Understanding and Adapting Co-Design for Mobile Health Systems
The widespread availability of mobile devices has paved the way for innovative approaches to delivering healthcare services through mobile health (mHealth) systems. However, the design and development of these systems present significant complexities, often hindered by limited stakeholder involvement and a lack of effective integration into existing healthcare landscapes. To address these crucial pitfalls, co-design has emerged as a vital approach, recognizing users as “experts of their own experience” and actively involving them in knowledge development, idea generation, and concept development.
Despite the recognized importance of co-design for mHealth systems, there has been limited specific guidance on how to effectively apply it within this complex domain. Researchers and practitioners face unique challenges due to the intricacies of human health, the diverse array of stakeholders involved (including patients, health practitioners, and app developers), and the necessity of addressing health behavior change.
To bridge this gap, a study leveraging the expertise of co-design method experts and mHealth system developers aimed to contextualize an existing co-design framework (specifically, the Sanders and Stappers framework) for mHealth applications and develop practical guidelines to navigate common challenges. The research involved an exploratory qualitative study with 16 semistructured interviews.
The findings reveal a contextualized co-design framework that introduces dedicated prototyping and implementation phases, critically emphasizing the need for deep immersion in real-world health contexts. This adaptation acknowledges the complexity of mHealth artifacts, distinguishing between low-fidelity concept generation and the development of mature, high-fidelity prototypes, while also separating system feasibility testing from wider system rollout.
Furthermore, the study constructed seven essential guidelines to directly address the unique challenges of co-designing mHealth systems. These guidelines encompass:
- Understanding Stakeholder Vulnerabilities and Diversity: Recognizing the unique circumstances and often vulnerable nature of mHealth users, and the diverse needs of all involved stakeholders.
- Planning for and Assessing Health Behavior Change: Emphasizing the integral link between mHealth systems and fostering behavior change, necessitating early consultation with behavior change literature and experts.
- Identifying and Involving Co-design Facilitators: Highlighting the critical role of empathetic facilitators who possess an authentic understanding of the intimate health context to mitigate power imbalances and build trust.
- Immersion in the mHealth Ecosystem: Stressing the importance of deeply embedding oneself in the health context to identify stakeholders, understand pain points, and account for complex policies and ongoing relationships.
- Identifying and Involving Postdesign Advocates: Identifying well-connected and respected stakeholders early in the process who can champion the system’s use and aid in implementation and rollout, overcoming barriers and facilitating integration into clinical practice.
- Applying Health-Specific Evaluation Criteria: Requiring rigorous feasibility testing, such as pilot-testing and randomized controlled trials, to address ethical considerations, determine risks, and confirm the system’s effectiveness before widespread implementation.
- Collecting and Analyzing Usage Data to Understand Impact: Underscoring the necessity of collecting usage data in the postdesign phase and combining it with qualitative methods to understand the why behind user behavior and inform continuous system refinement.
This comprehensive approach provides a shared frame of reference to guide mHealth system development, foster interdisciplinary collaboration between information technology and health research, and ultimately ensure that systems are user-centered, effective, and seamlessly integrated into the complex healthcare landscape.
APA Reference for this article:
Noorbergen, T. J., Adam, M. T. P., Teubner, T., & Collins, C. E. (2021). Using co-design in mobile health system development: A qualitative study with experts in co-design and mobile health system development. JMIR Mhealth Uhealth, 9(11), e27896. https://mhealth.jmir.org/2021/11/e27896
