Evaluating technology designed for low- and middle-income environments using specialized heuristics

Development and Use of Heuristics to Evaluate Neonatal Medical Devices for Use in Low-Resource Settings

Medical devices save lives each day; however, in many low-resource settings, a lack of critical technologies often impacts a clinician’s ability to use these devices effectively. In addition, equipment is often unsuitably designed for differences in tolerances for electrical power disruptions, durability, consumables scarcity, maintainability, and ease of use. Successfully executed designs for low- and middle-income environments can address these specific constraints of the operating environment.


Heuristics, or rules of thumb used to evaluate a design, are often employed to guide design and prevent foreseeable usability problems that can lead to errors. However, these rules of thumb can fall short when an environment differs from the standard design constraints experienced by product developers.

The question becomes, can unique heuristic sets be developed and used to improve medical devices for low- and middle-income environments? Are environment-specific heuristics important when developing products for groups or locations with unique design concerns, such as those in low- or middle-income environments?


Our study builds on previous research about heuristics and applying heuristic evaluation to medical devices. It introduces a heuristic set specifically addressing neonatal medical equipment designed for low- and middle-income countries. In this study, we discuss this new set of heuristics created to aid engineers and equipment developers in successfully executing suitable, sustainable designs for low-resource settings. The set includes 14 standard and five new heuristics that are unique to low-resource environments—these were used to evaluate 23 neonatal medical devices, and the paper discusses how this unique heuristic set performed.


Developing specialized heuristics aids developers in avoiding dangerous usability errors unique to low- and middle-income countries by addressing specific design considerations for those environments. Most importantly, using environment-specific heuristics when designing for these unique environments can make lifesaving differences in patient outcomes.