3.1 Interpretive Content Analysis

For our study we chose to conduct an Interpretive Content Analysis (ICA) to explore CD as a new way of looking at certain design endeavors. ICA is a systematic method for exploring and describing meanings within various communications (e.g., books, images, physical artifacts, audio/video files, other media) (Morgan Reference Morgan1993; Drisko & Maschi Reference Drisko and Maschi2015). Furthermore, it departs from traditional qualitative content analysis (Calloway & Ariav Reference Calloway and Ariav1995; Hsieh & Shannon Reference Hsieh and Shannon2005; Magenheim et al. Reference Magenheim, Nelles, Rhode, Schaper, Schubert and Stechert2010; Schreier Reference Schreier2012; DeFranco & Laplante Reference DeFranco and Laplante2017) by respecting latent and contextual content (Drisko & Maschi Reference Drisko and Maschi2015) to prevent latent content from being overlooked and to maintain the distinctive nature of individual cases (Drisko & Maschi Reference Drisko and Maschi2015). Researchers use ICA not only to describe content and meanings by answering questions of ‘what’ and ‘how’, but also to make inferences about intentions, thoughts, and feelings. These inferences are based on various forms of communication by answering questions about ‘why’, ‘for whom’, and ‘to what effect’ (Krippendorff Reference Krippendorff2013; Drisko & Maschi Reference Drisko and Maschi2015).

This methodology offered a contextual advantage for identifying explicit manifestations of CD as well as inferring considerations for dignity, empowerment, and security from latent or symbolic content within the cases we explored (Ahuvia Reference Ahuvia2001; Drisko & Maschi Reference Drisko and Maschi2015). Interpretive, contextualized inferences made it possible to make judgments about the intentions, thoughts, or feelings of the subjects in each case (Drisko & Maschi Reference Drisko and Maschi2015), particularly as they related to the core components of CD (i.e., dignity, empowerment, and perceptions of security). Furthermore, ICA allowed us to extend the foundational exemplary cases by expanding the data (Schreier Reference Schreier2014).

3.2 Selection of cases

Case selection was loosely based on qualitative sampling techniques in that the ongoing process of adding more cases took place during data analysis and we focused on a purposive sample of cases (LeCompte, Tesch & Goetz Reference LeCompte, Tesch and Goetz1993; Drisko Reference Drisko2003; Drisko & Maschi Reference Drisko and Maschi2015). This ongoing process was especially appropriate for this study because new cases were added for analyses as we discovered them. This procedure also allowed us to continue to expand our data.

Table 1. List of cases that were analyzed and helped in framing CD

We found a number of cases where the designer expressed a deep concern for the users in vulnerable situations, approached the problem with a ‘helping the user’ instead of ‘solving a problem’ mindset, and paid special attention to the needs of the users that affect their sense of dignity, empowerment and security. A list of the 12 cases that we analyzed is given in Table 1. These cases are videos of various designs (products and services) wherein the designer has intuitively considered the emotions of the user in the problem-framing phase of design. We identified potential cases in an ongoing process as we developed the concept of CD. These cases have been chosen for explaining CD as they exemplify the use of CD. All these cases are based in contexts where the user is emotionally engaged and deeply affected by the problem, thus making her/him feel vulnerable and not being able to influence the situation she/he is in; cases exemplify feeling less dignified, less empowered and less secure. CD can be applied to any design problem, from that of a simple everyday object to that of more complex situations like in health care or contexts with fewer resources, as in the cases described in this paper. A CD approach is intended to enhance the dignity, empowerment and security of a user in general, but it is more applicable in situations where a lack of these can be identified to negatively influence the experience of the user. For example, CD is better suited to change the experience of a person from feeling inferior to feeling empowered than feeling empowered to feeling superior. It can be applied to any design problem which focuses on helping the users feel less vulnerable, threatened and more in control of the situation, for example, they have control on how their peers view them, or they feel empowered to change their current situation or feel more secure in their surroundings. The more extreme cases have been chosen to explain the development of CD as the users’ feelings of dignity, empowerment and security or the lack of these, are easier to notice in situations which have a high level of emotional engagement. For example, when one chooses to not wear a prosthetic leg to avoid feeling awkward and out of place even at the cost of this adversely affecting her/his life, we can see that ‘feeling dignified’ is important to the user. The severity of this cannot be compared to a situation when one feels awkward using an everyday object, like a wristwatch or water bottle and decides to not use it. Hence, we have chosen to explain CD using more extreme cases that have a bigger impact on the users’ lives. Quotes from the various cases that reveal a deeper concern for the user as expressed by the designers are listed in Table 2. These also reflect what seemed to motivate the designers and their influence on how the problems were framed.

