An Exploratory Case Study of Implementing Participatory Co-Design of a Digital Health Solution for Life Skills Development of Learners with Autism Spectrum Disorder in Low Resource Contexts

Abstract

This exploratory case study examined the envisioned features of a digital health solution designed to support individuals exhibiting behaviors consistent with moderate to severe autism spectrum disorder (ASD). The proposed solution sought to facilitate learning by integrating learners' interests and strengths while accommodating their challenges and support needs. The design adopted an individualized and personalized approach guided by learners' primary support systems, including parents and teachers.

Conducted over 20 months, the study engaged parents and teachers of learners with ASD in a low-resource area in Metro Manila, Philippines. A participatory and co-design approach was employed, combining qualitative surveys and interviews with design thinking, requirements engineering, and iterative development methodologies to inform the conceptualization of a digital life-skills learning solution.

To establish a foundation for design, the research first examined documented characteristics of learners with moderate-to-severe ASD through empathy mapping and persona development, informed by existing literature. Building on this foundation, direct engagement with parents and teachers provided contextualized insights into learners' lived realities. Participants described students as demonstrating notable strengths in creative domains while experiencing significant challenges in daily living skills, behavioral regulation, and communication. Parents frequently balanced caregiving with employment responsibilities amid limited financial and social support, relying on nurturing, structured, and interest-driven approaches. They reported persistent difficulties related to behavioral and sensory regulation, financial strain, limited access to specialized services, and minimal extended-family support. Educators likewise encountered constraints, including diverse learner needs, limited training, resource scarcity, uneven workloads, insufficient institutional backing, and inconsistent parental involvement - factors that contributed to burnout and constrained educational outcomes.

These layered insights informed the subsequent synthesis and co-design process, during which findings from literature and stakeholder experiences were translated into actionable design elements. Drawing on human-centered, inclusive, and agile principles, the research team developed a digital health solution encompassing 45 integrated design themes. These features included customizable visual learning activities informed by video modeling and task analysis, gamified positive reinforcement systems, visual scheduling supports, behavior and emotion regulation tools, individualized learning plans, communication functionalities, and a platform to foster digital community-building among families and educators.

Several limitations shaped the study's trajectory. Direct participation was limited to parents and teachers, as learners themselves were not involved in data collection or co-design activities, thereby constraining the extent to which their firsthand perspectives were represented. Heavy workloads, limited participant availability, and resource constraints further reduced opportunities for collaborative workshops, necessitating greater reliance on surveys and interviews: the small, localized sample - predominantly male learners, limited generalizability, and restricted examination of gender-related differences. Infrastructure challenges, including connectivity issues and varying levels of digital literacy, affected prototype interaction, while technical constraints delayed full feature implementation. Future research should address these considerations to enhance robustness, inclusivity, usability, and scalability.

Despite these limitations, the study contributes to the fields of digital health solution and educational technology for ASD by articulating potential digital capabilities that may expand access to evidence-informed learning supports in low-resource settings. The proposed solution offers mechanisms to reduce caregiver burden, empower parents in home-based instruction, and equip educators with tools suited to resource-constrained environments. Collectively, these contributions advance the pursuit of more equitable, sustainable, and impactful autism services, particularly in underserved communities where traditional supports remain limited.