Co-designing Cultural Probes


Catherine Montgomery, Joanne Mair and Santini Basra

This is the second post in our Critical Care Futures series. If you need to catch up, head back to the  first post where we give a little context on this project — ‘Exploring Futures for Critical Care Research’ — while also introducing Cultural Probes as an engagement tool, and our rationale for using them in this project.

In this post we reflect on the process of designing cultural probes for this project. Cultural probes are complex research tools — there is a huge spectrum of possibility regarding the shape that they can take, and several factors need to be balanced in order to produce one which is appropriate and effective.

In our process, we brought together a diverse, interdisciplinary group to co-design the probes — the group was made up of four ‘co-designers’ who worked alongside the core project team. These co-designers represented the four intended audiences of the engagement activity:

  • ICU Survivors and/or Relatives
  • ICU Clinicians
  • ICU Researchers
  • Ethics Committee Members

Together we collaborated on the generation and then refinement of concepts for the probes, and then subsequently the four co-designers helped us test and iterate the first versions of these.

This post brings together three individuals who were involved in the co-production of the probes to reflect on the challenges and process from their own perspectives:

C atherine Montgomery

 is a Sociologist of Science and Medicine at the University of Edinburgh.

Santini Basra is the director of Andthen, a team of design researchers who specialise in conducting research about people’s perspectives on the future.

Joanne Mair is a Clinical Project Manager who focuses on the translation of novel diagnostics from bench to bedside. Joanne has also undertaken various roles as part of the NHS ethics committee service.

Santini: It’s been lovely collaborating with you both over the last couple of months to design these probes. I’m interested in learning about whether this has been a familiar experience for the two of you — both in terms of working collaboratively in this way, and contributing to the development such an open-ended exploratory research tool?

Catherine: For me, this has felt close to the ways in which I’ve done research in the past — engaging with key stakeholders, working in a multidisciplinary way, being led by what comes up (open-ended research is a mainstay of the sociological work I usually do). What has been less familiar, and really enjoyable, is the flipped power dynamic at work — rather than ‘steering’ this, being a participant in the process myself. Jo, I wonder how this has felt for you?

Jo: This is quite different to how I have carried out or been involved in research in the past. Although I engage with stakeholders and the end-users of the “product” they come from quite defined walks of life and set out with a specific aim which is normally to fulfil milestones in a grant. Within my ethics role, we work within a provided set of information over which we also have a very defined role. I really enjoyed the way everyone involved in this project was asked to look at it from their own perspective and expertise but also from other peoples’ and how they would engage, use and reflect on the outputs.

I feel that the openness of the collaboration allowed the team to explore the probes from all angles without feeling they had to be an expert in what they were saying, was that similar for yourself Catherine?

Catherine: Yes, it was. What worked really well was getting everyone around the table together — former patients, ethics committee members, researchers, clinicians and designers. This doesn’t often happen and I think the very act of getting people in the room together unlocked an energy and a mutual curiosity that helped shape the development of the probes in a very positive way. The kinds of spontaneous conversations you have in that scenario, and the way they stimulate others to jump in and add their ideas, are hard to manufacture through more traditional methods.

Santini: It’s interesting that you bring up flipping power dynamics — I often see the challenges around managing power dynamics when working on research or engagement projects. As researchers or facilitators we hold a lot of power, but for me, it’s always important to flip that, as ultimately those we are working with are experts in their own experience. Co-design is a great way to make this flip, it really positions participants as experts (and therefore collaborators). But co-design is a tricky process to manage, especially when dealing with something as open-ended as cultural probes — what did you both find challenging about it?

Jo: I found the inclusivity aspect challenging — in my head I kept going back to “would everyone manage to take part in this” rather than being able to see the probes as different elements that will hopefully encompass everyone. I found it difficult to separate out my “role” within the design process from the challenges I typically encounter when carrying out research and as part of the ethics committees. I really enjoyed hearing everyone’s viewpoints and felt we could have talked for much longer but everything has to have a time limit!

Catherine: Condensing these discussions into the timeframe of a workshop was challenging. Probes can sometimes invite expansive and unexpected responses, ideally it would be nice to have more time to explore these. Being both goal-oriented and at the same time inviting creative responses is a tension — I’m not sure if this was particularly pronounced because we’re working in health research. Distilling the ideas that everyone came up with as part of the co-design process was really tricky and I think there are multiple avenues we could have gone down with the probes, but didn’t due to the process of consensus-forming. Santini, I’d be interested in how this felt from your point of view as a designer?

