Inclusive Design Thinking for the Development of Digital Health Applications: A Methodology Review.

Inclusive Design Thinking (IDT) is an approach that specifically addresses disadvantaged user groups and involves them in the innovation process. In recent years, IDT has emerged as a particularly promising approach for increasing citizen and patient engagement in the development of digital health applications. Although IDT is based on existing frameworks of design thinking and human-centered design approaches, there is still no overview of its methods for digital health solutions. Our aim was to develop such a systematic overview of the methods used, aligned with the design process, and thereby facilitate the practical application of IDT. 44 IDT methods could have been consolidated and assigned to the phases of the IDT process. This work provides the first systematic overview of IDT methods used for Digital Health (DH). Future work could expand on this and, for example, investigate the effectiveness of the methods in more detail.

A framework for remotely enabled co-design with young people: its development and application with neurodiverse children and their caregivers.

Introduction: This paper describes an innovative Framework for Remotely Enabled Co-Design with Young people (FREDY), which details an adaptable four-stage process for generating design concepts with children and other key stakeholders in a naturalistic and inclusive way. Methods: Recommendations from existing patient engagement and design methodologies were combined to provide research teams with procedures to capture and analyse end-user requirements rapidly. Resulting insights were applied through iterative design cycles to achieve accelerated and user-driven innovation. Results: Applying this framework with neurodiverse children within the context of healthcare, shows how creative design methods can give rise to new opportunities for co-creating across diverse geographies, abilities, and backgrounds as well as strengthen co-designer approval of the co-design process and resulting product. Discussion: We summarise key learnings and principles for fostering trust and sustaining participation with remote activities, and facilitating stakeholder design input through continuous collaboration, as well as highlight the potential benefits and challenges of utilising FREDY with neurotypical populations.

Walking on Virtual Surface Patterns Leads to Changed Control Strategies.

Inclusive design does not stop at removing physical obstacles such as staircases. It also involves identifying architectural features that impose sensory burdens, such as repetitive visual patterns that are known to potentially cause dizziness or visual discomfort. In order to assess their influence on human gait and its stability, three repetitive patterns-random dots, repetitive stripes, and repetitive waves (Lisbon pattern)-were displayed in a coloured and greyscale variant in a virtual reality (VR) environment. The movements of eight participants were recorded using a motion capture system and electromyography (EMG). During all test conditions, a significant increase in the muscular activity of leg flexor muscles was identified just before touchdown. Further, an increase in the activity of laterally stabilising muscles during the swing phase was observed for all of the test conditions. The lateral and vertical centre of mass (CoM) deviation was statistically evaluated using a linear mixed model (LMM). The patterns did cause a significant increase in the CoM excursion in the vertical direction but not in the lateral direction. These findings are indicative of an inhibited and more cautious gait style and a change in control strategy. Furthermore, we quantified the induced discomfort by using both algorithmic estimates and self-reports. The Fourier-based methods favoured the greyscaled random dots over repetitive stripes. The colour metric favoured the striped pattern over the random dots. The participants reported that the wavey Lisbon pattern was the most disruptive. For architectural and structural design, this study indicates (1) that highly repetitive patterns should be used with care in consideration of their impact on the human visuomotor system and its behavioural effects and (2) that coloured patterns should be used with greater caution than greyscale patterns.

Vertical arrays of artificial rockpools on a seawall provide refugia across tidal levels for intertidal species in the UK.