Once a case was identified, it was shared with the research team (the authors) to discuss if it was suitable to be considered for analysis. Videos of these cases were chosen for analyses as they provided more insight into the thought processes and motivations of the designer.

Analyzing video data had many advantages (Jacobs, Kawanaka & Stigler Reference Jacobs, Kawanaka and Stigler1999). They were rich with language, visual content and could be watched and discussed multiple times. Videos were used as the designers would often ‘talk’ about their motivation to solve a problem. In printed media, the details of the product were there but the whole story of the design was often not mentioned. Even though we recognize that using videos had limitations like being edited, they were a readily accessible source where we could hear the designer talk about their stories. All the videos were either talks or interviews, where the designer verbally shared first-hand information about the design and how it came to be, which was typically missing from the printed media. The printed media typically contained information about the product and how it impacted the life of the user after the solution was created, but the videos were more impactful in the way the designers shared their stories of design, how they felt about the user and about their motivation to help the user. In their talks and interviews, the designers recollected their approach to the problem and why they actually wanted to solve it.

The coding of the videos occurred in many phases and revealed information that a mere transcription or audio recording could not. For example, one could see the facial expressions of the designers such as how perturbed they were to hear about the problem or how passionate they were about solving the problem. Watching and hearing the designers talk about the motivation and conception of the idea helped us to understand how and why the problems were approached in a certain way that made a difference in framing the problem. We observed that there were similarities among the ways that the designers (in our cases) approached their problems; all of them were intuitively using approaches similar to a CD approach.

Table 2. Quotes from the designers that reflect deeper concern for the user

Table 3. (A) Examples of questions that guided the researchers during analyses. (B) The emerging themes of CD that have been related back to these questions

3.3 Analysis of cases

As mentioned earlier, the development of CD was not a linear process (Figure 4). The main cases that helped the researchers to notice the differences in approach of the designers were Jaipur Foot, Darfur Stove and GE MRI. Looking for similar motivations of deep concern and empathy for the users from the designers, the researchers found more similar cases. After the preliminary analysis of these six cases, the initial set of themes that defined CD emerged: dignity, empowerment, safety, health and happiness (Seshadri et al. Reference Seshadri, Reid and Booth2014). The coding and analysis here were ‘not literal, but [were] arguable low-inference interpretations’ (Drisko & Maschi Reference Drisko and Maschi2015). These interpretations were used in the light of the context and latent content in the cases to develop the initial set of themes for CD during the preliminary analysis.

In the next phase, these cases were analyzed alongside new cases to conclude that happiness and health are generic themes and not unique to these cases. During the next and final phases of analyses, the researchers approached the analyses of the cases with three main themes: dignity, empowerment and safety. While listening to the videos, we were looking for the latent content or meanings that alluded to these themes. Examples of questions that guided the researchers are presented in Table 3.

The initial discussions were guided by the notion of dignity, empowerment and security being absent or present, which also informed the questions shown in Table 3. After the themes began to emerge, we discussed how these user needs could impact the users’ lives and formalized these discussions into a list of questions that were then used in the later stages of the study. During these iterative analyses and discussions, the research team developed an underlying and coherent understanding of CD and the themes. When a researcher heard something relevant, the video was paused and the researchers discussed the content of the video, meaning and intention of the designer during the design process. If consensus was reached, the quote from the video was extracted, recorded and notes taken about the discussion (as shown in Figure 5). CD has been developed as a model that is constructed as a result of the analyses of the cases, the emergent codes, contextualization in Maslow’s hierarchy of needs and addressing a gap in literature to draw focus to niche aspects of sensitive user needs. The analyses and the development of the framework of this model did not rely on counting words or codes but was based on ‘inferences about the likely inner thoughts, purposes, and views of others that are not explicitly communicated’ (Ginger Reference Ginger2006). The coding was ‘largely descriptive’ (Drisko & Maschi Reference Drisko and Maschi2015) where sections of the data were selected and the meaning behind these were inferred. There were no pre-determined coding categories at the commencement of the analysis and different ideas emerged as the analysis proceeded, which were later grouped into themes of dignity, empowerment and security. Reliability and congruence were achieved by ‘negotiating agreements and disagreements’ (Armstrong et al. Reference Armstrong, Gosling, Weinman and Marteau1997), checking the analysis with the other researchers, discussions and reaching consensus through discussions. The three main themes are based on connotative categories (Drisko & Maschi Reference Drisko and Maschi2015) where the content is not explicitly stated but the latent and overall meaning is considered while discussing the intention of the designer. For instance, the word ‘dignity’ was seldom used but the designer referred to contexts and user needs which reflected how she/he considered the dignity of the user. The questions that guided the researchers while doing the analyses are presented in section A of Table 3 while the themes that emerged as a result of the analyses are presented in section B of the same table. The questions were a result of the discussions around the ideas of dignity, empowerment and security, even though these terms had not been formally coined to be the pillars of CD. For example, during discussions, the research team discussed how the user felt out of place, inferior, embarrassed, a sense of risk or fear etc. Even though the specific words, ‘dignity, empowerment and security’ were not always used, the content guiding the discussions was synonymous to these. It helped to frame the questions that were used in the later stages of the analyses, after which the themes of CD were formally coined to be dignity, empowerment and security. In Table 3, the questions and themes have been related side by side for better understanding.

