted by CHWs identified low or very low food security among 64% of 83 residents who completed the baseline survey, which is similar to rates found in a previous study among formerly homeless populations placed in PSH. Major themes identified through an analysis of resident feedback include (1) lack of needed kitchenware/appliances for food preparation, (2) knowledge gaps on how to purchase and prepare healthier food, (3) positive perceptions of healthy food options, (4) expanded preferences for healthy, easy-to-prepare foods, (5) regaining cooking skills lost during homelessness, (6) positive experiences participating in group activities, (7) community re-entry, and (8) resident ownership. Preliminary findings suggest the use of a human-centered design methodology for planning and implementing this multi-level CHW intervention helped reduce food insecurity, engaged participants in learning and adopting healthy and safe cooking and eating practices, and fostered social connectedness and feelings of community among formerly chronically homeless PSH residents.

Designing classroom assessments with the end user in mind

Teachers are key users of classroom assessment data; however, their needs and preferences are often overlooked in the design and development of the assessments themselves. We used principles of Human-Centered Design (HCD) to systematically solicit, study, and integrate teachers’ needs in the design and development of a classroom-based early mathematics assessment. We recruited 18 teachers to participate in a series of research activities that align with HCD methodology. Data informed the articulation of the use case and test specifications, thereby elevating teachers’ voices to improve test-development decisions that consider the end users from the start.

A feasibility assessment of a traumatic brain injury predictive modelling tool at Kilimanjaro Christian Medical Center and Duke University Hospital.

Traumatic brain injury (TBI) is the most common cause of death and disability globally. TBI, which disproportionately affects low middle-income countries (LMIC), uses significant amounts of health system resources in costly care and management. Innovative solutions are required to address this high burden of TBI. One possible solution is prognostic models which enhance diagnostic ability of physicians, thereby helping to tailor treatments more effectively. This study aims to evaluate the feasibility of a TBI prognostic model developed in Tanzania for use by Kilimanjaro Christian Medical Center (KCMC) healthcare providers and Duke-affiliated healthcare providers using human centered design methodology. Duke participants were included to gain insight from a different context with more established practices to inform the TBI tool implementation strategy at KCMC. To evaluate the feasibility of integrating the TBI tool into potential workflows, co-design interviews were conducted with emergency physicians and nursing staff at KCMC and Duke. Qualitatively, the TBI tool was assessed using human centered design (HCD) techniques. Our research design methods were created using the Consolidated Framework for Implementation Research which considers overarching characteristics of successful implementation to contribute to theory development and verification of implementation strategies across multiple contexts. Our knowledge translation method was guided using the knowledge-to-action framework. Of the 21 participants interviewed, 12 were associated with Duke Hospital, and 9 from Kilimanjaro Christian Medical Centre. Emerging from the data were 6 themes that impacted the implementation of the TBI tool: access, barriers, facilitators, use of the TBI tool, outer setting, and inner setting. To our knowledge, this is the first study to investigate the pre-implementation of a sub-Saharan Africa (SSA) data- based TBI prediction tool using human centered design methodology. Findings of this study will aid in determining under what conditions a TBI prognostic model intervention will work at KCMC.

Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy.

