human centered design research

• Reviews / Why join our community?
• For companies
• Frequently asked questions

Human-Centered Design (HCD)

What is human-centered design (hcd).

Human-centered design is a practice where designers focus on four key aspects. They focus on people and their context. They seek to understand and solve the right problems, the root problems. They understand that everything is a complex system with interconnected parts. Finally, they do small interventions. They continually prototype, test and refine their products and services to ensure that their solutions truly meet the needs of the people they focus on.

Cognitive science and user experience expert Don Norman sees it as a step above user-centered design .

“The challenge is to use the principles of human-centered design to produce positive results, products that enhance lives and add to our pleasure and enjoyment. The goal is to produce a great product, one that is successful, and that customers love. It can be done.” — Don Norman, “Grand Old Man of User Experience”

See why human-centered design is a vital approach for accommodating real users—real people.

• Transcript loading…

The Trouble with “Users” is They’re Only Human

At many points in technological history, Don Norman helped designers understand their responsibility to the people who use the things they design. Great advances were made in electronics and computing throughout the second half of the 20th century. The problem was, the designers of many systems often overlooked the human limitations of the people who had to interact with them.

Early computers were extremely hard to understand. The first ones — created in the 1940s — required specialists to operate them in closed environments. By the 1980s, things had changed; A large portion of smaller computers were being used by people without specialist knowledge. Problems were bound to arise, and did. The early Unix system Ed (for “Editor”), for example, did not prompt users to save their changes, causing many users to erase their work when turning off their computers. Highly visible prompts to save our work were yet to come.    

From no save prompts, to the “Do you want to save changes” dialog box, to auto-save: The save functionality in documents has been iterated over the years to improve the experience for the people working with these tools.

Don Norman also studied the control rooms of potentially hazardous industrial centers and aviation safety. Following the Three Mile Island nuclear accident in 1979, he was involved in analyzing the causes and potential solutions. A partial meltdown of a power-station reactor had released dangerous radioactive material into the environment. The problem centered around, not the highly competent staff members, but the design of the control room itself.

From design mistakes such as this, we learned crucial lessons. It was clear that designers had to accommodate the human needs of their systems’ user ship. There could be no room for ambiguity or misleading controls, for instance. Designers would instead have to anticipate human users extensively through how each system looked, worked and responded to them, which aligns with circular economy principles to maximize resource efficiency and sustainability. So, rather than focus on the aesthetics of the interface and the design itself, designers needed to understand and tailor experiences for the people at the controls, accounting for their various states of mind while interacting with and reacting to changes in the system. To avoid disasters, the dehumanizing idea of “users” had to vanish so designers could put people first in design. It was time for human- or, better still, people-centered design .

Follow the Clear Path to Human-Centered Design

In 1986, Norman and co-author Stephen Draper’s User Centered System Design: New Perspectives on Human-Computer Interaction was published. The result of extensive collaboration between researchers across the U.S., Europe and Japan, this comprehensive volume represented a shift in human-computer interaction. However, the authors realized they didn’t like the term “users”; the emphasis demanded a more “human” entity in control. Their timing was superb. Not only had the home-computing market exploded, but strides in technology would soon usher in the Internet age, greater connectivity and more complexity in the systems that people of all types would use.

Norman coined the term “user experience” shortly afterwards. This signaled a focus on the needs of the people who used products throughout their experiences. Norman explained the reason for the evolution away from “user” was to help designers humanize the people whose needs they designed for. Human-centered design has four principles:

People-centered : Focus on people and their context in order to create things that are appropriate for them. Participatory design ensures user involvement in the process.

Understand and solve the right problems , the root problems: Understand and solve the right problem, the root causes, the underlying fundamental issues. Otherwise, the symptoms will just keep returning.

Everything is a system: Think of everything as a system of interconnected parts.

Small and simple interventions: Do iterative work and don't rush to a solution. Try small, simple interventions and learn from them one by one, and slowly your results will get bigger and better. Continually prototype, test and refine your proposals to make sure that your small solutions truly meet the needs of the people you focus on.

It's important to remember, as we focus on the human aspect, we expand our scope to societies and, ultimately, humanity-centered design . And as our world becomes more intricately involved with complex socio-technical systems and wicked problems to address, the insights we leverage from human-centered design will continue to prove essential.

Interaction Design Foundation, CC-BY-SA 4.0

Learn More about Human-Centered Design

To learn more on human-centered design, take our courses:

Design for the 21st Century with Don Norman

Design for a Better World with Don Norman

Norman, Donald A. Design for a Better World: Meaningful, Sustainable, Humanity Centered . Cambridge, MA, MA: The MIT Press, 2023.

Read this JND article for additional insights about the human-centered design principles.

This thought-provoking MovingWorlds post explores human-centered design extensively.

Questions related to Human-Centered Design

Human-centered design is vital because it ensures that we create solutions tailored to human needs, cultures, and societies. It is a discipline that emphasizes a people-centric approach, solving the right problems, recognizing the interconnectedness of everything, and not rushing to solutions. It involves working with multidisciplinary teams and experts, and most importantly, it has to come from the people, embracing a community-driven design approach. This approach is a subset of humanity-driven design, which aims to address the major challenges humanity faces and, ultimately, save the planet.

Human-centered design (HCD) is a methodology that places the user at the heart of the design process. It seeks to deeply understand users' needs, behaviors and experiences to create effective solutions catering to their unique challenges and desires. HCD emphasizes empathy, extensive user research, and iterative testing to ensure that the final product or solution genuinely benefits its end-users and addresses broader societal issues.

Agile is primarily a project management and product development approach that values delivering workable solutions and iterating based on customer feedback. Agile teams break projects into small, manageable chunks and work in short bursts, called  "sprints," which allows for frequent reassessment and course corrections.

While there's some overlap in their collaborative and iterative natures, the core difference lies in their objectives: HCD is about understanding and solving for the human experience, while agile is about efficiently managing and adapting work processes to changing requirements. 

Design thinking is a broader concept that includes human-centered design to solve major problems on a global and local scale. Human Centered Design is narrower in scope and aims to make interactive systems usable and useful.

For a more thorough understanding of these design approaches, please watch this informative video.

Human-centered design, as explained by Don Norman in the video above, focuses on people and their needs, even when addressing broad societal issues. It emphasizes creating solutions that cater to individuals, communities, and larger groups. Although it tackles significant challenges, its essence remains rooted in understanding and designing for humanity.

Human-centered design is used to design efficient and usable products. However, Don Norman encourages designers to apply the principles of human-centered design to address large societal problems to ensure solutions meet the needs and experiences of people.

As highlighted in the video above, human-centered designers collaborate with professionals from other fields like engineering, computer science, and public health. HCD’s uniqueness lies in emphasizing design by the people and for the people.

While both prioritize the user, human-centered design is broader than UX design. UX often focuses on websites and digital interfaces, as mentioned in this video.

In contrast, human-centered design encompasses all types of products and indeed even larger societal challenges to ensure solutions cater to people's needs and experiences.

Human-centered design prioritizes understanding and addressing the needs of people. Unlike designs that emphasize aesthetics over usability, human-centered design values function and user well-being, as highlighted in this video.

It considers the broader socio-technical system, ensuring sustainable and user-centric solutions.

Discover the principles of human-centered design through Interaction Design Foundation's in-depth courses: Design for the 21st Century with Don Norman offers a contemporary perspective on design thinking, while Design for a Better World with Don Norman emphasizes designing for positive global impact. To deepen your understanding, Don Norman's seminal book, " Design for a Better World: Meaningful, Sustainable, Humanity Centered ," from MIT Press, is an invaluable resource.

Answer a Short Quiz to Earn a Gift

What is the primary goal of Human-Centered Design (HCD)?

• To create aesthetically pleasing designs
• To focus on people and their needs
• To reduce the cost of production

Which of the following is a core principle of Human-Centered Design?

• Everything is a system.
• Implement the first idea quickly.
• Solve the most superficial problems first.

Why is iterative prototyping important in Human-Centered Design?

• Because it continually tests and refines solutions.
• Because it finalizes designs quickly.
• Because it only applies the first round of user feedback.

How does Human-Centered Design approach problem-solving?

• It addresses surface-level issues.
• It focuses on technical specifications first.
• It understands and solves root problems.

Why is understanding the context important in Human-Centered Design?

• To apply a singular solution
• To reduce the time spent on research
• To tailor solutions to specific user environments and needs

Better luck next time!

Do you want to improve your UX / UI Design skills? Join us now

Congratulations! You did amazing

You earned your gift with a perfect score! Let us send it to you.

Check Your Inbox

We’ve emailed your gift to [email protected] .

Literature on Human-Centered Design (HCD)

Here’s the entire UX literature on Human-Centered Design (HCD) by the Interaction Design Foundation, collated in one place:

Learn more about Human-Centered Design (HCD)

Take a deep dive into Human-Centered Design (HCD) with our course Design for the 21st Century with Don Norman .

In this course, taught by your instructor, Don Norman, you’ll learn how designers can improve the world , how you can apply human-centered design to solve complex global challenges , and what 21st century skills you’ll need to make a difference in the world . Each lesson will build upon another to expand your knowledge of human-centered design and provide you with practical skills to make a difference in the world.

“The challenge is to use the principles of human-centered design to produce positive results, products that enhance lives and add to our pleasure and enjoyment. The goal is to produce a great product, one that is successful, and that customers love. It can be done.” — Don Norman

All open-source articles on Human-Centered Design (HCD)

Human-centered design: how to focus on people when you solve complex global challenges.

• 3 years ago

Design Thinking: Top Insights from the IxDF Course

• 3 weeks ago

Open Access—Link to us!

We believe in Open Access and the  democratization of knowledge . Unfortunately, world-class educational materials such as this page are normally hidden behind paywalls or in expensive textbooks.

If you want this to change , cite this page , link to us, or join us to help us democratize design knowledge !

Privacy Settings

Our digital services use necessary tracking technologies, including third-party cookies, for security, functionality, and to uphold user rights. Optional cookies offer enhanced features, and analytics.

Experience the full potential of our site that remembers your preferences and supports secure sign-in.

Governs the storage of data necessary for maintaining website security, user authentication, and fraud prevention mechanisms.

Enhanced Functionality

Saves your settings and preferences, like your location, for a more personalized experience.

Referral Program

We use cookies to enable our referral program, giving you and your friends discounts.

Error Reporting

We share user ID with Bugsnag and NewRelic to help us track errors and fix issues.

Optimize your experience by allowing us to monitor site usage. You’ll enjoy a smoother, more personalized journey without compromising your privacy.

Analytics Storage

Collects anonymous data on how you navigate and interact, helping us make informed improvements.

Differentiates real visitors from automated bots, ensuring accurate usage data and improving your website experience.

Lets us tailor your digital ads to match your interests, making them more relevant and useful to you.

Advertising Storage

Stores information for better-targeted advertising, enhancing your online ad experience.

Personalization Storage

Permits storing data to personalize content and ads across Google services based on user behavior, enhancing overall user experience.

Advertising Personalization

Allows for content and ad personalization across Google services based on user behavior. This consent enhances user experiences.

Enables personalizing ads based on user data and interactions, allowing for more relevant advertising experiences across Google services.

Receive more relevant advertisements by sharing your interests and behavior with our trusted advertising partners.

Enables better ad targeting and measurement on Meta platforms, making ads you see more relevant.

Allows for improved ad effectiveness and measurement through Meta’s Conversions API, ensuring privacy-compliant data sharing.

LinkedIn Insights

Tracks conversions, retargeting, and web analytics for LinkedIn ad campaigns, enhancing ad relevance and performance.

LinkedIn CAPI

Enhances LinkedIn advertising through server-side event tracking, offering more accurate measurement and personalization.

Google Ads Tag

Tracks ad performance and user engagement, helping deliver ads that are most useful to you.

Share Knowledge, Get Respect!

or copy link

Cite according to academic standards

Simply copy and paste the text below into your bibliographic reference list, onto your blog, or anywhere else. You can also just hyperlink to this page.

New to UX Design? We’re Giving You a Free ebook!

Download our free ebook The Basics of User Experience Design to learn about core concepts of UX design.

In 9 chapters, we’ll cover: conducting user interviews, design thinking, interaction design, mobile UX design, usability, UX research, and many more!

• Business Essentials
• Leadership & Management
• Credential of Leadership, Impact, and Management in Business (CLIMB)
• Entrepreneurship & Innovation
• Digital Transformation
• Finance & Accounting
• Business in Society
• For Organizations
• Support Portal
• Media Coverage
• Founding Donors
• Leadership Team

• Harvard Business School →
• HBS Online →
• Business Insights →

Business Insights

Harvard Business School Online's Business Insights Blog provides the career insights you need to achieve your goals and gain confidence in your business skills.

• Career Development
• Communication
• Decision-Making
• Earning Your MBA
• Negotiation
• News & Events
• Productivity
• Staff Spotlight
• Student Profiles
• Work-Life Balance
• AI Essentials for Business
• Alternative Investments
• Business Analytics
• Business Strategy
• Business and Climate Change
• Design Thinking and Innovation
• Digital Marketing Strategy
• Disruptive Strategy
• Economics for Managers
• Entrepreneurship Essentials
• Financial Accounting
• Global Business
• Launching Tech Ventures
• Leadership Principles
• Leadership, Ethics, and Corporate Accountability
• Leading Change and Organizational Renewal
• Leading with Finance
• Management Essentials
• Negotiation Mastery
• Organizational Leadership
• Power and Influence for Positive Impact
• Strategy Execution
• Sustainable Business Strategy
• Sustainable Investing
• Winning with Digital Platforms

What Is Human-Centered Design?

• 15 Dec 2020

One of the primary reasons startups fail is a lack of market need. Or, in more straightforward terms: The founders built a product or service no one wants.

Creating a successful business requires identifying an underserved need , validating your idea , and crafting an effective value proposition . When taking these steps, one way to ensure you’re on the right path and developing products and services the market will adopt and embrace is bringing prospective customers into the process and leveraging human-centered design.

Access your free e-book today.

Human-centered design is a problem-solving technique that puts real people at the center of the development process, enabling you to create products and services that resonate and are tailored to your audience’s needs.

The goal is to keep users’ wants, pain points, and preferences front of mind during every phase of the process. In turn, you’ll build more intuitive, accessible products that are likely to turn a higher profit because your customers have already vetted the solution and feel more invested in using it.

The Phases of Human-Centered Design

In Harvard Business School Online’s Design Thinking and Innovation Course , HBS Dean Srikant Datar breaks human-centered design down into four stages :

Here’s what each step of the process means and how you can implement it to create products and services people love.

This first phase is dedicated to collecting data and observing your customers to clarify the problem and how you might solve it. Rather than develop products based on assumptions, you conduct user research and assess customer needs to determine what prospective buyers want.

The clarify phase requires empathy—the capability of understanding another person’s experiences and emotions. You need to consider your customers’ perspectives and ask questions to determine what products they’re currently using, why and how they’re using them, and the challenges they’re trying to solve.

During this phase, you want to discover customers’ pain points , which Dean Datar breaks down into two types:

• Explicit : These are pain points users can describe; they’re aware of what frustrates them about their current experience.
• Latent : These are pain points users can’t describe and might not even know exist.

“Users will be upfront about explicit pain points,” says Dean Datar in Design Thinking and Innovation . “But researchers will need to dig into the experience—observing, listening, and trying it for themselves to get at the latent pain points that lead to transformative innovation.”

To determine your customers’ pain points, observe people using your product and conduct user interviews . Ask questions such as:

• What challenge were you trying to solve when you bought this product?
• What other options did you consider when making your decision?
• What made you choose this product over the alternatives?

With each answer, you’ll start to generate insights you can use to create a problem statement from your users’ perspective. That’s what you’ll try to solve in the following phases.

The inspiration you gather in the first phase will lead you to the second: ideate. During this stage, you can apply different design thinking tools, such as systematic inventive thinking (SIT) or brainstorming, to overcome cognitive fixedness —a mindset in which you consciously or unconsciously assume there’s only one way to interpret or approach a situation.

Once you’ve overcome cognitive fixedness, the goal is to generate dozens of ideas to amplify creativity and ensure no one gets attached to a potential solution before it’s been tested.

