Category: Co-design processes

Articles and research on co-design and co-creation methods

Universal design as ‘symbiosis’

Symbiosis is not a word usually associated with universal design, but it’s another way of looking at it. Symbiosis means interaction between two different organisms living in close physical association to the advantage of both.

An article from Malaysia uses symbiosis in the context of designs for the disabled body advantage the non-disabled body – it’s a win-win.

The article covers the usual introductory material about universal design and then moves into a discussion on indoor spaces. The research questions focus on the application of universal design to achieve integration.

The paper recounts three case studies to show how people with disability can get the same sense of belonging as non-disabled people. The use of materials, space function and space planning each have a role to play.

Case studies

Bill and Melinda Gates Discovery Center showing people looking at exhibits.

Bill and Melinda Gates Discovery Centre

The first case study is the Bill and Melinda Gates Discovery Center in Seattle. The centre fosters a collaborative working environment to educate people about global issues including disability.

The second case study is the Cooper Hewitt Smithsonian Design Museum. This building is a studio of visual and accessible sensory experiences.

The third case study is Hazelwood School in the UK which transformed a school for children with disability into one for all children.

Hazelwood School

All three projects posed challenges to designers to find ways in which everyone could feel welcome and use the spaces. The article provides more detail on each case study and useful references.

The authors conclude that universal design played an important function in aiding architects to design for people with and without disability.

The purpose of universal design is to create symbiotic relationships between people

The title of the article is, Universal design (UD) in indoor space: Symbiosis between disabled bodies and abled bodies. The abstract uses some confusing language and terms, but the article follows universal design thinking. The links to the case studies are also worth a look.


Co-design in Health Care

Health care is a service and like any service, you want the best for your customers. Customer feedback is common with most services, but knowing the problems after the event is not very effective. The first step is setting up a process that is going to get the most useful design decisions. That means co-designing from the very beginning including co-designing the research method.

Entrance to the emergency section of a hospital.. Co-design in health care.

An inclusive design approach means listening.

A new paper documents the process of using an inclusive design approach to design the study. As a report of the process the paper necessarily includes many stories from participants. These stories are rich in information not limited by survey or interview formats and questions. It is up to the listener or researcher to guide these experiences into practical solutions.

The methods in this study are applicable to any public service, such as transport or education.

Storytelling and research design

Storytelling often goes beyond describing the immediate barriers and difficulties in using a service to reveal the impact on a person’s life.

“The inclusive design approach to the study was not rigid because inclusive design is about diversity, variability and complexity”

Three design exercises

The study reports on three options for design exercises:

Design Exercise Option One: co-designers talk about any part of the health care service that needs re-design. Then the group imagines a future where the barrier no longer exists.

Design Exercise Option Two: co-designers discuss their own or another’s experience during the Covid-19 pandemic.

Design Exercise Option 3: co-designers use the research centre’s “virtuous tornado” exercise. The virtuous tornado is a diagram with three circles, In the centre is the statement, “Like and Use”. The next ring has the statement “Don’t like or have difficulty using”. The outer ring has the statement “Can’t Use”. See the diagram below.

Three rings of a circle indicating the three statements.

Figure 1 from the report with the three options for activities

Co-design is a hot topic at the moment and this paper adds to the research and ideas of how to run co-design processes.

The title of the article is, Co-Design as Applied to Accessibility in Health Care and comes from researchers based in Canada.

Essential elements of co-design

Ayoung man with a black beard and hair is talking to someone across a table with coloured paper and pens. We need elements of co-design.Co-design in an academic context is part of participatory action research, or PAR. It’s used to understand, inform and change the design of policies, programs and services. But what are the essential elements of co-design? As we know, community engagement or consultation is not the same as co-design. Including diverse stakeholder and user perspectives is essential for developing best practice.

Gabrielle Brand and her team have identified five core co-design principles in the field of health education. Briefly they are: inclusive, respectful, participative, iterative and outcomes focused. These principles apply in other fields too. 

Core co-design principles 

Inclusive: Involve key industry stakeholders and consumers from the initial proposal design. That includes the development and framing of learning focus to final educational outcome and delivery.

Respectful: Health care consumers are considered “experts by experience”. All input is equally valued in design, development and delivery of education.

Participative: The research process is open, responsive and empathetic in co-creating education. It generates new understandings of health and healthcare experiences.

Iterative: A cyclic, collaborative process that takes time. It embraces movement towards a shared education vision. It includes the risk of failure.

Outcomes focused: The focus is on achieving a shared educational outcome co-created during the co-design process.

