Design and global health

The contribution of design to optimising global health interventions is increasingly recognised.1 The field of applied design is diverse and encompasses technical, creative and social skills and mindsets2; design may be carried out by expert designers or by ‘diffuse’ designers.3 Design for global health may involve design thinking,4 human-centred design,5 service design and codesign. And the use of design for global health has especially been promoted in relation to the concept of social innovation.6 7

There is already a tradition in global health of using approaches such as transdisciplinarity, perspective taking or empathy, working with participants from across the spectrum of needs, iterating and creating products or services that will improve the lives of those affected.8 For example, some global health researchers actively seek to include the community of those who are experiencing health challenges into research in a participatory way.

Design seeks to accomplish a similar goal but with different perspectives, tools and strategies, and with a focus on innovation while recognising the potentially competing needs to reinvent versus innovate in the context of sustained existing knowledge and practice. There is a need to use design when and as appropriate to complement existing knowledge and practice, and to ‘balance a concern for understanding current or past practices with a concern for envisioning alternative or future practices’.5

The need for guidelines for reporting research involving design

In a previous scoping review of peer-reviewed journal articles on human-centred design and public health,9 we found that few articles included detailed methods and results, information on design expertise within teams, reflexivity/positionality or socioinstitutional dynamics. Importantly, much of the literature neglected to describe stakeholder engagement processes related to the use of design, which is a key feature of both global health and person-centred methods.

Existing guidelines are available for related disciplines such as qualitative health research and public involvement in health research.10 While these guidelines serve an important function, they are not sufficiently specific to the field of design for health, which is unique in several ways. Design for health necessitates including participants (and others who will use the design outcomes) explicitly in the research process, iterates on proposed solutions quickly and directly with participants, and makes the results more immediately actionable than is typical in theoretically driven social and behavioural, or qualitative, research.

Findings of research on health programming and implementation that involves design are beginning to appear in peer-reviewed health and medical journals, in addition to being found more typically in ‘grey literature’ not indexed by a commercial publisher, including public or private reports, working papers, government documents, white papers and evaluations. Clearer guidance for authors, journal editors, community members and peer reviewers will influence publication and the potential for stakeholders from diverse communities and disciplines to locate design-based health research.11 As the global health community increasingly seeks ways of scaling up beneficial interventions, clear and transparent reporting of approaches to achieve impact is warranted.12

Reporting guidelines add value and allow programme reports and research articles to be useful for a wider audience.13 14 Incomplete reporting makes research inaccessible, introduces bias and does not provide full transparency.15 Reporting guidelines for health research involving design may help investigation and programmatic activities to be shared and used more frequently and effectively.

Based on this analysis, and discussion among communities of practice in design for health,16 we have identified a set of items that are important for reporting on research that uses design. Inclusion of these items will make research that has applied design more transparent, so that global health practitioners can more easily understand what has been done, by whom, with whom and to what effect. Providing better information on design-based projects will also support global health stakeholders to determine if design could be usefully applied to their own work.

Proposed guidelines for reporting research involving design

In tables 1 and 2, we present a proposed draft set of guidelines for reporting on research that has incorporated design. This work represents the collaborative effort of a group of global health researchers, designers, funders and evaluators. We developed the guidelines drawing from processes described to develop other reporting guidelines such as the Consolidated Criteria for Reporting Qualitative Research17 and Standards for Quality Improvement Reporting Excellence18 guidelines.

In developing the guidelines, we consulted existing literature on guideline development processes,19 along with information drawn from the emerging field of design for health, to independently develop reporting checklists which we then collated and deduplicated, discussing any disagreement during group discussions. Finally, we jointly compiled the content presented in tables 1 and 2. The guideline development process was recorded using the Enhancing the Quality and Transparency of Health Research network guidance, where registration can be located.20

The first table provides an outline and high-level overview of reporting elements that would support readers to understand the basic elements of the research, including the background or why the research has been done, the approach or how the research was done (by whom, with whom and in what way), the results of the research (and what design decisions or decision points led to the results, as well as impacts, if any, were noted) and, finally, a discussion and conclusion of how design informed the study, along with the way forward.

Table 2 provides more detail on what elements should be reported for those sections to be fully transparent and comprehensive. For example, including unique and key elements such as how the design challenge was framed (in the Background section) and what specific strategies or tools were used in the different design research phases of, for example, discovery or insight gathering versus testing or prototyping (in the Approach section).

The guidelines are intended to support teams involved in codesign of health research to disseminate their work in a systematic and transparent way for improved understanding across disciplines, to support researchers and practitioners with planning and reporting design-based research, and crucially, to improve the potential of the public to review and interpret it. With more frequent reporting and documenting of transparent, evaluable design-based practices, we can go farther to promote global health programme responsiveness, effectiveness and equity.

An invitation for input

The guidelines presented here serve as a prototype for the development of comprehensive reporting guidance on design for global health. We provide these guidelines for public comment in the hope that gathering input from the global health community will improve the reporting and evaluating of health research that has incorporated design. We invite input from all stakeholders who create and use health research involving design on the guidelines presented through an open survey mechanism (see REDR Survey).

The current guideline will be modified in response to feedback, and a final prototype will be tested through a two-round, electronic Delphi process. With this feedback in the guideline development process, stakeholders will be able to contribute to making research more accessible and more transparent. It is anticipated that the publication of this commentary will elicit momentum to build the evidence base for the use of design in global health.

Ultimately, stronger reporting guidelines for health research involving design will ensure that research and programmatic activities can be shared and used more. Interdisciplinarity drives innovation in global health research, necessitating that the products of novel research partnerships and processes are disseminated widely. In order to enable diffusion of potentially catalytic approaches such as design, reporting must appear more readily in literature reviewed by stakeholders in global health.

We hope that in providing guidance to increase and improve reporting on design for health, this may be accomplished while respecting varied disciplinary traditions and meeting the needs of a wider community of global health stakeholders.