Sketching With Design Cards: A Medic Mobile Participatory Design Method

Études de cas


Medic Mobile is a digital health organization that designs, deploys and supports software tools for community health workers delivering care at the last mile. User-centered design is core to our process of understanding our users, determining what workflows our tools should

FIGURE 1. This image depicts a hand-drawn workflow for a mobile-enabled antenatal care initiative. In this workflow, health workers use Medic Mobile tools on their phones to register, refer and track visits and to report danger signs and delivery information for pregnant women in their communities.

support and deciding how our tools should work. We’ve developed the unique method of using design cards, featuring simple sketches of key people, places and things, to facilitate design sessions with users. Health workers play a vital role in our design process because they are the experts on their own daily work; their insights are essential to developing tools and workflows that fit the context and help to improve the health of communities. Communicating visually by sketching, a process made easier using design cards, helps health workers participate in imagining new systems that better serve them and their communities.


Understanding workflows is vital for making informed judgments about which technologies may be useful to solve a problem or accomplish a particular goal. Experienced designers use sketches to help to communicate with a broader audience about what they imagine building. Design cards are an inclusive and accessible method that encourages individuals who may have had little design training to get involved in the design process

Medic Mobile develops tools, such as SMS-based text forms and subscriber identity module (SIM) applications for patient and medical supply information, that health workers can deploy using

FIGURE 2. Design cards depict common elements in health and development work.

simple mobile phones. Building workflow maps (see Figure 1) is essential to  designing appropriate tools and configuring the system. To facilitate this process, Medic Mobile created a deck of design cards featuring images of common elements in community health programs (e.g., a patient, a health clinic, medicine.) During a design session, cards are laid out to depict the workflow that users describe. Figures 2 and 3 show the design cards and how they are used to create workflows.

Design cards:

• Make the process more participatory and transparent by engaging users in system design and iteration.

• Assist the design team in obtaining key information, reducing misunderstandings and supporting meaningful conversations with target users.

• Help to create a shared vision and commitment to improve health care delivery among partners.

FIGURE 3. A workflow sketched using design cards. Image: Medic Mobile.


Medic Mobile uses many strategies during the design process to engage users. Sketching ideas and workflows is one of our most reliable and favored methods. Sketching helps validate the information we receive from users and provides a degree of clarity and transparency that is difficult to achieve with written notes. It is flexible and brings a participatory element to the process that may be missing from user analysis or technical product specifications. Making design visible is also useful when working through translators. It creates a more direct connection to the user and ensures that important information isn’t missed.

We found that many facilitators and workshop participants weren’t confident at sketching complex workflows and concepts. To solve this problem, we developed a set of design cards to depict the most common elements in workflows related to healthcare delivery and development projects in general (E.g., a patient, health worker, medicine, clinic.) This allows our team, partners and users to build sketches quickly and dynamically. Each card depicts a component of the healthcare system: community members, healthcare workers, places, technology tools and actions, such as clinic visits. The images on the cards are clearer and more consistent than hand-drawn sketches that users might try to draw themselves in the absence of sketch cards, so participants can more easily communicate their ideas and make corrections to the workflow.

Design cards have an inclusive effect, enabling our participants to more actively engage in discussion. Medic Mobile has run workshops with individuals with varying levels of experience and education, including patients, health workers, Ministry of Health officials, nonprofit program managers and academics. Individuals enjoy taking part in a participatory design process using design cards, and we’ve seen them facilitate dialogue and learning, teamwork, empathy and creativity.

Project Lifecycle Application

The Medic Mobile team uses design cards as part of our broader user-centered design process, but design cards can be integrated into any design or implementation process that your organization uses.

Consider how they fit into a project lifecycle framework:

• Analyze & Plan. Design cards can be used during the initial phases of an initiative’s or tool’s development to gather foundational information. Design cards facilitate gathering data on the ecosystem for which a tool is being designed. They can help to clarify existing workflows, highlight challenges, and identify the individuals involved and any technological, legal and policy requirements that may exist. As participants describe a scenario, we select cards corresponding to keywords: a pregnant woman, a health clinic and medicine, for example. Once a basic workflow is in place, we introduce additional cards to explore how the workflow responds to changes. We might place a card that shows rain falling from clouds over the pregnant woman’s house to ask how her journey changes during the rainy season, or we might remove the supplies card from the clinic to find out what happens when medicine isn’t available. This helps to ground future designs in the practical realities of program implementation within the constraints of the ecosystem and ensures that the community’s priorities have been heard.

• Design & Develop. In imagining a new system supported by Medic Mobile tools, we use design cards to explore improvements to the current workflow. We add or reorganize cards to quickly and easily explore new workflows, test users’ receptivity to new concepts and discuss the potential impact. Design cards are flexible and make it easy to experiment with new ideas and adjust as necessary. They can also help facilitate group roleplaying to try on different scenarios. This process helps our initiatives to be resilient, impactful and realistic. In our experience, hosting conversations with users in this participatory and inviting way helps to generate new ideas and bring information to light that can inform the workflow design.

• Deploy & Implement. No matter how much thoughtful design work is done, additional insights inevitably appear after the tool is in use. Practical experience with our tools can yield meaningful design changes and improvements to the deployed system. Design cards can

facilitate the collection of this valuable information during iteration meetings and give partners and users a way to communicate insights, new ideas and challenges. Design cards can also help partners to design support systems surrounding the digital tool, such as for supervision, training or technical troubleshooting.

• Cross-cutting: Monitor & Evaluate. The opportunity to design with the user extends through to monitoring and evaluation (M&E). Meeting with stakeholders to gather qualitative data on the pilot phase and identify opportunities for improvement is an important part of M&E. Participatory workshops and design-card exercises can help users to articulate impact stories resulting from the new system, provide substantive feedback on the model and communicate the challenges they experienced. These lessons learned can help to interpret quantitative monitoring data and inform future initiatives or iterations of the digital tool.

“Our job as designers and facilitators is to continually call attention to the needs of end users.” – Dianna Kane, Senior Designer with Medic Mobile and creator of the design cards



A Design Journey for Maternal and Child Health Case Study, Principles for Digital Development.

Global Health, Design Thinking and Social Justice: Isaac Holeman at TEDxCambridgeUniversity (video), TEDx Talks.

Information on design practices and to order cards, Medic Mobile.

Medic Mobile Design Cards in Action: System Role Play (video), Medic Mobile.

Medic Mobile’s Human-Centered Design Toolkit: A Spotlight on Sketch Cards, Medic Mobile.

Q&A with Medic’s Senior Designer Dianna Kane on Sketch Cards, Medic Mobile.

To learn more about Medic Mobile and the organization’s approach to participatory design, contact Dianna Kane,

Images and Quotes

FIGURE 4: Using design cards at a Nepal Leprosy Trust and American Leprosy Missions leprosy group meeting at Lalgadh Leprosy Hospital and Services Center in Dhanusha District, Nepal. PHOTO CREDIT: JAY EVANS


FIGURE 5: Design cards at Medic Mobile’s San Francisco office. PHOTO CREDIT: KATIE KELLY













FIGURE 6: Using design cards at a home visit with family members and community health workers in Narok, Kenya, through partnership with Christian Aid. PHOTO CREDIT: MAEGHAN ORTON