Figure 5. Overview of the process used for coding the videos.

One of the key observations was differences in problem framing (by the designers) where the problem was not only framed to create a solution but was influenced by the designer’s motivation to help and focus on the feelings of the user. After doing numerous iterations of watching, discussing, and analyzing the videos (Jacobs et al. Reference Jacobs, Kawanaka and Stigler1999), it emerged that the designers had been focusing on the dignity, empowerment and/or security of the user. These were identified as the core ideas of CD. Although these were rarely explicitly mentioned by the designers, the model of CD was informed by the common themes in the cases, which were identified by using ICA and the approach of the designers who framed the problem to focus on enhancing the experience of the user and not just addressing a certain user need. The three exemplary foundational cases that laid the foundation of CD will be discussed in the next section. We watched the videos additional times and extracted excerpts using the core philosophy of CD i.e., sense of dignity, empowerment and/or security.

4.1 Foundational case 1: The Jaipur Foot

The Jaipur Foot is a below-knee prosthetic leg that was collaboratively designed in 1968 by a doctor and a sculptor. Dr. P. K. Sethi, an orthopedic surgeon working with patients with below-the-knee amputations, was perturbed by the patients’ high rejection rate of the prosthetic limbs with which he fitted his patients. At the same time, Ram Chandra Sharma, a sculptor who was conducting craft classes for children in the hospital at the time, learned about this problem and thought, ‘What if the foot looked like a foot?’. He used rubber to give the prosthetic limb the look of a real foot. The doctor–sculptor pair focused on developing a prosthetic that looked real, and adapted to the unique lifestyles and culture of their patients that many other prosthetic solutions did not. They also considered the socio-economic context of the patients by making the Jaipur Foot as inexpensive as possible and by providing meals and lodging for the patients who could not afford it. Their unique business model was developed not to be incredibly profitable, but to be low cost and easy to fit, and sustainable to manufacture; soon it became quite successful and became a popular prosthetic across the world. The acceptance rate of the product increased, and people from different parts of India and the world started using it. Since then, there have been many developments to the Jaipur Foot. One of the latest ones is in the calipers for paralytic poliomyelitis, where wood and metal conventional calipers have been replaced with low weight thermoplastic calipers (Jain Reference Jain2016). Dr. Jain says, ‘Since these are total contact orthosis, they can be worn inside the cloth[e]s and are not visible from outside. [A] 90% rejection rate converted to above 95% acceptance rate’ (Jain Reference Jain2016).

Problem framing: The problem was framed not only to address the function of a prosthetic to enable a person with an amputated below-the-knee leg to walk but also considered aspects of patients’ lifestyle and emotional well-being. As Dr. P. K. Sethi noted, ‘Fitting an artificial limb is not a simple biomechanical problem. It is a problem which involves the entire lifetime, lifestyle and culture of the people, which in our context meant that they should be able to walk barefoot, then the foot should look like a foot, they should be able to squat on the floor, sit cross-legged on the floor, [and] walk on uneven terrain.’

This quote highlights that the designers not only focused on the functional use (i.e., enabling the user to walk) but also an emotional need of the user, as it empowered users to independently engage in their lifestyle and cultural norms of squatting, sitting cross-legged, and traversing rugged terrain barefoot. The empowerment of the users was considered in a holistic manner beyond simply getting them walking again. A quote by the sculptor–designer Ram Chandra Sharma, ‘Right next to my room was an artificial limb workshop. Looking at the limbs, I wondered – why not make a foot that looked [like a] real [foot]?’ shows intentional thinking about the users’ need for dignity and social acceptance. He realized that prosthetic users do not want to feel awkward or different from others and want to be seen as equal members of society. Dignity of the users was specifically addressed by making the prosthetic foot look like a natural foot while meeting their practical needs and the resulting design was widely accepted by the users.

