Human centred design is increasingly used within health research for the co-creation of innovative digital and service solutions [21, 29]. These approaches have also been implemented within audiology research, particularly in the development of digital interventions for hearing rehabilitation and hearing aid skills development [26]. This study utilised a HCD approach to adapt a paper-based hearing wellbeing program into Luminear, a web-based application. A multidisciplinary co-design team of researchers, designers, and adults with lived experience of hearing loss worked through Discover, Define, Develop, and Deliver stages to understand the users of the program, ideate potential solutions, iterate prototypes, and develop a minimum viable product.
The HCD process resulted in extensive changes to the paper-based hearing wellbeing program. Many of these changes were related to the way that material was presented in an interactive digital application. The original program consisted of ten written modules that bundled information, activities, and strategies together. Across iterations of Luminear, the co-design team designed a personalised program experience, which included the creation of a visual profile, module progression, gamification via unlocking and collecting strategies, and progress monitoring. These features were aligned with the insights about positive digital experiences for adults living with hearing loss, and users more generally [40].
The written content of the hearing wellbeing program was also edited considering end-user insights that the content was overly academic and difficult to read. Compared to the original written material, Luminear was simplified and presented in bite-sized chunks throughout the modules to increase readability. As shown in Table 7, the readability of the program improved, with the Flesch Kincaid Reading Ease scores being within the recommended “standard” reading ease scores between 60–79 [41]. Comparatively, twenty websites with health information about hearing loss had an average Flesch Kincaid Reading Ease score of 51.82 (± 10.85) [42], suggesting that Luminear may have greater readability than other websites on hearing loss [41]. Following insights about the formality of the written content, the content was also re-written in an informal manner, with aspects of humour included to increase engagement [43].
Reflexivity
As with qualitative research, design approaches warrant consideration of the expertise, position and perspectives of researchers playing a role in co-design. As active participants in the HCD process, the researchers have influence on the ideation and iteration of the design solution. Whilst all co-designers played a significant role in the process, EL was deeply involved in each of the stages, and lead the final direction of the project given collated data and insights. EL is a researcher with a background in clinical audiology, counselling training, and previous experience in multimedia design. An active reflection process was utilised to ensure an ongoing consideration of researcher perspectives and their potential influence on the design process.
Future research
This study used a HCD process to develop Luminear, a digital health application aiming to address the psychosocial impacts of hearing loss in adults. The next step in this project is to determine if the MVP is suitable for efficacy testing in a randomised controlled trial. This will be determined via a feasibility study, which will be used to understand implementation barriers and facilitators, and to gather preliminary user experience and efficacy data.
There were several changes and inclusions recommended by the co-design team that could not be implemented in the MVP given budget limitations. For example, the inclusion of video, animations and images in the modules received positive feedback in walk-through interviews and has potential to increase engagement and efficacy [44]. The MVP largely consists of bite-sized text content, with some visual elements, such as the profile graphic, and module strategy material. User experiences will be explored in subsequent stages of the project to determine if a lack of visual components impacts the experience of Luminear users.
It is important to note the high educational level of all co-designers, including those with lived experience of hearing loss. As a result, there may be aspects of the program that have not been adequately adapted for people with lower education and literacy levels and from non-English speaking backgrounds. Therefore, further editing of content may be required to increase accessibility of the program.
Overall, the utilisation of a HCD approach was a strength of the study, allowing for a diverse group of end-users, researchers, and designers to collaborate to develop an appropriate digital intervention. Multidisciplinary teams are essential in digital health development given the variety of skillsets and knowledge required across health, design, and technology industries [45]. Multidisciplinary collaboration will continue to be employed as the efficacy and implementation of Luminear is explored in subsequent stages of the project.