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Empathic handover: how would you feel? Handing over dementia experiences and feelings in empathic co-design
Abstract
It is difficult to inform design with experiences from people with dementia. When it comes to involving this vulnerable user group and connecting multidisciplinary design teams, current empathic co-design methods and tools are scarce, seem fragmented and lack a coherent and structured approach. In response, we provide guidance to design teams by proposing a novel, empathic co-design approach that enables a user researcher, who encounters people with dementia, to transfer insights to team members who do not. Our proposal addresses three sequential co-design activities facilitated by an empathic principal designer: (1) individual harvest meetings, (2) collective handover workshops and (3) empathic ideation workshops. Using a case study involving a dementia simulator, we illustrate how the approach contributes to understanding users, transferring insights and translating empathy into design. The positive evaluation of the simulator led us to conclude that the approach not only guided the design team by offering a practical and coherent process, but also enabled individual team members to be receptive, inclusive and committed to people with dementia.
... Public Health 2023, 20, 3475 2 of 27 disorder is shorter than that of the general population without mental illness. The gap in mortality was estimated to be a [15][16][17][18][19][20][21][22][23][24][25] year shortened life expectancy in patients diagnosed with a (severe) mental illness, including in countries where the quality of healthcare is acknowledged to be good [6,7]. An unhealthy lifestyle is an important cause of the gap in mortality. ...
... The outcomes of this study might lead to validated personas with useful insights into MHNs regarding maintaining and increasing oral health. These personas can serve as an empathic handover in the development of oral health nursing interventions [24]. ...
... Pictures and background information were added to help designers to create an elaborate and relatable image of this person. Therefore, personas have the function of an "empathic hand-over" [24] by giving a living insight into the MHNs through their reading of the personas. ...
In mental health, oral health is often given little attention. Mental health nurses (MHNs) are professionally the appropriate target group to support maintaining and increasing oral health. We aimed to develop and validate personas that reflect the attitudes and needs of MHNs regarding oral health in patients with a psychotic disorder. We used a human-centered design with contextual interviews (n = 10) to address the key issues of the problems and needs of MHNs working with patients with a psychotic disorder. We analyzed the data thematically and reflected on insights into unique personas, which were then validated by conducting semi-structured interviews (n = 19) and member checking. Four personas were found based on attitudes and perspectives, barriers, needs, suggestions for interventions, and site conditions regarding practicing oral care in this patient group. Our findings were as follows: the attitudes and perspectives differed from not feeling any responsibility to a holistic obligation, including oral health; suggestions for interventions for MHNs ranged from interventions focusing on improving skills and knowledge to using practical tools; most MHNs recognized themselves within a persona that had a holistic obligation that included oral health; in addition, the MHNs indicated that they considered the issue of oral health in this patient group important, but, in practice, took little responsibility for that role. These findings suggest that a toolkit with interventions for MHNs that are tailored to the personas that emerged from our research should be developed by MHNs in co-creation with designers. The differences between the perceived role and MHNs' practice in oral health highlighted the need for role clarification and professional leadership of MHNs regarding oral health, which should be considered when developing interventions.
... In order to assess the impact of these interventions, we are developing an Empathy in Design Scale to serve as a standardized quantitative empathy measurement tool [10]. The scale items are based on four dimensions of empathy in design [16,25,46]. The scale can be used both with designers and employees. ...
... Surma-aho and Hölttä-Otto [49] define five categories of approaches to empathy in design: empathic understanding (i.e., understanding of others' experiences), empathic design research (i.e., methods used to understand others' experiences), empathic design action (i.e., usercentred conception and generative methods), empathic orientation (i.e., designers' "conscious preference for a human-centred evidence"), empathic mental processes (i.e., processes by which designers are empathic towards users). Three frameworks [16,25,46] are generally cited ( Figure 1) to represent the empathic process in design. These theories and frameworks of empathy in design offer new perspectives for measuring empathy. ...
... To prove the effectiveness of the methods deployed at a large scale, we are developing a standardized scale of empathy in design. Our preliminary 18-items empathy in design scale (under development [10]) includes four dimensions, based on key frameworks of empathy in design [16,25,46]: Emotional Interest/Discovery (EI), Sensitivity/Immersion (S), Personal Experience/Connection (PE), Self-Awareness/Detachment (SA). The Empathy in Design Scale will be used for measuring railway service stakeholders' empathy before and after empathic interventions. ...
Research in HCI and design position empathy as a key factor of a successful user-centred approach, supported by the emergence of empathic design methods. However, there is a dearth of empathy measurement tools to investigate the actual ability of design methods to trigger empathy among designers and beyond within the organization. For service stakeholders, a measurement tool would facilitate understanding the value of empathy for breaking silos in the organization and delivering high-quality services and products.
The Empathy in Design Scale, a self-reported tool under development, aims at measuring the impact of empathic design methods within an organization. In this paper, we share our preliminary work on triggering and measuring service stakeholders’ empathy (e.g., employees of service companies) in the context of a national railway service. We discuss the added value and limitations of a standardized measure of empathy and its implications to bring the field forward with new perspectives and opportunities.
... Likewise, empathy does not trigger direct behavioral response but rather the behavioral motivation to act or not act (empathy does not go hand in hand with prosocial behavior) [6]. This motivation is key in the design literature [14,21,35,36]. In design, empathy has been used as "a defning characteristic of designer-user relationships when design is concerned with user experience [44]. ...
... Their combination results in four dimensions: (a) perspective-taking when designers imagine how the users think and feel (cognitive, other-oriented), b) empathic concern when designers feel concern for the users (afective, other-oriented), (c) emotional congruence when designers experience the same emotional state as users (afective, self-oriented), (d) projection when designers imagine how they would think and feel if they were the users (cognitive, self-oriented). Based on this taxonomy of empathy, Smeenk et al. [35,36] describe fve factors of empathy: emotional interest, sensitivity, self-awareness, personal experience, and mixed perspective. Designers' emotional interest is when they choose to be receptive to users' emotions and interaction contexts. ...
... We consider empathy as a state which depends on the context [6] and can evolve over time [15]. Building on the frameworks of empathy in design by Kouprie et al. [21], Hess et al. [14] and Smeenk et al. [35,37], empathic tendency includes an initial discovery, an immersion into the user's world, a connection with one's own personal experience and a detachment from the users' viewpoint. The ability to navigate within these dimensions, and the underlying cognitive or afective empathy types, is key (labeled mixed-perspective in [35]). ...
... Although existing health and ergonomic products have utilized training games to study cognitive deterioration, it was discovered that dementia elderly with cognitive, emotional and behavioral issues could thwart the communication between people with dementia and members of the design team [6,12,13]. In order to enhance the participation of stakeholders in co-design projects, Smeenk, Sturm, and Eggen [14] developed a three-step design framework to overcome the difficulties of working with elderly with dementia. This paper aims to build on this established philosophy by investigating the societal, design and health aspirations of Hong Kong elderly with dementia by applying the framework of empathic co-design, and the psychological therapeutic approach of reminiscence to develop a series of ten sets of ergonomic training board games that aims to delay the deterioration of cognitive functions of elderly with dementia in six domains; namely memory, language, recognition, visuospatial function, numeracy and attention [14,15]. ...
... In order to enhance the participation of stakeholders in co-design projects, Smeenk, Sturm, and Eggen [14] developed a three-step design framework to overcome the difficulties of working with elderly with dementia. This paper aims to build on this established philosophy by investigating the societal, design and health aspirations of Hong Kong elderly with dementia by applying the framework of empathic co-design, and the psychological therapeutic approach of reminiscence to develop a series of ten sets of ergonomic training board games that aims to delay the deterioration of cognitive functions of elderly with dementia in six domains; namely memory, language, recognition, visuospatial function, numeracy and attention [14,15]. This paper will illustrate the process between designers, academics, health professionals and elderly through observation and semi-structured interviews. ...
