Conference Presentations by Fernando Carvalho
Behavioural insights' is a term that refers to the application of findings from behaviour science... more Behavioural insights' is a term that refers to the application of findings from behaviour science to support the design of public policy and services. The potential for an expanded use of behavioural insights to healthcare quality improvement has been underlined in the NHS Five-Year Forward View. In the report, the NHS recognises that changes in staff behaviour will be of primary importance to reducing human error and delivering of "new care models" (NHS, 2014). Improving quality in healthcare entails implementing and sustaining a continuous cycle of change and critical evaluation (Scoville et al., 2016). Adopting this improvement cycle can be challenging in many respects that range from recognising the most pressing problems and developing appropriate solutions, to managing data and evaluating practice and outcomes . Many approaches and tools to Quality Improvement exist -including recent HFE integrative proposals -and yet little is known about how behavioural insights can be applied to quality improvement in healthcare.
Behaviour insights have been successfully applied to redesign interactions in various health and ... more Behaviour insights have been successfully applied to redesign interactions in various health and public services. The design field has shown to have substantial contributions to this process as it offers a variety of methods and tools that can facilitate or enable effective change. However, design for behaviour change can be counterproductive if a set of relevant issues – pertaining both to the practical and the philosophical realms – are not carefully considered in the first place. Some primary questions, or ethical dilemmas, that arise as a result of this thought process are: 1. How do we know what is good behaviour? 2. Who is good behaviour for? 3. Who decides what good behaviour is? 4. When is behaviour insights application inappropriate/unethical? Interventions aiming at changing behaviours directly impact people's lives, and some changes can determine, limit or completely eliminate individual choice for the sake of addressing the collective well-being. This 'choice conflict' constitutes one of the central ethical concerns regarding behaviour change interventions, and it has been discussed by several authors from diverse fields, even being an integral part of some intervention frameworks. The implications of the 'choice conflict' also cascades down to be a part of other ethical dilemmas, relevant to intervention design and implementation, such as determining in whose hands lays the responsibility for change, as well as in the issue of understanding what 'good behaviour' is. Behaviour change interventions must draw from reliable evidence and contextualised information, which enables key stakeholders to agree on what constitutes 'good behaviour' in a particular context and for practitioners to design behaviour change interventions appropriate to those whose behaviour we hope to change. Sound scientific evidence depends on research methods and knowledge of state-of-the-art theories which can evolve; on the other hand, evidence must be supported or complemented by a general consensus which is culturally and historically determined, and heavily dependent on social norms, individual beliefs, and ethical and moral values. These values are, in turn, constructed, reinforced and challenged as societies' progress. So, a landscape of changing evidence and changing values make it for an extremely complex environment in which decisions need to be taken. We would like to explore these questions with a behaviour insight example in the NHS (Stop A&E time waster) and discuss a potential way forwards to address ethical dilemmas. A promising way of turning ethical dilemmas into fruitful resources would require a shared responsibility between state, community and individuals– all being active stakeholders within the intervention space. In conclusion, behaviour change intervention design needs to be the result of a collective, participatory process – one which takes into account the perspectives of different stakeholders, as well as the global and local context in which the intervention will take place, from the assessment phase all the way up to planning, implementation, evaluation, maintenance, and replication.
Papers by Fernando Carvalho
This paper reflects on fundamental ethical issues concerning designing for behavioural change, in... more This paper reflects on fundamental ethical issues concerning designing for behavioural change, in order to raise questions about the factors that should be considered by design practitioners when developing interventions. It draws on existing literature on philosophical ethics, moral psychology and design. It proposes a list of ethical questions and considerations to be made throughout the design process. A case study addressing behavioural changes in antibiotics prescriptions (for Urinary Tract Infections) was carried out to demonstrate how the ethical questions identified are asked and considered. We provide a framework for addressing these issues with the hope that it will help minimise the risk of problematic and unethical intervention design processes.
Behaviour insights have been extensively applied to public policy and service design. The potenti... more Behaviour insights have been extensively applied to public policy and service design. The potential for an expanded use of behaviour change to healthcare quality improvement has been underlined in the England's National Health Service Five-Year Forward View report, in which staff behaviour is connected to the quality of care delivered to patients and better clinical practice (NHS, 2014). Improving the quality of healthcare service delivery involves adopting improvement cycles that are conducted by multiple agents through systematic processes of change and evaluation (Scoville et al., 2016). Despite the recognition that some of the recurring challenges to improve healthcare services are behavioural in essence, there is insufficient evidence about how behavioural insights can be successfully applied to quality improvement in healthcare. Simultaneously, the discussion on how to better engage participants in intervention design, and how to better enable participation are not seen as fundamental components of behaviour change frameworks. This paper presents an integrative approach, stemming from comprehensive literature review and an ongoing case study, in which participatory design is used as the conduit to activate stakeholder engagement in the application of a behaviour change framework, aiming to improve the processes of diagnosing and managing urinary tract infection in the emergency department of a hospital in England. Preliminary findings show positive results regarding the combined use of participatory design and behaviour change tools in the development of a shared-vision of the challenges in question, and the collaborative establishment of priorities of action, potential solution routes and evaluation strategies.
This paper describes the development of a unique load-bearing system providing hands-free carriag... more This paper describes the development of a unique load-bearing system providing hands-free carriage by
distributing weight across the lower body, which constitutes the strongest structures of the human
anatomy. The Hip Harness Carrying System enables users to utilize their arms and upper body for
various tasks or additional support in a variety of applications including emergency rescue, agricultural
harvesting, construction work, military transport, and diverse general carrying tasks.
