Human-Centered Design

Human-centered design (HCD) is an approach to aligning innovation development with the needs of the people and settings that use those innovations.

HCD’s focus on the lived experiences of people who interact with or are affected by products and services is well-suited for the development or redesign of evidence-based programs, practices, and policies (EBPs). HCD offers methods for engaging individuals and communities, helping to learn how to better design care experiences or the products and services necessary to support those care interactions (Chen et al., Dopp et al., Lyon et al., Lyon et al.).

Diverse definitions and applications of HCD reflect the numerous fields that have contributed to its evolution. Broadly, HCD is an approach to creating compelling, intuitive, adoptable, and engaging products, systems, and services (Giacomin). HCD’s origins are linked with human factors engineering, human-computer interaction (HCI), and user-centered design (UCD). These three fields borrow from traditions of cognitive science and social and organizational psychology (Lyon et al.) to characterize interactions between individuals/communities and designs, especially in the context of digital technologies. While HCD’s origins are rooted in technology, it has been used beyond digital technologies to address therapeutic elements and implementation supports (Lyon et al.). HCD has been applied to improve usability, reduce burden, and increase the contextual appropriateness of clinical interventions and implementation strategies (Lyon et al., Lyon et al., Alexopoulos et al., Lyon et al., Mohr et al.) 

Design work has also been popularized by the related concept of design thinking, a framework that conceptualizes design as a broad mindset and is commonly applied to social impact issues, including in public health (Chen et al.), with mixed evidence for impact (Fayard et al.). HCI, UCD, and design thinking are part of an umbrella of design concepts and communities that have been increasingly applied in health research. At the UW ALACRITY Center, we believe an inclusive definition of HCD is advantageous when seeking to design technologies, interventions, and services in public health based on an assessment of user needs and contextual fit.

What is the relationship between HCD and implementation science?

HCD and implementation science (IS) share common objectives and offer complementary methods that can support clinical interventions and implementation strategies innovation and redesign (Lyon et al., Dopp et al., Dopp et al., Chen et al). HCD’s focus on considering multiple perspectives, engaging with affected individuals and communities, and iteratively improving innovation-context fit is well-matched to the goals of IS.

HCD and IS have many similarities, including a focus not just on content of health interventions but also on their delivery mechanisms, engagement with end-users and other closely affected people, and recognition of the importance of context. Specifically, HCD methods can be used to assess implementation determinants (e.g., by identifying and prioritizing determinants across individuals, populations, policies, and systems), tailor strategies to improve their ease of use and usefulness, and evaluate implementation mechanisms and outcomes (especially usability, a unique construct from HCD; see below) (Lyon et al.). Discovery-oriented HCD work can help inform and operationalize implementation strategies (Chen et al.). There are also more general opportunities to explore the alignment and integration of HCD and IS techniques (Dopp et al.). Most of the work at the intersection of HCD and IS has been unidirectional, seeking to integrate HCD into implementation research and practice initiatives, with little work explicitly focused on the potential benefits of IS for HCD. The table below compares HCD & HCI to IS.

Dimensions	HCD/HCI	Implementation Science
Scale	Single system/platform as element of systems	Multi-system/multi-level
Focus	Innovation & impact, including adaptation and scale	Strategies to facilitate translation to practice; Adaptation and tailoring of evidence-based approaches to context
Participants	Primary users, secondary users, other immediately affected people	Multi-level, including policymakers, organizational leaders, service providers, and/or service recipients
Goals	Increase engagement & proximal effects	Implementation and service outcomes
Duration	Short to intermediate	Long term (sustainment)
Research approach	Discovery, process oriented with a focus on user-centered and participatory methods	Ultimately hypothesis driven (often following early formative work), outcomes oriented, validation
Theory	Theory from many fields. Model-building to explain use and context; design patterns for describing transferable approaches to addressing problems	“Classic” theories drawn from psychology, sociology, and organizational theory (Per Nilsen); Frameworks for understanding possible factors affecting implementation and strategies for addressing those; Development of implementation-specific theories

What methods are used in HCD?

HCD draws on a wide range of methods, some of which are novel and others of which reflect adaptations of familiar methods. Some methods are borrowed from other fields, and methods adaptation is not unique to HCD. Consequently, it is challenging—and often inappropriate—to claim specific approaches as “HCD methods.”

