A flexible third-place, design research enquiry during the pandemic

Abstract This report presents the reflections and insights generated while undertaking a design for health PhD during the COVID-19 pandemic. It examines how design researchers adapted using creative strategies and reveals the researchers' reflections and learnings for this imposition. This research began in late-2019, shortly before the arrival of the Covid-19 pandemic.


Introduction
This report presents the reflections and insights generated while undertaking a design for health PhD during the COVID-19 pandemic. It examines how design researchers adapted using creative strategies and reveals the researchers' reflections and learnings for this imposition.

Research context
The aim of the PhD project is to explore how Augmented Reality (AR) technologies, together with Environmental Graphic Design (EGD), might improve the workplace experience and overall wellbeing of healthcare staff. To date, there are limited examples of AR and EGD being combined. A design-based research process has been used to explore the potential of combining these technologies to communicate personal health and wellbeing messages. Three prototypes: (1) icon stickers that trigger AR content on a handheld device, (2) AR content projected onto everyday objects, and (3) a full-wall graphic with projected AR content were tested with a range of user groups. The initial findings suggest there may be potential to improve employee wellbeing by combining AR and EGD in office environments.
This research began in late-2019, shortly before the arrival of the Covid-19 pandemic. In this report, we share insights from the process of adapting and changing the initial research design and method in response to broad public activity restrictions, and disruptions associated with the pandemic response.

Adapting methods in design research
The research project was originally planned as an exploratory case study using a co-design methodology (Steen, Manschot, and De Koning 2011). The project planned to engage research participants from the Royal Adelaide Hospital (RAH) through a series of co-design workshops. In the first phase of the project, we planned to engage healthcare employees to clarify the current work issues, then collaboratively develop a series of prototypes that used environmental graphic design (EGD) and augmented reality (AR). In the second phase, we planned to install these prototypes within their healthcare work environment (at the RAH) then use a think-aloud protocol to collect participants' reflections on their experiences with the prototypes (Elizabeth 2010).

Phase 1
In response to the public activity restrictions, and a general ban on researchers entering hospital facilities, the research approach was modified to become an experimental case study that used a framework of Participatory Action Research (PAR) to bring together a variety of engagement methods. In the first phase, this included conducting virtual focus groups and oneto-one conversation to clarify elements rather than live co-design workshops. In the second phase, the approach to testing prototypes with participants was adapted in response to the ban on researchers accessing healthcare facilities, with a simulated healthcare work context constructed within a science museum where the museum is located nearby the Royal Adelaide Hospital (RAH), the original research location.
A key part of co-design practice is helping participants to engage in challenges through design thinking processes and activities (Slattery, Saeri, and Bragge 2020). This requires experienced facilitators and can also require participant to step outside their comfort zone, particularly when working in fields such as healthcare where positivist and experimental methodologies are seen as a default for research. This set of skills was particularly evident in the required pivot to the Museum venue for user testing.
The recruitment of participants for any research project is challenging, yet this became increasingly difficult when recruiting healthcare professionals during the pandemic. In seeking to reconsider our research design to this challenge, recruitment was expanded to additional hospital sites, and the approaches to engagement were created based on the willingness of the end-user community to engage, rather than on the preferences of the research team. While we explored the possibility of conducting virtual co-design workshops in the development of the prototypes, participants were more comfortable in taking on a reflective and reviewing role.
The less personal environment of online engagement, as compared with a face-to-face environment, made building participants capacity to engage through design thinking and co-design activities very difficult. Engagement in co-design requires and understanding of a complex set of practices and a great deal of time investment, not only in developing pragmatic skills, but also in building relationships and encouraging participants to switch to alternative mindsets when constructing prototypes together to ensure that the practice is effective (Iniesto, Charitonos, and Littlejohn 2022). While this may have been possible had participants been able to commit additional time to the process, the nature of working with healthcare staff during the pandemic meant that it was not possible to spend this amount of time with the staff group. This necessitated a switch to treating the engagement as a focus group rather than a generative co-design process, and a wider reframing of the process as PAR rather than co-design.
The switch was also catalysed by general time pressures of the PhD research. The aforementioned challenges of recruitment, combined with the need to change ethics protocols, seek additional approvals, and recruit additional sites meant that time became a major concern for the project. A flexible participant engaged, collaborative enquiry enabled a useful strategy for working with participants and developing prototypes, as much of the prototyping design process was conducted by the research team, rather than as a collaborative process as would have been the case in a co-design process. These design decision making process were however, informed by the participant interviews and focus groups. This process still involved acquiring feedback from participants in a collaborative manner but placed participants in a more reflective rather than generative role. As part of this shift, we recognized that decision-making power on the prototype had been shifted away from the users (research participants). This was identified as a catalysing potential bias, so a second round of focus groups, in addition to the original plan for a thinkaloud protocol, was established for phase two of the project.
This kind of pivot in the processes being used is often observed in agile design practices in response to changing project focus or the identification of new user needs (Brito and Quaresma 2019). However, in this project, we used this pivot process to redress a change in the research design and the ensuing power-structure of the processes (that had originally been established with the intent of co-designing with participants) was not entirely replaced by a designer-led process.
An additional layer was also included to these processes, with informal individual discussions offered to participants on an as-needed basis to ensure they were provided opportunities to contribute. This was particularly useful when participants were legally directed to remain in isolation, or when increased demand on the health system made participation more difficult.
Using PAR, we were able to gain insights from a series of virtual focus groups to develop strategies and tools for prototyping, while at the same time, retaining at least some of the sense of empowerment of participants involved in the research (Rosier et al. 2022;Baum, MacDougall, and Smith 2006).

