Harnessing technology to reduce inequality, influence positive social change, and solve complex public health problems is no easy task; but could Public Health England implement the services required to help solve such problems?
Charlotte Fountaine and Kassandra Karpathakis of Public Health England speak to HEQ about the future of digital health
At the HETT Show, hosted in ExCeL London in October 2019, there was a common theme: measuring the success of digital health interventions, and with this, a new challenge was introduced.
At the event, Health Europa Quarterly had the opportunity to speak with Service Designer Charlotte Fountaine and Digital Strategy Lead Kassandra Karpathakis, of Public Health England (PHE), where we learned about the dynamic challenges the health industry faces; specifically focusing on how the digital and research teams of PHE are developing a practical approach for evaluating the effectiveness and value of digital public health interventions.
Striving to design essential services that harness technology to reduce inequality and influence positive social change, Charlotte Fountaine (CF), Service Designer at Public Health England, designs services with organisations across the public, private and charity sectors.
Similarly, Kassandra Karpathakis (KK), Digital Strategy Lead at Public Health England, has the task of combining technology, traditional healthcare approaches, and human-centred design to solve public health challenges. Karpathakis has been leading a project to establish the first national approach for embedding evaluation into the design and delivery of digital health technology.
Here, Health Europa Quarterly explores the world of digital health with both Karpathakis and Fountaine and delve further into the project, the challenges involved in embedding evaluation practice into digital health technology and PHE’s mission to reduce health inequalities.
Could you explain the project you’re involved in?
KK: I lead the team designing a service for evaluating digital health products. The service aims to enable teams, inside and outside of government, developing and commissioning digital health products and services to better evaluate their interventions. I’ve also been involved in exploring how digital could support the NHS Health Check; and a behaviour change service for children above a healthy weight and their families.
Have you faced any roadblocks when designing services to reduce inequality and influence positive social change?
CF: There are many challenges but also lots of positive opportunities. Public health services have a wide and far reaching remit. They must cater to everyone. As a result, when we are designing services, we are very careful about what we put out to the public and everything needs to undergo government approval, assessments and so on.
This means that the design process takes a lot longer, but in the end, it is about achieving a higher quality. In terms of the challenge, the speed at which we can work at is a lot slower than, for example, a health start-up; but this is because we are designing services to be used by the general public, digital and public health professionals, so we must have a better level of rigour.
It’s a case of quality over quantity.
KK: One of the other challenges we face a lot is having to balance the different styles of communication and languages that our key stakeholders use. Public health professionals, academics and digital experts all come from very different worlds, which, if not handled properly, can cause unnecessary confusion and the occasional heated discussion.
We’ve had moments in the evaluation of digital health products project where we’ve all been using different words to talk about the same thing or using the same phrase to describe a very different process. For example, implementation can mean a different thing to academics compared to digital experts.
We overcame these challenges by sitting down, defining key terms for our projects and sense checking them with each of the different user groups to make sure we are all on the same page. Once we were all agreed we were speaking the same language, life was much easier for everyone involved and we could really pick up the pace.
What kind of challenges were involved to establish the national approach for embedding evaluation into digital health projects?
KK: One of the biggest, but most exciting, challenges we faced was to design a service that was flexible, yet rigorous. As well as something that gave people clear guidance and chance to experiment with an array of new evaluation methods, without dictating to them which route they should take.
Until recently, a lot of guidance and industry best practice was that you must do an RCT (randomised control trial) on your digital health product, which can be quite a big, time-intensive undertaking.
The introduction of the National Institute of Health and Care Excellence’s (NICE) new “Evidence Standards Framework for Digital Health Technology” opened up that conversation to new and proportionate methods of evaluation, and in turn, our evaluation service for digital health needs to carry through that ethos.
Our guidance and training will hopefully make you a more skilled evaluator and more informed digital team.
CF: Another challenge we’ve worked to overcome when designing this service is the differing understanding of the importance of evaluation across different people involved in commissioning and designing digital public health services. It’s not enough to just give people an evaluation tool, you need to convince them of the value in being able to evaluate the effectiveness of whatever they’re building to deliver tangible health outcomes.
KK: Adding to Charlotte’s comment, influencing users to prioritise evaluation is also a key element of the service. We are doing this through communications with users, publishing blogs, speaking at conferences; and working to establish a community of best practice.
Could you tell us a bit about the end goal of the service design of PHE’s evaluation service? How will its success be measured?
KK: We want to help the wider health system demonstrate the impact, cost-effectiveness and benefit of digital health products to public health. To build on this, success for the service means users are building the capability they need to evaluate their digital health products, leading to an increase in the number of products that are evaluated. We are capturing this data as part of our effort to evaluate our own service.
It is also, in partnership with NICE, about repositioning how we should be evaluating and what is proportionate. With a smoking cessation app, for example, a single app would not enable the whole population to stop smoking; however, you can start to quantify the scope of what can be achieved by a single app, for example, you have improved 1,000 users’ short term health after they have quit smoking, and this was sustained over six months.
Personally, I believe the ambition of the service is about shifting the conversation by saying we can measure aspects that can be used for improving people’s health. We know where we situate ourselves within the broader health system so that we can start to compare digital interventions to each other, potentially to traditional services, and start to get a clearer picture of whether all the interventions together are improving population outcomes.
How has PHE prepared for digital inclusivity and human-centric service design?
CF: Public Health England has an accessibility working group. This is essentially bringing together individuals from all disciplines: interaction design, content, design, service design.
We also have the disability awareness group, who work together to look at everything that we are producing, and review aspects such as: does a project meet the needs of people who have access needs? Does it meet accessibility requirements?
KK: We also ensure our projects are not just London based, that we do our best to we work with different localities across the UK, rural areas, and different types of rural areas to ensure the service we designed isn’t just for urban populations living in London. We strive to build that into our user research and ensure that we build it into our testing as well.
The service has undergone accessibility testing with users, an external accessibly audit, and we have plans to continue testing the service with more users who face barriers to digital products. I believe that one of the interesting things is learning that the UK is so far ahead, in terms of how we are approaching things when it comes to human-centred design; and how we are always open to sharing our work openly.
That said, we’re going to be publishing the evaluation service for digital health on GOV.UK, so it will be open for all to use. I’d love your readers to take it, apply it and make the best products they can; and then share their feedback with us.
Public Health England is looking for initial feedback on its digital evaluation service with the first version launched on GOV.UK. If you are interested in helping shape the future of digital healthcare, please read the guide on GOV.UK and fill in our feedback form or get in touch at firstname.lastname@example.org.
Digital Strategy Lead
Public Health England
Please note, this article will appear in issue 12 of Health Europa Quarterly, which is available to read now.