Guideline-directed medical therapies (GDMTs) improve quality of life and health outcomes for patients with heart failure (HF). However, GDMT utilization is suboptimal among patients with HF. The aims of this study were to engage key stakeholders in semistructured, virtual human-centered design sessions to identify challenges in GDMT optimization posthospitalization and inform the development of a digital toolkit aimed at optimizing HF GDMTs. For the human-centered design sessions, we recruited (a) clinicians who care for patients with HF across 3 hospital systems, (b) patients with HF with reduced ejection fraction (ejection fraction ≤ 40%) discharged from the hospital within 30 days of enrollment, and (c) caregivers. All participants were 18 years or older, English speaking, with Internet access. A total of 10 clinicians (median age, 37 years [interquartile range, 35-41], 12 years [interquartile range, 10-14] of experience caring for patients with HF, 80% women, 50% White, 50% nurse practitioners) and three patients and one caregiver (median age 57 years [IQR: 53-60], 75% men, 50% Black, 75% married) were included. Five themes emerged from the clinician sessions on challenges to GDMT optimization (eg, barriers to patient buy-in). Six themes on challenges (eg, managing medications), 4 themes on motivators (eg, regaining independence), and 3 themes on facilitators (eg, social support) to HF management arose from the patient and caregiver sessions. The clinician, patient, and caregiver insights identified through human-centered design will inform a digital toolkit aimed at optimizing HF GDMTs, including a patient-facing smartphone application and clinician dashboard. This digital toolkit will be evaluated in a multicenter, clinical trial.

Using human-centered design to develop a national research landscape for marine energy in the United States

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.

Beyond Self-diagnosis: How a Chatbot-based Symptom Checker Should Respond

Chatbot-based symptom checker (CSC) apps have become increasingly popular in healthcare. These apps engage users in human-like conversations and offer possible medical diagnoses. The conversational design of these apps can significantly impact user perceptions and experiences, and may influence medical decisions users make and the medical care they receive. However, the effects of the conversational design of CSCs remain understudied, and there is a need to investigate and enhance users’ interactions with CSCs. In this article, we conducted a two-stage exploratory study using a human-centered design methodology. We first conducted a qualitative interview study to identify key user needs in engaging with CSCs. We then performed an experimental study to investigate potential CSC conversational design solutions based on the results from the interview study. We identified that emotional support, explanations of medical information, and efficiency were important factors for users in their interactions with CSCs. We also demonstrated that emotional support and explanations could affect user perceptions and experiences, and they are context-dependent. Based on these findings, we offer design implications for CSC conversations to improve the user experience and health-related decision-making.

A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study.

When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. Data collected during usability testing concerned the 6 domains of the app-food and diet, activity, fluid intake, sleep, good mental health, and financial well-being-and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented-including shift management and catch-up cards-during this cycle of development. This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change.

Development of a Family-Centered Communication Tool for Kidney Health in Premature Infants: Qualitative Focus Group Study Using Human-Centered Design Methodology.

Premature infants are at increased risk of kidney-related complications, including acute kidney injury (AKI) and chronic kidney disease (CKD). The risk of CKD in prematurely born infants is underrecognized by health care teams and caregivers. Understanding how to communicate the risk of CKD to caregivers is essential for longitudinal clinical follow-up and adherence. This study aimed to determine family caregiver attitudes toward kidney health and risk communication during a neonatal intensive care admission. We also sought to understand caregiver preferences for the communication of information surrounding the risk of CKD in premature infants. We augmented standard qualitative group sessions with human-centered design methods to assess parent preferences and clinician perspectives. Caregivers recruited had a prematurely born child who spent time in the neonatal intensive care unit at Riley Hospital for Children in Indianapolis, Indiana, and experienced AKI or another kidney complication, which put them at risk for future CKD. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. A total of 7 clinicians and 8 caregivers participated in 3 group sessions. Caregivers and clinicians readily acknowledged barriers to and drivers of long-term kidney monitoring as well as opportunities for communication of the risk of long-term kidney disease. Caregivers' primary concerns were for both the type and depth of information conveyed as well as the time at which it was communicated. Participants emphasized the importance of collaboration between the hospital care team and the primary care provider. Participant input was synthesized into several prototype concepts and, ultimately, into a rough prototype of a website and an informational flyer. Caregivers of premature infants are open to communication about kidney health during their neonatal admission. The next phase of this work will translate caregivers' preferences into family-centered communication tools and test their efficacy in the neonatal intensive care unit.

