Thank you for completing the second session of Applying Human-Centered Design to Improve Nutrition Programming. Next is an ungraded quiz to test your understanding of Session 2.
Click the Knowledge Check button to get started.
Now that you have an Intent Statement – your project’s north star with specific behaviors and intended audiences defined – it is time to deepen the team’s understanding of the problem through design research.
Design research is a user-focused framework of research methods that allows you to uncover:
Qualitative and quantitative research methods provide the core design team with a better understanding of a project’s requirements, as well as the user’s needs. As a result, this enables them to create better and more satisfying solutions.
At this stage, you should involve the voices of design, expertise (e.g., technical experts), and experience (e.g., audience).
Those who have design expertise to lead the team through the design process.
Those who have technical expertise in the subject area.
Those who have direct experience with the problem.
Now that you have framed your project and found your HMW question, it is time to think through your research work plan. Click each step to learn more (Nigeria examples are listed at the end of the session).
There is a lot that can be done before conducting primary data collection.
WHAT do we want to learn?
WHO can we learn it from?
HOW will we learn it?
Consider who your research participants are, the level of sensitivity of the research, and what the research environment is (how much time you have, your budget, etc.) when selecting research methods.
Your data collection tools are the tangible way with which to gather the information you need. Adopting the right tools will allow you to go beyond superficial (potentially biased) data and uncover insightful, latent knowledge. Flip each card to learn about a few of the many different types of data collection tools available.
Shadowing and observation activities designed to uncover the target population reality – through which you’ll learn much about the differences between what is said and what is done, such as power dynamics, emotional triggers, and unreported interactions (e.g. fly on the wall, observation guide, and spontaneous interviews).
Structured or semi-structured interviews with the target population to gather their perspectives, experience, and preferences. These can be individual or in small groups (e.g. IDI).
Engage users by inviting them to react and interact. These tools use activities at any step of the research to elicit conversations and go beyond the surface level (e.g. Card sorting, and storytelling).
Platforms that leverage WhatsApp or other tools to conduct qualitative and quantitative interviews remotely and asynchronously (e.g. WhatsApp questionnaires).
Ask yourself: Who can we learn from? HCD is about bringing the end user to the center of the design process. That is why it is necessary to identify who will be the end users, their influencers, and who is part of the solution delivery system. All these people are potential participants in your design research.
The project lead should discuss with their Core Design Team, including trained researchers, how to select research participants. The team should define:
HCD is not a discipline that seeks statistical validation, the aim is to collect enough data to understand trends and themes. For this reason, the rule that 5 people are worth more than 500 is a principle followed.
Therefore, to determine the number of people your research needs to reach, considering HCD principles, turn to the trained researcher in your team, considering limits such as time, budget, and risks.
Choose places where it is most convenient for the participants (e.g., household, community, health facility, etc.).
Logistics variables are essential to allow your team to reach a bigger and wider group of people. Develop a logical plan that takes into consideration the best time for participants and the best routes for your team.
The Core Design Team identified the following research participant profiles based on the intended audiences and their influencers. Click each profile to reveal the selection criteria.
In Nigeria the following methods were chosen to interact with target populations:
After defining the target group and methods, we were ready to define the sample size.
The Core Design Team defined the number of participants considering limitations (e.g., timing, audience availability, COVID-19, and budget) and the intended scope of design research (quality over quantity).
| Study Populations | ||||||||
| Community Health Workers | Household Influencers | Mothers or Primary Carer | Community Leaders | |||||
| DE* | DI** | DE | DI | DE | DI | DE | DI | |
| Suru | 30 | 5 | 20 | 2 | 30 | 5 | 20 | 2 |
| Arewa | 30 | 5 | 20 | 2 | 30 | 5 | 20 | 2 |
| Fakai | 30 | 5 | 20 | 2 | 30 | 5 | 20 | 2 |
| Total number of participants | 90 | 15 | 60 | 6 | 90 | 15 | 60 | 6 |
| Total sample size: | 342 | |||||||
After completing this session, you will be able to:
Part of the value of the HCD process is that it reflects diverse perspectives. This starts by forming a core group of stakeholders – often referred to as the Core Design Team – at the beginning that is typically composed of 5-10 people, each of which plays a specific role or “voice” (ThinkPlace Global Institute of Regenerative Design). Flip each voice card to learn about their role on the Core Design Team.
Those who have direct experience with the problem.
The project sponsor who helps define the project and is responsible for the outcome.
Those who have technical expertise in the subject area.
Those who have design expertise to lead the team through the design process.
Each member of the Core Design Team will be directly involved in different phases of the design process, including setting the project intent. For this reason, consider the Core Design Team for the Nourishing Connections case study example and adopt a similar approach to create your own Core Design Team.
Breakthrough ACTION Nigeria team as program managers
Breakthrough ACTION Nigeria, CCP, JSI and ThinkPlace staff
Johns Hopkins Center for Communication Programs (CCP) and JSI team
ThinkPlace team of designers
Some of these voices were included at different stages of the process, whereas the Voice of Experience was involved throughout and augmented with direct users, religious and community leaders, and CHW leaders.
In the problem discovery stage, the Core Design Team explores the current state of the problem and defines the objective, responding to the question: What problem are we trying to solve?
To understand the context in which the problem of interest exists, conduct desk research to dive into the current state before defining it specifically. At this stage, it is important to know the following:
When you are trying to solve a complex issue, start by carefully identifying the specific purpose of the design effort and align the Core Design Team around the purpose to keep everyone focused on the specific design challenge at hand.
Global Institute of Regenerative Design & Terry, 2022
- “The Intent defines the argument, or the why of the project. It’s about building a shared intent between the key project sponsors and key partners.”
- “The Intent defined well at the start allows everyone to remain focused on the project purpose, intended outcomes and key scope.”
- “The Intent stops us from drifting from the original purpose, and this will increase the likelihood of success.”
- “The way to define intent is to engage people who hold accountability for the project results.”
All members of the Core Design Team are involved in setting the intent. As the project lead, the voice of design will be responsible for soliciting inputs and synthesizing them into a final intent statement for review and reflection by the whole team.
Click each step to learn how they were applied to the Nourishing Connection case study example in Nigeria
In this step we aim to understand the context in which the key behaviors are being practiced, what solutions are currently offered, and understand what works and what does not work about those solutions. Apply information gathered during problem discovery to align stakeholders and create a rich shared understanding.
Key questions in this step include:
The interaction and exchange of nutritional information between Community Health Workers (CHWs) and caregivers for infant and young children has been extensively researched by a consortium of organizations in Nigeria, resulting in a tried and tested SPRING C-IYCF package that has shown improvements in IYCF training and information sharing.
Despite improvements, Breakthrough ACTION and USAID Advancing Nutrition research findings from ongoing nutritional programs have identified challenges in user-friendly, client-centered job aids to improve nutrition behaviors. This project aims to take a human centered design approach to explore the behavioral drivers for nutrition, focused on complementary feeding and to design and test prototypes for novel SBC approaches that support CHWs to better educate, empower, and activate caregivers’ nutritional behaviors.
In this step, we create a concrete vision of the future state of the desired behavior change. It is critical to prioritize just 1-3 key behaviors among the intended audience(s) to avoid creating something that is too general and therefore ineffective.
The project will:
The novel nutritional counseling tool will be:
This step maps out how we will achieve the desired future state, both from a social and behavior change perspective and from a project plan perspective.
Defining the design challenge is the last step in crafting an Intent Statement, which will serve as your project’s north start.
What is a design challenge? The term “design challenge” broadly refers to the problem you are trying to solve using the HCD methodology. In the beginning of a project the design challenge is broad but is refined throughout the Discover & Define phase as you gain a deeper understanding of the problem and context. Arriving at a clear and specific design challenge at the end of the Discover & Define phase is critical before advancing to the next phases.
How to develop your design challenge? Start by writing an initial draft that reflects the problem you intend to solve. It should be objective and bring information such as:
How Might We template:
How might we _____________ (action) _____________ (what) ___________ for __________ (target audience) ____________ in order to ___________ (what change)?
HMW example:
“How might Nigerian CHWs better educate, empower, and activate caregivers to initiate timely and adequate complementary feeding from 6 months and improve diet diversity for young children from 6-24 months?”