Implementation: While implementing the design, the creators emphasized the holistic aspects of the prosthetic beyond its effectiveness or function, for the end user. They considered the complete user experience including how the users would come to the medical office to be fitted or to obtain the prosthetic, how long it would take to be fitted, how they would be fitted, and the long-term maintenance of the prosthetic. They even considered the users’ ability to pay for the prosthetic (e.g., their sense of financial security) and their need to feel empowered in the face of losing a limb, an extremely disempowering experience, as reflected by the following quote: ‘Free boarding and lodging is provided to needy patients and up to 70 of them can be accommodated here at any point of time,’ and ‘One of the key reasons for the widespread acceptance of the Jaipur Foot amongst the poor is the organization’s emphasis on complete rehabilitation.’ The Jaipur Foot designers also employed staff who themselves were proud users of the Jaipur Foot, which indicated that they respected their value as individuals; this empowered the workers as well as the prosthetic clinic patients. This hiring of Jaipur Foot users also helped to dignify those with prosthetics as valuable employees in their own right and as role models for patients just starting their journey of change and acceptance. They also recognized that the users would be more aware of and understand the importance of each step in the creation, fitting and distribution of Jaipur Foot. Some excerpts from the videos illustrate the importance of precise measurements taken by a staff member who also uses the Jaipur Foot: ‘Even a small error in measurements could mean a lot of discomfort for the user. As someone who uses the Jaipur Foot himself, Prajapati knows this only too well.’

Evaluation: The Jaipur Foot team assessed the success of the Jaipur Foot not only in terms of solving the problem of walking again for those with below-the-knee amputations, but by how the prosthetics supported their need for dignity and to be valuable members of society, their need to return to their day-to-day activities and work and to fit into society versus being ostracized for being different or ‘less than’. D. R. Mehta, the founder and chief patron of Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), the organization that provides Jaipur Foot, described his work as ‘so satisfying, personally. [A] person comes in calling, he gets a limb in day or two and for no charge at all and walks out. It’s not merely the thought of giving a limb, it’s also restoring their economic power.’

4.2 Foundational case 2: The Berkeley Darfur Stove

The Berkeley Darfur Stove was developed by Dr. Ashok Gadgil, a professor in Civil and Environmental Engineering at the University of California, Berkeley and his team. The stove was designed to help refugees (predominately women who cooked for their families) in Darfur by providing them a more efficient way of cooking. The new fuel efficient stove, ‘Berkeley Tara’, was made of metal and reduced the fuelwood consumption by 70%–75% as compared to the three-stone fire traditionally used by the refugees (Gadgil & Amrose Reference Gadgil and Amrose2006). As it was more efficient and used less fuelwood, this stove reduced the number of times the refugee women had to walk to fetch firewood, and hence reduced the hardships and danger that they faced while doing so. The motivation for the stove was to make the refugees feel more secure by making stoves with increased fuel efficiency which reduces their time fetching wood, away from the safety of the refugee camp, and in the process also empowering these women to continue to cook in ways they were accustomed to.

Problem framing: The problem was framed with the intention to improve the physical security of the user while also empowering them in their local context. This might be in contrast to an approach focused on finding the best technical solution (e.g., a gas-powered stove) without regard for the user’s traditions or situational/cultural context. The office of Foreign Disaster Assistance, a part of the US agency for international development called Dr. Ashok Gadgil, asking for help in Africa. Gadgil says, ‘[The officer] said, literally, that the Darfur refugee women are being raped in droves as they ‘must’ leave the safety of the camps to gather fuel wood. Can you do something about it? $\ldots$ Since the Darfur crisis started, I was aware of what was going on and felt terrible about it, but like most of us, I didn’t think I could help.’ These statements along with the one from Table 2 reflect Gadgil’s motivation to dive deeper into this problem. Another excerpt highlights the plight of the users; ‘[W]omen are forced to travel far outside the camps, often walking for up to seven hours to find wood [to use for cooking]. Any encounter with the Janjaweed militiamen while searching for firewood almost certainly would result in rape.’ He explained that the women ‘ $\ldots$ have to go because there are a few men in the camps, about twenty percent of the camp residents are men, but if the men get caught outside, they are killed. Its a horrible choice [for the women].’ The problem was framed with an intention to solve this desperate situation of the users.

Implementation: Before implementing the design, a team traveled to Sudan in 2005 to better understand the context and the problem. A team led by Gadgil went to Sudan and spoke with the Sudanese women and their families to gather more information to design a better cook stove that would be suitable to their traditional cooking practices. The team learned details about their typical cooking methods, types of pots used and how they gathered fuel for cooking. Thus, the designers were able to keep the lifestyle of the user in mind while creating the product. They created a stove that not only empowered the users to facilitate them to keep themselves safe but also use their current utensils and cooking styles in a more efficient way. As Gadgil explains, ‘I figured one should be able to design the stove that should be cheap, should work with their pots, with their fuel, with their cooking style.’ He was considering their financial, socio-cultural and practical needs.

