In the world today, health systems are under tremendous pressure from rising demand and limited resources. Governments, hospitals and health technology developers across the globe are increasingly turning to digital solutions to improve access, quality and efficiency of care. Yet new research indicates that the success of these digital health tools depends not just on technology but on involving the people who use them from the earliest stages of development.
This insight was underscored in a recent editorial published in npj Digital Medicine, where experts argue that co‑designing digital health interventions with the end‑users themselves is the missing link in creating solutions that truly work for patients, health workers and communities.
Table of Contents
What is Co‑Design and Why It Matters
At the heart of this discussion is the concept of co‑design. Put simply, co‑design means involving the people who will use a digital tool directly in creating it. Rather than building a health app, wearable device or digital service in isolation, developers work hand in hand with patients, clinicians, caregivers and other stakeholders so that the end result reflects real needs and lived experiences.
In the past, many digital health solutions were developed with limited input from the very people they were supposed to help. As a result, even well‑intentioned programmes sometimes failed to gain traction once deployed. This can happen when tools are technically impressive but impractical, culturally insensitive or difficult to use in everyday settings. The editorial points out that involving end‑users early helps designers avoid these pitfalls and create interventions that fit within the social and clinical context where they will be used.
For example, remote monitoring apps that require constant internet access may frustrate users in regions with unstable connectivity. Similarly, digital appointment systems designed without input from frontline health workers may overlook practical workflow challenges. When users are part of the design conversation, such issues are more likely to be identified and resolved early on.
Lessons From Global Health Systems
The editorial draws from a broad review of literature showing how co‑design has been applied across health systems and technologies. In many cases, co‑design takes the form of user experience surveys, focus groups or collaborative workshops where developers listen to and learn from the perspectives of patients, healthcare professionals, caregivers and policymakers.
Across the examples examined, three main themes emerged. First, clear and consistent engagement with users leads to interventions that are more acceptable and relevant to the communities they serve. Second, understanding the context in which technology will operate is essential for adoption. Finally, involving end‑users can also help identify unintended consequences early, such as creating barriers to access or reinforcing existing inequalities.
One crucial insight highlighted is that co‑design must go beyond simple token participation. It should be meaningful and continuous throughout the lifecycle of the project, from conceptualisation to deployment and evaluation. When users are genuinely empowered to contribute, they help shape not just what is built but how and why it works.
For healthcare systems in low‑ and middle‑income countries like Nigeria, the approach is particularly relevant. Digital solutions that are unaware of local cultural norms, resource constraints or infrastructural challenges risk failing, regardless of how innovative they appear on paper. Co‑design helps developers to ground digital health innovations in real‑world realities.
Challenges in Involving End‑Users
Despite the clear benefits, co‑design is not without its challenges. One of the biggest obstacles is the time commitment required from both developers and users. Organising meaningful engagement sessions, gathering feedback, and iterating designs takes time and effort. In contexts where funding cycles are short and development timelines are tight, this can pose a real difficulty.
Another challenge is power imbalances between developers, researchers and end‑users. If participation is superficial or controlled by those with technical expertise, the voices of patients and frontline workers may be overshadowed. The editorial stresses that developers must consciously create spaces where all participants feel heard, respected and valued.
There is also the risk that co‑design becomes a box‑ticking exercise rather than a transformative process. Simply consulting users once or twice at the beginning does not count as true co‑design. Instead, developers should seek ongoing engagement at every stage of a project to ensure that feedback informs decisions as the intervention evolves.
Bridging the Digital Divide
A particularly important point raised is the role of co‑design in addressing the digital divide. The term refers to inequalities in access to digital technologies based on socio‑economic status, education, geography or age. If digital health solutions are designed without considering these factors, they may inadvertently worsen health disparities by favouring those who are already digitally connected and literate.
For instance, an online health education platform may be useful in urban centres with high smartphone penetration but irrelevant in rural areas where people rely on feature phones or face network challenges. By involving a diverse group of end‑users, designers can ensure that interventions cater to a wider range of needs and contexts.
In this way, co‑design becomes a tool for equity, not just efficiency. It encourages developers to think about who is left out of digital health advances and how solutions can be adapted to be more inclusive.
What This Means for Nigerian Healthcare
For health systems in Nigeria, where digital health innovations are accelerating, but resources are constrained, the message is clear. Technology alone is not enough. To succeed, digital interventions need to be shaped by the people they intend to serve.
This means health ministries, clinics and developers working together with communities to co‑create solutions that are practical, culturally relevant and accessible. Whether it is an app to track medication adherence, a remote consultation service for rural patients or a public health messaging platform, co‑design can improve uptake, trust and outcomes.
The editorial also serves as a call to action for policymakers and funders. Supporting co‑design processes requires flexibility in project planning and funding models. Grants and contracts should allow space for iterative development and user engagement, rather than imposing rigid deadlines that prioritise delivery over quality.
In addition, training for developers and health professionals on co‑design methods can help build capacity within the Nigerian health innovation ecosystem. By nurturing local expertise in participatory design, the country can leverage digital technologies more effectively to meet its health challenges.
Looking Ahead for Digital Health Innovation
The future of digital health will be shaped as much by human insights as by technological breakthroughs. The editorial makes a compelling case that end‑user involvement is not a luxury but a necessity for building digital health interventions that are meaningful and impactful.
As healthcare systems continue to embrace digital solutions, the role of co‑design will become increasingly central. For innovators, practitioners and policymakers alike, the lesson is to listen first and build second. When users are partners in the process rather than passive recipients, digital health can fulfil its promise to transform care delivery and improve health outcomes around the world.
In essence, co‑design brings health technology back to the people it is meant to help. It reminds us that in a world of rapid technological change, human experience remains the foundation of effective, sustainable and equitable healthcare.
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