The develop phase is when you combine and critique the ideas you’ve brainstormed to create a range of possible solutions. By combining and evaluating your ideas, you can better meet users’ needs and determine what you want to move into prototyping to reduce costs, save time, and increase your final product’s quality.

Three characteristics of human-centered design that are vital to consider when critiquing ideas are desirability, feasibility, and viability.

• Desirability : Does this innovation fulfill user needs, and is there a market for it?
• Feasibility : Is this functionally possible? Does the organization have the resources to produce this innovation? Are there any legal, economic, or technological barriers?
• Viability : Is this innovation sustainable? Can the company continue to produce or deliver this product profitably over time?

When you start prototyping, you should have presumed answers to these questions so you can learn more about your concepts quickly and, ideally, at a low cost.

“It’s important to evaluate concepts and create prototypes early and often so that you can foster an experimentation mindset and develop tested solutions that are ready for implementation,” says Dean Datar in Design Thinking and Innovation .

4. Implement

The final phase of the process is implementation. During this stage, it’s crucial to communicate your innovation’s value to internal and external stakeholders, including colleagues and consumers, to bring it to market successfully, encourage adoption, and maintain growth.

In the implementation phase, take time to reflect on your organization’s culture and assess group dynamics. Is your team empowered to develop and iterate on user-focused solutions? You can’t continue creating innovative solutions without the right culture.

It’s important to note that your work isn’t over once you reach the final phase. Customers’ wants and needs will continue to evolve. Your goal is to adapt to meet them. Keeping humans at the center of the development process will ensure you’re continuously innovating and achieving product-market fit.

Human-Centered Design in Action

A great example of human-centered design is a children’s toothbrush that’s still in use today. In the mid-nineties, Oral-B asked global design firm IDEO to develop a new kid’s toothbrush. Rather than replicating what was already on the market—a slim, shorter version of an adult-sized toothbrush—IDEO’s team went directly to the source; they watched children brush their teeth.

What they realized is that kids had a hard time holding the skinnier toothbrushes their parents used because they didn’t have the same dexterity or motor skills. Children needed toothbrushes with a big, fat, squishy grip that was easier to hold on to.

“Now every toothbrush company in the world makes these,” says IDEO Partner Tom Kelley in a speech . “But our client reports that after we made that little, tiny discovery out in the field—sitting in a bathroom watching a five-year-old boy brush his teeth—they had the best-selling kid’s toothbrush in the world for 18 months.”

Had IDEO’s team not gone out into the field—or, in this case, children’s homes—they wouldn’t have observed that small opportunity, which turned a big profit for Oral-B.

Leveraging Human-Centered Design in Your Business

By leveraging human-centered design in your business, you can avoid becoming another startup statistic and instead gain a competitive edge by creating products and services that customers love.

Are you interested in learning more about the benefits of human-centered design? Explore our seven-week Design Thinking and Innovation course , one of our entrepreneurship and innovation courses . Not sure which course is right for you? Download our free flowchart to find your fit.

This post was updated on January 6, 2023. It was originally published on December 15, 2020.

About the Author

What is human-centered design

table of contents

Setting the stage for human-centered design.

In a world of complexities and technological advancements, design has transcended from mere aesthetics to becoming the crucible where functionality and user experience merge. This transformation mandates a revision of traditional design paradigms.

Introducing Human-Centered Design (HCD) as a paradigm shift

Enter Human-Centered Design, a disruptive methodology that situates the human experience at the prime of the design process . Unlike traditional design approaches, which often focus on technical or business requirements, HCD seeks to combine these necessities with a deep understanding of the human psyche.

The DNA of Human-Centered Design

Historical context: when and why hcd came to be.

Emerging from the shadows of ergonomics and cognitive psychology, Human-Centered Design came into prominence in the late 20th century. The difficulties of the Information Age, marked by an unprecedented explosion of digital interfaces, needed a design approach that transcended mere functionality and delved into user satisfaction and inclusivity.

Key pioneers and thought leaders: The architects of HCD

Pioneers such as Don Norman and Jane Fulton Suri have been instrumental in architecting the principles of HCD. Their oeuvre, resonating with empirical research and multidisciplinary insights, has laid the epistemological groundwork for this transformative design ethos.

Defining Human-Centered Design

The ISO defines Human-Centered Design as an "approach to interactive systems development that aims to make systems usable and useful." While this definition encapsulates the foundational elements, it warrants further dissection to appreciate its profundities.

Understanding the human element: A simple explanation

In layman's terms, HCD is the deliberate manipulation of design variables to prioritize human needs, emotions, and capabilities at each phase of the design process.

HCD vs. traditional design: A comparative snapshot

Unlike traditional design paradigms that are often fastidiously linear and compartmentalized, HCD adopts a more cyclical and integrated approach, systematically intertwining user research, ideation, prototyping, and evaluation.

The Core Principles of Human-Centered Design

Empathy: the heart of the process.

Empathy serves as the sine qua non of HCD. It obliges designers to immerse themselves in the user's world, enabling a nuanced understanding of pain points, aspirations, and contextual limitations.

Collaboration: The strength of the collective

HCD extols the virtues of collaborative multidisciplinary teamwork. It incorporates perspectives from psychology, anthropology, and data science to engender simultaneously innovative and practical solutions.

Iteration: The cycle of perpetual improvement

Iterative design is a cornerstone of HCD. This involves a cyclical process of prototyping , testing, analyzing, and refining a product or service in response to user feedback.

Usability: The end goal

The conclusion of the HCD process is a product that not only settles a particular problem but does so in a way that is intuitive, accessible, and pleasurable for the user.

Anatomy of the HCD methodology

The four pillars: stages of human-centered design, research: digging for user gold.

User research, the first pillar, employs qualitative and quantitative methods to excavate deep-seated user needs, preferences, and behavior patterns. This encompasses ethnographic studies, contextual interviews, and even heuristic evaluations.

Ideation: The creative cauldron

In this stage, creative techniques like brainstorming , mind mapping, and lateral thinking are employed to generate many potential solutions.

Prototyping: Making ideas tangible

The abstract is made corporeal through prototyping. This low-fidelity representation of the final product serves as a test bed for ideas, allowing for inexpensive, rapid iterations.

Testing: The reality check

Usability testing offers empirical data on how real users interact with the prototype. It exposes any incongruences between user expectations and the design's performance, thereby directing iterative refinements.

Tools of the Trade: The HCD toolkit

Interview techniques: peeling back the layers.

Semi-structured interviews and the "Five Whys" technique are invaluable tools for unearthing the intrinsic motivations and tacit knowledge that often elude more formal research methods.

Surveys and questionnaires: Data-driven design

Well-crafted questionnaires can yield a cornucopia of quantitative data, enhancing the rigor and objectivity of the design process.

User Personas: Crafting character profiles

Personas , or synthetic profiles of archetypal users, are instrumental in focusing the design process, providing a clear demographic and psychographic context.

Wireframes and mockups: The Blueprint before the build

Wireframes and mockups serve as schematic diagrams of the digital world, delineating the architecture and flow without being burdened by aesthetic details.

The impact of Human-Centered Design

Elevating user experience and usability, real-world examples: hcd success stories.

Companies like Apple and Airbnb have transmogrified entire industries by clever application of HCD principles, demonstrating how empathetic design can catalyze monumental shifts in user experience and market dynamics.

How HCD makes products more intuitive

By synthesizing user needs and technological capabilities, HCD engenders products that are not just functional but also intrinsically intuitive, reducing the cognitive load on the user.

Business Case: The ROI of Human-Centered Design

Customer retention: the loyalty loop.

With increasingly discerning consumers, HCD is a potent tool for engendering brand loyalty through superior user experiences.

Increased sales and market share: Numbers don't lie

Various empirical studies substantiate that companies implementing HCD strategies frequently experience market share and profitability surges.

Brand Enhancement: The Halo Effect

An effectively designed product doesn't just solve a problem. It elevates the brand, creating a halo effect that augments consumer trust and brand equity.

Beyond Business: HCD for societal good

Case studies in healthcare: saving lives by design.

In fields like healthcare, the ramifications of HCD transcend commercial metrics and extend to life-altering impacts, such as improved patient care through intuitive medical devices.

Environmental sustainability: Designing a greener future

HCD principles are increasingly harnessed to solve grand challenges like climate change, emphasizing sustainable practices without compromising usability.

Public policy: When governments embrace HCD

Various governmental bodies are adopting HCD methodologies to craft policies and services that resonate more deeply with citizens, enhancing civic engagement and governance.

Challenges, criticisms, and ethical considerations

The potential downsides of human-centered design, the time and resource conundrum.

While the benefits of HCD are manifold, it is also a resource-intensive process requiring an amalgamation of diverse skill sets, potentially escalating both time and monetary investments.

When HCD fails: Examples and lessons

Even with the best intentions, HCD is not infallible. The failures, often arising from a lack of genuine user involvement or superficial implementation, provide salient lessons for future endeavors.

Ethical questions: The double-edged sword of HCD

Manipulative designs: when user engagement goes too far.

An ethical dilemma exists where design can become too persuasive, trapping users in a cycle of addictive behavior.

Inclusivity and bias: Ensuring HCD is for everyone

To be genuinely human-centered, design must be inclusive, catering to diverse demographics and accessibility needs, avoiding the perpetuation of societal biases.

Conclusion: The lasting legacy of Human-Centered Design

A recap of why hcd matters.

HCD amalgamates empirical rigor with empathetic insights, making it an invaluable framework for crafting solutions that are effective and resonate on a deeply human level.

The future: What's next in the evolution of HCD?

As emerging technologies like AI and Virtual Reality continue to evolve, so too will the methods and applications of Human-Centered Design, promising ever more nuanced and responsive user experiences.

Recommended reading and resources

For those intrigued by the potentialities of HCD, seminal works like "The Design of Everyday Things" by Don Norman or IDEO's "Human-Centered Design Toolkit" offer deep dives into this transformative methodology.

Glossary of terms

Empathy : Deep understanding of user needs and emotions.

Usability : The ease with which users can effectively use a product.

Iterative Design : A cyclical process of refining a product based on user feedback.

Persona : A synthetic profile representing an archetypal user.

Frequently Asked Questions

What is Human-Centered Design? : An approach that integrates user needs and business requirements into a cohesive design process.

Why is it important? : It creates more usable, effective, and impactful products, enhancing user satisfaction and business metrics.

How is it different from traditional design methods? : Unlike traditional design, HCD involves users throughout the design process, employs multidisciplinary teams, and emphasizes iterative refinement.

What is collaborative design?

Read article

The 5 Design Thinking Steps

What is design thinking?

Get on board in seconds

Join thousands of teams using Miro to do their best work yet.

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Guidance on building better digital services in government

Introduction to human-centered design

Hcd principles.

Reading time: 2 minutes

The guiding principles of human-centered design include:

• No wrong ideas
• Collaboration

When engaging in HCD research:

• Listen deeply for what people say they want and need, and how they may be creating workarounds to meet their needs.
• Listen for the root causes that inform the attitudes, behaviors, and beliefs of the people you’re interviewing.
• Be aware of your own internal biases or judgments.
• Fail early; fail fast; fail small. Know that iteration is learning.
• Learn first, don’t jump to solutions.
• Be inclusive and seek out multiple perspectives from both researchers and research subjects.
• Be flexible in your thinking and plans. Adapt to changing conditions. Sometimes unexpected events or even kinks in the process can open the door to key insights.

HCD in practice

HCD allows us to understand the types of experiences customers want from a system, product, or service. We refer to the customers’ desired experience as the “frontstage” of the design effort. HCD helps us craft the processes that create those desired experiences. We refer to this behind-the-scenes work as “the backstage’’ of the design effort. By tending to both the front and back stages, HCD allows us to put the customer at the center of our design development.

Case in point

The HCD approach has already created immense value for agencies. For example, a redesign of USAJOBS (the hub for federal hiring with nearly 1 billion job searches annually by over 180 million people) resulted in a 30% reduction in help desk tickets after the first round of improvements. This reflects an easier experience for users, and creates savings in support costs.

Header image credit: Vladimir Kononok/iStock via Getty Images Plus

Join 60,000 others in government and subscribe to our newsletter — a round-up of the best digital news in government and across our field.

Digital.gov

An official website of the U.S. General Services Administration

The faculty and students in Human Centered Design share a multidisciplinary approach to research spanning humanities and physical and social sciences, and integrating materials, design, engineering and social science concepts and methods. Our research work embodies true elements of radical design in a way that enriches our health and wellbeing and supports a healthy ecosystem. 

Human-Centered Design

Human-centered design (HCD) provides a structured yet flexible approach to problem solving that puts the people who will ultimately benefit from a solution at the center of the design process. It is a powerful and practical tool to enhance community-based participatory research, implementation research, and medical product innovation.

Investigators are using HCD at Pitt to co-create research questions and co-design studies, treatments, interventions, and technology with the community members, patients, and participants who will be most impacted by their research.

In all design efforts we support, the HCD team at CTSI strives to incorporate   the principles of design justice  to promote accessibility and equity in the design process.

The CTSI Human-Centered Design team is certified through the  LUMA Institute  to practice, facilitate, and teach HCD. We provide:

• Methods Consultation and Coaching:  Want to use HCD in your research but don’t know where to begin? Reach out to our team to get feedback and tips on how to incorporate HCD frameworks and choose methods that best fit your research project.
• Facilitation Consultation and Coaching:  Already planning to incorporate HCD in your research but looking for guidance leading design sessions? We can provide consultations and coaching on adapting methods for in-person or virtual sessions, creating agendas and templates, and ensuring accessibility and equity during facilitation.

You can request these services by filling out the intake form below, just select “Human-Centered Design Consultation/Training” and let us know how we can help!

CTSI offers Human-Centered Design Foundations for Health Research Certification training for research teams. Researchers who have completed HCD training have found it highly beneficial , and report using HCD to refine interventions, uncover barriers to implementation, write innovative grants and manuscripts, and collect critical input from team members and community partners.

Pitt faculty and staff doing health research can take advantage of this valuable professional development opportunity to enhance their research. Register or join our waitlist for an upcoming training here:

You can find publicly available HCD toolkits and resources and over 100 HCD health research journal articles in our SharePoint repository.

Assistant Director, Human-Centered Design E-mail: [email protected]

Human-Centered Design Facilitator E-mail: [email protected]

IHCD believes that there is an urgent need to gather data about what works and what fails for people at the edges of the spectrum of ability, age, and culture. IHCD invests in contextual inquiry research with real people interacting with real physical or digital environments.  We have recruited a base of over 300 people with physical, sensory, or brain-based conditions who vary in age from late teens to late 80s and culturally diverse. And we have extensive experience recruiting user/experts in other parts of the nation and the world.  As a measure of our respect for the expertise of their lived experience, each user/expert is paid for their time. 

A primary user/expert personally lives with one or more functional limitations.

A secondary user/expert is a friend, spouse, family member, service provider, therapist, teacher, or anyone who has extensive experience sharing life with primary user/experts and paying close attention to the interface with their environments.

“IHCD’s User Expert Lab has helped to enrich our designs—both physical and digital.  Throughout recent redesigns of several subway stations as well as the complete rebuild of mbta.com, the feedback we received for the lab and its users helped to ensure we were designing with the diversity of our customers’ needs in mind.  As a result we have found ourselves focused more on user experience than just mere compliance.” - Laura Brelsford, Assistant GM for Accessibility, MBTA

New England ADA Center Research 

IHCD’s New England ADA Center releases startling findings about the true nature of disability by region, state, and city. Read all the findings here.  

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices

Affiliation.

• 1 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.
• PMID: 34874893
• PMCID: PMC8691403
• DOI: 10.2196/28102

Background: Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations.

Objective: This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research.

Methods: A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users.

Results: This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user's needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners.

Conclusions: We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups.

Keywords: design thinking; design-based research; human-centered design; methodology; mobile phone; review; user-centered design.

©Irene Göttgens, Sabine Oertelt-Prigione. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 06.12.2021.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

PRISMA (Preferred Reporting Items for…

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the screening…

Illustration of human-centered design processes.…

Illustration of human-centered design processes. HCD: human-centered design; HPI: Hasso Plattner Institute; UCD:…

Levels of end user involvement…

Levels of end user involvement during human-centered design processes.

