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Creating a Framework for Defining Quality for HCD in ASRH Programming

Human-Centered Design (HCD) is a relatively new approach towards transforming Sexual and Reproductive Health (SRH) outcomes for youth and adolescents. But what does ‘quality’ look like when applying HCD to Adolescent Sexual and Reproductive Health (ASRH)?

The HCDExchange Quality and Standards Working Group chaired by YLabs set out to define what quality looks like in the nascent HCD+ASRH field of practice.

The process for defining Quality and Standards was divided into three phases.

  1. Phase one was a scoping study focused on reviewing existing literature to understand how HCD has been applied to ASRH programming, learning from successful practices and any existing frameworks.
  2. Phase two focused on the co-creation of the quality standards framework
  3. Phase three is the virtual launch of the framework which comes off at 5pm EAT on Thursday, January 20, 2022. Sign up for the launch event here.*

Phase One: Scoping Study

The primary aims of the scoping paper were to:

  1. Review the application of HCD on ASRH programming within the regions of East and West Africa and South Asia;
  2. Identify the best practices when applying HCD to ASRH;
  3. Explore the evidence to date on these emerging best practices; and
  4. Determine the gaps in evidence and areas for future study.

We searched for results from South Asia and sub-Saharan Africa ranging from 2011 to 2021. Considering the nascency of the field, we did not limit ourselves to published peer-reviewed studies but also referred to unpublished or grey literature such as reports, technical briefs, conference abstracts, guidelines, and handbooks. The questions that guided the scope of inquiry were:

  1. What are emerging best practices when applying HCD to ASRH program design and implementation?
  2. What activities or processes are necessary to ensure both the design and implementation process safely, respectfully, and thoughtfully engages youth and their communities to achieve ASRH outcomes of interest?

Most of the case studies focused on countries in East Africa, with a paucity of literature on West Africa and South Asia. This lack of representation proved the need for more documentation, especially for an emerging practice like the application of HCD in ASRH. Alongside reviewing the literature, we interviewed experts who have worked at the intersection of HCD and ASRH in sub-Saharan Africa and South Asia. We learned from the experiences of these experts to understand their perspectives of quality methods, the methods they use to uphold these standards, and the enablers and barriers for maintaining quality. After synthesizing findings from the expert interviews, we arrived at eight preliminary domains for quality standards. We documented specific examples of these domains from the literature and noted any gaps. From this point, we moved into phase two of the process in exploring what ‘quality’ is when applying HCD to ASRH.

Phase Two: Co-Creating the Framework with the Community

Phase two began with a virtual gathering of the Quality and Standards Working Group along with a few members of the HCDExchange Secretariat to review and align on the domains and identify any gaps or edits that needed to be made. The goal was to agree on the domains that came out of the scoping study in order to create corresponding principles that would best represent each domain as part of a quality standards framework.

Attendees represented designers, implementers, funders, evaluators and youth who are reflective of the audiences that would eventually be the users of the quality standards framework produced.

We collaborated in real time on a Mural board where everyone could jot down their ideas, work off of what others had written, and identify emerging themes. We also alternated between small facilitator-led breakout groups and larger group discussions in order to engage participants and facilitate more targeted, meaningful conversations.

We thought of principles as tangible recommendations to bring the domains to life and then reviewed them to ensure that they were clear, broadly applicable to all audiences (funders, implementers, designers), commanded attention, and representative of the message within the domain. For example, for the domain ‘safeguarding and protection of youth,’ the principle was refined as follows:

All project teams must develop safeguarding plans and processes at the project outset which protect youth team members and youth participants. Develop and implement safeguarding plans tailored for different kinds of youth engagement throughout the design process.