Evaluation: The stove did not eliminate the problem – the women’s need to leave the refugee camp to forage for wood, but it reduced the problem to a large extent as it required 75% less wood for cooking. According to Gadgil, ‘Something that should be at least 25%–30% efficient, that’s a four fold gain in their efficiency and that means instead of going out every other day they would [have to] go out once a week.’ The creators thought not only about solving the problem but considered the safety and dignity of the users; they aimed to improve the refugees’ lifestyle and sense of self by helping them build their economy as noted in this quote: ‘For the team, finding a way to manufacture the simple sheet-metal stoves locally, thereby helping to build the internal economy of the refugee camps is more important than the bottom line. We do want to foster innovation in Darfur.’ Gadgil adds, ‘This project gives me one more reaffirmation that use of modern science and engineering technology can go very far in solving desperate problems of people who are at the very bottom of the economic pyramid.’

4.3 Foundational case 3: General Electric (GE) Magnetic Resonance Imaging (MRI) for kids

Getting an MRI scan can be a frightening procedure for people, especially for children. When children typically get an MRI scan, they are scared, nervous and cannot keep still. Therefore, in order to complete the procedure, 80% of the time children have to be sedated. Doug Dietz, an industrial designer for GE who also created the MRI machine, explained how he redesigned the experience of getting an MRI scan for children. Dietz explains that he became interested in the problem when he learned that most children had to be sedated before going into the MRI machine. Upon visiting the hospital, he noticed that the MRI procedure created enormous stress for parents in addition to their concern for their child’s health. So he decided to try to change this very cold, noisy, isolating and scary procedure into one that would be more enjoyable for the children by turning the MRI experience into an adventure, like a ‘pirate journey’ or a ‘nautical adventure’ for the children.

Problem framing: Dietz explains how he came to realize the problem when he looked at it from the patient’s and their parents’ perspectives:

Dietz understood that it is not only the emotions and feelings of the child but also those of the parents that are affected when a child has to undergo an MRI scan:

Dietz understood that he needed to do something that focused on enhancing the sense of security for young MRI users and their families.

Implementation: Dietz wanted to better understand children in order to address the anxiety they were facing due to the MRI procedure. He visited a day-care center and realized that he ‘had to learn more about some of the developmental stages of children, some of these things that would cause the anxiety.’ He mentions that children have a fertile imagination and considering this, the team included many elements in the final design that would cater to all the senses and change their experience, for example, to that of a ‘pirate journey’ or ‘nautical adventure’. They were able to change the sense of security of the children and make them feel less scared of the scan by changing the design of the room to a ‘story-based theme’ and making the scan as a part of the story, thus giving the children an experience of play rather than that of a medical procedure.

Evaluation: Initially, approximately eighty percent of children had to be sedated before going for the scan. With this new redesign, they sedated just two children in over a year when the redesigned machine was being used in this hospital. The designer himself assessed the redesign based on his success in how calm the parents and children felt and in the reduction to their anxiety. He says, ‘What I really think I would measure myself in this kind of a project is have I had influence on that conversation in the car on the ride home for that family and if I have had that opportunity to make that a different kind of conversation for this family.’ He also mentions that not only most children did not have to be sedated, some children even wanted to come back to play, which shows that the redesign made a difference in the experience of the children.

All 12 cases contained quotes from their designers that reflected at least two of the three themes. Since a similar method was used to analyze all 12 cases, we do not present detailed analyses of all the cases here. However, a summary of all the studies is presented in Table 5, which shows how each case addressed particular theme(s).

Table 5. The three themes addressed in the 12 cases

Two more cases that are different are discussed in more detail in the following section. The Lemon Tree group of hotels provides jobs to differently abled people and is an example of how CD can be also used for designing a service and not necessarily a product. The other case, Playpump, shows that just using the elements of CD is not enough for the design to be successful with the users, but that a holistic approach toward design and other aspects of HCD, like user feedback are imperative for a design to be well accepted and successful.

4.4 Case 4 (related to service): Lemon Tree Hotels

Lemon Tree Hotels is a group of hotels in India that in 2016 had a staff of 3500 employees, 15% of which were ‘employees with disabilities’ or differently abled individuals, and another 10% were from socially, educationally and economically disadvantaged backgrounds. In the various interviews with the media, the staff from Lemon Tree have spoken about respect and dignity of the special people that they employ and how they need to be treated equally. The organization not only empowers disabled people by employing them but also provides them an environment where they feel dignified and respected.

