Article
Shital Desai1,2,*, Jasmine Plumb1, A.M. Viens3,4
1Social and Technological Systems (SaTS) lab, School of Arts Media Performance and Design, York University, Toronto, Canada
2Department of Computational Arts, School of Arts Media Performance and Design, York University, Toronto, Canada
3Global Strategy Lab, York University, Toronto, Canada,
4School of Global Health, York University, Toronto, Canada
Abstract
Speculative Design is about re-envisioning our imagination to create possible and desirable futures while avoiding the least desirable. Its problem-finding approach, in contrast to problem-solving approach, helps designers generate critique and inquiry around wicked problems. This paper explores the scope of using the speculative design method to address Anti-Microbial Resistance (AMR), a wicked problem and pandemic of the future. We present a design futures methodology that includes identification of signals of change in the context of AMR to prime inspirations for idea generation in a prediction generator–a tool to generate speculations. The methodology was then evaluated in a classroom setting with Design students.
Keywords
Speculative and Critical Design (SCD), Speculative Design, Critical Design, Wicked problem, Antibiotics, Antimicrobials (AM), Antimicrobial Resistance (AMR)
Introduction
Traditional design aims to address world issues through problem solving by focusing on dynamic elements in the present system. However, the world faces wicked problems such as financial crises, marginalization (racial, social, and economic), environmental disasters, and political strife, which are difficult to solve. Speculative and Critical Design (SCD) imagines what it would be like to design without current technological, cultural, and political limitations. This method allows governments, communities, and businesses to consider future challenges when designing services, products, interfaces, systems, communities, or policies in the present. Furthermore, the practice helps these groups address tough questions that we create for our communities. SCD could also take a critical and discursive lens to highlight important societal issues. Additionally, SCD enables designers to broaden their imaginations and create new innovative systems and prototypes for the future that question existing hypotheses and prejudices on the role of systems, products, and services in our lives.
Antimicrobial resistance (AMR) is a super wicked problem of the 21st century. As antimicrobial usage increases across the world, bacteria and other microbials are undergoing changes at a faster rate to survive drugs designed to control them. As a result, these microbes can infect humans and animals, with existing medicines unable to control the infection. In turn, AMR can spread easily and quickly. AMR is thus considered a global problem (CDC, 2022; Holmes et al., 2016; WHO, 2022). Researchers in global health are addressing this problem through institutional, legal, and systemic analysis (Jamrozik & Selgelid, 2020; Penney et al., 2021; Weldon et al., 2022). Design researchers such as (Darby et al., 2021; Emmanuel Tsekleves, 2019) are using multidisciplinary and creative methods to identify possible solutions for AMR by involving primary stakeholders in the design process. The authors studied cleaning practices in Ghanaian households and identified interventions to reduce spread of antimicrobials through behaviour change and policy recommendations. Mitchell et al. (2021) suggest that awareness and information about AMR lacks among the general masses. For systemic and logistic reasons, people are often unaware of the implications of their behaviour and habits on the environment and global health.
Design pedagogy for the 21st century needs to be reframed through the lens of Design Futures Literacy, that ensures that we train young designers for designing for complex problems of not only tomorrow but also present challenges. Design is seen as taking a proactive role to in anticipating the future through situated thinking and making, better understanding of use and users and looking ahead of the immediate or short term (Celi & Morrison, 2019).
We thus explored an SCD approach in a design education setting to generate inquiry and critical discussions around AMR and its impact on our life and environment. This paper presents a Design Futures approach in an educational setting. We begin with a review of SCD and AMR, followed by the design brief provided to undergraduate design program students. Next, we explore the Design Futures process/methodology that was followed in the course. Finally, we present the design we staged to an audience of young adults (mostly design students) for discussions and preliminary inquiry.
Background/Literature Review
Wicked problems are societal problems that do not have clear identifiable solutions due to their complex and interconnected nature. No criteria or determined formulas exist to indicate when these problems are solved. Thus, found solutions can only be deemed better or worse. As a super wicked problem, AMR is a time-sensitive issue that current problem-solvers do not have the necessary power to address; furthermore, these problem-solvers are attempting to minimize the impact of AMR through currently existing policies (Levin et al., 2012; Littmann & Simonsen, 2019).
Wicked and super wicked problems demand fundamental changes to our values, beliefs, attitudes, and behaviour (Littmann et al., 2020); Speculative and Critical Design (SCD) claims to achieve these shifts (Dunne & Raby, 2013). However, design as a discipline traditionally fixates on problem solving. When problems are unsolvable, designers need to move away from their traditional mindset towards one where they go beyond material solutions to tackle wicked problems. SCD can spark new perspectives by inspiring one’s imagination of what could be and by achieving critical thought through designing products, systems, and worlds that challenge reality and spark social debate.
Antimicrobial Resistance
AMR is responsible for the growing ineffectiveness of antibiotics, antivirals, antifungals, and antiparasitic against infection. AMR results from the evolution of microorganisms, bacteria, viruses, fungi, and parasites. These evolutions allow harmful organisms to adapt to the medicines we use to treat them. Consequently, treatment becomes more challenging and the risk of disease, infection, and death increases (Antimicrobial Resistance, 2021).