Pervasive Augmented Reality to support logistics operators in industrial scenarios: a shop floor user study on kit assembly

Augmented Reality (AR) is a pillar of the transition to Industry 4.0 and smart manufacturing. It can facilitate training, maintenance, assembly, quality control, remote collaboration and other tasks. AR has the potential to revolutionize the way information is accessed, used and exchanged, extending user’s perception and improving their performance. This work proposes a Pervasive AR tool, created with partners from the industry sector, to support the training of logistics operators on industrial shop floors. A Human-Centered Design (HCD) methodology was used to identify operators difficulties, challenges, and define requirements. After initial meetings with stakeholders, two distinct methods were considered to configure and visualize AR content on the shop floor: Head-Mounted Display (HMD) and Handheld Device (HHD). A first (preliminary) user study with 26 participants was conducted to collect qualitative data regarding the use of AR in logistics, from individuals with different levels of expertise. The feedback obtained was used to improve the proposed AR application. A second user study was realized, in which 10 participants used different conditions to fulfill distinct logistics tasks: C1 — paper; C2 — HMD; C3 — HHD. Results emphasize the potential of Pervasive AR in the operators’ workspace, in particular for training of operators not familiar with the tasks. Condition C2 was preferred by all participants and considered more useful and efficient in supporting the operators activities on the shop floor.

Multispecies design: 3D-printed biomimetic structures to enhance humidity levels

The paper changes the focus of the design debate from a human-centered design methodology to a posthuman design that takes both human and nonhuman agents into account. It examines how designers might use a multispecies perspective to produce projects with distinguished intelligence and performance. To illustrate this, we describe a project of structures for plants that started on a course in an academic setting. The project methodology begins with “Thing Ethnography”, investigating the movement of a water bottle inside a house and its interaction with other objects. The correlation between water and plants was decided to be further expanded, considering how water might enhance the environmental humidity and create a cooler microclimate for indoor plants. According to their effectiveness, 3D-printed biomimetic structures were designed and manufactured as water droplet supports considering different materials, and positioned in various configurations around a plant. Humidity levels and temperature of the structures were measured. As a result, this created a novel method for mass customization and working with plants. The paper discusses the resultant evidence-based design and the environmental values related to it.

Digital Health at Enterprise Scale: Evaluation Framework for Selecting Patient-Facing Software in a Digital-First Health System.

The digital transformation of our health care system will require not only digitization of existing tools but also a redesign of our care delivery system and collaboration with digital partners. Traditional patient journeys are reactive to symptom presentation and delayed by health care system-centric scheduling, leading to poor experience and avoidable adverse outcomes. Patient journeys will be reimagined to a digital health pathway that seamlessly integrates various care experiences from telemedicine, remote monitoring, to in-person clinic visits. Through centering the care delivery around the patients, they can have more delightful experiences and enjoy the quality of standardized condition pathways and outcomes. To design and implement digital health pathways at scale, enterprise health care systems need to develop capabilities and partnerships in human-centered design, operational workflow, clinical content management, communication channels and mechanisms, reporting and analytics, standards-based integration, security and data management, and scalability. Using a human-centered design methodology, care pathways will be built upon an understanding of the unmet needs of the patients to have a more enjoyable experience of care with improved clinical outcomes. To power this digital care pathway, enterprises will choose to build or partner for clinical content management to operationalize up-to-date, best-in-class pathways. With this clinical engine, this digital solution will engage with patients through multimodal communication modalities, including written, audio, photo, or video, throughout the patient journey. Leadership teams will review reporting and analytics functions to track that the digital care pathways will be iterated to improve patient experience, clinical metrics, and operational efficiency. On the backend, standards-based integration will allow this system to be built in conjunction with the electronic medical record and other data systems to provide safe and efficient use of the digital care solution. For protecting patient information and compliance, a security and data management strategy is critical to derisking breeches and preserving privacy. Finally, a framework of technical scalability will allow digital care pathways to proliferate throughout the enterprise and support the entire patient population. This framework empowers enterprise health care systems to avoid collecting a fragmented series of one-off solutions but develop a sustainable concerted roadmap to the future of proactive intelligent patient care.