Problem framing: Lemon Tree Hotels not only address the problem of high rates of unemployment for differently abled people but the jobs that they provide also help them (the people) to maintain their self-esteem, sense of empowerment and dignity, while providing them with a livelihood. The organization has shown compassion toward disabled people and this can be seen in excerpts such as ‘we tried to bring people with disability to the mainstream while respecting the dignity of the person.’ They have taken care to not impact the self-respect of their employees but provide them with mainstream jobs like everyone else has that helps them to feel respected, self-sufficient and capable, ‘We wanted to give some opportunity to people who would not otherwise get a job. But over time we found they are great employees. We also found that close to 10% of India is disabled in some form or the other and they [the differently abled] don’t get jobs easily because there is no social net in our country. So we said why shouldn’t we look at roles in our organization where their disability isn’t actually an element, that is, they can be like normal people. There is no sense of charity because I think that’s what kills somebody’s self-dignity.’ One speech-impaired employee expresses his satisfaction with the job in this quote (transcribed sign language): ‘The employees here treat me at par with all others. When I am serving guests in the restaurant, the guests are delighted by my service. I feel very happy to [serve] them. I am as good at my work as anyone else.’

Implementation: People with different disabilities like down syndrome, speech, hearing or any other cognitive impairments are hired at the Lemon Tree Hotels. The Human Resources (HR) department places the special staff in different roles, based on their abilities. For example, a woman who has difficulty walking works as a front desk attendant, greeting customers. The customers are also made aware about the special staff as they wear name tags with a description about themselves that provides more information. Lemon Tree HR also emphasize that they sensitize their other staff to work with the special people: ‘It is important to sensitize the existing staff. The employees are instructed to behave in a normal way with the disabled staff and make way for their development $\ldots$ [Additionally to] make the work atmosphere truly inclusive, sign language is taught to all the able-bodied staff members. This ensures free communication and efficiency amongst all employees.’ Lemon Tree management thinks holistically about their staff. They not only want to provide them with regular work but also think about their career: ‘The next challenge is like, once we (are) sensitized toward these ‘kids’, how we have to give them the career graph also.’

Evaluation: This design is not only targeting the end users but also stakeholders by changing the mindset of the customers who come to the hotel: ‘This initiative by the Lemon Tree Hotels to employ people with disabilities is empowering lives and changing mindsets.’ They want to scale up and create more opportunities as noted by Rattan Keswani, Deputy Managing Director (MD): ‘We’re actually trying to design a hotel in other part of Gurgaon [in India] where the entire design is based on the requirements of people with disabilities, and our vision is that we could we make 90+ percent of the employees $\ldots$ [those] who have some disability or the other.’

In this case, dignity and empowerment of an individual was the goal. In the next case, community empowerment was a design goal, but designers failed to think it through thoroughly enough, which led to the failure of the product.

4.5 Case 5 (an example that failed): Roundabout Playpump

The Playpump was developed and installed in KwaZulu-Natal province in South Africa in 1994 to make water collection more fun and reduce the labor involved in pumping water. Trevor Field, an agricultural executive and a key member of this Playpump project team says, ‘The idea was to try and develop a system that would make the collection of water a lot easier and a bit more fun.’ A Playpump system was designed as a children’s merry-go-round connected to a borehole that is attached to an overhead storage tank. As the children spin on the merry-go-round, the force pumps water from a borehole to an overhead storage tank. This system was installed at various locations in grade schools and crèches (day-care centers) where children play on a regular basis. This design was aimed to empower the community to get easy access to clean water always.

Problem framing: Field explains that prior to the installation of the Playpump, children were falling sick due to drinking unclean water from a well with a shallow water table. The water drawn from a borehole using the Playpump was tested and safe for drinking. He also explains that girls or women have more responsibility of fetching water in many communities in Africa, but by using the Play Pump, boys also became involved in collecting water as they play on the merry-go-round. He says, ‘indirectly we’re changing the gender responsibility from girls to boys.’ The problem was framed to develop a solution that capitalizes on a common daily life activity (play). They wanted to empower the user and also tried to keep the system simple: ‘Tap-stand is very simple, just nice and sturdy so that it doesn’t get damaged by cattle or over-enthusiastic children. It’s got a very simple tap $\ldots$ .’ The design was created to provide the community with continuous and easy access to clean water by utilizing one of the regular play activities of the children. Water could be drawn from a deeper water table so it is clean and stored in an overhead tank, so people can get clean water at any time.

Implementation: While implementing the solution, they kept various aspects in mind: the pump was installed at schools and crèches where many children aged six to fourteen years play. The wheel could be spun either left or right to pump water and the design was kept very simple so that it would be easy for the children to use and also reliable. They kept it simple, with only two moving parts. As Field explains, ‘Keeping it that simple then the reliability increased dramatically.’ They also installed some billboards surrounding the storage tanks and the funds generated from the advertisements helped to maintain and sustain the pump; other billboards offered public service announcements. He also mentions that they were planning to expand this Playpump project to other regions where they needed this kind of pump.

Evaluation: Upon installation, the Playpump was very successful in providing clean water to the people in Africa. The children did not fall sick as often and the school attendance increased. Field saw this as a measure of their design team’s success: ‘The kids used to get really sick. They used to get diarrhea and vomiting and all sorts of things before we put the Playpumps in $\ldots$ school attendance has increased quite dramatically and that is really, for me, that’s great success $\ldots$ .’

