JMIR Publications

ABSTRACT

Background:

Digital health interventions (DHIs) are changing the dynamic of healthcare by providing personalised, private, instantaneous solutions to end users. The explosion of digital health however, has been fraught with challenges. The approach to co-design (ideation, testing, evaluating) with end users varies across a diverse domain of digital health stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital (user experience and retention) health (safety and efficacy). Several methodologies, methods and frameworks are being deployed in an attempt to mediate this challenge to varying degrees of success.

Objective:

The objective of this systematic review was to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken in order to draw a line through the key problem areas and gaps at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users.

Methods:

We conducted a systematic search of key databases for studies on end user involvement in co-designing DHIs. Searches were divided into three relevant streams: health behaviour, user experience and digital methodologies and frameworks. The eligibility criteria was guided by the PerSPEcTiF framework and the PRISMA checklist. In line with this framework, studies were included in this review that: (1) Address research on DHIs; (2) Focus on interaction and co-design with end users; (3) Explain results such that uptake, effectiveness, satisfaction and health outcomes are discernible, positively or negatively; and (4) Describe actionable procedures for better DHI design. 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 May 2024. From 13961 studies records initially screened for title and abstract, 489 were eligible for a full-text screening, of which 171 studies matched the inclusion criteria and were included in a qualitative synthesis.

Results:

Of the 171 studies analysed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies, identifying the following core themes when co-designing with end users - Advancements: (1) Participatory Co-Design. Challenges: (1) Participatory Co-Design, (2) Environment and Context, (3) Testing, (4) Cost and Scale. Gaps: (1) Pragmatic Hybridised Framework, (2) Industry Implementability.

Conclusions:

This research supports a pragmatic shift towards utilising mixed-methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of the digital health co-designers (user experience) with the pragmatism of agile (design methodology) and the rigour of healthcare (metrics).