Child-Centred Design for Health
Play and storytelling are important aspects of children’s learning about serious issues in health and medicine
Typically, design for child health is made by adults and the resulting designs are top heavy on the serious nature of medical information. Obviously, tech for health must foreground medical accuracy, but my work on designing play to improve health outcomes shows that adult designers are missing two crucial aspects that might make a big difference to children’s uptake and interaction with medical products- play and storytelling.
Understanding the importance to children of play and storytelling in medical contexts came about through a two-year Innovate UK-funded research and development project. We included children in creating a mixed realities play kit to help reduce the need for a General Anaesthetic (GA) among children undergoing a Magnetic Resonance Imaging (MRI) scan. Details of the outcome of the project can be found here, but the intention of this article is to show how making the project child-centred brought about new insight into what children want from technologies for health.
I led the project by working across both my roles in industry and academia, however the development of the play kit sat entirely within Dubit, a company specialising in digital media for kids. We won the funding on two key factors: that Dubit would apply its expertise in children’s play and entertainment to the medical space, and the potential to reduce the huge cost of routinely giving children a general anaesthetic in preparation for an MRI scan.
Why are young children routinely given a general anaesthetic to have an MRI?
MRI is a non-invasive scanning method that employs strong magnetic fields and radio waves to examine parts of the body. An MRI scan is used to facilitate diagnosis, help determine treatment and evaluate its effectiveness. In 2016–17, 142,020 MRI scans were carried out in England on children aged 0–14 (Dixon, 2017). Dixon (2017) also notes that MRI activity is expanding rapidly with an increase of 10% between 2015–16 and 2016–17. However, a successful MRI scan relies on the patient being absolutely still for long periods of time to produce the high quality images needed for diagnostic purposes. As parents and medical staff worry about young children’s ability to lie still, many opt for a general anaesthetic, but hospital play specialist have developed effective means of preparing children that alleviate the need for a GA. Embedding this knowledge in a play kit that children could use at home would reduce pressures on the limited number of hospital play specialists in the UK.
Co-design highlighted the potential of play and storytelling in the design of child health
To ensure effectiveness, we chose to include children throughout the design and development processes.
Bayer Healthcare (2014) suggests that there are a number of frequently asked questions by children and young people in relation to preparing for an MRI scan. These are concerned with what an MRI is, whether it will hurt, its safety, and how it works, whether the noise can damage hearing, who performs the scan and how long it takes before the patient can return home. Our participants had largely the same concerns.
It is an ethical responsibility in designing research methodologies to use with children that they be engaging and related to common practices in their daily lives. For this reason, I use collaborative art-, play- and design-based methods, and this is how we found the benefit to children of play and storytelling in exploring medical information. I use physical making, playful interaction and drawing when gathering data with young people, and this carries through to the design process based on those findings.
For this project, traditional research methods were unable to address the design and development needs (Van den Akker, 1994). So, the wider research team (Jill Thompson and Penny Curtis, University of Sheffield; Amy Clark, Dubit Research; and Steve Love, Glasgow School of Art) and I used drawing, making and game play, which were considered as participatory design methods.
As we deployed these methods, the child participants continually included fictional elements in their play and story worlds to make sense of the factual medical information.
Drawing- Child participants drew themselves and their favoured forms of physical and digital play. Their ongoing conversations during this activity were captured using a voice-recorder placed in the middle of each group of children. The recorders captured spontaneous conversations about their drawings, as well as answers to the researcher’s specific questions about their favoured types of play, why they like them, and with whom and where they play. This method was intended to produce insight into children’s existing play practices so that we could build on these when developing the play kit design. The intention was that a product that tied in with children’s existing interests would make it more likely that our new product would be used after production.
Several months later, we used drawing as a means of developing character designs for the play kit app. As is shown in the image on the left children drew on top of designs to express changes they thought should be made. Children added details onto the characters such as accessories, or altered facial features. They also suggested that having Father Christmas as the doctor could be funny and make children laugh when they were worried.
