Cross-Cultural Design for Healthy Ageing

By Lisa Scharoun and Vivien Sung

This book is based on many years of research and practical pedagogical experiences around cross-cultural and multidisciplinary design for healthy ageing.  It provides important insight into origins, design, implementation, and impact of cross-cultural design student study tours, and takes an original approach by foregrounding pedagogical practice for exploring healthy ageing solutions.

The populations of Australia and many other countries in the Asia Pacific region are ageing. The next few decade will see up to half of the population in many countries represented by the over 65s. The impact of this change in population balance will be profound and it represents a potential global shift in design for society. This will challenge designers, planners and health care professionals to develop solutions to better meet the needs and harness the capacity of our growing and diversifying populations of older citizens, in relation to housing, community interaction and co-operation, health and well-being, and the integration new technologies. Different disciplinary and cultural perspectives can be a means to create new ideas and approaches that provide a deeper understanding of the needs of the global ageing population.

This book examines some of the challenges associated with ageing in multi-cultural societies. We explore some of the major issues facing society in the area of ‘healthy ageing’ and propose a method of working with cross-disciplinary groups of health practitioners, designers, architects and cultural practitioners. Through case-studies of a series of workshops run in China and Singapore with Australian, Chinese and Singaporean students, we review the benefits of this approach and provide a framework for engaging designers, planners and health professionals in the process of creating new design solutions for the growing global ageing population.

This book is especially useful for academics and educators in the design and health areas. Design professionals in urban, architectural, interior, industrial, graphic, multimedia, fashion, interaction, service and user-experience design will find many useful ideas. Health professionals across the range of disciplines, including medical practitioners, nurses, physiotherapists, other allied health professionals and carers practising in different settings such as aged-care facilities, government offices and others will also find it useful.

It also provides insights and ideas for innovators, businesses and everybody interested in exploring design and innovation for an ageing population, which has been identified as a growing market. It may also be useful to anyone who wants to understand how to provide care for ageing members of the family and friends, or for anyone who wants to better understand issues around their own ageing.

Although there are many articles and books on social design, there has been very little work on the methods to combine the discipline areas of Health and Design in the creation of concepts and artefacts around design for healthy ageing. There is also very little on the understanding of ‘Cross-cultural Empathy’ in design. This book takes an original approach to ‘Design for Healthy Ageing’ by combining not only a varied discipline group of practitioners from design and health but also presenting cross-cultural methods to deal with issues associated with the social cause.

The primary readership will include professionals and academics in the areas of cross-cultural design, health, ageing and related policies, government institutions and gerontologists.  It will also be of interest to tutors and lecturers across design practice internationally, and the case studies are useful for those with a specific geographical interest (Australia, Singapore, China), including clinicians, carers and other health professionals in those areas.

• Language: English
• Publisher: Intellect Books
• Release date: Sep 23, 2020
• ISBN: 9781789383102

Book preview

Cross-Cultural Design for Healthy Ageing

Cross-Cultural Design for Healthy Ageing

EDITED BY

Lisa Scharoun, Danny Hills, Carlos Montana-Hoyos, Fenke Peng, and Vivien Sung

First published in the UK in 2020 by

Intellect, The Mill, Parnall Road, Fishponds, Bristol, BS16 3JG, UK

First published in the USA in 2020 by

Intellect, The University of Chicago Press, 1427 E. 60th Street,

Chicago, IL 60637, USA

Copyright © 2020 Intellect Ltd

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission.

A catalogue record for this book is available from the British Library.

Cover designer: Aleksandra Szumlas

Copy editor: Newgen KnowledgeWorks

Cover image: Lisa Scharoun

Production manager: Laura Christopher

Typesetting: Newgen KnowledgeWorks

Print ISBN 9781789383089

ePDF ISBN 9781789383096

ePub ISBN 9781789383102

Printed and bound by Shortrun Press, UK.

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This is a peer-reviewed publication.

