Developing person-centred digital health solutions is vital for ensuring that healthcare innovations truly meet the needs of individuals. Involving stakeholders through a collaborative co-design approach enhances the relevance, usability, and acceptance of the solutions. Co-design, including best practices and success stories, should be better promoted as a funding requirement for research and innovation initiatives. Support for training and capacity building for applying co-design methodologies can increase the uptake of the developed solutions.
The role of digital health solutions in supporting the healthcare system
Europe’s health and care systems face serious challenges, such as ageing, multi-morbidity, health workforce shortages, and the rising burden of preventable non-communicable diseases caused by risk factors such as tobacco, alcohol, and obesity, and other diseases including neuro-degenerative and rare diseases. Public spending on health and long-term care is steadily rising in EU Member States and across the globe, and is expected to continue to do so (European Commission, 2016).
Digital solutions for health and care can increase the well-being of millions of citizens and radically change the way health and care services are delivered to patients, if designed purposefully and implemented in a cost-effective way. Digitalisation can support the continuity of care across borders, promote health and prevent disease, support the reform of health systems and their transition to new care models, centred on people’s needs and enable a shift from hospital-centred systems to more community-based and integrated care structures (European Commission, 2018).
Person-centred digital health solutions for empowerment
In 2018, the European Commission outlined its vision for the role of digital solutions (tools) for citizen empowerment and person-centred care. The vision urged for a shift from treatment to health promotion and disease prevention, from a focus on disease to a focus on well-being and individuals, and from service fragmentation to the integration and coordination of services along the continuum of care (European Commission, 2018).
Developing person-centred digital health solutions is vital for ensuring that healthcare innovations truly meet the needs of individuals. Tailoring digital tools to the specific requirements of users enhances their relevance, usability, and acceptance.
By designing digital health solutions that are user-friendly and personalised, individuals are empowered to take control of their health. This empowerment leads to better health outcomes, as individuals are more likely to engage with and adhere to their treatment plans. Furthermore, person-centred solutions foster a sense of ownership and responsibility, motivating individuals to maintain their health proactively.
Involving different stakeholders in developing new solutions
Involving various stakeholders in the development of digital health solutions is crucial for ensuring that the final products meet the needs and expectations of all users. This collaborative co-design approach enhances the relevance, usability, and acceptance of the solutions.
Engaging patients in the design process ensures that the solutions address their real-world needs, preferences, and challenges. Patient involvement leads to more personalised and user-friendly tools that enhance patient engagement and adherence.
Including healthcare professionals in the development process ensures that the solutions are practical, integrate seamlessly into clinical workflows, and support clinical decision-making. Their input helps in creating tools that are both effective and efficient in improving patient outcomes.
Involving other stakeholder groups is also important, such as policy makers and regulators (ensuring that the solutions comply with legal and ethical standards), technology developers (ensuring that the solutions are technically feasible and leverage the latest technological advancements), and researchers (e.g. helping to validate the effectiveness and impact of the solutions through evidence-based approaches).
In the following, the focus is on patients and health professionals as the key actors representing end users of most digital solutions.
Key principles related to co-design with end users
To successfully apply co-design processes when developing digital health solutions, different aspects need to be considered. They are outlined below, along with examples of projects and initiatives from the DHU community, as documented in the DHU Radar.
End user involvement in development stages.
This is a crucial aspect of co-design and aims at ensuring the solutions are being developed with the end users being involved in all relevant stages, from ideation up to testing and implementation. Continuous feedback from users ensures that the solutions are aligned with their needs and preferences.
Example of end user involvement
The DM4All integrated mHealth management system for patients with diabetes was developed with end users from five countries, which were involved through focus groups, surveys and interviews in needs development, prototyping and testing, and piloting of the solution.
Mapping of needs and requirements.
Conducting thorough needs assessments helps to identify the specific requirements and pain points of different user groups. This ensures that the digital health solutions are tailored to address real-world problems and enhance user satisfaction. Needs need to be elaborated using language that the end user is familiar with, and allowing for discussion and clarification of aspects the user might be unfamiliar with. Following this, needs can be translated into requirements for developing the solution, the language for which is mostly understood by developers. End users can still be used to elicit requirements by applying more engaging methods, such as developing use cases – scenarios or stories that end users can be asked to describe.
