Using human-centered design to advance health literacy in local health department programming: a case study

Background: Human-centered design (HCD) and behavioral science are structured, evidence-based methodologies used to develop and evaluate community-driven interventions. While HCD focuses on deeply understanding user needs and co-designing solutions, behavioral science applies empirically tested principles to drive behavior change. Together, these methodologies enable the development of interventions that are both user-centered and behaviorally informed. The Pima County Health Department and project partners leveraged these collaborative methodologies to assemble a Community of Practice to improve health literacy and adherence to COVID-19 public health practices among Hispanic/Latine individuals of childbearing age and ability in Pima County. Methods: Human-centered design processes identified and evaluated barriers facing the target population. On the basis of these findings, two pilot interventions were implemented between July 2023 and November 2023: one in a clinical setting with 92 participants and another in a community setting with 207 participants. A mixed-methods approach was used to evaluate the impact of these pilots. Quantitatively, a pre-post evaluation and survey design estimated the effect of an intervention by comparing outcomes before and after implementation using paired t-test and chi-square tests. Qualitatively, structured post intervention interviews were conducted with participants who were randomly selected based upon their initial consent and willingness to participate. Results: Participants in the clinical and community pilots perceived fewer barriers to health-seeking behaviors after the intervention. Both pilots increased participants’ confidence in health-seeking behaviors (p < 0.01). Only the clinical pilot resulted in an increase in health literacy. In the clinical pilot, the number of unvaccinated participants decreased, and the number of participants who reported needing a booster increased. The community pilot did not find a statistically significant difference in COVID-19 vaccine uptake. Conclusions: Integrating human-centered design and behavioral science into public health interventions can improve health literacy and confidence in health-seeking behaviors among historically and contemporarily excluded populations. Local health departments can use these methods to develop multicomponent interventions that foster mutual co-invention with communities and improve population health outcomes. Future research should focus on long-term impacts and explore broader applications of these approaches in different contexts. Trial registration: This project received University of Arizona IRB review and approval. This study was not considered a randomized controlled trial and did not require registration.