Brand and her team used conversational interviews transcribed verbatim for analysis. An organic iterative approach to data analysis developed shared understandings. Artefacts were also used in the process for eliciting sensory triggers for participants and for developing vignettes. 

The article details part of a vignette to explain how it was used with learners. It’s based on a mother of an adult son with a psychosocial condition. Members of the research team benefited from knowing they had valuable and legitimate expertise on a research project. 

Title of the article is, A research approach for co-designing education with healthcare consumers. It has a mental health education focus, but the methods are applicable in other fields. 

One of the issues with co-design and PAR is passing ethics approval processes. When an ethics committee labels particular groups as ‘vulnerable’ they apply different approval criteria. However, including the voices of a broad range of people involves the participation of vulnerable groups. 

The end result of this kind of research is to “transform hierarchical health care relationships towards a more humanistic model of care”. 

From the abstract

Context: Community and consumer involvement in health professions education (HPE) is of growing interest among researchers and educators. It prepares health care graduates to effectively learn from, and collaborate with, people with lived experience of health issues. 

Approach: We describe the background to our work with health care consumers including the five core principles for successful co-design and how to apply them as a research approach in HPE.

We used arts and humanities-based teaching methodologies including engagement, meaning-making and translational education strategies. This illustrates how this research approach has been applied to reframe mental health education and practice in Australia. Furthermore, we share some reflective insights on the opportunities and challenges inherent in using a co-design research approach in HPE.

Conclusions: For the consumer voice to be embedded across HPE, there needs to be a collective commitment to curriculum redesign. This paper advances our understandings of the educational research potential of working with health care consumers to co-design rich and authentic learning experiences in HPE.

Co-design research approaches that partner with and legitimise health care consumers as experts by experience may better align education and health professional practice with consumers’ actual needs, an important first step in transforming hierarchical health care relationships towards more humanistic models of care.

Assoc Prof Gabrielle Brand is based at Monash University Peninsula Campus.

Health professional education research

Two New Zealand researchers in health science say it is time to apply universal design principles to health education research. They take the universal design principles that originated in architecture and translate them to universal design for research.

The researchers use the The three pillars of universal design for learning (UDL) as the means to crosswalk from architecture to research. The aim is to embrace and enact diversity in research design. This, of course, means engagement with people most often excluded from health education research. 

The title of the article is,  Designing for justice: How universal design theory could bolster health professional education research.

 

QDN’s Co-design principles

Front cover of QDN Co-design priniciples.Co-design is the new buzzword in the field of disability. But co-design isn’t only about disability inclusion. It’s a design process that seeks the best design for the intended users. Including people from a diversity of backgrounds, ages, levels of capability and experience is good practice. It’s how you do universal design. But what is it exactly and how does it work? 

The ultimate in co-design is to include users from design concept stage. The next best thing is to include users in testing the first prototype. Many design firms say budget and time constraints prevent them from implementing this highly iterative method. But how much does it cost to remedy poor design and lack of compliance? 

Co-design should not be confused with community consultation which seeks opinions about a design. User testing is not a form of co-design either. Co-design is where designers and users share the power of designing together. Co-design processes work for developing products, buildings, websites, services, policies and guidelines.

Queenslanders with Disability Network (QDN) have published their Co-Design Principles. This document obviously focuses on people with disability and the Queensland context. Regulation, legislation and policies such as the state disability plan fill most pages. 

 Five values underpin QDN’s co-design principles and processes:

      • Authentic Voice – We ensure those with limited or no voice are heard and valued
      • Collaborative Action – We learn from collective experiences, values, and wisdom 
      • Rights – We believe in a human rights approach 
      • Respect – We value human difference and diversity 
      • Resilience – We are here for the long term.

Co-design processes

A three page summary has the key points above and the co-design processes. 

The starting place – Craft the question that reflects intent/purpose and invites inquiry. 
Build the team – Get diversity and support inclusion
Discovery Phase – See the issue from different viewpoints, and perspectives. Hear from others including those who disagree
Pause and Reflect – Take time to pause and reflect on what you have learnt in the discovery phase and what you still don’t know before jumping to solutions
Sense-making – Look at the data, story, research, and evidence in their raw form and work together to make sense and meaning of what has been gathered
Generate options – Stage where sense-making starts to yield conclusions, ideas
and possibilities, and people get in the creative zone
Developing Prototypes – Generate as many ideas as possible and develop a working example of the policy, service, program, product, or scenario-based solution
Learning, reworking, and refining – Part of the learning cycle and reworks can produce ‘prototype’ – the solution for testing, piloting, or putting into action
Embed what works – Turn it into action and make it real. Keep people engaged and stay accountable.

