The tradition of participatory design refers to the involvement of users in the development of new technology, and reaches back to the 1970s in Scandinavia. One of the best known participatory design projects from that time was the UTOPIA project, involving graphics workers and their union in the development of new technology that enhanced the skills of the workers and improved the typographic quality of newspapers (Greenbaum & Kyng 1991, 12) see also Bødker et al. 1987)). Participatory design originally related to the development of systems for workplaces, as presented in the book by Greenbaum and Kyng (1991), but is increasingly being applied to new contexts, such as the design of technology for healthcare professionals or patients (Aarhus et al. 2010), the home (Petersen et al. 2009), museums (Dindler 2010), and schools (Iversen 2005).
Participatory design is grounded in a democratic vision of empowering users by having them participate in the development of technology. The vision of participatory design is to balance the power relation between system developers and users, and to have users participate fully in the process and have a voice in vital decisions (Clement & Van den Besselaar 1993, 29; Greenbaum & Kyng 1991, 1). This rests on the premise that the development of new systems is inherently political, and that conflicts of interest must be resolved during development, to avoid rejection of the end products by the users, or degrading the skills of the workers (ibid., 2). At the time, this democratic approach broke with the convention that system developers were experts, and that intended users should not be involved in the process of developing new technology. Furthermore, participatory design is based on the belief that inclusion of the users will result in better technology.
The argument is that involving the end-user will result in better products, as the system design must take into consideration the complexity of context, the use situations, and work procedures. This complexity involves more than formal guidelines, as it entails unarticulated collaborative work, of which the user has greater knowledge than the system developers (Clement & Van den Besselaar 1993, 29; Greenbaum & Kyng 1991, 2, 15). From this perspective, including the users should lead to a system that supports work and enhances the skills of the user.
Moreover, the development of methods for involving users in the design activities is central to participatory design. This is an ongoing, experimental effort, which has resulted in a collection of principles, practices, and approaches to design, rather than a fixed set of methods (Dindler 2010, 21). A basis for a collaborative design involving
users is that methods for establishing a common ground for collaboration and bridging the worlds of the system developer and the future user are to be applied during the process (Greenbaum & Kyng 1991, 4). Furthermore, tools and techniques for capturing the complexity of work, identifying problems, envisioning solutions, and producing prototypes are needed, and their capacity for being understood by both the system developers and users is a crucial aspect of these methods. Examples include primitive mockups in cardboard, which all participants can understand and shape (Ehn & Kyng 1991). This allows for enacting use of primitive mockups by participants in real world settings, making it possible to explore how the prototype will function and affect everyday life and work practices, and thus generate new, improved design concepts and prototypes.
New techniques and methods for involving the user continue to evolve, and discussions of democratic ideals surface sporadically, addressing the rationale and development of participatory design. Recently, Kyng (2010) outlined changes in elements of participatory design that exist in the gap between techniques and politics (Kyng 2010, 49). Research projects are now funded by establishing partnerships with private companies, transforming them from adversaries into partners; users are not only workers, but may be patients and their families, which makes it more difficult to establish frequent, ongoing collaboration with them. The setting has moved beyond the workplace, and therefore user interests must be safeguarded by researchers, rather than by trade unions.
The question of intellectual property rights has become crucial to the trajectory of such projects, as ideas generated as part of the shared efforts may result in profitable products (ibid., 52). It is within this spectrum of elements that shapes participatory design projects that the ElderTech study and Healthy Home project must be understood.
Participatory design activities
Development of the assistive technology in the ElderTech project was primarily accomplished by IBM, a central project partner. Early user involvement primarily involved input from nurses, social and healthcare assistants, and social and healthcare helpers, in response to suggestions made by the system developers, and was presented in the shape of PowerPoint mockups of the user interface. Later in the process, one workshop scenario was carried out, in which nurses, assistants, and elderly participants enacted various use situations using working prototypes. The workshop scenario identified problems that demanded both technical and organizational attention, such as
adjusting the sensitivity of the Tablet PC curser, which elderly users with shaking hands found difficult to control, or agreeing on who should be responsible for trivial system breakdowns, such replacing the batteries. Lastly, the users’ experiences with the prototype in the pilot study provided the company, municipality, and researchers with valuable knowledge of future challenges.
The Healthy Home project was based on a process of participatory design in which a team of healthcare professionals (obstetricians, nurses, midwives, dieticians, and a secretary), representatives from companies, and a team of researchers (computer scientists, a nurse, and a ethnographer) worked together from the beginning, in a participatory design process. Later, pregnant women with diabetes also participated in workshops. Supplementing the ethnographic studies at the outpatient clinic, a series of participatory design workshops was initiated to involve the users, both healthcare professionals and pregnant women with diabetes. A Future Workshop was held, identifying problems, and generating concepts of design that envisioned future solutions.
This was followed by a design workshop, in which design concepts were discussed, a waiting room workshop, to gather input regarding the design concepts from more pregnant women and their relatives, and finally, a scenario workshop, in which the design concept decided upon, the eDiary, was presented by using a mockup made of cardboard boxes and paper. Additionally, a cultural probe and a design workshop in the home during a HomeHealthTour informed the design idea of a personal health record (Aarhus et al. 2009a). Initially, the project partners had a vague idea of using technology to overcome the geographical distance between the outpatient clinic and the pregnant women going for checkups once a week or every second week, as for some of the women this demanded up to four hours of transportation. During the course of the project, these ideas were refined. Both the ethnographic field studies and the participatory design workshops indicated that moving cardiotocographic monitoring (CTG) or other parts of the treatment from the outpatient clinic to the home would jeopardize the sense of security, not only on the part of the women, but also the healthcare professionals. Instead, efforts were made to reduce the distance between the outpatient clinic and the home by supporting the women in performing self-care and improving their communication with the healthcare professionals, rather than moving the treatment site.
In the two projects, participatory design was framed differently, particularly with regard to how and when users were involved in the process, and with regard to the role of the
participating companies. In the terms used by Shapiro, these contrasting approaches may be characterized as “weak” and “strong” (Shapiro 2010, 71). The ElderTech project had what may be termed a weak or pragmatic perspective on user involvement: User input was regarded as offering a valuable contribution to successful design regarding what is feasible, what causes frustration, what tools would be useful, and so forth. In this instance, this perspective risks engaging elderly persons in the refinement of technology, the purpose of which they do not see, so that relationships with these users become instrumental, bordering on being exploited, in the words of Shapiro (ibid., 73). The Healthy Home project had a so-called strong approach regarding user participation. This perspective derives from an understanding of the users as social beings whose practices may only be understood in the context of interrelations with people and artifacts. To address this complexity in the design and development of future technology, researchers must not only include users in workshops, but must dedicate significant effort to the observation and analysis that inform the design space (ibid., 71).