DOCTORAL RESEARCH
Design impact in opioid-overdose environments
Understanding what "smart" alarms mean to EPMS users, before building them
Doctoral Disertation
Qualitative Methods
Spatial Analysis
The challenge
The opioid overdose crisis is a public health emergency with devastating consequences in the United States. This crisis is an unprecedented increase in mortality due to unintentional overdoses involving opiates, such as prescription analgesics, heroin, and illegally manufactured fentanyl.
Community-led initiatives (CLIs) are organizations of citizens with a common interest in taking ownership of their health and ultimately saving lives from opioid overdoses. Design supports CLIs' mission at strategic and operative levels, even when there is no participation of professional designers, and these processes happen organically. Design is also an enabler of innovation, but we do not understand the current design processes inside this organization and how they impact the mission of overdose prevention. The purpose of this research is to understand the impact of design in CLIs working in the prevention of opioid overdoses.
Outcome & impact
Shaped the direction of the naloxone distribution program of Hamilton County Public Health's epidemiology department.
Produced 2 publications and a doctoral dissertation on naloxone access.
Delivered the framework of design application and innovation for community-led initiatives in the overdose prevention space
Used as roadmap for a Ph.D program in Design for the college of design, architecture, art, and planning; at the University of Cincinnati submit the program proposal at the graduate college
Research Process
01 — Systematic review
Managed relations with third-party vendor.
02 — content analysis
13 one-on-one interviews, conducted via video call.
03 — interviews
Using swim lane process mapping and thematic coding
04 — spatial analysis
Make the next decision easier for everyone.
05 — non-participant observation
Make the next decision easier for everyone.
Process Highlights
methodology
Research Questions and Methods
The structure of the research was set in a primary question comprised of 3 secondary question. his research used a mixed-methods approach and engaged ina systematic review of the tools available for communities to fight the overdose crisis. 2) A spatiotemporal analysis of opioid overdose mortality in Hamilton County, Ohio, in relation to naloxone distribution sites. 3) A content analysis of the types of design artifacts associated with overdose prevention. 4) Interviews with 2 CLI officers working in Cincinnati, Academic researchers working in participatory action research with communities, and professional designers working in this space. And 5) non-participant observation of design interventions in the urban environment around CLIs.
methodology
PRISMA Systematic Review
This review followed the PRISMA framework, which structures the reporting of research on health-related interventions. The search yielded 41 relevant articles describing community-based initiatives addressing the opioid crisis in any form. These communities weren't limited by geography: some were organized by state or city, while others formed around shared characteristics like ethnicity, religion, or sexual identity. Across the sample, a clear pattern emerged: communities are self-organizing and taking ownership of the crisis, approaching it from multiple angles rather than following a single model.
No two initiatives offered the same mix of services, and no prerequisites defined who could respond to the crisis; Naloxone distribution was the most common intervention, reflecting both the urgency of saving lives and Narcan's proven effectiveness. What stood out most was the collaboration between top-down efforts (federal and state funding, health departments) and bottom-up ones (community coalitions, people who use drugs distributing Narcan themselves). This blend of scales and approaches positions community-led initiatives as a benchmark for social innovation: they strengthen local relationships while also shaping public debate and pushing policymakers toward more inclusive, justice-oriented responses to the crisis.
method
Content Analysis
The purpose of this method is to help answer what types of design are associated with the prevention of overdoses. The market review consists in collecting information about design typologies, outcomes, and artifacts linked to the reduction of opioid-related overdoses in communities. This qualitative approach is a content analysis method applied to design typologies.
method
In-depth Interviews
Five participants were selected through a non-statistical purposeful sample, chosen to cover academic research, professional design practice, and community involvement. Across this group, design happens both formally, through trained professionals, and organically, through non-expert or "diffuse" design, but in both cases it's treated as an iterative process that stays centered on people who use drugs and community members. That process faces real friction: self-doubt about whether non-experts can propose legitimate solutions, limited funding for design initiatives, and a struggle for legitimacy in fields like health sciences. Dr. Kate Sellen attributes this friction to design's fundamentally different working style and methods, which can clash with collaborators who expect designers to simply produce artifacts rather than shape strategy.
