Prosthetic pride

Foto's: Wolfgang Moll

Photo’s: Wolfgang Moll

An artificial leg, a hearing aid, a dust mask: there is a fair degree of stigma attached to some products. How do you deal with that as a designer? Kristof Vaes completed his doctorate on this subject in a joint study by the University of Antwerp and TU Delft.

An asthmatic child who has to wear a dust mask to filter out fine dust particles doesn’t want to look ill or weak. That was the starting point for Flemish product designer and lecturer Kristof Vaes when he was asked to design just such a mask in 2008. How can you make a mask like that not only acceptable, but pleasant or even fun to use?

Vaes found this such a fascinating assignment that he chose it for his doctoral research into product-related stigma: social disapproval associated with a particular product. People’s experience of all kinds of protective equipment and medical products can be unpleasant or uncomfortable. And many of them are not well-designed either, says Vaes. ‘They have been developed by a medical team, for whom ergonomic and physiological considerations are paramount,’ he says. ‘It needs to function properly in a technical sense, but scant attention is given to the emotional side of the story.
Although for some products, that is now happening – wheelchairs for example.’

How can you help designers in creating products and ensuring that they are appreciated as much as they are needed? In studying this, Vaes’s initial focus was not on the users, but on bystanders or passers-by. They can cause feelings of unease by making comments, staring, or keeping a greater distance than normal when they pass by. ‘That can be very confrontational, even if the user feels fine with the product,’ says Vaes.
He says that the cultural context also plays an important role. ‘In the West, we associate a white dust mask with the fear of contamination, while in Japan people actually wear such a mask out of respect, in order not to infect others. Or let’s take the walking stick: for us it’s a symbol of old age and disability, but in African countries it’s a sign of wisdom. As a designer, you need to know about cultural differences like these before you start designing.’

Sometimes it is not so much the product itself, but using it that can be the cause of social stigma. ‘If I had to inject myself with insulin in a public space, I would have to bare my arm and stick a needle into it. As a designer, you can play on how other people might react to that.’ For example, when people see someone with a severe deformity, according to Vaes they often have an instinctive, gut reaction: they are scared or surprised. ‘It is difficult to suppress this reaction; it happens in the first few milliseconds. After that, people may be extra friendly, or they might smile at the person: this is a more conscious and deliberate response. These are the two phases when people encounter someone with a stigma-related product. “

According to Vaes, designers can work on that initial shock moment, so that it definitely will not occur. And they can ensure that during the second (conscious) phase of the reaction, people see a more positive image, for example by adding big sporty tyres or attractive wheel rims to a wheelchair. Or by designing it without handles, which removes the suggestion that the wheelchair user needs to be pushed.

Design of a pressuremask by Gert van Laar

Design of a pressuremask by Gert van Laar

To measure product-related stigma, Vaes conducted a range of experiments. First he gauged the gut reaction of the test subjects by showing them pictures of people with and without various types of masks. But that method turned out to be too far removed from reality.

So he sent sixty Master’s students out into the streets of Antwerp for three days wearing a mouth mask. They had to get a friend to shadow them, take photos and report what they experienced. They found among other things that people in buses would sit further away from them. Vaes then set out to measure what is known as the interpersonal distance – a parameter from social psychology.

‘Using cameras, we looked at how people reacted when they encountered someone with a mouth mask in a controlled space, how they walked past them and if they looked at that person. If the passer-by walked past the mask wearer, we measured how much distance there was between them. For people without masks, the average was 110 centimetres. For people wearing a white dust mask the distance was fifty centimetres further.’
We found that the white dust masks caused the most extreme reactions, people kept a greater distance with those. People reacted less to neoprene masks in bright colours. Prototype masks with a transparent mouthpiece were found to be less off-putting, while a mask incorporated into a bandana (a ‘shawl mask’) was often do not even recognised by people as a mask at all.