Similar articles

• Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Osborne SR, et al. Med J Aust. 2020 Dec;213 Suppl 11:S3-S32.e1. doi: 10.5694/mja2.50881. Med J Aust. 2020. PMID: 33314144
• The future of Cochrane Neonatal. Soll RF, Ovelman C, McGuire W. Soll RF, et al. Early Hum Dev. 2020 Nov;150:105191. doi: 10.1016/j.earlhumdev.2020.105191. Epub 2020 Sep 12. Early Hum Dev. 2020. PMID: 33036834
• Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis. Nimmanterdwong Z, Boonviriya S, Tangkijvanich P. Nimmanterdwong Z, et al. JMIR Mhealth Uhealth. 2022 Jan 14;10(1):e29512. doi: 10.2196/29512. JMIR Mhealth Uhealth. 2022. PMID: 35029535 Free PMC article. Review.
• Human-Centered Design Lessons for Implementation Science: Improving the Implementation of a Patient-Centered Care Intervention. Beres LK, Simbeza S, Holmes CB, Mwamba C, Mukamba N, Sharma A, Munamunungu V, Mwachande M, Sikombe K, Bolton Moore C, Mody A, Koyuncu A, Christopoulos K, Jere L, Pry J, Ehrenkranz PD, Budden A, Geng E, Sikazwe I. Beres LK, et al. J Acquir Immune Defic Syndr. 2019 Dec;82 Suppl 3(3):S230-S243. doi: 10.1097/QAI.0000000000002216. J Acquir Immune Defic Syndr. 2019. PMID: 31764259 Free PMC article. Review.
• Toward Inclusive Approaches in the Design, Development, and Implementation of eHealth in the Intellectual Disability Sector: Scoping Review. van Calis JFE, Bevelander KE, van der Cruijsen AWC, Leusink GL, Naaldenberg J. van Calis JFE, et al. J Med Internet Res. 2023 May 30;25:e45819. doi: 10.2196/45819. J Med Internet Res. 2023. PMID: 37252756 Free PMC article. Review.
• Co-designing Entrustable Professional Activities in General Practitioner's training: a participatory research study. Andreou V, Peters S, Eggermont J, Schoenmakers B. Andreou V, et al. BMC Med Educ. 2024 May 17;24(1):549. doi: 10.1186/s12909-024-05530-y. BMC Med Educ. 2024. PMID: 38760773 Free PMC article.
• Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers. Turuba R, Katan C, Marchand K, Brasset C, Ewert A, Tallon C, Fairbank J, Mathias S, Barbic S. Turuba R, et al. PLoS One. 2024 Apr 18;19(4):e0297532. doi: 10.1371/journal.pone.0297532. eCollection 2024. PLoS One. 2024. PMID: 38635804 Free PMC article.
• Exploring the multi-level impacts of a youth-led comprehensive sexuality education model in Madagascar using Human-centered Design methods. Baumann SE, Leeson L, Raonivololona M, Burke JG. Baumann SE, et al. PLoS One. 2024 Apr 10;19(4):e0297106. doi: 10.1371/journal.pone.0297106. eCollection 2024. PLoS One. 2024. PMID: 38598416 Free PMC article.
• Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review. Moorthy P, Weinert L, Schüttler C, Svensson L, Sedlmayr B, Müller J, Nagel T. Moorthy P, et al. JMIR Mhealth Uhealth. 2024 Apr 5;12:e52179. doi: 10.2196/52179. JMIR Mhealth Uhealth. 2024. PMID: 38578671 Free PMC article. Review.
• Centering healthcare workers in digital health design: Usability and acceptability of two-way texting to improve retention in antiretroviral therapy in a public HIV clinic in Lilongwe, Malawi. Mureithi M, Ng'aari L, Wasunna B, Kiruthu-Kamamia C, Sande O, Chiwaya GD, Huwa J, Tweya H, Jafa K, Feldacker C. Mureithi M, et al. PLOS Digit Health. 2024 Apr 3;3(4):e0000480. doi: 10.1371/journal.pdig.0000480. eCollection 2024 Apr. PLOS Digit Health. 2024. PMID: 38568904 Free PMC article.
• Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, Riedel-Heller S, König HH. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011 Aug 03;68(4):387–420. doi: 10.1177/1077558711399580.68/4/387 - DOI - PubMed
• McPhail S. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manag Healthc Policy. 2016 Jul;Volume 9:143–56. doi: 10.2147/rmhp.s97248. - DOI - PMC - PubMed
• Matheson GO, Pacione C, Shultz RK, Klügl M. Leveraging human-centered design in chronic disease prevention. Am J Prev Med. 2015 Apr;48(4):472–9. doi: 10.1016/j.amepre.2014.10.014.S0749-3797(14)00618-7 - DOI - PubMed
• Chan K. A design thinking mindset beyond the public health model. World Med Health Policy. 2018;10(1):111–9. doi: 10.1002/wmh3.253. - DOI
• Vesely R. Applying 'design thinking' to health care organizations. Health Facil Manag. 2017 Mar;30(3):10–1. - PubMed

Publication types

• Search in MeSH

Related information

• Cited in Books

LinkOut - more resources

Full text sources.

• Europe PubMed Central
• JMIR Publications
• PubMed Central
• MedlinePlus Health Information
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Research Areas

Faculty, research associates, and students in the department of Human Centered Design & Engineering advance the study and practice of design to improve cognition, behavior, engagement, or participation among individuals, groups, organizations, and communities of people.

Our approaches are fundamentally interdisciplinary and sociotechnical : we draw on a wide range of disciplinary traditions as we investigate the interaction of people's practices and meanings with technology.

Our department's research and teaching focus on six interrelated areas of study:

Influencing Behavior, Thinking, and Awareness

Design for emergent collaborations and organizations, low resource and underserved populations, material and embodied technologies, data science and data visualization, learning in professional and technical environments.

Faculty and students work collaboratively across many of the areas listed above. Students do not formally identify themselves as belonging to a particular research area and all graduating students receive engineering degrees in Human Centered Design & Engineering, not a particular area of study. While the HCDE researchers listed in each area below emphasize certain areas of study in their teaching and research, all faculty have additional areas of expertise not listed here.

As designers, we have the ability to create interventions that support or prompt changes in people's everyday lives, ideally for the better. We study how interventions affect people's behavior, thinking, or awareness. In addition, we design and assess new tools for making these changes. Focus areas include health and wellness, leisure, education, civic engagement, politics, social influence, persuasive technology, behavior change, reflection and mindfulness, awareness, incentives, and motivation.

We study and build digital technologies that people use to coordinate, collaborate, and interact in other ways. Our work typically focuses on emerging uses, practices, capacities, and organizational arrangements associated with collaborative technologies. We understand, influence, design, implement, and assess sociotechnical systems. Our research spans multiple contexts such as decision making, leisure, work, volunteerism, creativity, and innovation and domains such as crisis informatics, maritime operations, collaborative text production, and infrastructure studies.

We design and evaluate technologies for resource-constrained environments and deploy those technologies to support vulnerable populations. Our work is motivated by a commitment to ensuring the world enjoys the benefits of diverse technological solutions that can serve multiple populations. Areas of research include low-resource environments, high-risk and safety-critical environments, complex systems, crisis informatics, disaster and humanitarian response, humanitarian relief, information and communication technologies for development, and human-computer interaction for development.

We conduct research on the material and embodied technologies that shape emerging sites and process of daily life, from home energy monitoring to 3D printing and technology repair. We are interested in the overlap and collision of atoms and bits, looking at how the merging of craft and digital fabrication technologies condition our social worlds. We look at a range of platforms and form factors, and we are especially interested in how computing extends, resists, and  transforms other technologies as well as social relationships, institutions, and communities. Areas of research include cultures of making, craft and repair, physical computing, open source hardware, digital fabrication, infrastructure studies, and science and technology studies.

We focus on the design, implementation, and evaluation of human-centered systems and techniques, such as visual analytics, in support of collaborative activities in environments that generate and require very large and complex data sets.

We focus on learning, with an emphasis on professional and technical activities. This work occurs across areas such as professional development and identity, translation of knowledge into action, expertise in problem framing, representation of design contexts, digital interfaces, reflection, engineering learning, design learning, language learning, and learning from text.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Community-Based Participatory Research and Human-Centered Design Principles to Advance Hearing Health Equity

Nicole marrone.

1 Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ

Carrie Nieman

2 Department of Otolaryngology Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

3 Johns Hopkins Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Inclusive and equitable research is an ethical imperative. Community-based participatory research (CBPR) as well as human-centered design are approaches that center partnership between community members and academic researchers. Together, academic-community research teams iteratively study community priorities, collaboratively develop ethical study designs, and co-create innovations that are accessible and meaningful to the community partners while advancing science. The foundation of the CBPR approach is reliant on its core principles of equity, co-learning, shared power in decision-making, reciprocity, and mutual benefit. While the CBPR approach has been used extensively in public health and other areas of healthcare research, the approach is relatively new to audiology, otolaryngology, and hearing health research. Recent applications of CBPR have been framed broadly within the theoretical positions of the socio-ecological model for a systems-level approach to community-engaged research and the Health Services Utilization model within health services and disparities research using CBPR. Utilizing human-centered design strategies can work in tandem with a CBPR approach to engage a wide range of people in the research process and move toward the development of innovative yet feasible solutions. Leveraging the principles of CBPR is an intricate and dynamic process, and may not be a fit for some topics, some researchers’ skillsets, and may be beyond some projects’ resources. When implemented skillfully and authentically, CBPR can be of benefit by elevating and empowering community voices and cultural perspectives historically marginalized in society and underrepresented within research. The purpose of the current article is to advance an understanding of the CBPR approach, along with principles from human-centered design, in the context of research aimed to advance equity and access in hearing healthcare. The literature is reviewed to provide an introduction for auditory scientists to the CBPR approach and human-centered design, including discussion of the underlying principles of CBPR and where it fits along a community-engaged continuum, theoretical and evaluation frameworks, as well as applications within auditory research. With a focus on health equity, this review of CBPR in the study of hearing healthcare emphasizes how this approach to research can help to advance inclusion, diversity, and access to innovation.

Health equity is critically important within hearing healthcare and auditory research. Central to the Healthy People national public health goals in the U.S. is the overarching goal of eliminating health disparities to achieve health equity across the population ( U.S. Department of Health and Human Services, n.d. ). Improving the inclusion, diversity, equity, and access in hearing healthcare involves parallel improvements in the research processes. There have also been recent national and global calls for increasing accessible and affordable hearing healthcare to eliminate disparities in access to care ( National Academies of Sciences, Engineering, and Medicine, 2016 ; World Health Organization, 2021 ).

A high proportion of the growing aging and diverse population in the U.S. is living with untreated or poorly managed hearing loss ( Arnold et al., 2019 ; Nieman et al., 2016 ; Reed et al., 2020). While the under-diagnosis and under-treatment of hearing loss in the general population is itself poorly understood, even less is known about the accessibility of hearing healthcare among diverse populations, those with low socioeconomic position, and those living in rural communities. In addition, there is limited representation of racial and ethnic minorities within the hearing healthcare workforce ( Council on Graduate Medical Education, 2016 ) and limited representation within auditory research study populations, as evidenced by a recent systematic review of clinical trials in the U.S. on hearing loss interventions for adults ( Pittman et al., 2021 ).

Further, bias may be introduced if the effects of hearing loss on communication, healthcare utilization, and other outcomes are assumed not to be mediated by culture, race, ethnicity, socioeconomic position, as well as other forms of sociocultural identity such as gender, disability, and language. In other areas of health research, this is referred to as the risk of taking a “monocultural view” ( Kagawa-Singer et al., 2015 ). Specifically, this refers to ignoring the potential explanatory power of multidimensional aspects of culture, and the complexities of the social determinants of health.

Community-engaged and participatory research has had a strong role in improving equity and inclusion throughout public health research ( Viswanathan et al., 2004 ), with emerging use in hearing healthcare research. Community-based participatory research, or CBPR, is an approach that involves a key partnership between researchers and the community. Benefits of a participatory approach include the identification of relevant and culturally appropriate research questions, enhanced data collection and interpretation, and facilitating the translation of research findings into action and social change ( Wallerstein & Duran, 2010 ; Viswanathan et al., 2004 ). Within intervention research, the CBPR approach strengthens both community capacity and community acceptability of the intervention and research study design, leads to practical and feasible research protocols, informs culturally responsive research practices, enhances recruitment and retention strategies, and yields the ability to address health problems resulting from complex interactions of individual, social, cultural, and political factors ( Hacker et al., 2012 ; Jagosh et al., 2012 ; Macaulay et al., 2011 ). Taking this approach within hearing healthcare research is at the intersection of disability and issues related to racial/ethnic diversity and systemic racism (Ellis et al., 2020).

Recently a scoping meta-review of community-engaged research and CBPR was conducted ( Ortiz et al., 2020 ). Over 100 reviews in the literature have been published to date within other disciplines including nursing, psychology, public health, and many others, with often interdisciplinary representations of CBPR and participatory research in the literature. However, none of these prior literature reviews had a focus on auditory research or hearing healthcare. The current review aims to address this gap in the literature.

The purpose of this article is to provide an introduction to CBPR and human-centered design principles to auditory scientists and describe how these approaches can be applied within auditory research to address issues of inclusion, diversity, equity, and access, ultimately contributing to the elimination of disparities in access to hearing healthcare. In this article, our goal is to advance an understanding of what it means to take a CBPR approach in the context of research aimed to advance equity and access to hearing healthcare. Here we propose that CBPR and human-centered design have potential to offer new perspectives from a broader range of stakeholders, including through principled efforts for greater engagement of, by, and for communities historically marginalized by systemic racism and other forms of oppression. Drawing from the literature, the practices involved in CBPR and its underlying principles, along with human-centered design, will be reviewed. Theoretical and evaluation frameworks, applications within hearing healthcare research, and challenges will also be discussed.

Community-Based Participatory Research (CBPR)

Viswanathan et al. (2004) reported on a review of CBPR sponsored by the Agency for Healthcare Research and Quality (AHRQ). The purpose of the review was to gather evidence to date in order to begin to develop a more unifying definition of the CBPR approach. Their consensus definition of CBPR describes it as:

a collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issue being studied, representatives of organizations, and researchers in all aspects of the research process to improve health and well-being through taking action, including social change. (pp. 3)

Principles of CBPR

Key principles expanding upon this definition included that CBPR involves co-learning and reciprocity by all partners, shared decision-making power within the academic-community partnership, and mutual ownership of the research process and its outcomes ( Viswanathan et al., 2004 ). An often-cited summary of eight principles of CBPR is attributed to Israel et al. (1998) . As summarized in Table 1 , these principles of CBPR are found within equitable partnerships between academic researchers and community representatives:

Comparisons between traditional research and Community-Based Participatory Research across the research process (adapted from Horowitz, Robinson, & Seifer, 2009 ).

• Community as a unit of identity;
• Taking a strengths-based approach building on the community’s resources;
• Equitable and collaborative partnership in all phases of the research;
• Mutually benefits all partners;
• Co-learning process that addresses health equity through capacity building and empowerment;
• Cyclical and iterative process;
• Considers health from positive and ecological perspectives;
• Collaborative dissemination of findings within and beyond the community of study.

Rather than a specific research method or set of methods per se, CBPR is an ‘approach,’ or an ‘orientation’ to research ( Cornwall & Jewkes, 1995 ). In fact, many different types of study designs have been conducted within a CBPR approach across different disciplines, including randomized control trials and quasi-experimental studies, surveys, and qualitative studies ( Clark & Ventres, 2016 ; De Las Nueces et al., 2012 ; Salimi et al., 2012 ). Taking a CBPR approach can include quantitative, qualitative, and mixed methods data collection. However, as we will discuss further in this review, CBPR is emergent in auditory research.

By describing CBPR as an approach or orientation to the research, it is often explained that its underlying principles differ in part from those of traditional laboratory or clinical research studies. An extensive comparison between traditional research and CBPR was carried out by Horowitz et al. (2009) and has been adapted in Table 1 . Among the important contrasts between traditional research and CBPR is the degree of community involvement at all stages of the research process, including identifying the research problem, study design and implementation, and dissemination of findings. Taking a CBPR approach will not be a fit for all research topics, researchers’ skillsets, and may be beyond some projects’ resources. On a practical level, this is exemplified within CBPR academic-community partnerships as equitably sharing project funding, responsibility, and decision-making power. This equitable partnership between researchers and the community of study not only improves external validity, it can lead to action and builds both community and research capacity that can have impact beyond the study itself ( Oetzel et al., 2018 ).