Antimicrobials enter an interconnected system involving healthcare, agriculture, science, the environment, households, and our communities; they then move through hospitals, and domestic and agricultural veterinary practices (How Design Can Compliment Science to Slow Antibiotic Resistance at Veterinary Practices – Arts and Humanities Research Council, 2018). Misuse or overuse of antimicrobials by healthcare professionals, veterinarians, and patients, can result in microorganisms developing resistance (How Design Can Compliment Science to Slow Antibiotic Resistance at Veterinary Practices – Arts and Humanities Research Council, 2018). This resistance does not end with a single microorganism but can be passed on through reproduction, in death, and by conjugation (TED-Ed, 2014).
Along with the global action plan released by the World Health Organization (WHO) in 2015, Canada has created its Federal Action Plan on Antimicrobials Resistance and Use in Canada (Canada, 2015). The plan focuses on a combined approach using three pillars, surveillance, stewardship, and innovation. Surveillance consists of monitoring quantitative data and potential threats across all stakeholders; stewardship sets a framework and rules for the prevention of increasing AMR and focuses on educating awareness around AMR and proper use of antimicrobials; and innovation deals with researching and developing new antimicrobials or alternate solutions to AMR that exists today (Canada, 2015). The pillars rely on one another to work effectively.
Currently, the consequences of AMR are felt across health, economic, and social sectors. The European Centre for Disease Prevention and Control (ECDC) reports that AMR is responsible for an estimated 25,000 deaths and an additional healthcare cost of €1.5 billion annually, as well as over 2 million infections and 23,000 deaths in the United States per year (Jamrozik & Selgelid, 2020; Marston et al., 2016). By 2030, AMR is projected to impoverish over 24 million people, and by 2050 cause extreme economic distress and kill 10 million people across the globe annually (New Report Calls for Urgent Action to Avert Antimicrobial Resistance Crisis, 2019).
While AMR demands action right now, it must first be acknowledged as a super wicked problem for which a solution extends beyond research and discovery of new antimicrobials. AMR demands the refinement of values, priorities, and authorities responsible. Through SCD, we could reimagine perspectives, beliefs, and values around wicked problems such as AMR. However, critics argue SCD’s inadequacy and call attention to the bias that can be easily replicated in speculative products, systems, and futures, threatening their potential for change. Our work is an exploration into use of SCD method to generate discussion and inquiry around AMR.
Speculative and Critical Design
Critical design (CD) and Speculative design (SD)–more recently referred to under the umbrella term, Speculative and Critical design (SCD)–have taxonomical differences that are often ignored. In brief, all SD is CD, and SCD simply emerged to avoid the limiting connotations of speculation alone (Johannessen, 2017; Malpass, 2012). As such, we refer to SD and SCD interchangeably.
Critical Design
Intended to help describe design as critique, Anthony Dunne and Fiona Raby coined the term Critical Design (CD) to employ speculative design proposals and question everyday technology (Johannessen, 2017). Over time, the increased use and interpretations of CD urged Dunne and Raby to revisit the term. Nearly a decade later, they elaborated on the framework of CD, emphasizing its need to disturb and exist simultaneously in our reality and the imagined reality. Meant to inspire a generation into discussion and inquiry around how life could be different, CD does not provide solutions as design traditionally does. Using approaches such as para-functionality, where design of function is just as important as design of form in questioning how products impact human behaviour (Dunne, 2005), CD facilitates inquiry into the futures we are designing every day, not only as designers but as consumers who hold great power over shaping material realities. These speculative representations of what could be, allow audiences to envision how the way they consume can impact the way realities evolve and help them become critical consumers who understand what they want to demand.
Along with being anti-solutionist, CD is also thought to be a pessimistic approach because of its dark themes which employ satire, irony, deadpan and black humour, and absurdity. Dunne and Raby justify this darkness by arguing that human nature and wicked problems are complex, dark, and unstable, and to engage with it, design must also be complex, dark, and unstable (Dunne & Raby, 2013). Darkness is also an important method of communication in CD because it is shocking and can shock an audience into reaction. However, Blythe et al. aspire that CD move away from its use of satire. They explain that for many cultural commentators, satire is a safe space for people who already agree with one another, rather than a way of inspiring social reform (Blythe et al., 2016). They also communicate novelist David Foster Wallace’s understanding of irony, a dominant cultural form that oppresses and discourages artists from trying to create change at the risk of appearing sentimental or naïve to ironists. They provide examples of alternative ideation and design methods, such as “magic machines,” which encourage absurdity and silliness in CD. These methods also recognize the severity of problems and the fragility of the approaches designed to address them (Blythe et al., 2016).
