Background
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‘Usability issues’ may arise when over-, under- or misuse of a technology affects users’ quality of life, safety, autonomy, mobility, etc.
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The term ‘designers’ refers to the scientists, clinicians, engineers and entrepreneurs who are fully engaged in bringing an innovation to the market.
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While recognizing that experts and non-experts possess varying levels and kinds of knowledge, following Burns et al.[10], the term ‘publics’ refers to all members of society.
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We use ‘expertise’ to refer to the ease with which someone can talk about a given innovation based on his/her experiential, scientific and/or practical knowledge [11]. This implies that a chronic disease patient could be an expert on, say, using a dialysis machine, while a radiology technician would be a non-expert with respect to this technology. Hence, individuals may move from the position of expert to that of non-expert depending on the issues under discussion.
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We use the term ‘deliberation’ to highlight the presence of a reasoning process that becomes explicit through a conversation between two or more individuals [12].
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The term ‘normative assumptions’ refers to sets of norms, principles, preferences and values that are tacitly understood, within a professional, disciplinary or cultural community, as the right way of interpreting the world in which an innovation is evolving [13].
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‘Judgments’ are socially situated appraisals that rely on knowledge and normative assumptions, summarizing the perceived desirability of an innovation (e.g., highly valuable, potentially risky or to be avoided).
Research objectives and conceptual approach
Literature review
How the design of health innovation relies on, and embodies normative assumptions
How prospective sociotechnical scenarios may foster reflexivity and creativity
How deliberative processes help make judgments explicit
Methods
Step one: developing prospective scenarios in three thematic areas
Enhancement technologies in teenagers | Preventive interventions for genetically ‘at risk’ adults | Ageing in a high-tech world | |
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Technologies
| A shirt with embedded sensors that provide real-time feedback about the mental state and cognitive performance of the person wearing it. | Implantable cardiac ‘rectifier’ that destroys cells genetically susceptible to cause arrhythmia later. | An assistive personal robot connected to the Internet, which can interact with individuals and the built environment (using face, voice and object recognition). |
Used with meditation techniques, the shirt can help one learn about oneself | The rectifier transmits data to a centralized system where experts confirm its plan of action | The robot is used at home and can ‘learn’ from its owner by asking questions and memorizing responses | |
Story theme
| Finding ways to be oneself while building skills and competence to move towards adulthood. | Pondering genetic risks and uncertainties while deciding whether or not to intervene in an otherwise healthy body. | Adapting to successive transitional states and a gradual loss of mental and physical abilities while seeking to remain autonomous as long as possible. |
Theme
| ‘A theme is something important the story tries to tell us—something that might help us in our own lives.’ |
Sheppard recommends not getting ‘too preachy’ and ‘not to say what the moral is.’ It is more interesting for readers if the theme grows out of the story with subtlety and nuances, so they feel they have learned something for, and by themselves. | |
Plot
| The plot usually revolves around a ‘conflict or struggle that the main character goes through.’ It can invoke personal needs and feelings, involve another character, or be in response to ‘the way things are.’ The protagonists ‘should win or lose at least partly on their own, and not just be rescued by someone or something else.’ |
In a good story, by trying to solve things that are problematic, the characters learn and grow. This is what the ‘story theme’ is about. | |
Sheppard underlines that ‘a novel can have several conflicts, but a short story should have only one.’ This conflict should grow in intensity, reach a ‘climax’ and then resume. | |
Characters
| Sheppard recommends laying out and defining the characters—who they are, how they think, what they do—before starting to write. Knowing those characters well will bring coherence to the story plot. These characters should have some traits that readers relate to, or even make them care about them. |
Sheppard also stresses that ‘a main character should have at least one flaw or weakness. Perfect characters are not very interesting. […] And they don’t have anything to learn.’ Similarly, a ‘bad guy’ should also possess some positive qualities. | |
Setting
| Sheppard recommends setting the story ‘in a place and time that will be interesting or familiar.’ |
In our case, since the scenarios are prospective, we describe settings that depart from those in which healthcare is currently delivered and from those in which people are now interacting. Nevertheless, our scenarios have to be plausible and therefore settings that are sufficiently concrete and puzzling are selected. |