Santini: That’s a key tension you highlight there, and it’s one that I think most designers wrestle with, especially as the practice of design has become more and more collaborative. Inviting some kind of openness and unconstrained creativity is really useful in getting the most out of a co-design session — this is why for instance designers will often encourage all ideas, and get away from the language of ‘good ideas’ and ‘bad ideas.’ But, design as you say needs to be outcomes focussed (eventually you need to make something) which means that you need to be careful about how you direct people’s contributions. You want people to be able to input in a way that is likely to have an impact on the outcome of the work, and typically you need people to be able to see a connection between their input and some kind of output — in this case, the design of the cultural probes. Finding that balance is difficult, as is distilling the range of ideas that you are left with after a co-design session. Typically, there will be several great ideas, but once you put them through a few filters — for instance, ‘what’s feasible?’ ‘what’s going to be easy to use?’ or ‘what best addresses the project objectives?’ — the answer becomes clearer and therefore easier to build consensus around.

You said something interesting there Catherine about the impact that the domain of health research might have on the way we were working. I’d be keen to explore that a little further — how do you think health research influences the tension between goal-oriented working and creative exploration?

Catherine: I think that a lot of health research is influenced by an epidemiological orientation to the world, which seeks to categorise, standardise, and provide answers to a tightly defined question within a given set of parameters. The logic of positivism underpins this approach, which tends to sideline more phenomenological, interpretative and constructivist ways of looking at the world. Qualitative research has sought to counter these tendencies and thereby expand the kinds of knowledge we produce related to health and illness, but even so, there can be constraints on what is considered useful knowledge, which can have a chilling effect on creativity. In this particular project, which is led by a multi-disciplinary team of people from design, medicine, nursing and sociology, I hope we’ve found a balance between creative exploration and providing useful insights to help shape the future of critical care research. But a part of me wonders if we could have been more radically creative if the topic was one where there was less at stake.

Jo, any further thoughts on this?

Jo: I have little experience with qualitative research but I appreciate the constraints on the impact we can have when trying to change the way we carry out research. I see this due to the processes and procedures that are in place due to other concerns for example legal and regulatory. Those who have to take responsibility for any comeback from participants or those who consent on behalf of them have processes in place to minimise any fallout, this means that we have to operate within a set of often rigid rules and behaviours. As such the useful knowledge that we gain can’t always be applied as freely as we would hope. Working within the “what can actually be done” and “what we would like to see” is difficult, I could see how this could create tension in a collaborative group. I felt that on one hand, I was really engaging with ideas whilst on the other hand I was thinking would these be difficult to carry out within the current processes effectively? When engaging with previous ICU patients I found out those who have been involved in trying to shape other research projects have found similar constraints. This doesn’t mean we shouldn’t keep advocating for change and demonstrating the buy-in from previous patients in a sensitive area for research.

Santini: I’d definitely agree that the topic (and also the target groups of participants) set some clear boundaries around how radical we can be with the research activity. When we’re researching less sensitive topics we’re generally very comfortable designing highly open-ended research activities, that really push a participant to explore the way they think or feel about something. But when working on sensitive topics such as this, there is a safeguarding component that needs to factor in. With cultural probes, we’re asking participants to complete activities on their own, without anyone from our team there to support them. With this topic, it’s likely that individuals we’re engaging have had very difficult experiences associated with the time that they or their family members have spent in the ICU, so it’s important to make sure the probes have some guardrails which avoid them straying into territory that’s triggering. Nonetheless, this will be a particularly interesting point to reflect on once everyone has completed the probes, and I’m keen to see what others think the impacts might have been if we structured them differently and whether they indeed feel like they’ve been co-designed. Let’s revisit this once they are all completed!

Sharing tools from our process

Some of the tools we developed to support this co-design process are available here to download for free, under a creative commons licence.

These include:

 Introduction to Cultural Probes

  • Introduction to Cultural Probes — a brief introductory presentation which outlines what cultural probes are, and gives a range of examples. 

