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Concept: User-centered design


Abstract Purpose: Recent debates about the epistemological origins of Universal Design (UD) have questioned how far universalist design approaches can address the particularities and diversities of the human form through a series of standardised, technical responses. This article contributes to these debates by discussing an emergent architectural paradigm known as DeafSpace, which articulates a set of design principles originating from the d/Deaf community in the US. Method: Commentary. Results: DeafSpace has emerged as a design paradigm rooted in an expression of d/Deaf cultural identity based around sign language, rather than as a response designed to compensate for, or minimise, impairment. It distinguishes itself from UD by articulating a more user-centred design process, but its principles are arguably rooted in notions of d/Deaf identity based around consensus and homogeneity, with less attention paid to the socio-political contexts which shape diverse experiences of d/Deafness and the exclusion(s) of d/Deaf people from the built environment. Conclusions: While proponents of DeafSpace argue that UD and DeafSpace are not mutually exclusive, nor DeafSpace principles applicable only to d/Deaf people, questions remain about the type of spaces DeafSpace creates, most notably whether they lead to the creation of particularist spaces of and for the d/Deaf community, or reflect a set of design principles which can be embedded across a range of different environments. Implications for Rehabilitation UD as a basis for rehabilitation has been critiqued on the basis that creates “standardised”, or universal solutions, thus negating the particularities of the human form. DeafSpace is an architectural paradigm rooted in socio-linguistic understandings of Deafness and the cultural identity of the Deaf community. It challenges UD’s technocratic emphasis on minimising impairment and asserts design which is rooted in a more qualitative understanding of individuals' relationship with their environment. DeafSpace seeks to place the user more centrally in the design process and draw on the experiential knowledge of (Deaf) users. However, it has less to say about the often exclusionary socio-political relations which underlie the built environment and shape the diverse experience of deafness. DeafSpace raises questions about how the needs of particular groups can be met through UD principles and in turn whether DeafSpace principles lead to the creation of separate spaces for the D/deaf community.

Concepts: Hearing impairment, Knowledge, Design, Design management, Deaf culture, User-centered design, Universal design, Design thinking


Seniors need sufficient balance and strength to manage in daily life, and sufficient physical activity is required to achieve and maintain these abilities. This can be a challenge, but fun and motivational exergames can be of help. However, most commercial games are not suited for this age group for several reasons. Many usability studies and user-centered design (UCD) protocols have been developed and applied, but to the best of our knowledge none of them are focusing on seniors' use of games for physical activity. In GameUp, a European cofunded project, some prototype Kinect exergames to enhance the mobility of seniors were developed in a user-centered approach.

Concepts: Scientific method, Cultural studies, Design, Greatest hits, Usability, Interaction design, User-centered design, Usability testing


There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function.

Concepts: Focus group, Evaluation, Following, Design, Pharmacy, User-centered design, Participatory design, Comparison of usability evaluation methods


Peer support services have the potential to support children who survive cancer by handling the physical, mental, and social challenges associated with survival and return to everyday life. Involving the children themselves in the design process allows for adapting services to authentic user behaviors and goals. As there are several challenges that put critical requirements on a user-centered design process, we developed a design method based on personas adapted to the particular needs of children that promotes health and handles a sensitive design context.

Concepts: Design, User-centered design


Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps.

Concepts: Educational psychology, Existence, Design, Personal digital assistant, Interaction design, User-centered design


Involving users through participation in healthcare service and environment design is growing. Existing approaches and toolkits for practitioners and researchers are often paper based involving workshops and other more traditional design approaches such as paper prototyping. The advent of digital technology provides the opportunity to explore new platforms for user participation. This paper presents results from three studies that used a bespoke situated user participation digital kiosk, engaging 33 users in investigating healthcare environment design. The studies, from primary and secondary care settings, allowed participant feedback on each environment and proved a novel, engaging “21st century” way to participate in the appraisal of the design process. The results point toward this as an exciting and growing area of research in developing not just a new method of user participation but also the technology that supports it. Limitations were noted in terms of data validity and engagement with the device. To guide the development of user participation using similar situated digital devices, key lessons and reflections are presented.