History of CBPR

The history of CBPR as a research approach stems from the social sciences, psychology, and education fields. There are considered to be two major sources of the history of CBPR, the Global Northern and Global Southern traditions, based on their geographic places of origin ( Wallerstein & Duran, 2017 ). The Northern tradition stems from the work of Lewin, a sociology researcher in the 1930s-1940s. The Southern tradition is attributed in part to the work of Brazilian educator and philosopher Paolo Freire, who advocated community empowerment and experiential learning within education research in the 1970s. Wallerstein (2021) explains that the more recent definition of CBPR reflects both traditions. Specifically, this approach includes the iterative research processes proposed by Lewin and others, giving honor to community knowledge and strengths, as well as the emancipatory, social justice focus of the Southern tradition based on the work of Freire and others. Reflecting its growing importance within health research and reducing health disparities, CBPR is now a core area of education in the discipline of public health along with other participatory health research approaches ( Wallerstein & Duran, 2017 ).

Research taking a CBPR approach has been documented globally to address a variety of health issues as well as social justice in education and social sciences research. For example, researchers in South Africa used CBPR principles to establish community priorities around cervical cancer screenings ( Mosavel et al., 2005 ). Researchers in that study used focus groups, interviews, and field visits, to engage community members’ feedback and establish partnerships that helped develop a cervical cancer prevention program. The result was a program that emphasized health and wellbeing, rather than pathology ( Mosavel et al., 2005 ). Additionally, the China Jintan Child Cohort Study used a CBPR approach to understand the impact of malnutrition and environmental toxins on the health of children ( Liu et al., 2011 ). In that study, researchers engaged community partners, including parents and teachers, to develop the research protocol, conduct field work, as well as communicate results and engage the public around the topic at health education fairs and poster presentations in local schools and hospitals. The authors conclude that a CBPR approach helped ensure that the topic was relevant to the community and that the protocol was acceptable, and the process helped establish a connection with the community.

CBPR Along the Continuum of Power Sharing in Research

Broadly, CBPR fits within a continuum of power sharing and community engagement in research ( Key et al., 2019 ; Wallerstein et al., 2019 ). The continuum extends on one end from fully investigator-driven research to the other end with fully community-driven research ( Figure 1 ). The continuum is not only based on who is driving the research question and direction but who and how the power is distributed between the investigator and study team and community representatives. Along this continuum, CBPR is situated towards the highest degree of community involvement and power sharing in research. An element that distinguishes CBPR from other research approaches along this continuum is having community involvement at all stages of the research process ( Wallerstein & Duran, 2017 ). Specifically, this can include community involvement from the earliest stages of assessing and identifying community needs, strengths, and resources; formulating a research question; designing the research study; data collection, analysis, interpretation; to the later stages of dissemination and identifying new directions for future research. This shared power dynamic is unique to CBPR. These characteristics separate CBPR from the typical approach to investigator-driven study design, as CBPR promotes empowerment and equity by sharing power in all phases of the research with the partnering community. This approach requires having a trusting relationship between academic and community partners, ongoing dialogue and co-learning, and all the while negotiating and balancing the interests of partners ( Resnik & Kennedy, 2010 ; Mohammed et al., 2012 ). See Figure 2 for methodological approaches to establishing longstanding successful CBPR partnerships.

Comparisons between traditional research and CBPR across the research process.

Methodological approaches to establishing longstanding successful CBPR partnerships (see: Examining Community-Institutional Partnerships for Prevention Research Group, 2006 ; Shalowitz et al., 2009 .; Coombe et al., 2020.)

While CBPR is often recommended, or even solicited by funding agencies, as an approach to engage diverse and vulnerable communities in research, it should not be viewed only as a means to enroll greater numbers of people of color or engage marginalized communities in the research. The CBPR approach emphasizes equitable partnership and reciprocity with communities to share power within the conduct of the research study itself ( Examining Community-Institutional Partnerships for Prevention Research Group, 2006 ; Shalowitz et al., 2009 ). Thus, the researcher who takes a CBPR approach recognizes, cultivates, and encourages far greater engagement of community members within the design and conduct of the research study, well beyond the recruitment of participants alone. When investigators recognize the importance of contributions of the community at all stages of the research process, this community engagement enables prioritization and value-shifting that honors the community’s needs and strengths. Further, engagement with community partners throughout the entire research process supports a mechanism for accountability so that the research fulfills its intended purpose, while drawing upon the strengths of the community without marginalization or exploitation to be relevant and effective for the communities served.

To expand the CBPR approach within auditory research, we will need both action from individual investigators and systemic supports. It is important for authors/researchers to appropriately represent their work and how it is positioned within the continuum of community-engaged research (see also Figure 1 ). Additionally, one must not misrepresent research that is conducted within a community setting as CBPR by staying transparent in reporting about the degree to which the study is truly CBPR. Likewise, acknowledging a continuum of community engagement and power-sharing within research, future readers and reviewers of grant proposals and manuscripts within auditory research may do well to watch for indicators of the quality of true CBPR implementation and not mistake community-placed recruitment for CBPR.

There are several key elements to highlight here about the unique process of dissemination of CBPR findings that may be unfamiliar to many auditory researchers. Collaborative authoring of the research studies with community representatives is a hallmark of CBPR dissemination. Co-authorship is intended to be reflective of the research team’s respect for community knowledge and substantive contributions provided by community partners within the scientific literature. Specific guidance for researchers about collaboration in authoring of CBPR for peer-reviewed journals with community partners was provided by Bordeaux et al. (2007) . Specific recommendations for the dissemination of qualitative CBPR studies has also been outlined by Dolwick Grieb et al. (2014). Also, unintentional systemic barriers for authorship may exist for community partners. For example, journals may require specific stipulations on what constitutes authorship, which we acknowledge is important to guarantee that there has been a substantive contribution. However, community partners who do not fit the traditional vision of authorship may be omitted from the scholarly process and unacknowledged in the research literature. To date, the question of how to appropriately and adequately represent the work of non-traditional partners in academia remains an unanswered question and represents an ongoing challenge to work towards resolving.

Another hallmark of the dissemination process of CBPR is presenting the study findings to audiences beyond the peer-reviewed scientific literature, in particular, with a focus on dissemination to the partner organizations and partnering community represented. In a systematic review by Chen et al. (2010) about reporting the dissemination of results to the community and general public, it was found that about half of the CBPR scientific publications reviewed included reports about dissemination beyond the peer-reviewed study. In a related survey, they found that authors of CBPR studies published in peer-reviewed journals also reported disseminating results to the participants of the study (98%) as well as to the general public (84%).

Overall, Chen et al. (2010) highlight that the dissemination process beyond the scientific literature has value in reinforcing a number of core principles of CBPR. Specifically, the coproduction of knowledge and its dissemination collaboratively can reinforce relationships and a commitment between the community partners and academic researchers. Dissemination should also serve the community and be of mutual benefit, that is, to share the information back with the partnering community as well as the larger scientific community. The involvement of community representatives can also influence how the information is presented, such as through pieces written for a lay audience or making information available across multiple languages. A potential challenge cited in this regard is that the funding timelines of researchers and community organizations may not adequately account for the additional time and resources needed to effectively and collaboratively disseminate findings within the community and general public. Yet, sustaining these efforts beyond a project’s funded timeline can also demonstrate the commitment by academic-community partners to long-term systems level and social change, which may take many years to cultivate beyond a funding cycle.

Culturally-Responsive Practices

Participatory research approaches such as CBPR are of particular interest in cross-cultural and multicultural research. According to González Castro et al. (2006) , culturally responsive research “refers to research designs and methodologies that adequately respect the local culture and effectively respond to critical cultural issues” (p. 139). A culturally-responsive approach is essential to CBPR (Wallerstein et al., 2019b). Some researchers have pointed out that there can be overly superficial considerations of culture when evidence-based programs merely undergo literal translations to another language without a more deep-level consideration of culture (Wallerstein et al., 2019b; Resnicow et al., 1999 ). Culture has been described as a ‘missing link’ in health research that will help lead to improved outcomes ( Kagawa-Singer et al., 2016 ). An emphasis on a culture-centered approach within CBPR places a specific focus on community engagement to integrate cultural context and cultural knowledge within research (Wallerstein et al., 2019b). It is argued that CBPR in this way may lead to structural change in research practices and social change through community empowerment.

Cultural Humility

Because the CBPR partnership often brings together individuals from different backgrounds, CBPR calls for researchers to be reflexive about their positions of power, and embrace a perspective of cultural humility ( Minkler, 2004 ). Cultural humility is defined as taking inventory of one’s own values, biases, and perspectives from one’s personal life and professional training, increasing awareness and understanding of others’ experiences, and examining and minimizing power imbalances ( Yeager & Bauer-Wu, 2013 ). A foundation in cultural humility can help foster better communication, help researchers more deeply understand the context of the study community, help promote relationships of mutual respect, and allow the team to work towards their mutual goal of health equity.

Human-Centered Design

Originating outside of academics, design methodologies, including human-centered design, have been increasingly incorporated into public health-oriented research. Design methodologies have typically been employed in the commercial sector and are broad, consisting of approaches, such as design thinking, co-design, human-centered design, among others. Similar to CBPR, these design methodologies include a strong emphasis on participation and engagement, including individuals who are the target of the service or product throughout the design process from design to testing and refining solutions.

Human-centered design has in part originated from design thinking and, at times, the terms have been used interchangeably. Design thinking began in the 1980s and was popularized in the 1990s as an approach to foster innovation in technology and business through the creation of consumer-driven products and services and is now increasingly used within healthcare and research ( Brown & Wyatt 2010 ; Suen et al., 2010). Broadly, human-centered design is a process that incorporates alternating divergent and convergent thinking through activities that attempt to capture the advantages of approaching challenges and solutions through a human-focused point of view while balancing real-world limitations (e.g., finances, time, etc. Chen et al., 2020 ). Like CBPR, the overarching goal is to develop solutions that are meaningful, feasible, effective, and, ultimately, address problems that are of high-priority for the involved individuals. Chen et al.’s review of CBPR and human-centered design identified key similarities between the two approaches and includes a focus on co-creation, the participation of partners throughout all stages of the process, bidirectional transfer of knowledge, along with guiding principles of flexibility, generalizability, systematic, and iteration ( Chen et al., 2020 ).

The process of human-centered design generally involves three phases, inspiration, ideation, and implementation ( Brown & Wyatt, 2010 ). While intended to be a flexible process that is not necessarily linear, the inspiration phase is generally the starting point and includes activities that work to frame, research, and synthesize the research team’s understanding of an identified problem ( Brown & Wyatt, 2010 ; Suen et al., 2021 ). The inspiration phase seeks to develop a deep understanding of the identified problem from the perspective of key stakeholders and in the process develop empathy and learn about barriers and workarounds ( Brown & Wyatt, 2010 ; Chen et al., 2020 ) without a focus on developing a solution. Next, the ideation phase seeks to translate the understanding of the problem garnered in the inspiration phase into possible solutions using multiple approaches to brainstorming ( Brown & Wyatt, 2010 ; Suen et al., 2021 ). Possible solutions are then rapidly prototyped to create a tangible representation of the solution that can be a low-risk way to check assumptions, gauge responses from key stakeholders, and uncover potential implementation challenges early ( Suen et al., 2021 ). The implementation phase focuses on the testing and prototyping of multiple potential solutions in a systematic and iterative fashion ( Suen et al., 2021 ; Chen et al., 2020 ). Throughout these phases, the exact methods can vary but often incorporate qualitative methodology, such as structured observations, semi-structured interviews, and focus groups and include activities designed to foster empathy, examine problems from multiple perspectives, and generate novel ideas.

While human-centered design offers a methodology and orientation that aligns well with the guiding principles of CBPR, important differences exist between the two and potential points of tension as well. Chen et al.’s review also identified differences between human-centered design and CBPR, namely differences in values, outcomes, and process ( Chen et al., 2020 ). For example, human-centered design is typically a limited, time-bound engagement with stakeholders rather than a long-term commitment between research teams and communities ( Chen et al., 2020 ). While participatory in nature, human-centered design does not recognize or emphasize power differentials between research teams and communities and the intentionality CBPR takes in shifting power to communities is not necessarily a component of human-centered design ( Chen et al., 2020 ). While such differences need to be recognized, human-centered design represents a methodology that can complement CBPR and serve as an additional tool in developing potential solutions that center communities’ needs and priorities while working to advance equity.

Frameworks in Participatory Research

For investigators new to a CBPR approach, one potential question may be in identifying an appropriate theoretical and/or evaluation framework for their research. Below we introduce multiple frameworks that have been used in CBPR studies, including in auditory research. We also introduce the CBPR Conceptual Model ( Wallerstein et al., 2008 , 2018 ), a framework used to evaluate and reflect on community-academic partnership processes within CBPR. See Table 2 for a summary of selected frameworks.

Examples of evaluation and theoretical frameworks that have been used in participatory research

Theoretical Frameworks

Theoretical frameworks can help to explain the variables that influence outcomes, and can help provide better understanding of the research question by connecting to existing knowledge. Studies involving CBPR are broad, and have included a variety of different theoretical frameworks, however, critical to the frameworks using CBPR is the consideration of the social determinants of health. As reviewed in this special issue by Bush and colleagues, social determinants of health are the “conditions in which people are born, grown, work, live, and age”, such as income, education, housing, and access to food (WHO, 2021). Below we describe two theoretical frameworks that have been used in studies that involve a CBPR approach, including within auditory research.

The socio-ecological model (SEM) is a theoretical framework that examines how factors of influence at the individual (e.g., age, education, attitudes, health literacy, behaviors), interpersonal (e.g., friends, family, coworkers), community (e.g., schools, workplaces, neighborhoods, church), institutional (e.g., academic, health care organizations, state and local health departments), and societal levels impact health conditions and health-related behavior ( Bronfenbrenner, 1989 ; McLeroy et al., 1988 ). The core principle of the SEM is that a person interacts with all levels of their environment, and there is a reciprocal interaction that influences a person and their environment. Numerous CBPR studies have used the SEM as a framework for understanding the multiple factors that impact health at different levels, to identify leverage points for intervention, and to develop approaches for prevention and health promotion (e.g., Mancera et al., 2018 ). A CBPR approach complements the SEM by integrating community engagement and stakeholder representation from multiple contexts, or levels of environments. In auditory research, Ingram et al. (2016) conducted a CBPR multilevel community needs assessment using the theoretical framework of the SEM in preparation for the Oyendo Bien (Hearing Wellness) clinical trial ( clinicaltrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT03255161","term_id":"NCT03255161"}} NCT03255161 ). The starting point for this work was co-learning from a multi-level community needs assessment. Established academic/community partnerships identified and allowed access to a range of relevant stakeholders for the qualitative needs assessment, including interviews and focus groups ( Ingram et al., 2016 ). CBPR partners co-designed the needs assessment to gain insights from older adult patients with hearing loss, family members, Community Health Workers, physicians, and other community members, thus addressing all levels of the Socioecological Model. Outcomes revealed the needs and strengths of the community to address hearing loss and ongoing health disparities ( Ingram et al., 2016 ).

The Health Services Utilization (HSU) model is a theoretical framework for studying the factors that contribute to an individual’s use of healthcare services ( Aday & Andersen, 1974 ; Andersen & Newman, 1973 ; Andersen, 1995 ). According to the HSU model, healthcare use is determined by the interaction between individual and contextual predisposing factors (e.g., age, race/ethnicity, gender, health beliefs, the demographic makeup of communities, and societal norms), enabling factors (e.g., health insurance, health policies in place, financial equity, availability of community supports), and need (perceived and evaluated individual and community health indices). A multitude of systematic reviews, retrospective chart reviews, and prospective research studies have used the HSU model as a framework to understand correlates of behaviors moderating healthcare usage, and to help contextualize results (see also review by Babitsch, Gohl, & von Lengerke, 2012 ). Using a CBPR approach can help provide context and guidance on variable selection and interpretation of findings within the HSU model (e.g., Podder et al., 2021 ). Within auditory research, the Conexiones (Connections) randomized controlled trial used the HSU model with a CBPR approach to evaluate the feasibility of Community Health Workers as patient-site facilitators in teleaudiology service delivery ( Coco, 2021 ), discussed below in the section “ Examples of Community-Based Participatory Research ”.

