Demystifying human-centred design: the application of iterative, human-centric approaches in global health market research
One of the biggest buzz topics in the global health community over the last couple of years has been human-centred design, also referred to as behaviour-centred design. In this blog I outline our understanding of a) human-centred design, b) how it can be applied to improve global health interventions, and c) how it intersects with market research.
The traditional approach to designing an intervention, campaign, product or program is as follows:
- A brainstorm is held to come up with a number of possible ideas
- A winning idea is selected
- That winning idea is rolled out to the market
Fundamentally, market research exists to inform and refine the selection of that winning idea and reduce the risk of launching a product that ultimately fails to achieve its behavioural objective. Rather than investing in something untested, additional steps in the process are incorporated prior to the selection and roll-out of the winning idea:
- Insights are obtained from end users (target population) or other influential stakeholders
- A brainstorm is held to come up with a number of possible ideas informed by those insights
- A number of ideas are critically evaluated by the end users
- The feedback is shared with the design team to support the selection of the winning idea and identify any refinement and improvements that are required to optimize uptake
- A winning idea is selected
- That winning idea is rolled out to the market
What is human-centred design?
Human-centred design (HCD) approaches present a new paradigm for design. The work of the Stanford Design School, in particular, has been hugely influential in shaping these principles. HCD shifts even more of the focus in the design process onto the end users by ensuring their perspective is considered throughout. There are three key ways in which this is achieved:
1. Incorporating behavioural science, or behavioural economics, perspectives into the initial design and interpretation.
Principles such as loss aversion / prospect theory (people feel the pain of a defeat more keenly than the joy of a victory) and framing (people’s decisions are shaped based on how information is presented to them – e.g. higher uptake of meat described as “90% fat free” than “10% fat”) are gaining popularity as a framework for explanation and a basis for design. Behavioural theory can be useful not just to diagnose the problem but also to frame the questions and interpret the outcomes. The principles of behavioural theory are not vulnerable to bias; they can act as checks and balances in qualitative research.
2. Consideration of end users’ holistic ecosystem.
Rigorous testing to understand the full spectrum of human interactions and the broader environment / setting in which a product is actually going to be used is critical in designing an effective solution. Not just ‘do they think it will work?’ prototype testing in a void, but actually exploring ‘will it work in practice?’, through the application of ethnographic or immersive methodologies.
3. Multiple rounds of rapid-fire iterative testing.
HCD allows for a systematic trial-and-error feedback loop to evaluate the impact of the solution, incorporating the wants and needs of end users at every step in the design process. This typically takes the form of an agile, phased research approach, in which potential solutions are funnelled down from many to few, with those that fail to perform being eliminated or evolved. Structured co-creation workshops and exercises to promote creative thinking are incorporated at each stage in the design / refine process.
While there are a multitude of definitions and different ways of conceptualizing human-centred design, the broad phases of the process are as follows:
- Definition (identifying the problem through primary market research with end users)
- Interpretation (framing the problem to facilitate opportunities)
- Ideation (generating potential solutions to the problem, potentially through co-creation with end users)
- Experimentation (prototyping and trialling these potential solutions in a holistic, real-life setting involving end users)
- Evolution (gathering feedback and adapting the solution over multiple iterations to refine and improve the design prior to roll out)
How can HCD be applied to improve global health interventions?
Deeper integration of the perspectives of the end user are particularly important in the context of global health interventions due to the multiple factors and cultural nuances that often make it challenging to make a positive difference. Many well-intentioned interventions flounder or fail because they lack the necessary understanding of human behaviour, in the context of the holistic ecosystem, and the real needs of the end users. Putting humans at the centre of the design process can help to untangle and ultimately tackle these complexities.
An example of how this has been implemented in practice is in the work of PATH and Artefact to develop solutions to improve maternal morbidity and mortality in low income countries by reducing infections that develop during pregnancy and labour. They started by using immersive research to gain a deep understanding of the environment, culture and behaviours that acted as barriers to pregnant women seeking medical help, thus increasing risk of infections. Insights from this understanding were used to formulate product design criteria for the potential solutions. Concepts built from these criteria were then tested and refined before scaling up the roll out of the solutions that proved to be successful.
Another example is the approach recently taken by PSI Tanzania to understand and avoid unintended teen pregnancy – starting by exploring girls’ perceptions, and the opinions of their network of influencers. This revealed a lack of demand for contraception and a lack of will among medical professionals to supply it. These insights were used to develop strategies to increase the demand, which were rapidly tested with constant input from the community prior to piloting and scaling up the successful solutions.
How does HCD intersect with market research?
In trying to understand why humans behave and react as they do, qualitative market research approaches are at the heart of human-centred design approaches. For example, ethnography is a valuable observational research methodology that can be used to gain a deep and immersive understanding of the holistic environment of the target population by ‘walking in their shoes’. User or usability testing of prototypes is also a core competency of qualitative market researchers. Techniques and methodologies rooted in human behaviour, such as exercises designed to catch respondents ‘system 1’ reactions (fast, instinctive) in addition to their ‘system 2’ (slow, effortful, logical) thinking, are increasingly being integrated into market research user testing approaches.
There are interesting parallels between human-centred design and the concept of ‘patient centricity’; putting the patient at the heart of every aspect of healthcare design and provision. This idea continues to gather momentum in pharma, with pharmaceutical companies increasingly incorporating patients into their mission statements. As the private and public sector increasingly come together to solve global health challenges, a common language and approach to design thinking will pay dividends.
In a future where design and marketing is expected to become increasingly focused on the end user experience, we expect to witness a trend toward deeper and more seamless integration between design and user testing, and a greater emphasis on understanding human behaviour. Systematic and contextualized consideration of human experience, behaviour and perspectives throughout the design process can only further increase success of global health interventions to better achieve development goals.