Global health disparities persist not from a lack of technical solutions, but from an inability to effectively implement existing measures. While financing, policy, and human resources are critical concerns, so too is the need to better understand and adapt to the people who execute and benefit from these solutions. This presents a significant opportunity for applied ethnographic methods from design (design research) to examine the norms, knowledge, and needs of these individuals and groups. This raises many questions about how design research - which we are still beginning to understand in the context of consumer-oriented research - will operate in global health and international development.

This dissertation is a case study of a design research project examining the information management practices of bagiin emch, nomadic health workers in rural Mongolia. The design research was conducted between June 2006 and August 2008 in Mongolia in cooperation with the Ministry of Health and the Asian Development Bank's Second Health Sector Development Program (HSDP-2). Study participants included bagiin emch who received handheld computers as a part of an HSDP-2 sub-project using information and communication technology (ICT) to improve rural health services. The emphasis of this research was not on technology, but on innovation: the development and adoption of new information management solutions. The core field method was serial hanging out: multi-day, design-oriented participant observation.

Serial hanging out is a novel approach to design research well suited to global health, so the contextual examination of the method is a primary contribution of this dissertation. The dissertation also operationalizes theoretical saturation for participant observation, providing empirically-based guidance for sample sizes, as had only been done for semi-structured interviews and focus groups prior to this study. This dissertation demonstrates how these methods achieve a richer understanding of people and phenomena, and how that is relevant to improving population health. At the same time, the dissertation explores how to use these methods most effectively, including an examination of design research capacity-building.

Serial hanging out in particular, and design research in general, have remarkable potential to contribute positively to gains in global health. This dissertation is about understanding how to make this happen.