“The Agent Is Needed in the Community, so You Have Missed the Point” - Reflecting on Adapting Design-Thinking to Tailored HIV Service Delivery in Malawi With a Focus on Interactions

Design Thinking as a participatory qualitative method has become popular for developing solutions in diverse academic fields. Little is known about the utilization of this approach in the Global South, particularly for improving and tailoring health service delivery to specific group needs. Design thinking studies tend to describe the methods and the final model(s) developed, yet largely omit interactions among participants that inform the design process. The results therefore often appear like a “deus ex machina”. In this article, we give a step by step account of how we conducted the various design-thinking phases, share our experience of the process and our joint analysis as an international research team. The study is based on improving men’s access to and retention in HIV services in Blantyre, Southern Malawi. Our focus is on participants’ interactions in pairs and groups as this interaction led to developing new models for service provision. We critically reflect on the challenges of co-designing across age groups and social standing in terms of dominance of some participants over others and on the power of the wider group to act as a corrective. By sharing our approach and lessons learned we want to encourage more design-thinking studies that focus on the process of developing participant-centered solutions and enable maximum participation from all participants – in our case, to improve and tailor HIV service delivery models.