Vaes devised two design tools to help designers to develop the right products. The first was an estimation model for stigma products: the Product Appraisal Model for Stigma (PAMS). This is a checklist of 27 questions for designers in order to help them explore the context in advance. The idea is that designers can use this model to identify the main sensitivities relating to stigmas.

He presented this questionnaire in the form of a cardboard pyramid with nine questions on each side, relating to the perception and use of the product. ‘How do people notice the product? How does that correspond to the goals of the user, the by-standers or the culture? Are there conflicts between these aspects? Are there confrontational moments when using the product? If I shake hands with someone who has a flesh-coloured artificial hand, what surprises me is not so much the visual aspect but the fact that the hand is cold. These are sensitivities that designers can discover in advance.’

Courtesy of 3D-systems

Artificial leg can be made from lighter and stronger materials

The second design tool that Vaes devised was a set of cards with seventeen possible design strategies: the Product Intervention Model for Stigma (PIMS). ‘These approaches or strategies are meant specifically to inspire designers to reduce stigma,’ says Vaes.He developed the set of cards after
studying 200 to 250 examples of well-designed products. ‘I looked at how they had done it, briefly describing each strategy and giving one or two clear examples of existing products.’

The cards can be divided into three sets: The first set of thirteen encourages the designer to keep the product free of negative associations. This can be done through de-identification, for example. If a user does not wish to identify with the product, the designer can make use of camouflage, flesh-colouring or transparency. People’s attention can also be diverted towards something else.

Of course, distracting attention from their own products does not come naturally to designers. Another strategy is to personalise the product. ‘We want users to feel proud. For example, you can allow someone to choose from two hundred snowboard helmets with different prints, or you can design a prosthesis on the basis of a personal interview. This ensures the user feels good about the product, and it reinforces the character of the user.’

Another product strategy involves the avoidance of confronting elements during use. As an example, Vaes holds up one of the cards showing an insulin syringe that is concealed inside a pen, but designers might also be able to make sure that users have to use the product as little as possible. ‘Let’s suppose we could make a dust mask with a built-in sensor that measures when the concentration of dust is very high, so that you need to wear the mask only when it is really necessary. This is also really nice – two Swedish designers built this cycling helmet into a kind of scarf. It’s actually an airbag that inflates over your head in the event of a fall.’

Materials and new technologies can also be put to good use. An artificial leg can be made from lighter and stronger materials, for example, and a hearing aid can appear smaller if it is transparent. Finally, a designer can align the product with an accepted existing product. A familiar example is a hearing aid that is integrated into the frames of glasses or a helmet that is almost invisible under a hat.

'We found that the white dust masks caused the most extreme reactions, people kept a greater distance with those.'

‘We found that the white dust masks caused the most extreme reactions, people kept a greater distance with those.’

Social behaviour
A second set is based on the principle of ‘user empowerment’. Here, designers make use of extra features that other users might be jealous of, like the blades of the bladerunner. ‘One student designed a mask where the filter was built into a toy figure that you could attach to the shoulder of a child, to their backpack for example. There is no additional functionality, but it makes the child feel stronger. Or you could add a pair of lips onto the mask. That kind of humorous, disarming touch can really help.

The third and final set of cards relates to cultural aspects. Vaes talks about how to launch a product, for example. ‘You can use famous cyclists to promote cycle helmets. You could also promote social integration. If you are designing a park bench, include a place that someone can put their wheeled walker or wheelchair under. Then they can actually participate in a conversation without people’s attention constantly being drawn to their wheelchair.’

Vaes is convinced that these design tools can help to reduce product-related stigma. Thinking back to his original design brief – a dust mask for asthmatic children – he would make the mask transparent. ‘That makes it more friendly, because then other children can see when their friend is smiling or laughing.’

Vaes would not incorporate the filter into the mask itself, so the mask does not get too heavy. ‘We can use a transparent tube passing over the shoulder to connect the mask to the filter unit, which is very compact, about the size of a Coke can. You can then put the filter unit inside a backpack, like a water bottle on a bike. You can also incorporate it in a fun way.’

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