Screenshot of open access article published at

New(ish) publication on the limitations of human-centered design (and the story behind it)

A few months ago, the article on “The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them” written by Lex van Velsen, Geke Ludden and me was published in the Journal of Medical Internet Research (JMIR, see the full open access publication here). This was quite an interesting journey, so I would like to share how the main idea of this paper and how it came about.

What is this paper about?

In this paper, we critically reflect on the limitations that user/human centered design approach brings with it. We do this as researchers who apply this approach in our projects and have done in the past. As we explicitly state, we are not opponents of Human-Centered Design (HCD). So this critical reflection is from the perspective of appreciation of and experience with applying HCD in the eHealth context. Because, if you deeply care about something, you also want to improve it and not turn a blind eye on the weaknesses.

Together we identified nine limitations that we currently see in the application of HCD in eHealth:

  1. HCD tends to lead to sampling bias
  2. End-user input might be biased and limited
  3. HCD tends to lead to over reliance on (fresh) end-user input
  4. End-users are only a subset of the people who should be heard during eHealth design
  5. Understanding the added value of HCD is complicated
  6. HCD risks supporting the status quo
  7. Traditional HCD and Designing for Behavior Change are not a good match
  8. HCD tends to miss out on ethical, societal, and political aspects
  9. HCD thinks about the beginning but not the end

For the detailed reflection on these limitations and our discussion on how we think we could move beyond them, please check out the open access article (click here).

How I became a co-author

Twice a months, we have something called “Scientific Sandwich” at Roessingh Research and Development (RRD), where we have lunch together and some of us present their current work. A few months after I started working at RRD in 2019, Lex presented at this meeting the initial idea of this paper that he was developing together with Geke Ludden. His presentation was quite a roller coaster for me, because partly I agreed, but also shook my head and noticed my pulse getting up. I wouldn’t say that he made my blood boil, but there were some arguments that I couldn’t get my head around 🙂 . In short: it was very thought-provoking and I kept discussing it with Lex. So at some point he asked, if I wanted to join, given that I had so many thoughts about it. Geke also agreed, so we started working together. Unfortunately, our kick-off coincided with COVID-19, so we mostly worked online together.

Submission & Rejection at CHI2022

Given that we criticise an approach that originated within the field of Human-Computer Interaction (HCI), we wanted to submit it to CHI. The ACM CHI Conference on Human Factors in Computing Systems is the premier international conference of Human-Computer Interaction and generally considered the most prestigious in the field. So this was a bit “go big or go home”. We submitted in September 2021 and learned in November, that we indeed could go home, because the paper was rejected. Given that the rejection rate is usually quite high, this came not as a total surprise though. CHI’22 received 2,597 complete submissions, of which 324 (12.5%) were directly accepted and 350 (13.6%) were accepted with major revisions.

Even though a rejection is never nice, there were comments from reviewers, that made me very happy. Especially this one:

There is so much to agree with, and so much to disagree with within this paper. On one side, the definition of HCD, the way this is phrased and contextualized, the sometimes narrow examples, and much more can be debated for a long time. On the other side, the points raised are really good and should actually be considered by every designer in the field.

Reflecting on the value of this paper makes me think, oh yes, this is something that everybody should read about. On the other side, I asked myself if CHI is the right venue for it. Ultimately, by looking at similar reflections and points of view (that can sometimes be very personal) in the past, especially the ones that are cited by the paper itself, I believe that a magazine article such as on Interactions, or even in Communications of the ACM would be the right venue for this paper.

“Points that should be considered by every designer in the field”… “everybody should read about it”. BEST REVIEW COMMENT EVER 🙂

It is unfortunate, that the flagship conference was not considered to be the right venue. The reviewer stated, that this is neither a method nor a research paper – which is true. However, CHI did publish some seminal work in the past that was also more of an essay (like the famous “Implication for Design” paper by Paul Dourish. Open access version here). So as “go big” did not work, so we looked for a new “home”. We took the valuable feedback provided by the CHI’22 reviewers and submitted the revised article to JMIR. With another revision round, the paper was finally published in October 2022.

Exploring Human-Centered AI in Healthcare – Workshop at ECSCW 2022

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