collaborative user-centred textile design research for healthcare: … · 2018-03-07 · aspects of...

MCLAREN,A.,STEVENSON,F.&VALENTINE,L.

©2017TheAuthors.PublishedbyLoughboroughUniversity.ThisisanopenaccessarticleundertheCCBY-NClicense(https://creativecommons.org/licenses/by-nc/4.0/).

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Collaborativeuser-centredtextiledesignresearchforhealthcare:improvingwellbeingandincreasingperformance

AngharadMcLaren1,DrFrancesStevenson2&DrLouiseValentine2

1. NottinghamTrentUniversity,UK2. UniversityofDundee,UK

ThisitemwassubmittedtotheproceedingsoftheLoughboroughUniversityTextileDesignResearchGroupINTERSECTIONSConference2017byAngharadMcLaren.Citation:McLaren,A.,Stevenson,F.&Valentine,L.(2017)Collaborativeuser-centredtextiledesignresearchforhealthcare:improvingwellbeingandincreasingperformance.InProceedingsofIntersections:CollaborationsinTextileDesignResearchConference,13September2017,LoughboroughUniversityLondon,U.K.Availablefromwww.lboro.ac.uk/textile-research/intersections.AdditionalInformation:Publisher:LoughboroughUniversity(©TheAuthors)Rights:ThisworkismadeavailableaccordingtotheconditionsoftheCreativeCommonsAttribution4.0International(CCBY-NC4.0)licence.Fulldetailsofthislicenceareavailableat:https://creativecommons.org/licenses/by-nc/4.0/PLEASECITETHEPUBLISHEDVERSION.



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Abstract: It hasbeenwidelyacknowledged that collaborationacrossdisciplines is required inorder todevelop innovative, sustainable textile solutions that address complex societal problems (Kane &Philpott, 2013; Igoe, 2010). Potential to develop life-changing innovations in the field of advancedtextiles for medical and healthcare has been identified as a key growth sector within Scotland, withcollaborativecross-disciplinaryuser-focuseddesignapproachesrecognisedascentraltodevelopingnewconcepts that address humanneeds (Malins et al. 2012). This paper describes three feasibility studiesundertakenbytheTextilesprogrammeattheUniversityofDundeebetween2012–2014;collaborativedesign-led research projects that supported localmedical and healthcare companies by providing keyexpertise in textile design, functional clothing design methodologies and user-centred processes fordesign-led innovation.Analysisanddiscussionfocusesonunderstandingthechallengesandbenefitsofcollaborative research between academia and local enterprise to textile design innovation, localeconomy,society,andeducation.Keywords:innovation,medical,wellbeing,user-centreddesign,economy.IntroductionIt has been widely acknowledged that collaboration across disciplines is required in order to developinnovative,sustainabletextilesolutionsthataddresscomplexsocietalproblems,particularlyintheareasofhealthandwellbeing(seeforexampleKane&Philpott,2013;Igoe,2010;Earleyetal,2010).TheScottishtextiles industry is theseventh largestcontributor to thenationaleconomywithavalueof£956million(Wilson,2015),andtechnicaltextiles(whichincludetextilesforhealthandwellbeing)isthemostrapidlygrowing sector within this, accounting for 40 percent of turnover despite only 10 percent of the totalmanufacturingcapacity(Malinsetal,2012).Potentialtodeveloplife-changinginnovationsinthefieldofadvanced textiles formedical and healthcarewithin Scotland has thus been identified as a key growthsector, with collaborative cross-disciplinary user-focused design approaches recognised as central todevelopingnewconceptsthataddresshumanneeds(ibid).The aim of this paper is to describe and reflect on three Technology Feasibility Studiesi (2012 – 2014)undertakenat theSchoolofArtandDesign,UniversityofDundee inordertohighlighttheroleofvaluedrivendesignincross-disciplinarycontextswithinthestudies.Keyobjectivesare:1.Tounderstandthechallengesandbenefitstothestakeholders2.Gatherinsightsandreflectontheimportanceoffacilitation.3.ToreflectonhowthesecollaborationscaninfluenceresearchandteachingwithinAcademia.4.Considerhowalloftheaboveisinfluencingthefutureoftextiledesign.Textiles at the School of Art and Design, University of Dundee is a value driven programme, withpartnership, innovation and craft central to the work and research championed as a key route to itsdevelopment.ThroughtheInnovationPortalplatform,itiscultivatingaportfolioofcommerciallyrelevantprojectsspecificallywithintextilesformedicalandtechnicalapplications,buildingitswealthofexperienceinworkingwith small-to-mediumsizedenterprises (SMEs) in theareaof innovative textiles. Itspurposebeing to identify new design, material and manufacturing opportunities within the Scottish textilesindustry,ultimatelycontributingtoknowledgeandunderstandingofdesignasameansofimprovingthequalityofpeople’slives.