Eco-engineering of coastal infrastructure aims to address the insufficient intertidal habitat provided by coastal development and flood defence. There are numerous ways to enhance coastal infrastructure with habitat features, but a common method involves retrofitting artificial rockpools. Often these are 'bolt-on' units that are fixed to existing coastal infrastructure but there is a paucity of literature on how to optimise their arrangement for biodiversity. In this study, 24 artificial rockpools were installed at three levels between High Water Neaps and Mean Tide Level on a vertical concrete seawall on the south coast of the UK. The species abundance of the rockpools and adjacent seawall were surveyed at low tide for 2 years following rockpool installation and compared. Over the course of the study, sediment had begun to accumulate in some of the rockpools. At the 2-year mark, the sediment was removed and assessed for macrofauna. Algal biomass of the seawall and rockpools was estimated using previously obtained dry weight values for the dominant algae taxa. After 2 years, it was determined that artificial rockpools successfully increase species richness of seawalls, particularly at higher tidal levels where water-retaining refugia are crucial for many species. The rockpools hosted 37 sessile taxa and 9 sessile taxa were recorded on the seawall. Rockpools increased the vertical elevation for brown canopy-forming seaweeds by providing better attachment surfaces. Although the retained sediment only hosted 3 infaunal species, it was observed to provide shelter for shore crabs during surveys. As sea levels and ocean and air temperatures continue to rise, vertical eco-engineering arrangements will play a crucial role in allowing species to migrate up the tidal zone, negating habitat loss and localised extinction.

Enabling spaces for (varied) co-existence.

For people in homelessness, access to social services may appear difficult and alienating, which often contributes to poor health and a risk of accelerated marginalization. Historically, day centres for people in homelessness have been characterized by an emphasis on providing refuge and momentary restitution, accommodating urgent basic needs. In this article, we present a case study of the design of a new day centre in Denmark that aspires to move beyond the historical place-for-being. Rather, the new day centre is to be a place-for-being-and-becoming, focusing on bridging the varied needs of people in homelessness with easy access to social services at the day centre. This article explores the creation of new behaviour settings along with the challenges and considerations in designing enabling spaces for people in societally marginalized positions, concurrently offering and supporting a sense of inclusion, the possibility to develop one's agency and experience of lived citizenship. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Co-designing the integration of voice-based conversational AI and web augmentation to amplify web inclusivity.

The Web has become an essential resource but is not yet accessible to everyone. Assistive technologies and innovative, intelligent frameworks, for example, those using conversational AI, help overcome some exclusions. However, some users still experience barriers. This paper shows how a human-centered approach can shed light on technology limitations and gaps. It reports on a three-step process (focus group, co-design, and preliminary validation) that we adopted to investigate how people with speech impairments, e.g., dysarthria, browse the Web and how barriers can be reduced. The methodology helped us identify challenges and create new solutions, i.e., patterns for Web browsing, by combining voice-based conversational AI, customized for impaired speech, with techniques for the visual augmentation of web pages. While current trends in AI research focus on more and more powerful large models, participants remarked how current conversational systems do not meet their needs, and how it is important to consider each one's specificity for a technology to be called inclusive.

Contributing to an inclusive education for neurodivergent students: sharing reflections, practices, and experiences.

It is estimated that one in seven individuals, more than 15% of the population in the UK, are neurodivergent. In recent years, there has been a notable increase in university students disclosing disabilities, specific learning difficulties, or mental health conditions. Despite this, students with disabilities and learning differences often experience lower levels of well-being compared to their peers, and their completion rates are significantly lower. Two years ago, I was tasked with creating a training program for academic staff to enhance their support for neurodivergent students. In this commentary, I share reflections on what I have learned while developing this training, and I outline effective strategies and approaches that can be implemented in the design and delivery of educational content. I advocate a collaborative approach to training development with neurodivergent students and with colleagues with various roles. The commentary draws upon the Universal Design for Learning framework to advocate for an educational environment that is welcoming and accommodating to all learners. It champions strength-based practices, steering clear of the traditional deficit-focused narratives. My goal with this reflection is to prompt educators to reflect on their teaching methodologies, engage in conversations with their students, and to consider substantial pedagogical changes that prioritize inclusivity over reasonable adjustments.

A study to depict challenges and opportunities building industry professionals face when designing inclusive and accessible buildings.

