Background: The PHISICC project is a collaboration between public-health researchers and human-centred design (HCD) practitioners. Using the HCD approach, the project aimed to re-design and test paper-based health information systems (HIS) to facilitate better decision making, data quality, and improve health outcomes.
Methods: We carried out a systematic review of global evidence on the effects of interventions to improve HIS, coupled with fieldwork to gather contextual evidence in Côte d'Ivoire, Nigeria and Mozambique. For the fieldwork, the public-health researchers focused on (i) reviews of records and reports; (ii) data quality verification exercises; and, (iii) inventory studies. The designers interviewed staff and patients, observed daily workflows, and engaged health workers in a co-creative dialogue to rethink the design of paper-based data tools, including how current tools could be improved to best facilitate their workflows and decision needs.
Results: HCD unveiled that paper-based HIS are largely created to serve the needs of stakeholders receiving data rather than the people recording it; are not adapted to actual workflow; and, do not support health workers’ decision-making needs. HCD allowed us to understand the dynamics of the HIS tools when they are used by the facility staff, thus gaining insights into stumbling blocks and bottlenecks in the HIS and how these affect daily work. This challenged our research question and approach to the systematic review. Tools found to be effective in a systematic review may still cause challenges and be misaligned with the needs of health workers in practice.
Conclusions: (1) Involving people in research entails changing a perspective: from health systems devices and tools to human experience; from context to human expectations; from facilitators and barriers to human interaction.
(2) HCD emerged as an insightful tool to understand not only contextual issues but also theoretical frameworks and how interventions may work. It also boosted the relevance of the systematic review.
(3) HCD can be more widely applied to understand and intervene on how evidence is used by stakeholders and policy makers.