Engaging Communities on Health Innovation: Experiences in Implementing Design Thinking.

Design thinking is an approach gaining momentum as a strategy for promoting empathy-driven, human-centered innovation. To evaluate the implementation of design thinking for engaging with communities about health and well-being, we undertook a qualitative analysis of an engagement between students and relevant community stakeholders during a project to develop a health intervention aimed at increasing medication compliance in an elderly community in South Africa. Major findings from this research indicated that design thinking offers opportunities for enriching community-university engagements. However, given constraints on time and procedure that are associated with the academy, the fast, dynamic style of design thinking is not optimally suited for developing the level of trust and rapport that is required for engagements in communities where social-cultural differences operate as barriers. Researchers who wish to utilize design thinking will need to devise and tailor additions to tool kits to meet the specific needs of engagements related to personal health and well-being.

The effect of structural motifs on the ectodomain shedding of human angiotensin-converting enzyme.

Somatic angiotensin converting enzyme (sACE) is comprised of two homologous domains (N and C domains), whereas the smaller germinal isoform (tACE) is identical to the C domain. Both isozymes share an identical stalk, transmembrane and cytoplasmic domain, and undergo ectodomain shedding by an as yet unknown protease. Here we present evidence for the role of regions distal and proximal to the cleavage site in human ACE shedding. First, because of intrinsic differences between the N and C domains, discrete secondary structures (α-helix 7 and 8) on the surface of tACE were replaced with their N domain counterparts. Surprisingly, neither α-helix 7 nor α-helix 8 proved to be an absolute requirement for shedding. In the proximal ectodomain of tACE residues H610-L614 were mutated to alanines and this resulted in a decrease in ACE shedding. An N-terminal extension of this mutation caused a reduction in cellular ACE activity. More importantly, it affected the processing of the protein to the membrane, resulting in expression of an underglycosylated form of ACE. When E608-H614 was mutated to the homologous region of the N domain, processing was normal and shedding only moderately decreased suggesting that this region is more crucial for the processing of ACE than it is for regulating shedding. Finally, to determine whether glycosylation of the asparagine proximal to the Pro1199-Leu polymorphism in sACE affected shedding, the equivalent P623L mutation in tACE was investigated. The P623L tACE mutant showed an increase in shedding and MALDI MS analysis of a tryptic digest indicated that N620WT was glycosylated. The absence of an N-linked glycan at N620, resulted in an even greater increase in shedding. Thus, the conformational flexibility that the leucine confers to the stalk, is increased by the lack of glycosylation reducing access of the sheddase to the cleavage site.

A user-centred design framework for mHealth.

BACKGROUND: Mobile health (mHealth) has the potential to improve access to healthcare, especially in developing countries. The proliferation of mHealth has not been accompanied by a corresponding growth in design guidelines for mHealth applications. This paper proposes a framework for mHealth application design that combines the Information Systems Research (ISR) framework and design thinking. We demonstrate a use case for the proposed framework in the form of an app to read the result of the tuberculin skin test (TST), which is used to screen for latent tuberculosis infection. The framework was used in the re-design of the TST reading app but could also be used in earlier stages of mHealth app design. METHODS: The ISR framework and design thinking were merged based on how the modes of design thinking integrate with the cycles of the ISR framework. Using the combined framework, we re-designed an mHealth app for TST reading, intended to be used primarily in a developing context by healthcare workers. Using the proposed framework, the app was iterated upon and developed with the aid of personas, observations, prototyping and questionnaires. RESULT: The combined framework was applied through engagement with end-users, namely ten healthcare workers and ten graduate students. Through review of the literature and iterations of the app prototype, we identified various usability requirements and limitations. These included challenges related to image capture and a misunderstanding of instructions. These insights influenced the development and improvement of the app. CONCLUSION: The combined framework allowed for engagement with end-users and for low-cost, rapid development of the app while addressing contextual challenges and needs. The integration of design thinking modes with the ISR cycles was effective in achieving the objectives of each approach. The combined framework acknowledges the importance of engaging users when implementing mHealth technologies, especially in developing and under-resourced contexts. Findings from this study support the use of this framework as a guide in the design of user-centred mHealth interventions.

A modified stakeholder participation assessment framework for design thinking in health innovation.

Increasing pressure to improve health outcomes of populations with limited resources has prompted an emphasis on innovation. Design thinking has been proposed as a systematic approach to innovation in health, owing to its human-centred methodology that prioritises deep empathy for the end-users' desires, needs and challenges, which results in a better understanding of the problem in order to develop more comprehensive and effective solutions. A key feature of design thinking is stakeholder participation. If design thinking is going to be used as an approach to design and implement effective, equitable and sustainable health solutions, assessing stakeholder participation should be integrated into the process. Therefore, the purpose of this review is to i) provide an analysis of the literature on assessing stakeholder participation in health and ii) propose a framework based on the literature analysis that can be used to assess stakeholder participation during the design thinking process in health innovation. Drawing from participatory research in health, where stakeholder participation is recognised as a core principle that facilitates the implementation of solutions, we integrate stakeholder evaluation tools into the design thinking approach. We draw on an assessment framework that describes levels of stakeholder participation by their involvement in making decisions about their health. Using a 5-point continuum where the lower end represents the medical approach (professionals make all the decisions) and the upper end represents the community development approach (all stakeholders are key decision makers), we propose a modified assessment framework to evaluate stakeholder participation during the design thinking process. The modified framework provides a simple and practical tool to evaluate stakeholder participation. Stakeholders can rate their perceived level of participation, as well as that of the other stakeholders. Evaluation of participation in a design thinking project may be used to improve participation, and therefore the uptake and sustainability of innovations. The framework may also be used in design thinking beyond health applications.