Despite differences in scale, innovation across these organizations shares the same core attributes: it's recombinant, building new solutions by combining existing ideas, concepts, and technologies; iterative, moving through repeated cycles of trial, error, testing, and adaptation; and collaborative, driven by teams, partnerships, and cross-disciplinary input rather than individual effort.
synthesis
Thematic Analysis
The interviews were transcribed and analyzed using qualitative data analysis software. Thematic analysis was conducted using an inductive process. Subsequently, the interviews were coded in a 2-staged process using descriptive and line-by-line coding
Artifact
Spatial Analysis
The analysis began by drawing a 1,200-meter (roughly 0.75-mile) buffer around each Naloxone distribution site, matching the 15-minute walk that urban planning frameworks use as a benchmark for access to basic resources. Five-year population estimates from the 2021 American Community Survey were layered in to characterize the census block group around each site, with ArcGIS handling the geographic processing and R Studio handling the statistics. Building on this, a spatiotemporal analysis tracked Naloxone distribution across Hamilton County using monthly time series data at the ZIP code level. Because the dataset captured every opioid overdose death in the county over six years, the analysis used a total population sampling approach rather than a smaller sample, producing univariate and multivariate models that compare overdose mortality by proximity to a distribution site while controlling for socioeconomic factors.
The results show that ZIP codes within 1,200 meters of a Naloxone distribution site see fewer overdose deaths, even though these same areas also carry a heavier concentration of the demographic, social, and economic disparities linked to overdose risk. That pattern makes sense in light of how Hamilton County Public Health actually places its sites: rather than causing overdose spikes, as a stigmatized reading might suggest, distribution sites are deliberately located in areas already identified as overdose hotspots. Once that risk concentration is accounted for, the areas closer to distribution sites show fewer overdoses, not more.
Mail-based and on-site Naloxone pickup programs, both run by the county health department, are each independently associated with fewer overdose deaths. But when these variables are tested against the county's overall trend of declining opioid deaths over time, their individual significance fades, suggesting the broader decline can't be pinned on distribution programs alone. That kind of interaction is typical for a problem as layered as drug mortality, where no single factor tells the whole story.
Artifact
Non-participant Observation
Non-participant observation took place around two Community Learning Institutions in Cincinnati, Weightless Anchor in Price Hill and Caracole in Northside, using a 400-meter buffer around each site. Four sessions (two per site) ran from September 14 to 29, 2023, timed to the tail end of summer when street activity and foot traffic peak. Geotagged smartphone photos captured design artifacts across public, semipublic, and semiprivate spaces, later filtered down to those supporting overdose prevention, the CLI's mission, or community mobilization efforts like meetings and neighborhood associations.
The photos show CLIs, NGOs, and communities actively shaping their environments to meet residents' needs, distributing Naloxone and fentanyl test strips while spaces like libraries and coffee shops double as informal resource hubs. The complexity of these artifacts varies, likely tracking differences in budget, which in turn shapes each CLI's strategy.
Mapping opioid overdose deaths against the photo registry shows more deaths occurred before Naloxone distribution began in these neighborhoods, and those earlier deaths were more spread out geographically than the more recent ones, which cluster farther from the CLI at the center of each buffer. With only 13 deaths total (10 before and 3 after distribution started), the sample is too small to support a correlation analysis.
Results
Application
Using segment-specific determinants uncovered in the research, I proposed a framework for understanding how market [redacted variable] shapes feature and platform expectations across segments. This gave the product team a structured way to target features and inform platform and pricing decisions by segment, rather than treating all customers the same way.
Conclusions
The impact of design in PD projects is: 1. Using human-centered research methods to understand better the actual needs inside a community or the real goals underlying an initiative. 2. Mediating between the stakeholders, becoming the common language speaker, increasing participation and often diversity, and 3. encouraging creativity and innovation with co-creation and structured methods of ideation, benchmark, co-design, etc.
It is common to measure the impact of an artifact, initiative or program. Impact of the organization is assesed through qualitative methods.
A spatiotemporal analysis was proposed as a method to analyze the impact of CLIs and naloxone distribution services on opioid overdose mortality.
ZIP codes with a NDS closer than 1200 m are associated with fewer deaths in Hamilton County.
Naloxone distribution by mail and on-site pickup, programs that have been put in place by the county’s health entity, are both correlated with fewer overdose deaths.
CLIs, NGOs, and communities, in general, mediate their environment to satisfy the needs of communication and access to resources.
PD seemed so inherently beneficial that the concept of measuring impact seemed too abstract and even tautological. only understood qualitatively
The impact of design in PD projects is: 1. Using human-centered research methods to understand better the actual needs inside a community or the real goals underlying an initiative. 2. Mediating between the stakeholders, becoming the common language speaker, increasing participation and often diversity, and 3. encouraging creativity and innovation with co-creation and structured methods of ideation, benchmark, co-design, etc.
It is common to measure the impact of an artifact, initiative or program. Impact of the organization is assesed through qualitative methods.
A spatiotemporal analysis was proposed as a method to analyze the impact of CLIs and naloxone distribution services on opioid overdose mortality.
ZIP codes with a NDS closer than 1200 m are associated with fewer deaths in Hamilton County.