Human Centered Design in Health Research 131 5 Discussion In this review, we explored how the different human-centred design (HCD) approaches, including design thinking (DT) and user-centred design (UCD), were applied for the development of innovations in health research. Overall, the concepts of HCD/DT and HCD/UCD were used interchangeably in 18 (22%) of the included studies. This applied to all studies that referred to HCD/DT, however, UCD was defined as a stand-alone entity in 48 (84%) of the papers that employed this approach. Most of the studies using HCD/UCD interchangeably referred to the ISO 9241-210 standard. This aligns with the theoretical framework pursued by the studies, i.e., a problem-driven versus solution-driven strategy. DT/HCD-based studies commonly engaged in understanding the underlying problem and focused on a broad range of health/social/medical topics. They often included a focus on human values and a multi-stakeholder or systems perspective. UCD-based approaches, instead, focused primarily on the direct identification of a solution and were mostly used in health technology innovation. They often focused on human factors to increase usability or user friendliness of the solution. The limitations of this functional approach in promoting human interests have been previously described as a potential shortcoming of UCD.[107] It has been reported that designers who use a problem-driven design strategy produce solutions with the best balance of quality and creativity.[22] However, in this review, 74 (90%) of the included studies used a solution-driven strategy. Although the evaluation of solutions can be used to further define the design problem, this was not an objective of the studies included. Their solution-driven approach generally focused on generating many ideas and solutions, potentially leaving the initial design problem ill-defined and ignoring the relationships between various stakeholders. Healthcare innovation could, however, significantly benefit from problem-driven design processes, especially from a perspective of resource efficiency. Innovation in healthcare is characterized by a development/implementation cost trade-off. Therefore, it is critical that the most impactful innovations be prioritized, based on critical understanding of the underlying problem.[108] HCD in health research is often perceived as a single unitary method, as emphasized by the reference to a single practitioner guideline in the included studies. In this review, however, we found that the application of HCD entails a wide array of design methods and techniques, that can be used selectively and that are dependent on the specific design case. Design methods diverge from the traditional methods of academic research as they are primarily oriented towards action or solution of defined problems, rather than towards theory and hypotheses building. To date, little is known about their
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