A few years after installation, the Playpumps were breaking down in many locations. 1000 Playpumps had been installed by 2008 with the aim of scaling to 4000 pumps by 2010 (Chambers Reference Chambers2009). Amy Costello, a reporter for Frontline/World, who had covered the Playpump’s initial success story followed up with another story when the pumps started failing about three years after installation:

Even though the Playpump was installed with intentions to empower the community, it was not fully successful due to various reasons, including a lack of foresight and holistic thinking. The community was not empowered to repair and maintain it and the design relied solely on children to play in order to pump the water, not considering that children may not want to play with it always. The reporter adds, ‘ $\ldots$ children, like everywhere in the world, sometimes get tired of playing on one toy all the time but if they were relying on the energy of children they really needed them to be spinning and spinning literally for hours a day to provide adequate water and of course they weren’t $\ldots$ .’ As reported by The Guardian (Reference Chambers2009), if children played for two hours constantly on the merry-go-round then the bare minimum water requirements for 200 people a day could be met.

For example, a pump was installed in a remote area in Mozambique, where there were only a few children, thus requiring the women to turn the merry-go-round to pump water. One of the women said that after working for six hours in the field they had to turn the merry-go-round wheel that would cause their arms to hurt. Using the old handpump was much easier, they reported. Even after turning the wheel, no water was getting pumped to the storage tank, which was a bigger problem. Whenever they would call the repair line, they received no response. One of the officials at Mozambique’s Rural Water Authority said, ‘Once the pump breaks, and takes more than 3 months to repair, people in these communities no longer trust the Playpumps, because they are demoralized. It does not work properly. We know it is for free, but it does not work properly.’ Costello also found a report stating many problems, like, there were pumps out of commission for up to 17 months, maintenance was ‘a real disaster’, the operation technique of the pump was not suitable for African women and children were not using it in the intended way. When the women were asked if they knew that this Playpump was going to be installed, they said that they had no information about it prior to its installation. The users were not involved throughout the process, which proved to be a problem. There were no advertisements on the billboards to pay for the maintenance. The idea of funding maintenance through billboard advertisements and relying on children to operate the pump may have worked well for some parts of Africa, but not all. This lack of holistic thinking in the implementation of the Playpump had dire consequences on the social climate within the communities where they were installed and failed. People had to travel to neighboring villages to obtain water which led to conflicts and tension among the people. Such product failures and subsequent consequences began to hamper the sense of dignity and empowerment of the users as they had to seek help from outside the village to fulfill a basic necessity as access to clean water.

The lack of maintenance and repair was a key cause for the failure of the Playpumps. One of the officials says, ‘You can put in a beautiful, perfect pump and if it breaks down and there’s no spare parts, then it was only as good as the six weeks or six months that it ever lasted for in the first place.’

This case of the Playpump shows that even though empowerment of users was a goal, the plan was not thought through well enough. For instance, the designers did not consider the differences in the populations of neighboring communities, nor did they consider what aspects needed to be included to promote user acceptance of this pump system. And while the designers wanted to empower the local community to maintain and repair the pump, somehow the education piece was not provided nor were mechanisms set up to enable community maintenance. These resulted in the decline of the Playpump project. There was also a push to scale up quickly which may have prevented proper planning and implementation of some of these aspects.

Clearly in this case, the approach of CD was not enough; the design also needed a holistic approach (in other words, consider all aspects of installing a Playpump system). This case is included to show that only CD will not be helpful to create better user experiences; a holistic approach considering the various aspects of design thinking, especially including approaches from HCD together with CD will be important for a design to succeed.

Each case does not equally focus on the three themes, but they help to illustrate how the ideas of dignity, empowerment and security emerged and were identified by the research teams. We define CD as an approach that addresses niche sensitive needs and involves a way of thinking where engineers and designers pay special attention to the users’ dignity, empowerment and sense of security. Niche sensitive needs include specialized needs that have the potential to strongly or subtly affect a person’s feelings and emotions if left unfulfilled. For example, a person feeling inferior to someone may not be getting her/his need to ‘feel equal’ fulfilled and hence feel unhappy.

The three themes that form the framework for the CD model emerged from the analysis of the data and will be contextualized in the next section. In the next section, we discuss these three elements in detail by providing more thorough definitions from the literature in design and psychology. Then we relate the cases to these definitions and also discuss some potential implications of CD.

5.1 Relating cases to the definitions

The cases highlight various aspects of the sense of dignity, empowerment and security that have been addressed by the CD approach. In most of the cases, these three themes are interwoven but we highlight the most prominent of the three themes in each case.

