# Applying the Human-Centered Innovation Biodesign Framework to the Development and Piloting of a Program to Mitigate Risk for Cognitive Decline Among Historically Underrepresented Individuals: Case Study

## TL;DR

This paper describes the development of a physical activity program for underrepresented groups at risk of cognitive decline using human-centered design.

## Contribution

The novel application of the human-centered innovation biodesign framework to create a culturally tailored physical activity program for minoritized individuals with memory challenges.

## Key findings

- The NATURE program was developed with input from Hispanic or Latino individuals with memory challenges and care partners.
- The framework provided a systematic approach to address unmet needs in physical activity interventions for minoritized populations.
- The pilot study plan includes measuring outcomes like well-being, sleep, and social connections using activity trackers and validated questionnaires.

## Abstract

Physical inactivity is a modifiable risk factor for dementia. Past physical activity interventions often overlook the voices of the end user in the design process, particularly minoritized groups living with dementia or memory challenges. To develop physical activity interventions, we use the principles of human-centered design.

We applied human-centered design using the innovation biodesign framework to develop a physical activity intervention, Nurturing Aging Through Uplifting Activities in a Restorative Environment (NATURE) program for minoritized individuals as a use case.

The innovation biodesign framework has three domains: (1) problem space, (2) invention, and (3) solution space. Each domain includes several activities. The problem space involves a needs assessment, needs screening, evidence-based literature review, review of existing models of programs, and iterative feedback from partners, leading to an invention. The solution space encompasses the implementation and validation of the invention and outcomes. We applied this framework in 3 steps: (1) identifying the problem: we used data points from multiple sources to identify needs and mapped them onto the problem space. These sources included reviews of the literature to identify existing interventions, findings from other nature programs to surmise gaps, and focus groups to iteratively identify unmet needs. (2) Designing the invention: we developed NATURE with Hispanic or Latino people with memory challenges and identified their preferred outcomes. (3) Mapping the pilot study. We added the study protocol and planned outcomes to the solution space.

In step 1, three evidence-based programs guided the development of NATURE to address physical inactivity and related risks of decreased well-being and dementia. We received 50 referrals for focus group participants, 22 were eligible and completed consent, and 21 (n=6 Hispanic or Latino people with memory challenges and care partners, n=8 outdoor professionals, and n=7 health care providers) participants completed the focus groups. We received feedback from participants on local nature activities, program frequency, duration, and delivery mode, a referral pathway, and outcomes using 5 focus groups and 2 interviews. In step 2, the 12-week NATURE program was developed to promote an active lifestyle and well-being, using nature activities that a person enjoys. NATURE accounts for a person’s preferences, needs, and daily situation and includes 4-6 sessions with 2 phone check-ins. Preferred outcomes were well-being, sleep, and social connections. In step 3, we mapped the plan to pilot NATURE using activity tracker technology to measure sleep, heart rate, and activity (well-being), and validated questionnaires.

The framework provided a systematic approach for mapping the development of NATURE to address the needs of Hispanic or Latino people with memory challenges, using human-centered design principles. Application of the framework can be a helpful tool to map the development of other interventions for minoritized populations.

ClinicalTrials.gov NCT06403345; https://clinicaltrials.gov/study/NCT06403345