Lessons learnt from applying a human-centred design process to develop one of the largest mobile health communication programmes in the world

Abstract

‘Design with the user’ is a guiding principle for creating digital solutions to solve systemic developmental challenges. According to this principle, digital solutions are more likely to be effective if the intended users are involved in the design process, thereby rooting design thinking in a human-centric approach that seeks to understand their characteristics, needs and challenges. However, few examples exist for human-centred design (HCD) processes being successfully applied in low-and-middle-income countries to create digital health interventions that achieve both scale and sustainability. This paper describes the application of a five-stage HCD process to develop a suite of mobile solutions to improve reproductive, maternal, neonatal and child health in Bihar, India, and discusses lessons learnt. Two of the solutions were later adopted by the government and scaled to 10 million subscribers and more than 300 000 front-line health workers (FLHWs) in 13 states. The socio-ecological model, which considers the interplay between individual, interpersonal, organisational, community and public policy factors, provides a conceptual framework for understanding key learnings from the HCD process. At the organisational level, we found that demand generation was constrained by deficiencies in the public health system, while at the community level, gender norms were a barrier to changing health practices. At the interpersonal level, mobile health solutions for mothers also had to address fathers, because they controlled women’s access to mobile phones. At the individual level, FLHWs had limited time to build their skills and needed more flexible, home-based learning opportunities; most FLHWs had access to mobile phones, but devices were overwhelmingly basic and digital skills limited; voice technology was required to maximise reach among low literate women and an authoritative yet empathetic narrator was required to humanise the digital experience, lend credibility and create engagement.

Linking Activity Theory Within User-Centered Design: Novel Framework to Inform Design and Evaluation of Adverse Drug Reaction Reporting Systems in Pharmacy

“…Implementing new systems without pilot testing and refining may fall short of their expected goals due to systems' architecture constraints or design failures that could have been identified and resolved prior to their final build [27]. User-centered design (UCD) is a framework that places users (eg, CPs) at the center of the design process from the initial stages of planning, designing the system requirements, evaluating, and deployment of the final product [28]. It involves the influence of end users during the design processes and has been shown to contribute to the acceptance, adoption, and success of systems [29].…”

“…It involves the influence of end users during the design processes and has been shown to contribute to the acceptance, adoption, and success of systems [29]. The core principles of UCD include: (1) understanding and specifying the context of use, (2) specifying the user including the organizational requirements, (3) producing design solutions, and (4) evaluating designs against requirements (Multimedia Appendix 1) [28,29]. Poor uptake of adverse event reporting systems by HP can occur when the system is designed without or with limited clinician input while prioritizing organizational data needs [12,30].…”

“…To date, there have been no reporting on factors affecting the implementation and adoption of pharmacovigilance (PV) systems in Australian community pharmacies and other primary care settings [16]. A key challenge to the successful utilization of any new system lies in strategies that drive uptake and adoption [28]. A recent 2022 systematic review concluded that future interventions should include a comprehensive multifaceted approach to improve the quantity and quality of ADR reporting [19].…”

Social innovation in health: concepts and practice

“…Another research study used a private sector delivery system to increase coverage of oral rehydration salts and zinc for children with diarrhoea in rural Zambia 37. Finally, a research study applied a user-centred design process to iteratively cocreate a large mobile health communication programme in partnership with the British Broadcasting Corporation 38…”

Innovaciones sociales para mejorar la salud

“…Por ello, los innovadores valoran especialmente el desarrollo de habilidades competencias personales (soft skills) que les faciliten la gestión y la sostenibilidad. Para ello, también participan en intercambios, encuentros con entidades filantrópicas y debates metodológicos sobre innovación social (12,18,(20)(21)(22)(23).…”