Cultural Probe Method cards

  • Cultural Probe Method cards — a printable set of cards which list different mediums one might use for developing a cultural probe. These can be used in an idea development session to help stimulate thinking and generate new concepts.

About ‘Exploring Futures for Critical Care Research’

‘Exploring Futures for Critical Care Research’ is funded by a Scottish Public Engagement Network (ScotPEN) Wellcome Engagement Award. The project is a collaboration between clinicians, social scientists and designers, working with ICU survivors and research governance staff to co-design cultural probes for public engagement. In addition to catalysing dialogue, the project aims to produce a set of future principles for person-centred approaches to data use and consent in ICU, as well as a public-facing installation about the future of ICU research.



Zoomorphic adventures with data animals at the surgical and critical care informatics away day

If data were an animal, what would it be?

Catherine Montgomery

Often we think about data as an object: inert, manipulable, and something we control. We collect it, harvest it, scrape it, clean it, curate it, store it, share it, analyse it and display it. In these endeavours, we think about human agency and the work that we – as clinicians, statisticians, data scientists, sociologists – do to make sense of the world through quantified means. But what about the data themselves? What do they do? And what would it mean to give them agency? This is something that Science & Technology Studies scholars do routinely to underscore the ways in which the material world interacts with humans to create societal order. As a fun and playful way to think about some of the features of data that we identify with or relate to, we can ask, “If data were an animal, what would it be?”

After a full day and a half of talking about data at the strategy away day, it was time for people to get their hands dirty at Doodles pottery for some ‘team-building’. What better occasion to paint our own data animals! Everyone chose an item to paint: a mug, a jug, a bowl, and got to work dabbing, splatting, etching, and painting their designs. Creative activities like pottery painting are said to be good for team building because they nurture trust between colleagues; usually, everyone starts with minimal expertise, which is a good leveller, and everyone makes themselves a little bit vulnerable by putting their creations out into the world. This kind of activity also helps people get in touch with their inner artist and the parts of their brain responsible for creativity, imagination and intuition. This is the birth place of data animals!

If the description of data as inert, manipulable, something we control were sufficient, we might have seen a lot of domestic data animals – cats and dogs, rabbits and rodents. Of these, there were none. Instead, we had a zebra and a giraffe, centipedes and dragonflies, frogs, foxes, owls, a death butterfly and a skull. Certainly, it seems that data are not tame in this group’s collective imagination!

So what did our data animals have to say about data? Riinu’s rainbow zebra shows the importance of reading between the lines; data analysis is not black and white and datasets are diverse, represented by the zebra’s rainbow stripes. Sarah’s giraffe represents the ability to use data for utilising resources that would otherwise be difficult to access (it’s also an animal in long-format). George’s frog follows an r-selection breeding strategy, otherwise known as an ‘r-strategist’: “this narrative is inspired by my approach to model selection – generating as many as one can sensibly think of and then whittling them down using natural selection/data metric driven selection”. Liz’s centipedes represent lots of quick-moving arms but overall, somewhat slow going; Annemarie’s death butterfly is superficially elegant and beautiful, but must be treated with respect as can be deadly if provoked or used badly. Ewen’s “ripped off owl jug” embodies imitation as the sincerest form of flattery: in data science, it is best to build on what has already been a success. Cath’s barn owl is a flash of light in the dark, but also eats other data animals for breakfast (sociologists of science and medicine can be a critical bunch). Ian’s animal is deceased and only the skull remains: “being the oldest member of the group I have datasets dead and buried all over Scotland…but a little bit of “data mining” might resurrect some of them?”

So: from sex and death to work and the constant striving for resources, social benefit and success, the data animals have it all. It would be disingenuous to suggest that the explanations we wove to account for our creations preceded the act of painting them; nonetheless, the stories we tell about data are an important way in which we relate to the world and the work that we do to make sense of it through research.


Cultural probes for public engagement

By  Catherine Montgomery Santini Basra Corrienne McCulloch Annemarie Docherty

If you’ve ever worked in or been a participant in health research, you will know that the process is one which strives for certainty in spaces where knowledge is uncertain, seeks signal over noise, and aims to follow a linear trajectory from research question to publication. In this most rational of endeavours, all parts of the process are designed with clarity, efficiency and risk-avoidance in mind: protocols dictate how the research will be conducted; ethics applications must anticipate all eventualities so as to minimise risk to participants and investigators; research tools and analysis plans must be pre-specified; the boundaries of the inquiry are set.