Evaluation Frameworks

Evaluation frameworks provide a structure to measure the extent to which a program or intervention has achieved the projected outcomes or goals. They may focus on the measurement of impact, outcome goals, and/or cost/benefit. This guiding framework may be particularly advantageous in auditory research, which can lack consistent reporting, limiting the ability to compare across studies ( Perez & Edmonds, 2012 ). Below, we provide an overview of two evaluation frameworks that may be applied to CBPR.

The PRECEDE-PROCEED model is a structure for planning, implementing, and evaluating health promotion interventions and programs ( Green, 1974 ; Gielen et al., 2008 ; Freire & Runyan, 2006 ). PRECEDE-PROCEED is an acronym for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. The framework is undertaken in two distinct steps. First, the PRECEDE phase includes a thorough needs assessment of problems and needs in a given population, such as through a forum or focus group, as well as setting priorities and identifying administrative and policy-related issues that can influence what can be implemented. Next, the PROCEED phase involves implementing the intervention, conducting a process evaluation, and evaluating impact. In CBPR, the PRECEDE-PROCEED model can help provide structure for identifying community knowledge, capacity, and readiness around an intervention (e.g., Bammann et al., 2021 ). An example of the use of the PRECEDE-PROCEED model in the auditory literature is described in Carson and Pichora-Fuller (1997) . The authors used a participatory approach for program planning to improve communication for seniors with hearing loss in a residential facility in Vancouver, British Columbia. The authors emphasized that the PRECEDE-PROCEED model is appropriate for program implementation and evaluation in the area of audiologic rehabilitation because it emphasizes an ecological approach that is community-based and addresses real-life concerns, and therefore results in program objectives that are more realistic to the target community or individual’s lives ( Carson & Pichora-Fuller, 1997 ).

The RE-AIM evaluation framework provides researchers with a specific and standardized guide for evaluating and reporting the feasibility and impact of public health interventions ( Glasgow, Vogt, & Boles, 1999 ). The RE-AIM acronym stands for Reach (participation rate and characteristics of individuals who are willing to participate in the intervention), Effectiveness (impacts of the intervention on outcomes of interest), Adoption (the factors influencing participants’ adoption of the intervention), Implementation (the extent to which the intervention is delivered consistently), and Maintenance (the extent to which an intervention becomes institutionalized or part of routine practice). The RE-AIM framework has been employed in numerous behavior change and health promotion interventions to measure various health issues and intervention targets ( Glasgow et al., 2019 ). RE-AIM helps guide consistent reporting of findings, helping to improve external validity and translation of research to practice. In CBPR, RE-AIM helps provide structure to evaluate community and organization-level capacity, feasibility, and readiness (e.g., Tapp et al., 2014 ). Furthermore, there are opportunities to integrate elements of human-centered design into the RE-AIM framework ( Chen et al., 2020 ). In an auditory research context, the Conexiones RCT used elements of RE-AIM to evaluate the extent to which the novel service delivery model under study was feasible ( Coco, 2021 ). RE-AIM complements CBPR because it provides a framework for sustainability, and can facilitate transparent communication and reporting of each stakeholder’s priorities, roles, and responsibilities.

CBPR Conceptual Model

In addition to these theoretical and evaluation frameworks, CBPR itself can be the focus of study. A conceptual model for CBPR was developed by Wallerstein and colleagues (2008 , 2018 ). In this conceptual model, the major constructs include the contexts, partnership processes, intervention and research processes, outputs, as well as major outcomes and how each of these areas feeds back into the others. This CBPR conceptual model may be of growing relevance and importance as more auditory researchers adopt a CBPR approach in the future.

Applications Within Auditory Research

An ecological approach within auditory research.

Taking an ecological approach to the study of hearing loss may already be familiar to some auditory researchers. An ecological and multi-dimensional view of hearing loss has been described in the auditory literature related to applying the World Health Organization International Classification of Functioning, Disability, and Health ( WHO, 2001 ) to hearing as the health condition of interest ( Meyer et al., 2016 ; Granberg et al., 2014 ; Danermark et al., 2013 ). Contextual factors within the WHO-ICF, such as social, language, and cultural factors, that influence lived experience of hearing loss as well as access to hearing healthcare services, can be studied with a CBPR approach. The role of an “auditory ecology” has been described by Gatehouse et al. (2003) and later expanded upon by Noble (2008) as the types of environments in which listeners must function and the interaction of these environments with the personal characteristics of the individual, their auditory abilities, and the amplification that they have access to from amplification technology such as a hearing aid. Likewise, within research and clinical practice related to rehabilitative audiology, the social context of a person’s lived experience with hearing loss is considered essential in taking a patient-centered and/or family-centered approach to comprehensive care ( Grenness et al., 2016 ).

Examples of Community-Based Participatory Research

There is a recent history of the use of CBPR within auditory research. A CBPR-based National Center for Deaf Health Research was established in 2005 following the work of the Deaf Health Task Force in 2003. The history of the University of Rochester Prevention Research Center is detailed in a publication by McKee et al. (2012) about engaging the Deaf community in Rochester, New York to conduct health research. This included studies such as the major Deaf Healthcare Survey, which was an American Sign Language linguistic and cultural translation of the Behavioral Risk Factor Surveillance Survey, a public health survey conducted by the Centers for Disease Control in all 50 states ( Graybill et al., 2010 ). The key benefits of their use of a CBPR approach are outlined by McKeee et al. (2012) including advancing an understanding of cultural and linguistic differences often held between researchers and the Deaf community using American Sign Language. An emphasis on maintaining cultural competency and cultural humility by the study researchers was described.

The Oyendo Bien clinical trial ( clinicaltrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT03255161","term_id":"NCT03255161"}} NCT03255161 ) is a CBPR study that involves community partnership and interdisciplinary collaboration, including with trained local Community Health Workers, audiologists, and public health researchers from the Arizona Prevention Research Center. Community partners are equal members of the research team, and are engaged at all levels of the research process, including a rigorous needs assessment framed within the socioecological model, study design, recruitment, intervention development and implementation of a randomized controlled trial, and dissemination of results. The intervention is a five-week Community Health Worker-facilitated hearing health education program focused on improving communication for Spanish-speaking older adults with hearing loss in Southern Arizona ( Marrone et al., 2017 ). A CBPR approach was undertaken for the co-development of the intervention with community partners. Building upon needs assessment findings ( Ingram et al., 2016 ), trainings for Community Health Workers were co-developed with audiologists and other members of the CBPR team. The outcomes of this iterative process were trainings to build awareness among Community Health Workers around hearing loss and community resources, as well as a series of more in-depth trainings on how to facilitate a hearing health education and support group. These trainings were co-developed by and for Community Health Workers with relevant prior work experience with leading health promotion groups for management of chronic health conditions with older adults ( Sánchez et al. 2017 ). The CBPR team then co-developed and iteratively revised a pilot intervention, Oyendo Bien ( Marrone et al., 2017 ). This collaborative process differed from other traditional research methods in which the researcher would revise the materials in a top-down approach. Instead, by taking a CBPR approach to the development of the Oyendo Bien program, the priorities and strengths of the community could be emphasized through the participatory engagement of community partners in the intervention development. Results of the Oyendo Bien 5-week Spanish-language hearing health education pilot study showed that, following the program, participants increased self-efficacy and decreased stigma around hearing loss ( Marrone et al., 2017 ).

The Conexiones clinical trial ( clinicaltrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT03864003","term_id":"NCT03864003"}} NCT03864003 ) builds off of CBPR community partnerships from the Oyendo Bien project team. This study first evaluated the feasibility of multilevel trainings for Community Health Workers as patient-site facilitators in teleaudiology-delivered hearing aid services for Spanish-speaking older adults with hearing loss in a US/Mexico border community in Southern Arizona ( Coco et al., 2021 ). As a CBPR study, community partners, including Community Health Workers, collaborated with researchers on developing study design and outcomes measure selection, recruitment, and dissemination of findings. The results of this study indicated that teleaudiology-delivered hearing aid services with Community Health Workers as trained local facilitators is a feasible service delivery model, as indicated by positive patient satisfaction, improved communication self-efficacy from pre-fitting baseline, and other hearing-related outcomes (Coco et al., submitted). Importantly, while the researchers were not from the community, they recognized that collaboration with local health staff was crucial for the project’s success. Further, a CBPR approach helped deepen partnerships in the community, built capacity through grant funding and trainings, and generated community-level awareness on the topic of hearing health. In addition, a CBPR approach helped ensure that the study question was relevant, and that the measurement tools were culturally appropriate and acceptable, thus improving the validity of study results.

Example of Human-Centered Design

The HEARS (Hearing health Equity through Accessible Research and Solutions) intervention is another community-engaged study that incorporates a Community Health Worker-partnered model to hearing care, specifically partnering with older adult peer mentors ( clinicaltrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT03442296","term_id":"NCT03442296"}} NCT03442296 ). Peer mentors deliver a structured hearing care program that includes fitting and orientation of an over-the-counter amplification device and targeted aural rehabilitation with indirect supervision by a team of audiologists ( Suen et al., 2021 ). Throughout the development and piloting of the HEARS intervention as well as the execution of a larger-scale randomized controlled efficacy trial, human-centered design practitioners have worked as consultants as well as embedded within the research team to aid in infusing human-centered design throughout the research process. From the development of training program for Community Health Workers delivering the HEARS intervention to the development of recruitment strategies, human-centered design was employed, including dedicated observations, brainstorming sessions, and prototyping activities with peer mentors and community partners ( Suen et al., 2021 ).

Additional Participatory Studies With Community Engagement

Hearing Norton Sound is a clinical trial involving CBPR to improve access to hearing screenings for the pediatric population ( clinicaltrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT03309553","term_id":"NCT03309553"}} NCT03309553 ). In this study, researchers evaluated a novel service delivery model in Alaska, US involving telemedicine referrals for hearing loss and middle ear disease for children in rural public schools ( Kleindienst Robler, Inglis, et al., 2020 ). The researchers elicited feedback on study design from an Alaska Stakeholder team, which included educators, Alaska Native parents, public health researchers, audiologists, otolaryngologists, and administrators.

iManage (My Hearing Loss) is an internet-delivered intervention for individuals with hearing loss developed using a participatory design approach. Stakeholders, including eHealth experts, individuals with hearing loss, audiologists, and other experts reviewed the conceptual design, participated in focus groups to provide feedback on content, evaluate a mock-up prototype, and review program content for future a usability evaluation ( Burden et al., 2020 ). Through this thorough process, the concept of the iManage tool shifted from its original focus on self-management to decision coaching on seeking care for hearing loss.

Advantages and Challenges of Conducting CBPR

One advantage of CBPR is that it makes possible studies that would otherwise be impossible without community partnerships. Also, a benefit of a CBPR approach is the synergy of partnerships, combining expertise across the team with community partners bringing a knowledge and understanding of community strengths, and research partners bringing subject matter expertise. Another advantage of CBPR is its focus on advancing equity and social justice. Further, involving the community in the research process leads to more relevant research questions and acceptable study designs, leading to potentially more valid results.

There are also a number of potential difficulties that CBPR teams need to work together to address. For example, CBPR often requires greater human and financial resources, and more time to develop and maintain relationships, as compared to traditional research. However, a greater number of funding agencies are recognizing this challenge and supporting greater resource allocation to community partners. An important area for researchers embarking on CBPR are the ethics involved in community/academic partnerships, including addressing the researchers’ cultural and historical context of identity within the community, as well as decision-making power and ownership of results ( Hoover et al., 2019 ). In addition to these potential challenges, several limitations common among CBPR studies have been cited in the literature and were summarized by Faridi et al. (2007) . First, there has been criticism of a lack of common terminology across studies and non-standardization of reporting, limiting a global understanding of the CBPR elements undertaken in each study’s context. As an antidote to this, a reporting guideline checklist was developed to help researchers when writing about CBPR studies ( Smith, Rosenzweig, & Schmidt 2010 ). Another critique has been that there is a wide range of degree of community participation across different CBPR research studies, with few studies attaining the ideal fully community-driven research. This issue may be addressed moving forward through greater description in reporting on ways in which the community is involved throughout the research process. Finally, some CBPR studies are criticized for their limited generalizability. However, this reflects the tension between adequate external validity for specific communities or cultural groups for whom the generalizability of traditional laboratory-based and clinical research can similarly be limited and criticized for lack of adequate representation and cultural responsiveness.

Limitations and Future Directions

The purpose of this article was to introduce auditory researchers to CBPR. A limitation of our article is that we did not conduct a systematic review, and thus the studies presented may not fully represent the full breadth of literature on this topic. In the future, as CBPR has greater uptake in hearing healthcare, likely systematic reviews will be warranted. Also, readers of this article are encouraged to continue learning about CBPR and build relationships with community partners and researchers with experience in CBPR. Our intention is not to imply that CBPR in the area of auditory research can be conducted on the basis of reading this single article, but it could serve as a starting point and a catalyst to developing interest. Future directions include a call for increasing CBPR and human-centered design within the field of auditory science to address health equity, and for all researchers to reflect on broader questions of equity in research.

Advancing Equity And Inclusion In Hearing Healthcare Research

Recently, Ellis et al. (2020) raised CBPR as an anti-racist research practice for Communication Sciences and Disorders (CSD). In what is likely to become a seminal article for our field, they review ways in which systemic racism disadvantages and is a burden on the lives of Black, Indigenous, and People of Color (BIPOC) populations. Ellis et al. observe that while research holds minimization of bias as a central tenet, health disparities are persistent. How can this be? The authors stress that it is critical for researchers to acknowledge the problem of the lack of diversity and inclusion within the research workforce and research participant samples within CSD. They implore their readers to acknowledge that the majority of research in the field of CSD has been developed by white scientific investigators with mainly white research participants.

Within auditory research specifically, Pittman et al. (2021) conducted a systematic review of clinical trials of hearing loss interventions for adults and documented the very limited representation of racial and ethnic minority individuals within auditory research and the limited reporting of these data at all. Surprisingly, only five prior clinical trials in the U.S. between 1990–2020 of the over 125 trials reviewed (those focused on adults and published before 2020) had adequate representation of racial and ethnic minorities (defined as >30% non-white representation). Additionally, only 12.7% of the studies even reported on the race/ethnicity of the participant samples. Certainly much greater work in this area is warranted for auditory research.

Urgently, Ellis et al. (2020) explain that a critical component of anti-racist research is to adequately involve the community in the research process through equitable collaborative partnerships and taking an alternative approach to research such as CBPR. They explain that different research questions can be asked when informed by community involvement and the power dynamics in research can be explicitly reflected upon. Researchers must adopt humility in the research process to ensure reflection and action on the potential influences of systemic racism, power, privilege, and implicit bias. Only then will there be adequate representation, inclusion, equity, diversity and access to innovation and the knowledge generated by research. To this point, the current authors acknowledge the privilege that it is to be able to conduct scholarship in the area of CBPR to advance hearing health equity. Collectively, the work of Ellis et al. joins with the work of others outside the field in presenting important insights into how CBPR can help to reduce health disparities (e.g., Wallerstein & Duran, 2006 ). Ward et al. (2018) explain that equity within a CBPR approach is characterized by resource-sharing, immediate benefit to the community, transparency, participation in meetings, and influence in decisions within the time period of the study itself, as well as long-term impacts leading to social change. We encourage investigators to reflect on power dynamics, positionality, and level of community engagement within the research process to move towards equity in research beyond considerations of representation or recruitment and retention alone.

