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The importance of user-centred design when designing digital maternity services

5th December 2023

In this post, Anne Watkins, Sian Thomas and Sarah Aston discuss the importance of user-centred design and how it has been applied to the Digital Maternity Cymru Programme.

About the programme

The Digital Maternity Cymru programme, hosted by Digital Health and Care Wales, is developing a digital maternity service to support the delivery of safe and effective care for all women and birthing people in Wales. 

One piece of work is to replace paper notes with digital versions that can be accessed on a device such as a smartphone or computer. This would allow clinical staff to access this vital data in whichever setting people attend and would mean they no longer are responsible for bringing the single set of paper maternity notes with them wherever they go.             

Moving from paper to digital systems can bring improvements in patient care, safety and service efficiencies – it can also bring the risk of digital exclusion for some who can’t, don’t know how or who won’t use online services.

What is user-centred design (UCD)?

User-centred design (UCD) is a process that places the people who will use a product or service at the heart of the design journey. It prioritises the needs, preferences, and behaviours of end users during the development phase.

UCD involves understanding users through research, creating designs based on their needs, testing those designs with real users, and then refining them based on feedback.

UCD aims to produce a product that meets the specific requirements of the end-user and goes beyond being just a functional product to something that’s easy to use and improves their experience.


Why choose a user-centred design approach?

The Digital Strategy for Wales, published by Welsh Government in 2021, says user-centred design is essential in providing more accessible and inclusive services, eliminating barriers that prevent people from being treated equally.

Wales is a diverse country, culturally, socially, and geographically. A combination of growing cities and rural, sometimes isolated towns and villages can significantly impact the effectiveness of any healthcare system and challenge digital advancement. A lack of technological infrastructure and internet connectivity in these isolated areas may cause limitations for users accessing a digital maternity solution. Travelling from rural areas to in person appointments can also be challenging, depending on the cost and availability of public transport or whether people have access to a car. By engaging with service users, we can understand the digital solution required to support these needs.

We need to appreciate the social, cultural and religious diversity of the families we serve, to provide a solution that is accessible, intuitive and easy to navigate. The poverty and deprivation survey for Wales released in January 2023 indicates that 11% of the population is materially deprived. These communities may struggle to access and utilise technology due to a lack of devices or technological literacy. Users may face communication and cultural barriers, struggle to engage with healthcare providers and not engage with services.

A user-centred design approach that focuses on inclusivity will provide an opportunity to offer  personalised content and information that resonates within these communities, enhancing user engagement. Users will feel empowered to manage their healthcare.

By understanding the challenges posed by geographical variations and social diversity, with a focus on all our service users, we can offer a solution that is accessible, relevant and impactful for our diverse populations and contribute to improved health care and reduced health inequalities in Wales. 

How have you applied user-centred design (UCD) to the Digital Maternity Cymru programme so far?

We worked with the Centre for Digital Public Services (CDPS) for the initial research phase of the DMC programme. We took a user-centred design (UCD) approach by communicating with service users, engaging them in the design process and focusing on user needs. We want to understand the experience of women who could have an increased risk of adverse health outcomes and are more likely to experience digital exclusion, and doing this will help us to start finding ways of improving the overall service. 

The first phase of our work focused on service users with a higher risk of health, inequalities and/or digital inclusion-exclusion. The voices of these population groups and communities are not frequently considered or adequately represented in the design process.

We choose to actively seek out diverse perspectives from seldom-heard user groups. UCD is vital for seldom-heard groups as it fosters inclusivity, equity, cultural sensitivity and empowerment. The cohort was selected from across all health boards in Wales.

It included women and birthing people from the following groups:

  • Black
  • Asian
  • Disabled
  • Living in deprivation
  • Living in relative rural isolation
  • English or Welsh is not their first language

Taking a user-centred design approach has shown that DMC has an opportunity to direct women and birthing people to official NHS Wales sources of digital information, which are evidence based and personalised to their individual circumstances. This will reduce the chance of people seeking information from alternative and potentially inaccurate online sources.

In our next blogpost, which we're co writing with the CDPS, we'll explore the methods we've used to engage with seldom heard users, while exploring the benefits and delving into the research findings.  

What are the next steps for Digital Health and Care Wales (DHCW) and UCD?

User-centred design is vital to delivering usable products and services. To quote product designer Frank Chimero, "People ignore design that ignores people." With that in mind, DHCW has set up a user-centred Design Working Group. The group aims to understand our current UCD offering and practices at DHCW, create a roadmap for a future UCD Centre of Excellence, and work across the organisation to facilitate its implementation. The roadmap will look at things like cultural changes, processes, standards, tools, professions, and professional development.


Anne Watkins, Maternity Informatics Clinical Lead at DHCW

Sian Thomas, Senior Responsible Owner for Digital Maternity Cymru at DHCW

Sarah Aston, Senior Lead Maternity Clinical Informaticist at DHCW