What do Apple's first computer mouse, Spotify, one of the largest streaming platforms in the world, and FitBit, the well-known wearable fitness tracker, all have in common? They are all examples of human-centered design, and now increasingly we, working in public health, are wanting a piece of the action; to use human-centered design to better understand our populations and to develop interventions in collaboration with the people we are serving. But what is human-centered design? The term human-centered design, also known as design thinking or user-centered design, has evolved over time, and originated in the fields of ergonomics, computer science, and artificial intelligence. In essence, it's a framework that comes up with solutions by involving the human perspective throughout the problem-solving process. The human involvement usually takes place through observing the problem within context, interviewing the community that would be affected by the outcome of the design process, and designing in collaboration with the people that one is serving. Together, this results in solutions that closely correspond with the needs of the target group. The approach has a high tolerance for both ambiguity and failure. It shares some characteristics with other methods used to design programs, such as traditional socio-behavioral research, but tends to be more nimble, flexible, iterative, and less protocol-driven. In the field of public health, human-centered design is increasingly being used during intervention development, and sometimes implementation, to design innovative solutions to complex public health problems. For example, I've worked on an initiative called Adolescents 360 in Ethiopia, Nigeria, and Tanzania. We used human-centered design to develop country-specific and adolescent-focused reproductive health programs to increase the use of modern contraception in adolescent girls. I will use this as a case study to walk you through the human-centered design process. The human-centered design process has three phases to intervention development; inspiration, ideation, and implementation. Inspiration is all about empathy or trying to step into the shoes of the user. This process is derived from social science research methods such as interviewing and observation, as well as direct participation by community members. In Adolescents 360, the aim was to understand the story behind adolescent girls relatively high fertility rate and low uptake of modern contraception. We recruited and trained young people from the community to conduct field research with our adolescent girls, boys, male partners, parents, community influences, and health providers, to understand their needs and the sexual and reproductive health contexts in which they lived. Field research during the inspiration phase yielded insight specific to each country, which was subsequently grouped into six cross-country themes. An important lesson from our early research was that not only do girls believe contraception prevents pregnancy, but there's widespread belief that contraception causes infertility. Pause the video here to read the quotes and themes from the study. Whilst you do, think about what insights you might find if you conducted similar field research in your own country. In the ideation phase, you attempt to make sense of what has been learned, identify opportunities for design, and conduct an iterative cycle of prototyping possible solutions and strategies. The most promising prototypes are then piloted. In Adolescents 360, we teamed up with young people from the community to generate lots of design ideas based on insights from the inspiration phase. Some of these ideas were developed further into coherent design concepts, and then a number of these were taken to prototyping. In other words, tested out with adolescent girls in the context in which they lived. For example, in Ethiopia, field research identified the aspirations of young married couples are shifting from having large families to providing a higher quality of life for fewer children. Couples often desire joint decision-making in contraceptive use. Yet in reality, knowledge and agencies continue to be a barrier. Therefore, we asked ourselves, how might we create opportunities for couples to learn about contraception and plan for their future? The idea of separate young wives and husbands clubs to learn about family planning was tested. However, the feedback was that husbands prefer to learn together with their wives, and married adolescent girls were indifferent to gender-specific learning platforms. So then the idea evolved into a family planning session for married couples. We found that couples were open to learning about family planning before their first child, but that there was a short window of opportunity when newly married couples were open to discussing together their future plans, which also included family planning. Through an iterative process, a unique solution was finally created called Smart Start. Smart Start links financial health to family planning using straightforward messaging that speaks directly to young couple's immediate needs; planning for their lives and the families that they want. The session is delivered by health extension worker using financial planning as an entry point to engage young newly married couples in planning their futures, positioning contraception as a tool to achieve these goals for stability, as well as to have a family. The last phase of the design process; implementation, includes piloting, monitoring, feedback, and bringing to life a final output that the user values. In the case of Adolescents 360, implementation at scale involved a further optimization period, where the selected solutions in each country were further modified to maximize scalability and affordability. Monitoring data were collected to inform how best to continually adapt the interventions for optimal fit amidst diverse local and health systems contexts. Therefore, there was a process of continuous quality improvement to enable the program to adapt to adolescent girls' and local health systems actors' needs. So you should now have a better idea of what is human-centered design, and how it can be applied to public health programming. As you've previously learned, participatory approaches can be defined in relation to ways of doing, knowing, and changing. As an approach, human-centered design can be about all three. I'll leave you with some questions, though. How participatory do you think the human-centered design process was for Adolescents 360 based on these key principles?
