Leveraging Implementation Science in Human-Centred Design for Digital Health

Document Title

Leveraging Implementation Science in Human-Centred Design for Digital Health

Document Information

• Subject Area: Human-Computer Interaction (HCI), Implementation Science, Design and Implementation of Digital Health Interventions
• Keywords: Implementation Science, Digital Health Infrastructure, Intervention Design, Health, Human-Computer Interaction

Research Background and Issues

• Identified Problems or Challenges:

  • The design and implementation of digital health interventions in real-world practice often fail to consider complex implementation factors, resulting in small-scale projects or pilot studies that cannot be scaled to practical applications.
  • There is a lack of clear design and implementation frameworks to ensure the sustainability and scalability of intervention systems, leading to significant resource waste.
  • Unlike traditional linear research paths, there is a need for faster transitions from design to practice while avoiding technological obsolescence due to time delays.

• Significance:

  • The design and implementation of digital interventions in the health domain directly impact the efficiency of health promotion and public acceptance, determining whether technologies can be scaled up for practical use and sustained over time.
  • Designing digital health technologies with real-world applicability is particularly critical in achieving public health goals, such as interventions to reduce breast cancer risk associated with alcohol consumption.

• Research Motivation and Related Work:

  • Implementation science research emphasizes implementation strategies and planning but often pays insufficient attention to the design of intervention technologies themselves. Integration with the HCI field is needed to enhance user-centeredness and iterative design capabilities.
  • Existing demonstrations of integrating user-centered design with implementation science are mostly limited to high-level analyses, lacking detailed implementation specifics.
  • The phenomenon of "pilotitis" in HCI is prominent, necessitating more systematic design processes to avoid resource waste and directly promote practical scalability.

Proposed Solution

• Proposed Method or Solution:

  • Embed the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework into the UK Design Council's Double Diamond design process to integrate implementation science principles into HCI.
  • Systematically consider the seven domains of NASSS (condition, technology, value proposition, adopter system, organization, wider system, and time) throughout the design process.

• Innovative Aspects:

  • Propose a specific process that integrates implementation science with design practices, emphasizing the interaction and sustainability of technology in complex environments through the NASSS framework.
  • Use case studies to demonstrate the practical feasibility of this process, optimizing outcomes and overcoming implementation barriers through the redesign of an intervention project targeting breast cancer risk.

• Implementation Steps and Key Techniques:

  • Steps include four phases: Discovery, Definition, Development, and Delivery, with the NASSS framework integrated into each phase of the design process.
  • Utilize existing tools, such as the NASSS Complexity Assessment Tool (CAT), to assess complexity and reduce implementation difficulties.
  • Highlight the iterative nature of design, optimizing designs through the review of preliminary trial data, collaboration with various stakeholders, and prototype development and testing.

Research Outcomes

• Specific Outcomes:

  • A preliminary case study (the redesign of the Health4Her health promotion intervention project) demonstrated that the new approach combining the NASSS and Double Diamond frameworks can enhance the effectiveness and implementability of intervention designs.
  • The project addressed issues in the previous version, which failed to significantly reduce alcohol use, and optimized organizational implementation challenges.

• Advantages:

  • Compared to traditional designs that focus solely on technological novelty, this method emphasizes real-world applicability and multi-level impacts, significantly reducing implementation barriers in complex environments.
  • By incorporating implementation science into the design phase rather than focusing solely on the later implementation stage, the method achieves efficient use of time and resources.

• Experimental or Evaluation Results:

  • Preliminary trials showed that the redesigned intervention significantly improved alcohol use reduction and health knowledge awareness.
  • The new design improved user acceptance by modifying interaction methods (e.g., using personal devices instead of on-site equipment) while reducing the need for staff support.

• Limitations and Future Directions:

  • The current redesign case is limited to a single-page web application with a narrow technological scope. Future work could extend this approach to more complex multi-user systems.
  • Due to the constraints of the randomized controlled trial (RCT) framework, some user feedback could not be integrated. Future iterations are planned in non-experimental settings.
  • Further exploration of the potential to combine other implementation science frameworks (e.g., COM-B) with different design methods is encouraged to improve the effectiveness and applicability of interventions designed for specific behaviors.

Conclusion

This study integrates the NASSS framework with the Double Diamond design process, providing an efficient and feasible example of integration for HCI and implementation science in practice. It contributes to the scalability and long-term application of digital health interventions. This approach offers new perspectives for designing multi-level influencing factors and fostering interdisciplinary collaboration, while its practical utility and theoretical contributions are reinforced through real-world case studies.