Bridging the Gap: from Theoretical Capacity Building to Practical Application
Human-Centered Design (HCD) is becoming a more mainstream practice in health programming, particularly because of the approach to co-creating with program participants. This integration of HCD presents a complex mix of challenges and opportunities. Ambiguities arise in the practical application of the methodology, highlighting disparities between the theoretical possibilities outlined in the literature and the actual feasibility on the ground, especially in the Global South.
The HCDExchange and JSI’s USAID Advancing Nutrition (UAN) collaborated on a learning engagement to document learnings from integrating HCD methodology into UAN’s SBC approach. We held two Learning Circles where we aimed to create an open space for reflection and sharing on how to create and manage an integrated HCD project. These discussions aimed to be exploratory, and both retrospective and forward-looking, where participants drew on their experiences from the UAN activity and other similar projects to think ahead about how practitioners can improve these practices moving forward. Read the reflections from the first Learning Circle on pivoting and failing fast.
In this second learning circle, we brought together public health professionals, researchers, and HCD designers to shed light on the nuances and complexities surrounding the adoption and application of HCD by implementation teams who may have a theoretical or minimal practical understanding of the methodology. Insights were crafted from this discussion to paint a picture of the realities and best practices for bridging the gap between the theory and practice of HCD, especially in the context of a Social Behavior Change (SBC) program. Below are the major themes and key insights uncovered:
Value of HCD to SBC Programming
HCD helps to assess problems with a new lens and adapt existing solutions to fit the needs and wants of users. From the outset, participants in the learning circle were curious about how HCD could result in positive outcomes. They were looking for new ways to solve long-standing problems that other approaches had not solved effectively.
HCD goes deeper with stakeholder engagement. There was a sense of enthusiasm and interest surrounding the HCD approach due to its participatory nature: systematic engagement of stakeholders from inception to conclusion, fostering a collaborative environment conducive to innovation and co-creation.
One thing that I think is really special and useful about the HCD process is that the whole group of stakeholders is involved from start to finish, and I think that is different than other participatory methods.
HCD can be a mechanism for finding the balance between the lived experiences of program participants and the technical expertise of researchers and implementers. The methodology establishes a unique way of blending these elements because of the way that users are engaged in co-design consistently throughout the process. The depth of understanding and empathizing with program participants equips implementers with a holistic perspective while ensuring that solutions resonate with user needs while being technically sound.
It kind of balances the technical expertise — which I do still think is extremely important; we know that there are positive practices, that research matters – but balancing that with lived experience and with user expertise, because we also know best what works in our own lives.
Challenges
HCD ‘jargon’ can present a barrier to understanding and adopting HCD. Implementers found themselves grappling with design terminology, making the process feel inaccessible. Designers are therefore encouraged to communicate using accessible language, explaining and demystifying HCD concepts, and aligning on terminology that might hold different meanings across different sectors. This alignment serves as the cornerstone for effective collaboration and mitigating misunderstandings.
[One thing] that I struggled a bit with was a whole new set of terminology and that I had to get my head around. Like the ‘ideation’; [it’s] easy to understand once you know that it’s really a simple process of developing the different ideas to solve the challenge that you’re facing. So it was all this getting familiar with all this new language and looking at how this would all result in a product.
I was interested in finding out what we would get from the research, and how [HCD] would add value to what we were already doing. I think what I call most difficult was coming from a kind of science-oriented way of thinking. Taking away your expert cap can be quite difficult when introducing HCD [into a project].
In theory, in [HCD] you should be totally open to whatever the outcome is from your design research, and whatever solution is pointing you to. But what I found in practice, is that there are a lot of stakeholders with different interests who already have an idea of what they want the solution to be, and it’s very difficult, when you get into the practice side, to actually dislodge those preconceptions.
Not having a clear idea of what was going to come or how it was going to come about until you were doing it made developing a timeline difficult [and] sharing what a process would look like [also] a little bit difficult, especially when introducing new tools. It would be really advantageous to develop plans for research like this, where implementing partners do have specific resources carved out to participate in the work in a more active and engaged way.
It’s very hard for [implementing partners] to forget about the product that they already built, that they put in their time and effort into.
Overcoming Challenges and Gaining Buy-in
The discussants shared how they managed to mitigate and overcome challenges, leading to buy-in to the HCD methodology across the project teams and the resulting adaptations. There is a need to increase active involvement of implementing partners. Overall, successful implementation required frequent communication and transparency from the design team, and active involvement of implementers in key activities and decisions. This level of engagement helped to foster both buy-in and a sense of ownership and commitment to the HCD process while addressing the feeling of having their work challenged by new approaches.
Trust in the process, and try to engage [implementing partners] in many key activities, as much as possible is the way that we could get buy-in from multiple stakeholders. [The designers] coming to be with us, taking us through the ideation process as part of the central design team, it now became clear… that it was now a matter of adaptation to what we are already doing in our programming.
Learning by doing is really key in the HCD process because it is something you have to kind of experience to really understand how it works.
I think one thing in hindsight that could have helped was maybe early on kind of having an opportunity to hear from other development practitioners who have used HCD in the development world setting or public health programming and learning just a little bit about their experiences. It was great to get all the theoretical information at the start, and the training but it’s always good to kind of hear from someone who has walked the walk.
Bridging the Gap
The integration of HCD into public health and other development initiatives demands a delicate balance of comprehension, collaboration, and a shift in mindset. Fostering alignment across expectations and terminology, and actively involving stakeholders paves the way for a transformative journey, enabling the creation of user-centric solutions that address long-standing challenges faced by communities.
These are the key steps to consider when planning and implementing an HCD-integrated program:
Project Planning
- Allocate resources for members of the implementation team and researchers to engage in the design activities.
- Collaboratively develop a work plan with the design team to allocate sufficient time for the design process and activities.
- Allocate time in the work plan for orienting implementing partners and researchers on the design process and terminology, and practical HCD training.
- Share relevant examples (eg.: case studies, reports) from other health practitioners and programs to help implementing partners and researchers understand how peers have utilized and benefited from HCD.
Project Implementation
- Engage program participants throughout the process
- Establish frequent communication touchpoints between all stakeholders and actors
- Include implementing partners in design activities to gain hands-on experience with the process
- Challenge assumptions and be mindful of the “expert” hat to create an open mindset for co-creation with program participants
Resources
Key resources for building a work plan for an HCD-integrated program:
- Workflow for High-Quality Nutrition Social and Behavior Change
- Nutrition SBC Work Plan Checklist
- Quality & Standards Framework
Key resources for documentation: