Examining Challenges to the Incorporation of End Users in the Design of Digital Health Interventions: Systematic Review (Preprint)

Abstract

Digital health interventions (DHIs) are changing the dynamic of health care by providing personalised, private and instantaneous interactions with end users. The explosion of digital health solutions however, has been fraught with challenges. The approach to ideate, test and evaluate varies across a diverse stakeholder group gathered around the end user(s), with numerous siloed approaches and no clear consensus. Health concepts like safety and efficacy contrast digital concepts like user experience and retention. Several methodologies, methods and frameworks are being deployed in an attempt to mediate this challenge to varying degrees of success.

The objective of this systematic review was to broadly assess the advancements and challenges to the incorporation of end users in DHIs, in order to draw a line through the key problem areas and gaps at a global level, with the ultimate goal of creating recommendations for better approaches to incorporate end users in digital health co-design.

We conducted a systematic search for studies on end user involvement in DHIs stemming three relevant streams: health behaviour, user experience and digital methodologies and frameworks. The search was conducted in a diverse group of 6 bibliographical databases: PsycInfo, PubMed (Medline), Web of Science, CINAHL, IEEE Xplore and Scopus, from January 2015 through December 2021. From 4980 studies records initially screened for title and abstract, 266 were eligible for a full-text screening, of which 116 studies matched the inclusion criteria and were included in a qualitative synthesis.

Of the 116 studies analysed, we found 5 different research approaches, spanning 8 different digital health solution types, and 5 different design methodologies, collected across 40 journals, with the following core themes - Current plus points: (1) Participatory Co-Design. Common pain points: (1) Participatory Co-Design, (2) Environment and Context, (3) Testing, (4) Cost and Scale. Gaps and Limitations: (1) Pragmatic Hybridised Framework, (2) Industry Implementability.

This research supports a pragmatic shift towards creating health-centric agile co-design approaches at-scale that account for the variance in complexity of digital health end user types; an approach that collectivises digital, health and behavioural outcome objectives into a more organic digital health design ethos, one that is more primed for the emerging big data era of digital health citizens.