This book is dedicated to all of the students who participated in our various study tours over the years, as well as to our families who held the fort while we were away!

Contents

List of figures

List of tables

Foreword

Tamsin Greulich-Smith

Acknowledgements

List of abbreviations

1. Overview

Carlos Montana-Hoyos

Introduction

Design for healthy ageing

Design

Health

Ageing

Healthy ageing

Studies around healthy ageing and design

Introduction to the complex issues of ageing in Singapore, Australia, China, Hong Kong, and Taiwan

Singapore

Australia

China

Hong Kong

Taiwan

Conclusion

2. Approaching Social Design Challenges through Multidisciplinary Collaboration

Lisa Scharoun, Carlos Montana-Hoyos, and Fanke Peng

Introduction

Definition of social design

Understanding human behaviour through design

Design methods: Design thinking and co-design

Multidisciplinary, cross-disciplinary, interdisciplinary, and transdisciplinary definitions and practices

Inquiry-based learning

Problem-oriented project learning

The benefits of collaboration between nursing and design

Strategies for working in multidisciplinary teams

Cross-cultural design

The importance of cross-cultural design

Cultural intelligence

Our method

Conclusion

3. Cross-Cultural Empathy in Design for Health

Vivien Sung

Introduction

Empathy in design: From user-centred design, participatory design, and beyond

The role and relevance of cross-cultural empathy in design

Cross-cultural empathy framework

Empathy pyramid

Contextual factors

Cross-cultural empathy map

Empathy map

Cultural patterns

Case study: Cross-cultural empathy approach in design for healthy ageing, FutureAging Lab China

Preparing for empathy

Developing empathy

Applying empathy

Conclusion

4. Clinician Perspectives on Preregistration Nursing Student Participation in Interdisciplinary, Cross-Cultural Study Tours and Design Workshops

Danny Hills, Khoon Kiat Tan, and Doreen Heng

Introduction

Why design and nursing?

Nurses and design thinking

Cross-cultural collaboration

Impacts and outcomes

Conclusion

5. Case Study: Cross-Cultural Design Workshops for Healthy Ageing in China

Fanke Peng, Li Hao, and Katrina Recoche

Introduction

Ageing in China

Methods

Discovery stage

Definition stage

Development stage

Delivery stage

Case study 1: ‘Design for Healthy Ageing’ 2016 in Guangzhou and Shantou

Days 1 and 2: Discovery and team building

Day 3: Definition and ideation

Day 4: Prototyping and testing

Day 5: Delivery

Outcomes of the 2016 workshop

Sole Mate – a project for Guangzhou workshop (13–18 November 2016)

Xiyanghong – a project for Shantou workshop (20–25 November 2016)

Simple Drug Sticker – a project for Shantou workshop (20–25 November 2016)

Co-Care – a project for Shantou workshop (20–25 November 2016)

Case study 2: ‘Co-design for Healthy Ageing’ 2017 in Guangzhou

Days 1 and 2: Design thinking workshop, cultural immersion, and team building

Day 3: Site visits

Days 4 and 5: Defining and developing

Days 6 and 7: Prototyping and testing

Day 8: Testing and presentation

Days 9 and 10: Exhibition set-up and display

Outcomes of the 2017 workshop

Escape from the Nursing Home

Memory Cloud

Virtual Reconnect

Discussion and reflection

Conclusion

6. Design for Healthy Ageing in Multicultural Societies: Approaching Issues Associated with Ageing in Singapore and Australia through Cross-Cultural and Multidisciplinary Workshops

Lisa Scharoun and Jie Hong Liu

Introduction

Ageing in Singapore: An overview

Ageing in Australia: Western heritage with an Asian future

Using design thinking methods to solve ‘wicked problems’

Case study 1: ‘Inspired by Singapore: Design for Healthy Ageing’

Day 1: Empathy

Days 2 and 3: Site visits (research)