Consequences (hoped for) | |
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Enthusiasts
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Sceptics
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Promises (e.g., increased control over the world and increased well-being) | Plausibility (uncertainty) |
Adverse side effects (cost/benefit) | |
Can the good not be produced otherwise (e.g., search for alternative) | |
Is the envisioned good really a good | |
Unforeseen problems will be solved by future solutions | |
Rights and principles (tensions between the individual and the collective)
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Positive right to the technology (e.g., people should have access to the technology) | Principle is wrong |
Principle is null in another culture/setting | |
Principle is right in the abstract, but does not apply to the issue Principle is right, but it supports the opposite conclusion, or it conflicts with another one that is more pressing | |
Negative right to the technology (e.g., free to acquire it as long as it does not harm others) | |
Justice (distributing the costs and benefits)
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Different bases: Equality; Merit; Need; Chance | |
Through trickle down effects, technology will benefit the whole society | Without political intervention, those in need or who are economically disenfranchised will never benefit |
Good life
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Humankind should move forward/upward | Knowing when/where to stop (‘not to play God’) |
Respecting natural limits (not create ‘monsters’) | |
Preserving humanness and pushing it to flourish ‘as-it-is’ | |
Social problems cannot be solved by technical fixes | |
Technology cannot be controlled | |
Frontiers/limits can be transgressed | |
Promethean vision | |
Relationship between technology and morality
| |
Deterministic (technology’s internal logic) | Voluntarists (technology is socially malleable) |
External forces too strong (markets, economies, scientific competition) | Technology is steerable in a morally desirable direction |
Pessimists (technology as a moral problem) | |
Technology is already immoral as it is | |
Technology will manoeuvre us (‘slippery slope’) | |
Optimists (technology as a moral solution) | |
Precedent (not novel moral issues) | |
Society will habituate itself |
Step two: developing multimedia support for each thematic area
Step three: face-to-face and online deliberations
Recruitment strategies
Deliberative workshops
Asynchronous online forum
Step four: integrating the data sources and summarizing the results
Research objectives | Variables of interest | OBS | DEL | SURV |
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RO.1 To analyze how members of the public, in face-to-face and online environments, reason and deliberate around the desirability of sociotechnical changes in three thematic areas. |
Processes:
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Ways in which participants reason, agree/disagree, and ponder the desirability of sociotechnical changes within/across thematic areas. | √ | √ | √ | |
The influence of group deliberations over the formation of one’s judgments (including the group moderator). | √ | √ | √ | |
Outcomes:
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Similarities/differences within/across thematic areas in participants’ knowledge claims, normative assumptions and argumentative patterns. | √ | √ | ||
Similarities/differences between the two deliberative environments in how views are articulated and shared. | √ | √ | ||
RO.2 To identify usability and ethical issues raised by various design assumptions and features in three areas |
Outcomes (to be interpreted in light of the scholarly literature):
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Usability and ethical issues that are addressed/ignored by participants within/across thematic areas. | √ | |||
Design assumptions and features considered desirable/undesirable, that predominate, are reframed or ignored by participants. | √ | |||
RO.3 To assess whether the sociotechnical scenario method fosters critical, reflective and creative deliberations around the design of health innovations |
Processes:
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Appraisal of the audiovisual and written components of each scenario. | √ | √ | √ | |
Participants’ level of engagement throughout the process and ability to relate to the protagonists’ and other participants’ stories. | √ | √ | √ | |
Expressions of creativity, reflexivity and critical sharing of information. | √ | √ | √ | |
Outcomes:
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Ways in which participants envision and describe the value of sociotechnical developments in healthcare. | √ | √ | ||
Critical observations toward design assumptions and features, and scope/depth of proposed alternatives (participants’ own conclusions). | √ | √ |
Observation
Content of deliberations
Self-administered participant survey
Item | Measurement |
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First part-Multimedia content and scenarios
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The videos have helped me understand the technologies | 5-level Likert-type scale |
The videos have helped me understand the online scenarios | 5-level Likert-type scale |
The following video made me react the most | List of the 3 videos and ‘none’ |