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TextilesformedicalandhealthcareWithgreaterlifeexpectancyandincreasedhealthissuesinsociety,advancedtechnicalandsmarttextilesfor medical and healthcare is an area that has been identified as having potential to offer substantialrewards “both in terms of improving existing design solutions and also in developing new technicalmarketsandeconomicopportunities”(MedicalTextilesReport2012,quotedinMalinsetal,2012).Therearevariousnuanceddefinitionsofsmarttextiles,anditisgenerallyagreedthatthesearematerialsthatwillsense,reacttoand/oradaptthemselvesinresponsetoenvironmentalconditionsorstimuli,suchas biochemical sources or movement (Kettley, 2016; Black, 2007). Technological advances in this areaexploredwithinthefollowingcasestudiesincludeconductivefibresthatcreatebiochemicaltextilesensors(Langenhoveetal,2007),responsiveshapememorypolymersthatchangeinshapeandsize(Pause,2007),and ‘wearable technology’ which exploit textiles as a soft, flexible surfacewithin which to incorporateelectronicsystemsthatcanbeworn(Kettley,2016;Braddock,Clarke&O’Mahony,2005).Benefitsoftheseelectronic(e-textiles)inmedicalandhealthcarecontextsincludetheabilitytofacilitateclinicalinteractionandmonitoringthroughenhancedcomfort,mobilityandconvenience,potentiallywiththeintegrationofpervasive,connectedsystemswhereintegratedelectronicscancommunicatewithmobiledevicessuchassmartphonesoraccessories(Black,2007).Advancedtechnologysuchasthismaystillbeinlargelyresearchphases, but it has been recognised that commercial drivers will enable its development towards costeffective solutions appropriate formedical and healthcare applications, often disposable or short-term(Malinsetal,2012;Black,2007).Innovationcanalso lie inthenovelapplicationofexistingtechnology intextileproductsformedicalandhealthcare(Black,2007).Scotlandisattheforefrontoftherapidlydeveloping‘technicaltextiles’market,offering an unrivalled range of textiles with specific performance or functional qualities (Malins et al,2012). Moisture absorption and wicking, breathability, anti-bacterial and odour absorption propertiesembeddedwithintextiles,aswellasconceptualideasleadingfromthesmarttextilesdevelopments,havebeen exploredwithin the case studies in this paper for their potential to bring enhanced comfort andwellbeingtousers.Materialchoicesarealso ledbyconsiderationofsustainability.AsoutlinedbyKaneandPhilpott (2013),designersoperatewithincomplexproblemspaceswhendevelopingand/orselectingmaterialsthathavethemost positive implications in terms of sustainability and are also commercially and technologicallyfeasible.Knowledgeandunderstandingofthewholelifecycleofmaterialsfrombothascientificanddesignperspective is essential to assess and select the most appropriate choice in relation to the intendedproductuse,toensurethatnegativeeffectsareavoidedandpositivefeaturesincluded(KaneandPhilpott,2013). These considerations are particularly pertinent when aiming for ‘positive’ features in terms offunctionality andmustbeweighedup in relation to the social implicationsof theproduct (ibid). This isparticularly relevant in the case studies outlined in this paper, wherematerials must address extremefunctionalrequirementsassociatedwithperformanceandquality,whilealsooftenbeingdisposableorforshort-termuseandnecessarilycheapatthesametime(Black,2007).Itisalsoimportanttorecognisethetacitqualitiesthattextilescanprovidebeyondfunctionalperformancefor their value in health and wellbeing, as elements of these are equally important as functionalrequirementsbutareoften secondary in this context.O’Connor (2010), forexample,discusseshow thecultural valueof textiles canhave their own ‘smart’ propertieswithoutbeing advanced technologically,due to ‘their ability to absorb and convey cultural value and social meaning’ throughmore traditionalaspectssuchascolour,pattern,symbols,andassociationwiththefamiliar.Differenttypesofmaterialscanembodyactiveandsymbolicqualities, Lycra forexamplegiving thewearerenhanced feelingsofhealth,activity, fun, and belonging for its associationswith active sports, enhanced performance qualities andinnovation,andaerobics/dancemovements (O’Connor,2010).Emotiveaspectsofaestheticandtactile



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appealsuchasthisconstituteanimportantpartofadesigners’contributiontonewproductdevelopment,ensuring performance in terms of comfort, fit, desirability and social perception. It is in these tacitassociationsandsymbolicqualitiesthattextilesplayanimportantrolebyaddingaestheticand/orhapticdesign value tomedical andhealthcareproducts in addition to functional properties, helping to ensureuseracceptanceofproductsanddevices(Black,2007:12).Within each case study described in this paper the tacit knowledge of each stakeholder is essential toensure that the final product is fit for purpose. Clark Moustakas (1990) identifies two types of tacitknowingas‘subsidiary’and‘focal’.Subsidiaryis‘visible’or‘describable’andfocalrelatestotheinvisibleaspects of an experience, which togethermake a ‘whole’ experience. In his book, ‘Heuristic Research:Design,methodology,andapplications’,MoustakascitesMichaelPolanyi’s fourtypesoftacitknowledgewhich,Moustakas explains, contain subsidiary and focal knowing. The first type is skill, which requiresphysical or bodily experience, sensory experience, confidence and optimism. Second is ‘physiognomy’which he describes through analogy as the ability to read/sense a person’smood through their bodilysignals. Third is our capacity to orientate ourselves through ‘groping about’ to pick up signals that arefamiliar.Finally,therearespeculativeskills,whichenablepeopletomakeadecisionabouttheirnextmove(heusesthechessplayerasanexample).Hispointisthattacitknowledgeisanessentialpartofresearchas itallowslimitlesspossibilitiesforknowing(Stevenson,2012).Thesefourkeytypesoftacitknowledgearecentraltodesigningobjectswithpeople,particularlywhenthestakeholdersseektosolveaproblemwithamaterialsolution.Design-ledapproachesCross-disciplinaryrelationshipsareincreasinglyformingbetweentextiledesignersandotherdiversefieldsduetorecognitionthatwiderknowledgeisrequiredwhenseekingtoaddresscomplexsocietalproblems(Igoe,2010).Withreferencetothetacitdomain,itisclearthatthedevelopmentofsmartortechnicaltextilesolutionsformedicalandhealthcarerequiresknowledgespanningvariousknowledgefields,fromscientificknowledgeofmedicalissues,materialsscienceandcomputing,tocommercialandmanufacturingexpertisefromindustry,hencetheneedforcollaborative,cross-disciplinaryresearch(Malinsetal,2012).Thevalueofdesigniscentraltothis.Keyaspectsrelatingtothecasestudiesinthispaperincludefirstlytheutilisationofuser-centreddesignmethodologiestofosterandfacilitatedeepempathicunderstandingofusers’requirements.Involvingusersdirectlyinthedesignprocesshasbeenrecognisedasimperativeindevelopingsuccessfuldesignsolutions(Malinsetal,2012).Secondly,indesignpracticemakingcanbeseenaformofinquiry,ratherthansimplyrealisationofpre-definedideas,functioningasanalysisandsynthesisofideasaspartofaniterativedesignprocess(Schön,1983).Theabilitytoexploreanddevelopideasthroughprototypesisavaluableprocessincollaborationsintermsofsharinganddevelopingunderstandingbetweenthoseinvolved(Bowenetal,2016).Ineachofthecasestudiespresented,prototypesweremadeasobjectstoexploreideas,andpresentedtocollaborators-otherteammembers,clients,usersorexpertconsultants-tofacilitatefeedback,knowledgeexchangeandimprovementsandnavigatecomplexitiesacrossdisciplines.Designalsohastheabilitytolookaheadandvisualisefutureconcepts,overcomingthechallengesofworkingwithusersorcollaboratorswhomaybeinclinedtoonlybasesolutionideasonexistingtasks,technologiesandsettingsthusinhibitinginnovationpotential(Talbot,2000).Creativepracticecanbedescribedasa“pragmaticinquiryintowhatmightbe”(Bowenetal,2016),whichhasparticularresonancewhenworkingwithcuttingedge‘smart’textiledevelopmentsoutlinedpreviously.Inacollaborativecontext,thisalsooffersopportunitytogeneratenewdialoguesandmakecreativeleapsacrossdisciplinestoapplydesignideastoneworexistingindustries(Malinsetal,2012).