... Hendriks, Truyen and Duval [10] argued that traditional participatory design methods anticipated elderly who participated in design process were cognitively capable since some members in the design team might not be fully aware of the stages of dementia. Smeenk, Sturm and Eggen [14] realised that co-designing products with people with dementia could be challenging because of the communication impairment at the latter stage. They employed a case study research design to evaluate their co-design activities with multidisciplinary design teams of helping professionals and their findings have provided insight to this study. ...
... In design practice, this often occurs due to a lack of time or budget, the designers' capacity and willingness, and ethical considerations like burdening (vulnerable) users (e.g. van Rijn KEYWORDS User-centred design; codesign; empathic design; empathic handover; mourning; dementia et al. 2011;Postma et al. 2012;Smeenk, Sturm, and Eggen 2017). For this reason, Smeenk, Sturm, and Eggen (2017) developed the Empathic Handover approach. ...
... van Rijn KEYWORDS User-centred design; codesign; empathic design; empathic handover; mourning; dementia et al. 2011;Postma et al. 2012;Smeenk, Sturm, and Eggen 2017). For this reason, Smeenk, Sturm, and Eggen (2017) developed the Empathic Handover approach. ...
... In a single-case study about the Empathic Handover approach (Smeenk, Sturm, and Eggen 2017), experts evaluated the design outcome, a dementia simulator, positively (Hattink et al. 2015). The practical and coherent empathic process guided the design team and enabled individual team members to be receptive, inclusive and committed towards users whom they did not meet in person. ...
This study aims at validating the transferability of the Empathic Handover approach, which we originally developed for the co-design process of a dementia simulator. We argue that empathy in design is operationalised using five factors: emotional interest, sensitivity, self-awareness, personal experience, and mixed perspectives. This heuristic proved useful in systematically comparing the empathic capacity of design students using the Empathic Handover and traditional user research approaches. Our comparative study indicates that the Empathic Handover approach enables designers to develop empathy with vulnerable users they did not meet in person (both people with dementia and people who mourn). Additionally, the study enables us to develop an elaborate notion of the working mechanisms of empathy in design as well as practical improvements to the Empathic Handover approach.
... The design of the interfaces was then explored. Previous work provides many useful strategies for engaging individuals with intellectual disabilities in the design process such as storyboards and pictures, and avoiding open-ended questions [74], [75], [76], [77], [78]. To better support participants' way of self-expression, real-time storyboarding was completed where prompts were presented to participants to expand upon, promoting communication. ...
... These interactive activities helped maintain engagement, improved understanding of new concepts and improved communication within the workshops. Additionally, storyboarding is an effective method for identifying, understanding and coming to grips with factors that capture and influence people's experiences [74], [75], [76], [77], [78]. A novel approach utilised was combining the interactive sessions with storyboarding to gain feedback, it has been possible to gain valuable insights, aiding the design and development of future affective interfaces. ...
Involving and engaging people with learning disabilities on issues relating to their mental wellbeing can bechallenging. This research explores how participatory design techniques and principles can be used to engagepeople with learning disabilities in designing technological solutions relevant to them that could monitorand aid their mental wellbeing. Specifically, we explore methods used in a series of co-design workshopsto engage people with learning disabilities in the use of tangible interfaces for mental wellbeing. A varietyof designs, sensors and interventions were explored during the workshops resulting in the development ofmultiple mental wellbeing interfaces. Furthermore, data collection trials using the developed interfaces havedemonstrated the potential to collect real-world labelled data that can be used to train machine learningclassifiers. The co-design approach adopted for the design of the mental wellbeing tangible interfaces ensuredthat effective and suitable devices have been developed.
... It also includes different technological approaches aimed at increasing or tuning designers' empathy towards users. These include wearable simulators which purpose is to "engage more closely with user experiences" (Kullman 2016, p. 83) by restricting the designer's physical capabilities, creating experience simulators (Smeenk, Sturm & Eggen, 2017), role-playing (Medler & Magerko, 2010), personas defined as "abstractions of groups of real consumers who share common characteristics and needs" (Miaskiewicz & Kozar 2011, p. 418), storytelling (Madsen & Nielsen 2010), empathy maps (Both & Baggereor n.d.), etc. In addition, designers have developed multi-step frameworks which, if followed, should facilitate the empathic connection with users (see Kouprie & Sleeswijk Visser, 2009;and Smeenk, Sturm & Eggen, 2019a). ...
... Facilitating the transfer of user insights empathically to design team members who were not in contact with users (Smeenk et al. 2017(Smeenk et al. , 2019b. ...
We constantly attempt to know what someone else may be thinking or feeling, what kind of personality they have, what their believes are, etc. Despite how common this "mind reading" process is to us we are surprisingly inaccurate when inferring someone else's mental states. The correct understanding of others' mental states – interpersonal accuracy – is key for successful social interactions and its scientific study demands a complex balance between controlled experimental and naturalistic conditions. Design and music performance are two contexts yet unexplored through the lenses of interpersonal accuracy.
In design, being interpersonally accurate towards users is deemed important for design outcomes. User-understanding is broadly referred to as empathy in design. Yet, empathy is not clearly defined. We expose this problem and suggest some conceptual clarity. In music performance, interpersonal accuracy allows us to better understand the complex communication between musician-listener. A musician experiences emotions while performing, but it is not known whether listeners can detect these accurately. We adapt two interpersonal accuracy methodologies, empathic accuracy, and emotional recognition accuracy. Empathic accuracy allows measuring the similarity between remembered and inferred mental contents of interacting dyads. Emotional recognition accuracy allows to measure the accurate judgment of someone's non-verbal emotional expressions.
Through adapting empathic accuracy in design cases, it was observed that designers obtained approximately 50% accuracy, and showed higher accuracy when inferring design-related mental contents than mental contents irrelevant to design. In comparison to previous empathic accuracy literature, designers obtained higher empathic accuracy scores. We attribute these to contextual cues such as awareness of the conversation topic, and the demonstration of concrete objects. Although the causal link between designers' empathic accuracy and design outcomes remains unestablished. Through adapting emotional recognition accuracy into music performance, it was observed that listeners perceived lower anxiety than that reported by the musician across experimental conditions. Furthermore, the listener's emotional recognition accuracy is a complex skill affected by variables such as multimodal perception, and the listener's musical background. Altogether, inaccuracy was observed across the context of design and music. Interpersonal accuracy can also be affected by multimodal perception and the perceiver's background. We conclude suggesting some ideas to improve interpersonal accuracy.
... 55,56 Despite the importance of adoption, this is often overlooked during the process of design. 24 Smeenk et al. 57 suggested that design team members often find it difficult to collaborate with users who have different abilities from them and live in difficult situations and often feel that they lack the necessary skills and experiences to co-design with older users. In addition, challenges such as resources (budget and time) often do not allow all the team members to join co-design sessions which means that some team members cannot work with users and immerse themselves in user situations. ...
... In addition, challenges such as resources (budget and time) often do not allow all the team members to join co-design sessions which means that some team members cannot work with users and immerse themselves in user situations. 57 This can make it difficult for designers to be receptive, inclusive and committed to people with dementia. Fennell 58 explains how app developers should question and reflect upon preconceived ideas regarding dementia to enable them to have empathy and develop technology that is sensitive to the needs of people living with dementia. ...
Objective
Researchers have used various theories and models to understand technology adoption, however, with the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing the adoption of digital health applications for people living with dementia and add to the current literature on this topic.
Methods
Searches were conducted in CINHAL, Web of Science, Psych Info, ProQuest Health and Medical, IEEE Xplore and Scopus. Citation searching and handsearching were used in the identification of other studies.
Results
Following an assessment of relevancy, nine studies remained and are included within this review. Methodological quality was assessed using The Mixed Methods Appraisal Tool (MMAT). A thematic analysis was used for the data synthesis of included studies. Each study reported on different types of apps.
Conclusion
From the synthesis of included studies, four analytic themes were identified; Theme 1: Personal and contextual factors; Theme 2: Perceived value and benefit; Theme 3: Design and content of app; and Theme 4: Digital Literacy and Confidence. People are diverse and so are their reasons for the adoption of apps. These findings provide an insight into the range of factors that impact the adoption of apps for people living with dementia. Understanding the factors that impact the adoption of mobile applications is critical to their success. These findings can be beneficial for app developers and for people living with dementia and their carers.