The hip harness arose from a realization that the best emergency medical care is ineffective if geographic
conditions block access. Within the compressed, disorganized architecture of numerous underserved
urban settlements, such barriers are defined by a maze of confining alleys, open-air sewage drains,
uneven terrain, and crowds of people in transit. Reality for the poorest often means that help never
arrives.
A case can be made that introducing the proper tool would not only improve the reliability of health
services delivered to slum dwellers, but will also facilitate other tasks that may benefit a much larger
population. Due to the characteristics of the environment and the challenges they impose, designing
equipment for rescue in slums will contribute to better rescue in other emergency scenarios, such as in
natural disaster sites, vertical construction, and war zones – all of which can occur virtually anywhere on
the planet.
During development of the Hip Harness Carrying System, a number of corelated applications expanded
the use of the product, helping to justify its production far beyond its initial function. Mainstreaming
technology designed for a particular context, allows the distribution of the hip harness across broad
geographic, socioeconomic and cultural contexts. Identified applications include carrying outdoor
equipment, such as canoes and gear; pulling/pushing rickshaws and carts; harvesting fruit; use in
construction sites; and other manual labor tasks involving carriage.
The following sections of the paper present characteristics of urban slums, analysis of existing carrying
methods, biomechanical data on human movement and carriage, and the features and applications of the
final design solution. The Hip Harness Carrying System presents users with the advantage of hands-free
carriage, and the ergonomic distribution of weight to diminish back overload and enhance the safety of
the task, bringing benefits to both rescuers and victims.
Drafts by Fernando Carvalho
This essay draws on the connections between design, intelligence and creativity to address some o... more This essay draws on the connections between design, intelligence and creativity to address some overarching political and ethical responsibilities of design choices.
Uploads
Conference Presentations by Fernando Carvalho
Papers by Fernando Carvalho
distributing weight across the lower body, which constitutes the strongest structures of the human
anatomy. The Hip Harness Carrying System enables users to utilize their arms and upper body for
various tasks or additional support in a variety of applications including emergency rescue, agricultural
harvesting, construction work, military transport, and diverse general carrying tasks.
The hip harness arose from a realization that the best emergency medical care is ineffective if geographic
conditions block access. Within the compressed, disorganized architecture of numerous underserved
urban settlements, such barriers are defined by a maze of confining alleys, open-air sewage drains,
uneven terrain, and crowds of people in transit. Reality for the poorest often means that help never
arrives.
A case can be made that introducing the proper tool would not only improve the reliability of health
services delivered to slum dwellers, but will also facilitate other tasks that may benefit a much larger
population. Due to the characteristics of the environment and the challenges they impose, designing
equipment for rescue in slums will contribute to better rescue in other emergency scenarios, such as in
natural disaster sites, vertical construction, and war zones – all of which can occur virtually anywhere on
the planet.
During development of the Hip Harness Carrying System, a number of corelated applications expanded
the use of the product, helping to justify its production far beyond its initial function. Mainstreaming
technology designed for a particular context, allows the distribution of the hip harness across broad
geographic, socioeconomic and cultural contexts. Identified applications include carrying outdoor
equipment, such as canoes and gear; pulling/pushing rickshaws and carts; harvesting fruit; use in
construction sites; and other manual labor tasks involving carriage.
The following sections of the paper present characteristics of urban slums, analysis of existing carrying
methods, biomechanical data on human movement and carriage, and the features and applications of the
final design solution. The Hip Harness Carrying System presents users with the advantage of hands-free
carriage, and the ergonomic distribution of weight to diminish back overload and enhance the safety of
the task, bringing benefits to both rescuers and victims.
Drafts by Fernando Carvalho
distributing weight across the lower body, which constitutes the strongest structures of the human
anatomy. The Hip Harness Carrying System enables users to utilize their arms and upper body for
various tasks or additional support in a variety of applications including emergency rescue, agricultural
harvesting, construction work, military transport, and diverse general carrying tasks.
The hip harness arose from a realization that the best emergency medical care is ineffective if geographic
conditions block access. Within the compressed, disorganized architecture of numerous underserved
urban settlements, such barriers are defined by a maze of confining alleys, open-air sewage drains,
uneven terrain, and crowds of people in transit. Reality for the poorest often means that help never
arrives.
A case can be made that introducing the proper tool would not only improve the reliability of health
services delivered to slum dwellers, but will also facilitate other tasks that may benefit a much larger
population. Due to the characteristics of the environment and the challenges they impose, designing
equipment for rescue in slums will contribute to better rescue in other emergency scenarios, such as in
natural disaster sites, vertical construction, and war zones – all of which can occur virtually anywhere on
the planet.
During development of the Hip Harness Carrying System, a number of corelated applications expanded
the use of the product, helping to justify its production far beyond its initial function. Mainstreaming
technology designed for a particular context, allows the distribution of the hip harness across broad
geographic, socioeconomic and cultural contexts. Identified applications include carrying outdoor
equipment, such as canoes and gear; pulling/pushing rickshaws and carts; harvesting fruit; use in
construction sites; and other manual labor tasks involving carriage.
The following sections of the paper present characteristics of urban slums, analysis of existing carrying
methods, biomechanical data on human movement and carriage, and the features and applications of the
final design solution. The Hip Harness Carrying System presents users with the advantage of hands-free
carriage, and the ergonomic distribution of weight to diminish back overload and enhance the safety of
the task, bringing benefits to both rescuers and victims.