The work aims to explore the application of sewage-based epidemiology under a design perspective, and focus on the environmental pollution and public health and safety issues brought about by urbanization, so as to expand access to health monitoring, improve user experience, increase the efficiency of information delivery, and promote social equity and justice. Through a participatory design approach, users were involved in the process of behavioral analysis to study the needs of community residents for public health information. At the same time, a semiotic ladder model was introduced to construct a framework for user needs research. The user's behavioral needs were mapped into behavioral meanings, and the qualitative analysis of the user's behavior was completed by means of cluster analysis of the meaning hierarchy, which led to the core clusters of meanings. Finally, a service system was constructed based on the core meanings and then evaluated through a participatory design approach. Through participatory design approach and semiotic ladder dismantling and analysis of user behavior, the touchpoints and behavioral meanings of community residents were searched for to achieve the establishment of a sewage health monitoring service system. Involving users in the design process are intended to increase the relevance of complex technologies to the design of organizational systems and enhance the user experience of the service system. The design provides new directions and ideas for sewage health monitoring and continues to refine the semiotic exploration of product construction.