Days 4 and 5: Ideation

Days 6 and 7: Prototyping

Days 8 and 9: Community display

Outcomes

Case study 2: ‘Inspired by Singapore: Co-design for Healthy Ageing 2018’

Day 1: Grouping and briefing

Day 2: Design thinking workshop

Days 3 and 4: Site visits to care homes and community hospital

Days 5 and 6: Ideation

Days 7 and 8: Prototyping and testing

Days 9 and 10: Exhibition set-up and display

Outcomes of the 2018 workshop

Overview of project outcome

Conclusion and further opportunities

7. Student Perspectives on Participation in Multidisciplinary, Cross-Cultural Study Tours and Design Workshops

Danny Hills, with contributions

Introduction

Student perspectives and experiences

Ruby Tribe, Monash University, Australia

Cheng-Wei Weng, Kun Shan University, Taiwan

Grace Chong, Nanyang Polytechnic, Singapore

Tracy Ng, University of Canberra, Australia

Jo-Lynn Koh, Nanyang Polytechnic, Singapore

Shao-Ming Chen, Chung Yuan University, Taiwan

Sharon Tan Yan An, Nanyang Polytechnic, Singapore

Debbie Jhaung, Khun Shan University, Taiwan

Paul Gardner, Monash University, Australia

Hariz Ilami, Nanyang Polytechnic, Singapore

Emmaline Seow, Nanyang Polytechinc, Singapore

Lin Ting-Yu, Khun Shan University, Taiwan

Tan Mei Qi, Nanyang Polytechnic, Singapore

Li Hao, Nanyang Polytechnic, Singapore

Dayna Carey, Monash University, Australia

Overview of results from the student surveys

Conclusion

8. Conclusions, Overview, and Recommendations

Lisa Scharoun, Fanke Peng, Danny Hills, Jie Hong Liu, Carlos Montana-Hoyos, and Vivien Sung

Afterword

Marina Dzhashi

Bibliography

Notes on editors

Notes on contributors

Index

Figures

3.1: The cross-cultural empathy framework facilitates the development of cognitive empathy in complex cross-cultural design challenges. It draws from various layered models of culture and contextual factors into a unique framework.

3.2: The cross-cultural empathy map enables the understanding of people from different cultural backgrounds.

3.3: Cross-cultural empathy map example in design for health.

3.4: Student participation and staff in Beijing.

3.5: Building empathy at the local rehabilitation hospital, in the field, and with team members.

3.6: Retirement transition concept: The inclusive platform.

3.7: Diabetes China smart chopsticks accessory and mobile education space.

3.8: Design for Ageing in the Home final exhibition.

3.9: Inclusive Design: Designing the Future for All exhibition.

5.1: Changing patterns of population distribution in China, by age groups and gender.

5.2: Anatomy of an interview.

5.3: Design thinking talks.

5.4: Field trip to the local nursing home in Guangzhou, China (2016).

5.5: Sole Mate by Melinda Coombes, Yuanquan Zhang, Mingrui Huang, Biao Liu, Zhouxiu Wei, and Josh Rummukainen.

5.6: Xiyanghong by Peirong Xu, Wei Tang, Zhouxiang Li, Ling He, Tahnee McElligott, and Douglas Catling.

5.7: Simple Drug Sticker by Su Yihui, Li Meiting, Lu Junhong, Jon Cleaver, and Hedayat Osyan.

5.8: Co-Care by Liting Hong, Chuer Gu, Fangyuan Cheng, Qingxian Liu, Chufeng Li, Melinda Coombes, and Jeremy Stevens.

5.9: Workshop space in Guangzhou 2017.

5.10: Design thinking session.

5.11: Field trip to the local care centre in Guangzhou, China (2017).

5.12: Students working on the front end and back end of their VR project.

5.13: Model-making of the housing in the fifties.

5.14: Group presentation to a panel.

5.15: ‘Design for Healthy Ageing’ opening night in Guangzhou 2017.

5.16: Top project of the design for healthy ageing 2017.

