In Fall 2016, an interdisciplinary team of undergraduate and graduate students at the Center for Social Design at Maryland Institute College of Art (MICA) collaborated with Baltimore City Health Department’s Tobacco Free Baltimore initiative to address the impact of smoke exposure in the home. In Baltimore, 50 percent of Baltimore middle schoolers live with a smoker. In 2013, 14 of 17 sleep-related deaths reported secondhand smoke exposure. Significant disparities exist, such as 37.12% of those with income $15,000-$24,999 reported smoking compared to a City average of 21.2% and 25.18% of Black people reported smoking cigarettes vs 18.76% for white people*.
Utilizing a human-centered, collaborative and design-driven approach, the team met with health professionals to better understand the problem, interviewed families to gain new insights, and facilitated design workshops to generate ideas and prototypes. The research and brainstorming resulted in HealthiAir, a pop-up event that supports families in creating smoke-free comfort zones in their homes, identifying practical ways to get started, and connecting to the resources they need.
*Source: BCHD Analysis of data from the Maryland Behavior Risk Factor Surveillance System, based on BRFSS Question: “Current Smoker (Smoked at least 100 cigarettes in their lifetime and currently smoke)”
The Center for Social Design utilizes a human-centered and collaborative process to understand social problems, identify opportunities for intervention, generate ideas, and make tools that support positive change. Our goal is to shift relationships between people and people, and people and institutions. Our process includes six interwoven phases:
1. Translate / Frame: Students organized existing scientific data and research associated with smoke free homes. They facilitated discussions and create visualizations to better understand key data and research and to appropriately scope the engagement to accentuate target behavior and outcomes.
2. Research: Students worked to understand the culture and context of the problem by understanding the culture and context of people. They talked to, observed, and learned from Baltimore families and healthcare professionals to locate needs and assets.
3. Synthesize: Students compiled observations and research findings. They created visualizations of key research and looked for common themes and insights in order to identify appropriate opportunities for intervention.
4. Ideate: In collaboration with stakeholders, students generated as many ideas as possible to address barriers to creating smoke free homes.
5. Prototype: Students developed tangible representations of the ideas. Through feedback and testing, they arrived at HealthiAir pop-up event intervention.
6. Test / Implement: In partnership with Baltimore City Health Department, students piloted HealthiAir in multiple contexts (schools, community centers, and apartment buildings) and collected feedback. The pilots helped identify important design tweaks to make before officially launching HealthiAir.
HealthiAir believes that if we ease the pathway to creating smoke-free comfort zones and engage people where they are on their journey, every home and family in Baltimore will breathe happy and healthy. We accomplish this by constantly reflecting back on HealthiAir’s design principles:
Honor stories and experiences: Respect the personal and lived experiences that are shared and allow them to inform our design process with integrity.
Acknowledge the reality of addiction: Be empathetic in our language and careful in our approach to address smoking without blaming or shaming behaviors.
Make knowledge actionable: Inform with solid facts and data but also translate information in a way that is relatable and approachable to motivate effective change.
Engage the whole person: Connect with all aspects of the people we design with (physical, mental, emotional, social) while being mindful of their individual needs.
Ease the pathway: Create interventions that don’t recreate stress while allowing families the agency to take action on their own terms. Do no harm, add no stress.
HOW HEALTHIAIR WORKS
For each HealthiAir pop-up event, participants are guided through 5 stages where each stage of HealthiAir features different prompts and activities aligned to the transtheoretical stages of health behavior change:
Sharing Stories (Precontemplation): Creating an open space for you to share and connect with others about how smoking has affected you on a personal level.
Exploring the Opportunities (Contemplation): Imagining, through drawing or writing, what your ideal smoke-free comfort zone would look like and how it would feel.
Accepting the Challenge (Preparation): Discovering the benefits and challenges of creating your smoke-free comfort zone and identifying your first step by signing a family pledge.
Continuing the Process (Action): Celebrating where you are on the journey and finding ways to keep yourself on track by creating House Promises*.
Supporting the Journey (Maintenance): To connect you to additional resources that you need that will ultimately help you quit smoking and give you the opportunity to continue sharing your experience by becoming a HealthiAir Community Advocate.
* House Promises are realistic and achievable steps made by families to create and maintain smoke-free comfort zones.
During the prototyping and testing phase, Baltimore City Health Department hosted six HealthiAir events with 76 Baltimore residents across various neighborhoods throughout the city. Thirteen people requested follow up referrals and eight residents joined a smoking cessation treatment group. After the event, HealthiAir participants shared that they felt like they gained new information (“I feel equipped with knowledge to share”), would recommend the program to others (“I would recommend the program to my husband to get him to quit smoking”), and that HealthiAir was different than other health programs because it involved “group sharing” and “got them thinking about steps to quit.”
Starting Fall 2017, any Baltimore resident can contact Baltimore City Health Department and request a HealthiAir pop up event in their neighborhood, church, or organization.
The team is currently working on building up the HealthiAir program by customizing the experience specifically around public housing. In July 2018, there will be a no-smoking policy in all public housing units. MICA’s Center for Social Design and Baltimore City Health Department are now working to use HealthiAir as a take-off point for families to come together and create not just a HealthiAir home but a HealthiAir community.