Centering Communities in Global Health: Using Human-Centered Design to Facilitate Collaboration and Intervention Development

Abstract

Background: Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development.

Purpose: The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi.

Research design and study sample: A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights.

Data collection: In the study's initial "discovery" phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second "design" phase, the Community Design Team crafted interventions to address harms associated with chhaupadi.

Results: Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants' literacy levels and engagement preferences, whether through group or individual activities.

Conclusions: Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.

Keywords: Nepal; community-engaged research; human-centered design; intervention development; menstrual health; menstruation; participatory methods; women's health.

Figure 1.

The diverge-converge diagram guides the HCD co-design process, from diverging ideas in phase 1 (top) to converging ideas in phase 2 (bottom).

Figure 2.

A trained HCD facilitator led the community design team members in a Stakeholder Mapping exercise, in which they brainstormed as a group to create a stakeholder map.

Figure 3.

One of the facilitators led a participant in a Walk-a-mile Immersion activity, with the support of a photographer and notetaker to better understand the lived experiences of women practicing chhaupadi.

Figure 4.

One of the facilitators supported pre-literate participants in capturing their thoughts for the Experience Diagramming activity. Post-it notes on the top were aspects of the practice that they considered positive, those at the bottom were considered negative, and those along the center line were consider neutral.

Figure 5.

One of the community design team members places a voting token on her favorite intervention idea during Visualize the Vote.

Figure 6.

One of the facilitators probes and supports one of the participants in filling up her Concept Poster.