Participatory design methods for medical device innovation in Uganda

Orthopaedic injury is set to become the 3rd leading cause globally of disability and death by 2030. Despite the cost-effectiveness and efficacy of orthopaedic surgery, there is a significant gap in access to care. Of importance to delivering safe, modern, and timely treatment is access to high quality medical devices. This access however is limited by a mismatch between the technology that industry is developing and what is needed in low- and middle-income country (LMIC) contexts. Through field study in a Ugandan hospital setting, this research examined two methods for participatory design of medical devices in LMICs that seek to overcome gaps in understanding between designers and users across different cultural and professional backgrounds, as well as the "Expert User" problem. The use of Cultural Probes and Outcome-Driven Innovation has proven useful to perform detailed needs finding, filtering and prioritization, which are critical early steps of the design process. The results point to a myriad of challenges across domains: technology, systemic, infrastructure, staff, and patients, which all contribute to difficulty in providing timely, safe surgical care. They also give designers insight into which technology areas are the most underserved, and which attributes of technology might warrant special consideration in the design process. From these results, the design of a bone reduction and alignment device was prototyped, with feedback sought from Ugandan surgeons. The many lessons from this research have been applied in the past five years to the development and commercialization of the DrillCover product through Arbutus Medical. It is our hope that industry, engineers, and designers take the lead in addressing the medical device mismatch by leveraging these participatory design methods when embarking on medical device innovation projects for LMIC users, and importantly, include these users in a collaborative design process for a higher likelihood of success.