Model-making- As a means of introducing children to the MRI process, a verbal explanation was given along with photographs of scanners. Children had lots of very detailed questions about what made the scanner so noisy. They were interested in the technical explanation of how they contained very strong magnets, but they also used their imagination to produce stories of clearly fictional elements of what might be causing the sound.
Children were separated into small groups and asked to assemble a model MRI scanner from pre-cut cardboard pieces prepared by the design team, based on pictures of an MRI scanner and a pre-made kit. Additionally, each group was provided with decorative items, such as coloured pipe cleaners, paper, pens and tape to customise the MRI scanner they had built. In order to offer motivation and further understanding of the purpose for what they were building, each group was also given a small toy character that “needed” an MRI scan. The child-participants were asked to consider how their character might feel if they were to have an MRI scan, and if there was anything they could do to customise the scanner to allow their character to feel more comfortable. Our research team observed for common problems, barriers and motivators in constructing the kit, and roles taken on by children when constructing, customising and playing.
This method was based on the notion that ‘design development activities, such as model-making were reported to be more enjoyed and appreciated by children’ (Birch et al, 2017, p.249). Further, providing each group of children with a set of pre-cut materials acted as a form of cultural probe, which Gaver et al (1999) describe as an assemblage of materials ‘designed to provoke inspirational responses’ (p.22), which in turn is a method that combines well with the strong correlation between making and thinking (Ingold, 2013; Mäkelä, 2007).
Such ideas were even more important given the age of the children (4-10-years), who might find verbal, written or more traditional means of offering their ideas to researchers challenging. James (2013) describes this as the ‘fundamental embodied’ ways young children exist and make sense of the world. Further, in his seminal text ‘Before Writing’, Kress (1997) also suggests that different modes of communication beyond speech and writing ‘give rise to their specific forms thinking’ (p.xvii), suggesting the use of design and making methods for a design and development project!
Children’s engagement with the model making followed many of our preconceived ideas for how they would respond. However, there was also a very clear theme of storytelling and play that emerged from the findings. As can be seen above, the toy characters were a vital part of the children’s final designs. Not only did they consider how toys might be feeling in relation to having a scan, but they also role-played why they were having a scan in the first place (including from having eaten a dog!).
Additionally, children brought in elements from completely imagined characters. For example, one group imagined that their toy character needed to be scanned with a giraffe, and as a result the scanner would need more than one entry point. Further given the shape of a giraffe they would need that entrance to be a completely different size and they set about building the addition with coloured pipe cleaners.
I believe these findings are not unusual to the ways in which children make sense of the world around them, combining fact and fiction to build knowledge. For those of us that have young children in our lives we will be aware of this as an everyday practice. It is only surprising that we are not utilising this more in products designed for their learning- in this case in the context of health education.
Bayer Healthcare (2014) A parent’s guide to MRI.
Birch, J., Parnell, R., Parsarika, M. & Šorn, M.(2017) Creativity, play and transgression: children transforming spatial design, CoDesign, Vol. 13(4), p.245–260.
Dixon S. (2017) Diagnostic Imaging Dataset Annual Statistical Release 2016/17 [Internet]. Leeds; 2017 [cited 2018 Apr 8]. Available from: https://www.england.nhs.uk/(https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2017/11/Annual-Statistical-Release-2016-17-DID-PDF-1.5MB.pdf)
Gaver, B., Dunne, T. and Pacenti, E. (1999) Cultural Probes. Interactions.
Ingold, T. (2013) Making: Anthropology, Archaeology, Art and Architecture. London: Routledge
James, A. (2013) Socialising Children. Studies in Childhood and Youth. London & New York: Palgrave.
Kress, G. (1997) Before Writing: Rethinking the paths to literacy. London & New York: Routledge.
Mäkelä, M. (2007) Knowing Through Making: The Role of the Artefact in Practice-led Research. Know Techn Pol , Vol. 20, p.157–163.
van den Akker, J. (1994). Designing innovations from an implementation perspective. In T. Husén & T. Postlethwaite (Eds.). The international encyclopedia of education (pp. 1491–1494). Oxford: Pergamon Press.