Concepts: Participation, Design, User-centered design, Software design


This paper describes a case study with a patient in the classic locked-in state, who currently has no means of independent communication. Following a user-centered approach, we investigated event-related potentials (ERP) elicited in different modalities for use in brain-computer interface (BCI) systems. Such systems could provide her with an alternative communication channel. To investigate the most viable modality for achieving BCI based communication, classic oddball paradigms (1 rare and 1 frequent stimulus, ratio 1:5) in the visual, auditory and tactile modality were conducted (2 runs per modality). Classifiers were built on one run and tested offline on another run (and vice versa). In these paradigms, the tactile modality was clearly superior to other modalities, displaying high offline accuracy even when classification was performed on single trials only. Consequently, we tested the tactile paradigm online and the patient successfully selected targets without any error. Furthermore, we investigated use of the visual or tactile modality for different BCI systems with more than two selection options. In the visual modality, several BCI paradigms were tested offline. Neither matrix-based nor so-called gaze-independent paradigms constituted a means of control. These results may thus question the gaze-independence of current gaze-independent approaches to BCI. A tactile four-choice BCI resulted in high offline classification accuracies. Yet, online use raised various issues. Although performance was clearly above chance, practical daily life use appeared unlikely when compared to other communication approaches (e.g., partner scanning). Our results emphasize the need for user-centered design in BCI development including identification of the best stimulus modality for a particular user. Finally, the paper discusses feasibility of EEG-based BCI systems for patients in classic locked-in state and compares BCI to other AT solutions that we also tested during the study.

Concepts: Patient, Paradigm, Sensory system, Case study, Logic, Modality, User-centered design


BACKGROUND: To reduce the large public health burden of the high prevalence of depression, preventive interventions targeted at people at risk are essential and can be cost-effective. Web-based interventions are able to provide this care, but there is no agreement on how to best develop these applications and often the technology is seen as a given. This seems to be one of the main reasons that web-based interventions do not reach their full potential. The current study describes the development of a web-based intervention for the indicated prevention of depression, employing the CeHRes (Center for eHealth Research and Disease Management) roadmap. The goals are to create a user-friendly application which fits the values of the stakeholders and to evaluate the process of development. METHODS: The employed methods are a literature scan and discussion in the contextual inquiry; interviews, rapid prototyping and a requirement session in the value specification stage; and user-based usability evaluation, expert-based usability inspection and a requirement session in the design stage. RESULTS: The contextual inquiry indicated that there is a need for easily accessible interventions for the indicated prevention of depression and web-based interventions are seen as potentially meeting this need. The value specification stage yielded expected needs of potential participants, comments on the usefulness of the proposed features and comments on two proposed designs of the web-based intervention. The design stage yielded valuable comments on the system, content and service of the web-based intervention. CONCLUSIONS: Overall, we found that by developing the technology, we successfully (re)designed the system, content and service of the web-based intervention to match the values of stakeholders. This study has shown the importance of a structured development process of a web-based intervention for the indicated prevention of depression because: (1) it allows the development team to clarify the needs that have to be met for the intervention to be of use to the target audience; and (2) it yields feedback on the design of the application that is broader than color and buttons, but encompasses comments on the quality of the service that the application offers.

Concepts: Value, Potential, Need, Usability, User-centered design, Human-computer interaction, Usability testing


Machine Learning (ML) methods are now influencing major decisions about patient care, new medical methods, drug development and their use and importance are rapidly increasing in all areas. However, these ML methods are inherently complex and often difficult to understand and explain resulting in barriers to their adoption and validation. Our work (RFEX) focuses on enhancing Random Forest (RF) classifier explainability by developing easy to interpret explainability summary reports from trained RF classifiers as a way to improve the explainability for (often non-expert) users. RFEX is implemented and extensively tested on Stanford FEATURE data where RF is tasked with predicting functional sites in 3D molecules based on their electrochemical signatures (features). In developing RFEX method we apply user-centered approach driven by explainability questions and requirements collected by discussions with interested practitioners. We performed formal usability testing with 13 expert and non-expert users to verify RFEX usefulness. Analysis of RFEX explainability report and user feedback indicates its usefulness in significantly increasing explainability and user confidence in RF classification on FEATURE data. Notably, RFEX summary reports easily reveal that one needs very few (from 2-6 depending on a model) top ranked features to achieve 90% or better of the accuracy when all 480 features are used.

Concepts: Better, Improve, Artificial intelligence, Statistical classification, Feature data, User-centered design, Verification, Usability testing


Designing usable forms of topical haemostatic agents is the most important activity during the design process, resulting in strengthened functional properties of the final medical devices. This study aimed to propose indications for a research programme based on risk management supporting the development of two usable forms of a topical haemostatic agent: chitosan/alginate lyophilized foam and chitosan/alginate impregnated gauze. Both of the usable forms of the topical haemostatic agent, being the main part of the modified combat gauze, were fabricated using the chitosan/alginate complex. Risk analysis is helpful in developing an appropriate research programme, significantly reducing the risk to an acceptable level.

Concepts: Risk management, Design, Design management, Antihemorrhagic, Interaction design, User-centered design, Chitosan, Metadesign