This How Might We (HMW) example has the ideal level of specificity around the intended audiences and clearly states the desired change without mentioning any solutions.
The outcome of this stage is an Intent Statement that reflects the inputs gathered through the previous steps, typically through a series of discussions with the Core Design Team. Synthesized by the design lead and validated by the rest of the Core Design Team, the Intent Statement captures the argument for change and the reason behind the project. It ensures that the team is aligned on the purpose, the goals, and the outcomes of the project. It is a reference which the team should refer to throughout the project and against which to track direction and progress.
Thank you for completing the first session of Applying Human-Centered Design to Improve Nutrition Programming. Next is an ungraded quiz to test your understanding of Session 1.
Click the Knowledge Check button to get started.
The HCD and social and behavior change (SBC) are highly complementary. Flip each card to learn more about how HCD is well-suited to develop SBC solutions.
An empathy-first approach, combined with sound research methods, helps surface a deep understanding of user needs, desires, motivations, attitudes, perceptions and current behaviors before developing solutions.
HCD focuses on the people or users experiencing the problem. It can be used to determine the flow of a Community Health Worker consultation, and in the same way it can be used to develop policy at the national level. Regardless of the size of the design challenge, the process remains the same.
SBC challenges are often complex in nature and operate within larger systems. HCD allows us to methodically work through complexity by exploring the problem extensively before converging on potential solutions.
HCD requires involvement of the end users and other key actors within the ecosystem, which captures and centers voices and ideas that may have previously been overlooked.
The iterative nature of HCD allows us to continuously collect feedback and develop ideas in collaboration with users. This results in solutions that closely match users’ preferences.
HCD’s iterative, co-creative, divergent approach to solution creation empowers nutrition and SBC practitioners to explore and test multiple solutions simultaneously to see what “sticks” rather than creating one potentially ineffective solution.
Consider Breakthrough ACTION’s Social and Behavior Change (SBC) Flow Chart, a three-phased process for developing SBC activities, and how the HCD process aligns with these phases. Below, click to expand each phase.
This phase assesses the findings and insights that already exist and establishes mechanisms to deepen understanding of the problem’s complexity. We accomplish this by establishing empathy with those with whom we work and uncovering new perspective and insights to guide solutions (Breakthrough ACTION, 2020).
DISCOVER
DEFINE
Grounded in deeper understanding, this phase informs how practitioners will address SBC by involving community members in the solution ideation process. We iteratively develop and test ideas and concepts within the context in which they will be applied to reach optimal outcomes (Breakthrough ACTION, 2020).
DEVISE
Once programs synthesize testing feedback into a prioritized suite of solutions, this phase marks progressive implementation of these solutions. We use real-time monitoring and evaluation to assess success and make necessary tweaks and adjustments as we scale solutions over time (Breakthrough ACTION, 2020).
REFINE, EVALUATE & ADAPT
Flip each card to learn about three key attributes of an HCD for SBC solution.
Does the solution have a relevant value proposition for the audience and end user? Does it appeal to them?
Does it solve a real problem?
Can the solution be operationally implemented?
Do the developers or implementers have the right capabilities to do so?
Is the solution financially and socially viable over the long term?
Can its components be easily adapted to new contexts?
A great innovation should be desirable because it has to be a product that people want or need. But should also be viable, because it should be a product that will be profitable or increase the impact. At the same time, it needs to be feasible, to be a product that can be created with new or existing technology.
HCD can produce multiple types of solutions. Click to expand each section and explore solutions generated through an HCD approach.
A prime example of using HCD for SBC for nutrition is the Nourishing Connections activity tested in Nigeria and developed by Breakthrough ACTION and the USAID Advancing Nutrition projects. This case study features SBC for nutrition solutions that unleash the potential of Community Health Workers (CHWs) to help improve caregivers’ nutritional behaviors. It will be referenced throughout this course to illustrate how HCD can be applied to solve nutrition SBC challenges in complex contexts. For additional reading about nutrition behavior change, see the USAID Advancing Nutrition Resources: Behaviors to Improve Nutrition and Enabling Better Complementary Feeding.