Phase 2
The second phase of the research was originally intended to be installed in a healthcare environment. As such, the majority of opportunities identified in the initial design of the project were focussed on device-based AR content. Restrictions on sharing physical devices, and a push towards limiting contact with physical surfaces catalysed a deeper and more critical exploration of the types of AR experience that might be possible. In particular, these restrictions catalysed a stronger engagement with Spatial Augmented Reality (SAR) technologies and approaches.
The technologies for these approaches are less developed than devicebased content, but the disruption necessitated the creation of what would go on to become some of the most successful prototypes. SAR enhances real world objects and scenes without the need for monitors, head mounted displays or handheld devices by projecting an additional layer of content (Rodrigues et al. 2020). Initial explorations focussed on using the same kinds of environmental graphics approaches that were originally intended to be used in device-based explorations, but later prototypes extended this to projection to enhance three-dimensional objects rather than two-dimensional graphics. With SAR, digital content is seamlessly integrated into the physical world, allowing participants to interact with their physical environments in new ways. Being immersed in the content, rather than a passive observer of content (such as looking at a screen), allows us to engage with the augmented world (Alzahrani 2020).
In this part of the research, the implication of an external constraint on the interaction with the protypes that were being produced meant that the research team explored new technologies and approaches. This alone is not necessarily a positive outcome, however, the overwhelmingly positive feedback on these approaches as compared with the initial device-based AR content suggests that these explorations can be seen as a silver-lining of the constraints that were put in place. Using SAR with both two-dimensional EGD and three-dimensional objects has emerged as a strong theme with positive participant responses and has become an unexpectedly fertile ground for future explorations.