Inclusive Design has been widely promoted in the fields of product, engineering, and user experience design. Despite the educational efforts made by scientists, practitioners, and institutions to raise awareness about accessibility and inclusion, Inclusive Design has not been widely embraced in architectural design practice, where it is often associated with design for disability. This multidisciplinary study, spanning behavioural science, ergonomics, and the social sciences of architecture, explores the challenges architectural design practitioners face when designing inclusively, and identifies opportunities to promote the adoption of Inclusive Design. The results of a questionnaire completed by 114 architectural design practitioners underscore the lack of client awareness of the benefits of inclusive design, highlight the important role practitioners can play in advocating for Inclusive Design, and emphasize the need to develop practices and tools that enhance the design and post-design phases of buildings to ensure inclusion, diversity, equity, and accessibility.

EmpRess: an eHealth implementation readiness checklist for dementia developed through an interview study of stakeholder needs.

OBJECTIVE: This study aimed to create a tool to assess eHealth interventions for dementia by adapting an existing implementation readiness (ImpRess) checklist that assessed manualised interventions. METHODS: In Part 1, online semi-structured interviews with individual stakeholders (N = 9) with expertise in eHealth and dementia were conducted (response rate 83%). The Nonadoption, Abandonment, and challenges to the Scale-Up, Spread, and Sustainability of Health and care technologies (NASSS) framework was applied, both to guide the construction of the interview guide, as well as to use its subdomains as codes in the deductive qualitative thematic analysis. Respondents were industry professionals (n = 3), researchers (n = 3), policy officers (n = 2), and a clinician (n = 1). In Part 2, the items of the original ImpRess checklist were supplemented by items that covered determinants discussed in the interviews, that were not included in the original checklist. RESULTS: The main findings from the interviews included: Participants' preference for a non-dementia-specific, more general approach to the checklist; the importance of searching for shared values with implementers; and the need for more systematic monitoring of implementation. CONCLUSIONS: The EmpRess checklist applies an inclusive design approach. The checklist will help evaluate the implementation determinants of eHealth interventions for dementia and provide up-to-date information on what is, and is not, working in eHealth for dementia care.

Othering Older People's Housing: Gaming Ageing to Support Future-Planning.

The 'othering' of ageing is linked to an integrated process of ageism and hinders planning for the future for both individuals and practitioners delivering housing and health services. This paper aims to explore how creative interventions can help personalise, exchange knowledge and lead to system changes that tackle the 'othering' of ageing. The Designing Homes for Healthy Cognitive Ageing (DesHCA) project offers new and creative insights through an innovative methodology utilising 'serious games' with a co-produced tool called 'Our House' that provides insights into how to deliver housing for older people for ageing well in place. In a series of playtests with over 128 people throughout the UK, the findings show that serious games allow interaction, integration and understanding of how ageing affects people professionally and personally. The empirical evidence highlights that the game mechanisms allowed for a more in-depth and nuanced consideration of ageing in a safe and creative environment. These interactions and discussions enable individuals to personalise and project insights to combat the 'othering' of ageing. However, the solutions are restrained as overcoming the consequences of ageism is a societal challenge with multilayered solutions. The paper concludes that serious gaming encourages people to think differently about the concept of healthy ageing-both physically and cognitively-with the consideration of scalable and creative solutions to prepare for ageing in place.

Inclusive design in electrical stimulation technologies and neurorehabilitation for clinician and patient end users.

Dr. Tamsyn Street is an interdisciplinary researcher working for the National Health Service (NHS) in the UK with a background in motor neurorehabilitation. In the last couple of decades there has been a rapid advancement in assistive technology solutions using electrical stimulation for neurorehabilitation. This editorial examines whether these advancements have translated into good inclusive design performance for clinician and patient end users. Suggestions for overcoming some of the existing challenges are proposed.

Toward user-centered assistive technologies for aging in place with cognitive impairment: a survey.