The goal of this article was to introduce CBPR to auditory scientists and those interested in health disparities research. The CBPR approach is contrasted with a traditional research approach, which may only engage community members as passive participants within the research study. Alternatively, CBPR fits within the continuum of community engagement in research along the end with high community involvement throughout the research process. An understanding of the eight key principles of CBPR begin to illuminate how and why CBPR is important to advance health equity. With a focus on health equity, CBPR and human-centered design in the context of hearing healthcare will play a part in advancing inclusion, diversity, and equity through increased access to innovation, respect and value of community wisdom, and making research contributions with high relevance to the community. Given the importance of diverse perspectives representing greater inclusion of people of color and multicultural populations, hearing healthcare research could benefit from wider adoption of a CBPR approach and human-centered design principles to advance health equity and anti-racist research practices.

Acknowledgements

The authors express their deep gratitude to our community partners who have provided endless inspiration for our shared dedication to eliminating disparities in access to hearing healthcare. We gratefully acknowledge those who have provided mentorship and guidance for our training in CBPR at the Arizona Prevention Research Center (Maia Ingram, MPH, Jill de Zapien, Scott Carvajal, PhD) and human-centered design partners at the Maryland Institute College of Art (MICA)’s Center for Social Design. We also thank Aileen Wong, AuD, who supported the writing of this manuscript with many insightful discussions.

Sources of Funding: Authors were supported by the National Institute on Deafness and Other Communication Disorders/National Institutes of Health (Marrone: R21/R33 DC013681; Nieman: K23 AG059900; Coco: F32 DC017081). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Nieman serves on the nonprofit boards of Access HEARS and the Hearing Loss Association of America.

Conflicts of Interest Dr. Marrone and Dr. Coco report no conflicts of interest.

• Aday LA, & Andersen R. (1974). A framework for the study of access to medical care . Health Services Research , 9 ( 3 ), 208–220. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Andersen RM (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior , 36 ( 1 ), 1–10. [ PubMed ] [ Google Scholar ]
• Andersen R, & Newman JF (1973). Societal and individual determinants of medical care utilization in the United States . The Milbank Memorial Fund Quarterly Health and Society , 51 ( 1 ), 95–124. [ PubMed ] [ Google Scholar ]
• Arnold ML, Hyer K, Small BJ, Chisolm T, Saunders GH, McEvoy CL, Lee DJ, Dhar S, & Bainbridge KE (2019). Hearing aid prevalence and factors related to use among older adults from the Hispanic Community Health Study/Study of Latinos . JAMA Otolaryngology-- Head & Neck Surgery , 145 ( 6 ), 501–508. 10.1001/jamaoto.2019.0433 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Babitsch B, Gohl D, & von Lengerke T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: A systematic review of studies from 1998–2011 . Psycho-social Medicine , 9 , Doc11. 10.3205/psm000089 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bammann K, Recke C, Albrecht BM, Stalling I, & Doerwald F. (2021). Promoting physical activity among older adults using community-based participatory research with an adapted PRECEDE-PROCEED model approach: The AEQUIPA/OUTDOOR ACTIVE Project . American Journal of Health Promotion , 35 ( 3 ), 409–420. 10.1177/0890117120974876 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bordeaux BC, Wiley C, Tandon SD, Horowitz CR, Brown PB, & Bass EB (2007). Guidelines for writing manuscripts about community-based participatory research for peer-reviewed journals . Progress in Community Health Partnerships : Research, Education, and Action , 1 ( 3 ), 281–288. 10.1353/cpr.2007.0018 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bronfenbrenner U. (1989). Ecological systems theory . Annals of Child Development , 6 , 187–249. [ Google Scholar ]
• Brown T, & Wyatt J. (2010). Design Thinking for Social Innovation . Stanford Social Innovation Review. Available from: https://ssir.org/articles/entry/design_thinking_for_social_innovation . Published 2010 [ Google Scholar ]
• Burden RS, Galloway LN, Rothpletz AM, Glasheen KA, & Preminger JE (2020). The development of an internet-based decision coaching guide to encourage audiology care: The results of a participatory design approach . American Journal of Audiology , 29 ( 3S ), 546–563. 10.1044/2020_AJA-19-00066 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carson AJ & Pichora-Fuller MK (1997). Health promotion and audiology: The community-clinic link . Journal of the Academy of Rehabilitative Audiology , 30 , 29–51. [ Google Scholar ]
• Chen PG, Diaz N, Lucas G, & Rosenthal MS (2010). Dissemination of results in community-based participatory research . American Journal of Preventive Medicine , 39 ( 4 ), 372–378. 10.1016/j.amepre.2010.05.021 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chen E, Leos C, Kowitt SD, & Moracco KE (2020). Enhancing community-based participatory research through human-centered design strategies . Health Promotion Practice , 21 ( 1 ), 37–48. 10.1177/1524839919850557 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Clark L, & Ventres W. (2016). Qualitative methods in community-based participatory research: Coming of age . Qualitative Health Research , 26 ( 1 ), 3–4. 10.1177/1049732315617445 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Coco L, Piper R, & Marrone N. (2021). Feasibility of community health workers as teleaudiology patient-site facilitators: a multilevel training study . International Journal of Audiology , 1–14. Advance online publication. 10.1080/14992027.2020.1864487 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ] Investigating the feasibility of community health workers as teleaudiology patient-site facilitators: a strategy to improve access to hearing aid services for older adults. (Unpublished doctoral dissertation). The University of Arizona, Tucson, AZ.
• Cornwall A, & Jewkes R. (1995). What is participatory research? Social Science & Medicine , 41 ( 12 ), 1667–1676. 10.1016/0277-9536(95)00127-s [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Council on Graduate Medical Education. ( May 2016). Supporting Diversity in the Health Professions . Health Services and Resources Services Administration. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/resource-papers/May2016.pdf [ Google Scholar ]
• Danermark B, Granberg S, Kramer SE, Selb M, & Möller C. (2013). The creation of a comprehensive and a brief core set for hearing loss using the international classification of functioning, disability and health . American Journal of Audiology , 22 ( 2 ), 323–328. 10.1044/1059-0889(2013/12-0052) [ PubMed ] [ CrossRef ] [ Google Scholar ]
• De Las Nueces D, Hacker K, DiGirolamo A, & Hicks LS (2012). A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups . Health Services Research , 47 ( 3 Pt 2 ), 1363–1386. 10.1111/j.1475-6773.2012.01386.x [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dolwick Grieb S, Smith KC, Calhoun K, & Tandon D. (2015). Qualitative research and community-based participatory research: Considerations for effective dissemination in the peer-reviewed literature . Progress in Community Health Partnerships: Research, Education, and Action , 9 ( 2 ), 275–282. [ PubMed ] [ Google Scholar ]
• Ellis C, Jacobs M, & Kendall D. (2021). The impact of racism, power, privilege, and positionality on communication sciences and disorders research: Time to reconceptualize and seek a pathway to equity . American Journal of Speech-Language Pathology , 1–8. Advance online publication. 10.1044/2021_AJSLP-20-00346 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Examining Community-Institutional Partnerships for Prevention Research Group (2006). Building and sustaining community-institutional partnerships for prevention research: findings from a national collaborative . Journal of Urban Health: Bulletin of the New York Academy of Medicine , 83 ( 6 ), 989–1003. 10.1007/s11524-006-9113-y [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Faridi Z, Grunbaum JA, Gray BS, Franks A, Simoes E. (2007). Community-based participatory research: Necessary next steps . Preventing Chronic Disease . 4 ( 3 ): A70. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Freire K, & Runyan CW (2006). Planning models: PRECEDE-PROCEED and Haddon Matrix. In Gielen AC, Sleet DA, DiClemente RJ (Eds.), Injury and violence prevention: Behavioral science theories, methods, and applications (pp. 127–158). San Francisco, CA: Jossey-Bass. [ Google Scholar ]
• Gatehouse S, Naylor G, & Elberling C. (2003). Benefits from hearing aids in relation to the interaction between the user and the environment . International Journal of Audiology , 42 Suppl 1 , S77–S85. 10.3109/14992020309074627 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gielen AC, McDonald EM, Gary TL, & Bone LR (2008). Using the PRECEDE-PROCEED model to apply health behavior theories . Health Behavior and Health Education: Theory, Research, and Practice , 4 , 407–29. [ Google Scholar ]
• Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, Ory MG, & Estabrooks PA (2019). RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review . Frontiers in Public Health , 7 , 64. 10.3389/fpubh.2019.00064 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Glasgow RE, Vogt TM, & Boles SM (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework . American Journal of Public Health , 89 ( 9 ), 1322–1327. 10.2105/ajph.89.9.1322 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• González Castro F, Rios R. & Montoya H. (2006). Ethical community-based research with Hispanic or Latina(o) populations: balancing research rigor and cultural responsiveness. In The handbook of ethical research with ethnocultural populations & communities (pp. 138–154). SAGE Publications, Inc., 10.4135/9781412986168 [ CrossRef ] [ Google Scholar ]
• Granberg S, Pronk M, Swanepoel, d., Kramer, S. E., Hagsten, H., Hjaldahl, J., Möller, C., & Danermark, B. (2014). The ICF core sets for hearing loss project: Functioning and disability from the patient perspective . International Journal of Audiology , 53 ( 11 ), 777–786. 10.3109/14992027.2014.938370 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Graybill P, Aggas J, Dean RK, Demers S, Finigan EG, & Pollard RQ Jr (2010). A community-participatory approach to adapting survey items for Deaf individuals and American Sign Language . Field Methods , 22 ( 4 ) 429–448 [ Google Scholar ]
• Green LW (1974) Towards cost-benefit evaluations of health education: Some concepts, methods, and examples . Health Education Monographs , 2 (Supp 1 ): 32–64. [ Google Scholar ]
• Grenness C, Meyer C, Scarinci N, Ekberg K, & Hickson L. (2016). The International Classification of Functioning, Disability and Health as a framework for providing patient- and family-centered audiological care for older adults and their significant others . Seminars in Hearing , 37 ( 3 ), 187–199. 10.1055/s-0036-1584411 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hacker K, Tendulkar SA, Rideout C, Bhuiya N, Trinh-Shevrin C, Savage CP, … & DiGirolamo A. (2012). Community capacity building and sustainability: Outcomes of community-based participatory research . Progress in Community Health Partnerships: Research, Education, and Action , 6 ( 3 ), 349–360. 10.1353/cpr.2012.0048 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hoover SM, Tiwari S, Kim J, Green M, Richmond A, Wynn M, ... & Corbie-Smith G. (2019). Convergence despite divergence: Views of academic and community stakeholders about the ethics of community-engaged research . Ethnicity & Disease , 29 ( 2 ), 309–316. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Horowitz CR, Robinson M, & Seifer S. (2009). Community-based participatory research from the margin to the mainstream: are researchers prepared? Circulation , 119 ( 19 ), 2633–2642. 10.1161/CIRCULATIONAHA.107.729863 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ingram M, Marrone N, Sanchez DT, Sander A, Navarro C, de Zapien JG, Colina S, & Harris F. (2016). Addressing hearing health care disparities among older adults in a US-Mexico border community . Frontiers in Public Health , 4 , 169. 10.3389/fpubh.2016.00169 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Israel BA, Schulz AJ, Parker EA, & Becker AB (1998). Review of community-based research: assessing partnership approaches to improve public health . Annual Review of Public Health , 19 , 173–202. 10.1146/annurev.publhealth.19.1.173 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jagosh J, Macaulay AC, Pluye P, Salsberg J, Bush PL, Henderson J, et al. (2012). Uncovering the benefits of participatory research: Implications of a realist review for health research and practice . Milbank Quarterly , 90 ( 2 ), 311–46. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kagawa-Singer M, Dressler W, George S, & Elwood WN (2015). The Cultural Framework for Health . Washington, DC: National Institute for Health. [ Google Scholar ]
• Kagawa Singer M, Dressler W, George S, & NIH Expert Panel (2016). Culture: The missing link in health research . Social science & medicine , 170 , 237–246. 10.1016/j.socscimed.2016.07.015 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Key KD, Furr-Holden D, Lewis EY, Cunningham R, Zimmerman MA, Johnson-Lawrence V, & Selig S. (2019). The continuum of community engagement in research: A roadmap for understanding and assessing progress . Progress in Community Health Partnerships: Research, Education, and Action , 13 ( 4 ), 427–434. 10.1353/cpr.2019.0064 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kleindeinst Robler S, Inglis SM, Gallo JJ, Parnell HE, Ivanoff P, Ryan S, Jenson CD, Ross A, Labrique A, Wang NY, & Emmett SD (2020). Hearing Norton Sound: Community involvement in the design of a mixed methods community randomized trial in 15 Alaska Native communities . Research Involvement and Engagement , 6 ( 1 ), 67. 10.1186/s40900-020-00235-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Liu J, McCauley L, Leung P, Wang B, Needleman H, Pinto-Martin J, & Group JC (2011). Community-based participatory research (CBPR) approach to study children’s health in China: Experiences and reflections . International Journal of Nursing Studies , 48 ( 7 ), 904–913. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Macaulay AC, Jagosh J, Seller R, Henderson J, Cargo M, Greenhalgh T, Wong G, Salsberg J, Green LW, Herbert CP, & Pluye P. (2011). Assessing the benefits of participatory research: A rationale for a realist review . Global Health Promotion , 18 ( 2 ), 45–48. [ PubMed ] [ Google Scholar ]
• Mancera BM, Mungal AS, De Santis J, & Provencio-Vasquez E. (2018). Reflections of men of Mexican origin: A grounded theory study of intimate partner violence risk factors . American Journal of Men’s Health , 12 ( 5 ), 1784–1798. 10.1177/1557988318787617 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Marrone N, Ingram M, Somoza M, Jacob DS, Sanchez A, Adamovich S, & Harris FP (2017). Interventional audiology to address hearing health care disparities: Oyendo Bien pilot study . Seminars in Hearing , 38 ( 2 ), 198–211. 10.1055/s-0037-1601575 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McKee M, Thew D, Starr M, Kushalnagar P, Reid JT, Graybill P, Velasquez J, & Pearson T. (2012). Engaging the Deaf American Sign Language community: lessons from a community-based participatory research center . Progress in Community Health Partnerships: Research, Education, and Action , 6 ( 3 ), 321–329. 10.1353/cpr.2012.0037 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McLeroy KR, Bibeau D, Steckler A, & Glanz K. (1988). An ecological perspective on health promotion programs . Health Education Quarterly , 15 ( 4 ), 351–377. 10.1177/109019818801500401 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Meyer C, Grenness C, Scarinci N, & Hickson L. (2016). What is the International Classification of Functioning, Disability and Health and why is it relevant to audiology? . Seminars in Hearing , 37 ( 3 ), 163–186. 10.1055/s-0036-1584412 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Minkler M. (2004). Ethical challenges for the “outside” researcher in community-based participatory research . Health Education & Behavior , 31 ( 6 ), 684–697. 10.1177/1090198104269566 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mohammed SA, Walters KL, Lamarr J, Evans-Campbell T, & Fryberg S. (2012). Finding middle ground: negotiating university and tribal community interests in community-based participatory research . Nursing Inquiry , 19 ( 2 ), 116–127. 10.1111/j.1440-1800.2011.00557.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mosavel M, Simon C, Van Stade D, & Buchbinder M. (2005). Community-based participatory research (CBPR) in South Africa: Engaging multiple constituents to shape the research question . Social Science & Medicine , 61 ( 12 ), 2577–2587. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• National Academies of Sciences, Engineering, and Medicine. 2016. Hearing Health Care for Adults: Priorities for Improving Access and Affordability . Washington, DC: The National Academies Press. 10.17226/23446 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nieman CL, Marrone N, Szanton SL, Thorpe RJ Jr, & Lin FR (2016). Racial/ethnic and socioeconomic disparities in hearing health care among older Americans . Journal of Aging and Health , 28 ( 1 ), 68–94. 10.1177/0898264315585505 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Noble W. (2008). Auditory reality and self-assessment of hearing . Trends in Amplification , 12 ( 2 ), 113–120. 10.1177/1084713808316172 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Oetzel JG, Wallerstein N, Duran B, Sanchez-Youngman S, Nguyen T, Woo K, Wang J, Schulz A, Kaholokula KA, Israel B. and Alegria M. (2018). Impact of participatory health research: A test of the community-based participatory research conceptual model . BioMed Research International , 2018 , 7281405. 10.1155/2018/7281405 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ortiz K, Nash J, Shea L, Oetzel J, Garoutte J, Sanchez-Youngman S, & Wallerstein N. (2020). Partnerships, processes, and outcomes: A health equity-focused scoping meta-review of community-engaged scholarship . Annual Review of Public Health , 41 , 177–199. 10.1146/annurev-publhealth-040119-094220 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Perez E, & Edmonds BA (2012). A systematic review of studies measuring and reporting hearing aid usage in older adults since 1999: A descriptive summary of measurement tools . PloS One , 7 ( 3 ), e31831. 10.1371/journal.pone.0031831 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pittman CA, Roura R, Price C, Lin FR, Marrone N, & Nieman CL (2021). Racial/ethnic and sex representation in US-based clinical trials of hearing loss management in adults: A systematic review . JAMA Otolaryngology-- Head & Neck Surgery , 147 ( 7 ), 656–662. 10.1001/jamaoto.2021.0550 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Podder D, Dasgupta A, Dobe M, Paul B, Bandyopadhyay L, & Pal A. (2021). Health care seeking behavior in a scheduled tribe community in India: A mixed methods research using the framework of Andersen’s Behavioral Model . Asia-Pacific Journal of Public Health , 33 ( 4 ), 369–377. 10.1177/1010539521993695 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Reed NS, Garcia-Morales E, & Willink A. (2021). Trends in hearing aid ownership among older adults in the United States from 2011 to 2018 . JAMA Internal Medicine , 181 ( 3 ), 383–385. 10.1001/jamainternmed.2020.5682 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Resnicow K, Baranowski T, Ahluwalia JS, & Braithwaite RL (1999). Cultural sensitivity in public health: Defined and demystified . Ethnicity & Disease , 9 ( 1 ), 10–21. [ PubMed ] [ Google Scholar ]
• Resnik DB, & Kennedy CE (2010). Balancing scientific and community interests in community-based participatory research . Accountability in Research , 17 ( 4 ), 198–210. 10.1080/08989621.2010.493095 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Richard L, Gauvin L, & Raine K. (2011). Ecological models revisited: Their uses and evolution in health promotion over two decades . Annual Reviews of Public Health , 32 , 307–326. [ PubMed ] [ Google Scholar ]
• Salimi Y, Shahandeh K, Malekafzali H, Loori N, Kheiltash A, Jamshidi E, Frouzan AS, & Majdzadeh R. (2012). Is community-based participatory research (CBPR) useful? A Systematic review on papers in a decade . International Journal of Preventive Medicine , 3 ( 6 ), 386–393. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sánchez D, Adamovich S, Ingram M, Harris FP, de Zapien J, Sanchez A, Colina S, & Marrone N. (2017). The potential in preparing community health workers to address hearing loss . Journal of the American Academy of Audiology , 28 ( 6 ), 562–574. 10.3766/jaaa.16045 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shalowitz MU, Isacco A, Barquin N, Clark-Kauffman E, Delger P, Nelson D, Quinn A, & Wagenaar KA (2009). Community-based participatory research: a review of the literature with strategies for community engagement . Journal of Developmental and Behavioral Pediatrics , 30 ( 4 ), 350–361. 10.1097/DBP.0b013e3181b0ef14 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Smith L, Rosenzweig L, & Schmidt M. (2010). Best practices in the reporting of participatory action research: embracing both the forest and the trees . The Counseling Psychologist , 38 ( 8 ), 1115–1138. [ Google Scholar ]
• Suen JJ, Han HR, Peoples CY, Weikert M, Marrone N, Lin FR, & Nieman CL (2021). A community health worker training program to deliver accessible and affordable hearing care to older adults . Journal of Health Care for the Poor and Underserved , 32 ( 1 ), 37–49. 10.1353/hpu.2021.0006 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tapp H, Kuhn L, Alkhazraji T, Steuerwald M, Ludden T, Wilson S, ... & Dulin MF (2014). Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices . Journal of Asthma , 51 ( 4 ), 380–390. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• U.S. Department of Health and Human Services. (n.d.). Healthy People 2030 Framework . http://www.health.gov/healthypeople/about/healthy-people-2030-framework
• Viswanathan M, Ammerman A, Eng E, Gartlehner G, Lohr KN, Griffith D, et al. (2004). Community‐Based Participatory Research: Assessing the Evidence. Evidence Reports/Technology Assessments , No. 99. Rockville, MD: Agency for Healthcare Research and Quality (US). Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK11852/ [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ward M, Schulz AJ, Israel BA, Rice K, Martenies SE, & Markarian E. (2018). A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships . Evaluation and Program Planning , 70 ( 2018 ), 25–34. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wallerstein N. (2021). Engage for equity: Advancing the fields of community-based participatory research and community-engaged research in community psychology and the social sciences . American Journal of Community Psychology , 67 ( 3–4 ), 251–255. 10.1002/ajcp.12530 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wallerstein NB, & Duran B. (2006). Using community-based participatory research to address health disparities . Health Promotion Practice , 7 ( 3 ), 312–323. 10.1177/1524839906289376 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wallerstein N. & Duran B. (2010). Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity . American Journal of Public Health , 100 ( s1 ), S40–S46. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wallerstein N, & Duran B. (2017). The theoretical, historical and practice roots of CBPR. In Wallerstein N, Duran B, Oetzel JG, Minkler M. (Eds). Community-based participatory research for health: Advancing social and health equity (pp. 17–29). Hoboken, New Jersey: John Wiley & Sons. [ Google Scholar ]
• Wallerstein N, Muhammad M, Sanchez-Youngman S, Rodriguez Espinosa P, Avila M, et al. (2019). Power dynamics in community-based participatory research: A multiple-case study analysis of partnering contexts, histories, and practices . Health Education & Behavior , 46 ( 1 _suppl), 19S–32S. 10.1177/1090198119852998 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wallerstein N, Oetzel JG, Duran B, Tafoya G, Belone L, Rae R. (2008). CBPR: What predicts outcomes? In: Minkler M, Wallerstein N (Eds). Community based participatory research (2nd ed., 371–392). San Francisco, CA: John Wiley & Co. [ Google Scholar ]
• Wallerstein N, Duran B, Oetzel JG, Minkler M. (Eds.). (2018). Community-based participatory research for health: Advancing social and health equity . (3rd. ed.) San Francisco, CA: Jossey-Bass. [ Google Scholar ]
• Wallerstein N, Oetzel JG, Duran B, Magarati M, Pearson C, Belone L, Davis J, DeWindt L, Kastelic S, Lucero J, Ruddock C, Sutter E, & Dutta MJ (2019). Culture-centeredness in community-based participatory research: contributions to health education intervention research . Health Education Research , 34 ( 4 ), 372–388. 10.1093/her/cyz021 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• World Health Organization. (2001). International Classification of Functioning, Disability and Health . Geneva, Switzerland: Author. [ Google Scholar ]
• World Health Organization. (2021). World Report on Hearing . Geneva: WHO. Available from https://www.who.int/publications/i/item/world-report-on-hearing [ Google Scholar ]
• Yeager KA, & Bauer-Wu S. (2013). Cultural humility: Essential foundation for clinical researchers . Applied Nursing Research , 26 ( 4 ), 251–256. 10.1016/j.apnr.2013.06.008 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

