Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya

Abstract

Background: Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs. Methods: We created a Design Team of health professionals, patients, microfinance officers, community health workers, and village leaders. Over 6 weeks, the Design Team utilized a four-step approach of synthesis, idea generation, prototyping, and creation to develop an integrated microfinance-group medical visit model for NCD. We tested the intervention with a 6-month pilot and conducted a feasibility evaluation using focus group discussions with pilot participants and community members. Results: Using human-centered design methodology, we designed a model for NCD delivery that consisted of microfinance coupled with monthly group medical visits led by a community health educator and a rural clinician. Benefits of the intervention included medication availability, financial resources, peer support, and reduced caregiver burden. Critical concerns elicited through iterative feedback informed subsequent modifications that resulted in an intervention model tailored to the local context.

Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

“…Our design team used a cocreation approach, in which participants represented end-users of the implementation strategy (not an external design thinking team). As has been described in prior studies in this setting, co-creation adds contextual insights not only to design products but also to implementation processes by building partnerships with local stakeholders (18,37).…”

“…The STRENGTHS project ultimately aims to improve referral networks and coordination of hypertension care using a combination of peer-based support and health information technology (HIT) (16). HCD is increasingly applied to implementation research, and we have successfully used this approach in previous studies (17,18). Here, we report on the process of developing and evaluating the STRENGTHS implementation strategy in western Kenya through an HCD approach prior to implementation in a cluster-randomized controlled trial.…”

Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya

“…In particular, the anticipated social network benefit of GMV could synergistically interact with the economic benefit of MF to further enhance both health and financial outcomes, beyond what might be possible with each component individually. Given that this qualitative inquiry was the formative component of a larger implementation research trial [ 12 ], we have been vigilant to incorporate the findings from this inquiry into the design of the BIGPIC intervention using a stakeholder-based, human-centered design process [ 31 ]. At the same time, we recognize that our planned intervention will not be able to fully solve all of the potential issues, such as poverty and lack of health insurance.…”

Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

“…Participants in general felt that, despite the barriers presented by stigma, skepticism, and socio-economic fragility, the combination of GMV and MF could potentially address those barriers and be successful despite those factors. Given that this qualitative inquiry was the formative component of a larger implementation research trial (12), we have been vigilant to incorporate the ndings from this inquiry into the design of the BIGPIC intervention using a stakeholder-based, human-centered design process (32). At the same time, we recognize that our planned intervention will not be able to fully solve all of the potential issues, such as poverty and lack of health insurance.…”