PURPOSE: To reduce the burden of Alzheimer's disease, the use of assistive technologies for patients and their informal caregivers is considered essential. However, these technologies are made as "one size fits all" instead of being tailored to accommodate people with varying degrees of cognitive impairment and those with diverse races/ethnicities. Thus, the aim of this survey was to determine whether the types of assistance needed most, and the technology used by those with cognitive impairment differed by race (White/non-Hispanics, Black or African Americans, and Hispanic/Latinos or Puerto Ricans) and severity of dementia (mild, moderate, severe). RESEARCH DESIGN AND METHODS: One hundred and eighty informal caregivers of people with different levels of severity of cognitive impairment and several different races/ethnicities filled out an online survey regarding assistance needed and technologies used. RESULTS: The results show that racial minorities considered the needs for assistance with Basic Activities of Daily Living as more important compared to White/non-Hispanics with mild dementia. Furthermore, Hispanic/Latinos or Puerto Ricans and White/non-Hispanics with severe dementia were shown to use technology that is designed to help with Instrumental Activities of Daily Living more than those with moderate dementia. Lastly, during COVID-19, devices to assist with walking, preparing meals and personal hygiene have been used significantly more by White/non-Hispanics with severe dementia compared to Hispanic/Latinos or Puerto Ricans. CONCLUSION: The results point to the need to design for those with severe dementia, regardless of race, and should focus on addressing needs related to both Instrumental and Basic Activities of Daily Living.

Developers of assistive technology should consider designing technology that can accommodate all severity levels of cognitive impairment.More research is needed to determine the usability of assistive technology that is designed for those with cognitive impairments.

Designing for inclusion in public playgrounds: a scoping review of definitions, and utilization of universal design.

PURPOSE: Public playgrounds afford children and families important opportunities for outdoor play, social participation, and inclusion. Unfortunately, many children and families experience barriers to accessing, using, and being included in public playgrounds. Consequently, Universal Design (UD) is promoted for providing conceptual guidance for designing for inclusion in public playgrounds. However, a lack of research evidence means researchers have engaged in the ongoing interpretation of the UD concept and related non-discriminatory planning and design concepts. Therefore, the aim of this study was to examine how UD, and related concepts, are used in peer-reviewed articles concerning public playgrounds. MATERIALS AND METHODS: A scoping review was conducted in November 2019, which identified 15 peer-reviewed articles that met the inclusion criteria. RESULTS: Analysis revealed that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design concepts arbitrarily and without regard for higher or lower order concepts. Two broad interpretations were evident: (a) UD is synonymous with accessibility for some, and (b) UD is a higher-order concept that goes beyond accessibility for others. Nevertheless, findings highlight the utility of UD in underpinning the design of public playgrounds in many developed countries; however, the concept requires further clarity and specificity as it pertains to playground design and more pertinently inclusion in outdoor play. CONCLUSIONS: We argue for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion.IMPLICATIONS FOR REHABILITATIONMost peer-reviewed journal articles reviewed fail to define what is meant by the term Universal Design.Of those that do provide a definition, the outcome of inclusion in play, or the application of Universal Design to enable play in public playgrounds was unclear.Research to date has mostly focused on related concepts, including accessibility and usability, with less emphasis on Universal Design.Recommend a tailored perspective of Universal Design for Play (UDP).

User-Centered Design Methodologies for the Prototype Development of a Smart Harness and Related System to Provide Haptic Cues to Persons with Parkinson's Disease.

This paper describes the second part of the PASSO (Parkinson smart sensory cues for older users) project, which designs and tests an innovative haptic biofeedback system based on a wireless body sensor network using a smartphone and different smartwatches specifically designed to rehabilitate postural disturbances in persons with Parkinson's disease. According to the scientific literature on the use of smart devices to transmit sensory cues, vibrotactile feedback (particularly on the trunk) seems promising for improving people's gait and posture performance; they have been used in different environments and are well accepted by users. In the PASSO project, we designed and developed a wearable device and a related system to transmit vibrations to a person's body to improve posture and combat impairments like Pisa syndrome and camptocormia. Specifically, this paper describes the methodologies and strategies used to design, develop, and test wearable prototypes and the mHealth system. The results allowed a multidisciplinary comparison among the solutions, which led to prototypes with a high degree of usability, wearability, accessibility, and effectiveness. This mHealth system is now being used in pilot trials with subjects with Parkinson's disease to verify its feasibility among patients.

