Elizabeth Tolley
Publication Date
December 31, 2017

FHI 360

"Ultimately, within the field of public health, we are aiming to understand why various population groups suffer negative health outcomes, design interventions that address the underlying causes and evaluate their effect. We have a number of tools that assist us in achieving these ends..."

Given challenges faced during efficacy trials of several microbicide and HIV prevention products, and the minimal end-user input into the product research and development process, the Initiative for Multipurpose Prevention Technologies (IMPT) and the United States Agency for International Development (USAID) are supporting a new focus to incorporate end-user feedback at all stages of product development. To help inform this work, this report presents learnings from and reflections on traditional socio-behavioural research (SBR) and human-centred design (HCD) as applied to the global health context - specifically in biomedical prevention for sexual and reproductive health. The report references several specific research projects in which the author, Elizabeth Tolley of FHI 360, has been involved. They include a study in Kenya and Rwanda to inform the development of a new, longer-acting injectable contraceptive method, a multiphase project to develop and test messages and materials for potential microbicide introduction in Kenya, and an HCD project in Kenya and India aimed at generating concepts for next generation contraceptive technologies. Brief descriptions of these case studies are included in an appendix at the end of the report.

The report describes SBR followed by HCD in terms of six characteristics, including: (i) the overall objective of the approach; (ii) the recruitment or participant selection; (iii) the researcher's or implementer's "proximity to the field"; (iv) the process used to collect and manage data; (v) the approach for analysing and/or drawing insights from the information being collected; and (vi) the output or dissemination approaches used to communicate the findings of the project.

In brief, Tolley explains that qualitative methods have been applied within the context of HIV prevention product development for about 20 years. Examples include SBR studies examining women's - and sometimes their partners' - perceptions of and experiences with products being used in trials. They also examined how the clinical trial context and the sociocultural contexts within which trials were being implemented affected participants' acceptability and use of products.

Moving to HCD, she characterises these approaches as: emphasising the use of participatory methods that involve users in the design and development process, focusing on the emotional triggers for behaviour, and featuring rapid cycles of prototype development and testing prior to reaching a final design solution. For example, HCD practitioners have been involved in applying design thinking to introductory activities related to HIV prevention (IDEO project) and/or multipurpose prevention technology (MPT) vaginal rings (Project Imbali), as well as to the development of concepts for next generation contraceptive methods (Ideation project). HCD tends to differ from more traditional application of SBR as follows:

  • Use of qualitative data collection is less protocol driven. The designers are free to follow their hunches and to change their questions and approaches mid-stream in pursuit of new/different information. This nimble/flexible/iterative quality is a key characteristic of HCD and is present from study design through data collection to write up.
  • Data collection seeks to understand the user context and therefore may be organised to some extent around a social-ecological framework. However, more explicit behavioural theories are not used.
  • Research is conducted to enable rich story-telling that can be transmitted visually or through media outputs, as stories are considered persuasive tools for the development of design-oriented insights, ideas, and inspiration.

In the Contraceptive Market Assessment and Ideation project (case study 4), for instance, phase 1 research sought to rapidly understand and document - through field notes, drawings, photos, and audio and video recordings - women's everyday lives, relationships and encounters with the healthcare system, and how these contexts might affect their attitudes towards and use of contraception.

Having presented a table that summarises differences between traditional qualitative SBR and HCD research (e.g., the former's output is usually text to convey the content with dissemination in peer-reviewed journals, whereas the latter's output might feature rich media collateral and a toolkit of assets that facilitate empathetic ideation), Tolley highlights some of the strengths and shortcomings of traditional SBR and HCD approaches. For example, text-rich documents like those conveying the results of traditional SBR require the reader to spend time carefully digesting the information and then further considering how the information should be applied to communication and counseling messages, the organisation of clinic services, or other interventions. In contrast, based on post-workshop evaluations, the visual collateral produced in the Contraceptive Market Assessment and Ideation project was instrumental in helping workshop participants maintain a focus on user needs as they developed future-forward concepts for new contraceptive methods. However, the move to infographics, short-form deliverables and applications formerly used (and indeed created) for high-level abstractions (e.g., PowerPoint, Keynote, Prezi) leave less room for nuance or description of more complex information, which is present in any behavioural research.

Tolley posits that there are two ways to think about synergies between SBR and HCD. One way is to think about whether there are points along the product development to introduction continuum where one research approach is likely to be more meaningful, efficient, or effective than the other; should we selectively use an approach based on the desired purpose/outcome? The second way is to think about which aspects of the two approaches should be retained and/or combined into a hybrid approach. On the latter, she suggests some of the features from each that she would choose:

  1. "Initial research should be protocol driven with some uniformity in how data are collected and synthesized. At the same time, it is important to look for ways to make traditional SBR more rapid and responsive - perhaps by limiting the full transcription (and translation) process when not essential.
  2. End-user research could make better use of participatory data collection methods, as well as the collection of visual data. More integration of these methods could also facilitate story-telling and improved formats to disseminate, inspire and galvanize the use of findings.
  3. One important question to be resolved is the degree to which a large, multidisciplinary team would spend time in the field. Could some of the immersive HCD approaches be included towards the beginning or end of more protocol driven data collection?
  4. Maintain a focus on human protections during the research process - especially when gathering visual collateral...
  5. Following the Ideation model, pair HCD 'designers' with content area SBR experts. Designers lend new eyes/perspective and potential adjacency knowledge while content experts make sure that designers don't reinvent the wheel.
  6. Pressure-test resulting concepts that come out of an HCD context to increase confidence that the concepts resonate more generally with end-users and/or their influencers."

Posting from Kathreen Daria to the IBP Knowledge Consortium Gateway on March 8 2018; and "Human-centered Design and Socio-behavioral Research: Scientific Rigor with a Dash of Savvy and Spice", by Elizabeth Russell - accessed on March 12 2018.