Speculative Design
While some CD employs speculative methods, Speculative Design (SD) is not limited to the design of interactions between humans and technology; SD also expands on CD by drawing on narratives from numerous disciplines to reach broader audiences and speculate around society-scale futures (Auger, 2013; Johannessen, 2017). SD inspires social dreaming and inquiry into what could be (Dunne & Raby, 2013).
The etymology and connotations of SD gravitate towards conjecture, to avoid such connotations, SD may be referred to as Speculative and Critical design (SCD) (Auger, 2013; Johannessen, 2017). Dunne and Raby praise conjecture when it is used to generate ideas and orient how design can be used to initiate critical inquiry into technology and dominant systems (Dunne & Raby, 2013). Auger notes SCD must move beyond the realm of conjecture, locate itself within science of the near future, and be based on signals of emerging technology (Auger, 2013). However, Auger elaborates that SCD can draw inspiration from a variety of disciplines such as literature, film, comedy, psychology, and ecology. These disciplines serve as perceptual bridges bridging the gap between the understanding of current realities and possible futures (or alternate realities) in which the design inhabits. For instance, SCD can use familiar experiences, to explain the function of speculative designs and interfaces more efficiently, just as comics use shared stories to tell their jokes in fewer words. These disciplines are employed to create engaging designs. Without an engaged audience, SCD would fail to create discourse and inquiry (Auger, 2013).
SCD is an emerging design approach focused on societal problems such as an AMR global health pandemic. As such, SCD uses conjecture and uses borrowed narratives to invoke critique and discourse but is not without flaws and the criticisms of a practice that is still evolving.
Criticisms of Speculative and Critical Design
A common critique of SCD is that designers ground their speculations in their own bias,’ ignorant to the context of the social issue they design for. When these designers come from the “intellectual white middle class” and remain unconscious of the privilege they exercise, imagined dystopias are classist, even patronizing (Blythe et al., 2016; Martins & Oliveira, 2017). The quote “The future happens to the poorest, most vulnerable people first” from Charlie Loyd’s Twitter meme is forthright and echoed by other critics regarding SCD (Blythe et al., 2016; Martins & Oliveira, 2017). SCD’s capabilities for provoking social debate and not reinforcing norms around any wicked problem are questioned as a potentially elitist branch of design (Johannessen, 2017; Martins & Oliveira, 2017). While Dunne and Raby deny SCD’s relation to critical theory and state its only similarity is critical thought, Johannessen raises how both share skepticism towards consumer culture. Johannessen also highlights Bardzell & Bardzell’s comparison of critical design to critical theory, in how both disrupt social conformity to encourage social emancipation (Johannessen, 2017). Sharing these similarities, SCD is scrutinized for its capacity to inherit the criticized elitist position of critical theory, especially if it intends to initiate social debate. SCD has already demonstrated reinforcing norms. As a field with limited representation of designers and characters in the imagined worlds, it is easy for the speculated futures to become heteronormative, cisnormative, and generally oriented around “white man’s” problems (Johannessen, 2017; Martins & Oliveira, 2017).
With innumerable stakeholders, SCD systems and products that address AMR must be wary of how one might reinforce norms within AMR and how AMR is experienced differently in low-, middle-income, and less-developed settings. For instance, antimicrobials may be overprescribed and misused in some countries, while low-, middle-income, and less-developed countries lack appropriate access to antimicrobials entirely (Jamrozik & Selgelid, 2020).
Research plays an important role in mitigating bias and grounding speculations in the reality that they are meant to critique. However, issues arise when the bulk of studies referenced come from the same place, like hospital settings where a majority of AMR studies are conducted (Emmanuel Tsekleves, 2019). In such cases, it would be important to look beyond the hospital and find studies like the Dust Bunny project, which explores how home hygiene practices in Ghana influence AMR bacterial infections (Emmanuel Tsekleves, 2019).
With wide gap between antimicrobial experiences, it is crucial that designers are not blatantly ignorant to these differences and aim to be aware of how their imagined dystopia may exist today. Shaped and articulated by examples, one must be wary of weaknesses of SCD approaches to avoid sustaining the norms SCD aims to undermine.
SCD meets the challenges that AMR poses as a super wicked problem. SCD does not approach AMR as a problem that can be solved; it employs speculative futures that critique social norms in hopes of sparking fundamental change in the trajectory of AMR and encouraging appropriate funding (Littmann & Simonsen, 2019). There are case studies which feature SCD approaches involved in addressing wicked problems within healthcare (Pau & Hall, 2020), there are few that document their methodology and discuss their approach. Case studies that focus on less-studied implications of wicked problems in healthcare and the epidemic of AMR are even scarcer. This paper aims to present our attempt to apply SCD to the scope of the wicked problem of AMR in an educational setting.
Methods, Approaches and Tools
SCD involves generating design ideas that are extrapolated into future scenarios, and speculations. The design should generate discussions and provoke inquiry. At the same time, they should be believable and valid for the current context and present time. However, there are tensions and debates around what design process should be followed to generate these artefacts.