There are good reasons for designing and executing research in this way, most of which are to do with protecting participants and ensuring the scientific integrity of the knowledge produced. But what kind of knowledge do these processes produce when the world under study is messy, complex, and riven with ambiguity? Reflecting on social science methods nearly two decades ago, Science & Technology Studies (STS) scholar John Law wrote:

“If much of the world is vague, diffuse or unspecific, slippery, emotional, ephemeral, elusive or indistinct, changes like a kaleidoscope, or doesn’t really have much of a pattern at all, then where does this leave social science? How might we catch some of the realities we are currently missing? Can we know them well? Should we know them? Is ‘knowing’ the metaphor that we need? And if it isn’t, then how might we relate to them?”

(Law 2004: 2)

The same holds true for methods beyond the social sciences. In health research, where the randomised controlled trial holds the trophy for most highly prized knowledge, mess, instability, the ephemeral and the vague are rendered into data which is clean, complete, definite and stable. How, then, to engage the public with the ensuing knowledge, which is removed by several degrees from lived experience?

ICU-HEART is a research project funded by the Wellcome Trust, whose vision is to use routine healthcare data to improve outcomes for critically ill patients with co-existing cardiovascular disease. It aims to do this by using large national datasets to characterise patients at risk of heart attack and to design a clinical trial which will be able to show evidence of intervention effect. In ICU, around 75% of patients are admitted as an emergency, over half of these admissions take place outside normal working hours, and nearly one in five patients die in hospital. In these scenarios, most patients lack capacity to consent to treatment decisions (including participation in research) and their closest relative must give consent for participation in research on their behalf. This is a difficult task which may have significant consequences during a moment that is fraught with emotional turmoil.

Development of technology and secure mechanisms to analyse data mean that the boundaries of research and clinical care are shifting. Healthcare data that is routinely collected as part of an ICU patient’s care can now be integrated with research and used to create data sources for clinical trials. The historic emphasis on experimental research (randomised clinical trials) no longer reflects the focus of research undertaken in Critical Care, where researchers can understand much about admitted patients and their outcomes from data collected as part of their clinical care.

The potential for technological advance in relation to care and knowledge begs the question of what critical care should be like in the future: for patients and their relatives, but also clinicians, researchers and those responsible for ensuring research is ethical. Should all patients admitted to ICU contribute to research? What kind of consent, if any, should patients and their relatives give for their data to be included in studies? How does care change if a patient is involved in research?

It would not be difficult to design a questionnaire to ask people their thoughts about these issues. We could define the universe of possible responses, give people multiple choice boxes to tick, and quickly get a set of answers. Alternatively, we could conduct a smaller number of in-depth interviews exploring participants’ experiences of taking part in research in ICU and asking what they think a good model of care and consent would look like in the future. In the first scenario, the answers we get are delimited by our own conceptual universe as researchers. There is little room for things we haven’t thought of, for nuance, for ambiguity, for depth of human experience, or indeed for empathic understanding. In the second scenario, there is space for all of these things to emerge, but only within the contrived setting of the research interview. In both cases, we institute an imbalance of power, between ‘us’ the active researchers or knowers and ‘them’, the passive researched, the known.

This is not what engaged research looks like, and if we want a future ICU in which all those involved feel they have a stake, we must engage a breadth of stakeholders in articulating its design. Academics at the Centre for Biomedicine, Self and Society have been actively working on the question of engaged research for some years. In a recent  paper, they stress the importance of researchers thinking through how their position in society affects the kind of knowledge they produce and the kinds of power relations it entails (Erikainen et al 2022). Implicit is an acknowledgement that all knowledge is situated, plural and partial — in other words, scientific knowledge is not a ‘view from nowhere’ but is implicated in a particular way of seeing the world from a given standpoint. There are many different types of knowledge, and each of these can provide a partial, but never complete representation of the world.

Given all of this, how could we engage different stakeholders around the question of what ICU as a place of care and research should look like in the future?