Methods such as interviews, focus groups, literature reviews, field observation, and surveys are already widely used in public health; however, in HCD, these methods are typically carried out with the ultimate goal of making better design decisions (Holtzblatt et al.). For example, interviews are frequently used as part of formative research to better understand behaviors and needs related to a design problem. Interviews can also be used as part of prototyping and are commonly coupled with other methods as part of usability testing (Lyon et al.).

Other HCD methods may be less commonly used in health research. For instance, prototyping is the creation of a preliminary version of an innovation or artifact to help answer questions. Prototyping aligns with HCD’s emphasis on rapid iteration and embracing of failure by detecting design solution shortcomings early to inform subsequent iterations. These prototypes may help assess role (what something does), implementation (how it will be made or how it will work), or look and feel (surface-level design details) (Houde & Hill). Some prototypes may be intended as tests of an idea that the team hopes will advance toward realization. Others may be idea that the design team never intends to advance toward realization, but instead present to people to learn their reactions as part of formative research.

Additional resources on design methods and techniques:

• The application of human-centered design approaches in health research and innovation: a narrative review of current practices. 2021. I Göttgens, S Oertelt-Prigione. 
• A glossary of user-centered design strategies for implementation experts. 2019. AR Dopp, KE Parisi, SA Munson, AR Lyon.
• Universal Methods of Design Expanded and Revised: 125 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions. 2019. B. Hanington B, B. Martin B.
• The person-based approach to intervention development: Application to digital health-related behavior change interventions. 2015. Lucy Yardley, Leanne Morrison, Katherine Bradbury, and Ingrid Muller.

Usability

• UW ALACRITY Center Guide to Usability
• Measuring the user experience: Collecting, analyzing, and presenting UX metrics. 2022. B Albert, T Tullis.
• Handbook of usability testing: How to plan, design, and conduct effective tests. 2008. J Rubin, D. Chisnell.

Co-Design

• Beyond Sticky Notes. 2020. KA McKercher.

Service Design

• This is Service Design Methods. 2018. M Stickdorn, ME Hormess, A Lawrence, J Schneider.

How can I assess my use of HCD?

We offer the following self-assessment questions for teams to evaluate their use of HCD. These questions are focused on appropriate use of HCD and effective use of resources.

Questions to assess an HCD process in health	Example approaches
Are you sharing decision-making (and associated resources) with the people who will use the system?	Many teams use community-engaged methods, and there is a broad spectrum from community informed (e.g., solely data collection) to community led (e.g., selecting and applying methods), with different points on that spectrum fitting some projects better than others (Harrington et al., Key et al.) If your work focuses on a specific direction, does the process have off-ramps or stopping points if you hear that it is not wanted (Baumer et al.) or realize it may do more harm than good?
Are you exploring multiple points in the design space?	Prototype multiple possible solutions rather than a single preordained solution or direction (e.g., an app). Make sure your approach includes opportunities to disconfirm the design team’s assumptions or beliefs about what is needed or what will work
Are you intervening at the desired scale/scope?	Challenge design teams to consider upstream interventions for greater impact (Veinot et al., Williams et al.), which is a strength of the public health field. For example, are there community-level interventions that might work better or more equitably than individual-level interventions? Ensure that any individual-level interventions or design solutions fit within broader levels of health and prevention.
Might your product generate or reinforce inequities or otherwise cause harm?	Ensure representative recruitment and/or over-recruit from historically marginalized communities. Explicitly consider unintended consequences of a design solution (e.g., systems that collect personal health data in ways that expose people to inappropriate data sharing, such as through data brokers or government access (Malki et al.). Disaggregate results by demographics and examine disparate experiences with designs and/or impacts. Track unintended consequences.
Are you using your resources efficiently and effectively?	Consider mixing and adapting different user research and design approaches to best engage participants, inform your design process, and triangulate across data sources. Review each planned design activity with a focus on how it will help the team make design decisions to determine whether it is essential. Ensure your design process has flexibility to adjust iterations and participants based on what you learn (e.g., to pause and adapt if you are hearing the same thing repeatedly).

Learn more

• Human Centered Design in Research Proposals
• UWAC maintains a spreadsheet of online and in-person training opportunities. Please reach out through our Contact Us form to request a copy of the spreadsheet.