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Designthinkingwasadoptedineachofthefollowingcasestudiesasitdrawsuponpeople’sreal-worldexperiencestoaddressmodernchallenges;itisahumancentreddesignprocessandinthesestudies,itwasemployedtooptimisedevelopmentoftheproductsbybringingtheneedsofclients,medicalprofessionals,careworkers,users,andpatientsclosertogetherasawayofmovingfromaconceptintoaphysicalworkingprototype.User-centreddesignapproacheswereadoptedtoexplorethefeasibilityofearlystagedesignideasthroughinteractiveworkshopsandtrials.Ineachcasestudy,academicprojectteamsworkedincollaborationwithmedicalandhealthcarefocussedSMEs.Insightscanbegarneredthatillustratethebenefitsofadesign-ledapproachtocollaboration,andinparticularthevalueofsensitivitiesbroughtbytextiledesignknowledgeandunderstandinginthedevelopmentofcollaborativesolutionsformedicalandhealthcarecontexts.TechnologyFeasibilityStudies(TFS)TFS1:GlitterBeachOstomyBagsGlitterbeach, an award-winning social enterprise designing, making and supplying swimwear andaccessoriesforstomapatients,proposedaTFStoexplorepotentialtextileinnovationsthatcouldincreasethewellbeing of ostomy bag users. Driving thiswas the CreativeDirector’s first-hand experience as anileostomybaguser,havingencounteredproblemswith theirdesign,materialsandusability,and findingtheseissueswidespreadamonghernetworks.Astomaisasurgicallycreatedsmallopeningonthesurfaceoftheabdomeninordertodiverttheflowofwastematterfromthebladderorbowels,whichiscollectedinanostomybagattachedtotheskinwithadhesives and flange systems, changed daily, and may require draining throughout the day and night(McLarenetal,2012).Asastomahasnonervesandisnotsphinctal, itreleasesoutputandfillsthebagwithoutthepatientnecessarilybeingaware,oftenresultinginleakageandnoticeablebulkiness(ibid).It is estimated thatover13,500peopleundergo stomasurgeryeachyear in theUK; themost commonunderlyingconditionsresultinginstomaformationarecolorectalcancer,bladdercancer,ulcerativecolitisandCrohn’sdisease(Clinimed,2017).Withincreasednumbersofostomybagusersworldwideandgreaterlife expectancy, design innovation within this product area offers substantial economic benefits to theScottishEconomyaswellasprovidingenhancedquality,dignityandwellbeingofthoselivingwithchronicdisease. The study therefore aimed to understand and address ostomy bag issues from the user’sperspective in order to develop and prototype design-led solutions. The project team consisted of DrFrances Stevenson, Academic Head of Design and Craft at University of Dundee; AngharadMcLaren, atextile designer, lecturer and researcher with textile industry and enterprise experience; and PatriciaGriffin,atextiledesignerwith30years’experienceasaRegisteredGeneralNurse,includingcareofstomapatients.MethodsThe research used both primary and secondary methods: evaluating potential design interventions,including a review of existing ostomy product innovations, performance materials, and smart textiletechnologies; interactive design-led workshops with a range of ostomy bag users; semi-structuredinterviews with clinical professionals; manufacturer research to scope industrial feasibility; followed byiterationsofprototyping,testingandevaluationofpotentialdesignsolutionstoreacharesolvedoutcomeforGlitterbeachtotakeforwardsintoproductionstages(Figure1).