The QDN website has more information about the organisation and their activities.

See other articles on co-design: The right to participate in co-design, and What does co-design mean? How does it work? 

Consulting people with disability

Front cover Consulting with persons with disabilities.
Full guidelines

Consulting people with disability just needs careful planning. Yes, of course it takes time, but all consultation takes time. But it is always worth it because it saves time in rectifications later. 

The United Nations Inclusion Strategy has guidelines for consulting persons with disabilities. The main guideline document is very detailed and links with the UN Convention Indicator 5. It covers representative organisations, when to consult, and how to do it. The Easy Read version is very helpful for everyone. 

 

Front cover of Easy Read Guide Consulting people with disability.
Easy Read version

The Easy Read version has the key information. It covers the importance of consulting, taking part in decisions, and working with representative organisations. There are links to the 2030 Sustainable Development Goals with the promise of “leave no one behind”. 

One key point in this version is that people with disability should be involved in decisions about everything – not just things to do with disability. 

 

Some days don’t have 24 hours

Lots of clock faces piled on top of each other showing different times. Week has seven days and every day has 24 hours. We all know that. But some people don’t have the same amount of time available within 24 hours as others. And it isn’t a case of poor time management. Time gets stolen. So what does it mean when I say, “some days don’t have 24 hours”?

Sheri Byrne-Haber pinpoints the issues in her article in Medium about the disability time thief. Sometimes it’s a few moments here and there, and sometimes it a regular chunk. 

This article shows why consulting with people with disability is not a matter of setting a date and time and sending out the invitation. The time of day and the place are really important considerations. 

The title of Byrne-Haber’s article is We don’t all have the same 24 hours. Anyone who thinks that we do lives in a monster privilege bubble.

 

What does Co-design mean? How does it work?

Two men look at a document. One is a doctor the other is a patient. The term co-design is being used more frequently, but what does co-design mean and how does it work? Well, that depends on the context. It could mean a design group working together. Nothing difficult about that concept. Or it could mean involving end users in the design process. This is where it gets more tricky and more questions arise.

At what point do you involve users? Which users do you involve? Will the users have the required knowledge and experience to contribute constructively? Will designers have the skills to be inclusive and listen to users? Participatory action research incorporates both designer and user learning. But these projects are necessarily long and usually have research funding attached. However, they usually produce knowledge and results useful in other settings. 

A related concept is co-design in quality improvement, for example, in a hospital setting. Both staff and patients have a role to play in advancing quality improvement. Differing levels of understanding between staff and patients can lead to tokenism. So how can we equalise knowledge so that everyone’s contribution is constructive? 

A research team in a Brisbane hospital grappled with this issue. Their research report is written in academic language and not easy to read. Nevertheless, they conclude that effective patient-staff partnerships require specific skills. Briefly, it means adapting to change, and generating new knowledge for continuous improvement.

A framework

The researches developed a framework that includes ten capabilities under three key headings. 

Diagram of the Co-design Framework.

 

    1. Personal attributes:
      • Dedicated to improving healthcare
      • Self-aware and reflective
      • Confident and flexible

2. Relationships and communication attributes:

      • Working and learning as a team
      • Collaborating and communicating
      • Advocating for everyone

3. Philosophies/Models:

      • Organisational systems & policy
      • Patient and public involvement best practice
      • Quality improvement principles.

These nine points are connected with the overarching theme of sharing power and leadership.

Title of the article is, “Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review”.

Other posts on co-design include The right to participate and co-design, and Co-design is another skill set. 

Maximise inclusion for ageing in place

A row of red brick terraced houses where people will age in place.
An image from the report

What does ‘ageing in place’ actually mean? For some it means staying put in the family home in their later years. For others it means staying in the same community. A co-design method was used to maximise inclusion for ageing in place. 

Researchers at the University of Manchester developed a ‘village’ model of support based on those in the US. The residents came together to identify the services that they need and how they could be better managed. Storytelling was an integral part of the data collection. Ideas were generated for supporting ageing in place at a local level. 

Front cover of the report on ageing in place.
Front cover of the report

The report on the project provides more detail about the diversity of the people they worked with. It recounts the difficulties recruiting volunteers and participants as well as overcoming distrust of decision-makers. Access to formal and informal meeting places was also an issue.

Recommendations include building social infrastructure and strengthening organisations led by older people. The title of the report is, Community interventions to promote ‘ageing in place‘. 

