Narrative Review of Human-Centered Design in Public Health Interventions in Low- and Middle-Income Countries: Recommendations for Practice, Research, and Reporting.

The application of human-centered design (HCD) is growing in global health, given its potential to generate innovative solutions to entrenched health problems by prioritizing human perspectives, needs, and desires. To address gaps in consolidated evidence on prior programs, we conducted a review of studies that applied a comprehensive HCD approach in low- and middle-income countries. A total of 535 articles were initially identified. Based on the inclusion and exclusion criteria, 22 articles were included. Most studies were conducted in sub-Saharan Africa and used qualitative or mixed methods throughout the HCD work. In the "discover and define" phase, user personas, journey maps, and interviews were commonly used to empathize with end users and key stakeholders. Studies used various strategies in the "ideation" phase, including idea generation based on feasibility and resource constraints. In the "testing" phase, low-fidelity prototypes were tested to obtain feedback from end users and stakeholders, enabling quick and cost-effective refinements. Prototype iterations occurred twice in most studies, but information about when iterations ceased was limited. Evaluations of design outcomes and health impacts were lacking. Studies cited multidisciplinary approaches, flexible methodology, and a sense of ownership among users and communities as strengths of HCD. Contrastingly, challenges in consistent participant engagement and limited scientific rigor were reported as weaknesses. Elements that enhanced program reporting included clear descriptions of HCD as cyclical, stakeholder maps (empathy tools), visual materials on design activities and prototypes, and transparency in failures. We recommend strengthening capacity among those applying HCD to optimize the effectiveness of the approach for global health. Although HCD is not inherently intended to serve as a rigorous research method, data triangulation and proper evaluations may ensure its usability as evidence in health research when appropriate. Also, a thorough reporting of design phases and providing detailed rationale behind design decisions can advance future HCD literature.