Gathering, and testing prototypes in new spaces
The previous section introduced some of the challenges of recruitment and participation. In this section, we discuss the role of online spaces, and synthetic research spaces established during the project.
Despite all of the aforementioned challenges faced by participants, the importance people place on contributing to interdisciplinary research of this nature became evident through participants seeking to problem-solve ways of participating rather than walking away from the research when disruptions, including changes to public activity restrictions, or access to healthcare facilities occurred. An interesting potential explanation for this was observed by de Lucas Ancillo, del Val N uñez, and Gavrila (2021) who identify a general increase in people's awareness of their physical environments, including work environments (de Lucas Ancillo, del Val N uñez, and Gavrila 2021).
During phase one of our research, a mixed of focus groups and individual discussions took place remotely through Zoom. Although Zoom has made collaborative prototyping challenging and has limited generative design opportunities, the online collaborative work was still productive, but in different ways to face-to-face collaboration. For instance, the increased reliance on technology such as using direct Zoom recording helps researchers to ensure the data collected was accurate and that remote communication also allowed for increased flexibility in scheduling the focus groups, allowing for participation for wider range of participants (Al-Habaibeh et al. 2021).
In phase two of our research when the prototypes were ready to be tested with research participants, we had to source a third space as hospital locations were still restricted in South Australia. The project created a simulated office environment within an Open Lab space in a public science museum to showcase and gain iterative feedback on the prototypes that were being developed. One of the key benefits that emerged through doing this was that the research became accessible to a wider public, as well as the specific end-users targeted in the project. This was unique in bringing a very specific end-user voice and a more general application focussed voice into the research practice. By creating a simulated healthcare work environment in the Open Lab space, people from a wide range of backgrounds were able to explore and give feedback on the design interventions. This less formal engagement with a wider group of people generated insights into the potential applications of the research and uncovered a series of attendant benefits and issues associated with the prototypes, that while beyond the specific scope of the study, identify future opportunities for more research in this area. Interestingly, this increases in scope and the generative nature of the opportunities identified, can be seen as in some ways re-aligning the research with the original intentions of co-design, despite being framed around PAR. That is, the wider and more open engagement provided opportunities to generatively explore ideas about what role AR could play in workplaces, rather than being restricted to an experimental proof of concept. As a result, opportunities for the study's impact to be extended into a broader range of industries have been identified.

Challenges
In the previous section, we discussed the established roles of online and synthetic spaces. This section will focus on the moral and ethical concerns of communication from the recruitment to participation stages. We will also highlight some key takeaways and learnings that can be applied to the future of research communication.
One of the main shifts to occur in this project, and in almost all collaborative and participatory research globally was the shift from face-to-face ways of working to remote collaboration through videoconferencing software such as Zoom (Zoom Video Communications), MS Teams (Microsoft Corporation), or Jitsi (8 Â 8 Incorporated). Video conferencing obscures many non-verbal elements of communication and therefore in most instances, makes humanconnections more difficult to establish. This meant that the researchers could not expect participants to engage to the same degree of depth as they may have in a face-to-face engagement.
Another interesting dimension of this challenge was in recruiting participants through remote mechanisms. Initially, the researchers planned to recruit participants via a flyer in a common space within the healthcare workplace environment, and to rely on people becoming interested in the research through its co-location with their everyday practices of work. However, not being able to access healthcare sites made this impossible, necessitating a switch to a remote recruitment strategy. Relying on email communication reinforced the important role that social interactions may play in recruitment mechanisms for studies such as this. Without the research becoming a subject of discussion, we suggest it may have been seen by some potential participants as yet another pressure on their already stretched time, rather than something that could be an enjoyable or rewarding experience. This detachment from the project was also carried forward into the focus groups in the first phase of the research, with participants not having discussed anything about the research with their colleagues prior to arriving in the virtual focus group. These 'out-of-session' practices that can be associated with co-design practice do not appear to have been extensively discussed in the literature but appear to be an important contributor to the overall experience of participating in a co-design process. Further research, particularly with regard to how face-to-face and online recruitment and participation strategies are blended together may help shed further light on what appears to be an interesting area for further reflection and research.

