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<h2 class="hd hd-2 unit-title">Overview</h2>
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<h4 class="p1">Introduction</h4>
<p class="p1">Careful and thoughtful design plays a role in the success of any technology, and is essential for technology in the ICT4D space. Designers creating interfaces for developing regions face unique challenges engaging users that can present major barriers to adoption or scale, and are often identified or addressed too late in a project’s lifecycle to be properly addressed. In this section we will discuss some of the major areas for consideration in the design of systems specifically in the global health space, both at the user interface level and in building the overall structure of user experience.</p>
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<h2 class="hd hd-2 unit-title">Audience Identification</h2>
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<h4>Audience Identification</h4>
<p>The most important step when approaching any topic related to User Experience is to first consider and identify the audience (or audiences). Answers regarding the question of “who is my audience?” will increase proportionally with a rising degree of complexity and outcomes of the tool in question. In cases where the tool is capable of solving a wide variety of problems, the grouping of audiences will likely funnel into three workflows: basic, intermediate, and advanced. From these workflows, commonalities of expectations can then be established among users in each category.</p>
<p>Establishing the profile of a solution’s primary level user is central to later identifying whether certain workflows are easily discoverable or intuitive. Typical characteristics of primary level users might include some degree of unfamiliarity with technology in general as well of a lack of awareness, desire, or ability to read any available documentation. Interactions targeting such users should rely more on visual cues rather than textual explanations of the interface. Additionally, primary level users might typically be engaging with technology as a supplement or aid to their core work. The technology is not their main focus, and these users are interested in completing tasks the fastest way possible. </p>
<p>With this in mind, primary level workflow should be as directed as possible, with few to zero options available to the user that may alter the direction or outcome of a particular task. Options should be broken into smaller, less complex workflows that presented as separate tasks from the beginning, rather than adding complexity during the middle of a workflow. Additionally, whenever options are present, the most commonly used option should be provided as the default choice.</p>
<p>When considering the design of primary workflows, it’s also advisable to draw inspiration from common experiences across all basic level users. With access to technology becoming more prevalent even in the most remote regions, it is safer to assume that certain experiences—social media and applications like Facebook or search applications like Google—are shared among the majority of primary level users. Once these shared experiences are identified, they can be used as an excellent basis for visual components, computer-human interactions, and information display that can be utilized as elements in ICT4D solutions. The more universal a workflow or design can be, the more it will be readily understood by a wider range of users, requiring less time spent learning the interface and more time accomplishing the core task at hand.</p>
<p>Once the primary level user is identified, the characteristics of intermediate and advanced users can be established. Intermediate users are less likely to be completely comfortable with technology than their advanced counterparts, but perhaps are more willing and able to read documentation relevant to accomplishing higher level tasks. Advanced level users have a higher probability of having technology central to their work and are very comfortable seeking out documentation to achieve complex tasks. </p>
<p>Options that may fall under the advanced category may include advanced search string formatting or use of APIs, and can rely exclusively on documentation to be discoverable. For the most part, advanced workflows should be last on the list of considerations when thinking about the user experience of ICT4D solutions. However, this does not mean that intermediate workflows should be ignored altogether.</p>
<p></p>
<p>Intermediate options should still remain relatively discoverable by users, but may require the aid of help text, simple documentation, or tutorials. These tasks might add complexity by allowing the user to choose from several non-default options midway through their workflow. While it’s easy to compound tasks together and create levels of complexity, it’s important to make sure that intermediate workflows still remain fairly directed. The less documentation a user must reference to complete a particular task, the faster they will be able to achieve the end goal.</p>
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<h2 class="hd hd-2 unit-title">Best Practice and User Testing</h2>
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<h4>Best Practice and Innovation</h4>
<p>One of the challenges facing designers creating health systems in developing regions is balancing the extent to which they rely on existing “host” platforms (operating systems, devices, etc.) that are commercially available with the specific needs of their users. User interface designers are generally accustomed to isolating their responsibilities while working within a platform. Operating system manufacturers, for instance, provide software developers with guidelines to follow in their products. Successful software more often than not will conform to these common design guidelines because it allows their users to interact with their software in a familiar and intuitive way that leverages and reinforces their prior experience. </p>
<p>For a project whose target user population has sub-60% literacy and speaks a language, which is not translated in an operating system’s distribution, however, it is unlikely that users will be able to benefit from a tool following the same patterns as the other software products on that operating system. Software that focuses on platform standards while ignoring the needs of its specific users face steep training costs and poor consistency.</p>
<p>The techniques for meeting the needs of users who are not well served by existing platforms can be broken down into a balance between three rough domains:</p>
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<li>Platform Targeting</li>
<li>Sandboxing</li>
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<h4>User Testing</h4>
<p> User testing is one of the cornerstones of successful interface design, and its value is demonstrated clearly when designing for global health applications. The usability mantra of “You are not the user” is particularly true across cultural and international boundaries, requiring frequent inclusion of user testing into successful iterative design. In practice, however, this need is threatened by significant challenges. Limited access to users, language or cultural barriers, and imperfect testing situations all raise the level of difficulty for achieving successful testing. While there are no universal solutions to these problems, some strategies can be employed to maximize the value of user testing and overcome some of these limitations.</p>