Existing tools and methods include templates and canvases that designers can use to identify the context for their design inquiry, diagramming devices that can help with analysis of the topic and tools that assist in generating ideas and concepts. Encinas et al., (2021) suggests an open set of methods to allow for critical emergence that challenges disciplinary dominance. The methods should facilitate discussions with no set path or direction that it wants us to lead to. For example, the Illegal Town Plan project aimed to create a platform for communities who are marginalized and excluded from the town planning process to explore ideas for the future of the town and present them through tangible outputs (Ward & Loizeau, 2020). To allow participation from community members with varying skills including architects, the visions were captured as films, drawings, photography, town planning documents and schemes and alternative master plans. The project allowed open discussions across disciplines and various systems that are impacted in the context. Similarly Raskob (2020) used playfulness and emergence in games to discuss diversity in technology, policy, society and ecology. A similar approach was used by (Near Future Laboratory, 2023) to construct material cultural artifacts representing symptoms and implications of all kinds of futures. The kit consists of four types of cards – Archetype: represents a cue or symbol from the present, attributes: represents characteristic or principles governing the design of the artefact, object: a fictional object in the future and action: functionality of the artefact. There are no rules to play the game, cards are picked from each group to brainstorm ideas, the order in which the cards are picked does not matter. However, these methods are not specifically focused on a topic area or context, some of which are driven by chance. We thus explored a method proposed by (de la O Campos & Güemes, 2020), which we adapted for the context of Global Health, shown in Fig. 1.
To begin design inquiry of any form, a good understanding of the context, the science behind AMR, policy and governance implications to AMR, impact of human behaviour and human experiences should be developed. So, the first step of SCD should be to research into all systemic elements of AMR. The information should be derived from existing literature such as reports, peer reviewed research articles and ethnographic studies with people, farmers, pharmacists, and other stakeholders.
The research data then needs to be grouped into three categories: Human Emotional, Local Geographical, and Global Economical. This categorization ensured that the information collected covered all areas (geographical, political, economic, and human) impacted by wicked problems such as AMR (Dunne & Raby, 2013). It also allows designers to approach inquiry through a systemic dialogue where interdisciplinary stakeholders can participate in the through brainstorming and a codesign process.
Systems thinking allows us to make sense of the complexity in the information by identifying variables that represent the system and the relationships between the variables. Re-enforcing loops are identified which are separated into positive, negative, and frozen loops.
Signals are important elements in futures thinking and SCD as they connect the present to the future. They should be collected and analyzed to indicate possible futures and provoke thought around preferable futures. Signals are a clue that things might soon become different and how they could make a difference (McGonigal, 2015). In his 1984 science fiction novel, William Gibson referred to signals as futuristic elements that are already here in the present but not yet evenly distributed. It could be new scientific breakthrough or a new technology. According to Gorbis (2013), a signal is a specific example of a future in the present.
The re-enforcing loops and the signals of change are used to brainstorm ideas. The goal is to come up with ideas for the current states in the system but using signals of the future such as technologies, policies, laws, etc. A directed focussed investigation on the signals is required, so that designers identify relevant signals and not digress away from the topic and potential idea. We developed following probe cards to document the relevance of the signals (Fig. 2).
Fig. 1: Proposed method for Speculative and Critical Design.
Fig. 2: Probe cards to discuss signals and their relevance to the potential ideas.
To explore possible speculations of potential ideas, divergent and convergent thinking methods are required. de la O Campos & Güemes-Castorena, (2020) developed a prediction generator tool that allows these processes to be employed within a double diamond model, as shown in Fig. 3.
Fig. 3: Prediction generator to develop speculations within a double diamond process (de la O Campos & Güemes, 2020; José de la O, 2021).
The Desires activity allows designers to state the potential idea and integrate the research and information behind the idea. We propose priming cards with questions to allow designers to brainstorm the potential idea and connect it to the information obtained during the research process (Fig. 4):
Fig. 4: Activity cards to prime designers to discuss the potential idea.
Similar cases of signals and ideas are identified, which further adds to the divergence of the discovery process. Common patterns such as events, contributing factors, features etc. should then be identified. The aim is to identify key points or findings from the information collected in the research, systems map, signal scanning, and similar cases. Common key findings are clustered together in themes, and relations between the clusters are identified using affinity analysis method (Centre for Care Innovations, 2017; Gielow, 2012; Goodwin, 2011; Pernice, 2018; Tague, 2004; Weprin, 2017).
To converge clustered information to a design brief, the prediction generator tool suggests articulating limitations that might arise in each of the clusters. Predictions are developed by provoking questions using a Fast Idea Generator (ideation tool from Nesta) on the patterns and limitations (Nesta, 2013). The fast idea generation uses following approaches for brainstorming ideas – Inversion, integration, addition, subtraction, translation, and exaggeration. Inversion turns common practice upside down, for example the normal practice of doctors treating patient is presented as what if patients become doctors. The scenario may seem futuristic but is feasible in the present system. People during COVID-19 pandemic found resources online such as WhatsApp to treat health related conditions so they do not have to see the doctor immediately. The approaches are explained in Table 1. Questions such as ‘What if’, ‘How can we’, ‘where does’ are used for each of the tactics to build scenarios for the future. In contrast to a quantitative structural analysis approach of scenario building (Gauthier & Wac, 2015), the Fast Idea Generator relies on discussions and narratives derived from the research and information.
