What do people really care about? It might not be what you take for granted

One of the most interesting lessons about design I’ve learned is that what people care about is often not what you think they care about. Let me illustrate using these three examples:

Example 1: When it comes to hospitals, young people value “hip” over “quality”

The values that guide people’s decision-making are constantly changing. What was considered high quality care 50 years ago is significantly different than what people value today. In a panel on healthcare hosted by Smart Design, one of the panelists told a story of how young people would rather go to a hospital with a nice lounge and a sleek flat-screen TV rather than a more established hospital that’s known to provide better medical care.

If you have built your 30-year career in the hospital environment and are now tasked with the goal of putting your hospital on the top of the charts, it is totally understandable why you might think

“why would any rational person in the right mind forego better care?”

The more knowledge and experience you have in a particular field, the more you need to be careful how your views might be biased. You might feel uncomfortable letting go of what you know, but if you can see how regular people have different values and priorities from you, you are that much more likely to speak in their language and convince them to use your service.

Doctor, Who? Smart Salon @ Smart Design NYC || July 28, 2015

Example 2: Malaria-preventing mosquito nets are not being used to fight malaria

Almost 1 million people are killed by Malaria annually. (source)

Malaria is transmitted through mosquitos. World Health Organization say that using mosquito nets can reduce child mortality in malarial regions by 20%. But even as millions of mosquito nets roll into warehouses across Africa, in some places nearly half of Africans who have access to the nets refuse to sleep under them.

This following blurb, extracted from this article, sums it up nicely.

The treated nets were not designed with the cultural preferences of the rural African villager in mind. Among other design flaws, their tight mesh blocks ventilation, a serious problem in the hot, humid places where malaria roosts. Minor discomfort might be tolerable in rural African communities desperate for anti-malarial prevention. But, as medical anthropologists have consistently found, because malaria is so common in much of sub-Saharan Africa, and because the overwhelming majority of cases go away on their own, most rural Africans consider malaria a minor ailment, the way that Westerners might think of the cold or flu. Many rural people also believe that malaria is caused not just by mosquitoes but also by other factors such as mangoes, or hard work.
The nets are like magic bullets in rural Africa; they save millions of lives by protecting people from malaria-carrying mosquitoes.

If the donors of the mosquito nets couldn’t predict their donations to go unused, there would’ve been no way for them to imagine what the nets were used for instead.

Out here on the endless swamps, a harsh truth has been passed down from generation to generation: There is no fear but the fear of hunger.
[Mosquito nets] arrive by the truckload in poor, waterside communities where people have been trying to scrape by with substandard fishing gear for as long as anyone can remember. All of a sudden, there are light, soft, surprisingly strong nets — for free. Many people said it would be foolish not to use them for fishing.
The unsparing mesh, with holes smaller than mosquitoes, traps much more life than traditional fishing nets do. Scientists say that could imperil already stressed fish populations, a critical food source for millions of the world’s poorest people.
Many of these insecticide-treated nets are dragged through the same lakes and rivers people drink from, raising concerns about toxins.

Example 3: What could outweigh AIDS?

25 million people are infected with AIDS.

So AIDS is a sexually transmitted infection, and it kills you. So this means that in a place with a lot of AIDS, there’s a really significant cost of sex. If you’re an uninfected man living in Botswana, where the HIV rate is 30 percent, if you have one more partner this year — a long-term partner, girlfriend, mistress — your chance of dying in 10 years increases by three percentage points.

If you live in a developed country and the probability of you dying in 10 years increases by three percentage points for every additional sexual partner you have this year, chances are you‘d rather skip out on having sex with more people — it just ain’t worth it.

If you want to understand why people in Uganda choose to have more sex partners despite the deathly costs, it may be helpful, as economist Emily Oster explains in her TED Talk, to

think about health the way than an economist does — as an investment.
Every time you have a carrot instead of a cookie, every time you go to the gym instead of going to the movies, that’s a costly investment in your health. But how much you want to invest is going to depend on how much longer you expect to live in the future, even if you don’t make those investments. AIDS is the same kind of thing. It’s costly to avoid AIDS. People really like to have sex. But, you know, it has a benefit in terms of future longevity. But life expectancy in Africa, even without AIDS, is really, really low: 40 or 50 years in a lot of places. I think it’s possible, if we think about that intuition, and think about that fact, that maybe that explains some of this low behavior change.

Lesson: design for the multi-facted kind of human we all are // Ask, test, iterate

People’s lives are complex and multi-faceted. Next time when you are asked with solving a problem, ask yourself: is this the only thing that people care about? (The answer is most likely a “no”) If not, then what in the lives of these people do they really care about? How might you tackle the particular problem you are facing with an approach that’s aligned what people’s priorities and values?

Another lesson that we can take away from these examples is that the way people see the world, especially those in developing countries, can be vastly different than how you see the world. When you think you know the answer to an “obvious” question, be a little cautious — things may not be as obvious as you think.

The sad truth is that some of the (hugely) costly failures in these examples could’ve been easily prevented had the people in charge developed a deeper understanding of people they were designing for, pilot-tested their solutions first, and iterated their way to a more human-centered solution.