Mapping Accessibility in Norway - A Tool and Method to Register and Survey the Status of Accessibility in Urban Areas and Recreational Areas.

The Norwegian mapping authority has developed a standard method and an easy and flexible tool for mapping accessibility mostly for people with limited or no walking abilities in urban and recreational areas. We choose an object-orientated approach where points, lines and polygons represent objects in the environment. All data are stored in a geospatial database and are presented as web map and can be downloaded and analysed using GIS software. By the end of 2021, more than 250 out of 356 municipalities are mapped using that method. The aim of this project is to establish a national standard for mapping of accessibility and to provide a geodatabase that shows the status of accessibility throughout Norway. The data provide a useful tool for national statistics, local planning authorities and private users. The results show that accessibility is still low and Norway and faces many challenges to meet the goals for Universal Design.

Housing Development for All? Learnings from the Ars Longa Case.

This paper discusses the prerequisites of inclusive housing development based on the learnings from Ars Longa, a block of flats for artists, designers and authors in Helsinki, Finland, that was initiated by a group of elderly persons. The study draws from research on co-design and universal design in housing. Post Occupancy Evaluation is used as method of investigation. Interviews with four key actors trace the barriers and enabling factors in the housing development process and assess the final design outcome. The results highlight the role of public institutions in supporting resident-driven projects, the financing of projects as major barrier to laypeople, and the potential of concept design in integrating the needs of stakeholders. Joint design with adjacent plots made extensive shared spaces feasible and clever design moves enabled spatial flexibility, whereas the connection of co-design activities to building design was deemed weak. The study shows that continuous management and community building are needed for negotiating the use of spaces and for fostering agency and belonging among residents. The paper contributes to research on inclusive housing development through an empirical case.

Communities, Sport, Inclusion. Strategies for Parish Complexes Social Reactivation Through Sport Practice Promotion.

The following contribution presents some findings deriving from the research project "Sport is Society" by Politecnico di Milano. The research reflects on the built heritage and its ability to be accessible and usable for different users with different needs in its structures and offer of services, focusing on sports activities and spaces. The study refers to collective ecclesiastical structures in the contemporary city. The research in this area demonstrates the possible degrees of innovation regarding the increase in the inclusiveness of private facilities with a public vocation, where sport represents a driver of social inclusion for the community. The research proposes advice to guarantee inclusive sports facilities for the community, highlighting the strict relationship between the inclusive city and the ecclesiastical heritage, as an emerging issue to be investigated and solved. Starting from its relevance and the potential of the structures to become a truly "accessible patrimony", the tool suggests strategies for policymakers and ecclesiastical administrations to make them become "open services" - usable and accessible by all - for and inside the urban community.

Policies and Processes for Accessibility from a UD Perspective: The Integrated Approach Supported by the Friuli Venezia Giulia Region (IT).

With Regional Law no. 10 of 19 March 2018 (General principles and implementing provisions on accessibility), the Autonomous Region of Friuli Venezia Giulia has set itself the objective of improving urban accessibility throughout the regional territory, in order to guarantee equal conditions for everyone to enjoy open spaces and the built environment. The improvement of accessibility is conceived as a long-term objective, to be implemented in stages, according to an incremental development project model. Still today, when work is carried out to eliminate architectural barriers, designers adopt an approach that looks at the "barrier/disability" binomial, identifying "dedicated" solutions and tackling the problem of accessibility in relation to specific targets of users whose ability to access and use spaces and environments is assessed in relation to the capability of a person generically defined as "normally able". In contrast, in a barrier-free approach, designers are called upon to adopt a broader perspective, to look at the variety of people who make up a real community (extended user base), and to consider different physical conditions, ages, abilities and capacities (motor, sensory and cognitive), from the early stages of the project. In order to promote change and to impart this change of approach, the Autonomous Region of Friuli Venezia Giulia has envisaged integrated actions, aimed, as a whole, at accompanying the process that guides the project culture towards a progressive adherence to the methodological criteria of Universal Design, introducing, at the same time, support measures aimed at financing the Municipalities of the Region both for the preparation of barrier elimination plans (PEBAs) and the implementation of the interventions identified in those plans. Among the envisaged actions, the most important is a general accessibility mapping, which includes the adoption of a terminology system (accessibility ontology) integrated in a specific computer application, through which the municipalities will be able to detect architectural barriers, in a homogeneous way, over the entire regional territory.