Table 1: Approached for generating scenarios using Fast Idea Generator (Nesta, 2013).
Approach | Example | ||
Inversion | Turn common practice upside down | Doctors treat patients | What if patients became doctors? |
Integration | Integrate the offer with other offers | People access a range of services in different locations | What if different local services had one point of access? |
Extension | Extend the offer | Schools provide learning opportunities to children and young people during the day | What if schools also offered sport and recreation; and community learning after hours? |
Addition | Add a new element | Supermarkets deliver groceries | What if supermarkets delivered groceries and also provided hot meals to older people in their homes? |
Subtraction | Take something away | Prisons are critical to an effective criminal justice system | What if you had to close three prisons? |
Translation | Translate a practice associated with another field | Hospitals and airports are different kinds of operations | What if airport management practices were applied to hospitals? |
Exaggeration | Push something to its most extreme expression | Schools support children and young people to learn, but only within designated times and in a designated space | What if students could access learning, anytime and anywhere they chose? |
Grafting | Graft on an element of practice from another field | Teaching and coaching are separate practices | What if coaching was introduced as part of secondary school education? |
Differentiation | Segment the offer | There is a ‘one size fits all’ approach | What if a service was personalized and differently segmented? |
These provoking questions finally result in a hypothesis or design brief for design and development of the speculative idea.
The design and development phase begins with divergent exploration of design ideas for which the design team brainstorms keywords to communicate the direction of the artefact to be designed. These keywords are representative of features, characteristics, and functionality. Design inquiry is then explored either through an empathetic presentation of the situation or an unempathetic/unfriendly behaviour of the design or presenting quantified information using data visualisation techniques. Mood boards are created with inspirational ideas from related or unrelated field or topic. The look, the feel and the style with visual characteristics are finalised. Finally, the Deliver phase involves translating the design specifications to sketches, conceptual models and tangible artefacts.
Case Study: Where Resistance Grows
The Design Brief
Speculative Interaction Design course (YSDN 3006) was a 3.0 credit undergraduate elective course in the design program at XX University. The objective of the course was to examine SCD methodologies which challenge the narrow assumptions and preconceptions that typically limit the form and function of designed artefacts. These methodologies looked beyond functional instrumentalism to consider how design can be used to incite mindful reflection rather than blind consumption and address society’s “wicked problems.” The course thus (1) developed a futuristic topic for investigation, (2) used futuristic thinking methods to develop an understanding of what the future looks like in terms of the topic trend and technology, and (3) applied speculative design methods to design artefacts to bring a change. The processes and practices in the course involved design students imagining futures based on current technological and cultural trajectories; however, rather than accepting those trajectories, students used design as an instrument to incite change and alter their direction.
Students worked on a semester project that focused on AMR– a major global health issue. Mitigating AMR will have significantly impact reaching 6 out of the 17 Sustainable Development Goals (SDGs) to meet the United Nation’s agenda by 2030. Global health researchers and experts in AMR research engaged with the course through guest lectures, regular critiques, and feedback on project outcomes. Since the course was delivered during the COVID-19 pandemic lockdowns, students collaborated using online tools: Zoom and Miro.
Applying the Methodology
As discussed in the methods, approaches and tools section above, the design process involved six stages to generate an artefact for design inquiry: Research, Systems Mapping, Signal Scanning, Discover-Define, Design-Development and Deliver phases. We describe the process and outcomes at each stage using one student’s work as a case study who is a co-author on this paper.
Research:
Students collected information on AMR from academic literature, magazine articles, podcasts, guest lectures from experts in AMR, and consultations with global health researchers. The categorization of information into Human Emotional, Local Geographical, and Global Economical, ensured that the information collected covered all systemic areas (geographical, political, economic, and human) impacted by wicked problems such as AMR (Dunne & Raby, 2013). Where necessary, students conducted additional research to ensure the categories were balanced. A screenshot of categorization of research on Miro board is shown below in Fig. 5.
Systems Mapping:
To address AMR, there needs to be a combination of surveillance (monitoring trends and threats), stewardship (preventative guidelines, education and regulations), and innovation (the development of new antibiotics) (Government of Canada, 2015). A clusters map using the systems thinking approach was created to explore different factors and sectors that are impacted by AMR. Consultations with experts in AMR, discussions with the global health research team, and a study of the dust bunny project (Emmanuel Tsekleves, 2019) primed further explorations that informed the systems map. The impact of AMR on the community, its roots, and sources was investigated and incorporated into the map. AMR took a central stage and an interconnection of elements, along with the relationships and connections (cause and effect) that feed into the system, was developed.
Fig. 5: Research on AMR categorized into Human Emotional, Local Geographical, and Global Economical.
