Human-centered design in the context of social determinants of health in maternity care: methods for meaningful stakeholder engagement

ABSTRACT

Purpose

The screening process for social determinants of health (SDoH) includes questions regarding life circumstances and barriers to accessing health care. For patients, these questions may be intrusive, biased, and potentially risky. This article describes human-centered design methods to engage birthing parents and health care team members around SDoH screening and referral in maternity care.

Methods

Three phases of qualitative research with birthing parents, health care teams, and hospital administrators were conducted in the United States. Shadowing, interviews, focus groups, and participatory workshops addressed the explicit and tacit concerns of the stakeholders regarding SDoH during maternity care.

Results

Birthing parents wanted to be informed of the purpose of the clinic collecting SDoH information and how this information is used. Health care teams want to feel they are providing reliable and quality resources to their patients. They would like greater transparency that administrators are acting on SDoH data and the information is reaching people that can assist patients.

Conclusion

As clinics implement patient-centered strategies for addressing SDoH in maternity care, it is important to include patients’ perspectives. This human-centered design approach advances understanding of knowledge and emotional needs around SDoH and offers insights to meaningful engagement around sensitive health data.

KEYWORDS:

• Human-centered design in healthcare
• social determinants of health
• participatory workshops
• maternity
• perinatal
• equity

Acknowledgments

We thank our participants for their time and willingness to share.

Disclosure statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs. Tully and Stuebe are inventors of a patented medical device, which is not addressed within this manuscript or otherwise relevant to the contents. The University of North Carolina at Chapel Hill intellectual property is licensed. The other authors declare no conflicts of interest.

Additional information

Funding

This work was supported by the Emerging Challenges in Biomedical Research Award as part of National Center for Advancing Translational Sciences (NCATS) support from the National Institutes of Health to the University of North Carolina at Chapel Hill [UL1TR002489].

Notes on contributors

Kelly A. Umstead

Kelly A. Umstead is an Associate Professor of Industrial Design at North Carolina State University. Professor Umstead brings expertise in human centered design and associated research methods to ensure that the needs of stakeholders are addressed within the design process and satisfied through design interventions. Her research brings a human-centered approach to health care delivery and medical device development.

Carolina Gill

Carolina Gill is a Professor of Industrial Design at North Carolina State University with a research focus on strategic innovation in the intersection of design, engineering, business, and healthcare. She has served as a catalyst for transformation by leveraging a human centered design approach and design thinking strategies in academic, industrial settings, and the healthcare sector.

Marina S. Pearsall

Marina S. Pearsall has a Master in Public Health Nutrition from the University of North Carolina at Chapel Hill and has extensive experience in women’s health research and as a breastfeeding peer counselor. Marina is a registered dietitian nutritionist specializing in pregnancy and postpartum nutrition. She strives to help women rediscover joy and nourishment around food by focusing on each client’s unique needs and how they can optimize their diet and lifestyle to improve their health.

Alison M. Stuebe

Alison M. Stuebe is a board-certified maternal-fetal medicine physician, Professor in the Department of Obstetrics and Gynecology, and Distinguished Scholar of Infant and Young Child Feeding in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. She leads interdisciplinary research on pregnancy, birth complications, postpartum depression, and breastfeeding and she is actively involved in the American College of Obstetrics and Gynecology (Chair, Redefining the Postpartum Visit Task Force), the Society for Maternal-Fetal Medicine (former Board Member) and the Academy of Breastfeeding Medicine (Immediate Past President).

Kristin P. Tully

Kristin P. Tully is a medical anthropologist and Research Assistant Professor in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. Her expertise is engaging birthing individuals, family members, clinicians, and community members through mixed methods research to understand health priorities and co-generate solutions to meet their needs. Broadly, her program of work advances reproductive justice by addressing what people need to know, feel, and have happen to be safe and well.