Example of needs and requirements elicitation
The ACTIVAGE project developed a com-prehensive set of “requirements for ageing well” for smart living environments, based on engagement with end users through questionnaires, interviews and focus groups.
Iterative design and development.
Adopting an iterative design process, where prototypes are developed, tested, and refined based on user feedback, helps to create more effective and user-friendly solutions. This approach allows for continuous improvement and adaptation to changing needs.
Example of iterative development
The DiaWatch solution of diabetes type 2 patients was developed as part of a pre-commercial procurement project, in which solutions undergo at least two prototypes followed by extensive piloting of a solution over several months by real end users.
DiaWatch on the DHU Radar
Change management considerations.
By involving end user representatives early on and engaging with them and their peers regularly during the development, the acceptance of the solution is increased. Early adopters can act as champions, by promoting the benefits they see in tests and prototypes, thus preparing the ground for a smoother adoption that is not just driven from the top management. This is especially true for more innovative solutions, which require more adaptation and demand for change.
Example of change management implementation
It is difficult to implement technology supported products and services, especially so for older people who are hesitant to use new technology. Life Plus detects falls in older people via an unobtrusive smart watch. The target users were involved from the start and provided with information materials about the way the smartwatch works and can help them. Likewise, the professional caregivers were involved in defining the functionalities and user interface of the platform that helps them monitor their patients.
Life Plus on the DHU Radar
Accessibility and inclusivity.
Ensuring that digital health solutions are accessible to all users, including those with disabilities or limited digital literacy, is crucial. Inclusive design practices help to create solutions that are usable by a diverse range of people, promoting equity in healthcare access.
Archetypes of real-life end-users – personas
Personas are research-based fictional characters used to represent different segments of users and can help to elicit, and consequently illustrate, their needs. They “summarize user research findings and bring that research to life in such a way that everyone can make decisions based on these personas, not based on themselves” (Mulder & Yaar, 2007, S. 19). This enables a user-centric design process within which the actual needs of users, rather than potentially biased perceptions of what designers or researchers may think users need, can be addressed, for example through specific design choices. Personas can further aid design teams to test solution ideas against population segments, to test the level of fit with needs, and test against different parameters such as literacy and mobility.
The Blueprint personas are an example of such personas. These personas represent different archetypes of patients reflecting various age groups, personal, socio-economic, health, and environment characteristics and illustrate their resulting needs (empirica GmbH, 2024). This is illustrated by the example of Nikos below. The Blueprint personas were developed in the context of the We4AHA project and the European Blueprint on Digital Transformation of Health and Care for the Ageing Society (WE4AHA Coordination and Support Action (CSA) 2017-2020, 2020). Initially, a set of 12 personas was developed. Since then, more personas were developed and are available in a growing repository (empirica GmbH, 2024).
Policy implications for co-design approaches in digital health
The following recommendations are targeting policy makers from the European Union, as well as from Member States.
Promote the application of co-design as a funding requirement for research and innovation initiatives. By including the need to apply co-design with end users, such as patients and health professionals, applicants are more likely to increase the acceptance of the solutions developed in their projects and thus avoid “pilotitis” – an excess of pilot projects that die as soon as the initial funding dries up.
Support for training and capacity building. Provide funding and resources for training programs to build capacity in co-design methodologies among stakeholders involved in digital health solution development. This includes training for healthcare professionals, technology developers, and patient representatives to enhance their skills in user-centered design and collaboration.
Promote best practices and success stories. Develop a centralised platform to share best practices, success stories, and case studies of effective co-design in digital health. This platform would serve as a resource for developers, policy makers, and other stakeholders to learn from successful examples and replicate best practices in their own projects.
References
empirica GmbH. (2024). Blueprint Personas. Retrieved September 16, 2024, from https://blueprint-personas.eu/
European Commission. (2016). Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability: Volume 1. Brussels: Institutional Papers 37.
European Commission. (2018). Communication on enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society. Luxembourg: Publications Office of the European Union.
Mulder, S., & Yaar, Z. (2007). The user is always right: A practical guide to creating and using personas for the web. Berkeley: New Riders.
WE4AHA Coordination and Support Action (CSA) 2017-2020. (2020). European Blueprint on Digital Transformation of Health and Care for the Ageing Society.
DISCLAIMER
Views and opinions expressed are those of the author(s) only and do not necessarily reflect those of DG CONNECT, European Commission. Neither the European Union nor the granting authority can be held responsible for them.