• Our Approach
• Explore the Research
• Insight Summary
• Exploratory Fieldwork
• 1. Tenants Renting During COVID-19
• 2. Landlords Leasing During COVID-19
• 3. Mothers Rethinking Work During COVID-19
• Focused Fieldwork
• 4. Small Landlords Leasing During COVID-19
• 5. Designing Technology for Non-English Speakers
• 6. Homeowners in 100-year Floodplain or Floodway
• 7. Homeowners Surviving Multiple Natural Disasters
• Program Feedback
• 8. Reactions to Harris County COVID Relief Fund
• 9. Building Large-scale Rental Assistance Programs
• Systems Review
• 10. Building a Homebuying Decision Making Tool
• 11. Building Human-centered Intake Applications

Using Human-centered Design to Reimagine the Social Service Ecosystem of Houston

Why human-centered design.

Human-centered design is a way of thinking that places the people being served—rather than any other stakeholders—at the center of the program design and implementation. At Connective, we center the voices of those who are directly impacted by the outcomes of our programs. And this is the approach we took when undertaking this research

Why We Embarked on This Research

Social services need a radical transformation. And we believe that such transformation will come from centering our efforts on the seeker’s experience. When the COVID-19 pandemic hit, we saw that needs and issues faced by people constantly evolved. To advocate for the right resources, we grounded ourselves in understanding what people were experiencing. Thus, from August 2020 through June 2021, we embarked on monthly design research sprints. Each month, we picked a topic to explore and dove in. And this research and the insights we have gained from it are products of that work.

Summary of Insights

Here are all of our insights in one place.

Small landlords and large landlords have a different perception of market demand for rental units. Small landlords with single-family units seem most stressed, even compared to small landlords with multifamily units. On the other, large landlords were much more confident about the strong demand for properties.

Across the board, landlords were aligned on two types of concessions: flexibility in timing of payments and eliminating late fees. And we saw that these concessions weren’t contractual; e.g., if there was a flexible payment plan, it was communicated verbally.

Some people feel like they are stuck in the middle: They are unable to get jobs that align with their skills and education because of job market competitiveness.

Accessing social services, whether government-funded or through a privately run organization, can be an obstacle course. Seekers spend hours of their limited time trying to figure out the system. For many, it means hours and hours of effort on top of already working round the clock to make ends meet. This hurdle means that often the most needy are least able to take advantage of the social services ecosystem. Difficulty in accessing unemployment benefits was called out multiple times during this sprint.

We saw that small landlords play a crucial role in keeping people housed, in preventing homelessness. There is an opportunity to leverage these folks to continue to preserve affordable housing. How do we make their lives easier?

If 60 percent or more of their tenants were paying rent, the small landlords we spoke to were able to cover expenses as they arose. However, they were worried about large bills, such as property taxes and high- ticket item repairs.

Small landlords are experiencing a mental and emotional health crisis as well. Short-term cash flow restriction isn’t just a financial issue, but a health issue as well. Their tenants are behind on rent. Property expenses are piling up. Many have had to dip into savings or contemplate selling off their property— a.k.a., “retirement funds”—during these uncertain times. This causes high levels of ongoing stress on them and their families.

Strengthening the landlord and tenant relationship is more crucial now. Tenants who don’t communicate with landlords and don’t have an open relationship with their landlords are at risk of eviction or stricter consequences. If the landlord believes that the tenants aren’t trying their best to get a stable source of income to be able to pay rent, landlords are more likely to think about evicting them.

Small landlords are feeling squeezed. And if it pushes them to the point of selling their properties, this can lead to a collective public crisis. For the tenants, foreclosures or distress selling (and even soft exits) can lead to disruptive dislocation. For the neighborhood, this can result in reduced property values.

Work closely with the community you’re designing for and other folks who serve that community. This will allow you to design features that you wouldn't otherwise have thought of. Our extended team included Spanish speakers. We solicited feedback from relevant service providers and interviewed several Spanish-speaking folks on their experience using our tool. Even during COVID, we were able to schedule Zoom calls with seekers and have them talk us through their experience using the tool.

Technology tools built for non-English speakers will always have two audiences: the seeker and those who may be helping them access the tool. Because of distrust and lack of tech savviness, a large portion of this community won’t access your tool without support. Build for BOTH seekers AND service providers, family members, and community navigators who help seekers fill out the application.

Some populations may have less social capital in our community, such as newcomers. Use your tool to help them build relationships and network. Identify other parties indirectly involved in or impacted by your tool. Ask: Who does the seeker need to interact with to access your service? Who else is directly involved? How can you build trust between the seeker and that party?

Homeownership is a relationship-centric identity. As such, resiliency work must also focus on relationships and trust-building. Instead of hyper efficiency, this work requires care and patience.

Resilience requires reimagining life, painting a new vision for your and your family’s future. To help people see or mitigate their flood risk will require behavioral change through building trust and supporting them in their journey of reimagining their futures.

It is challenging for a homeowner to understand how their flood risk is changing over time. Some people were informed that their house location had low flood risk when they moved in, and that has stuck with them. They were surprised to learn that their home was now located in a higher-risk area. Changing flood risk brings apprehension that moving anywhere else will also bring the same challenges.

“When I moved in, I was told I was not in a flood zone. But now I am. How could I trust moving into another “low-risk” area?”

Policymakers and program designers should be careful not to overgeneralize about people’s priorities and attachment to community identity. While some families may have place-based attachment, others may not. There is no way to know unless you ask.

Some folks were wary of “people coming in from New York and paying pennies on the dollar,” and assumed community land trust and other nonprofit buyout programs were related to those private efforts.

Future programming (e.g., housing counseling) should be informed by trauma responses. We saw chronic and complex trauma—trauma from multiple events and compounding of different types of trauma from repeated disasters and injustices

People have a lack of trust in government and nonprofit programs due to previous experiences. Transparency builds trust and allows program organizers to drive the narrative of the program.

Seekers may deprioritize data privacy and protection when they need immediate financial support. As such, there is an opportunity to have data and privacy advocates on all program teams—those who will champion data rights even when the seeker may deprioritize it.

In any program and application design, show the fine print, clearly, in layman’s terms. People need this to build trust that has been eroded by traditional, institutional ways of working. People have their guard up and have an eye out for such details that will disqualify them. For each program, clearly share:

• What are the expectations of the applicant?
• What are the hidden fees?
• What’s the turnaround time?
• What will likely disqualify you even if you meet all the criteria?
• What happens when the program is dissolved?
• In what scenarios will the payment need to be returned? (Note: the question isn’t, “Will I need to return the payment?”)

When designing services, keep intersectionality in mind. One way you can do so is through designing for multidimensional personas such as the Non-English Speaking Immigrant who is also a Day to Day Survivor and a First Time Seeker. Or the Houston Transplant who is also a Gig Worker and a Single Parent.

Going through a disaster is traumatic. Disaster recovery programs can add to this trauma.

In general, most people don’t know what type of social services to seek or how to access them. The social service that people mentioned the most was food pantries. Social services that we were surprised people didn’t mention at all included financial planning and housing counseling. Frustration with pro bono legal aid services was mentioned by a few people, who described them as a “wall” with so much bureaucracy that “it was better not to climb the wall and just move on.”

During disasters, you’ll see that people may hold onto old norms. We saw that many tenants were operating in pre-COVID mentality. “I shouldn’t ask for help unless it’s absolutely necessary,” or “landlords won’t make concessions.” We know that tenants who asked for help under these dire circumstances typically received the help they needed. People who didn’t ask for help were less likely to get it. A part of disaster recovery work might be supporting people in changing their mindsets—to learn when, where, and who to ask for help.

Usually, people knew two other families in the neighborhood. Most people knew and sought help from their immediate neighbor. However, these relationships aren’t strong enough or a high enough priority to keep people where they are.

If you ask people what they are struggling with the most, they say food and similar household expenses. When asked what they would use money for first, they said mortgage and utilities. There is a disconnect! How might we work with debt collectors, mortgage lenders, and utilities providers to relieve families of the immediate burden of avoiding losing their housing so they can focus on other necessities such as food and healthcare?

We are seeing a significant rise in the group that has never experienced trouble paying their expenses, utilities, mortgage or property taxes. Many find themselves in a dire situation, experiencing trouble paying bills every month or so! This group is seeking social services for the first time. How might we design social services to support people who are not used to navigating the system?

There is no singular narrative. We tried to see if there was any relation with number of storms weathered and the impact of COVID-19 on households. The results were all over the place. While we can’t make conclusive statements about the impact of multiple storms and people’s struggles during COVID, we know that people were hit hard, and that impacts their ability to recover from the next disaster.

On an average, each household we surveyed has experienced 2.2 storms. And many dip into their savings, liquidate assets, or take out loans to recover from a disaster.

On average, 50% of people spent over $10k in repairs from Hurricane Harvey. 60% reported dipping into their savings, and 60% reported borrowing money from either family or lending institutions.

91% of those impacted by Tropical Storm Imelda incurred $10k or less in damages. 54% of them dipped into their savings, and 51% reported borrowing money from either family or lending institutions.

Overall, more than 3 out 4 of all people we surveyed are having trouble paying their monthly mortgage and almost 9 out 10 are having trouble with daily expenses. Perhaps if it weren’t for spending money on other storms, they might not be experiencing such drastic difficulties or having to dip into savings or take out a loan during COVID-19.

