A reflective tool to consider notions of healthcare community participation in design

This paper aims to interrogate the meanings and assumptions related to the term ‘participation’ in design with and within healthcare communities. Drawing on a PhD case study that focussed on patient engagement in spinal cord injury (SCI) rehabilitation, it aims to contribute to this discussion with a novel framework that considers the epistemologies of both healthcare and design. The proposed framework is informed by well-known models in this area, including Arnstein’s Ladder of Citizen Participation (1969), critiques the hierarchical nature of such models, and expands on them by proposing temporal considerations of a design process. The framework encompasses a variety of healthcare community stakeholders at different stages of the design process, and prompts consideration of the role of the designer within such co-design practices. For the author, the act of populating this framework facilitated a much deeper understanding of how the design methods employed facilitated meaningful participation (or not) within the PhD study. It does not presume to fully define the nature of participation, rather it hopes to provide a starting point for other designers and healthcare practitioners to adapt it to their own contexts, and facilitate collective reflection within and between the fields of design and healthcare.