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FindingsFindingsconfirmedthatexperienceofostomybagissuesleadstoamultitudeofpsychologicalandphysicalproblemsforusers, includingdecreasedfitness levels, lowself-esteem,depression, lackofconfidence insocial and public situations, break down of personal relationships, and lifestyle restrictions. Thedetrimental effects to both physical and mental health can impact further on the existing medicalconditions,causingadditionalhealthcarecomplications.Keydesignfindingsinclude:• Bulk:needstobeaddressedtoimprovefitfordifferentbodyshapes;• Leakage:shapeandattachmentsneedadjustedparticularlyneckarea;• Irritation:identifyquickdryingormoisturecontrollingmaterialsskintoaddressissuescausedbyleaks,

sweatingandmoistureunderthebagaftershowering,swimming,orbathing;• Discretion:exploreodourabsorptionand‘quiet’materialstopreventbagsrustlingconspicuously;• Psychological:‘nude’skincolourbagsarenegativelyassociatedwith‘medical’products.

Figure1.Lefttoright:Interactivefocusgroupactivities;Prototypedevelopment;Userfeedbackworkshops.

Source:AngharadMcLaren

Outcomes • Designandproductionofimprovedostomybagprototypeswithimprovedshapeandsizetoprovide

enhancedfit,comfort,andusabilityforarangeofbodyshapesandsizes;• Aprofessionalrelationshipestablishedwithpotentiallocal(UK)ostomyproductmanufacturerto

developostomybagdesignsfurtherthroughpossiblelicensingroutestomanufacture;• Designandproductionofostomybagaccessoryprototypetoprovideincreasedcomfortandwellbeing,

usingquickdrying,wicking-fabriclinedspacerfabricforenhancedtemperatureandmoistureregulation.

FutureOpportunitiesAsecondstrandofenquirycentredonsmartsensorytextilesystemconceptswithfutureresearchanddevelopmentpotential.Thisexploredhowtointegrateanearlywarningalertand/orcreatebarrierswhenaleakhadoccurredtoallowusersextratimetoreactbeforeexperiencingfurtherskinirritation,damagetoclothing/bedding,andvisiblehumiliatingresults.Designconceptsinclude:



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• Asubtle,personalisedtextilesensorsystemembeddedintheostomybagoraccessorycover,linkedtomobiletechnology.

• Responsiveshapememorypolymerattachmentsaroundtheadhesivehydrocolloidattachmenttosenseleakagesandreacttopreventitworsening.

TFS2:MTCMedicalProtectorsMTCMedicalProtectors isarangeofinnovativeproductscreatedbyacommunitycareprofessionalwhohad identified the lack of suitable protection for patients with leg injuries, particularly those withincontinence, to prevent wounds or dressings from contamination when changing soiled clothing. Thisincreasesriskof infectiontobothpatientsandcarers,andinthecaseofcontaminationanNHSnurse isrequiredtochangethemprofessionally(McLarenetal,2014).TheMTCMedicalProtectorswereconceivedas a result, to provide protection, reduce the pressure on NHS resources, enhance patient and carerwellbeing, and provide a healthier care environment. Four product prototypes (MTC 001 – 004) werepresentedtotheprojectteamwithinitialdesigndrawings,imagesandverbalinstructionsforuse.Thosewereunavoidablysingle-useproductsmadefromaplasticfilm,soitwasimportanttothecompanyto source themost environmentally friendlymaterials. Twoof the products in the range needed to besoluble,asthebagandcontentswouldbewashedindomesticwashingmachines.Alltheotherproductsinthe range would be disposed in domestic waste streams, so the client specified that a biodegradableplasticwaspreferred.As theproductsare intendedprimarily foruse indomestic care settingsbynon-professionals caring forinjuredorunwelladults,children,orbabies,itwasalsoimperativethattheproductwasuser-friendly.Thecompany had already selected a manufacturer, established technical and commercial feasibility of thedesigns, and had a patent application was underway. The TFS therefore aimed to test the productsperformanceandusabilityfromadesignperspective,withtheobjectiveofimprovingtheprototypestoanearproductionstage.TheprojectteamconsistedofDrFrancesStevenson,AcademicHeadofDesignandCraftatUniversityofDundee;AngharadMcLaren,atextiledesigner, lecturerandresearcherwithtextileindustryandenterpriseexperience;andPatriciaGriffin,atextiledesignerwith30years’experienceasaRegisteredGeneralNurseworkinginthecaresector.MethodsFirstly,amaterialsreviewassessedandsourcedappropriatematerialsfromenvironmentalperspective.Anethnographic approach tested product prototypes in workshops that simulated care situations with arangeofusers–communitycareworkers,nurses,andmembersofthegeneralpublic–togainfeedbackfromavarietyofperspectiveson:theproductsdesign,thematerialsperformance,andinstructionsforuse.Richexperientialdatawasgatheredforanalysisfrom:observationofthetrials;reflectivequestionnaires;interviews; and/ or personal diaries. This aimed to understand the product’s usability, specifically: howclear they foundthe instructions;howsafeandsecure they felt theproductwas;howwell theproductfitted; and how effectively the product performed. Finally, wash trials tested performance of solublematerialsindomesticwashcycles.Findingsinformedprototypingiterationstoimproveandfinalisedesigns(Figure2).Findings• Materialreview:terminologyusedtodescribe‘environmentallyfriendly’plasticsiscomplex,andcanbe

unclear/misleading.Exploreddefinitions,qualities,environmentalcredentialsandavailabilityofbiodegradable,compostable,oxybiodegradableandbioplasticstoassessandidentifymostsuitableforthespecificproductcontextsofuse;



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• Materialsourcing:oxybiodegradableplasticidentifiedasthepreferredoption,butacommercialsourceintherequiredquality(i.e.thinplasticfilm)wasnotavailableatthetime;compostableandsolublebioplasticfilmsweresourcedduetobeingmostviableandenvironmentallyfriendlyalternative;

• Productusabilitytesting:instructionsandpositionofadhesivetabsconfusing;• Materialtesting:Securityofadhesivetabsandstrengthofmaterialimportant,especiallyinthebaby

productrangeswherethepatientisoftenlivelyandactive.Tearsoccurredwhenbeingslidunderadultpatient’sclothing;

• Instructions:needtobeclearerandincludevisualpromptsinbothinstructionsandonproducte.g.arrows.Usewordingthatencouragesagentlerapproach,usingtermssuchas‘gently’and‘withcare’;

• Overalleffectiveness:participantswerereasonablyconfidentintheproductseffectiveness;• Washtrials:materialsdissolvedsatisfactorilyindomesticwashcyclesatarangeoftemperaturesleaving

noresidueonfabrics(e.g.clothing/bedding),butadhesivestripremained.

