The following six principles are intended as reminders when investigating and responding to the human challenges facing health programmes. They are grounded in what we know to be true about human behaviour and can improve the effectiveness of our efforts.
We have a tendency to overlook the small stuff, like the inconvenient barriers of dealing with health programmes. Because people don’t always make reasoned calculations weighing costs and benefits, the small stuff can dominate decision-making.
Most people, most of the time, are not thinking about best health practices. And when they are, it’s not always (or often) given very deep reflection. If we remind ourselves that most people spend little time thinking about vaccination, we will ask less of users and make our programmes simpler, and easier to use.
One of the more common terms in public health is ‘behaviour change’. A singular focus on behaviour change can be misleading. Changing the context in which people behave often has more powerful implications for ‘behaviour change’ than directly asking that people change their behaviour.
Knowing about a technology, how treatments work, or having an accurate understanding of a health benefit does not necessarily correlate to high levels of participation. When we accept that it is possible to alter behaviour without ever changing what is in someone’s mind, we open ourselves to more innovative solutions.
What people believe, say and do can be three different things. How we explain our own behaviour is not always accurate. This makes it critical to disentangle what people self-report about their behaviours from what is actually happening.
Intentions can be poor predictors of corresponding actions. Instead, we should focus on what it takes to get caregivers and health-care workers to act. Behaviour depends as much (if not more) on removing the barriers to taking action as it does on forming intentions.
While input from many parties is important, it can lead to a slow process. There are moments—like brainstorming— where you will invite additional participants to join. But start with a core team of three to five members that will participate in the entire process.
This process plays off everyone’s creativity, not just those who hold
“design” positions. Everyone is familiar with the challenges and therefore capable of thinking about causes and designing solutions.
Mock-ups, sketches and role play give users a physical representation to experience and react to. Even a rough approximation of your idea will create clarity for you as the creator and allow for realistic feedback from users.
Work fast and be nimble. This entire process may be completed in a short amount of time. It should never drag on for months. Trust your intuition, you know what you’re doing.
Since this process occurs in short sprints, it encourages experimental trials that may not always work out. That is okay—instead of agonizing over the perfect solution, try many possibilities and learn just as much from what does not work as from what does.
Regardless of formal training, you are capable of leaving your desk and going into the field to observe and investigate challenges. Go to where the problem is, interview health-care workers and observe caregivers.
Facts are important, but stories make facts memorable. Share your stories from the field. Whom did you meet? What did you see? How did you see it in a new way?
Ideally, each team member holds a different role so your team
has diverse and complementary perspectives. Consider team members’ breadth of experiences, not just varied titles and functions.
This process encourages Post-It use, because they allow for many possibilities instead of “the perfect” answer, lend themselves to collaboration (everyone can contribute ideas), and force you to distill your thoughts (one per square).
This field guide introduces human-centred design as an approach to addressing challenges related to community demand for basic health services like immunization. Human-centred design is a problem-solving process that begins with understanding the “human factors” and context surrounding a challenge and works directly with users—the intended clients or consumers of services—to develop solutions that are viable and appropriate in a given context. Designing for people and their everyday interactions helps uncover and solve the right problems using local capacities and resources.
No expert has more knowledge than a caregiver, nurse, or a community health worker about how to solve their most pressing problems. The methodologies in this toolkit acknowledge this by focusing on collaboration and designing with—not for—the people we seek to serve. Human-centred design works to uncover latent needs that service providers and programme recipients may not even know they have before the process begins. The approach is “bottom up” in the sense that both problems and solutions are defined and developed locally, not imposed from elsewhere.
While this guide primarily focuses on issues and examples related to immunization, the process and tools are relevant to a broad range of health programmes that depend on generating community demand for services. Please adapt and deploy this approach for your own programme priorities.