Through creative problem solving and community collaboration, design thinking can help public health create targeted solutions to health challenges.
Design thinking, or human-centered design, is a creative approach to problem solving that began in product design but has broad, interdisciplinary applications in public health practice.
Liz Chen, PhD, MPH, assistant professor of health behavior, serves as the design thinking lead at Innovate Carolina and co-leads the Carolina Graduate Certificate in Innovation for the Public Good. Unlike other problem-solving approaches that use empirical data to move forward and find a single solution, Chen says design thinking involves going backward, in a sense, to further understand a problem in context alongside people who are impacted by the challenge before trying to solve it.
“We rely on building empathy and letting end users lead,” Chen says. Design thinking practitioners work with those experiencing a public health challenge to design multiple potential solutions. Constant data collection, iteration and learning from failures are built into the process.
Design thinking goes hand in hand with approaches like community-based participatory research, Chen says, where communities have more power in generating solutions than other public health approaches. Design thinking also involves small-batch, cyclical testing similar to implementation science and continuous quality improvement processes.
“Our students look for ways to engage directly with audiences so they aren’t the ones holding all the power and making decisions about how interventions look,” she says.
— Liz Chen, PhD, MPH
“Our students look for ways to engage directly with audiences so they aren’t the ones holding all the power and making decisions about how interventions look,” she says.
While a Master of Public Health (MPH) student in the health equity, social justice and human rights (EQUITY) concentration, Jared Bishop (’21) worked as one of Chen’s design thinking research assistants. He joined the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) team at the UNC Center for Health Promotion and Disease Prevention’s Food, Fitness and Opportunity Research Collaborative (FFORC) to help design educational opportunities for caregivers of young children. They partnered with Cooking Matters, a national program that teaches participants to use nutrition information to make healthier choices and cook delicious, affordable meals.
The FFORC team’s multi-stage, multilayered process was grounded in design thinking. Bishop and colleagues identified places where caregivers would prefer to access food skills education: health care settings, schools or early childhood education centers, and food retail environments — specifically, grocery stores. They conducted separate design thinking processes for each.
Inside grocery stores, they held caregiver-only sessions to identify “pain points” and “happy points” about the shopping experience and then held cocreation sessions with managers who implement SNAP-Ed in different states.
“We did design thinking with an equity focus,” Bishop says, “centering the voices of caregivers. Not only did we listen to their feedback — we made sure their voices were uplifted when we worked.”
The process made the caregivers feel seen and heard, Bishop says. “Hearing that other parents have the same concerns about navigating those areas was comforting for them, knowing they’re not alone.”
The FFORC team’s project resulted in a publicly available toolkit and roadmap to use design thinking to build SNAP-Ed plans.
Margaret Benson Nemitz, MPH, an alumna of the health behavior MPH program, and colleagues at the North Carolina Institute for Public Health (NCIPH) implemented design thinking with local health departments to plan how they might reach their annual goals better.
“There are many similarities between what human-centered design teaches us and what strategic planning teaches us,” Benson Nemitz said.
They recruited six local health departments in N.C. to participate on a design team. They framed their challenge through a design thinking lens: “How might we design a support system for quality improvement for all local health departments while providing for differences among health departments?” The participants, all new to design thinking, met monthly from July to December 2021.
“No one knew what to expect. No one knew how to think in this way."
— Margaret Benson Nemitz, MPH, NCIPH community assessment coordinator
“No one knew what to expect. No one knew how to think in this way,” she said. “It was fun to watch representatives get comfortable drawing their ideas, asking big questions and us all being confused together.”
They spent time with a literal drawing board, Benson Nemitz said, even adding things they later determined wouldn’t work in practice alongside the ideas they thought would work. But that openness, creativity and quick feedback are built into design thinking.
“It was interesting how foreign the process felt to the group,” she said, “and how much joy there was. How much freedom and fun and play.”