Figure2.Lefttoright:Usertrials;userfeedbackonprototypes;andprototypedesigndevelopment.Source:AngharadMcLaren

Outcomes• Testingoffourproductprototypestoassessproductusability,effectivenessandfitandsuitability/

performanceofmaterials;• Designandproductionofimprovedprototypesandinstructionsforuseforthecompany’srangeoffour

protectivemedicalcovers;• Materialperformanceandwashteststodeterminesuitabilityforproductapplications;• Recommendationsfornextstepsofproductdevelopmentandtestingpriortocommercialisation.TFS3:AsymmetricalBraTheAsymmetricalBraCompany(ABC)hasdevelopedaninnovativemedicalbra,withpatentpending.DrJohnBiddlestonedesignedtheconceptasaresultofhisclinicalworkwhilsttraininginPlasticSurgeryatthe University of Dundee. John was assisted by the School of Art and Design’s Textile Department todevelop a working prototype that could lead to commercialisation opportunities. Dr Louise Valentine,Head of Entrepreneurship, Enterprise and Employability at University of Dundee with a background inindustrial design, and Claire Adholla, textile designer and lecturer, developed and tested the productconceptfromadesignperspectivebycreatingandtesting3Dworkingprototypes.The Asymmetrical Bra is designed principally for women following breast surgery to improve support,reducepainandpreventinfectionanditmustnotsupportthedeteriorationofawoman’shealth,(i.e. itmustnotexacerbatethepost-operativewoundbyencouragingMRSAforexample,orcreateanewirritantsuchasarash).Thecontextforthisnewproductdevelopmentistheimmediatepost-operationphaseofamastectomyi.e.thefirsttwoweeksafteranoperation.



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MethodsDatawasgatheredviaafocusgroupandculturalprobes(Koskinenetal,2011;Gaveretal,1999)about1)howwomenwhoarephysicallyaffectedbybreastcancercan,want,orneedtousetheproduct,2)howtheyperceivetheAsymmetricalBraconceptand,3) thedesignandperformanceofbespokeprototypes(Figure3).BreastCanceraffectsallwomenofallagesandbecausethelargestnumbersofwomenwhodevelopthedisease sit in the 50-80 years age bracket, the feasibility study focussed on this demographic. Theparticipantshadundergoneunilateralmastectomywithoutreconstruction.Therewasnorestrictionofthelengthoftimepost-operation.Itwasessentialthattheirmastectomywoundswerecompletelyhealedandtheywerewillingtotakepartinaninitialworkshopfollowedbyaweeklongstudywheretheywouldhaveabespoke,asymmetricalgarmentmadeforthem.Apatientadvocacygroupwasinvitedforthisresearchstudy,therebyavoidingtheoreticalissuesofconflictofinterestforlocalpatients,thelackofdiversitythatexistslocallywhilebeingmindfulofthecapacityofthetemporarilyreducedsizeoftheNHSteaminTayside(2014).ThepatientadvocacygroupwastheStMichael'sBreastCancerSupportGroup,Cornwall,UK-awell-establishedandactivegroup.

Figure3.Lefttoright:Materialtestingactivities;prototypedevelopment;culturalprobefeedbackdata.Source:LouiseValentine

FindingsThetypeofactivityundertakenwhiletestingthefivebespokeABCPrototype2.0brasincludedgardening,shopping,houseworkandwalking.Thekeydesignfindingsinclude:

• Brastraps:goodwidthinthemainalthoughoneparticipantwouldhavepreferredittobewider;greaterlengthofstrapsneededandmakinganadjustmenttothestrapsneedstobeaneasyprocessaswomeninthe50-80agebracketmaylivealone;rubbingand-orirritationwascausedandthestrappingleavesadistinctredmarkontheskinafteracoupleofhoursofwearing;

• Brafastenings:goodbutthehooksneedtobeextended,especiallythecaseforthefrontfastenerwhich‘dugin’becauseitwasnotcovered;considerationtobegiventopeoplewhoareleft-handedaswellasrighthanded;

• Smartfabric:X-staticFabricasitissoftandcomfortableagainsttheskin.• OverallBraFabric:preferenceforsmooth,t-shirtbramaterialbecauseofthegiveandflexibility.