Designing a Child-, Family-, and Healthcare Provider-Centered Procedure Room in a Tertiary Care Children's Hospital.

The study aim was to co-design new pediatric procedure room prototypes with children, caregivers, and healthcare providers (HCPs). Medical procedures can cause pain and anxiety for children and their families. If spaces are not designed for patients' needs, procedures may take longer, require sedation, and result in an inferior care experience. Involving HCPs in co-designing optimal spaces can result in more efficient and safer environments. co-designing spaces with patients and their families can inform psychologically safer and less traumatic environments. We followed human-centered design methodology. Data were collected via semi-structured interviews, field observations, and two multidisciplinary design workshops with patients, caregivers, and HCPs. Themes from the data were extracted using a content analysis and used to make evidence-informed recommendations for design features. The study took place from October 2021 to February 2022. Patients, families, and HCPs reported similar needs: (1) control over the environment, including the ability to adjust lighting, temperature, and sound; (2) space that supports patient privacy; (3) the use of evidence-based pain reduction and distraction methods; (4) attention to the sensory environment, including visual (light, color), tactile (textures of furniture and equipment), auditory, and olfactory stimuli; (5) human factors organization of the space and equipment; (6) accessible and equitable spatial design; and (7) the significance of the journey leading up to and after the procedure. It is feasible to co-design procedure rooms that support evidence-based psychological, physical, and pharmacological interventions that are known to minimize pain for children.

Abstract P398: Using Human-Centered Design Methodology to Identify Challenges and Inform the Development of a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy From Diverse Clinician, Patient, and Patient Health Partner Perspectives

Introduction: Despite overwhelming evidence that guideline-directed medical therapies (GDMT) for heart failure (HF) can reduce mortality and improve quality of life, significant gaps in treatment optimization persist. GDMT initiation and up-titration are especially critical for improving patient outcomes post-hospitalization. Objective: Identify challenges encountered post-hospitalization in optimizing GDMT for HF management by engaging key stakeholders in human-centered design (HCD) to guide the development of a digital toolkit to increase HF GDMT optimization. Methods: HCD is used to solve complex problems by soliciting input from stakeholders. We recruited: a) clinicians (physicians and advanced practice providers) who provide care to patients with HF across three health systems, b) patients with HF with Reduced Ejection Fraction (HFrEF, EF < 40%) discharged from the hospital within 30 days of enrollment, and c) patient health partners when available. We conducted separate virtual sessions for clinicians and patients/health partners using semi-structured interview guides to identify challenges, motivators and themes. Results: We enrolled 10 clinicians, 10 patients, and 2 patient health partners. The clinicians had a median age of 37 years (IQR: 35-41) and 12 years (IQR: 14-9) experience caring for patients with HF; 80% (8/10) were women, and 50% (5/10) were physicians. Patients had a median age of 53 years (IQR: 48-64); 40% (4/10) were women, 60% (6/10) were a racial/ethnic minority, and 50% (5/10) were married. Top challenges to HF GDMT optimization (e.g. number of medications) and digital toolkit features identified during the clinician HCD sessions are reported in Figure 1. Conclusions: The clinician and patient/health partner HCD findings will inform the development of the digital toolkit, including a patient-facing smartphone application and clinician dashboard, for HF GDMT optimization. We will also conduct HCD sessions in Brazil to further co-design the digital toolkit for low resource settings.