... It is a concept generation tool based on engaging designers in empathic experiences, which simulate disabilities or situational disabilities (Johnson et al. 2014;Raviselvam, Hölttä-Otto & Wood 2016). Creating experience simulators such as Smeenk, Sturm & Eggen's (2017) dementia simulator as part of their Empathic Handover method (Smeenk et al. 2017(Smeenk et al. , 2019b focus on facilitating the transfer of user insights empathically to design team members who were not in contact with users. Role-playing is often used to visualise a product from the user's point of view (Medler & Magerko 2010). ...
... It is a concept generation tool based on engaging designers in empathic experiences, which simulate disabilities or situational disabilities (Johnson et al. 2014;Raviselvam, Hölttä-Otto & Wood 2016). Creating experience simulators such as Smeenk, Sturm & Eggen's (2017) dementia simulator as part of their Empathic Handover method (Smeenk et al. 2017(Smeenk et al. , 2019b focus on facilitating the transfer of user insights empathically to design team members who were not in contact with users. Role-playing is often used to visualise a product from the user's point of view (Medler & Magerko 2010). ...
Empathy is argued to be a key factor for a successful design discussion. However, such causality cannot be empirically proven based on how empathy is currently defined in design community. Empathy is used as an umbrella construct, broad and encompassing of diverse phenomena, making it difficult to quantify. We suggest improving such a situation by introducing a definition of empathy based on psychology literature, which provides structure and guidance for studying the role of empathy in design. We first break empathy to components. Then, we review empathy as used in design. Finally, we synthetize the reviewed material. From this synthesis, we conclude that empathy in design shares several key components of empathy in psychology; particularly with state influences, top-down control process and emotional stimuli. These are present in design methods although they have not been studied using such terms. Incorporating psychological components of empathy into design can help conceptualising empathy from a different angle, thus opening interesting new avenues for future research. We hope that our treatment provides present and future designers with some useful guidance.
... These works promote socially inclusive practice [12,48,104], empowerment and agency [38,74,106,110] and a sense of self and identity [4,58,66,78,109]. For instance, various studies have illustrated that the evaluation of technology in the care context requires empathy [88,96], reflexivity on the part of the researcher [47,50,96], and recognition that residents with dementia are capable of mutual conversations and should be included as such [36,66]. ...
... These works promote socially inclusive practice [12,48,104], empowerment and agency [38,74,106,110] and a sense of self and identity [4,58,66,78,109]. For instance, various studies have illustrated that the evaluation of technology in the care context requires empathy [88,96], reflexivity on the part of the researcher [47,50,96], and recognition that residents with dementia are capable of mutual conversations and should be included as such [36,66]. ...
Research in HCI is increasingly investigating the role of technology in supporting meaningful and social activities to enhance the lived experiences of people with dementia. However, to further enrich the daily experiences in care, more insight is needed into how technology can directly promote social participation and pleasurable experiences in everyday care situations. This paper discusses the deployment of VITA and SAM: two research products that address the social and emotional needs of residents in day-to-day dementia care. We report how both products offered aesthetic and sensory enrichment, created new experiences in the everyday, and were integrated into the care environment. Furthermore, we identify implications for design to provide: 1) aesthetics in care, 2) authentic experiences, 3) reinforcing everyday life, and 4) community-driven use in practice. We contribute to existing research by demonstrating how technology for dementia care can transcend instrumental use and culminate in warm-felt everyday experiences.
... Others, as the process of projecting into users' situation [13] or merging with them to gain a deeper understanding of their circumstances [14]. Furthermore, product development pedagogical materials [15,16], practice-guided tools, and frameworks have been introduced into the literature towards these ends [7,9,14,[17][18][19][20][21][22][23][24][25]. ...
... Lastly, in this study we provide a concrete way of measuring empathy in design. Although previous frameworks [14] and methods to foster empathy [7,9,14,[17][18][19][20][21][22][23][24][25] with a user have been proposed, no concrete way of measuring empathic performance on a specific design context existed. Here we show three design cases, all very different from each other, to exemplify how the empathic accuracy paradigm could be used in design. ...
2020 American Society of Mechanical Engineers (ASME). All rights reserved. The success of design needfinding is largely dependent on how well designers understand their users. It is further claimed that user understanding and designers' capacity to adopt users' perspective, i.e. designers' ability to understand others, are key skills that should lead to successful design outcomes. The general ability to understand someone else's mental contents, such as what they else think, feel, wish, and believe, is called theory of mind. In this study, we connect concepts of humancentered design and theory of mind through empathic accuracy, a performance-based method for measuring empathy. We state two hypotheses. First, that designers are equally accurate at inferring thoughts as they are at inferring feelings. Second, that designers are more accurate in inferring design-related mental contents than those that are not related to design. We answer these hypotheses by analyzing results of altogether 24 designers watching recorded needfinding interviews of 6 users and inferring their mental contents. We observed that feelings were more accurately inferred than thoughts, although the data showed some inconsistencies. A stronger case can be made for designers' accuracy of design-related entries, where designers were consistently more accurate at inferring design-related entries than non-design-related ones. These results provide concrete insight into how designers understand users and how empathy could be quantified in the design context.
... In empathic design, several practical techniques have been developed, including ethnographic methods, empathic modeling, empathic priming, and perspective-taking [20][21][22][23]. These methods aim to help designers to establish direct or indirect connections with users and enhance their understanding of the user. ...
... These methods aim to help designers to establish direct or indirect connections with users and enhance their understanding of the user. For example, when designing for people with visual impairments, empathic priming methods, such as wearing eye covers, allows designers to experience the users' reality [22,23]. Although covering one's eyes cannot provide a completing user experience, it still gives designers opportunities to understand the difficulties users with visual impairments can face. ...
Empathy is an essential ability for designers to step into users’ shoes and potentially discover their latent needs. However, although empathy helps designers to better understand users, the degree to which designers can actually understand them remains unclear. Consequently, it is essential to measure the accuracy of designers’ empathic understanding. In our previous work, we have adopted an experimental procedure from psychology to quantify designers’ empathic accuracy. However, the measure as such is time-consuming. Therefore, we attempted to shorten the experimental time while retaining the validity of the measure. This paper reports on the process of shortening the measure and compares the original instrument with the shortened one. The data collected from the shortened instrument shows excellent internal consistency and between subject variance and is able to produce similar results to the original longer measure.
... However, it is important to note that, especially in the health context, it may not always be possible for end users to gather in the same physical space: Hence, for co-design to be accessible to end users, generative engagement does not necessarily need to occur in the presence of all stakeholders or in the same physical space. For example, Smeenk et al [54] described an empathic handover approach in which end users can participate in the early phases of co-design alongside a principal designer who later translates these contributions [54]. On the other hand, there are also co-design phases that require immersion in the real-world context in which the mHealth system will eventually be implemented (see also guideline 4). ...
... However, it is important to note that, especially in the health context, it may not always be possible for end users to gather in the same physical space: Hence, for co-design to be accessible to end users, generative engagement does not necessarily need to occur in the presence of all stakeholders or in the same physical space. For example, Smeenk et al [54] described an empathic handover approach in which end users can participate in the early phases of co-design alongside a principal designer who later translates these contributions [54]. On the other hand, there are also co-design phases that require immersion in the real-world context in which the mHealth system will eventually be implemented (see also guideline 4). ...
BACKGROUND
The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners have emphasized that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and integration into existing system landscapes. Co-design is an approach to address these pitfalls. Despite a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mHealth systems.
OBJECTIVE
The objectives of our study was to (1) contextualize an existing co-design framework to mHealth applications and (2) derive guidelines to address common challenges of co-designing mHealth systems.
METHODS
We conducted an exploratory qualitative study consisting of 16 semi-structured interviews with co-design method experts (8) and mHealth system developers (8). Data were analyzed using thematic analysis.
