Meso: Change at the community or service provider level


When designing to make a change at the meso level with community groups or service providers, it will be important to think more about how cultural norms, power dynamics, and/or organisational rules/processes can influence interactions. These interactions may be between family or community members, clients and the different providers operating across the same health system. For an intervention to be successful at affecting change at this level, it is critical to be attuned to organizational rules, structural constraints, and the various incentives embedded within a community or set of established relationships, much like you would find at the level of a health care facility. Beyond simply "users" you will need to begin to think more on the system level. With its emphasis on integrating many different and complementary perspectives (including different bodies of knowledge, competencies, professions, stakeholders and interests), service design and strategic design expertise offers tangible ways of developing and managing a truly interdisciplinary collaboration.

Common outputs or deliverables

Tips and tricks

  • Consider whether you have taken the time to fully understand the interactions, relationships and system level influences from different user and other stakeholder perspectives.
  • Consider whether your team is biased toward a specific solution before gaining that broader system's perspective and try to remain open to exploring a range of solutions.
  • Consider the types of skillsets that you might need given that you are focused on change at the meso level. For example, if you are designing a new product to ensure better flow of information across a system, you do not only want a designer who is strong in graphic and information design. You may benefit from having a User Experience (UX) designer who understands that a product can be the entry point for strong engagement over time and through multiple touchpoints.
  • Given your focus goes beyond individuals to a deeper understanding of how they are interacting in certain settings, it will be helpful to have a deep understanding of cultural norms and social expectations. Keep this in mind when putting together the project team as you may need to bring in specific social science expertise (eg. Psychologist, Sociologist, or Anthropologist) if your design partner is not especially strong in that area.
  • Consider the role that iterative prototyping and strong adaptive implementation plan could play in ensuring greater uptake of change on more of a meso level and how to incorporate that into your project.


  • Be wary of project plans that only involve interacting with a subset of the actors who are part of this experience. When thinking on meso or community/provider level, and seeking changes in relationships and interactions across different groups, you will want to understand how different actors come together.

Questions for potential partners

  • Could you tell me a bit more about the types of design expertise you have on your team and how you would bring these together in this work? What about other types of expertise that you feel are necessary for really understanding people's behavior in social contexts? (For more on the types of expertise to which design is complementary refer to this guide.)
  • We have quite a bit of data on why this intervention will lead to improved health outcomes. However, we don't fully understand how it will be incorporated into a current setting. Can you tell me a little bit about how you integrate work that you haven't done yourself into your process?
  • Can you share with me some of the challenges that you've experienced designing at a meso or community level and how you have overcome them?
  • What kind of experience do you have in implementing new products and services at a system level and who do you prefer to partner with in these situations?

Resources and links