Innovating health care: key characteristics of human-centered design

Melles, Marijke; Albayrak, Armaĝan; Goossens, Richard

doi:10.1093/intqhc/mzaa127

Cited by 154 publications

(132 citation statements)

References 21 publications

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“…Interventionists should therefore draw from industry best practices to meet their recipients’ expectations. Asking end users of a digital intervention to interact with it, and assessing their experience, is an essential best practice [ 23 ] for ensuring the technology is user-centered and intuitive to use. For example, mockups of how the digital intervention will look can be shown in a study by Melles et al [ 23 ] or as a static image on a tablet.…”

Section: Discussionmentioning

confidence: 99%

“…Asking end users of a digital intervention to interact with it, and assessing their experience, is an essential best practice [ 23 ] for ensuring the technology is user-centered and intuitive to use. For example, mockups of how the digital intervention will look can be shown in a study by Melles et al [ 23 ] or as a static image on a tablet. Users can then be asked to think aloud [ 24 ] as they review the information presented, react to the information, and describe what actions they believe they can take next.…”

Section: Discussionmentioning

confidence: 99%

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Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis

Marcu¹,

Ondersma²,

Spiller³

et al. 2022

J Med Internet Res

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Background Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients’ technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis

Marcu¹,

Ondersma²,

Spiller³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

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“…In the fall of 2019, we conducted an intensive 16-week HCD studio [ 21 ] focused on addressing the delivery of feedback to EM clinicians related to post-ED encounter patient outcomes. MICA design faculty (BS and CM) led the studio in partnership with CDEM researchers.…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes–feedback platform. Here, we describe the iterative development of this platform, Linking Outcomes of Patients (LOOP), under a human-centered design (HCD) framework [ 21 ] and execute this through a unique collaboration between the Johns Hopkins Schools of Medicine and Engineering as well as Maryland Institute College of Art (MICA). We also report the functionality and usability of LOOP as assessed by the direct measurement of the end user clinicians’ knowledge, skills, and attitudes as they interacted with and used LOOP.…”

Section: Introductionmentioning

confidence: 99%

A Patient Outcomes–Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)

Strauss¹,

Morgan²,

Khuri³

et al. 2022

JMIR Hum Factors

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Background The availability of patient outcomes–based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning. Objective This study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use. Methods This multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ≥30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR. Results An initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63% respondents identified as useful), escalation of care (20/24, 83%), and return to ED (16/24, 67%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from “not easy” to “very easy” to obtain and from “not confident” to “very confident” in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague. Conclusions This study demonstrates the potential for human-centered design of a patient outcomes–driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning.

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“…Qualitative data were analyzed using a general inductive thematic analysis approach until thematic saturation was achieved [21][22][23]. More specifically, each set of notes was reviewed to independently extract quotes or ideas that represented discrete themes.…”

Section: Themesmentioning

confidence: 99%

Using human centered design to identify opportunities for reducing inequities in perinatal care

Nijagal¹,

Patel

Lyles

et al. 2021

BMC Health Serv Res

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Background Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. Methods We used human-centered design (HCD) to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. The HCD method has three phases: Inspiration, Ideation, and Implementation. This study focused on the first and second. In the Inspiration phase we conducted semi-structured interviews with a purposeful sample of stakeholders who had either received or participated in the care of Medicaid-insured pregnant people within our community, with a specific emphasis on representation from marginalized communities. Using a general inductive approach to thematic analysis, we identified themes, which were then framed into design opportunities. In the Ideation phase, we conducted structured brainstorming sessions to generate potential prototypes of solutions, which were tested and iterated upon through a series of community events and engagement with a diverse community advisory group. Results We engaged a total of 171 stakeholders across both phases of the HCD methodology. In the Inspiration phase, interviews with 23 community members and an eight-person focus group revealed seven insights centered around two main themes: (1) racism and discrimination create major barriers to access, experience, and the ability to deliver high-value pregnancy care; (2) pregnancy care is overmedicalized and does not treat the pregnant person as an equal and informed partner. In the Ideation phase, 162 ideas were produced and translated into eight solution prototypes. Community scoring and feedback events with 140 stakeholders led to the progressive refinement and selection of three final prototypes: (1) implementing telemedicine (video visits) within the safety-net system, (2) integrating community-based peer support workers into healthcare teams, and (3) delivering co-located pregnancy-related care and services into high-need neighborhoods as a one-stop shop. Conclusions Using HCD methodology and a collaborative community-health system approach, we identified gaps, opportunities, and solutions to address perinatal care inequities within our urban community. Given the urgent need for implementable and effective solutions, the design process was particularly well-suited because it focuses on understanding and centering the needs and values of stakeholders, is multi-disciplinary through all phases, and results in prototyping and iteration of real-world solutions.

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Innovating health care: key characteristics of human-centered design

Cited by 154 publications

References 21 publications

Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis

Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis

A Patient Outcomes–Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)

Using human centered design to identify opportunities for reducing inequities in perinatal care

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