Co-design in health: What can we learn from art therapy?

Driven by calls for democratizing design and empowering patients, researchers are turning to methods that involve users more directly in the design process. Methods such as participatory design and co-design provide a way of engaging individuals in the hands-on creation of their own health technologies. However, some of the ways in which we practice co-design in health are at odds with what the approach aims to achieve. We focus on our own ideas of success, such as improved health outcomes, treatment, or adherence, when the emergent nature of co-design often takes us in entirely new directions. We expect that participants will tell us their health-related needs and generate ideas alongside us, but health is highly personal, and talking about it with others can be emotionally distressing. For individuals with difficulty verbalizing their own experiences, we ask others, such as proxies, to fill in for them, even though this minimizes the role of those with health conditions, whom we most hope to engage through co-design. To rethink co-design in health, we turn to a facet of the healthcare ecosystem that is not often studied by human-computer interaction or healthinformatics researchers: the clinical practice of art therapy. Art therapy is a profession in which participants, guided by the art therapist, use art materials, the creative process, and the resulting artwork to express feelings, reconcile conflicts, foster self-awareness, and achieve other goals. As others have noted, most research in healthcare focuses on doctors and nurses; examining other perspectives, such as those of therapists, can provide new directions for research [1]. Art therapy services are situated within the broader healthcare landscape and alongside biomedical views of health. Yet art therapists approach clinical encounters in ways that are fundamentally different from those of other healthcare practitioners. This departure from mainstream biomedical thinking, while remaining situated within clinical contexts, makes art therapy a compelling site for inquiry. Approximately fve years ago, our research group began a fruitful partnership with an art therapy program in a skilled nursing facility. Through our feldwork, we began to see the work of art therapists as a situated example of co-design involving people with diverse health experiences. Over the years, our feldwork involved art therapists who work in varied settings (e.g., hospitals, private practice, residential communities) and with a range of populations, including individuals experiencing addiction, child-welfare recipients, immigrants, and domestic violence victims, as well as those with.