To move or not to move?

We expect to grow old, but because we don’t aspire to grow old, we rarely plan for it. “I’ll worry about it when the time comes” is a usual response. A report from AHURI looks at the housing situation for older Australians and some previous research is confirmed.

Most respondents felt their current home would suit them as they grow older, but they are not planning ahead. If they are, they lack information on how to go about it, what to look for, and what their options are other than age-segregated housing. A significant proportion of respondents hadn’t thought about planning ahead for their living arrangements. This is one reason why we need the Livable Housing Design Standard adopted in all states and territories. It is in the 2022 edition of the National Construction Code and there is a handbook for designers.  

Plenty of material in this report for anyone interested in housing and older people. Title of the report is, Older Australians and the housing aspirations gap. There’s a full report and an executive summary. 

But do all older people want to stay put?

Apartment block with blue windows and balconies with plants and washing drying.It is often said that older people want to stay put, but this may not be the case for everyone. A study from Berlin, Germany looked at this issue in depth. While some of the findings might be specific to Berlin, the article raises interesting questions.

The researchers found that social class, gender, age and migrant history were not necessarily measures of movement behaviour. The top three reasons that emerged were: to have a smaller apartment, an obstacle-free apartment, and to have to a cheaper apartment. 

The title of the article is, Why Do(n’t) People Move When They Get Older? Estimating the Willingness to Relocate in Diverse Ageing Cities.  This is an open access article in Urban Planning journal. The results indicate decisions to move are multifaceted. Older adults are not an homogeneous group with the same needs. As with other studies, older people want the same things as younger people. 

Related reading

Jem Golden provides an overview of the research project in a LinkedIn article.  The main objectives are:

    • Advance understanding of ‘ageing in place’ in cities using interdisciplinary perspectives
    • Examine policies and age-friendly initiatives aimed at supporting ageing in place across seven cities
    • Explore experiences of ageing in place among diverse ageing populations (reflecting different ethnic, gender and class backgrounds) living in urban neighbourhoods
    • Develop methods and tools for measuring and reporting the impact of age-friendly interventions
    • Co-produce innovative models of dissemination with various stakeholder groups

Videos more effective than policy

A brightly coloured film strip with the word Video on it.Policy is often seen as the way to make change. But when it comes to being inclusive it hasn’t worked very well. If policies, codes and papers are not accessible to all stakeholders, how can we create inclusion? Janice Rieger says videos are more effective than policy.

The title of her short paper and workshop is, Reframing Universal Design: Creating Short Videos for Inclusion. Her research provides insights on how videos travel and reach different audiences. This results in a significant impact and enacted change and informed policy. Dr Rieger concludes that “video impacts more than policies, codes and papers ever can”. 

Here is an extract from her paper:

“Video is a visceral medium, offering the opportunity to reframe universal design practice and education. It captures movements and can be co-created with people with disabilities. Videos co-created for inclusion encourage detailed and rich embodied knowledge and experiences because information is prompted by association with one’s surroundings. Significantly, videos have the capacity to excavate personalized knowledge of those with different abilities and uncover systems of exclusion that are often hidden or naturalized, and shamedly rendered invisible through policies, codes and papers.”

In a short video titled, Wandering on the Braille Trail, Sarah Boulton explains how she navigates the environment using her white cane and tactile ground markers.

 

Designers need help to prioritise

A table with white notes with the word "ideas" written in different ways on each one.Designing inclusively means to do the best you can to include everyone. But conflicts arise when a design feature suits one group and not another. So how do designers decide what is best? This is where designers need help to prioritise features that provide the most social good. And where else to look but to user groups, older people and people with disability.

A thoughtful conference paper discusses some of the underlying philosophy of inclusive/universal design and takes the road of pluralism. The authors argue that inclusive design, if taken literally, is unattainable. Justice and fairness are discussed and the authors frame this as ‘design as a deliberative enterprise’. Two case studies where people with disability were included in the design process provide a practical basis for their arguments.

The title of the paper is, Inclusive Design as a Deliberative Enterprise: The multifold value of involving disabled people in design.

Editor’s note: Taking the dictionary definition of “inclusion” for the purposes of research can be helpful if it aids implementation. Perhaps “universal” becomes a better term because it is not about perfection. Rather it is about the iterative process of continuous improvement to include as many people as possible in designs.