For the final activity of the virtual convening, our goal was to create a structure for the framework to help guide the application of quality principles in the HCD+ASRH community. Participants split into small groups based on the intended audience (designers, implementers, funders, and evaluators) and selected the domains that they felt were most relevant to their specific audience. They then brainstormed what components must be in the resource in order to ensure that their audience could both achieve and be held accountable to the related principle. Various indicators, checklists, diagrams, and documentation standards were noted as potential ideas. By the end of the virtual convening we had drafted nine initial quality principles and began to develop a vision and structure for a quality and standards resource.

Phase Three: Virtual Launch of the Framework for Quality and Standards of HCD in ASRH Programming

We are excited to be launching the final framework which consists of eight quality and standards principles for the application of HCD to ASRH programming. The framework also includes tips and resources that will serve to guide the safe, effective, and inclusive practice of HCD in ASRH programming.

Join us at 5pm EAT on Thursday, January 20, 2022* to see how we, as a community, have set the bar for gold standard approaches in using HCD to advance young people’s health and wellness.

Final Reflections

Reflecting upon our experiences, we recognize that many of the domains and related principles we drafted are similarly seen in the global adolescent health field. This brings to mind two questions:

  1. Does driving quality in HCD differ when designing specifically for ASRH (as opposed to global adolescent health)?
  2. Many of the domains and related principles we defined are also seen in the global adolescent health field. In what ways is their application distinct from traditional public health interventions?

We sought out to create something foundational for this niche field by experimenting and iterating along the journey. To compensate for the limitations in literature, we conducted expert interviews with stakeholders from the target geography and further validated emerging domains and principles through a virtual convening. We realized that defining quality needs a rigorous process and are left wondering if there are other methods for us to do better.

As young designers and researchers, it was eye-opening to engage with experts from multiple audiences in the field and hear from their diverse experiences of applying HCD to ASRH. We also found it critical to do an extensive review of literature to explore previous practices and reflect upon them. Without the different perspectives from the interviews and the literature, we would not have been able to foresee the overarching relevance of these domains and principles. We witnessed the complexity of a multi-stakeholder field, where each perspective comes from the experience of a different role (designer, implementer, evaluator, funder), and realized that it is only by learning from them all that we may derive something to pave the path for HCD in ASRH.

*This post originally appeared on HCDExchange on January 9, 2022. As such, the January 20, 2022 event promoted herein has now passed. 

Nicole Ippoliti

Technical Director, YLabs

Nicole Ippoliti is the Technical Director at YLabs, where she brings adolescent health expertise to the design and implementation of global adolescent programming focused on behavioral change. Nicole brings 12 years of experience leading the research and design of innovations to advance SRH, HIV, and economic opportunity for youth worldwide.

Dr. Shola Olabode-Dada

Senior Behavioral Scientist, YLabs

Dr. Shola Olabode-Dada promotes healthy behavior change among youth by conducting research, synthesizing information, and fostering relationships with key stakeholders. In her current role, as a Senior Behavioral Scientist, she collects the evidence and explores all possibilities to decipher the mystery of how young people make decisions about their health.​

Saehee Lee

Research and Technical Team Intern, YLabs

Saehee is a second-year MPH student at the Mailman School of Public Health studying Sociomedical Sciences with a concentration in Health Promotion Research and Practice. She is currently supporting YLabs as a Research and Technical Team Intern, and also works at the Region 2 Public Health Training Center creating an online community for community health workers. Saehee previously spent 3 years at the UCSF Global Health Group’s Malaria Elimination Initiative where she co-authored a report outlining how to more effectively utilize community engagement strategies in malaria control and elimination.​

Meru Vashisht

Quality and Standards Associate, HCDExchange

Meru Vashisht is the Quality and Standards Associate at HCDExchange and a Design Strategist at TinkerLabs, India. She works at the intersection of gender and youth, deriving insights and design directions from design research conducted in complex social challenges. She has used HCD towards the larger goal of gender equality while working across domains like sexual health and rights, migration, women entrepreneurship, employment generation, livelihood and domestic abuse. She also spends her time volunteering, writing, designing and campaigning for feminist causes.​

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