RESULTS
The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases. Additionally, seven guidelines were developed: (1) specificity of targeted mHealth context, (2) immersion in mHealth context, (3) health behavior change, (4) co-design facilitators, (5) post-design advocates, (6) health-specific evaluation criteria, and (7) usage data and contextual research to understand impact.
CONCLUSIONS
System designers encounter unique challenges when engaging in mHealth development. We hope that the contextualized framework and guidelines will serve as a shared frame of reference to facilitate interdisciplinary collaboration at the nexus of information technology and health research.
... Others, as the process of projecting into users' situation [13] or merging with them to gain a deeper understanding of their circumstances [14]. Furthermore, product development pedagogical materials [15,16], practice-guided tools, and frameworks have been introduced into the literature towards these ends [7,9,14,[17][18][19][20][21][22][23][24][25]. ...
... Lastly, in this study we provide a concrete way of measuring empathy in design. Although previous frameworks [14] and methods to foster empathy [7,9,14,[17][18][19][20][21][22][23][24][25] with a user have been proposed, no concrete way of measuring empathic performance on a specific design context existed. Here we show three design cases, all very different from each other, to exemplify how the empathic accuracy paradigm could be used in design. ...
The success of design needfinding is largely dependent on how well designers understand their users. It is further claimed that user understanding and designers’ capacity to adopt users’ perspective, i.e. designers’ ability to understand others, are key skills that should lead to successful design outcomes. The general ability to understand someone else’s mental contents, such as what they else think, feel, wish, and believe, is called theory of mind. In this study, we connect concepts of human-centered design and theory of mind through empathic accuracy, a performance-based method for measuring empathy. We state two hypotheses. First, that designers are equally accurate at inferring thoughts as they are at inferring feelings. Second, that designers are more accurate in inferring design-related mental contents than those that are not related to design. We answer these hypotheses by analyzing results of altogether 24 designers watching recorded needfinding interviews of 6 users and inferring their mental contents. We observed that feelings were more accurately inferred than thoughts, although the data showed some inconsistencies. A stronger case can be made for designers’ accuracy of design-related entries, where designers were consistently more accurate at inferring design-related entries than non-design-related ones. These results provide concrete insight into how designers understand users and how empathy could be quantified in the design context.
... Most research providing important information about the role of empathy in design is qualitative (e.g. Kouprie & Sleeswijk Visser 2009;Kankainen et al. 2012;Smeenk et al. 2017). While the qualitative approach allows us to delve into the specific context and understand the experience of the agents involved within, it does not allow us to make quantitative predictions. ...
... In the present study, the performance of our designers was not significantly different between the beginning and end of the interview. We wonder whether a designer could increase her or his empathic accuracy towards a user if provided with immediate feedback, thus aiding the designer to understand the context and experience of the user (Kouprie & Sleeswijk Visser 2009;Smeenk, Sturm & Eggen 2017). Future studies could compare the empathic accuracy performance of designers versus non-designers when watching the same contextual interviews and test whether design training translates into differentiated outcomes. ...
Empathic design highlights the relevance of understanding users and their circumstances in order to obtain good design outcomes. However, theory-based quantitative methods, which can be used to test user understanding, are hard to find in the design science literature. Here, we introduce a validated method used in social psychological research – the empathic accuracy method – into design to explore how well two designers perform in a design task and whether the designers’ empathic accuracy performance and the physiological synchrony between the two designers and a group of users can predict the designers’ success in two design tasks. The designers could correctly identify approximately 50% of the users’ reported mental content. We did not find a significant correlation between the designers’ empathic accuracy and their (1) performance in design tasks and (2) physiological synchrony with users. Nevertheless, the empathic accuracy method is promising in its attempts to quantify the effect of empathy in design.
... However, many studies indicate that it is challenging for young designers to empathize with the elderly population. Current research shows that for young designers, barriers exist in designing for the elderly population, which include a lack of similar life experiences (Smeenk et al., 2017), differences in physiological limitations (Pinheiro et al, 2022), stereotypes of the elderly population (Hallewell Haslwanter, 2022), and negative attitudes towards aging (Palmore, 2015;Sargent-Cox, 2016). ...
With the aging population increasing, understanding this emerging user group is a current important topic. Past research has indicated that personas are beneficial for young designers to make inferences about the elder group, and can evoke creativity. Therefore, this research has adjusted the existing personas for better results in both aspects. This research has added the identity category to the existing personas, expecting that it would guide young designers to be aware of the identities of the video characters other than the elders, thus considering more potential needs and be able to understand the characters by their words instead of the group they belong to 17 students with design background were recruited in this research. They watch the interviews of the elders and write different versions of personas, followed by scoring through empathic accuracy process and creativity evaluation process. The results of the research indicated that, adding the identity category to the personas did enable to find more potential needs, however, it did not have any effect on empathic accuracy. Compared to the current design process that emphasizes on improving the empathy of designers in order to recognize a wider range of needs, this research suggests that improving the ability to identify needs does not necessarily require “reading minds” of the users, that is, having to fully understand the thoughts and feelings of users does not necessarily lead to creativity; by letting designers be aware of the identity categories of the group, the potential of recognizing needs can be expanded, thus bringing more possibilities to design.
... We found this was often lacking; some SMEs were so focused on their own product and making their own product function, that they could not see the evident shortcomings to make it work for people with dementia. Providing a basic level of training, and insights into the first-person experience of dementia, would contribute to a better adoption of the products [27]. Different experiences of co-creation have reported the need for developing individualized solutions to empower people living with dementia [28], addressing both physical needs and psycho-social well-being [29], and involve multiple stakeholders over the course of the entire product design and development process to overcome adoption challenges [30]. ...
Dementia is a growing societal challenge putting pressure on care systems across Europe. Providing supporting technology for people living with dementia, referring to both people with dementia and their caregivers, is an important strategy to alleviate pressure. In this paper, we present lessons learned from the Interreg NWE Project Certification-D, in which we evaluated technological products with people living with dementia, using a Living Lab approach. Living Labs were set up in five different countries to conduct field evaluations at the homes of people living with dementia. Via an open call products from small to medium enterprises across northwestern Europe were selected to be evaluated in the Living Labs. In this paper, we describe the setup of and reflection on Living Labs as multi-stakeholder collaboration networks to evaluate technological products in the context of dementia. We reflect on the experiences and insights from the Living Lab researchers to execute and operate the Living Labs in such a sensitive setting. Our findings show that Living Labs can be used to conduct field evaluations of products, that flexibility is required to adopt a Living Lab in various care settings with different stakeholder compositions and expertise, and that Living Lab researchers serve as both a linking pin and buffer between people living with dementia and companies and thereby support the adoption of technological products. We close the paper with a proposal of best practices to encourage inclusivity in, and scalability of, Living Labs in the context of dementia.
... Empathy is another aspect to be considered in the codesign process. There are approaches and frameworks used to empathize with users during the co-design process [55,56]. The literature points out Personas as valuable tools to create empathy with users in the design process [15,22,42]. ...
The ability of human beings to live longer is an outstanding achievement of science in the 21st century. New technologies and innovations have an essential role in ensuring the well-being of the new generation. By adopting Internet of Things (IoT) technologies, it is possible to improve autonomy, security, and quality of life. However, designing IoT solutions for Home Care and older users brings new challenges to the Human–Computer Interaction field. Older users are heterogeneous and critical users of technology and interactive solutions. In this context, it is necessary to promote the participation of older users in the design process aiming at considering their specificities, intentions of use, and individual preferences and necessities. We propose a co-design method based on Design Thinking and Personas. Our research contributes to methods and a case study assessment regarding IoT-based Home Care solutions’ co-design. The proposed approach considers older users’ wishes and needs in an iterative, creative, and participatory way. We tested the proposed method in a case study with nine older adults. Results indicate the effectiveness and difficulties of involving older users in the design process. Our results contribute to a better understanding of how to carry out participatory activities with older adults in the context of Home Care.
