Human-centered design (HCD) methods and strategies were distinct by design phase. In the “discover and define” phase, studies used multiple design tools and research methods to fully empathize with end users. In the “ideation” phase, studies allowed innovative ideas to emerge, followed by prioritizing ideas based on feasibility and resource constraints. In the “testing” phase, rapid testing enabled quick and cost-effective refinements, with 2 rounds of iterations being the most common.

Monitoring and evaluations of design outcomes and health impacts were lacking. A lack of monitoring and evaluation efforts and scientific rigor has been cited as a weakness of HCD.

Reporting patterns greatly varied. Descriptions of the cyclical nature of HCD, stakeholder maps, and visual materials on design activities and prototypes enhanced an understanding of the programs.

Program implementers and donors should invest in the capacity-building of health practitioners using HCD to foster their skills in engaging underresourced groups and stakeholders, as well as in implementing and scaling designed solutions.

Design practitioners should be trained to collect data from diverse sources for deeper empathy with end users and stakeholders, contributing to the scientific rigor of an HCD-based program.

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.

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