As defined earlier in this paper, human dignity means valuing end users as individuals with the need to feel empowered, safe and secure, dignified and valued members of their community. It also means recognizing them as capable of setting and achieving goals important to them and their pursuit of self-actualization. The Jaipur Foot, SpeechVive, and the Firefly Incubator along with the Lemon Tree Hotel’s hiring of disabled individuals emphasize valuing the end user as an individual by creating products and services that empower them, support their natural behavior and encourage them in the pursuit of self-actualization. They not only encourage the users by valuing them as individuals but also provide means to enable them to do the same. Each of these cases show that the user’s dignity was considered, whether by respecting their need to feel that they are valued members of society in the Jaipur Foot and SpeechVive cases or by providing them with means that support their sense of dignity, personal empowerment and efficacy as in the case of Lemon Tree and Firefly.

Empowerment in the CD approach means enabling the end user to be agentic, motivated, and competent in their pursuit of self-actualization. Additionally, the ‘Embrace’ baby warmer, the Berkeley Darfur Stove, the LifeSaver water bottle, Rabbit Ray, UV Waterworks and Leveraged Freedom Chair also empower the users to feel more competent by enabling them to be in control of their environments. They enable the users to maintain an independent lifestyle and go about their daily activities without depending on external sources such as, help from other people including therapists or family members, whether it be for Parkinson’s disease patients who could speak more clearly as in the case of SpeechVive, gain the independence to move around various types of outdoor terrains in the case of LFC, or feel more empowered to keep themselves safe as in the case of the Berkeley Darfur Stove. The Berkeley Darfur Stove project also demonstrates elements of economic empowerment by creating a means by which the community could manufacture and sell the stoves themselves.

Dignity and empowerment also relate to the end user’s sense of well-being and security. Security is a sense of positive well-being for both the short and long term related to health, safety, work and belonging to society. The 12 cases presented here show, to some degree, that the design had a positive influence on the sense of well-being and security of the user. Some of the cases such as the GE MRI for Kids, Jaipur Foot, Embrace baby warmer, Berkeley Darfur Stove, Firefly Incubator, LifeSaver and Rabbit Ray focus more on the security, safety and health of the users. The Rabbit Ray and the GE MRI for Kids help the users (children) feel more secure in unknown, frightening environments such as hospitals and clinics and help the users gain a sense of positive well-being.

We observed three common themes across all 12 cases: the designers aimed to enhance the users’ sense of dignity, empowerment and security even though they did not use these exact words. The next section summarizes some implications of our findings for the development of CD.

6.1 CD probes that can be used in the design process

The cases described above show that many engineers and designers already incorporate some level of CD into their work. For instance, many designers think about users’ emotional needs such as the need to feel empowered, independent, capable and valued members of society. The goal of this work is to provide a foundation to help increase the intentionality of this thinking in the design process. When designers follow a typical HCD process, there are no specific guidelines to consider the sense of dignity, empowerment and security of the user. The questions in Table 3 that were used for analyzing how the designers in the cases were considering the dignity, empowerment and security of the user may also be used to probe the thought process of the students/designers while creating new designs. These questions will not provide designers with direct solutions but can be used to probe the discussions (about dignity, empowerment and security) according to the context of use. Cardoso, Badke-Schaub and Eris (Reference Cardoso, Badke-Schaub and Eris2016) have indicated that use of questions facilitates inflection moments during the design process. The inflection moments help the designers to reflect on the current design ideas and change trajectory if required. The question-based probes presented in Table 3 are intended to prompt discussion and reflection about the dignity, empowerment or security of the user among the design team. They are intended to help the designers think about these social and psychological needs of the users and address them through their designs.

The authors of ‘Built to Love’ (Boatwright & Cagan Reference Boatwright and Cagan2010) discuss the importance of designing products that generate positive emotions for customers and provide a tool called ‘The eMap’ to assist companies in this process. The tool includes sixteen emotion categories some of which capture the spirit of CD (Boatwright & Cagan Reference Boatwright and Cagan2010). Thus, considerations of this kind are important to industry.

6.2 CD included in engineering and design education

The CD framework has the potential to not only impact end users, but designers themselves. These and several other probes are currently being tested in an engineering design class at a North American University. When the graduating designers understand and absorb these ideas as a part of their design education, they may be able to implement them in the design process in industry. Through initial observations of design students in freshman engineering, sophomore mechanical engineering, and senior capstone design at a North American University, the CD framework has challenged students to think in new ways. Regardless of the design project, students thought through the set of questions and used them as probes for CD in the design process and as they evaluated their designs, particularly at the conceptual design phase. Aspects of dignity, empowerment and security of the users were reflected and also explicitly mentioned in some of the final design outcomes. Freshman engineering students used similar guidelines to provide peer-to-peer feedback on design concepts.