Engaging communities to advance healthcare through human-centered design
A Q&A with Purdue’s Natalia Rodriguez
Human-centered design (HCD) is a comprehensive approach to problem solving that focuses on the specific needs and wants of people from the beginning to the end of the design process. In biomedical engineering and health technology, HCD is a way to meaningfully engage end users to generate innovative solutions to a particular challenge. It involves working together to create a product that will meet real-world needs, and that people will be willing and able to use.
Technological innovation, especially in health, is growing at an unprecedented pace. But the uptake and adoption of these technologies varies dramatically across different contexts, and can be problematic in low-resource settings where it could provide the greatest benefit.
If you think about it, technological innovation can make health disparities worse, because it improves healthcare in high-resource environments while often leaving others even further behind. HCD is important because it helps us understand the perspective and context of end users so we can design technologies that are acceptable; usable; appropriate (culturally, socially, economically); and likely to be adopted by the people who need them most.
One of the best-known examples of HCD is user experience, or UX, design, which companies like Apple employ to improve the ease of use and appeal of their products. They’ve obviously had huge success in their approach. The health technology industry is way behind in this area.
How does HCD differ from traditional approaches?
Traditionally, in biomedical engineering, we design technologies to address needs defined by the academic literature or what we learn from our clinical partners, and based on what we know to be technically and scientifically feasible. This approach often results in many brilliant innovations never actually making it to people. We call this the “implementation gap.”
Human-centered designers believe that the people who face particular challenges every day best understand those challenges, and therefore hold the key to their solution. An HCD approach typically begins with observing a specific context or community, as well as talking to people in that context about their needs and how they think those needs should be addressed.
Then we come up with ideas together. Engineers take those ideas and design a first draft, or prototype, of the technology; take it to the users for their feedback; and then use that feedback to make it better. The whole process repeats until we get it right, meaning the technology meets all of the functional and context-specific user requirements.
In public health, we often take a similar approach to designing health interventions with communities with poor health outcomes. The process of engaging community members to define their own priorities and the best ways to understand and address their specific health needs is called community-based participatory research, or CBPR. In tandem with HCD, CBPR can help us design the best ways to deliver and implement health technologies in these communities.
CBPR helps answer questions like these: Where, how and by whom can the technology be used to maximize its impact on health? How will health behaviors change as a result of introducing the technology? Which barriers to health could this technology help overcome? What new problems could this technology create for the community, and how can we prevent or minimize them?
What are you working on?
My research combines HCD and CBPR. I’m particularly interested in rapid diagnostic tests and the powerful role they could play in reducing health disparities. The most salient example right now is COVID-19 rapid tests. I think the whole world has witnessed the importance of being able to quickly detect whether or not someone has a disease.
One of my CBPR projects is in partnership with a community-based organization that serves people experiencing homelessness in Tippecanoe County, Indiana. Imagine how difficult it was for homeless shelters to keep everyone safe while having to wait two to three days to get test results back during the height of the pandemic. It was impossible, and led to several shutdowns and service disruptions for people who were already extremely vulnerable.
It was also very difficult for shelter staff to persuade homeless individuals to agree to be tested in the first place, much less enforce mask wearing or social distancing. So, we hired and trained community health workers to provide education and conduct rapid COVID testing at the shelter. It’s been a game changer.
In another project, I’m linking HCD and CBPR to inform the development of a rapid test for human papillomavirus (HPV), the virus that causes cervical cancer. We are trying to improve HPV screening for a Hispanic community in Lake County, Indiana, that has the highest cervical cancer rates in the state. This is a preventable disease that is easily treatable if we catch it early. No one should be dying from it.
We are engaging many different stakeholders — doctors, nurses, community health workers, patients, cultural leaders, church leaders, policy makers, you name them — to understand what this test should look like, where and by whom it should be administered, and what kind of education needs to go along with its introduction to maximize its impact.
If we could design the test to make it easy enough for a community health worker to use, and if she could go door to door educating women on cervical cancer and testing them on the spot, it could be a major breakthrough for cervical cancer screening.
How does your work fit into WHO’s strategy around cervical cancer?
We see this as part of the World Health Organization’s global strategy to accelerate the elimination of cervical cancer — a global call to action that recognizes that this is the one cancer the world can actually eliminate, and the time to do it is now. The strategy aims, in WHO’s words, “for all countries to achieve 90% human papillomavirus [HPV] vaccination coverage, 70% HPV screening coverage with a high-performance test, and 90% access to treatment for cervical pre-cancer and cancer by 2030.”
If we’re going to get there, we can’t just keep doing what we’ve been doing. We need to innovate in designing new tools, and finding better ways of delivering and implementing these tools. That’s what my team is trying to do, and HCD and CBPR are powerful ways to do it.
Who are you working with?
I’ve been very lucky to find amazing community partners — like the LTHC Homeless Services, the Indiana Community Health Workers Association, HealthLinc community health center, and Planned Parenthood. I also have outstanding collaborators at Purdue — in both the Weldon School of Biomedical Engineering (Jackie Linnes), and the Department of Public Health in the College of Health and Human Sciences (Yumary Ruiz and Monica Kasting).
The cervical cancer project is funded by the National Cancer Institute at the National Institutes of Health (NIH). The COVID-19 project is funded by the Indiana Clinical and Translational Sciences Institute, the United Way of Greater Lafayette, and Purdue’s College of Health and Human Sciences.
What’s the future of HCD and community-engaged approaches?
I think the world has realized — or is quickly realizing — that in medicine, technological innovation alone is rarely the answer. This past year has laid bare the vast inequities that exist in our world, and emphasized the need to engage and empower marginalized populations. The growing commitment to community engagement is now reflected in many major federal initiatives, including clinical and translational science programs as well as minority health and disparities research funding.
For example, the NIH recently launched an initiative that I’m particularly excited about, called the Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) program. These types of initiatives create opportunities for interdisciplinary teams to come together to figure out both the technological and social aspects of using innovative diagnostic tools to address health disparities.
HCD and CBPR allow us to do both of these things simultaneously, while also empowering and uplifting the voices of the underserved. So, I’m very hopeful for the future of engineering in public health, and super excited to be part of this movement.
Natalia Rodriguez, PhD, MPH
Assistant Professor, Weldon School of Biomedical Engineering, College of Eng.
Dept. of Public Health, College of Health & Human Sciences
Member, Purdue Engineering Initiative in Engineering-Medicine
Purdue University
Related Links
Purdue Engineering Initiative in Engineering-Medicine
Purdue Engineering Rising to the Challenge webinar: “Engineering Health Access”
Health Techquity Lab (Rodriguez Lab)
