Evaluating Human-Centred Design for Public Health: A Case Study on Developing a Healthcare App with Refugee Communities. (Preprint)

Abstract

BACKGROUND Australian women from migrant and refugee communities report less sexual and reproductive health (SRH) awareness. They experience reduced access to SRH-specific care as well as culturally-relevant support that could assist them to make evidence-based decisions about their own health and service utilisation. Addressing public health problems through human-centred design (HCD) is an ethical and effective approach to developing solutions with underserved populations that are more likely to experience significant disadvantage or social marginalisation. OBJECTIVE This study aimed to evaluate the HCD approach that Shifra, a small Australian-based not-for-profit focused on improving access to healthcare for refugees and new migrants, undertook in developing a web-based application to deliver local, evidence-based and culturally relevant SRH information to its users. The evaluation focused on the following three questions: 1. To what extent did Shifra complete all the steps of the design thinking process shown? 2. To what extent did the final Shifra app incorporate the contributions of all co-designers? 3. To what extent were the co-designers satisfied with the process? METHODS The primary data for the first question involved a thorough review of all of Shifra’s organisational documents. Since there is a notable lack of validated tools evaluate HCD projects a maturity rubric was designed to synthesise the findings from the document review. This rubric was developed through consultation and several iterations of feedback from the expert panel were used to improve the usability, completeness and level of detail of the rubric. RESULTS A co-design process was successfully applied to the development of a web-based app for refugee and migrant women in reproductive health. This evaluation also yielded several important recommendations for improving Shifra’s HCD approach moving forward, findings that can be applied to other projects seeking to undertake an authentic community co-design process. First, with so many people of diverse backgrounds contributing to the project, clear communication about roles and expectations is critical. Second, it is important to set realistic expectations and role clarifications with co-designers. Third, it is important not to view all end users as interchangeable. Finally, by setting aside adequate time to develop collaborative relationships amongst all co-design groups the HCD process is an opportunity to give power and control back to the end user population for whom one is designing the health intervention. CONCLUSIONS Improving refugees’ access to SRH is complex and multidimensional and requires innovative and thoughtful problem solving. HCD is one way to address complex problems in an ethical and effective way and it is how Shifra chose to approach the development of its solution to this problem. This evaluation of Shifra’s HCD approach provides a helpful and rigorous guide in reporting that may encourage other organisations undertaking HCD work to evaluate their own implementation. CLINICALTRIAL N/A