... Improvisational theatre and stakeholder roleplay are convivial tools as well. There are also tools that provide more guidance and come pre-prepared, such as our empathic co-design canvas (Smeenk, Bertrand, Köppchen, 2021), card deck games like discussed in the book Design, Play, Change (Smeenk & van Willenborg, 2022) and empathic discussions and role-play (Smeenk et al., 2017). • In the virtual reallity experience Intake of the virtual reality experience ...
When I was sixteen, I got a fantastic moped,
just like the ones ‘greasers’ rode. At school, I
stole the show and once, I even found a note
tucked under the bell asking if I was interested
in selling it. The moped wasn't actually my
idea. While I quite liked the classic model and
design, I had no burning desire or aspirations
to own a moped. It was more that my father
really wanted to give me one. It had been his
dream as a teenager – and a luxury his parents
could not afford. And so I must and would have
one, whether I wanted it or not.
I did have a tremendous amount of fun with
that moped. My father still has it; he's saving it
for the grandchildren. But my oldest daughter,
who will be sixteen in two weeks, is completely
uninterested. And my youngest won't be riding
it either, because it stinks and is bad for the
environment. She thinks a bicycle or a horse
would be a better alternative, nice and green.
On top of which, you're not even allowed to
bring a two-stroke motor into Amsterdam any
more.
Much has changed in three generations. We've
become more aware of the consequences –
intended or otherwise – of our own behaviour.
My father took pleasure in the miracle of tech
nology and I enjoyed using a means of trans
portation, but my daughters understand how
that individual pleasure can pose a threat to
our world and its climate. And so, in a mere
three generations, via the pursuit of prosperity
and guilt-free consumption, we've gone from
postwar shortages and dreams of having more,
to the question of what kind of society we want
to live in and whether it might be a good idea
to do with less in order to improve conditions
for the planet and more of our fellow creatures.
My lecture is entitled ‘The world tilted’ because
I, like many others, believe we are now at a
tipping point (Gladwell, 2000). In short, we
have reached the point at which we can no
longer deny the necessity of change. Simply
because we can see it with our own eyes and
experience it with our bodies. A little less pros
perity. Being more considerate to one another,
to animals and to our planet – how hard can it
be? As individuals, each of us can take small
steps, like my daughters are doing. Together,
as a society, we still find this to be the most
difficult thing imaginable. This is where, as a
design-based researcher, I hope to do my part.
With optimism, through trial and error and
from one experiment to the next, I want to
explore ways to collaborate with others in
order to give the world that extra boost – to
help it over the tipping point and into a drastic
shift toward a better world. In this lecture, I will
describe how I imagine this scenario.
... Moreover, there are studies that do not provide an integrated understanding of UX in association with technological devices (Megges et al., 2018), and one study reported that few technology systems are specifically designed to approach the cognitive limitations that affect older adults with cognitive impairment (Wargnier et al., 2018). In a population sector that is already subject to the frustration and lack of confidence that is associated with the limitations of their condition, the impact of unsuitable technological designs can add to such negative feelings (Smeenk et al., 2018). ...
Introduction
Incorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience (UX) measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment (MCI) or dementia.
Method
The Medline, PubMed, Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years (2009–2019), and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies.
Results
Ten studies were selected: five were cognitive stimulation and five were cognitive training. Most of them (60%) were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time (45%) and help (40%) but can complete tasks (60%). Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies.
Conclusion
Measuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies.
Review registration
This review was registered in the PROSPERO (CRD42020158147) International Register of Systematic Review Protocols.
... Using the research team members' extensive networks, we will recruit a convenience sample of 5 to 8 end users per country that will include (1) older adults, (2) caregivers, (3) professionals with experience caring for people with memory issues, and (4) technology developers. The group size and configuration is based on other co-design studies [51]. We will strive to have an equal proportion of each type of end user with a group size of 8 persons. ...
Background
Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options.
Objective
We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users’ mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options.
Methods
Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed.
Results
The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021.
Conclusions
This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults’ autonomy, and, ultimately, inform SDM about housing options.
Trial Registration
ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484
International Registered Report Identifier (IRRID)
DERR1-10.2196/19244
... Given that empathy is such a crucial element in design and various other disciplines, extant research in design (Ho, Ma & Lee, 2011;Hess & Fila, 2016;Smeenk, Sturm & Eggen 2018) and higher education (Ashworth & Lucas, 2000;McAllister & Irvine, 2002;Killick, 2012) has explored empathy from diverse perspectives. Especially in design, considerable amount of scholarly attention has been devoted to understanding our users and stakeholders to frame the problems we aim to solve (Brown, 2008;Dorst, 2011). ...
Preparing a workforce that is well-equipped with the skills and knowledge to navigate the complexities of our global human society is a key responsibility of design and higher education. Extant research has advocated design as one of the essential skills to master in the future, and this design literacy has been claimed to be a critical factor in creating innovations and new solutions towards transforming our societies. To explore how non-designers become more design literate, in this paper we present findings from a study looking at how multidisciplinary student teams develop their design literacy in an action-oriented course setting. Based on our initial analysis, blending the boundaries between universities and the surrounding society positively contributes towards developing design literacy. This, in turn, has pedagogical implications as well as increases our understanding on how design travels to other disciplinary domains.
... This distinction helps designers deliberately focus on their current experiences in situ or on past experiences in similar situations other than the specific design context. An example of the latter is found in the empathic handover approach (see Smeenk, Sturm & Eggen, 2017), where designers-in an empathic discussionconnect to own experiences in order to understand others' feelings. ...
Although empathy is an essential aspect of co-design, the design community lacks a systematic overview of the key dimensions and elements that foster empathy in design. This paper introduces an empathic formation compass, based on a comparison of existing relevant frameworks. Empathic formation is defined here as the formative process of becoming an empathic design professional who knows which attitude, skills and knowledge are applicable in a co-design process. The empathic formation compass provides designers with a vocabulary that helps them understand what kind of key dimensions and elements influence empathic formation in co-design and how that informs designers’ role and design decisions. In addition, the empathic formation compass aims to support reflection and to evaluate co-design projects beyond the mere reliance on methods. In this way, empathic design can be made into a conscious activity in which designers regulate and include their own feelings and experiences (first-person perspective), and decrease empathic bias. We identify four important intersecting dimensions that empathy is comprised of in design and describe their dynamic relations. The first two opposing dimensions are denoted by empathy and differentiate between cognitive design processes and affective design experiences, and between self- and other orientation. The other two dimensions are defined by design research and differentiate between an expert and a participatory mindset, and research- and design-led techniques. The empathic formation compass strengthens and enriches our earlier work on mixed perspectives with these specific dimensions and describes the factors that foster empathy in design from a more contextual position. We expect the empathic formation compass—combined with the mixed perspectives framework—to enhance future research by bringing about a deeper understanding of designers’ empathic and collaborative design practice.
... In the second step participants can join collective handover workshops as appropriate. Finally, the third step in the process is holding an ideation workshop with participants [103]. Another solution is to consider the process of making and designing as a tool for understanding the context and finding problems, rather than having separate research and design phases [104]. ...
A large number of mobile mental health apps are available to the public but current knowledge about requirements of designing such solutions is scarce, especially from sociotechnical and user centred points of view. Due to the significant role of mobile apps in the mental health service models, identifying the design requirements of mobile mental health solutions is crucial. Some of those requirements have been addressed individually in the literature, but there are few research studies that show a comprehensive picture of this domain. This exploratory review aims to facilitate such holistic understanding. The main search keywords of the review were identified in a cross-disciplinary requirements workshop. The search was started by finding some core references in the healthcare databases. A wider range of references then has been explored using a snowball method. Findings showed that there is a good understanding of individual design requirements in current literature but there are few examples of implementing a combination of different design requirements in real world products. The design processes specifically developed for mobile mental health apps are also rare. Most studies on operational mobile mental health apps address major mental health issues while prevention and wellbeing areas are underdeveloped. In conclusion, the main recommendations for designing future mobile mental health solutions include: moving towards sociotechnical and open design strategies, understanding and creating shared value, recognizing all dimensions of efficacy, bridging design and medical research and development, and considering an ecosystem perspective.