Do you have comments about the videos? | Free text box |
The online scenarios helped me reflect about questions raised by the technologies | 5-level Likert-type scale |
The online scenarios stimulated discussion | 5-level Likert-type scale |
The online scenarios that made me reflect the most are those associated with… | List of the 3 scenarios and ‘none’ |
I felt concerned by the dilemmas faced by the characters (Nathan, Mathis and Catherine) | 5-level Likert-type scale |
I felt much more concerned by the dilemma of … | List of the 3 characters and ‘none’ |
Workshop and online deliberations
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Throughout this project: | |
I was brought to look at technologies differently | 5-level Likert-type scale |
I could consider new viewpoints | 5-level Likert-type scale |
I discovered effects of technology that I had never imagined | 5-level Likert-type scale |
I reflected more about the pros and cons of technologies | 5-level Likert-type scale |
I looked for additional information on the topics discussed | 5-level Likert-type scale |
I shared my reflections with people around me | 5-level Likert-type scale |
I had ideas to improve technologies around me | 5-level Likert-type scale |
If yes, share one idea … | Free text box |
I consider that I know more about: | |
The way technologies may transform society | 5-level Likert-type scale |
The way technologies may transform values | 5-level Likert-type scale |
The way individuals and society may intervene in technology | 5-level Likert-type scale |
The way values may influence technology design and use | 5-level Likert-type scale |
Second part-Deliberative environments
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During the workshop: | For workshop participants |
I was confortable sharing my ideas | 5-level Likert-type scale |
I could express disagreements | 5-level Likert-type scale |
I voluntarily omitted expressing certain viewpoints | 5-level Likert-type scale |
I shared opinions that I would not have formulated as easily in writing | 5-level Likert-type scale |
During the online forum: | |
I was comfortable sharing my ideas | 5-level Likert-type scale |
I could express disagreements | 5-level Likert-type scale |
I voluntarily omitted expressing certain viewpoints | 5-level Likert-type scale |
I shared opinions that I would not have formulated as easily verbally | 5-level Likert-type scale |
Did you prefer one of the two deliberative environments? | For workshop participants who may answer ‘none’ |
Why? | Free text box |
General impressions about my participation
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Throughout the project: | |
I have had the opportunity to express myself freely | 5-level Likert-type scale |
I was attentive to the views of other participants | 5-level Likert-type scale |
My arguments were well thought out | 5-level Likert-type scale |
I contributed to further the reflections of other participants | 5-level Likert-type scale |
Participating in the process required considerable efforts | 5-level Likert-type scale |
I remained interested throughout the experience | 5-level Likert-type scale |
General impressions about the participation of other participants
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Throughout the project: | |
Participants have had the possibility to express themselves freely | 5-level Likert-type scale |
The arguments of the other participants appeared well thought out | 5-level Likert-type scale |
I have heard viewpoints that differed from mine | 5-level Likert-type scale |
Certain viewpoints conflicted with my values | 5-level Likert-type scale |
My viewpoint was well received by the other participants | 5-level Likert-type scale |
Group exchanges have furthered my reflections | 5-level Likert-type scale |
The moderator contributed to stimulate the group’s reflections | 5-level Likert-type scale |
The moderator respected the opinions of participants | 5-level Likert-type scale |
Do you have something to add about this experience? | Free text box |
Third part—Information about the participants
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To which age group do you belong? | 18 to 29; 30 to 39; 40 to 49; 50 to 59; 60 to 69; Over 70 |
Gender | M or F |
Do you live: | By yourself? With a partner? With your family? With roommates or in a residence? |
Do you self-identify with an ethnocultural community? | If yes, which one(s)? |
What language(s) do you speak at home? | Free text box |
Do you self-identify with one of the following religions? | Buddhism; Christianism; Hinduism; Islamism; Judaism; Other; None |
Do you frequently interact with children or teenagers? (e.g., many times a month) | Yes; No |
Do you frequently interact with people over 65? (e.g., many times a month) | Yes; No |
What is your current occupation or the job you have held in the past and you most identify with? | Free text box |
Which is the highest level of education you completed? | High school; Collegial; Undergraduate studies; Master’s level; PhD |
How often are you in contact with healthcare services, for you or your relatives? | Never; Rarely; Occasionally; Frequently |
How do you characterize your ease with technology in general? | Uncomfortable; Mostly uncomfortable; Mostly comfortable; Very comfortable |
What is your household income? (that of your parents if you live with them) | Less than $20,000; $20,000 to $39,999; $40,000 to $59,999; $60,000 to $79,999; $80,000 to $ 99,999; Over $100,000 |