Development of a Digital Behavioral Intervention to Reduce the Consumption of Sugar-Sweetened Beverages Among Rural Appalachian Adults: Multiphased, Human-Centered Design Approach

To avoid the low engagement and limited efficacy of digital behavioral health interventions, robust human-centered design (HCD) processes are needed. The primary objective of this study was to describe a flexible, step-by-step HCD process to develop digital behavioral health interventions by illustrating iSIPsmarter as an example. iSIPsmarter is a digital intervention for reducing the consumption of sugar-sweetened beverages (SSBs) that comprises 6 internet-based cores metered out over time to deliver the program content, an integrated SMS text message strategy to engage users in reporting SSB behaviors, and an electronic cellular-enabled scale for in-home weighing. The secondary objective is to illustrate the key components and characteristics of iSIPsmarter that resulted from the HCD process. The methods were guided by the Model for Internet Interventions and by best practices in HCD and instructional design processes (eg, rapid prototype development and think-aloud protocol). The 3-phased (ie, contextual, prototype testing, end user testing phases) process followed in this study included a series of 13 semistructured one-on-one interviews with 7 advisory team participants from the targeted Appalachian user group. The interviews were content coded by 2 researchers and then deductively coded to the suggested areas of digital behavioral health interventions. The participants provided rich perspectives pertaining to iSIPsmarter's appearance, behavioral prescriptions, burdens, content, delivery, message, participation, and assessment. These inputs included requests for built-in flexibility to account for varying internet and SMS text message accessibility among users; ideas to resolve the issues and problems encountered when using the prototypes, including those related to navigation and comprehension of content; ideas to enhance personalized feedback to support motivation and goal setting for SSB consumption and weight; and feedback to refine the development of realistic and relatable vignettes. The participants were able to interact with multiple prototype drafts, allowing researchers to capture and incorporate feedback related to the iSIPsmarter dashboard, daily SSB and weight diaries, action planning, core content, interactions, and vignettes. Using scientific models and established processes is critical for building robust and efficacious interventions. By applying an existing model and HCD and instructional design processes, we were able to identify assumptions and address the key areas of the iSIPsmarter intervention that were hypothesized to support users' engagement and promote behavior change. As evidenced by the rich feedback received from the advisory team members and the resulting iSIPsmarter product, the HCD methodology was instrumental in the development process. Although the final iSIPsmarter content is specific to improving SSB consumption behaviors among adults in rural areas, the intent is that this HCD process will have wide applications in the development of digital behavioral health interventions across multiple geographic and behavioral contexts.

Supporting Physical Activity in Later Life: Perspectives From Older Adults

The older population, especially those living alone, is less likely to meet recommended physical activity levels than other age groups and deserves more attention in this era of population ageing. However, existing technologies for supporting physical activity have been generally poorly aligned with the needs of older adults. Reasons for such problem are manifold, including the lack of involving older adults in design and evaluation, prevalent technology-driven perspectives, and the complexity of designing behavior change technology. Therefore, this research project aims to investigate how to better design behavior change technology to support the needs of older adults living alone for physical activity, which will address four main aspects: meeting user needs, investigating the rationale of technology design, improving co-design practice, and evaluating designed technology. To this end, this project will employ a human-centered iterative design methodology and actively involve the target group in the design process to let their voices heard and incorporated in design. This research will not only contribute to a deeper understanding towards the needs and preferences of this insufficiently studied group, but also identify implications for improving co-design practices as well as design opportunities for future behavior change technology.

Developing an Unstructured Supplementary Service Data-based mobile phone app to provide adolescents with sexual reproductive health information: a human-centered design approach

