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Public health programmes are frequently developed by experts with limited feedback from communities.1 Crowdsourcing, allowing a group to solve a problem and then sharing the solution with the public, may help to improve public health programmes. Crowdsourcing can often take the form of participatory contests.2 Previous crowdsourcing contests have focused on producing individual components of communication programmes, such as videos,3 4 images5 6 or logos.7 However, crowdsourcing contests have not focused on designing the final programme and plan for implementation. The purpose of this project was to crowdsource the development of an HIV testing programme using a designathon.
The concept of a crowdsourcing designathon is related to, but distinct from, a hackathon. Hackathons are intensive, approximately 72-hour contests that bring together young people to complete a task.8 9 For example, hackathons organised by a university have brought together students and others interested in technology to create a mobile application.10 Medical hackathons have challenged participants to create devices that help people with dementia, disability and other illnesses.9 11 12 We propose the concept of a crowdsourcing designathon, drawing on the principles of crowdsourcing in order to design a public health programme with strong community input. The purpose of this article is to describe a crowdsourcing designathon, summarise designathon outputs and discuss designathon implications for public health.
The purpose of our crowdsourcing designathon was to develop a community-based HIV testing programme to be implemented in eight Chinese cities. This concept was influenced by theories of crowdsourcing13 and community-based participatory research.14 Our designathon was implemented in the following steps: forming a local steering committee; open call for participants; prepare for the event; 72-hour implementation; sustaining engagement and evaluation (table 1).
Our SESH (Social Entrepreneurship to Spur Health) group contacted local professionals in public health, communications, civil society and design to serve on the steering committee. Each committee member lived in the region, had unique relevant expertise and was willing to be physically present for the designathon. The function of this committee was to provide mentorship to participants during the designathon and evaluate HIV testing programme ideas that resulted from the designathon. All members received guidance on how to encourage participation and avoid providing examples to participants.
We first sent a call for participants to the eight local centres for disease control and prevention (CDCs) in the eight cities, and suggested them to recommend a CDC staff and a community-based organisation member as co-leaders of each team (16 participants). After that, an iterative process of community consultations in Guangzhou was used to develop the call for participants and related promotional materials. The open call for participants stated the purpose of the contest and encouraged nationwide participation from those with experience in public health, design, advocacy and communications. We evaluated each individual and selected the top individuals within each category (24 participants). Since the communications group only had two applicants, both were included. The open call was promoted through social media and in-person events. The SESH team posted messages calling for participants using major local men who have sex with men (MSM) websites (eg, GZTZ, SDTZ, Danlan), social media (eg, Weibo, WeChat) and a Chinese contest platform.
The designathon was held over 72 hours at a university campus in Guangzhou, China. Our research team covered participants’ transportation, accommodation, insurance and meals. The co-leaders pitched their ideas for an HIV testing campaign to other participants during a 5 min speech. All other participants were then allowed to choose which team they would join. Our SESH group provided each team the following: working space, computer, projector, printer, camera, HIV testing-related materials (ie, top-ranked concepts and images from a recent crowdsourcing contest in China) and technical support. Teams were allowed to consult individuals outside of the designathon. They were given the option of adapting concepts/images from the previous contest or generating completely new concepts/images. Warm-up activities helped teams from different disciplinary backgrounds to get to know each other and efficiently work together.
Each team presented their HIV testing promotion plan (logo, tagline and mock-up images) to the judges (steering committee members also played the role of judges at this stage) at the end of the 72 hours. Judges and other participants were allowed to ask questions about each team’s final programme. Judges evaluated each programme plan based on the following criteria: (1) able to encourage HIV testing, (2) able to generate enthusiasm and (3) community-based; (4) feasible in the local context. Each of the four criteria were given equal weight. Images from each team are presented as online supplemental figures 1–8. Both campaign concepts and images from the designathon will be implemented as part of an eight-city HIV testing campaign. This programme will be evaluated using a stepped wedge randomised controlled trial.15 We selected a stepped wedge randomised controlled trial because the intervention included both individual and community-level components within a real-life context. In addition, previous randomised controlled trial research on promoting HIV testing using crowdsourcing made withholding the intervention difficult.3
A total of 53 individuals applied to participate in the designathon and 40 were selected. Of the 40 selected participants, one participant dropped out of the designathon because of a health problem. The 39 final participants were from the following cities: Guangzhou (8), Qingdao (4), Jining (4), Jinan (3), Zhuhai (3), Yantai (3), Jiangmen (3), Shenzhen (2), Wuhan (2), Guiyang (2), Nanjing (2) and others (3). The median age was 25.5 years and the range was 19–52. Twenty-four participants were 19–28 years old; 11 participants were 29–37 years old; five participants were older than 38 years old. Twelve participants were women and 28 participants were men. Our participants had expertise in the following fields: public health (26), design (11), advocacy (12) and communications (2). They included students (15), public health officials (8), community-based organisation members (12) and other (4).
