Using Human-Centered Design for More Inclusive Maternal Health

We uncovered the social support gaps in maternal health and co-designed solution prototypes with community-based organizations through design workshops, highlighting the potential of design thinking as a tool for centering equity in public health practice.

At Ariadne Labs, clinical teams use human-centered design to develop solution prototypes for documented gaps in health care delivery. We recently described one such initiative in our article “Racial/Ethnic Inequities in Pregnancy-Related Social Support: Design Workshops with Community-based Organizations in Greater Boston” in the Journal of Public Health Management and Practice special issue on structural racism. In our article, we report on our approach to closing gaps in social support for birthing people, particularly people of color, in Boston. As the article details, we partnered with The Boston Foundation and The Women and Health Initiative at Harvard T.H. Chan School of Public Health to map the landscape of community-based organizations (CBOs) in Greater Boston and learn about their current work and gaps through surveys and interviews. We then held a series of design workshops to prototype solutions with organizational stakeholders who care for people navigating pregnancy and the transition to parenthood.

In our experience, designing for equity and justice is an underutilized and highly promising practice to create a more inclusive process for improving public health, especially in terms of diversifying input, centering marginalized voices, making public health accessible to a wider range of stakeholders, and more quickly catalyzing action. In this blog, we highlight these opportunities using the framework of the core functions of public health – assessment, policy development, and assurance – to demonstrate the potential of design thinking as a tool for centering equity in public health.

Assessment: Diversifying information networks

Our project was funded primarily by The Boston Foundation, the community foundation for Greater Boston with a rich history of catalyzing collaboration for social change. Their partnership anchored the project in the region in a visible way, and they reinforced this by hosting a networking event for us to (a) share and discuss our research findings, (b) introduce the process of human-centered design, and (c) recruit interested stakeholders to participate in forthcoming design workshops. We connected with and engaged a much wider range of stakeholders than is typical for our clinical teams, which diversified the voices that co-designed our solution prototypes with us. As we reported in the article, organizations that participated in the design workshop spanned housing, education, law and policy, doula care, social services, and mental health, in addition to traditional public health departments, hospitals and health systems. 

In the maternal health literature, there is much less known about the CBOs that bridge healthcare systems and pregnant patients, compared to research on the role of hospitals, clinicians and patient populations in impacting perinatal health. Given the growing awareness that the perinatal period is highly vulnerable to social, physical, and mental changes with long-term consequences, it is critical to understand how our community-based partners support birthing people and their families.

Policy development: Making public health accessible

Design workshops create space for interested stakeholders to proactively and collaboratively translate research findings into solutions, as opposed to merely listening to “experts”–typically clinicians, researchers, and policymakers–and hearing recommendations for the community. More conventional forms of community engagement in the public sector, such as briefings or public meetings, tend to be unidirectional and extractive. Even when public health practice is more participatory, barriers to participation may persist if people feel ill-equipped to understand the science or the engagement process; elite organizations tend to dominate. In contrast, human-centered design is interactive, transparent, and has low barriers to participation. Facilitated exercises emphasize brainstorming, storytelling, and drawing from experience, using simple visual templates, sketching, sticky notes, and lists, for example, to record and highlight ideas and themes. Because this approach intentionally centers the expertise of community members over researchers, it can be a highly accessible form of translational science. As such, it has transformative potential for democratizing public health policy development, and creating more inclusive policy that centers people’s lived experiences and creates a path for co-creation of policy that imbues a sense of ownership and accountability among all stakeholders. 

Getting to Assurance: Catalyzing action through design

Our design workshops led to a solution prototype of a coalition of partners to enhance collaboration among CBOs and allied organizations in Greater Boston. Almost 30 organizations from the Boston metro, most of them led by women, participated in our design workshops. This legitimized the prototype for the funder, without obscuring the participation gaps in co-design (eg, disproportionate white leadership and ties to the major health systems). Our team received an additional round of funding that supported further advocacy of the solution prototype, including meetings with policymakers, funders, and contributions to public testimony. We are cautiously optimistic that through a mix of philanthropic support, favorable legislation, and ongoing stakeholder collaboration, we will continue to move this collective impact model forward.

Design thinking for more inclusive public health practice

In this post, we argue that design thinking can be a tool for centering equity in maternal health by furthering the three core functions of public health – assessment, policy development, and assurance – in a more democratic, inclusive way. Design thinking is a means for disseminating science to a much broader range of stakeholders, and linking research to action. In addition to typical peer-reviewed publications, we also presented at the 2021 CityMatCH Leadership and MCH Epidemiology Conference, the membership organization of large urban public health departments. We delivered testimony to the Massachusetts Commission on Racial Inequities in Maternal Health. We presented at the 2021 National Community Leadership Summit hosted by Boston Medical Center’s Vital Village Network. Finally, we are now engaged in planning meetings with potential partners in the next phase of the work, including backbone organizations. At the time of this writing, we are hopeful in the realization of a sustained investment in a coalition of CBOs to support birthing people in Greater Boston. Regardless, we know the seed for transformative, collaborative care for birthing people of color in the region has been planted, nurtured by human-centered design as translational science for more equitable public health.

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Leigh Graham, PhD, MBA, is a Senior Advisor and Core Faculty at the Lab, a Research Scientist at Harvard T.H. Chan School of Public Health, and a Design Critic at Harvard’s Graduate School of Design. She is a qualitative social scientist and expert on urban policy and social equity.

Amanda DiMeo, MSc, is a Research Manager on the Delivery Decisions Initiative (DDI) team, where she provides support across the DDI portfolio of projects. Amanda received her MSc in Public Health from the London School of Hygiene and Tropical Medicine and a BSc in Health Science from Boston University. 

Rose L. Molina, MD, MPH, is Core Faculty at Ariadne Labs and works with the BetterBirth Program and the Delivery Decisions Initiative to design, test, and spread solutions to ensure that everyone receives appropriate, safe, and respectful care during pregnancy, childbirth, and transition to parenthood with a focus on equity and social justice.