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• WoundDressingArea:shapeofthewounddressingareaisadequatetoinadequate.Thisisanareaofthedesignthatisdifficulttopredicthowitwillfunctionwhenneededinspecificsituationsforindividualwomen;

• FittingProsthesisintotheBra:doesnotwork;• PocketPosition:requiresfurtherconsiderationasawoman’smastectomyoperationscarsizeimpactson

howtheyrespondedtothis.Themostseverewasfromawomanonlyoneyearfromheroperationwithaverylargescar;

• WashTests:helditsshapeafterwashinganddryingusingstandardtechniques(handwashandmachinewashat40degrees);washedwellandtheinsidefabricstayedsoft;

• OverallFitting:requiresfurthermodificationstoenablewomennottonoticetheyarewearingabraand-orbeconsciousofhowtheirchestarealookstothepublicwhentheyarewearingclosefittingclothese.g.t-shirt;

• OverallLook,Feel&Function:requiresimprovementintermsofelegance,sophisticationandcomforttherebymeetingthephysicalandemotionalneedsaswellasthemedicalones

Outcomes

• Testingofsixmaterialstoassesswhichofferthebestwoundmanagementproperties• Designandproductionofaworkingprototypebra• Testingoffivebespokeprototypebraswithwomenwhohaveundergonesinglebreastmastectomiesto

gainfeedbackonthelook,feelandoverallperformance• Insightintothemanufacturingrequirements• NextstepsforproductdevelopmentandcommercialisationDiscussionThefollowingdiscussionreflectsuponthefourkeyobjectivesofthepaperinrelationtothecollaborativetechnologyfeasibilitystudiesdescribed.In each case study, the product outcomes of each provide clear benefits to society by providingenhanced comfort, dignity and wellbeing of patients and carers. The collaboration through theInnovation Portal TFS platform allowed companies to explore early stage research and developmentideas beyond their own capabilities through funding and specialist academic expertise. This enabledthemtodevelopideasandtakethemtowardsacommercialoutcome,offeringnewdesign,materialandmanufacturingopportunitieswithinScotland.Development of the Asymmetrical Bra faced difficulties surrounding the high cost of ordering smallquantitiesofhighperformancesmartmaterialforR&Dratherthanhigh-levelmassproduction,andtheproductionofbespokehandmadebras.Thecollaborationallowedaccesstofinanceandcraft-leddesignexpertise to overcome these and rapidly develop initial ideas to aworking prototype stage.All threecase studies utilised tacit embodied knowledge of textile design practitioners to make and developprototypes, and problem-solving skills to overcome challenges of using a wide range of technicalmaterials.In theGlitterbeach study, a significant challengewas discovered in achieving industrial production ofnewostomyproductsdue toextensiveclinical trials required formedicalproductapproval.However,establishmentofaworkingrelationshipwithanostomybagmanufacturerwasdeveloped,whoagreedtoworkwiththecompanytodeveloptheproductfurtherthroughindustrialprototypingandinitial in-housepatient trials,with thepossibilityof full clinical trialsandamanufacturing licenceagreement ifsuccessful. This shows the value of design artefacts – the prototypes – as mediators facilitating



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communication between parties, showing the manufacturer the results of a value driven design-ledprocesswithpositive improvements forwellbeing and clear commercial potential due todemand forimprovements.WorkingwithacreativedesignteamprovidedfurtherbenefitstoGlitterbeachbyprovidingfurthershort-termproduction(ostomybagaccessory)andlong-termresearchanddevelopment(smarttextileconcepts)optionsforthecompany.Thisledfromanunderstandingdevelopedbyworkingcloselywithcompanyandgaining insights into theiraimsandobjectives fromacommercialandsocialperspectivee.g. to increasetheirproductofferingsandthereforepotentialincomeforon-goingbusinesssustainability,andalsosatisfytheiraimtoimprovethewellbeingofostomybagusers.Complex sustainability decisions were required in the MTC study to select the most appropriatecommerciallyandtechnologically feasiblematerials forsingle-use,disposableand/orsolubleproducts.Understanding the product’s lifecycle and specific context of use – domestic care in people’s ownhomes,withproductsdisposedofbyeitherdissolving inhightemperaturedomestic laundrycyclesordisposedofindomesticwastestreams–aswellasthespecificdefinitions,qualities,andimpactofso-called‘sustainable’plasticsateachstageoftheproductslifecyclewasnecessary.Thesocialbenefitsofthe product – improvedwellbeing of patients and carers – and the reduced consumption of furthermaterials required for replacement of contaminated dressings were also considered in assessing thefeasibilityoftheproductfromasustainabilityperspective.Textile design expertise and knowledge of smart textile developmentswas key to the success of TFS 1(Glitterbeach) and 3 (Asymmetrical Bra). The ostomy bag accessorywas designed using a spacer fabriclinedwithCoolmax™ lined–awicking fibre,morecommonlyused insportswear,whichactivelydirectsperspiration away from the skin to allow evaporation and breathability – for enhanced comfort andwellbeing due to temperature andmoisture regulation. Thesematerialswere valued by users for bothperformance and their sporty associations, andwere chosen as theywere available in awide range ofcolour options to disassociate products from the distinctly negative associations of traditional ‘nude’colouredmedicalproducts.Comfort, functionality,andperformanceoftextilesandproductdesignwerealsokeytotheAsymmetricalBraproject,withusersreportingtheimportanceofasmooth,flexiblefit,andsophistication/ elegance of design as well as the need to offer effective wound management. Thiscombination of haptic, aesthetic and functional qualities was important for desirability, function andconsumeracceptanceofproductsthatcontributetobothphysicalandpsychologicalhealthofusers.TheGlitterbeachcollaborationalsointroducedadvancedsmart/e-textilesideastothecompany,allowingnew dialogues around future innovation potential that could support the development of newtechnologiesacrossdisciplines.Designvisualisationtechniquesenabledthistobeexploredinworkshopswithusers,encouragingthemtranscendwhattheyperceivedtobetechnologicallypossibleand imagine‘what might be’. The resulting smart, connected e-textile system concepts had the potential to fosterfuturecross-disciplinarytextileresearch,linkingmarketdemandwiththeapplicationofnewtechnologies(Malinsetal,2012).User-centreddesignmethodologieswithanempathicapproachwerecentraltoeachstudy,allowingtheproject teams towork closelywith users in the design process to understand their perspectives andinformsensitivedevelopmentofresolvedprototypeproducts.Workshopsarerecognisedasaninherentwayofworkingandnurturingcreativityindesignanddesignresearch(Inns2007,Laurel2003).Theyarespaceswherepracticalactivitiesarecarriedout.Withineachcasestudy,collaborativeworkshopstakeplace in different environments,which are designed to facilitate creativework and understanding ofeach other’s issues, approaches, and priorities. They are places where risk-taking, experimentation,problemsolvingandaestheticsconcerningmaterialsareexploredthroughphysicalactivities.Theideaofcollaboratingthroughworkshopactivityseemedthemostappropriatewaytoaccessanddevelopideas



