Designing a digital tool together with clients

What it is

Designing together means that you make a digital tool with the people it is about. These are your clients, the care workers who work with it and the organisation that pays for it. From the start, they help decide what the problem is and what helps.

Another word for this is co-creation. What exactly it is and what it isn’t, you can read in Co-creation in care and support.

Clients know how their question is tied to the rest of their life, while a maker from outside often sees only one piece. With this knowledge from lived experience, you can describe a problem more concretely.

The result doesn’t have to be an app. It can also be a website, a game, a training course or a card on paper. Sometimes a regular phone appointment works better than something new.

Why it matters

Many people find digital care hard to use. It becomes simpler and easier to understand when makers work with people who are less digitally skilled from the start. That is why some makers mainly test their app with this group: if the app works for them, it also works for many others.

Designing together can also save money and time. If you test early, you see in time, for example, that setting up a tool is too complicated, and the design can still be improved without high costs. Makers who see how someone with a disability uses their work often become more motivated as a result.

How to do it

Below is an order in ten steps. You can use it if your team makes something itself, and also if you have something made by someone else. The steps sometimes overlap.

Who takes part

1. Start with the question. Write down in one sentence what is going wrong now, seen through your client’s eyes. For example: “I miss appointments with the neighbourhood team because I can no longer keep track of the letters.” Don’t write: “We need an app.” The problem behind the question doesn’t come up by itself, so ask more questions. For example, ask how someone remembers appointments now, with a calendar on the fridge or an alarm on their phone.

2. Invite different people. Ask clients, colleagues and someone who makes decisions, such as a team leader. Also ask people who are often left out, such as older people and people who find reading hard. Don’t assume that what one person says applies to a whole group.

   If you involve the decision-makers too late, things can still get stuck later on. Tell each group what it brings them: for care workers it is about convenience and fewer mistakes, for managers about time and money, for clients about their quality of life.

   Also invite someone who knows your client well, such as a support worker or informal carer. A reaction that you read as a sign that something is wrong can, in some people, also be joy, and someone who knows the person knows that. Set up the conversation so that both your client and the support worker can contribute.

3. Make taking part easy. Invite people personally, in plain language, at a place they know. Keep questions short, and make sure people can also take part by talking instead of writing.

   Work with images instead of a lot of text, for example with photos. Say beforehand that everyone is free to stop whenever they want. Also give a suitable payment, and catch up informally, for example over lunch. For people with a mild intellectual disability, Movisie (a Dutch knowledge centre for social issues) has simple activities.

Making something to talk about

4. Make something simple straight away, and call it a trial version. A sketch on paper, a story about an ordinary day, or a map of who does what. The more tangible it is, the better people can react. If people think something is finished, they start judging it and think along less. So say that it is a first version to try out (a prototype), and ask: “What should be different here?”

   You can also build up a made-up person together with the group, with characteristics and experiences from that group. This is called a persona.

5. Let people do something. Give a task, such as: “Show how you would find your next appointment here.” Watch where someone gets stuck and ask more questions. Also let people show what already works well in other apps and where they get stuck.

The same words

6. Use your client’s words. If your client says “the letter from the municipality” and you say “the beschikking” (the formal decision), choose your client’s word. Avoid jargon, in what you say and in what you write; this also applies when you work with experts by experience. How to write like this is in Writing at B1 level for your clients.
7. Tell people what you do with their input. People want to know what their opinion has changed, and they are more likely to take part if they notice they are being listened to. At the end of a conversation, also ask your client how it was for them. In How did the conversation go? your client chooses a little face for sentences such as “I felt heard”.

Once more

8. Adjust the design and test again, with other people. One person wants a bigger button, the next finds that button too big. So ask more often and ask different people, so you can see what is a pattern. In between, check whether you are still working towards your client’s goal, and not only the organisation’s.

   At the start, reactions are mainly about how easy something is and how it looks. Later, it is about what it achieves. So agree in good time how you will see later whether the tool helps.

Then build

9. Build when the picture is clear. Make the tool accessible according to the Web Content Accessibility Guidelines (WCAG), the international guidelines for accessible websites and apps. See What is WCAG? You need the guidelines as well as the people who take part, because even a large group doesn’t show every disability.
10. Test the real tool with the people who are going to use it. Test the content, such as texts and videos, and also test how it works and whether the buttons do what they should. Then change whatever was unclear.

Choices you make

• In a group or one by one. In a group, people react to each other, and that often leads to new ideas. But not everyone dares to speak in a group. A conversation at someone’s home takes more time, but then you also hear the quieter voices. Make a deliberate effort to give room to minority voices.
• Experienced or new. If you want to learn how people with a disability use the web, ask people with a lot of experience at the start. But an experienced participant sometimes knows tricks that others don’t, and gets further because of that. So later on, also test with people who have little experience.

Points to watch

• Be honest about what is already fixed. If a decision has already been made, don’t pretend people can still choose. Taking part for show, without influence, is called tokenism.
• Don’t use real client data in sketches and trial versions. Always ask first whether someone is okay with you recording or photographing something. If in doubt, ask your organisation’s privacy expert: the data protection officer (in Dutch: functionaris gegevensbescherming, FG). See also The AVG (GDPR) in care and support.
• Keep a route without a screen open, and offer extra help. Even when everything has been made easier to understand, it doesn’t suit everyone: see What is digital inclusion?.
• Also work with experts by experience if you use a game. There are games that let makers experience how hard digital care can be, such as the escape case (escapekoffer) from Pharos (a Dutch knowledge centre on health inequalities).
• Plan several rounds. Designing together takes time. Also plan time for the support workers who take part.

Questions

How many people should I talk to? There is no fixed number. Most projects have little time and money, and then you can’t ask a great many different people. In that case, choose people who are as different from each other as possible, and ask in more rounds, as in step 8.

Can I give participants a payment? Yes, a suitable payment is recommended. If someone receives benefits, be careful. For volunteers, an expenses allowance can affect their benefits. This can also be the case with a payment for giving input. So ask the person to check first with the organisation that pays their benefits, and ask within your organisation how you arrange this.

We are buying a tool instead of having one made. Does this still work? Partly. You no longer help decide how it looks. But you can decide together what you need, as in step 1, and test it together before you choose. This testing is also recommended for digital care from other makers that your organisation uses. You can read how to choose after that in Choosing a digital tool for your client.

Find out more

• Co-creation in care and support: what making things together is, and what it isn’t.
• What is digital inclusion?: who is left out now, and what you can do about it.
• Self-direction and digital tools: how your client stays in charge.
• Introducing a digital tool in your team: what comes after building.
• Custom work: how we design together with organisations.