The original challenge was to accelerate progress in improving complementary feeding behaviors. Why? Because optimal feeding practices during the complementary feeding period from 6 to 23 months of age are critical to improving young child nutrition, and therefore lifelong growth and development.
Globally and in Nigeria, CHW counseling of caregivers is a common approach to improve young child feeding practices. Often, CHWs focus on delivering informational messages, using generic recommendations, which may increase knowledge but not always lead to behavior change.
To improve caregivers’ complementary feeding practices, specifically timely introduction of food and feeding a diverse diet to children 6 to 23 months of age, CHWs needed user-friendly, client-centered job aids.
The repetition of this process – the broad, divergent thinking followed by the narrow, prioritized convergent thinking – enables practitioners to push beyond the limits of traditional thinking. It also helps practitioners make key decisions about which problems to solve and how to solve them. Various methods and tools to apply divergent and convergent thinking will be referenced throughout this course.
How might we help CHWs design tools for themselves that are easy to use, meaningful, and impactful?
The HCD process led to the design of the CHW Job Aid called Nourishing Connections which, together with a set of Supporting Tools, help CHWs build trust and deliver nutrition counseling to caregivers with empathy.
Click the covers to learn more about Nourishing Connections.
After completing this session, you will be able to:
Understanding Human-Centered Design (HCD) requires nutrition and SBC practitioners to understand a unique process, a unique set of evolving tools, and a unique mindset. Together, these set the stage for successful application of HCD. Throughout this course, we will explore each of these aspects through the lens of the Nourishing Connections case study.
HCD is a creative approach to problem solving that places users at the center of the design process (ThinkPlace, 2023). It is a methodology used to improve systems, services, and products in a way that truly benefits the people using them by taking a human perspective and involving users at every step of the problem-solving process.
HCD helps practitioners break from traditional ways of thinking and problem solving and arrive at people-centered solutions that stick.
Consider how you may have tried to solve a problem in the past. It may have involved some desk research, devising a solution, alone, and then releasing the solution into an environment where, more often than not, the solution is not adopted as intended.
HCD flips that approach upside down.
“HCD takes inspiration from real people, works within market and technological constraints, and considers every product touchpoint as an opportunity to surprise, delight and deliver benefits to users.”
– Thomsen & LaCour, 2013
It requires practitioners to get out from behind their desks, immerse themselves in the context of real users and other key stakeholders to deeply understand the problem. It allows us to approach the problem with a beginner’s mindset and reframe deeply entrenched problems into something that sparks new inspiration and ways of thinking.
HCD methods and tools, described in this course, open the door to entirely new solutions while keeping space to improve upon what is known to work. Understanding, thinking, creating, testing, and implementing solutions together with users allows for impactful and sustainable positive change.
The Double Diamond Framework for Innovation (Design Council, 2005) helps explain the HCD process at a high level through its application of two different types of thinking: divergent and convergent. Flip each card to reveal the definition (Image credit: SlideModel.com).
Think broadly, keep an open mind, consider anything and everything.
Think narrowly, refocus, and identify one or two key problems and solutions.
The repetition of this process – the broad, divergent thinking followed by the narrow, prioritized convergent thinking – enables practitioners to push beyond the limits of traditional thinking. It also helps practitioners make key decisions about which problems to solve and how to solve them. Various methods and tools to apply divergent and convergent thinking will be referenced throughout this course.
So, even though the process looks like this:
It can often feel like this! (Newman, D.)
But the sound methodology is still at play.
Following the HCD process alone is not enough. HCD is equally about the mindset you bring to the process: curious, humble, empathetic, creative, visual, and prepared to try (perhaps fail), learn, and improve.
The HCD mindset:
Flip each traditional thinking card to reveal the HCD mindset
Logic only
Emotion, empathy, and intuition
Starts with the solution
Starts with the context
Relies on precedent
Unconstrained by the past
Quick to decide
Quick to explore
Correct vs. incorrect
There’s always a better way
Dislikes ambiguity
Invites ambiguity
Results only
Results, meaning, and value
Afraid of mistakes
Failing is learning
Click the buttons to learn more about building empathy in HCD and how to practice active listening as a way to build empathy.
