Assistive technology (AT) has the potential to alleviate the impact of chronic health conditions on individuals, caregivers, healthcare services, and wider society. Up to 70% of AT is, however, prematurely abandoned since it does not meet user needs. Preliminary research has highlighted the potential of a co-design approach that prioritises the needs of the user, combined with a digital design and manufacturing system (DDMS). Evidence suggests that this method can deliver personalised AT with improved fit, functionality and aesthetic value. If implemented at scale, such a model could reduce premature AT abandonment and deliver significant social, environmental and economic benefits.
This short article accompanies the Tidal Network+ project “Improving the efficiency of co-designing personal assistive technology through the use of digital design and manufacturing systems”, which was funded by the EPSRC (Grant number EP/W00717/1).
Custom assistive technology from Dr. Jonathan Howard's PhD research which informed the need for this research
Barriers to Scaling up Custom AT
A literature review (Howard et al., 2022, a) has pinpointed key obstacles in accessing appropriate assistive technology (AT):
Lack of customisation to users’ health conditions and independence goals
Limited involvement of users in the design process
Insufficient knowledge and training among healthcare professionals
Limited availability of local services
Prior research by the project’s lead investigator (Howard et al., 2022, b) demonstrated the benefits of integrating user-centred co-design practices, combined with affordable digital design and manufacturing (DDM), into existing healthcare services: enhanced health, wellbeing, and social outcomes, reduced barriers to AT utilisation and less AT abandonment and waste.
However, the process was intricate, time-intensive, and expensive, with over 96% of the costs attributed to the clinician’s time. It relied on the implicit knowledge of the clinical team, hindering the sharing of solutions.
Recent work (Howard et al., 2023) has highlighted the efficiency gains offered by adjusting parameters in existing 3D computer-aided designs (parametric design).
This laid the foundation for a service model where AT could be co-designed by both modifying previous solutions or creating new devices. The challenge lies in expanding this concept through establishing mechanisms for sharing knowledge, facilitating local services, and optimising the co-design process.
Our Project aim
This project aimed to develop a blueprint for such a service. Following the Design Council’s Double Diamond research model, we set out to:
Discover the current landscape of AT provision through working with healthcare specialists from across the ecosystem.
Define the challenges facing the development of co-designed DDM AT and identify areas for optimisation.
Develop potential service models, evaluating the most promising ones, and refine these to create a proposed solution.
Deliver a service blueprint, wireframe model and video illustrating how such a service could work, plus policy recommendations to facilitate its expansion across the NHS in Wales and the UK.
What we Found & What it Means
Nineteen potential barriers to the scaling-up of a personalised AT process were identified and grouped into four themes:
The design of current off-the-shelf AT
Access to current off-the-shelf AT
Healthcare professional staffing within the current system
Systemic pressures in the healthcare service
Our proposed solution is an internet-based platform that will enable healthcare specialists and end-users to collaborate on the design and modification of personalised AT.
This system would facilitate the sharing of best practices and innovative ideas among peers and users, contributing to rigorously evaluated solutions that meet both regulatory requirements and user needs. It would enable custom designs to be fabricated same-day within a distributed network of manufacturing facilities close to the point of need under a common regulatory-compliant quality management system. It would incorporate a central, quality-controlled database of information on both off-the-shelf and custom AT.
A customisable design to make gripping a Satavex spray easier. Rendered by PDR's Design team
How We'll Get There
Achieving this goal necessitates advancements in design and manufacturing technology, updated policies, and radical servicing innovations.
Key areas of focus include:
AT user experience research to create a platform suitable for people’s confidence and ability.
Development of a user-friendly non-CAD interface, which is accessible to both designers and non-designers, to enable the easy modification of designs.
R&D to radically increase production speed of technologies such as 3D printing.
Healthcare economic assessments to determine the concept’s potential value.
Implement machine learning or other intelligent methods to enhance the database.
Research to understand end-user needs to establish the demand for personalised AT and the level of customisation required.
Explore the modularisation of current custom AT designs and how these can be adapted for a web-based platform.
Up-skilling health professionals in DDM processes.
Policy and procedures:
Establishment of policies that allow physical libraries for AT solutions.
Explore alternative business models for the hospital-supported delivery of custom AT.
Internet platform development:
Create a secure app/web-based platform to host and connect healthcare specialists.
Implement regulatory-compliant systems that function seamlessly across health boards and any external parties in industry and the maker community.
Where to Find Out More
Find out more about our work in AT at https://deggbeer.wixsite.com/co-at-design
Howard J, Fisher Z, Kemp AH, Lindsay, S., Tasker, L. & Tree, J. Exploring the barriers to using assistive technology for individuals with chronic conditions: a meta-synthesis review. Disability and Rehabilitation: Assistive Technology. 2022 2022/05/19;17(4):390-408. (Howard et al., 2022 a)
Howard, J., Tasker, L. H., Fisher, Z., & Tree, J. (2022). Assessing the use of co-design to produce bespoke assistive technology solutions within a current healthcare service: a service evaluation. Disability and rehabilitation. Assistive Technology, 1–10. https://doi.org/10.1080/17483107.2022.2060355 (Howard et al., 2022 b)
Howard, J., Bowtell, M., Fisher, Z., Tasker, L. H., & Tree, J. (2023) Can a previously co-designed device be used by others? A service evaluation of the use of the Sativex spray holder for individuals with multiple sclerosis. Disability and Rehabilitation: Assistive Technology, DOI: 10.1080/17483107.2023.2228344