Developing Innovative Solutions for Universal Design in Healthcare and Other Sectors.

For over half a century, researchers have sought to better understand the needs of people with disabilities in the built environment, and for more than a quarter century, they have sought to understand the effectiveness of universal design (UD) on a wide range of people and populations. This research led to the creation of the innovative solutions for Universal Design (isUD) building certification program, which addresses knowledge gaps in the practitioner's field with UD criteria. The isUD focuses on commercial buildings but aims to expand to other sectors including healthcare and residential settings. The research and outcomes used in the development and evaluation of the isUD combined with lessons learned from implementation of the isUD program suggest a path forward to improve and expand the program. Several research studies have evaluated the effectiveness of UD standards. One study compared university residence halls, one of which was built using a draft version of UD standards using a guided tour and online surveys among other methods.[1] Another study used online surveys to compare a workplace built using the isUD with the former workspace.[2] Another study used in-person surveys to compare public right-of-way features pre- and post- design intervention.[3] Lastly, an innovative doctoral dissertation that proposes a new methodological tool to evaluate UD in healthcare settings [4-5] has been analyzed to inform the isUD's expansion into the healthcare sector. The results indicate there is value in using UD to address equal access to and use of facilities for people with and without disabilities, and people of diverse social, cultural, and economic backgrounds. Facilities built using UD standards and tools are more usable, comfortable, and satisfying for users. However, the results also indicate there is room for improvement to make the isUD tool more effective. These improvements will better enable expansion of the tool to be usable in settings with more specialized requirements. While UD is often effective at improving human performance, health and wellness, and social participation across some measures, and while tools that assist with UD implementation may further help achieve these outcomes, to gain widespread adoption across multiple sectors, such tools must be shown to be consistently effective in achieving UD outcomes across all measures. These improvements can help expand availability of UD to a wider, more diverse audience.

Designing Hospitals Through the Lens of Universal Design. An Evaluation Tool to Enhance Inclusive Healthcare Facilities.

Various studies highlight a gap on reliable methods to measure the quality of projects and environments in terms of Universal Design (UD) and Design for All (DfA). In particular, healthcare facilities need decision support systems to improve the well-being of as many users as possible through a systematic approach. The present research proposes an evaluation tool to support designers and decision makers in the adoption of UD to develop healthcare facilities suitable for a wide range of users. Several methodologies have been adopted: an in-depth literature review on the current state of knowledge on UD evaluation, workshops and focus groups with both users and experts, and the analysis of four hospital case studies. The result was an evaluation framework built by using a Multi-criteria Analysis (MCA) methodology. The first version of the tool was applied to an American hospital and validated d in an Italian pilot case study. The research outlines a tool called Design for All A.U.D.I.T., able to evaluate Physical, Sensory-cognitive, and Social qualities based on a hierarchical framework with criteria and indicators based on UD and DfA. The framework evaluates the different areas of the hospital from outdoor to indoor spaces, allowing hospital administrators to act to improve the well-being of users according to the critical aspects of UD identified by the tool. The analysis provides a report of the facility status and design strategies to support designers for new projects or buildings renovations. The application shows that DfA A.U.D.I.T. can assess hospitals by examining both spatial qualities and DfA criteria. The tool could represent a decision support system in the national and international context, where many hospitals are not newly built. Further research will include application in different facilities and building typologies, aided by the flexible structure of the tool, which allows measurement of the environment's quality in terms of DfA and UD.