Designing technology using a co-design approach
Co-design is an inclusive user-centred approach to designing services and products drawing on the expertise and lived experiences of people using the product to provide feedback to improve the end user's experience iteratively. [1]
As with many design and development approaches, applying one over another has advantages and disadvantages. Although co-design can result in more effective product design, it is usually not applied in practice. [2] The barrier to undertaking co-design is the perceived increase in costs [3] associated with recruiting, collecting, and analysing data generated from end-users, with the inability to predict or anticipate the outcomes further complicating deployment.
From a return on investment (resource – time, money, human) perspective, the advantages outweigh the challenges regarding successful integration, user experiences, adoption and acceptance of the solution. Effective co-design processes reflect the participant group's diversity, representation, and engagement.
Collaborating with a cross-section of people – a mix of those who are actual users and incidental end users - in their role or position within the organisation supports MDTs to:
- Understand and not assume how people will interact with their product in context to their roles and responsibilities relating to their work or living environment to create designed products that better fit users and organisations. [4]
- Empathise with difficulties experienced by users from the perspective of their lived experiences, cultural background or life circumstances to create more suitably designed products.
- Increase awareness of the technological requirements or specifications to support the capabilities of users by understanding the impact of digital literacy levels, English proficiency, health literacy, and physical, cognitive, and sensory impairments [5] on interactions.
- Look beyond user stereotypes and dispel held stereotypes of how users, especially older people, [3, 6] interact with technology that could influence or potentially bias technology design.
- Uncover insights to increase user-friendliness, the easier it is to use the more likely people will adopt the technology as part of their practice, anticipating and accounting for barriers to implementation. [3]
This involvement will result in richer, more meaningful information for developers to fine-tune and tailor the product.
Users can offer from their perspective descriptions of what the technology should do, what information is important to be displayed, their expectations of their experiences using the technology and what kind of data the technology should be collecting or analysing. [5, 7]
However, caution is advised because:
- Conducting research into user needs and requirements is time-consuming.
- It can pressure timelines and budgets, especially when plans are inadequate.
- Increased strain is experienced by teams after the initial research activity. It relates to the following stages:
- adoption of requirements into a technical scope and
- translation of the scope into prototypes for testing. [8]
- Co-design invites all voices to be heard. However, 'many' opinions can complicate the process as it can be difficult to identify a potential solution.
- Users, including stakeholders, will want a complete integrated solution to solve the identified problem which is typically far removed from what can be achieved given time, resources and budget constraints.
Participant considerations when co-designing within aged care settings
Co-designing with, and for, older people
Understanding older people's needs, attitudes, and abilities is fundamental to designing a digital product for their use and knowing when to include them during the testing of these products during development.
While older people are increasingly using technologies, they can still find it challenging. They can be less confident in using new technologies, have safety and privacy concerns, have difficulties engaging due to physical or cognitive constraints, and have difficulty navigating platforms, systems and applications.
Not all older people have the same level of access to technology and skill development. Groups who face digital exclusion include people who:
- Are socially and economically disadvantaged,
- Have lower levels of education,
- Live in regional, rural or remote geographical areas,
- Have English as a second language or are from a refugee or migrant background,
- Unable to keep up with the rapid pace of technological change has become a significant social issue as more information and access to services move online. [9]
Successful co-design with users requires us to welcome diverse sets of users.
Co-designing with, and for, people living with dementia
Technology has an increasing role in supporting people living with dementia (PLWD). When designing digital products for PLWD, it is crucial to understand their lived experiences and how they already engage with technologies familiar to them in their everyday lives. [10]
When there is an expectation that PLWD and their carers will have an opportunity to use technology, they must play an active role in the design and testing of the product. Being invited to participate in co-design can also offer PLWD additional benefits such as:
- Having a voice or opinion and being heard,
- Learning new digital literacy skills and technical capabilities,
- Feelings of empowerment, of being seen and valued as a person, and
- Increasing confidence when using technology.
Involvement can lead to more appropriate and suitable technological solutions being developed and PWLD's increased acceptance, willingness to use, and adoption rates. [11]
Unfortunately, PLWD and their carers are often excluded from being involved in technology development projects or prototype testing. [12] This may be due to developer concerns around not wanting to cause distress or make the person feel self-conscious or stigmatised by their condition. [11] Co-designing activities commonly rely on skills or abilities that PLWD struggle with, such as communication, dexterity in their hands, or the ability to apply abstract or creative thinking to solve problems due to cognitive decline. [13] However, these challenges should not limit involvement. Rather, co-design activities can be modified to match a person's ability, skill or strength to increase opportunities for involvement instead of their limitations or situational disability being the focus of the sessions. [13]
Tips for co-designing for and with PLWD:
- Always invite carers to be involved. They have a vital role in supporting the use of technology [14] and highlighting any challenges or difficulties. [15]
- Create a friendly and supportive environment to foster positive experiences and meet the individual needs of PLWD and their carer.
- Be selective in the types of activities that would suit participants' abilities, skills or strengths - for example, selecting PLWD who can communicate verbally to participate in focus groups or workshops and then interface testing for those who have retained their dexterity.
- Be clear and use appropriate terminology when asking questions to elicit needed feedback.
- Encourage everyone to ask questions and for them to provide honest, open feedback.
- Explain to participants how their feedback will be used in the design process.
Always keep participants updated with what is happening across the development and implementation phases. This can increase the anticipation and potential use of the technology. [11]
Co-designing with, and for, aged care staff
As primary end-users or incidental users of technologies within aged care facilities, staff are key for MDT to understand the complexities and implications of their technology on business models, workflows, and care outcomes.
Each staff member can offer information to the MDT from their perspective of working in the facility, service and organisation in the context of their role.
They can:
- Identifying product requirements,
- Highlight aged care-specific ethical and legal considerations that should be reflected in the design and
- Review the suitability for environment, context and workforce.
When co-designing with staff, it is important to:
- Ensure there is sufficient time and resources for the activity.
- Have clear and open communication with managers of the staff who will be potentially involved around time commitment and anticipated workload.
- Always try and recruit more participants than is required for each stage of the co-design process.
- Make sure staff have sufficient information about what is involved and their commitment.
- Reimburse staff for participation in activities outside their normal (rostered) work hours.