This was intended to be an article published in UC Berkeley’s Public Health Advocate magazine. However, publication was halted due to the Coronavirus pandemic. I still wanted to publish the article somewhere, so it appears here in a near-finished form.
Senior Lorraine Pereira is grappling with a difficult problem. Bitmark, a digital rights organization, approached Pereira and her team of Fung Fellows to help create a trust of individual data other organizations could use for research purposes. Especially in light of recent scandals related to digital privacy, people may be reluctant to give up their data, even if it is anonymized and supports well-intentioned academics. How can we empower individuals to take ownership of data in the Information Age when most of what happens to it is outside of our control? This reason was one of many that lead the team to center the user while they started brainstorming solutions.
“We wanted to get people excited about wanting to take ownership of their data,” Pereira says. “We brainstormed how to present consent and ownership [to college students specifically] in an exciting way.” While background research in areas such as behavioral understanding is often used in program creation, Pereira explained that the team wanted to design an effective program rooted in democracy, partnership, and equity. To accomplish this goal, they turned to human-centered design.
Defining Human-Centered Design
Human-centered design emerged when creators realized centering users in the product design process lead to a host of positive impacts, including safety, user satisfaction, and productivity. Although many people think HCD is largely limited to the product development space, there’s a large overlap between the underlying motivations and values behind both human-centered design and public health. It’s becoming increasingly more common for both public health and design organizations to capitalize on this synergy.
Warren Lai, a senior in the undergraduate-run student design consultancy Berkeley Innovation, explains that HCD is built on understanding the people you’re designing for. Many development techniques are centered around pragmatism or optimization, focusing on improving a product’s efficiency or technological capabilities rather than making the product itself more usable. In The Design of Everyday Things, Don Norman illustrates the significance of user-friendliness in his autopsy of the Three-Mile Island nuclear power plant accident: failures attributed to “human error” could have been prevented through a more intuitive control room design and emergency protocol.
“Error was inevitable,” he writes. “Design was at fault, not the operators.” Human-centered design, like public health, is preventive, anticipating the challenges users will face. Centering the user experience makes space for empathy in the product creation process that gives designers a better understanding of why users need the product and what problems might arise in using it.
The HCD process is especially important when designers are removed from users’ circumstances and identities, and communities. This is often true in public health, where those with the solutions come from different backgrounds than those receiving them. For example, water quality and sanitation interventions that built latrines in rural Bolivia didn’t reach their desired impacts because of a difference in priorities and lifestyles between those building the latrines and those using them: instead of using them for the purposes the designers intended, they used them in a way that made more sense — whether that was to store crops, livestock, or merely as a status symbol. The program designers thought they were building latrines, but instead built storage units that did little, if anything, to improve sanitation outcomes.
A better program design would have incorporated users’ perspectives. In this example, the dissonant perspectives lead to a relatively small misunderstanding. However, this asymmetry could potentially precipitate larger consequences, especially when more privileged groups are the ones administering the intervention. By centering the users’ experience and perspectives, HCD shares power with users and shifts this asymmetry, as those receiving the product are incorporated into the product creation process and have the space to advocate for themselves and their experiences. Additionally, because there’s less ambiguity about what the intended impacts are, success is more likely. The synergy between effectiveness and equity drew the Fung Fellows to use this process while designing a solution for Bitmark.
“[HCD] is a democratic process centered around equal partnerships and involvement of all parties,” concludes Pereira. “It’s not just about the end product.”
Human-Centered Research
Like other public health students, Lorraine Pereira learns about program evaluation and intervention trial design in her classes. Professors constantly probe Pereira and her classmates to question why certain programs or treatments that work in controlled settings but not the “real world”.