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throughconnecting,communicatingandpracticing.RichardSennettdescribestheworkshopasacentreof co-operative activity (Sennett, 2012) and advocates that at their core workshops are centres ofmutuality where social bonds are strengthened through making things, facilitating tacit and explicitknowledgeexchangebetweenstakeholderstoinformthedevelopmentofproductprototypessensitivetothespecifichealthcarecontextofeachstudy.Eachstudyfacedchallengesmanagingtheexpectationsofallstakeholders’duetoperceivedhighneedtodeveloptheconcept,aswellasthehighlysensitivenature of the subject, so presenting and testing on-going iterations of prototyping allowed all tounderstandandcontributetothedesigndevelopmentprocess.In an educational context, these case studies offer the opportunity to share the experience of newinterdisciplinary knowledge and dialogues with students through practical examples of how textiledesign thinking and practice can be applied in wider societal contexts. They demonstrate theimportanceofkeycompetencies–cross-disciplinaryworkingandunderstanding,collaborativedecisionmaking, empathy and sensitivity – alongside in depth practical textile design knowledge, skills andunderstanding required forworking in increasingly complex design contexts due to increasing healthproblems, population size, and life expectancy (Malins et al, 2012), alongside an increasing globalsustainabilityagenda(UN,2017).Theycontributetoknowledgeandunderstandingofdesignasameansof improvingthequalityofpeople’s lives,encouragingasustainable futuredirectionfor textiledesignresearchandpractice.ConclusionsInthispaper,empiricalaccountsofthreecasestudieshavebeendescribedtodemonstratethevalueofcollaborationbetweenSMEs,academia, industry,users,patients,andmedical/ careprofessionals in thedevelopmentoftextileproductsformedicalandhealthcare.Eachoftheoriginalconceptshadpotentialtoprovide clear benefits to society by providing enhanced comfort, dignity andwellbeing of patients andcarers.TheexpertiseprovidedbytheUniversityresearchteamswasessentialtosuccessfullypreparetheproductprototypesformarket,asthecompaniesrequiredexpertiseintextiledesign,intheapproachandmethodology of functional clothing and product design, and user centred design processes to developprototypesandindustrialpartnership.Reflections have revealed the challenges and benefits of cross-disciplinary collaboration, the value ofdesign-ledfacilitation,particularlyintakingauser-centreddesignthinkingapproach.Emotionalsensitivity,empathy,commercialunderstanding,andtechnicalintegritywerekeyaspectsofthedesigninvestigations,facilitatedthroughcreativedesignworkshops.Assuch, thesecasescanbeseenasexamplesofcreativepracticethatproductivelycreatednotonlyartefactsbut importantlyalsoasetof relationshipsbetweenstakeholders to support creative exchange (Bowens et al, 2016). It could also be concluded that theinterface between academia, design and health focussed SMEs provided space to develop newinterdisciplinary knowledge to generatewider societal benefit and encourage sustainable future textiledesigndirections.

AcknowledgementsThe case studies in this research have been funded by the Scottish Government’s Innovation PortalTechnologyFeasibilityscheme(InnovationPortal,2017).

References



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Black,S.(2007).TrendsinSmartMedicalTextiles.InL.vanLangenhove(ed.)SmartTextilesforMedicineandHealthcare,pp.1–20.Cambridge:WoodheadPublishers.Bowen,S.,Durrant,A.andNissen,B. (2016).Thevalueofdesigners’ creativepracticewithincomplexcollaborations.DesignStudies.46(2016)pp.174-198.http://dx.doi.org/10.1016/j.destud.2016.06.001BraddockClarke,SandO’Mahony,M(2005).TechnoTextiles2.ThamesandHudsonClinimed. Stoma Types. Available at: http://www.clinimed.co.uk/Stoma-Care/Stoma-Types.aspx[accessed14thMay2017]Earley,R.,Goldsworthy,K.andVuletich,C.(2010).Textiles,Environment,Design(TED):MakingTheoryInto Textiles Through Sustainable Design Strategies, Pedagogy and Collaboration. In: Future TextileEnvironments. Brink, R. and Ullrich,M. (eds.) University of Applied Sciences, HAW College Hamburg,2010.Gaver,B.,Dunne,T.&Pacenti,E.(1999).CulturalProbes.Interactions.Volume6,Issue1,Jan./Feb.1999Pages21-29.Igoe,E. (2010)Thetacit turn.DUCKJournal forResearch inTextilesandTextileDesign1.Availableat:http://www.lboro.ac.uk/departments/sota/research/Duck_NEW_2010/volume1.htmInnovation Portal (2017). About the Innovation Portal. Available at:http://www.innovationportal.co.uk/main/about/Inns,T.(ed.)(2007).Designingforthe21stCentury:InterdisciplinaryQuestionsandInsights.Routledge:London.Kane,F.andPhilpott,R. (2013).TextileThinkingforSustainableMaterials.MakingFutures.Vol3 ISSN2042-1664Kettley,S.(2016).DesigningwithSmartTextiles.London:FairchildBooksKoskinen,I.,Zimmerman,J.,Binder,T.,Redström,J.&Wensveen,S.(2011).DesignResearchThroughPractice:Fromthelab,fieldandshowroom.Elsevier:USA.Langenhove, L. V., Hertleer, C. & Westbroek, P. (2007). Textile Sensors for Healthcare. In: L. vanLangenhove(ed.)SmartTextilesforMedicineandHealthcare.Cambridge:WoodheadPublishers,pp.1–20.Laurel(2003).DesignResearch:MethodsandPerspectives.MITPress:USA.Malins,J.,Steed,J.,Fairburn,S.,Robertson,S.,McIntyre,L.,Cruickshank,L.andScott,K.(2012).Futuretextilevisions:smarttextilesforhealthandwellness.AvailablefromOpenAIR@RGU.[online].Availableat:http://openair.rgu.ac.ukMcLaren, A., Stevenson, F., Griffiths, P. and Bryant, L. (2014). Initial introductory interviewwithMTCMedicalDirector:LindaBryant.McLaren, A., Stevenson, F., Griffiths, P. and Lee, V. (2012). Initial introductory interview withGlitterbeachCreativeDirector:VictoriaLee.



