The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them

Abstract

Human-centered design (HCD) is widely regarded as the best design approach for creating eHealth innovations that align with end users’ needs, wishes, and context and has the potential to impact health care. However, critical reflections on applying HCD within the context of eHealth are lacking. Applying a critical eye to the use of HCD approaches within eHealth, we present and discuss 9 limitations that the current practices of HCD in eHealth innovation often carry. The limitations identified range from limited reach and bias to narrow contextual and temporal focus. Design teams should carefully consider if, how, and when they should involve end users and other stakeholders in the design process and how they can combine their insights with existing knowledge and design skills. Finally, we discuss how a more critical perspective on using HCD in eHealth innovation can move the field forward and offer 3 directions of inspiration to improve our design practices: value-sensitive design, citizen science, and more-than-human design. Although value-sensitive design approaches offer a solution to some of the biased or limited views of traditional HCD approaches, combining a citizen science approach with design inspiration and imagining new futures could widen our view on eHealth innovation. Finally, a more-than-human design approach will allow eHealth solutions to care for both people and the environment. These directions can be seen as starting points that invite and support the field of eHealth innovation to do better and to try and develop more inclusive, fair, and valuable eHealth innovations that will have an impact on health and care.

A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype

“…However, we are aware that user involvement may also bring challenges in application development. van Velsen et al [ 49 ] pointed out that user involvement in eHealth design is challenging because the few involved users represent only a fraction of the larger user group, so their input may be biased and limited. Those authors [ 49 ] also noted that there is often an overreliance on user input.…”

“…Another limitation is the use of the AssCE as the basis of the application’s development, which limits the use of other assessment forms. To use TOPP-N, nursing programs need to adopt the AssCE [ 49 ]. Further development of TOPP-N will allow educational institutions to include and use their own evaluation forms in the system.…”

“…Mutual learning and shared understanding are core concepts of participatory design, as they ensure mutual respect between stakeholders and enable everyone to take part in the shared decision-making process. [49]. Further development of TOPP-N will allow educational institutions to include and use their own evaluation forms in the system.…”

Navigating the complexities of mobile medical app development from idea to launch, a guide for clinicians and biomedical researchers

“…Additionally, by fostering that relationship with the clinical care of the subjects, it is possible to conduct user research with stakeholders through observation sessions and contextual inquiry. Which can help mitigate some of the overreliance on user input [ 32 ].…”

“…Thus, it is important to design an app such that the app fills a clearly defined and currently unmet need for a group of people (i.e., a medical reference guide, an appointment booking system, a prescribed training program). Otherwise, you run the risk of aiming to change a given behavior which has been identified as a limitation of traditional HCD and follows a different design process [ 32 ].…”