Design Thinking in health: An example of innovation for cervical cancer in Colombia
Jorge Ivan Botero
Electronic Engineer graduated from Pontificia Javeriana - Cali with a master's degree in Robotics.
Digital Solutions Specialist at Nexa BPO
Freelance translator of engineering research articles
Human-centered design o human-centered design (HCD) is being increasingly welcomed in the healthcare sector. Although health-focused design is a relatively nascent research framework, its interdisciplinary nature allows for a convergence of the areas of health, engineering, occupational therapy, and social research. In public health, and particularly in cancer prevention, the HCD is capable of generating greater commitment from the community and stimulating the identification of challenges as well as the design and implementation of strategies to face complex problems. In this article, we present a case study of the user-centered Design Thinking methodology in the healthcare sector, giving a glimpse of what can be achieved by combining these two worlds.
Currently, cervical cancer ranks fourth among the different types of cancer and is the fourth leading cause of death associated with some type of cancer worldwide. In fact, the cervical cancer death rate in 2018 increased 6.9 per 100,000 women compared to the previous year, with more than 300,000 deaths in total. Despite public health efforts to prevent this disease, it is evident that in Latin America there are still notable barriers to access to effective prevention, such as low quality in the processing of laboratory samples and deficiencies in information and monitoring systems. . Other barriers of an individual nature include ignorance about cancer and its screening methods, fear of invasive procedures, spiritual or religious beliefs, discrimination or rejection in a close environment, even by the partner, and a lack of adherence to programs of prevention.
To face this problem, a team of researchers from the Pontificia Universidad Javeriana, made up of engineers, health professionals and designers, set the goal of developing new prevention mechanisms for this type of cancer. The target user or person, As it is known in Design Thinking, it was made up of women between 25 and 65 years of age, located in low-income areas and with levels of education. The goal of the project was to improve access to cervical cancer prevention using the HCD. From the beginning, women, communities, administrative staff and health providers were involved in the co-creation process using the Design Thinking methodology. The latter is based on a four-stage iterative process: needfinding, ideation, prototyping and validation with the end user. The purpose behind its application is to offer added value to the target audience where the problem to be solved is relatively ambiguous or complex.
Needfinding o definition of user needs
Based on an initial research process, the design team was able to inquire about the main needs of the patients of the Ladera ESE local health network that serves low-income populations in the city of Cali and rural areas with difficult access. The members of the design team visited different health posts as part of the experiential nature of the methodology and conducted in-depth interviews with women who attend health centers and the personnel who work in these centers. The information was collected and analyzed, focusing on the voice of the user, leaving aside prejudices and own subjectivities. The analysis allowed defining five specific needs that should be addressed to improve access to cytology:
- Strengthen education on topics such as cytology and HPV
- Promote and offer the cytology service to women who have never had the test
- Modify the speculum, perceived as a source of fear and discomfort
- Take advantage of the time patients spend in the waiting room
- Improve delivery time of cytology results linked to better follow-up of cases with abnormalities
After having synthesized the different focus of attention, a series of interdisciplinary workshops were developed for the generation of ideas or solutions integrating different points of view of health professionals, administrative personnel, health professionals and experts in user-centered design. The main objective is to generate as many ideas as possible through creativity-based techniques such as brainstorming (brainstorming), blue slip, list of attributes and brainwriting (writing ideas). The initial bank of ideas was reduced to a smaller group of proposals, allowing team members to select those that they would like to see materialized in the form of a prototype.
A prototype is an initial sample of a product or service before it is used in a real context. Prototyping allows you to test an idea, a concept or an experiment and reduce uncertainty in innovation processes or sprints. This implies validating in a technical or experiential way whether or not the prototype responds to the needs of the end users in an environment that is as close to the real context as possible. The technical feasibility of the idea is also validated and sometimes the imagination is even awakened or traditional schemes are broken. In this phase of the project, critical prototypes were developed which, unlike classical prototyping, do not seek to converge to a single solution but rather allow exploring a design space in search of insights or key learnings. This decision is due to the intrinsic complexity of the problem addressed.
Four prototypes emerged from this process:
Educational manicure "Encanto":
Given the importance of personal image in our culture, the first prototype was conceived as an educational manicure service offered free of charge in the waiting rooms of health centers. The experience was developed in partnership with a local business known as La Manicurista. A group of manicurists were trained in cervical cancer prevention to inform users about the disease, the importance of early detection, and dispel myths or misconceptions about cytology.
Campaign "Do not turn your back on cytology":
In order to promote the cytology test in women who had never taken the test, a media campaign was developed through media such as YouTube, WhatsApp, text messages and Beacons. The latter are devices capable of transmitting messages through a low-cost Bluetooth connection with a range of up to 300 meters.
In order to optimize time in health centers, an application was designed that allowed patients to respond to a survey while they waited to be called for their appointment. The survey inquired about their knowledge, attitudes and practices regarding cytology while reinforcing healthy behaviors or clarifying wrong answers.
During the process of Needfinding, some women interviewed expressed that cytology is an uncomfortable experience mainly due to the use of the speculum. Additionally, the delivery of the results takes between 20 and 30 days, which significantly delays the opportunity for diagnosis and treatment. The Citobot is a device composed of an endoscopic camera that captures images of the cervix in real time in order to detect precancerous lesions immediately using an embedded artificial intelligence system. This prototype was tested in the simulated hospital of the Pontificia Universidad Javeriana de Cali and was validated with health professionals, who argued that it has enormous potential as a diagnostic strategy. The device was supported by Colciencias in 2019 and is currently in the process of being patented.
Human-centered design has proven in countless cases that it has the potential to bridge the gap between knowing and doing something with a clear goal in mind. In this article, we have shown how from Design Thinking it is possible to propose new strategies to solve a highly complex problem with a multidisciplinary approach where it is recommended that the design team be made up of people who are not biased by the application sector. Improving cervical cancer prevention, especially in areas with difficult access and low levels of schooling, is not an easy task. However, initiatives as simple as an educational-focused manicure or as advanced as a portable early diagnosis device can have a real impact on the quality of life for many women.
The research article was published in the journal PLOS ONE by researchers Marcela Arrivillaga, Juan Pablo García Cifuentes, Paula Bermúdez and the writer, Jorge Botero. They can consult it here.
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