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.

Conclusions: Contextualized interventions are important in settings with multiple barriers to care. We demonstrate the use of HCD to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya. HCD can be used as a framework to engage local stakeholders to optimize intervention design and implementation. This approach can facilitate the development of contextually relevant interventions in other low-resource settings.

Trial registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015.

Keywords: Delivery of healthcare; Human-centered design; Kenya; Microfinance; Non-communicable diseases; Problem-solving.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Human-centered design stages and activities in the BIGPIC design process. Steps 1–4 describe each stage of our project in the context of the HCD steps (Discover, Design, Test, and Refine). As HCD is an iterative process, the arrows describe how the results of each step impact the next

Fig. 2

BIGPIC design team members

Fig. 3

Format of BIGPIC design team meetings

Fig. 4

Benefits and Concerns related to the BIGPIC model

Fig. 5

The BIGPIC model. The final BIGPIC intervention consists of an integrated group care and microfinance model. In this figure, the surrounding circles represent the unique milieu that has informed BIGPIC’s development. These include community strengths (green text), barriers to care (red text), and concerns regarding the BIGPIC model (blue text) elicited from community and pilot participant feedback, as described in Fig. 1 (Steps 1, 3, and 4). The surrounding descriptors in black text are key features and implementation strategies of the BIGPIC model. Each can be mapped to a community-driven strength, barrier, or concern. The text highlighted in yellow represents changes that were made during the Design Team Re-evaluation (Fig. 1, Step 4) in response to participant feedback

Fig. 6

Key themes were organized together to stimulate idea generation