Designing for people living with dementia (People Living with Dementia, referring to people with dementia and their (in)formal caregiver network (Brankaert 2016).) (PLWD) is challenging. The benefits of involving PLWD in the design process are widely represented in literature. However, ethical and practical considerations can make it difficult to include PLWD. In these cases there’s a need for approaches to transfer unique experiences with PLWD from one designer who had experiences with PLWD to members of the design team who are unable to meet PLWD. The aim of the doctoral research is to develop accessible handover approaches to be used in the professional design context. This paper describes three concerns that emerged from research thus far (i.e. a literature review and ethnographic research); (1) the designers’ interpretation, (2) the uniqueness of each experience, and (3) the search for methods able to transfer these experiences. These concerns provide a framework for the development of handover approaches, validated with student-designers. These student cases are now in the process of being analysed in order to make conclusions for future research to build on, however the first insights gained from four past student cases are shared in this paper.KeywordsPeople living with dementiaDesign for dementiaHandover toolsSocial design
Toen ik zestien werd kreeg ik een fantastische ‘nozem’ brommer. Ik stal er de show mee op school en vond zelfs een keer een briefje onder mijn bel of hij te koop was. Die brommer was niet mijn eigen idee. Ik vond het oldtimer-model en design erg mooi, maar ik had geen prangende wens of aspiratie voor een brommer. Het was meer mijn vader die me heel graag een brommer wilde geven. Het was zijn tienerdroom en een luxe die zijn ouders niet konden betalen. Dus ik moest en zou er een krijgen of ik dat nu wilde of niet.
Ik heb enorm veel plezier van die brommer gehad. Mijn vader heeft hem nog steeds. Hij bewaart hem voor de kleinkinderen. Maar mijn oudste dochter, die over twee weken zestien wordt, wil hem helemaal niet. En ook mijn jongste gaat er straks niet op rijden. Want het ding stinkt en hij is slecht voor het milieu. Een fiets of een paard vinden ze een beter alternatief, lekker schoon. Bovendien mag je met een tweetakt Amsterdam helemaal niet meer in.
In drie generaties is er veel veranderd. Ons bewustzijn van de (onbedoelde) gevolgen van ons eigen gedrag is gegroeid. Mijn vader
schepte genoegen in het wonder van tech- niek, ik had plezier van een vervoermiddel, maar mijn dochters zijn zich bewust van hoe dat persoonlijke genot het klimaat en onze wereld bedreigen. In drie generaties gaan we zo van naoorlogse tekorten en dromen van meer, via het streven naar welvaart en lekker consumeren, naar de vraag in wat voor samen- leving we willen leven en of het niet wat minder kan zodat het met de aardbol en met meer van ons beter gaat.
‘De wereld gekanteld’ heet mijn rede, omdat ik net als vele anderen denk dat we op een ‘tipping point’ zijn (Gladwell, 2000). Dat is kort gezegd het punt waarop we niet meer kunnen ontkennen dat dingen anders moeten. Gewoon omdat we het met eigen ogen zien en lijfelijk ervaren. Een beetje minder welvaart. Meer aandacht voor elkaar, voor de dieren en voor onze planeet: hoe moeilijk kan dat zijn? Als individu kunnen we kleine stappen nemen, zoals mijn dochters dat doen. Samen, als maatschappij hebben we er nog de grootst mogelijke moeite mee. Als ontwerpend onderzoeker wil ik daar mijn bijdrage leveren. Optimistisch, uitproberend en van experiment naar experiment wil ik op zoek naar hoe ik de wereld samen met anderen dat extra zetje kan geven; om de kanteling door te zetten in een serieuze ommezwaai naar een betere wereld. In deze rede beschrijf ik hoe ik dat voor me zie.
Background
The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development.
Objective
Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems.
Methods
Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development.
Results
The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact.
Conclusions
System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.
Co-design aims to bring designers and end-users together to improve the quality of design projects. In this paper, we study how the distance between designers and users can be reduced with an empathic approach particularly in settings where it is significant. By investigating various approaches on empathy in design and architecture, we were able to retrospectively understand different aspects of the design process of a maternity ward project in which we were involved. Engaging a theoretical clarification of empathy as a multi-dimensional concept made it possible to empirically explicate diverse difficulties that designers face when trying to employ empathy as a guiding philosophy in their work. As a result, we identified three registers of empathy on a varying scale of depth that can be integrated in the design process. Our work shows that various registers of empathy can complement each other or be utilised in different circumstances where one form might be more appropriate than another. By presenting these registers, we seek to unbox the different views on empathy and draw attention to the potential of empathic engagement when aiming for depth in a project.
The authors highlight how many hospitals are not designed to care for people with dementia, not least because “Designing at a human scale is challenging in the context of large-scale and complex acute hospitals.” They describe dementia-friendly design as an inclusive approach which pays attention to cognitive impairment alongside the age-related changes such as physical frailty, mobility, visual impairments, hearing loss, and circadian rhythm difficulties. These cognitive, physical, sensory and age-related issues underpin dementia-friendly design. They are encouraged by how dementia-attuned research and design is contributing to the developing knowledge base and will contribute the support of a wide range of patients, visitors and staff of all ages, sizes, abilities and disabilities as well as people living with dementia.
This chapter narrates the search for ways to involve people with dementia in the design process based on insights from three projects, several workshops and an educational module involving people with dementia and their network of caregivers and family. This six year-trajectory was part of a Ph.D. project and started ambitiously with the endeavor to find a dedicated method for involvement, inspired by those developed to involve children or people with aphasia. The aim was to develop a set of design guidelines for (successfully) involving people with dementia in the design process. It became clear that using a set of guidelines as a universal, dedicated, or passe-partout way of working for every person with dementia, would not work. We argue that the foundations for a more suitable individualized approach lie in the build-up of a personal relationship between the person with dementia and the designer. Based on such a personal relationship, ways to facilitate involvement of a person with dementia can be defined and design decisions can be collaboratively taken. Person-Centered Care is seen as a guide in the build-up of the relational expertise that a designer needs in order to collaborate with a person with dementia and that enables designers to value and articulate shared decision making.
At the moment, our society is experiencing more and more grand challenges such as climate change, the aging population, migration, overtourism and loneliness. In the light of this increasing design complexity, many have argued for co-design as a way to catalyze multidisciplinary collaborations and for more empathy in the design process. However, empathy is a complex notion.
In this thesis, we take a step towards formalizing empathic formation in co-design as a legitimate methodology of inquiry and document intermediate knowledge that is generated from this type of 'subjective' design. The results consist of 1) an Empathic Formation (EF) compass, in which the key components of empathy, design and their interrelations are specified, 2) a Mixed Perspectives (MP) methodology in which personal experiences, feelings and intuition are credibly embedded, and 3) an Empathic Handover (EH) approach enabling designers to develop empathy with users they did not meet in person. Using this knowledge, designers are better equipped to navigate empathy in co-design settings, and can be more confident that the design effect is based on empathy and not on an incident.
There is a growing emphasis on designing with people with diverse health experiences rather than designing for them. Yet, collaborative design becomes difficult when working with individuals with health conditions (e.g., stroke, cancer, abuse, depression) that affect their ability or willingness to engage alongside researchers and verbally express themselves. The present paper analyzes how the clinical practice of art therapy engages these individuals in co-creative, visual expression of ideas, thoughts, and experiences. Drawing on interviews with 22 art therapists and over two years of field work in a clinical setting, we detail how art therapists view making as expression for people with complex communication needs. Under this view, we argue that art therapy practice can inspire collaborative design engagements by understanding materials as language, creating space for expression, and sustaining expressions in a broader context. We discuss practical and ethical implications for design work involving individuals with complex communication needs.
Although it is common for designers to base design decisions on own experiences, the specific utility, and legitimacy, validity of this first-person perspective in design is currently not sufficiently understood and recognized. In particular, wisely applying the first-person perspective in projects that require great sensitivity can be a major contributor to design outcomes. As such, a better understanding of the relative value of the first-person perspective compared to—and combined with—other fundamental perspectives (introduced as
perspective transitions and clusters) can contribute to enrich and develop design methodologies.
