Adam Mary B, Minyenya-Njuguna Joy, Karuri Kamiru Wilson, Mbugua Simon, Makobu Naomi Wambui, Donelson Angela J
AIC Kijabe Hospital, Kijabe, PO Box 20, 00220, Kenya.
Donelson Consulting, 3173 Adelle Place, Tucson, Arizona, 85749, USA.
Health Policy Plan. 2020 Nov 1;35(Supplement_2):ii150-ii162. doi: 10.1093/heapol/czaa129.
Human-centred design (HCD) can support complex health system interventions by navigating thorny implementation problems that often derail population health efforts. HCD is a pragmatic, 'practice framework', not an intervention protocol. It can build empathy by bringing patient voice, user perspective and innovation to construct and repair pieces of the intervention or health system. However, its emphasis on product development and process change with fixed end points has left it as an approach lacking explanatory power and reproducible measurement. Yet when informed by theory, the tremendous innovation potential of HCD can be harnessed to drive sustainability, mediate implementation problems, frame measurement constructs and ultimately improve population-level health outcomes. In attempting to mine, the potential of HCD we move beyond the pragmatic 'how it works', to the theoretical question, 'why it works'. In doing so, we explore a more fundamental human question, 'How can participation and engagement be sustained for impact in close to the community health systems?' In this exploration, we illustrate the power of HCD by linking it to our theory of trust building. The research method we utilize is that of a longitudinal process evaluation. We leverage the heterogeneity of five community health units from the diverse setting (rural, peri-urban slum) to better understand what works for whom and in what context by tracking 21 groups of community health volunteers (CHVs) over 12 months. We report results with a focus on the outlier case failure to illustrate the contrast with common features of sustained CHV engagement, where recurrent reciprocal cycles of trust building are demonstrated in the successful implementation of action plans in plan-do-study-act cycles for improvement. All was accomplished by CHVs with no external funding. We conclude by discussing how HCD could be unleashed if linked to theoretical frameworks, increasing ability to address implementation challenges in complex health systems.
以人为本的设计（HCD）可以通过解决那些常常使人群健康工作脱轨的棘手实施问题，来支持复杂的卫生系统干预措施。HCD是一个务实的“实践框架”，而非干预方案。它可以通过引入患者声音、用户视角和创新来构建和修复干预措施或卫生系统的各个部分，从而建立同理心。然而，其对具有固定终点的产品开发和流程变革的强调，使其成为一种缺乏解释力和可重复测量方法的途径。然而，当以理论为依据时，HCD巨大的创新潜力可以被利用来推动可持续性、调解实施问题、构建测量架构，并最终改善人群层面的健康结果。在试图挖掘HCD的潜力时，我们从务实的“它如何起作用”，转向理论问题“它为何起作用”。在此过程中，我们探索一个更基本的人类问题：“如何在接近社区卫生系统的环境中持续参与并产生影响？”在这个探索中，我们通过将HCD与我们的信任建立理论联系起来，来说明HCD的力量。我们采用的研究方法是纵向过程评估。我们利用来自不同环境（农村、城郊贫民窟）的五个社区卫生单位的异质性，通过在12个月内跟踪21组社区卫生志愿者（CHV），更好地了解什么对谁有效以及在什么背景下有效。我们报告结果时重点关注异常案例失败情况，以说明与CHV持续参与的共同特征的对比，在成功实施计划-执行-研究-行动循环以改进的过程中，信任建立的反复互惠循环在其中得到体现。所有这些都是由没有外部资金的CHV完成的。我们最后讨论，如果将HCD与理论框架联系起来，如何释放其潜力，增强应对复杂卫生系统实施挑战的能力。