Systems map in Fig.6, shows that antibiotics spread into various systems and sub-systems of veterinary, agriculture, and hospitals/clinics. Traces of antimicrobial could emerge from any of these sub-systems and then propagate to all the interconnected systems, spreading AMR through reproduction, in death, and by conjugation. AMR also spreads through human behaviour and inappropriate sanitary practices, such as inadequate handwashing, improper cooking practices, inadequate sterilization, and more.
Fig.6: Systems map showing the impact of AMR distributed across sub-systems.
The discussions and brainstorming on the systems map resulted in exploration of sources of spread of AMR in homes, through surfaces, and interactions in home environments (Fig. 7). This resonated with everyone involved with the course closely and personally during the ongoing pandemic. The focus then thus narrowed down to the speculative design topic– ‘future of bacterial transmission through interactions and surface materials’.
Signal Scanning:
Two signals of change emerged while brainstorming materials, technologies, policies and structures that could be define how our future will be shaped: Sharklet– a bioengineered surface that kills bacteria (“Endotracheal Tube,” 2021) and Predictive touch– the touchless touchscreen (Palmer, 2020). Sharklet is a micro-patterned surface that inhibits bacteria from settling on its surface. Inspired by the serrations on sharkskin, the texture is made up of minuscule protrusions and dips that are configured into diamond-shaped patterns along the Sharklet surface. This signals a future of surfaces that are prone to bacterial infections and require constant disinfection. Predictive touch, touchless touchscreens sense where an individual is pointing at on a screen. The global pandemic has signaled a need for a future of touchless screen-based interactions where this technology could become useful. The signals of change primed inspirations for idea generation (José de la O, 2021). The Sharklet and the predictive touch technologies raised questions around elevators of the future and the spread of AMR via bacteria in elevators.
Discover and Define Phase:
Exploration with the signals of change inspired us to begin the discovery process with a potential idea of ‘future of bacterial transmission through interactions with surface materials.’ The student project under consideration stated the desire of mitigating bacterial infection and spread in elevators through new technology (Fig. 8). Current elevator interactions that might increase the spread of AMR bacteria were stated and alternatives were provided.
Fig. 8: Conceptualization of the SCD project– what is to be tackled, why, and what is the position? What do you want to say?
A mind map of existing technologies that are used to mitigate bacterial infection (not necessarily AMR) and its spread through tactile interactions was created (Fig. 9). The exploration with similar cases resulted in technological and non-technological ways to avoid spread of AMR, such as use of elbows and mobile devices to call an elevator.
The pattern generation activity resulted in themes that were representative of alternative interactions with high-touch surfaces, clustered as follows: fear of touching high- touch surfaces, using personal technology to interact with high-touch surfaces; non-tactile forms of interacting with high-touch surfaces in elevators; and antimicrobial surfaces (Fig. 10). Limitations were identified in each of the clusters, shown in Fig. 11.
Provoking questions were generated using a fast idea generator (Fast Idea Generator, 2014). Some of the questions generated were: “What if people teleported to travel from floor to floor?; How can we maintain private security if people are able to teleport?; What if there were no lobbies or hallways because people would just be able to teleport to where they need to go?; How can we learn how to teleport?; What if the elevator buttons were touchless?; How would the decreased use of the sense of touch within the community affect mental health?”; and, “How would the decreased use of the sense of touch within the community affect mental health?” See Fig. 12 for all questions generated. These provoking questions were then used to generate hypotheses, following were shortlisted to take it forward to the design and develop phase: “Through this system that uses touchless elevator buttons, I can generate inquiry around the integration of new technologies to mitigate AMR spread within the community.”
Fig. 9: Similar cases– Who is doing something related to your topic or problem? We listed current cases for reference then listed alternatives.
Design and Develop:
Equipped with a design brief for SCD (hypothesis), the student project presented in this paper as an exemplar developed an artefact that generates inquiry around the problem of AMR. The designer student brainstormed the keywords to communicate the features and characteristics of the artefact to be designed with other student designers and the teaching team: touchless, surface, AMR, bacteria, cross contamination, and ultra-haptic. This brainstorming allowed exploration of various design inquiry direction, finally deciding to look into ways to present AMR related issues through unempathetic and unfriendly experiences for the audience. We described features of the potential artefact, for example “How does it look?,” “How does it work?” and, “How does it achieve being critical?” (See Fig. 13).
Fig. 10: Clusters or patterns from the information gathered on AMR.
Fig. 11: Limitations identified for each alternative.
Fig. 12: Provoking questions generated using prediction generator.
The questions on the design functionality features led us to include quantitative elements to the design – for example interactions with the elevator buttons will become more user unfriendly as more people interact with them.
Next, a mood board visualising the design direction, specifically for methods of designing a user-unfriendly elevator was created. Inspirations to drive the design efforts were added to the mood board. Images representing the design functionality features, the look and feel of the design, depicting the feel, style, and visual characteristics of the prototype were added to the mood board. SeeFig. 14(L-R) for the visual explorations, such as: closeups of sharp spikes, dirty buttons, kin, an infected thumb, cheese grater, dark corridor, and a gel stress ball being squished.
