Image: Michael Berthaume and Nicola Bailey, King's College London
Poor understanding of users makes many research projects self-serving, say Michael Berthaume and Nicola Bailey
In low- and middle-income countries, lower-limb amputees have access to two different kinds of prosthetic foot. In the UK, more than 30 are available.
The idea that patients’ needs vary more in the UK than in, say, Sri Lanka, Cambodia or Tanzania is clearly absurd. Rather, this bias towards the global north stems partly from a lack of engagement with the people who will be using the product or process being designed.
Unless universities design products alongside and for communities, they risk extending this bias, benefiting themselves to the detriment of the people they have pledged to help.
In a recent visit to the Sri Lankan School of Prosthetics and Orthotics in Ragama, this lack of understanding became apparent as we looked to share affordable and cutting-edge technology in prosthetics research developed in the UK.
Crash and burn
Smartphones, for example, can take 3D scans of patients’ bodies. But reduced hardware performance and software compatibility meant we could not download apps onto collaborators’ phones, which overheated and crashed.
More generally, barriers including financing, climate and differences in skillsets and resources prevent solutions such as 3D scanning and printing from taking off in places like Sri Lanka.
We realised that—as often happens when researchers from universities in high-income countries engage with groups in LMICs—we did not understand the realities of the people using our products, be they patients, the prosthetists who design and fit artificial limbs, or manufacturers. In prosthetics, this leaves people unable to walk or use limbs.
If we had carried on using 3D-scanning technology in Sri Lanka, we could have produced an impact case study through engaging an underserved community, but we would not have been serving them.
The solution is fieldwork, but fieldwork done right.
Get out there
Engineering researchers are making more effort to learn about users’ needs and expectations. But this information is usually gathered from behind a desk, in a conference room, or in a lab, via routes such as focus groups, literature reviews, reports and social media. As a result, the data, and its interpretation, are artificial and biased.
Fieldwork involves meeting users in the real world. Being in their environment brings unique perspectives, particularly around environmental and cultural challenges.
In Sri Lanka, imported prosthetics with metal components—for example, split-hook arms—can rust quickly in the humid air and seize up. Without observing how prosthetics interact with the environment, this problem, and its solutions, may have been missed.
The design process doesn’t end when the product is delivered but when it’s accepted and used by the community. For this, fieldwork must continue for months or years after devices have been provided. This requires methods from the social sciences, such as ethnography, to give researchers a more complete understanding of how their product might be used.
For example, watching Sri Lankan amputees cook in their homes highlighted how their kitchen arrangements, methods and utensils differ from those in the UK. Lower-limb prosthetics were used as pivots and for stability rather than for walking, impacting their usage and the level of flexibility needed.
Fieldwork is also needed close to home. In June, quadruple amputee Alex Lewis rowed across the south of England for charity. Without studying how he used his body weight to row the boat, designing the prosthetics that helped him complete the challenge would have been impossible.
Truly impactful
To make their work truly impactful, universities must make fieldwork part of the engineering and design process—in engineering education and in research and industrial projects. Students should be encouraged to be interdisciplinary, studying social science skills so they can gather and interpret the information they need.
Funding institutions need to normalise the idea that design projects do not end until a product is successful and accepted in the environment it was designed for. Impact should be judged by how products perform across their lifecycle. This approach will help researchers in any field create designs that are optimised for the needs of the people they are trying to help.
Engineers are tasked with creating new technologies, yet a lack of meaningful engagement with end-user communities means these technologies often fail in unforeseen ways. Fieldwork may not be a silver bullet for product design, but it can lead to better products for the longer term.
Michael Berthaume and Nicola Bailey are in the Department of Engineering at King’s College London