BackgroundAdolescent pregnancies and sexually-transmitted infections continue to impact 15 – 19-year-olds across the globe. The lack of sexual reproductive health information (SRH) in resource-limited settings due to cultural and societal attitudes towards adolescent SRH could be contributing to the negative outcomes. Innovative approaches, including mobile phone technologies, are needed to address the need for reliable adolescent SRH information.ObjectiveThe study aimed to co-design a Unstructured Supplementary Service Data (USSD) based mobile app prototype to provide confidential adolescent SRH information on-demand and evaluate the mobile app’s usability and user experience.MethodsA human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. To participate, an adolescent must have been 15 to 19 years old, resided in Kibra and would be able to access a mobile phone. Adolescents were enrolled for the alpha and field testing of the app prototype at different time-points. The Mobile Application Rating Scale (MARS) a multidimensional mobile phone evaluation tool was used to access the functionality, engagement, aesthetics and quality of information in the app. Responses from the MARS were reported as mean scores for each category and a mean of the aggregate scores making the app’s quality score. The MARS data was also evaluated as categorical data, A Chi square test of independence was carried out to show significance of any observed differences using cumulative and inverse cumulative distribution functions.ResultsDuring the usability test, 62/109 (54.9%) of the adolescents that were followed-up had used the app at least once, 30/62 (48.4%) of these were male participants and 32/62 (51.6%) female. On engagement, the app had a mean score of 4.3/5 (SD 0.44), 4.6/5 (SD 0.38) on functionality, 4.3/5 (SD 0.57) on aesthetics and 4.4/5 (SD 0.60) on the quality of information. The overall app quality mean score was 4.4/5 (SD 0.31). The app was described as ‘very interesting’ to use by 44/62 (70.9%) of the participants, 20/44 males and 24/44 females. The content was deemed to be either ‘perfectly’ or ‘well targeted’ on sexual reproductive health by 60/62 (96.7%) adolescents, and the app was rated ‘best app’ by 45/62 (72.6%) adolescents, 27/45 females and 18/45 males, with a p-value = 0.011.ConclusionsAdolescents need on-demand, accurate and trusted SRH information. A mobile phone app is a feasible and acceptable way to deliver adolescent SRH information in resource-limited settings. The USSD mobile phone technology shows promise in the delivery of much needed adolescent SRH information on-demand..

Human-Centered Design of a Digital Health Tool to Promote Effective Self-care in Patients With Heart Failure: Mixed Methods Study.

BackgroundEffective self-care is an important factor in the successful management of patients with heart failure (HF). Despite the importance of self-care, most patients with HF are not adequately taught the wide range of skills required to become proficient in self-care. Digital health technology (DHT) may provide a novel solution to support patients at home in effective self-care, with the view to enhancing the quality of life and ultimately improving patient outcomes. However, many of the solutions developed to date have failed to consider users’ perspectives at the point of design, resulting in poor effectiveness. Leveraging a human-centered design (HCD) approach to the development of DHTs may lead to the successful promotion of self-care behaviors in patients with HF.ObjectiveThis study aimed to outline the HCD, development, and evaluation process of a DHT designed to promote effective self-care in patients with HF.MethodsA design thinking approach within the HCD framework was undertaken, as described in the International Organization for Standardization 9241-210:2019 regulations, using a 5-step process: empathize, ideate, design, develop, and test. Patients with HF were involved throughout the design and evaluation of the system. The designed system was grounded in behavior change theory using the Theoretical Domains Framework and included behavior change techniques. Mixed methods were used to evaluate the DHT during the testing phase.ResultsSteps 1 to 3 of the process resulted in a set of evidence- and user-informed design requirements that were carried forward into the iterative development of a version 1 system. A cross-platform (iOS and Android) mobile app integrated with Fitbit activity trackers and smart scales was developed. A 2-week user testing phase highlighted the ease of use of the system, with patients demonstrating excellent adherence. Qualitative analysis of semistructured interviews identified the early potential for the system to positively influence self-care. Specifically, users perceived that the system increased their confidence and motivation to engage in key self-care behaviors, provided them with skills and knowledge that made them more aware of the importance of self-care behaviors, and might facilitate timely help seeking.ConclusionsThe use of an HCD methodology in this research has resulted in the development of a DHT that may engage patients with HF and potentially affect their self-care behaviors. This comprehensive work lays the groundwork for further development and evaluation of this solution before its implementation in health care systems. A detailed description of the HCD process used in this research will help guide the development and evaluation of future DHTs across a range of disease use cases.