<h4>Planned User Testing:</h4>
<p> Working around limitations is at the core of user testing in ICT4D applications, and understanding the target user population and the available testing facilities as much as possible will assist in that process. If testing will need to be performed in an outdoor setting, creating a binder full of small pieces of paper for an interactive paper prototyping testing session will likely lead to frustration and limited value. Designers should be mindful that some common usability testing techniques like “Wizard-of-Oz” testing may not be culturally appropriate or possible with their sample users, and users who have limited exposure to computing can have major difficulties interacting with abstract low-fidelity paper prototypes</p>
<p> The advantages of low-fidelity prototyping (low cost, low barrier to change, etc.) remain valid in global health settings, but testers should be aware that their testing may require significantly more time to explain the testing and abstractions, work around language issues, and appropriately convey scenarios. Designers should plan tests around those limitations, and consider the balance of introducing higher fidelity fixtures for ease of experience. Since user attention in testing sessions is always limited, planning low-fidelity tests may require more users than expected to cover all scenarios intended. </p>
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<h2 class="hd hd-2 unit-title">User Test Formats</h2>
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<h4>User Test Formats</h4>
<p>When performing user-testing sessions in ICT4D settings, designers should expect to be as flexible as possible. A myriad of potential complications can arise which can derail a complex testing process like limited participation, the need and success of a facilitator or translator at driving the session, and unexpected divergences from profiled users or the testing facilities. For instance, a user testing session could be planned for 15 doctors from local facilities, but in practice 15 nurses or practitioners could arrive from those facilities instead with different backgrounds. Alternatively 8 hours of testing could be scheduled, but interruptions or delays could result in a smaller testing window being available.</p>
<p>The key to effective testing in these contexts is flexibility and preparation. It is helpful to break down testing into separate pieces and prioritize which elements should be completed first. Having a significant number of different experiments prepared for testing will ensure that time with users can be optimized, even if not all of the experiments can be completed. A similar approach is helpful for breaking down the process of experiments. It is ideal to be able to perform a paper prototyping test with rigid discipline (no coaching, individual users, etc), but in practice that may not work effectively with users who are unwilling to explore. Having backup plans prepared, like paired exploration between multiple users to make the situation more comfortable, will help ensure that testing sessions produce useful outputs. Allowing users to share roles and responsibilities in testing, either as a pair or including users as a part of the prompting processes, can generally allow for much freer feedback and participation.</p>
<h4>Testing Process and Outputs</h4>
<p>For projects involving a mix of language skills, user-testing sessions for global health projects will often require a translator or facilitator to drive the overall process. Getting feedback directly from users during testing can present difficulties due to language barriers (for verbal feedback) or literacy issues (for issuing questionnaires or surveys). It is tempting for testers and designers to ease their testing sessions for including users who speak common languages or don’t have literacy issues, but doing so can significantly bias the process and results of user testing and should be avoided when possible. </p>
<p>Clear scenario driven prompting and observation can be the most powerful tools during testing sessions. If users are presented with unambiguous goals and prompts during user testing a significant number of issues can be determined directly from user interaction with the scenarios, and direct feedback can be elicited more uniformly. When performing mid-to-high fidelity testing in particular, such as user acceptance testing actual interfaces or software, answering essential usability questions of uptake, learnability, and discoverability will be significantly more reliable when testing includes users picked for their representation of the target group rather than ease of testing or communication.</p>
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<h2 class="hd hd-2 unit-title">User Engagement</h2>
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<h4>User Engagement</h4>
<p>Due to the global nature of many ICT4D solutions, it is important to consider not only the ease with which a user can understand and learn a workflow but how well it caters to his or her culture or experience on a personal level. A more engaged user will be more likely to complete tasks thoroughly and with purpose, leading to greater accuracy and better results. Central to increasing the feelings of personalization and engagement of users is use of multimedia and language localization. With this in mind, an application can feel less like an intervention from an outside world with no cultural context, and more like a tool necessary to accomplish the task at hand.</p>
<p>Due to the varying levels of literacy that may be encountered by ICT4D solutions, it is important to reduce the amount of text presented to the user whenever possible and rely more on other forms of multimedia to disseminate information. Such forms of multimedia may include audio, images, or video. Audio is particularly useful in cases where the literacy the user, beneficiary, or both may be low and the information presented is particularly complex. It is often useful to include both text and audio reading information displayed. In cases where a particular idea is more simply conveyed visually rather that textually—for instance, the proper way to hold a newborn—images or video should be included alongside or in place of text. When using imagery, it’s also important to consider whether to use photographs or drawings. Due to the visual complexity that photographs can provide, it is often more effective to utilize drawings or cartoons instead, as specific control can be placed on what visual details to highlight. Additionally, certain scenarios may be easier to draw or symbolize rather than photograph. In particular, abstract ideas are more effectively communicated with drawings instead of photographs; for example, a warning sign or skull and bones can be used to indicate danger. </p>
<p>While multimedia should be preferred over text, any written language included by ICT4D solutions should always be localized to the user’s native language. This not only improves the accuracy of information delivery, but improve the level of personalization and satisfaction from the user. In addition to providing local translations for text, it is equally as important to localize any audio present in multimedia files. Cultural features of people from the user’s home region should also be considered when creating drawings and cartoons of humans for the application—even changes as subtle as the type of clothing can have a profound effect on the reception of visual multimedia.</p>
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