A well-designed artefact is of little value if it never reaches the hands of a user. Several other factors must also be in place before a person will have the need, desire and opportunity to begin to use a design. The field of design has become highly sophisticated in its approach to user involvement in order to produce better designs. However the quality of a design outcome can only ever take it so far towards ensuring it will actually enter the hands of potential users. This is especially true in the medical domain where the use of a medical device is determined not by consumer choice, but by the progression of a medical condition. In this situation becoming a user may significantly compromise a persons sense of identity but delaying use beyond a certain point can have serious consequences for their health and wellbeing. Design has an important role here by addressing what happens before people begin to use a device. By turning the attention of design to finding opportunities to diminish the impact of use on peoples sense of identity, and creating more favourable circumstances for people to become users, a greater number of people could be encouraged to begin using medical devices at a point where it will give them the most medical benefit.
This dissertation presents a sustained investigation into how design can respond to what happens before people become users. It consists of five papers in which the notion of ‘pre-users’ is introduced to describe people who are not yet users of medical devices, but are in position to be so now, or in the future, due to a progressive medical condition. It goes on to illustrate the contribution pre-users can make to design as part of project run in collaboration with two medical device manufacturers, and shows how design and innovation processes that focus on user involvement can be adapted to involve people who represent pre-users in design.
As part of this dissertation the key characteristics of a pre-user driven design process are outlined. This includes demonstrating that a pre-user driven process requires a shift in mindset from directly trying to solve problems or meet needs, to identifying opportunities to indirectly influence whether or not people will become users. It also shows how focusing on pre-use lends itself to having multiple design outcomes that ‘complement’ each other.
A key characteristic of pre-user participation is identified as a need for sensitivity towards the pre-users relationship with the project objective. Approaches to accommodate this are proposed, including two strategies of indirect enquiry. These are exploring controversy through abstraction and combining controversy with recognisability, which can be employed to explore potentially controversial issues in a sensitive and non- confrontational manner.
This dissertation makes two additional contributions as a consequence of the investigation into pre-use. The first is identifying that the momentary displacement of use as the focus for design in order to identify other important relationships, could in general be a useful approach for design. The second contribution is a methodological one, describing how artefacts that embody analytical understandings but are designed to provoke responses in an open-ended manner, can serve as exploratory research tools for design.
Overall this dissertation this dissertation contributes to design research by outlining how the concepts of pre-use and pre-users can be useful for design, including describing how user driven approaches to design can be adapted for a pre-user driven process and what needs to be taken into consideration when organising pre-user participation. In it provides two extra contributions, firstly about the benefits of momentarily displacing use as the focus of design, and secondly how artefacts and design concepts can serve as exploratory tools in a design research process. For industry, the approach outlined in this dissertation is of interest to any companies whose product uptake is similarly affected by issues that are indirectly related to the quality of the product itself.