5.17: Digital and physical modelling of Escape from the Nursing Home by Kalan Garside, Pan Chuangkai, Lin Yanqi, Wu Yalang, Cheng Haiyang, and Braiden.

5.18: Design prototype for Memory Cloud by Freya, Emma, Mai Baowen, Wang Ting, Yang Haifan, Lv Xiaoyang, Zhu Shicheng, and Huang Rilun.

5.19: Virtual Reconnect by Liang Hao, Guo Jinshuai, Dylan Jeffreys, Gan Yifan, Luke Secomb, Pang Huandi, and Cai Liwen.

6.1: Student Workshop cohort 2017.

6.2: Students participate in empathy activities.

6.3: Visits to care homes.

6.4: Student exhibition at the National Design Centre.

6.5: Digital prototypes: Gold Edge.

6.6: Digital prototypes: On the Go.

6.7: Digital prototypes: Ubunto Village.

6.8: 2018 workshop cohort in front of Nanyang Polytechnic.

6.9: Group briefing.

6.10: Site visits.

6.11: Empathise, define, ideate.

6.12: Prototyping.

6.13: Exhibition opening night at the National Design Centre.

6.14: FUNKtional Space.

6.15: Bijou Pod.

6.16: ReMEDber.

6.17: Asystem.

6.18: CareConnect.

6.19: 27 Fortitude Step.

6.20: Student testing the Fortitude Step prototype.

7.1: Authors of the testimonies.

Tables

2.1: CQS (Cultural Intelligence Scale) developed by Ang et al.

5.1: A rough schedule for the workshops in Guangzhou and Shantou.

5.2: 2017 Guangzhou workshop schedule.

Foreword

Tamsin Greulich-Smith

Most healthcare systems today are grappling to cope with demands that are overwhelming. One of the causes of this burden on our healthcare systems relates partly to the success of the healthcare services provided. We have become so good at curing people, or helping them to cope with chronic conditions, that human beings are living longer than ever.

In 2017, Singaporeans were the longest living population in the world, with a life expectancy of 84.8 years. This is wonderful news to be celebrated. However, an ageing population is not without its challenges. While our aspiration is for people to live longer in good health and with a positive quality of life, in reality, our demands for healthcare services increase the older we get. After the age of 50, data indicates that our need for healthcare grows exponentially. In Singapore, research suggests that out of those 84.8 years of life, 10.6 years are lived in poor health.

The work I am involved in is driven by the vision of creating an impact on the future experience of health not only to help healthcare systems transform to better meet these increasingly demanding future patient needs but also crucially to stimulate greater ownership of citizen health among a wider ecosystem, so that less of our lives are lived in poor health. Our aspiration is to strengthen the role of the social services sector in tackling the social determinants of health; to stimulate all businesses, regardless of their primary goal, to play a role in encouraging healthier lifestyle choices; and, most importantly, to empower and motivate individuals to take ownership of their health.

Together, as a multiplayer ecosystem, we may be able to create a future of health in which we as individuals are living healthier lives, by default, with a healthcare system running in stress-free mode to pick us up when we fall. To reach that point, we need a model based on collaboration and empathy. Hence, this book, and the work underpinning it, has a valuable role to play in the future of health.

Reading this book brought many points of resonance to me and reminded me of the experiences of a diverse group of hospital staff I worked with to remove stress points from their Emergency Department (ED). Through a collaborative, diverse design thinking approach, this team of clinicians, nurses, and hospital administrators began to see the human side of healthcare, lifting them out of their efficiency-biased, productivity-focused viewpoint, which will be familiar to many of us working in busy service environments, and into the more complex terrain of multiple stakeholder perspectives, the territory in which breakthrough solutions can often be found for our most challenging, complex problems. Building these skills allowed the cross-functional team to go on to design and implement solutions that are creating tangible impacts in their ED.