Fig. 13: Description of the features of the design.
Fig. 14: Mood board helped envision the final design: top row left to right – (Spiky Architecture, n.d.; ATIS547, 2008; Blyth, 2002; MD, 2012), bottom left to right – (Cheese Grater, n.d.; Unsplash, n.d.; Li, n.d.; Stress Ball, Anti-Stress, Squishy, n.d.).
Deliver:
During this phase, the SCD brief (hypothesis) was revisited to question how it was being achieved and how design would be successfully critical. COVID-19 pandemic lockdown restricted our access to the fabrication lab and tools to create tangible prototypes. So, we focussed on developing a conceptual model using digital tools. Design ideas were sketched and combined with the visual explorations on the mood board. A conceptual model was developed in Blender, which is discussed in the next section.
Conceptual Model
The SCD design called, “Where Resistance Grows,” is a 3D-rendered elevator model. The design aimed to make people aware of the buttons they touch in high-touch areas, such as elevators, and how they contribute to spread of AMR. The design was deliberately made unfriendly to imagine different ways of interacting with surfaces in elevators. The unfriendly behaviour from the design sparked a discussion and inquiry. Some ideas explored were slime or hand sanitizer being dispensed upon pushing an elevator button (see Fig. 15), or, buttons becoming spiky when pushed (see Fig. 16). With the intention of creating a user-unfriendly experience that generated inquiry into the spread of AMR, the design also played with the idea of the surfaces becoming representations of infection when they are interacted with (see Fig. 17). The high-touch surfaces are equipped with pressure sensors that sense and track the frequency of interactions with elevator surfaces. The surfaces swell into large pustules deforming the surface. The size of the pustules increases with the increase in the number of tactile interactions with the surfaces. The deforming surfaces are complemented by audio that emphasize to people the urgency of addressing AMR.
Fig. 15: When a resident pushes the elevator button, the button dispenses slime or hand sanitizer like a pump dispenser.
Fig. 16: When a resident pushes the elevator button, it activates sharp spikes that do not go away until the button is sanitized and reset.
Fig. 17: As more people touch the elevator buttons, they become inflamed and discoloured just like a bacterial infection in humans.
Three renders of the conceptual models were developed to test the colour, lighting, and patterns, see Fig. 18. Screen captures of the animation for the conceptual model are shown in Fig. 19.
Fig. 18: 3D models of SCD to test lighting and colours.
Fig. 19: Screen captures from the animation of the final model.
Design Inquiry
The artefacts generated out of the SCD process–the conceptual gif model and the poster were presented to other designers, students, and global health researchers at an online exhibition for discussions. The analysis of the discussions generated through the artefacts revealed two main themes:
Lack of information about AMR in public
The artefacts generated a sense of curiosity amongst the general public (non-experts) who unanimously expressed their lack of knowledge about AMR, how antimicrobials are transmitted in the system, and the implications to the health and economy sectors. Global health researchers and policy makers played the role of experts; they provided information to the audience about the implications and sources of AMR. People participating in these discussions realized that their personal choices and behaviors, such as consumption of antibiotics, meat products, agricultural practices, water sanitation and hygiene (WASH), and wastewater management practices contribute to the spread of AM.
Thus, a direct design implication was to generate awareness about AMR, best practices in agriculture, consumption of medication, and methods to maintain hygiene and sanitation. Firstline, a Canadian health technology company, has partnered with the World Health Organization to develop a new gold standard resource–AWaRe Antibiotic book– to help countries fight against antimicrobial resistance (AMR) and guide health professionals to select the best antibiotics for their patients. The objective was to help healthcare practitioners make right decisions about medication prescription, significantly increasing access to antibiotics through the power of information and service design (Firstline, 2022). However, it is also necessary to see a change in human behaviour accompanied with structural changes, such as innovations in policy, governance, and legal. Design can play a role in facilitating these changes, through service, and product design initiatives.
Need for One Health approach to create impact at a systemic level.
The problem of antibiotic resistance is not restricted to people and their health. The consequences of inappropriate human choices and behavior is having a global impact on the animals, plants, and environment that we live in. Thus, one disciplinary approach is not enough to tackle wicked problems such as AMR. Experts from multiple disciplines need to come together to apply their disciplinary methods and knowledge to address the unified goal of eliminating AMR. However, this collaboration also needs to: improve access to existing antibiotics, boost development of new antibiotics, and develop effective stewardship practices to protect existing antibiotics from becoming ineffective (Hoffman & Outterson, 2015, pp. 6-11). Daulaire et al. explains that this is because “Ensuring universal and appropriate access to essential medicines is a necessary precondition to any policy on restricting the use of antimicrobials in low-income settings; absent this, any restriction is likely to be ethically and politically challenged, or simply ignored,” (Daulaire et al., 2015, pp. 17-21). A One Health approach is gaining recognition globally as an effective way to fight AMR related issues at the intersection of animal, human, and environmental factors. The approach is collaborative, multisectoral, transdisciplinary, and aims to achieve optimal health outcomes, considering the relationship between human, animals, and their shared environments. It is important to involve stakeholders from human health (e.g., doctors, nurses, public health practitioners, epidemiologists), animal health (e.g., veterinarians, agricultural workers), and environment (e.g., ecologists, wildlife experts), also including groups such as law enforcement, policymakers, agriculture, community groups, pet owners, etc.