In this paper we report on a case study targeting mourning. We describe when and how junior designers employed the first-, second-, and third-person perspectives and how they were combined. This leads to new insights. First, we improve the current understanding of perspectives. Second, we identify the specific value of transitions between perspectives. Third, we introduce perspective clusters and highlight how these—as building blocks—can give flexible guidance to design. These insights, in turn, support a mixed-perspectives approach. This approach supports empathic design by enabling designers to be receptive, inclusive, and committed toward users. Moreover, it supports designers in employing (relevant) personal experiences and intuition in a more credible and intentional way.
Codesign with people living with cognitive or sensory impairments poses challenges for researchers and designers, due to differences in their mutual experiences and due to the fact that many well-established codesign methods and techniques may not be appropriate and need adjustment. This paper describes a search for an appropriate, dedicated methodological approach for involving people living with impairments in codesign projects. Based on both existing literature and on a series of three academic workshops, we aimed to understand how researchers and designers adjust common codesign techniques and to derive general principles from those adjustments. During our search for a dedicated codesign approach, however, we came to change our view, and therefore our aims. The outcomes of the workshops, more specifically the identification of common challenges that researchers and designers experience, showed that such a dedicated approach may not be the best way to advance the field of codesign methods for people living with impairments. Instead, we now advocate a highly individual approach towards adjusting codesign techniques. In addition, we suggest a new tradition of sharing experiences in order for researchers and designers to learn from one another in the form of method stories.
The aim of this article is to present the findings of a review of studies that focused on technology supporting people with dementia and their caregivers. A literature search was carried out in eight scientific literature databases covering literature published between January 1992 and February 2007. A total of 46 studies providing original data and one review were included in this review. Analyses covered the aims of the studies, the technology used, study design, methods, outcome variables, and results. Most studies were carried out in residential care and focused on the needs of formal caregivers. Only a few studies involved people with dementia actively using the technology. The studies are difficult to compare because of the large variety of aims, technologies, design, and outcome measurements. There is a need for more research in this area, in particular, with people who have a mild stage dementia living in the community.
In user-centred design, a widespread recognition has surfaced for the importance of designers to gain empathy with the users for whom they are designing. Several techniques and tools have been developed to support an empathic design process and several issues are indicated that support an empathic process, but precise definitions and a framework of what makes ‘empathy’ is missing. Although the need for empathic approaches in design has been repeatedly stressed, a fundamental basis of the concept of empathy is missing. The goal of this paper is to inform the discussion in the design community by applying the concept of empathy as it has developed in psychology. This paper presents a review of how empathy has been discussed in design and psychology literature, and proposes a background framework for supporting empathic approaches in designing. The framework presents empathy in design as a process of four phases, and gives insight into what role the designer's own experience can play when having empathy with the user. This framework can be applied to three areas: research activities, communication activities and ideation activities.
We describe the development, application and evaluation of a design method tailored for working with people with mild to moderate dementia. Our experiences with the approach highlighted areas where designers and participants held radically different views. The tenet of our approach was that to overcome these differences we needed to create an empathic relationship between participants and designers. To achieve this we modified participatory design techniques to foster respectful engagement with participants in the development of a digital aid to facilitate "safe walking". The process begins with broad qualitative scoping and design work then moves to developing personally tailored, individual designs to further exploration of the experiential elements of the domain while reducing the need for the participants to engage in abstract thought. Reflection highlights a number of important areas that demand consideration when undertaking research in this area and, more generally, when performing design work with people with dementia.
Personas have become a well-lauded method to aid designers in keeping the needs of the intended user population at the forefront of the design process. However, few studies have ethnographically observed design teams that use personas, and fewer studies have looked specifically at how designers linguistically invoke personas in their decision-making sessions. This discourse analysis of the decision-making sessions of designers at a top tier design firm reveals that although the designers dedicate much time researching, developing, and refining personas, personas themselves make relatively few appearances in the designers' language during decision-making sessions. This study shows that, for persuasive ends, these designers, who are advocates of personas, routinely use other less precise and more designer-centric linguistic mechanisms in lieu of personas. Despite the scarcity of personas in the decision-making sessions, this ethnographic case study also explores the value of personas for this team even when the personas are not explicitly linguistically invoked.
Designers have been moving increasingly closer to the future users of what they design and the next new thing in the changing landscape of design research has become co-designing with your users. But co-designing is actually not new at all, having taken distinctly different paths in the US and in Europe. The evolution in design research from a user-centred approach to co-designing is changing the roles of the designer, the researcher and the person formerly known as the ‘user’. The implications of this shift for the education of designers and researchers are enormous. The evolution in design research from a user-centred approach to co-designing is changing the landscape of design practice as well, creating new domains of collective creativity. It is hoped that this evolution will support a transformation toward more sustainable ways of living in the future.
Debates about involving people with dementia in qualitative research are extensive, yet the range of methods used is limited. Researchers tend to rely on interview and/or observation methods to collect data, even though these tools might preclude participation. I modified the conventional diary interview method to include photo and audio diaries in an effort to investigate the lives of people with dementia in a participatory way. Sixteen people with dementia kept a diary-written, photo, or audio, whichever suited them best-for 1 month. The purposes of this article are to share the methodological insights gained from this process in the context of emerging literature on sensory ethnography, and to argue for the broader application of the diary interview method in dementia-related research, on the grounds that it mediates an equal relationship and makes visible the "whole person," including the environment in which that person lives.
In recent years, various methods and techniques have emerged for mapping the contexts of people's interaction with products. Designers and researchers use these techniques to gain deeper insight into the needs and dreams of prospective users of new products. As most of these techniques are still under development, there is a lack of practical knowledge about how such studies can be conducted. In this paper we share our insights, based on several projects from research and many years of industrial practice, of conducting user studies with generative techniques. The appendix contains a single case illustrating the application of these techniques in detail.
For a decade HCI researchers and practitioners have been developing methods, practices and designs 'for the full range of human experience'. On the one hand, a variety of approaches to design, such as aesthetic, affective, and ludic that emphasize particular qualities and contexts of experience and particular approaches to intervening in interactive experience have become focal. On the other, a variety of approaches to understanding users and user experience, based on narrative, biography, and role-play have been developed and deployed. These developments can be viewed in terms of one of the seminal commitments of HCI, 'to know the user'. Empathy has been used as a defining characteristic of designer-user relationships when design is concerned with user experience. In this article, we use 'empathy' to help position some emerging design and user-experience methodologies in terms of dynamically shifting relationships between designers, users, and artefacts.
The four-volume set LNCS 8117-8120 constitutes the refereed proceedings of the 14th IFIP TC13 International Conference on Human-Computer Interaction, INTERACT 2013, held in Cape Town, South Africa, in September 2013.
The 57 papers included in the first volume are organized in topical sections on 3D navigation, 3D technologies - 3D object manipulation, augmented reality, cognitive workload, cognitive workload and decision support, creating effective 3D displays, cross-cultural, intercultural and social issues, data entry mechanisms and devices, design and evaluation, design and evaluation of prototypes, design to support creativity, designing for inclusiveness, designing with and for people with special needs, display manipulations, and diversity / ICT in social development.
Most persons with dementia in the Netherlands live at home, where they are cared for by informal carers such as family members or friends, who offer this care unpaid. Their care-task poses a high burden on these informal carers, increasing the risk of health problems and social isolation. Many informal carers indicate they want more information on the behaviour of those they care for.
To develop and evaluate Into D'mentia, a simulation set in a living kitchen in which visitors experience a day in the life of someone with dementia. During this 'day', modern techniques such as sensors and projections, simulate the limitations of having dementia. This intervention is evaluated on usefulness and user friendliness, and on its effect on empathy, attitudes towards dementia, coping, carer burden, person-centered care capabilities and care satisfaction.
