Cocreating Principles for Digital Health Equity - Cross-sectional, Qualitative Study for Participatory Human-centered Design in Catalonia

Sep 29, 2026

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Digital health technologies are expected to broaden access to care, yet traditional top-down development often intensifies existing inequalities and keeps end users outside design. The COVID-19 pandemic accelerated digital transformation while revealing persistent gaps that technology can both narrow and widen. This study cocreates actionable design principles for equitable digital health transformation across Catalonia by applying participatory human-centered design with diverse stakeholders to support person-centered, integrated, longitudinal care models.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

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JOURNAL OF MEDICAL INTERNET RESEARCH Piera-Jiménez et al Original Paper Cocreating Principles for Digital Health Equity: CrossSectional, Qualitative Study for Participatory HumanCentered Design in Catalonia | Jordi Piera-Jiménez 1,2 , MBA, PhD; Núria Vilarasau Creus3 , MSc; Ada Maymó Costa3 , MA; Xabier Michelena 1,2,4 , MD, PhD; Andrea Climent Fageda2 , MSc; Alèxia Farré3 , BSc; László Herczeg3 , MA; Lekshmy Parameswaran3 , MEng, MA; Gerard Carot-Sans 1,2 , PhD; Luis Valle2 , MBA, PhD | | --- | | 1Digitalization for the Sustainability of the Healthcare System (DS3) research group, Barcelona, Spain 2Information Sysems Directorate, Catalan Health Service, Barcelona, Spain
3The Care Lab, Barcelona, Spain
4Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
Corresponding Author:
Jordi Piera-Jiménez, MBA, PhD Information Sysems Directorate Catalan Health Service
Gran Via de les Corts Catalanes 587 Barcelona 08007
Spain
Phone: 34 651041515
Email: jpiera@catsalut.cat
Abstract | Background: Digital health technologies promise to democratize health care access yet often exacerbate existing inequalities when developed through traditional top-down approaches that prioritize technology implementation and exclude end users from design processes. The COVID-19 pandemic accelerated digital transformation while simultaneously exposing how technology can both bridge and widen gaps in health care access . Understanding how to systematically integrate equity considerations into digital health transformation across entire health systems has become increasingly urgent. Objective: This study aims to cocreate actionable design principles for equitable digital health transformation through a large-scale participatory human-centered design (PHCD) process involving diverse stakeholders across Catalonia’s health care ecosystem (northeast Spain), with the aim of establishing guidelines for information systems that support a person-centered, integrated, and longitudinal care delivery model. Methods: We conducted a qualitative PHCD research study involving 265 participants representing diverse stakeholder groups: citizens and informal caregivers (n=106), health care professionals (n=83), health care managers and leaders (n=50), and experts representing various domains of digital health innovation (n=26) . Through two sequential rounds of participation between June 2024 and April 2025, we used design thinking methodologies and cocreation tools in 24 sessions across Catalan geography and 7 topic-specific expert sessions. Data collection used innovative visual tools, including journey mapping, care model animations, future scenario storyboarding, and facilitated ideation techniques. Analysis followed an inductive-deductive approach combining affinity mapping, thematic synthesis, and participant validation to transform stakeholder proposals into actionable design principles. Results: Participants identified critical barriers to digital health equity, including digital literacy gaps, fragmented information systems, a lack of user involvement in design, and insufficient consideration of vulnerable populations' needs. The cocreation process yielded 10 fundamental principles: (1) the person and their care circle at the center, (2) health for everyone, everywhere,(3) tools for more compassionate care, (4) a better professional experience, (5) an active role of the population, (6) personalized and proactive care,(7) systematic use of data for decision-making,(8) integrated quality data working for health,(9) an information system that builds trust, and (10) collaboration as a driver of innovation. Conclusions: This study shows how large-scale, rigorously conducted PHCD can uncover and address equity barriers in health information systems. Beyond producing 10 actionable design principles, it highlights how engaging diverse stakeholders can turn complex inequities into practical guidance for equita

FAQs

What problem does the study address in digital health transformation?

The study addresses how digital health technologies can democratize access but also exacerbate inequities when developed with top-down approaches that exclude end users from the design process.

How was the participatory human-centered design process conducted?

A qualitative PHCD study involved 265 participants across Catalonia, using two participation rounds (June 2024 to April 2025) and design thinking methods across 24 sessions plus topic-specific expert sessions.

What principles did participants generate to support digital health equity?

Participants produced 10 actionable principles, including centering the person and their care circle, enabling health for everyone everywhere, using compassionate tools, strengthening data-driven decision-making, building trust through information systems, and driving innovation through collaboration.

Sep 29, 2026

Upload by hdkawk