Why good design is a crucial in any health equity strategy

Furniture and clothing are two obvious examples of why a “one-size-fits-all” design approach rarely works. But perhaps the best example is healthcare, where every patient or member has their own conditions and emotions. That’s why designing for health equity is the right thing to do.

The healthcare landscape has changed rapidly in any number of ways in the past few years, but notably during recent U.S. events that highlighted structural inequalities. Those factors are just some of the reasons why the Centers for Medicaid & Medicare Services (CMS) updated its Framework for Equity.

At Lirio, health equity has always been an important research pillar (along with engagement, effectiveness, and economic value). Our design process, which follows the Double Diamond model, helps us deliver on health equity by including research and insights from marginalized populations from the earliest stages of product development. Combined with our personalization capabilities, this means we don’t just include the range of behavioral content in our interventions, but also have developed to deliver personalized outreach to the right recipient based on their individual needs.

Because good design isn’t one-size-fits-all, the Lirio Behavioral Design team is constantly nudging our process forward as we learn from experience, incorporate new tools or techniques, and evolve technological capabilities. That means anyone serious about designing equitable digital health tools needs a flexible but robust toolkit for their design process. Recently, a team from the Society of Behavioral Medicine’s Health Equity Special Interest Group (SIG) collaborated on a paper that provides such a toolkit. Here’s what it includes.

Choose Equity Characteristics That Matter

People differ from each other across countless dimensions, but the importance of these differences may vary for a given health objective. In order to design for health equity, teams should agree which characteristics influence outcomes for a particular project. For example, in designing a digital health intervention for hypertension – a condition that increases the likelihood a patient will develop diabetes – the Lirio team recognized that race and digital access/literacy are important factors in whether and how patients might experience hypertension and be able to interact with behavioral interventions. There are frameworks like PROGRESS-Plus, eHLF, the Framework for Digital Health Equity, and the Health Implementation Framework that can provide structure for identifying which categories are meaningful for design.

Select Design Methods and Techniques with Room for Equity

Whether a design method results in an equitable product depends on the people who use it; it’s up to designers to ensure that they maintain a focus on their target end user’s needs within any process. That said, there are a few design methods that lend themselves to designing to equity and which teams might adopt in their work toward equitable outcomes:

• The Double Diamond model intentionally moves between convergent phases focused on data gathering, idea generation, and broad thinking, and divergent phases focused on prioritization, requirements documentation, and execution. This method creates opportunities to capture insights related to marginalized user populations in the convergent phases, and prioritize features that serve those groups in the divergent phases.
• The Integrate, Design, Assess and Share (IDEAS) Framework provides a structured process for teams to incorporate insights from diverse user groups into their design, gather feedback on prototypes from intended users, and evaluate outcomes for equity.
• Community collaboration techniques include either individual community members or community-based organizations as design partners. These relationships can facilitate direct access to members of marginalized communities to better understand their needs, dissemination of products to the intended people, and a continued focus on end users.
• Participatory design or co-design involves having end users participate in design activities through creative activities that help tap into their latent needs for the product. Expert facilitators can step participants through a design process while listening carefully to their contributions and extracting key themes and ideas.

Which of these methods is right for a particular team and project depends on several factors, including timelines, resources, team composition, and any pre-existing relationships with community organizations or leaders. While we offer some advice for how to choose the right tool for any given team and project, we also recommend future work that helps people choose a design approach based on data and outcomes from other projects that used it.

Look to Case Examples for Inspiration

A great way to determine what health equity approaches to consider is to look to other projects. In our paper, we identify 12 different digital health projects that incorporated a health equity focus, and then deep dive on six that used different design methods from each of the categories above. Some of the examples like Lirio’s Precision Nudging –  incorporate existing research in the earliest design phase to ensure the tool met the needs of marginalized communities. Others, like Hopelab’s imi, included members of the target user groups directly on the design team from the outset. Still others, like the FAITH! app, demonstrate how community partnership can look over the long term.

Health equity is undeniably critical for the future of digital health in a world that is increasingly diverse. Achieving it with digital health tools will require attention, collaboration, and the right toolkit.   We hope our recent paper helps provide the latter.

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