The role of design and designers is manyfold. Design research could facilitate collaboration, coordination, and communication between these stakeholders through codesign and participatory design activities and various design disciplinary knowledge could contribute to the design of products and services to support the interventions and solutions cocreated by the stakeholders.
There is limited work that uses the One Health approach involving designers to tackle AMR issues. For example, the dust bunny project in the UK (Darby et al., 2021) are taking an interdisciplinary human-centred approach to design policies and resources around AMR. Design research methods, combined with microbiology science, are providing solutions to cleaning and sanitation in Ghanaian households. Introducing AMR in curriculum to train students and researchers in tackling wicked problems is required. In Canada, the DESIGN project is integrating systems with situational, legal, comparative, and impact analysis with Design thinking methods to identify interventions for tackling AMR in low-, middle- and high-income countries (Wiktorowicz, 2023).
Understanding impact of Human Behaviour on spread of AMR
Previous and current works on AMR primarily focus on amendments to policy, governance and law pertaining to factors controlling AMR. People are often not included in the study of systems where there are high risks of spread of AMR. It is important to understand how human behaviour, for example, such as consumption of antibiotics, agricultural practices, and domestic household practices affect the spread of AMR and in turn affect the success or failure of resources and structures in place. The discussions also brought up an important issue of existing disconnects in the systems between policy design and human consumption of the policies. Often the information is lost or miscommunicated during the policy administration. Thus, an effective journey and connections between the policies and their use by people and human behavior must be designed.
Implications to Design Futures Education
The SCD introduced in an undergraduate curriculum through the Speculative Interaction Design course (YSDN 3006) is a step towards educating students about wicked problems and UN SDGs. The course delivery followed the principles of experiential education, with an opportunity for students to work on a real-world problem and collaborate with inter-disciplinary stakeholders (author 1 et al., 2021). Introducing undergraduate design students to SCD methods offers a new perspective to view design as an inquiry tool rather than a problem-solving tool. This is critical because problem-solving design approaches often result in new products, promoting consumerism and leading to other systemic challenges. SCD also offers students a platform to use critical and creative thinking in their design process and outputs. For example, mapping the current research to future scenarios required students to extrapolate signals from today into the future. Visualizing these scenarios for inquiry required students to harness skills at the intersection of critical and design thinking.
In the future, the course will include systems thinking and mapping at the Discovery & Define stage to allow students to understand the systemic relationships of AMR and better appreciate the One Health approach. A futures systems map will be generated to understand the implications of the signals in the future.
Introducing SCD in design education is important for training design students to empathize with humans, animals, and the environment. However, integrating SCD in design education requires an interdisciplinary teaching team, student groups, and a studio environment with making and prototyping facilities. There could be institutional barriers, such as faculty load assignments and semester teaching schedules in incorporating interdisciplinarity in the course. In the future, vertical studio teaching will be explored to bring students with different design skills and levels together, and the course will also be offered to graduate students.
Design futures will also be introduced in a cross-campus capstone classroom–C4– which will bring together students from different disciplines (faculties and schools on campus) with diverse skills and knowledge to work on a partner (both industry and community) project (York University, 2022).
The students’ key takeaways from the Speculative Interaction Design course (YSDN 3006) were – (1) the introduction to SCD tools and approaches, (2) role of design as an inquiry tool to generate a critique around wicked problems, and (3) how AMR is a growing global health wicked problem. The course influenced individual students’ knowledge around the AMR threat and SCD as a critical and discursive tool. Reflecting on the delivery and outcomes of the course, it is important to acknowledge the limitations of a remotely delivered studio course. Although, the limitations were mitigated to some extent using digital tools, such as Zoom, Miro, and Padlet to substitute in-person activities, online tools alter the exploration of critical and creative thinking. The in-person class post covid uses tangible tools, such as Lego Serious Play, to sketch and map activities while designing future scenarios. We are exploring tangible making of the future scenarios in the classroom, resulting in physical tangible outputs.
The animation video of the conceptual model and a poster generated as artefacts for generating enquiry around spread of antimicrobials (AM) is available here: https://padlet.com/satslab/bpwug8ur81ju92rj. The conceptual model was developed as a .gif output and presented to stakeholders and public in an online exhibition.
Acknowledgements
We are thankful to the students in the course for their trust, patience, and hard work as they explored a new perspective of design that they had never been exposed to before. The work was funded by the Academic Innovation Funding (AIF) at York University in Toronto, Canada.
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