Thinking Beyond the Device: An Overview of Human- and Equity-Centered Approaches for Health Technology Design

Abstract

A shift in the traditional technocentric view of medical device design to a human-centered one is needed to bridge existing translational gaps and improve health equity. To ensure the successful and equitable adoption of health technology innovations, engineers must think beyond the device and the direct end user and must seek a more holistic understanding of broader stakeholder needs and the intended context of use early in a design process. The objectives of this review article are ( a) to provide rationale for the need to incorporate meaningful stakeholder analysis and contextual investigation in health technology development and biomedical engineering pedagogy, ( b) to review existing frameworks and human- and equity-centered approaches to stakeholder engagement and contextual investigation for improved adoption of innovative technologies, and ( c) to present case study examples of medical device design that apply these approaches to bridge the gap between biomedical engineers and the contexts for which they are designing. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 25 is June 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The Importance of Human-centered Design in Equitable Health Promotion Initiatives

“…Another setting where HCD has been applied is in the realm of digital health, where there is an ongoing shift from a techno-centric to a more patient-centric focus. 10…”

How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study

“… 3 7 12 It is now clear that merely meeting technical specifications is insufficient. 6 Critical to the effective deployment, implementation, and impact of clinical practice tools is early and continued engagement with end-users and broader stakeholders so that their priorities are addressed through design processes. 6 13 Currently, however, thinking about how to optimise design of clinical practice tools either does not happen at all, or is deferred until far too late in the process of tool development, leading to a high level of waste associated with non-adoption or poor implementation.…”

“… 6 Critical to the effective deployment, implementation, and impact of clinical practice tools is early and continued engagement with end-users and broader stakeholders so that their priorities are addressed through design processes. 6 13 Currently, however, thinking about how to optimise design of clinical practice tools either does not happen at all, or is deferred until far too late in the process of tool development, leading to a high level of waste associated with non-adoption or poor implementation. 14 15 Though a range of design methods is available and widely used in other industries, 8 their use in development of clinical practice tools has been strikingly limited.…”

“…User-centred design is among the most well established of the various approaches that can support better usability of clinical tools, 16 and is already a staple in the development of medical devices. 6 9 10 17 18 Seeking to enhance usability of products and systems through a focus on user needs and perspectives, 16 user-centred methods are distinguished by their systematic and typically iterative approach to optimising design through consideration of contexts of use, usability goals, user characteristics, environment, tasks, and workflow. 16 19–21 By taking into account human capacities and limitations such as effects of stress on cognition, influence of fatigue, overload through multitasking, and limited memory capacity, 9 19 21 user-centred approaches have potential to enable systematic consideration of safety, effectiveness, and efficiency when designing clinical practice tools.…”

“…A user-centred approach to development of clinical practice tools is valuably complemented by co-design principles. 6 18 25 Such principles encourage developers and users—including, for example, healthcare professionals, patients, human factors engineers, and graphic designers—to nurture collective creativity and to work in partnership. 25–27 Application of these principles to development of clinical practice tools could strengthen or expand user-centred approaches, 6 18 in particular by emphasising the need for early and continued engagement of end-users and broader stakeholders throughout the design process, 6 17 18 28 29 and mobilisation of multiple forms of expertise.…”