HIV test promotion themes developed by each team were compelling and feasible (table 1). Several programme themes emerged from the designathon. Four teams focused on HIV self-testing within their community and four were focused on facility-based HIV testing (table 1, online supplemental figures). In addition, four teams proposed to use social media platforms (gay mobile partner seeking applications, WeChat, QQ, etc), including two teams that integrated online and offline engagement. Three teams specifically targeted a subpopulation such as MSM or college students. We also evaluated the images produced by the designathon. Among the 23 images that came out of the designathon, 15 images were adapted from the earlier image contest and eight images were newly developed in the designathon (table 2).
Judges provided individualised feedback to each team. Overall, the judges noted that programmes were well-designed, inspiring, community-friendly and creative. One judge commented that “by allowing people from different backgrounds to work together, the outcomes broke the limitations of a single perspective and incorporated various social sectors to promote HIV testing.’ Another judge also commented that ‘the designathon method showed great potential for public health intervention development.’
Our designathon represents a new method to solicit community input into public health programmes. The designathon created a set of strong HIV testing programmes and several elements of these programmes were adapted or directly used in subsequent pilots. We expand the literature by describing a new method, including images and videos from campaigns, and discussing implications for public health. Our case suggests that public health designathons have several advantages that are important to consider.
Compared with conventional, expert-driven approaches, designathons have comparatively greater community engagement, potential for innovation and multisectoral collaboration. Bringing community members from different sectors together as part of the event created a strong sense of community ownership. Community engagement has been championed as a key component of HIV campaigns.16 In addition, our data suggest that this type of approach can generate novel and efficient solutions. Nine themes and 23 images were developed during the 72 hours of the designathon. Finally, this approach leveraged knowledge, expertise and wisdom from a diverse group of local individuals. Given the extensive involvement of non-experts in the process of campaign development, this is consistent with the notion of crowd wisdom.13
This designathon has implications for research and policy. From a research perspective, further implementation science research is needed to clarify optimal settings for designathon contests. For example, this format may be particularly well suited to public health programmes focused on youth and students who are already familiar with hackathons. In addition, while there is a more extensive entrepreneurship literature on innovation challenges,12 17 the public health literature is sparse. In terms of policy, designathons may be an effective way to develop local public health programmes. The multisectoral and strong community orientation suggests that designathons may be helpful for the development of local public health policies. Several government agencies have already organised crowdsourced design contests to improve public health.2
This approach also has limitations that should be noted. First, the designathon is not a panacea for community-based health campaigns and should not replace evidence-based public health communication methods. Second, our designathon was implemented in the context of a larger crowdsourcing trial, providing a unique opportunity for final programmes to be implemented. Third, we only received 53 applicants for 40 slots. Increasing the visibility of the call for participants could expand our pool of participants.
Crowdsourcing designathons may be useful for creating more engaging and effective public health programmes. This format draws on crowd wisdom, local community engagement and multisectoral feedback to enrich public health services. Designathons represent a participatory approach that may create more locally responsive messages and could also engage local communities earlier and more deeply in the process of developing health programmes. Further implementation experience is needed to better understand the potential advantages and disadvantages of this new approach.
The authors thank all the people who contributed to the crowdsourcing contest and the designathon, including those who submitted the entries, submitted the application for designathon and organised the two programmes. Specifically, the authors thank the 39 team members who attended the designathon. The authors also thank designathon judges (Dr Yan Li from Guangdong CDC, Dr Xiaorui Tao from Shangdong CDC, Dr Zhengzhong Cai from Zhongkai Agricultural Engineering University in Guangzhou, Dr Cees de Bont from Hong Kong Polytechnic University and Dr Mieke van der Bijl-Brouwer from the University of Technology Sydney). Sincere thanks to Dr Mengfeng Li in Sun Yat-sen University for providing space and volunteers for the designathon contest. We also would like to thank the staff at Social Entrepreneurship to Spur Health (SESH) Global, Danlan Gongyi (淡蓝公益), Lingnan Partner(岭南伙伴), Guangzhou CDC and Guangdong Provincial Center for Skin Diseases and STI Control, who contributed to our work.
JDT, WT and HL contributed equally.
Contributors This commentary was conceived by JDT, WT and HL. JDT wrote the first draft. CL, RF and BC helped with figures and tables. TMT and ST organised the designathon. All authors contributed to the manuscript and approved the final version. All authors meet criteria for coauthorship.
Funding This work was supported by the National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310), UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532 to JDT), UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410) and the UNC Chapel Hill, Johns Hopkins University, Morehead School of Medicine and Tulane University (UJMT) Fogarty Fellowship (FIC R25TW0093). The listed grant funders played no role in any step of this study.
Competing interests None declared.
Ethics approval This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Guangdong Provincial STD Control Center IRB and the UNC IRB.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All unidentified data associated with this commentary are available upon request.
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