Above and beyond these improvements, the head of the department observed that this team catalysed an observable cultural shift across the ED. Rather than battling resistance to change, this hospital was surprised to find that across every part of the ED, from nursing to senior consultants, from administrators to volunteers, there was a growing energy to look for opportunities to continually innovate. As impacts were observed, so the passion to improve grew stronger and spread wider.

So, one of the greatest points of resonance for me within this book is that we can achieve more together than on our own. The book celebrates building diverse perspectives into the lens with which we view our challenges and then into the co-creation and iteration of their solutions. The more we engage diverse stakeholders, the better we understand the problems we are trying to solve, the stronger the outcomes we co-create, the more unimaginable the impacts.

The book also shows us that healthy ageing is a multidisciplinary journey. It is not an issue addressed entirely by healthcare, mobility, housing, or any other individual sector or industry. Ageing encompasses every aspect of our life, and hence the multi-practitioner design approach benefits the outcomes. This was the second strong point of resonance for me. Just as we cannot think about our heath purely in terms of healthcare, so we should not limit our scope of thinking about ageing.

This is particularly pertinent when we consider the biased views most of us hold towards the ageing process. We tend to cherish inanimate objects as they age, celebrating their ascension towards the lauded states of classic, vintage, or antique, and financially we highly value many items the older they become. Yet, ironically, we show less appreciation towards the ageing human body, which we personally do all we can to avoid incurring ourselves and which we all too often appear to treat as a burden rather than a blessing in society.

The design thinking process depends upon framing the design challenge in order to ideate the right solutions. Perhaps this book is a timely reminder to reframe the way we look at ageing. Does healthy ageing require us to consider a new term for the human process of growing older? If today’s babies are anticipated to live for 150 years, surely we must rethink the ageing journey for people who will live almost twice as long as we do today. If we reframe ageing as a positive feature of healthy life, each birthday celebrated as an achievement, perhaps we stand more chance of unlocking the creativity required to design those breakthrough solutions for our healthy tomorrows.

The book also describes the personal impact this work has had upon the students participating in the design workshops. Individually, their reactions may be unique, but this type of response is not uncommon. In fact, it reflects the incredible experiences I have observed among colleagues and stakeholders, over and again, as we have worked together to create positive health outcomes.

In particular, working together to improve the health or well-being of vulnerable citizens is incredibly rewarding and motivating. Health is an emotive issue, which is why applying a purely logical approach to problem-solving will not always create the impactful solutions we hope for. Applying a human-centred design approach can allow us to unlock solutions that make a tangible difference to peoples’ lives. The outcomes of such work impacts you in a way that makes every step of the journey, and all of the hard work, immensely worthwhile. Despite the often-discouraging tales we may read in our various media channels, it seems that human beings generally feel inspired to help others and feel motivated to use their skills for a positive impact. The challenge is in understanding how they can make a difference.

At the beginning of my teaching programs, I customarily ask my students for a show of hands.

‘How many of you want to change the world?’ I ask them.

It astounds me that so few throw their hands to the sky. When I ask why there is such a lack of desire to make the world a better place, they answer by asking, ‘What difference can I make?’

This is disheartening but understandable. For most of us, it does feel impossible. Trying to create any kind of impact, especially doing it alone, feels daunting. And doing it without a roadmap feels overwhelming. While we might all wish that we could create impact, change the world, improve our futures, it still feels as though there is an insurmountable step between making that wish and taking action to make it happen.

Perhaps this book, with its carefully considered tools to guide cross-cultural design, can become that roadmap for the change we would like to see in the world, be that design for healthier ageing, or applying the underpinning skills and frameworks to create impacts in other areas of life.

It is both a feel-good book to inspire and a guidebook for those wishing to design futures that are better than today. As well as sharing experiences and insights, it offers tools to take us, step-by-step, through a cross-cultural, multi-perspective, co-owned design process that can result in exciting new possibilities.

This is a handbook for anyone desiring to make a difference to the future of our health. We are all ageing, and, through design, we may be able to unlock solutions that allow us to age as we wish to, happily, healthily, and following our heart’s desires.

