Transforming health systems with design health literacy: Presenting the 40-20-40 model for digital development

Lars Münter*, Danielle Drachmann, Mouna Ghanem, Yvonne Prinzellner, Carolien Smits, Katharina Werner, Vera Bulsink, Isabel Schwaninger, Lex Van Velsen, Nicolaj Holm Faber

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review


Intro: Digital tools and services are becoming the standard for delivery of health care, especially hastened by the restrictions and needs during the COVID-19 pandemic. While early experiences with telemedicine have been a foundation for modern day digital tool development, the use of co-creation, user meta dialogue, and follow up services are often short and few. This represents a powerful potential for designing upcoming services for a multi-level platform. This requires, however, equity in digital health literacy, which is often not the case. Rather than seeing effect or impact as the outcome of the service itself, the value of including and referencing user expectations before and after the session holds an even stronger value; therefore we've explored and created a new co-design approach to digital development we call the 40-20-40 model. Results: Using the 40-20-40 approach we focus on early user communication and input as a part of the specific session or service design, a prologue-phase, that gathers vital input to align expectations. After the specific intervention-phase, we utilise the epilogue-phase as an extension of the intervention itself, an echo of the prologue, and a gathering of user outcomes. We believe the pro- and epilogue phases represent a total of 80% of the overall impact of our services. We also argue that digital developers and public health service providers would benefit from a stronger use of this design model to improve the quality of care and the use and impact of care services, in particular for patients with limited digital health literacy.

Original languageEnglish
Article number100122
JournalComputer Methods and Programs in Biomedicine Update
Publication statusPublished - Jan 2023
Externally publishedYes


  • Co-creation
  • Digital health literacy
  • Empowerment
  • Health literacy
  • Self-management


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