Hiring processes and other company policies have also caused a mindset shift in employee-employer relationships. Some people no longer trust companies or the corporate culture to look out for them.

Transportation is an important piece of the puzzle in Houston.

Reducing barriers to entry is one of the most significant ways that social service providers can ensure resources are distributed equitably and quickly. Consider how your organization can lead in removing roadblocks in processes and tools that delay assistance for those that need it the most

Want to participate in a design sprint?

• What is Translational Science?
• News & Events
• Michigan Institute for Clinical and Health Research at the University of Michigan
• Letters of Support
• All MICHR Support

Human-Centered Design Consultation

Learn how to transform research into impactful interventions

What is this offering?

Human-Centered Design (HCD) consultations are facilitated to streamline the translation of research insights into tangible interventions and services. The HCD methodology prioritizes user experience, ensuring interventions resonate with target audiences. The goal is to help teams navigate the ambiguity of the design process, delivering impactful outcomes aligned with their research goals; from grant proposals to study implementation, this offering supports study teams at every stage by facilitating design research, co-creation sessions, and user testing solutions.

How this advances translational science

Leveraging creativity, innovation, and broad expertise with the goal of increasing the speed and impact of research.

Translational Science Categories:

Designing a Study /

• Give to ERAU
• Embry-Riddle Home

Degrees & Programs

• Certificate Programs
• Associate's Degrees
• Bachelor's Degrees
• Master's Degrees
• Doctoral Degrees

Looking For?

• Professional Programs
• Honors Program
• Language Institute (ERLI)
• Office of Global Engagement
• Summer Camps
• Apply Now
• Get Info

Aerospace Human-Centered Innovation Hub

The Aerospace Human-Centered Innovation Hub investigates ways to accelerate innovation in flight operations through human-centered design research.

We aim to improve human and system performance by designing better training, procedures and processes, interfaces, and tools that support the work of the humans in the system. Through our research, we identify emerging needs and develop novel solutions to real-world problems. We partner with airlines, academia, industry and government entities to ensure out solutions are feasible and effective.

• Video conferencing system
• Flat-panel, fixed-based simulator
• Two Empatica health monitoring watches

Research Capacity

The Innovation Hub's research methods include human-centered design, ethnography, experimentations, cognitive work analysis, modeling and simulation. The research team engages in multiple sponsored research programs focusing on improving the operational effectiveness, efficiency and safety of the global air transport system.

Lab Information

Location: Tomcat Building 121

Lab Director: Dr. Barbara Holder

Contact Us: To speak to someone about this lab or any of our facilities, call us at 386-226-6100 or 800-862-2416, or email [email protected] .

Future Student Resources

• Admissions FAQ
• Campus Map and Directions
• College Fairs
• Daytona Beach Area
• Estimated Costs
• Feature Stories
• Language Institute
• Schedule a Visit
• Student Blogs
• Student Clubs

Current Student Resources

• Academic Calendar
• Campus Directory
• Career Services
• Course Catalog
• Dean of Students
• Disability Support
• ERNIE Central
• Financial Aid
• Health & Wellness
• Office of the Registrar
• Office of Title  IX Compliance
• Safety & Security
• Student Financial Services
• Parents & Family
• Future Students
• Veteran Student Services

More From Forbes

Building an innovative culture through human-centered design.

• Share to Facebook
• Share to Twitter
• Share to Linkedin

Founder and Director at ParkHub .

Successful technology businesses prioritize innovation and focus on designing solutions that work the way people do. Creating a culture of innovation and human-centered design may seem like distinct concepts, but in my experience, they intertwine deeply—both respect and rely on the diversity of human experience.

Any great endeavor starts with a clear set of values. In my organization, these values manifest in our commitment to clear, respectful and honest communication. Every individual, irrespective of their designation, knows they're hired, rewarded and, if need be, let go based on these values. These guiding principles ensure that "If you want to go fast, go alone. If you want to go far, go together."

Inclusion Fuels Innovation

We're in an age where it's all too common to hear that "no one has a monopoly on a good idea." Although this might sound cliché, I've witnessed its truth firsthand. Our goal is to democratize innovation—to tap into the collective genius of every individual, regardless of their title.

From interns and engineers to CTOs and accountants, everyone brings unique insights to the table. By welcoming diverse perspectives and emphasizing inclusion, we fuel the innovative process. And when those ideas shine, they're rewarded; when they falter, they're analyzed respectfully and strategically.

Best High-Yield Savings Accounts Of 2024

Best 5% interest savings accounts of 2024.

Studies have shown that diverse teams are more innovative in the workplace. For example, one study of more than 1,700 companies found that those with above-average diversity produced more revenue from innovation (45% of the total) than those with below-average diversity.

To truly push the boundaries of innovation, companies must avoid falling into the trap of homogeneous thinking. A team that resonates with a single tune may arrive at solutions faster, but they're likely reinforcing the status quo rather than challenging it. Innovation demands a cacophony of perspectives, ensuring that the solutions we craft cater to a wide range of users and challenges.

The Human-Centric Approach

As mentioned, I believe innovation goes hand in hand with a human-centric design process. Human-centered design is an approach to problem-solving that prioritizes the needs, behaviors and experiences of the end users.

Organizations that follow design thinking practices have 32 percentage points higher revenue growth gains than companies that don't over a five-year period, according to a McKinsey study. Human-centered design focuses on creating solutions that are intuitive, accessible and beneficial for individuals. Many of the everyday brand names we recognize—IBM, Google, PepsiCo and Nike—rely on this design thinking as a core part of their business culture.

For this design methodology to be successful, it requires diverse perspectives to ensure comprehensive understanding and cater to a wide range of users. This inclusion fosters solutions that are both innovative and resonate with the broadest audience possible.

For example, our technology serves a wide range of users, from parking lot attendants to executives. To be effective, we need to understand the unique needs, challenges and interactions each of these user groups has with our product.

Take parking, for instance. For most, it's a mundane activity, often riddled with inconveniences. But our technological solutions aim to transform this experience. To do so, we needed to understand the entire ecosystem, from the parking attendants handling cash and customers looking for a hassle-free experience to the executives seeking comprehensive reports.

This deep dive into the user experience led to an innovative approach, allowing us to digitize traditional processes. We introduced electronic forms of payment, optimized operational workflows and streamlined transactions—all rooted in human-centric design principles.

True innovation isn't a one-off effort—it's a continuous cycle. I rely on a structured innovation cycle of experimentation, testing, reviewing results and iterative improvements. Drawing insights from customer support feedback and sales engagements, we continuously refine our products to address real-world challenges and enhance user experience—and you should, too.

A Look Ahead

In many sectors, such as parking, the shift from traditional methods to tech-driven solutions has only just begun. The global market for fee-based parking alone is vast, and as we transition from cash-based transactions to digitized solutions, the room for innovation is immense. By embracing human-centered design and fostering a culture of continuous innovation, organizations can not only meet but anticipate the evolving needs of their user base.

The fusion of innovation and human-centered design offers a potent formula for transformative growth. It reminds us that, at its core, innovation is about people: understanding their challenges, meeting their needs and enhancing their experiences. And as we look to the future, these principles will undoubtedly guide the way.

Forbes Business Council is the foremost growth and networking organization for business owners and leaders. Do I qualify?

• Editorial Standards
• Reprints & Permissions

Human-computer interaction

Redefining human experiences through innovations in research, design, and technology.

Embodied AI Workshop at CVPR 2024

Microsoft at CHI 2024: Innovations in human-centered design

Microsoft Research Forum video on the Metacognitive Demands of Generative AI

Inclusive Digital Maker Futures for Children via Physical Computing

Showing 1 – 10 of 4350 results

RUBICON: Rubric-based Evaluation of Domain Specific Human-AI Conversations  

Param Biyani, Yasharth Bajpai , Arjun Radhakrishna , Gustavo Soares , Sumit Gulwani

AIware 2024 | July 2024

The CoExplorer Technology Probe: A Generative AI-Powered Adaptive Interface to Support Intentionality in Planning and Running Video Meetings  

Gun Woo (Warren) Park, Payod Panda , Lev Tankelevitch , Sean Rintel

DIS ’24 | July 2024

Embodied AI Workshop at CVPR 2024  

Upcoming: June 18, 2024  |  Seattle, Washington

Host conference:  (opens in new tab)The Conference on Computer Vision and Pattern Recognition (CVPR) (opens in new tab) June 17-21, 2024 Panel speakers: Ashley Llorens, Ade Famoti, Stevie Bathiche, Olivia Norton Workshop scientific advisor: Andrey Kolobov…

Explaining CLIP’s performance disparities on data from blind/low vision users  

Daniela Massiceti , Camilla Longden , Agnieszka Slowik , Samuel Wills, Martin Grayson , Cecily Morrison

2024 Computer Vision and Pattern Recognition | June 2024

Video Video Project

Meet MicroCode: a Live and Portable Programming Tool for the BBC micro:bit  

Kobi Hartley, Elisa Rubegni, Lorraine Underwood, Joe Finney, Thomas Ball , Steve Hodges , Eric Anderson, Peli de Halleux , James Devine , Michal Moskal

23rd annual ACM Interaction Design and Children (IDC) Conference | June 2024

Inclusive Digital Maker Futures Workshop  

Upcoming: June 16, 2024  |  Delft, Netherlands

Host conference: 23rd ACM Interaction Design and Children Conference (opens in new tab) June 17-20, 2024 This workshop will bring together researchers and educators to imagine a future of low-cost, widely available digital making for children,…

MicroCode  

Microsoft MicroCode is an icon-based programming language and editor for young learners to code with the BBC micro:bit V2. MicroCode allows you to program the micro:bit V2 with only an Arcade shield accessory – no…

GitHub Project Publication

Insights into the Challenges and Opportunities of Large Multi-Modal Models for Blind and Low Vision Users: CLIP  

June 4, 2024  |  Daniela Massiceti

Daniela Massiceti delves into the transformative potential of multimodal models such as CLIP for assistive technologies. Specifically focusing on the blind/low-vision community, the talk explores the current distance from realizing this potential and the advancements…

Research Forum 3 | Panel: Generative AI for Global Impact: Challenges and Opportunities  

June 4, 2024  |  Jacki O'Neill , Tanuja Ganu , Sunayana Sitaram , Daniela Massiceti

Microsoft researchers discuss the challenges and opportunities of making AI more inclusive and impactful for everyone—from data that represents a broader range of communities and cultures to novel use cases for AI that are globally…

Participation in the age of foundation models  

Harini Suresh, Emily Tseng , Meg Young, Mary L. Gray , Emma Pierson, Karen Levy

FAccT 2024 | May 2024

• Follow on Twitter
• Like on Facebook
• Follow on LinkedIn
• Subscribe on Youtube
• Follow on Instagram
• Subscribe to our RSS feed

Share this page:

• Share on Twitter
• Share on Facebook
• Share on LinkedIn
• Share on Reddit

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Reflections from the Deputy Director of the HHS Office of Long COVID Research and Practice

Every day I receive e-mails from people with Long COVID desperate for help. I have friends, family, and colleagues who have Long COVID or similar conditions. My mother has lived with POTS (Postural Orthostatic Tachycardia Syndrome) for over a decade-it often dictates what we can and cannot do as a family. I personally know what it feels like for a medical diagnosis to suddenly upend one's life for an undetermined amount of time.

I have been doing this work since May 2022. A dedicated team has worked hard to create a new Office of Long COVID Research and Practice , launch the Secretary’s Advisory Committee on Long COVID , hire our inaugural Director , and work with hundreds of passionate colleagues inside and outside of government. We are deeply committed to solving the challenge of Long COVID.

Today on Long COVID Awareness Day we recognize the tens of millions of Americans impacted by Long COVID. We recognize the clinicians and researchers that are working to understand and treat Long COVID. We recognize those who fight for answers. We see you.

Today we release a new report that lays out our goals and objectives for this work and how we think about it. We see this work falling into five domains: research, clinical practice, supports and services, public education, and coordination. Below are my reflections on each domain. Read the full report for more details.

Long COVID is complex. When Long COVID was first recognized, and research began, we lacked a fundamental understanding of the full clinical spectrum and causes of Long COVID—we didn’t know why people were not getting better. Before the RECOVER Initiative even started collecting samples, the National Institutes of Health (NIH) designed a comprehensive infrastructure to support collaboration between different government regulatory agencies, scientific steering boards, patient advocacy groups, and academic institutions to support the upcoming work and design a system that would most effectively capture meaningful outcomes. Next, RECOVER necessarily spent time and effort collecting observational data from study participants (e.g., asking them questions about their symptoms and collecting biospecimens like blood and saliva) to better understand the disease and its impacts on people’s lives, and find essential clues to the underlying causes of Long COVID. These clues have in turn helped develop clinical trials for treatments, cures, and ways to prevent Long COVID.

Long COVID is new, but we are not starting from scratch. RECOVER, other federally funded research initiatives at Centers for Disease Control and Prevention , the Department of Veterans Affairs , and the Department of Defense are not starting from scratch. The research community is building on efforts to understand other infection associated chronic conditions that also impact the body in complex, hard to understand, and likely related ways. An advocate working on myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS) for decades told me that she now, for the first time, believed that we would find answers to help people. NIH researchers tell me they have never seen anything like RECOVER. With Long COVID, we have the opportunity and responsibility to finally understand why some infections leave some people so sick for so long.

Clinical Practice

Healthcare providers want to help patients with Long COVID. Yet we know they face daily practical challenges. Care coordination across multiple specialties is difficult without the right support. Reimbursement models don’t account for the time needed with each patient and the sometimes complex and diverse tests that need to be performed. Long COVID clinics have emerged to meet this demand, but we continue to hear about long wait times and lack of access, especially for rural populations. As a result, healthcare research agencies within HHS are funding projects to study what high quality care looks like for people with Long COVID and how to expand access beyond Long COVID clinics. Other agencies are working with Community Health Centers to apply best practices to treat the populations most impacted by the pandemic. CDC provides information for clinicians and tips for patients to speak to clinicians. Provider associations have started to publish guidance for providers. We are forming linkages between researchers and clinicians to speed translation of research findings to implementation and for clinical practice to inform research.

Services and Supports

Long COVID research is underway. Clinicians are learning and developing new models of care. The fact remains that people affected by Long COVID need help today. We know that Long COVID can impact all aspects of a person’s life—their ability to work, study, take care of themselves and their families, and enjoy life. It is vital to continue the services and supports that can help people engage in their daily activities. In 2022 we released a report that pointed to federal programs that can help support people across all stages of life. However, many people with newly developed Long COVID may not realize they are eligible for accommodations and protections under federal law if their condition affects their ability to carry out one or more of your daily life activities. Numerous federal agencies are working to ensure that those with Long COVID are aware of their rights and have access to accommodations that allow them to continue to live their lives.

While Long COVID is on my mind most all of the time, and public awareness seems to be increasing, we still need to spread the word. Public health education campaigns are working to inform people that COVID-19 can cause Long COVID, but we still need help getting the word out. We also need to continue to spread prevention messages. As long as people are infected with COVID-19, some people will progress to Long COVID. And repeat infections increase your risk of Long COVID. Luckily, early research findings suggest that vaccination for and treatment of COVID-19 reduces your risk of Long COVID.

Coordination

Collaboration is critical to addressing Long COVID. The effects of Long COVID are far reaching, and therefore so is our work. We work with hundreds of colleagues across federal government departments and agencies, and nearly as many non-governmental partners. Working together allows us to share expertise, data, knowledge, and resources. It also ensures that diverse perspectives are represented. It is not easy or fast, but it is necessary. We listen to it all—the support and the criticism—and it helps us do our jobs better.

This report reflects our current thinking on Long COVID, and the activities the federal government is undertaking to meet the goals and objectives laid out here. The federal government continues to play a critical role in this work, but we will never be able to solve this challenge alone. If you are reading this, please find yourself in the work and join us.

Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases

Subscribe to RSS

Receive latest updates

Related Blog Posts

Calling innovators! HHS Long COVID Healthathon launches with $25K in prizes

Driving Long COVID Innovation with Health+ Human-Centered Design

U.S. Summary of the 75th World Health Assembly