Nine informal carers and 23 care professionals took part in the research into the Into D'mentia simulation. Before and after their visit, they filled in several questionnaires, with, among others, their opinion on the usefulness and user friendliness of this experience.
Participants found Into D'mentia a highly useful and user friendly development. They indicated that the simulation offered good insight in the life of someone with dementia, and that they could offer better care thanks to this experience. Participants also indicated that they often thought back on their experiences in the simulation, in order to better understand the behaviour of people with dementia.
Into D'mentia offers a unique, accessible way to experience the limitations dementia has on daily life. Users indicate that it is a useful and user friendly innovation. Into D'mentia appears to be a suitable method to support informal and professional caregivers.
A carer or teacher often plays the role of proxy or spokesperson for a person with an intellectual disability or form of cognitive or sensory impairment. However, simple functioning interactive design prototypes enable people with cognitive or sensory impairments to try out the prototypes and participate in a process of design in use or design after design. In this paper we examine two cases of design after design. One case involves adults with cognitive or sensory impairments, the other, children identified with language delays and special needs on the Autism spectrum. Proxies were consulted iteratively during the invention of prototypes, which were then trialled. For the person with cognitive or intellectual impairments, the prototypes enabled concrete expression of likes, dislikes, capabilities, emotional wants and needs and forms of expression that hitherto had not been fostered. Carers and designers were surprised at the ways in which the technology was used and how it fostered new forms of social interaction and expression. We conclude that design after design is an effective approach for engaging people with intellectual disabilities, giving them greater capacity for expression and power in design and offering the potential to expand and deepen their social relationships.
Empathic design aims to build creative understanding of users’ experiences for new product development (NPD). In this paper, we review the literature of empathic design, and we discuss our own experiences with introducing and practicing empathic design in several NPD projects at Philips Research over the past years. Having experimented with empathic design in an industrial context, we experienced success but also encountered eight challenges that relate to discrepancies between the theory of empathic design as described in literature on the one hand, and the application of empathic design in an industrial context on the other. Three cultural and methodological changes are proposed for addressing these challenges in the future. These include changing focus (a) from rational approaches to including empathic approaches, (b) from users as informers to users as partners in NPD practice, and (c) from being informed of user research to being engaged in user research. The first two changes strongly resonate with Sanders’ (2006) dimensions of change. The third dimension
is new, and highlights an area of empathic design that is largely unaddressed in the literature.
Background:
Involving people with dementia in research is not self-evident. Inclusion of people with dementia in the development process of user-friendly, supportive IT applications may be especially useful to improve the quality of these applications and may be beneficial to the person with dementia. The aim of this study was to gain insight into the involvement of people with dementia in developing supportive IT applications. The focus of involvement was on phase, methods, role and impact on the quality of the IT application and on the person with dementia.
Method:
A systematic search was undertaken using Cochrane Library, PubMED, PsycInfo, EMBASE, and CINAHL. Publications were selected using the following inclusion criteria: publications had to address a development process of an IT application involving people with dementia. The BMJ checklist was used to assess the quality of the included publications.
Results:
Twenty-six publications relating to 15 IT programs met the inclusion criteria. People with dementia were mainly involved in the exploratory and technical development phases. The methods most frequently used to involve the participants were interviews, observations and usability try-outs. In most studies, participants were objects of study and informants. People with dementia provided useful feedback and gave valuable recommendations for researchers and designers regarding the development of user-friendly, supportive, IT applications. Involvement in all phases may have empowering effects on people with dementia.
Conclusion:
To develop valuable, user-friendly, supportive IT applications that increase the quality of life of people with dementia involvement in all phases of the development process is of great importance.
This paper describes a comparative study, which explores the influence of different sources of information on design sessions aiming for product concepts for children with autism. Six design teams were informed about children with autism under three conditions: A teams had only background information, B teams had background information and direct contact, and C teams had background information plus a video. Each team conducted a design session resulting in one product concept. These sessions were videotaped, transcribed and analysed for signs of empathy. The proposed product concepts were evaluated by parents and teachers of the children. Results show that the two B teams discussed the user group most intensively, and produced concepts that fitted the user group best. The two A teams made many false assumptions about the user group. One C team discussed the user group intensively and produced a product concept appreciated by caregivers, while the other C team did the opposite. The latter team was not motivated for the session. The results indicate that, and show examples of how, direct contact brings empathy with users to design teams and positively influences the quality of the product concepts they produce. Willingness and motivation of designers are key factors in empathic design.
Principled knowledge is a mark of any established disciplinary practice. Its derivation and validation of varies across disciplines, but HCI has tended towards posthoc ('a posteriori') syntheses. We present an alternative a priori approach that is relatively compact and open to inspection. We use John Heskett's position on the origins of design outcomes to derive six metaprinciples for all design processes: receptiveness, expressivity, committedness, credibility, inclusiveness and improvability. Although very abstract, these meta-principles generate critical insights into existing HCI approaches, identifying gaps in suitability and coverage. Practical value is increased by progressive instantiation of meta-principles to create first craft-specific, and ultimately project-specific, Interaction Design principles. A worth-centred approach is adopted to illustrate progressive instantiation towards a framework of adapted and novel HCI approaches. The internal coherence of the six metaprinciples is shown to provide direct effective support for synergistic progressive instantiation.
Adverse-and even positive-outcomes in a chronic stress experience.
A survey of members of the Alzheimer's Disease and Related Disorders Society confirmed high rates of psychological morbidity, though not of depression, and social isolation in family carers of persons with dementia. Psychological morbidity in carers was associated with having an affected person at home, the carer being a spouse, demanding problem behaviours, poor physical health in the carer, social isolation, dissatisfaction with social supports, greater use of psychotropic medication, and a deteriorated marital relationship. Carers and patients had high rates of consultations with doctors and other health professionals. There was a vulnerable group of carers who were impaired psychologically, socially and physically. The identification of risk factors to carer morbidity may lead to useful interventions.
Communication and Consultation: Exploring Ways for Staff to Involve People with Dementia in Developing Services
- K Allan
Allan, K. 2001. Communication and Consultation: Exploring Ways for Staff to Involve People with
Dementia in Developing Services. Bristol: Policy Press.
The Leader's Guide to Storytelling: Mastering the Art and Discipline of Business Narrative
- S Denning
Denning, S. 2005. The Leader's Guide to Storytelling: Mastering the Art and Discipline of Business
Narrative, Vol. 269. Hoboken, NJ: Wiley.
Gamestorming: A Playbook for Innovators, Rulebreakers, and Changemakers
- S B Gray
- S Brown
- J Macanufo
Gray, S. B., S. Brown, and J. Macanufo. 2010. Gamestorming: A Playbook for Innovators, Rulebreakers,
and Changemakers. Sebastopol, CA: O'Reilly Media.
Dementia Reconsidered: The Person Comes First
- Ideo
IDEO. 2015. The Little Book of Design Research Ethics, London: IDEO. https://lbodre.ideo.com/
Kitwood, T. 1997. Dementia Reconsidered: The Person Comes First. Buckingham: Open University
Press.
Introduction to User Experience and Empathic Design
- I Koskinen
- K Battarbee
Koskinen, I., and K. Battarbee. 2003. "Introduction to User Experience and Empathic Design. " In
Empathic Design: User Experience in Product Design, edited by I. Koskinen, T. Mattelmäki and
K. Battarbee, 37-50. Helsinki: Edita IT Press.
Werkboek Landelijke Dementie Programma [Workbook: National Dementia Programme
- J Meerveld
- J Schumacher
- W Krijger
- R Bal
- H Nies
Meerveld, J., J. Schumacher, W. Krijger, R. Bal, and H. Nies. 2004. Werkboek Landelijke Dementie
Programma [Workbook: National Dementia Programme]. Utrecht: NIZW.
Ethics: Engagement, Representation and Politics in Action
- T Robertson
- I Wagner
Robertson T. and I. Wagner. 2012. "Ethics: Engagement, Representation and Politics in Action. " In
Routledge International Handbook of Participatory Design, edited by J. Simonsen, and T. Robertson,
64-85. New York: Routledge.