Lessons Learned From the Use of Human-Centered Design Approaches to Improve Nutrition in Nigeria.

Background. Improving children's diets from 6 to 24 months can support children's survival, growth, and development, but progress toward this goal has stalled globally. Human-centered design offers a new approach to resolving program challenges, especially when integrated with social and behavior change (SBC) theory and rigorous evaluation. Method. Two human-centered design processes were conducted. In Ebonyi state, Federal Capital Territory, and Sokoto state a combined high-fidelity prototype, drawn from three low-fidelity prototypes, focusing on improving dietary diversity was developed and tested. In Kebbi state eight low-fidelity prototypes focused on developing tools to improve community health worker (CHW) nutrition counseling were developed and tested. High-fidelity prototype testing combined design and behavior change indicators and qualitative and quantitative methods. Prototype Testing Results. Seven of the eight prototypes in Kebbi state tested well. Prototypes that integrated SBC theory and encouraged two-way conversations between CHWs and caregivers were most successful. The high-fidelity prototype tested in Sokoto demonstrated improved knowledge and efficacy regarding dietary diversity and increased self-reported dietary diversity. Three low-fidelity prototypes in Kebbi will be combined into a counseling package for CHWs. The implementation of the high-fidelity nutrition prototype will be expanded. Discussion. Human-centered design is a promising approach to address complex global health challenges and can be strengthened through the integration of SBC theory and traditional monitoring and evaluation approaches, but this is challenging. Implications for Practice. It is essential to establish a foundation of human-centered design and SBC knowledge among all implementers, incorporate both knowledge bases throughout the process, and center in-country expertise.