HCD allows public health practitioners to maintain a rigorous, data-driven approach to program creation while underscoring equity and collaborative democracy. Dr. Sandra McCoy, an associate professor in residence at UC Berkeley’s School of Public Health, explains that incorporating HCD into the planning process can preemptively address these concerns before the trial happens. Like Norman’s assessment of Three Mile Island’s control room, centering the user while designing a public health intervention can lead to more effective solutions while using less resources and time. Although it can be used to create more successful programs because of “its deep empathy with the user perspective and emphasis on their motivations and behaviors,” Dr. McCoy clarifies that HCD is not a substitution for the scientific method. She maintains that the next step is to rigorously evaluate HCD processes with respect to the intervention through the same epidemiological methods that are used in research.
“Using the design process slows you down and increases cost,” she explains, adding that those incorporating human-centered design in their strategies need to factor in limited resources in designing these interventions. Indeed, McCoy used her epidemiological expertise to assess CyberRwanda, a digital health platform developed by YLabs. In designing CyberRwanda, YLabs, a youth-centered global health organization, collaborated with their users — Rwandan teens — to create a platform for adolescents to access reproductive health information and products. Dr. McCoy and her team measured CyberRwanda’s effect on teen pregnancy rates, access to family planning resources, and HIV testing. Human-centered design and traditional research methods, rather than being separate approaches, are components of an interdisciplinary strategy to improve public health.
Designing Your Education
Last December, Berkeley Innovation partnered with YLabs to deliver a Design for Public Health and Social Good workshop. Students from interdisciplinary backgrounds attended a hands-on session hosted by an epidemiologist and product designer from YLabs. Throughout the work-session, students were encouraged to collaborate and think critically about how design thinking and epidemiology can help mitigate barriers to health equity.
Lai explains that Berkeley Innovation aimed to highlight the collaborative process inherent to HCD and show students from diverse backgrounds that design is more than just the visual end product.
“There’s opportunities in any field to apply [these] principles,” he maintains, “This is especially true when creating products that are directly interfacing with humans.” It is important to see how interdisciplinary knowledge can be applied in practice, and Lai hopes the event was successful in showing students that service design is a real and active field.
While events and workshops are great ways to discover new fields and modes of thinking, there are numerous ways on campus to apply these principles on long-term projects. Pereira explains that the Fung Fellowship is one such experience that combines experimental, project-based learning with interdisciplinary collaboration.
Design for Impact
In the classroom, we’re often constrained to the way things are or have historically been done. Settings like the Fung Fellowship allow students to not only apply theoretical knowledge, but to question it and improve upon it in practice.
For example, working on the Bitmark project led Pereira to question existing methods of consulting individuals for their opinions, such as interviews and ethnographies.
“We need to move away from extractive processes that don’t align with our values,” she explains, “and this is a step towards democracy and democratization of the design process.” To determine how Bitmark should address the idea of data ownership and empowerment, Pereira’s team created an undergraduate advisory board with whom they have ongoing and in-depth communication about consent and what these students would like in exchange for contributing their data.
“We’re getting to know them and making sure they’re enjoying the process,” Pereira explains. “It’s a fun project because it’s like no other user engagement I’ve done so far.”
The Fung Fellows took an approach true to the principles of human-centered design. Instead of prioritizing efficiency or optimization, the team centered the user’s perspective in their solution — by soliciting the user’s perspective firsthand. They made a genuine effort to connect with their users by getting to know the individual through long-term connections. It would’ve been more cost and time effective to collect data through a survey — and you could probably collect data from more people to boot. However, the quality of the data collected through these methods is arguably sub-par and less reflective of the holistic user experience.
As members of the public health community, we can engage in more project-based, collaborative learning opportunities as well as critically evaluate the methods we have for gathering information and designing to make sure they’re as inclusive as possible. Additionally, we as students, faculty, and alumni can push for more of these opportunities to be integrated into mainstream curricula, recognizing the importance of an effective program design process that centers equity and empathy.
“The expertise of ordinary people that use the product is important, revealing, and powerful,” Pereira maintains, “and should be at the center of any design process.”