Acknowledgements

This research was made possible through multiple grants from the Australian Government’s Department of Foreign Affairs and Trade New Colombo Plan, as well as support from the Queensland University of Technology (QUT) New Professor Grant Scheme and QUT Women in STEM Writing Scheme. We would like to acknowledge the support of Mr Greg Mews as our research assistant on this project as well as Dr Tamsin Greulich-Smith and Marina Dzhashi for providing a foreword and epilogue to our text. Along with our institutions – QUT, University of Canberra, Federation University, Nanyang Polytechnic, University of Technology Sydney, Dubai Institute of Design and Innovation, and Monash University – we would like to thank all of the healthcare facilities, residents, and healthcare professionals who worked with us during our study tours.

We would also like to acknowledge the support of the DesignSingapore Council, the National Design Centre (Singapore) and 751D-Park in hosting our exhibitions, as well as the Australian High Commission in Singapore and the Australian Embassy in Beijing, Shanghai, and Guangzhou for supporting and exhibiting our work. We would also like to thank our partner institutions, Shantou University, South China Agricultural University, Guangxi Arts University, Shanghai Jiao Tong University, Kun Shan University, THEi Hong Kong, Tsinghua University, and Politecnico di Milano, for their participation and assistance with the projects described in this book.

Abbreviations

1

Overview

Carlos Montana-Hoyos

That time of year thou mayst in me behold

When yellow leaves, or none, or few, do hang

Upon those boughs which shake against the cold,

Bare ruin’d choirs, where late the sweet birds sang.

In me thou seest the twilight of such day

As after sunset fadeth in the west,

Which by and by black night doth take away,

Death’s second self, that seals up all in rest.

In me thou see’st the glowing of such fire

That on the ashes of his youth doth lie,

As the death-bed whereon it must expire

Consumed with that which it was nourish’d by.

This thou perceivest, which makes thy love more strong,

To love that well which thou must leave ere long.

(Sonnet 73 by William Shakespeare)

Introduction

We wrote this book as a compilation of many years of research and pedagogical experiences around cross-cultural and multidisciplinary design for healthy ageing. In it, we combine different voices and perspectives, including descriptions of several cross-cultural design for healthy ageing workshops conducted with students from design and nursing disciplines in different Australasian locations. These experiences are described in detail, offering a roadmap and many ideas for readers to build upon. Literature reviews and background research inform these practical experiences, which were then used to develop new theory and insights around the topics, mainly from academic and pedagogic points of view. The multiplicity of voices of student participants in the workshops provides a more personalised account of these experiences, while our reflections highlight the pedagogic and life-changing value of these experiences.

We are a multidisciplinary team of researchers based mainly in Australia. Initially, a majority of the team members met while working at the University of Canberra (UC), with specialties in nursing, graphic design, industrial design, and fashion design, all from different cultural backgrounds and with interests in health and healthy ageing. Building on research undertaken with several study tours of Australian students from design and nursing to various Asian countries, mainly China and Singapore, and through collaborations with numerous partners including higher education institutions in Singapore, China, Hong Kong, and Taiwan, the research team explored the multi-layered relationships between design and healthy ageing.

The book is structured into eight chapters. This first chapter provides an overview and introduction, by establishing a background for ‘design for healthy ageing’ in relation to culture, cross-culturalism, multiculturalism, and other key topics. To contextualise the projects we conducted mainly in China, Australia, and Singapore, we also summarise some of the recent literature on related topics, exploring current practices around ageing and demographic trends within each country listed above, and identifying current and upcoming challenges in this area.

Design thinking, co-creation, multidisciplinarity, and cross-culturality are crucial today, but while they are desirable and sought by many, these multi-layered practices are also challenging. The second chapter explains design thinking and cross-cultural design methods that we used to address complex ‘wicked’ problems and social design challenges through multidisciplinary collaboration. Here we review the importance of working cross-culturally in today’s global marketplace and the value to new education systems, which prepare future professionals for