Cultural probes are a method developed in the field of design research to elicit inspiration through provocation. Consisting of visual and tangible kits that include various kinds of descriptive and exploratory tasks, such as photographing, diary-writing and collage-making, probes aim to sensitise participants to observe, reflect upon and report their experiences — while also sharing insight into their deeply held values, beliefs and ways of seeing. They offer an opportunity to disrupt the typical researcher/researched roles — probes are typically sent to participants who can complete them in their own time, in their own space, and in their own way, as activities usually are intended to be open to interpretation. “Traditional methods seem to set up a sort of game, with implicit rules limiting the relationship between researcher and researched to one addressing controlled content areas,” wrote Gaver, one of the inventors of cultural probes (Gaver 2020: 22). To counter this, probes were designed to subvert the traditional relationship between researcher and researched, allowing a conversation through which each could reveal aspects of themselves to the other. Narrating The Presence Project, in which cultural probes were first developed, Gaver describes embracing ambiguity and valuing subjectivity, leaving space for exploration, and encouraging imagination and dialogue about possible futures. This, he writes, “allowed us to work both playfully and purposefully breaking the boundaries of prevailing scientific approaches to address new values and emotions” (Gaver 2020: 11).

To us, cultural probes represent a tool for catalysing conversations between patients and relatives, clinicians, researchers, and research governance staff about the future of critical care. Existing dynamics between these different groups are characterised by entrenched power relations and protocolised ways of acting, which are not conducive to breaking the mould and imagining alternative futures. In ‘Exploring Futures for Critical Care Research’, we aim to challenge these dynamics by encouraging playfulness, embracing different kinds of knowledge, and making space for imagination as critical care moves into the data-driven era.

About ‘Exploring Futures for Critical Care Research’

‘Exploring Futures for Critical Care Research’ is funded by a Scottish Public Engagement Network (ScotPEN) Wellcome Engagement Award. The project is a collaboration between clinicians, social scientists and designers, working with ICU survivors and research governance staff to co-design cultural probes for public engagement. In addition to catalysing dialogue, the project aims to produce a set of future principles for person-centred approaches to data use and consent in ICU, as well as a public-facing installation about the future of ICU research.

About the authors

Catherine Montgomery is a Sociologist of Science and Medicine at the University of Edinburgh.

Santini Basra is the director of Andthen, a team of design researchers who specialise in conducting research about people’s perspectives on the future.

Corrienne McCulloch is a Research Nurse Manager and NRS Clinician in NHS Lothian.

Annemarie Docherty is an academic Critical Care Consultant in Edinburgh. Her primary research interests lie in the integration and analysis of prospective and routinely collected healthcare data to improve outcomes for critically unwell patients.

References

Erikainen S, Stewart E, Filipe AM et al. Towards a feminist philosophy of engagements in health-related research [version 2; peer review: 2 approved] Wellcome Open Research 2022, 6:58  https://doi.org/10.12688/wellcomeopenres.16535.2

Gaver, W. (2020) The Presence Project, Second Edition. London: Goldsmiths Press

Law, J. (2004) After Method: Mess in Social Science Research. London: Routledge



Critical Care Futures

“Our biggest challenge in conducting research in ICU is gaining consent. We want the public’s help to find out the best ways to ask for consent and explain why we need it.” – Annemarie Docherty

‘Exploring Futures for Critical Care Research’ is a new project recently awarded funding by the Scottish Public Engagement Network (ScotPEN) through a Wellcome Engagement Award. The project, led by Dr Annemarie Docherty in collaboration with Dr Catherine Montgomery and Dr Corrienne McCulloch, aims to facilitate dialogue between different ICU stakeholders on the boundaries between research and care in order to influence our approach to ICU research in the future. The project will use methods from design research – cultural probes – to generate insights into experiences of ongoing ICU research and to capture preferences for this in the future for the people who contribute to research studies.

Image credit: Interaction Research Studio

Cultural probes are used in design research to gather information about people’s behaviours, values and thoughts. They take the form of interactive, playful and thought-provoking tasks. In collaboration with Glasgow-based design studio Andthen ( https://www.studioandthen.com/) we will co-design probe tools with patients, relatives and researchers who work or spend time in ICU. Working with Andthen and with probe participants, we will transform these insights into a public-facing installation about the future of ICU research. This will be a scalable output, that can be replicated in ICUs around the UK. We will also produce an insight report for professionals to guide them in person-centred approaches to data use and consent.

The CLAP Study

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