Key insights and learnings
While the pandemic has impacted our research as described, we wish to emphasize that we must be aware of how our choices today may impact future generations in the post-pandemic era. This section will highlight ways on how taking ethical and sustainable decisions will ensure future research and generations' health and wellbeing moving forward.
Conducting PhD research in the context of COVID-19 required increased adaptability, including being open to change, and being prepared for the unexpected. Building collaborations required both researchers and participants to remain flexible in order to complete the journey together. Self-care emerged as an important principle for both the research team and the participants, with interdisciplinary stakeholders spending time expressing empathy, actively listening and engaging in a variety of other care practices.
Adaptability is key to maintaining wellbeing for both participants and researchers during uncertainty (Rahman et al. 2021). Finding ways to work in response to the extreme circumstances introduced more reliance on the use of digital tools, including the use of video conferencing for focus group interviews and design reviews. Despite the challenges described in the previous section, the digital tools also created some interesting opportunities for both researchers and participants. For researchers, these technologies allowed transcriptions and documentation to be captured digitally in real-time, simplifying the transcription process. For participants, many appreciated the flexibility of taking part in research from wherever they were, without needing to travel, although it is unclear if this resulted in a lessening of the depth of agreement, due to multi-tasking and the lack of the embodied experience described earlier.
Online research, including video conferencing and conducting qualitative group research has become more prevalent during the pandemic, and appears to be something that will continue even once face-to-face interactions are re-normalized (Boland et al. 2022). Although further research is required in this area, these technologies appear to help some research participants feel more comfortable in sharing their opinions and discussing sensitive subjects, while simultaneously making others feel the opposite.
An important learning from this project is that this hybridized form of research should not be holistically categorized as being better or worse than traditional research practices, but instead, that it is different. In beginning to consider how these forms of research can benefit each other, the power of physical reconfiguration in helping change perspectives is something that is applied in face-to-face research, but, despite the emergence of virtual reality collaborative environments and platforms, the social practices, conventions and expectations of videoconferencing do not provide for such flexibility, When considering the lessons that may flow in the other direction, the ability to document processes in real-time, and to more holistically facilitate participant-led documentation of workshop processes through anonymous contribution opportunities in online environments (such as Mentimenter, via a shared online document, or whiteboard space) is something that could be integrated into our face-to-face practices.
An A þ B þ C formula to take forward A key takeaway from the experience of the pandemic is the need to become critically aware of our ways of working to better prepare us for unexpected events in the future. Although design-research by definition, has an element of exploration and open-ended questioning, the PhD experience prior to the pandemic was often able to follow established protocols quite closely. This is not a linear research practice but could be defined as a linear research journey. Researching during the pandemic required more dynamic change and response, requiring researchers to devise alternative backup plans. Remaining adaptable (A), actively making backup plans (B), and demonstrating compassion for others (C) is a simple A: Adaptability refers to the ability to remain flexible and to look for new opportunities that are created by last-minute changes in a research plan. Design practice is ideally placed for these types of approaches, but it is important to also consider how this can work within the context of design research.
B: Having a Backup plan (or three) provides a sense of security and safety during these unpredictable events. The development of these backup plans can also strengthen the initial research project plan, by critically reflecting on why each element is being proposed in the way that it is, and whether there are alternatives that could also be effective.
C: Compassion, is important while recruiting, getting to know, collecting, and analysing data, and sharing insights and findings with research participants. Self-compassion can also help researchers deal with stress and anxiety caused by everyday life during a pandemic (Keng and Hwang 2022). This element of the formula is not something that is typically covered through formal ethics approval processes, but this lens appears to provide an opportunity to deepen researchers' reflections on participants' motivations for engaging (or not) in research practices.
yet important set of considerations to take forward into future participatory research.

Conclusion
Describing undertaking a PhD during the COVID-19 pandemic as a unique experience is perhaps an understatement. But the critical lens these experiences have placed on design research methods and methodologies particularly in the context of the health sector has enabled innovation in the ways we do design research, and deeper insights into our traditional ways of working. The challenges of recruiting in an online environment are interesting and suggest there is a need for further research to explore participant motivations. The new opportunities for participation, data collection and analysis are also interesting areas for further exploration, as are the opportunities created with a 'third space' environment that connects researchers, formal participants, and a wider public. Finally, the model of adaptability, actively making backup plans, and approaching research through a lens of compassion provides a useful framework for researchers to take forward as we re-engage through hybrid work practices.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Notes on contributors
Aprille Chua is a PhD candidate at the University of South Australia, Creative. An emerging researcher, Aprille focuses on designing for health and wellbeing using augmented environmental graphics to improve wellbeing and user experience. As a former design educator, Aprille is passionate about creating infographics that support learning and development.
Ian Gwilt is a Professor of Design at the University of South Australia. Current areas of research include visual communication design in the context of healthcare and wellbeing. He is interested in the development of novel data visualization techniques for non-specialist audiences, and the design of interactive, augmented and virtual reality tools in care provision.
Aaron Davis is an award-winning designer. Currently lecturing Architecture at the University of South Australia, Aaron has extensive experience in a range of research and teaching fields, with a focus on co-design in healthcare. Aaron's research focuses on improving collaboration among complex interdisciplinary teams and engaging end-users through design processes.