Design for health: a holistic approach

The foreword of The World Mental Health Report: transforming mental health for all (World Health Organization 2022) draws attention to the scale of the mental health crisis that the world is currently facing. In the year following the outbreak of COVID-19, levels of anxiety and depression rose globally by 25% (WHO 2022, vi). However, this figure is not thought to be reflective of the scale of the problem which is seen as much higher.

Social isolation, loneliness, fear of infection, grief and uncertainty are all cited in the report as significant factors contributing to these figures. Young people were disproportionately affected with increases in self-harming behaviours. The publication makes for grim reading at times, highlighting particularly disruptions in service provision and resulting gaps in care. Yet the report also offers hope, sharing examples of where people with lived experience have been engaged and empowered to use their experiences to create positive change.

Reading the report led me to reflect that one of the strengths of the design for health community is a holistic approach. This holistic approach utilizes design and creative practice as methods to find ways to hear the voices of people using products or services. Fundamentally it recognizes the importance of the physical, emotional, cognitive and spiritual, and the contribution that design and design-led research can make to each of these aspects of self. This issue of the journal bears testament to this. The collection of papers highlights the breadth of design research and practice. As we begin to understand the hidden consequences of the pandemic this holistic approach will become even more important.

Given the release of the World Mental Health Report (WHO 2022), it seems fitting that this issue of Design for Health begins with a paper which speaks directly to the role that design research can play in addressing the mental health needs of young people. ‘Robot-mediated interventions for youth mental health’ describes work undertaken by Alves-Oliveira and colleagues in creating alternative mechanisms through which to deliver aspects of psychological therapy to young people. Recognizing that costs and access to services were barriers facing many adolescents with mental health needs, the authors designed a digital robot to deliver micro-interventions to young people. In a small, preliminary study undertaken over a period of two weeks it was found that young people preferred the interactive nature of the robot, rather than the workbook traditionally used. The intention of the study was not to replace human therapy, but rather provide and extend the range of tools available to health care practitioners. The paper has much to offer in broader debate and discussion relating to mechanisms of engagement as well as some of the complexities in finding ways to model the psychological mechanisms underpinning therapy.

The second paper of this current issue continues this theme of mental health and the role that design can play. ‘Visualizing mental health: co-designing innovative mental health promotion prototypes through interdisciplinary collaboration between psychology professionals, communication design students and tertiary design educators‘ is an article authored by Donovan and colleagues. The focus of this work is on a Visualizing Mental Health project, a mental health literacy education and training collaboration delivered as part of a design education programme at the University of South Australia.

Mental health literacy recognizes the importance of preventative approaches that improve population understanding of mental health and ways that good mental health can be fostered. The authors offer a convincing argument of the value that designers and particularly communication designers bring to this space. The work highlights the importance of interdisciplinary collaboration, bringing together mental health clinicians, undergraduate communication design students and tertiary design educators. The paper describes well the breadth of work created by students on the programme including prototypes of products, programs and campaigns, creating space to reimagine ways of raising awareness of mental health in the broader community and in clinical practice. An initiative of this nature supports the development of design skills as well as the ability to work with others. Given that student populations are often at risk of experiencing mental health challenges, the design of a programme of this nature potentially enables students develop awareness and create strategies to protect their own mental wellbeing and build future resilience.

Working with students is a theme which is also explored in the research article: ‘Developing novel visual messages for a video screen hand sanitizer: a co-design study with students‘ by Stones and colleagues. Research continues to highlight the importance of hand hygiene in reducing infection. Stones and colleagues focussed their enquiry on gathering student insights to inform the development of hand-hygiene products aimed at educational environments. A cohort of international students were recruited and their views elicited in relation to preferences for hand hygiene message tone, content and visual appearance. The work generated a number of interesting, playful ideas, including some based around animated sequences and highlights the value of involving end-users in the research and design process.

The process of involving end users in research can offer different perspectives and valuable insights as exemplified in Weatherly and Reay’s case study ‘Exploring a human-centred approach to improve the usability of medical devices used in an outpatient intravenous antibiotic treatment’. The authors identified a need to improve existing practices in the area of outpatient antibiotic delivery within a Health Board in New Zealand. An iterative design process which placed end users at the centre the existing system was undertaken and through this a new product solution was identified. The case study highlights the value of placing patients’ experiences at the centre of product improvement and the role this can play in driving medical device innovation.

The research paper by Lievesley and colleagues, ‘Co-designing for behaviour change: The development of a theory-informed oral care intervention for stroke survivors’ also utilized a co-design methodology. Recognizing that much provision for people focuses on the acute phase, in the days directly following the stroke Lievesley and his research team engaged in a co-design methodology with people living with stroke, their families and carers, as well as with health and social care professionals, to elicit deeper understanding of factors that could improve mouthcare for this community. In addition to this approach the authors explored a broader theoretical base relating to behaviour change in order to identify ways to integrate recognized behaviour change techniques into the design of the intervention. The outcome of the work is a patient facing resource which takes an important step towards addressing the needs of individuals following stroke and which is informed by behaviour change theory, evidence from qualitative research and a co-design process.

‘Effective use of storyboarding as a co-design method to enhance power assisted exercise for people with stroke’ by Young and colleagues is the final paper in this issue. The research article continues the co-design theme in the development of interventions for individuals following stroke. Power-assisted exercise equipment can support people post-stroke through assisting multi-directional movements. In this research article the authors describe how storyboarding was used to engage professionals and end-users, leading to the creation of artefacts that expressed preferences relevant to the design of the Graphical User Interface used to display feedback on exercise performance. The authors conclude the paper by reflecting on how the digitization of power assisted exercise has the potential to enhance the stroke recovery pathway. They highlight how engaging end users and clinicians as experts in the process has the potential to create better products by optimizing user independence and recommend others to use storyboarding during product development.

This editorial began with a reflection of the holistic approach that much of our design for health research takes. The papers in this issue highlight time and time again, the breadth of research being undertaken but also the importance of finding ways to give people voice and to draw on their expertise to inform the development of products, services and interventions. This is an approach echoed by the World Health Organisation (2022, vii) when it highlights that every country, no matter its situation, has many opportunities to significantly improve mental health for its adults and children but key to this is investing in people, in finding ways to listen to the narratives from people around the world with lived experience and acting on these.