Abstract

Designers are challenged to consider human differences in order to meet the needs of the widest possible audience – the purpose of inclusive design. Yet, paradoxically, taking differences seriously may severely restrict ‘the widest possible audience’. How can design be fair if it is impossible to meet the needs of all? Earlier work on inclusivity and quality in design argued for conceiving inclusive design as a deliberative enterprise that involves both designers and the users they design for. A critical reason to involve the latter is that those affected by design decisions are likely to be best positioned to collect contextual information about the needs and demands to be
addressed.

In this paper, we build on this earlier work to take a more detailed look at the deliberative feature of inclusive design. To this end, we analyze two cases in which disabled people, not educated as designers, are involved in design: the first case concerns disabled students and staff of KU Leuven, who give students in engineering-architecture advice on their design projects; the second case concerns the Accessibility Advisory Council in Leuven, Belgium, which is chaired and composed by disabled people, and gives advice on design projects the city is involved in. The analysis is based on written reports and conversations about the project discussions with disabled students/staff and the Advisory Council.

Through this analysis we show that the value of deliberation in this context is multifold: letting contextual information filter in the design process; allowing users to advance reasons for and against possible design alternatives, and draw attention to implications, inconsistencies, ambiguities affecting the relevant beliefs and preferences; enabling both designers and users to reflect on reasons that can be shared, and putting them in a situation of interaction where they can recognize their interrelation with a group.

Human-centred design playbook

Front cover of the Human-Centred Design Playbook from the Government of Victoria. The cover is dark blue and bright pink with white text. Human-centred design is an approach to problem-solving that puts people at the heart of the process. It’s about empathy with users. This style of approach has the potential to generate more varied ideas for design solutions. It’s more than community engagement – it’s a collaborative and iterative design process. Collaboration and iteration are at the core of a universal design approach.

The Victorian Government’s Human-Centred Design Playbook was developed specifically for its staff – public servants. And not just those with job descriptions that are about policy, planning and design. 

The aim is to help staff collaborate better with the service design team, service designers, and external design agencies. The guide does some of the thinking in helping to assess options and practical steps for implementing the project.

Taking an iterative approach to design is at the heart of the process. “We iterate because we know that we won’t get it right the first time. Or even the second… it allows us to keep learning.” 

At 100 pages covering methods, design plans, outputs and case studies this playbook has everything. The Digital, Design and Innovation branch of the Department of Premier and Cabinet produced the playbook. It is designed as a starting point for planning and scoping design-based activities. 

You can download a copy of the playbook directly from the website. 

The playbook complements the Victorian Government’s Whole of Government Universal Design Policy. 

 

Co-design with older adults

A creative workshop scene. A woman is holding a pair of scissors, another is holding a pen over paper. Co-design with older adults.Finding out what older adults might want and need in their daily living experiences takes more than just asking them, especially if they have a cognitive impairment. A recent study found that using creative methods, such as drawing and creating models, older people can express their needs in a tactile format. This also creates rapport with designers who can then devise better mobility, dining and leisure activities. This method is enjoyable for all participants.

The title of the article is, Participatory Design with Older Adults: Exploring the Latent Needs of Young-Old and Middle-Old in Daily Living Using a Universal Design Approach. You will need institutional access for a free read from SpringerLink.

Or ask for a free read through ResearchGate.

From the abstract:

Population ageing will continue to accelerate due to continuing decline in fertility and improvement in survival in major diseases. People who are experiencing cognitive or physical impairment, they often feel alone and experience different degrees of social loneliness.

This paper discusses co-design experiences with various stakeholders to explore latent needs of older persons in their daily living using a universal design approach. Through iterative use of creative methods, freehand sketching and physical models, older adults express their needs in a more accurate, tactile format.

Findings reveal that commonality of interest among older persons are important in building rapport among other participants. It also helps designers develop designs related to health care, mobility, dining and leisure activities.

Older adults and co-design

Close up of an older man and woman with their heads together dancing. He is wearing a hat and cravat, and she is wearing a red flower in her hair. They look loving.Older adults want the same designs as anyone else. Too often older people are gathered together under the umbrella of “the elderly”. This term assumes everyone is the same. It’s applied to people as young as 60 or 65 and every age after that. We can debate the terms of “older” and “elderly” but in the end, we are talking about people and design.

An article in Design Week challenges assumptions about older people and design. It reports on a study involving older people in design projects. They found older people “want what we want”. The ‘we’ in this context is young designers. A key point is that people can live independently for longer if things are designed around their needs. In the end, age isn’t relevant. But designing inclusively is. That’s why devices designed specifically for older people are bought but often abandoned. 

The title of the article is, Why age is often the “least relevant thing” when co-designing with the elderly.  It’s an easy read magazine article with good points for designers.

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