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Moustakas,C.,(1990).Heuristicresearch.Design,methodology,andapplications.USA.SagePublishing.O'Connor,K.(2010)HowSmartIsSmart?T-shirts,Wellness,andtheWayPeopleFeelabout“Medical”Textiles.TEXTILE,8:1,50-66Pause,B.(2007).Applicationofphasechangeandshapememorymaterialsinmedicaltextiles.In:L.vanLangenhove (ed.) Smart Textiles forMedicine and Healthcare. Cambridge:Woodhead Publishers, pp.74–87.Polanyi, M., (1962) Personal knowledge: towards a post-critical philosophy. London. Routledge andKeganPaul.Schön,D.(1983).TheReflectivePractitioner:HowProfessionalsThinkInAction.BasicBooks:UK.Stevenson, F. (2012).Making Changes: applying heuristics to a practice-led investigation of creativewellbeingwithinthecontextofcontemporarycraft.UnpublishedPhDThesis,UniversityofDundee,UK.Wilson,L.(2015).ThesustainablefutureoftheScottishtextilessector:challengesandopportunitiesofintroducinga circulareconomymodel. In:Product LifetimesAndTheEnvironment (PLATE)ConferenceProceedings,17-19 June -Nottingham,UK.EditedbyT.Cooper,N.Braithwaite,M.Moreno,G.Salvia.PublishedbyNottinghamTrentUniversity:CADBE.Pp.401-406.ISBN978-0-9576009-9-7.

Note/s1 The Innovation Portal, funded by the Scottish Government, aims to promote and foster productivecollaboration and knowledge transfer between academia and Scottish industry to support thedevelopmentofinnovativecommercialoutcomes(InnovationPortal,2017).TechnologyFeasibilityStudies(TFS)formpartoftheirsmallgrantsscheme,allowingScottishsmallandmedium-sizedenterprises(SMEs)toinvestigatecommercialandtechnicalfeasibilityofaninnovationproject,researchintellectualpropertyposition,financeinitialtesting,anddesignprojectframeworks(ibid)withina12to16-weektimescale.Thisplatform allows companies to explore early stage research and development ideas beyond their owncapabilities throughcollaborationwithspecialistacademicexpertise,helpingdevelopsolutionsand takethemtowardsacommercialoutcome. AngharadMcLarenAngharadisaLecturerinTextileDesignandSustainableClothingResearchCoordinatoratNottinghamTrentUniversity,andformerLecturerandAssociateResearcherattheSchoolofArtandDesign,UniversityofDundee,withpriortextileindustryandenterpriseexperience.Researchinterestsincludesustainablefashionandtextiles,crafttheoryandpractice,textileforperformance,healthandwellbeing,andrelationshipsbetweencommunity,[email protected] DrFrancesStevensonAsatextilepractitionerFrancesworkswithinthecontemporarycraftareaandstrivestocreatetextileproductsthatdemonstrateinnovationintheirdesignandexcellenceintheirmaking.AsAcademicHeadofDesignandCraft(SchoolofArtandDesign,UniversityofDundee),shebelievesmakingprocessesthatcombineinnovationandexcellenceareintegraltothestudentslearning,boththroughthechallengesencounteredwithinthephysicalmakingprocessandtherevelationsthatmanifestthemselvesthroughworkingorreflectingontheprocessorthefinishedobject.Sheisparticularlyinterestedinthemaking



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processandtheimportanceofmaintaining‘creativebuoyancy’asadesigner/maker,ultimatelyraisingquestionsconcerningwhymakingandlearningthroughmakingstillmattersfromapersonal,educational,[email protected] DrLouiseValentineDrLouiseValentineisHeadofEntrepreneurship,EnterpriseandEmployabilityfortheSchoolofArtandDesign,UniversityofDundee,andVicePresidentoftheEuropeanAcademyofDesign.Shewasintegraltothe£8MDigitalR&DFundfortheArts(2011-14),supportingthedevelopmentofnewbusinessmodelsandnewwaysofeffectivelyengagingwiththepublic.SheisaFellowoftheRoyalSocietyoftheArtsandAssociateEditorofTheDesignJournal.ShestudiedIndustrialDesignbeforegainingherdoctoraldegreeinDesignThinking(2003)andpost-doctoratesinCraft,InnovationandPartnershipWorking.Herresearchfocusesondesignmindfulnessandthevaluedesignaddswhenusedasaleadershipandperformancemanagementtoolinbusiness.Sheiseditorof'Prototype:DesignandCraftinthe21stCentury'(2013)[email protected]

collaborative user-centred textile design research for healthcare: … · 2018-03-07 · aspects of...

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