RunningwithScissors,13thEADConferenceUniversityofDundee,10-12April2019

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Combiningdesignresearchwithmicrobiologytotackledrug-resistantinfectionsindifferenthomeenvironmentsinGhana:Challengingtheboundariesofdesignthinking

EmmanuelTseklevesa*,AndyDarbya,CollinsAhorlub,DziedzomDeSouzab,RogerPickupc,DanielBoakyebaImaginationLancaster,LICA,LancasterUniversity,UnitedKingdombNoguchiMemorialInstituteforMedicalResearch-UniversityofGhana,GhanacBiomedicalandLifeSciences,LancasterUniversity,UnitedKingdom*Correspondingauthore-mail:e.tsekleves@lancaster.ac.uk

Abstract:Theaimofthispaperistwofold.Firstly,topresentdesignresearchworkthat crosses into specialist medical areas, in this instance that of antimicrobialresistance(AMR);andsecondly,tocontributetothedebateontheneedfordesign-drivenresearchtoexplorealternativewaysofdeliveringhealthcarebyfocusingonpreventivedesign responses. Thesepoints are addressed in theexplorationof aninternational design-led research project, Dust Bunny. The project uniquelycombinesdesignresearchandmicrobiologytoprovideaninformedassessmentofsocietal practices in domestic cleanliness and to co-create novel solutions thatreduce infections in the home. The findings and experiences from this uniquetransdisciplinary collaboration (design, microbiology, epidemiology and socialscience)revealseveral insightsonthechallengesandopportunitiesonchallengingtheboundariesofdesignthinking.

Keywords: Design for health, antimicrobial resistance, preventive design,globalhealth,designthinking

1.IntroductionAlthoughpredominantlymedical,globalchallenges,suchasAMR,arehugelycomplexproblemswithdiverseinfluences,drivenbyhumanactivityasmuchasbybiologicalmechanisms.Biomedical,clinicalandmedicalexpertisealonecannottackleAMRandcollaborativeandinnovativeinterdisciplinaryapproachesareneededtotacklethechallenge.

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Bacteriafoundinthenaturalandbuiltenvironment(e.g.,homes,schools,hospitals,etc.)arebuildingtheirresistancetodrugs.Theyarechangingtoprotectthemselvesagainstantibiotics.Thismeansthatinthenot-too-distantfuture,somethingassimpleasaminorcutorinfectioncouldbecomelife-threatening(O’Neill,2014).TheissueissuchaconcernthatAMRisnowconsideredaglobalhealthcrisis.ThesituationisevenmorecriticalindevelopingcountriesinAfrica,suchasGhana,wherethereareagreatnumberofdeathsfrominfectiousdiseases(Feiginetal.,2010).

Despitetherebeingclearevidenceformicrobialexposureandinfectiontransmissionwithinthehome(Rintalaetal.,2012),therehasbeenlessresearcheffortinvestedinunderstandingthehomeenvironment,duetothedifficultyofconductingdetailedstudies(Curtisetal,2003).Althoughthetransmissionroutesofdustinthehomeenvironmentarewellknown(Rintalaetal.,2012),whathasnotbeenstudiedishowtopreventbacterialinfectioninhomeenvironmentsandtherebyreduceresistance.

Furthermore,thehygieneguidelinesavailableforpreventinginfectioninthehomeenvironment,aretargetedathygieneprofessionals(Beumer,2002)anddonotreachtheeverydayhouseholdinGhana.Thereis,therefore,amuch-requiredandunmetneedtoidentify,understandanddevelopdomestichygienepracticesthatarerelevanttodifferenthomeenvironments,andeducationalandculturalbackgroundsindevelopingcountries,suchasinGhana.Thesenewpracticesmustreduceexposuretobacterialpathogensand,thereby,limitthedevelopmentofAMR.

Withinthiscontext,theDustBunnyprojectaimsatdevelopinganunderstandingofthehomeasasourceofinfectionbyantibioticresistantbacteria,foundandcarriedbydust.ThisisdonebyexploringhygienepracticesacrossdifferenthomeenvironmentsinGhana,todefinethebacterialmicrobiome,toconsiderwhetherthisantibioticresistanceisdrivenbyhouseholdpracticeswiththeultimateaimtoreducebacterialinfectioninthehomeenvironmenttherebyreducingAMR.

Followinganintroductionoftherelatedworkandresearchmethodology,wepresenttheinitialfindingsfromtheDustBunnyprojectanddiscussthechallengesandopportunitiesindesignresearchbeingappliedinsuchaspecialistmedicalarea

2.RelatedWork2.1DesignResearchinPreventiveHealthDevelopingstrategiesforpromotinghealthorpreventing‘illbeing’ofthepopulationformsoneofthemostcomplexglobalchallenges.Traditionallydesignershavepaidattentionpredominantlytoacuteandchroniccare,throughnewmedicalproducts,prostheses,hospital,clinicandcarehomedesign(Jones,2013;Tosietal,2016;Mawsonetal.,2014;Ludonetal.,2014).Morerecentlythecomplexpictureofmaintainingpopulationwellbeingandhealthpreventionhasbeguntoemerge,andthustheroleofdesignersindirectlyinsupportingthepromotionofhealthylifestyleorintheircontributiontoillbeing.Workssuchas(Ulrichetal.,2008;Chamberlainetal.,2015;TseklevesandCooper,2017)havedemonstratedthepropensityofdesigntocontributesignificantlyinhealthandwellbeing.

Akeychallengethatemergeswithinthiscontextishowshouldweshapeourbuiltenvironmentsandinfrastructuretosupporthealthierbehaviours?Whatisabundantlyclear,here,isthatasweshapeourenvironmentitisshapingus,ourpsychological,physiologicalandphysicalstatusaswellasourinteractionswithotherpeopleandwiththenaturalenvironmenttoo(Frank&Engelke,2005;Wood

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etal.,2010;Dempseyetal.,2012).Theenvironmentiscloselylinkedtothelifestylesweadoptandagainitisclearfromthewealthofresearchinthisarea(Franketal,2003;Smith&Cummins,2009;Robertson-Wilson&Giles-Corti,2016)thatthecurrentstateofourenvironmentplaysasignificantroleinthepredominantlysedentarylifestylesadoptedtodaybutalsointermsofmicrobialexposureandinfection(viral/bacterial)transmission(McMichael,2000;Weiss&McMichael,2004;Kembeletal,2012;Prussin&Marr,2015).

2.2DesignResearchinSpecialistMedicalAreasTheuseofparticipatorydesignandcodesignwithinhealthisrelativelycommoninthedesignliterature(Donettoetal,2014;Minkler&Wallerstein,2011)withpositiveoutcomesreportedintheareasofcommunity-basedhealth(Israeletal,2001;Greenhalghetal,2016)thoughtherehasbeenlimitedexplorationoftheseapproacheswithinAfricananddevelopingcountriescontexts(DelaHarpeetal,2012;Cepiku&Giordano,2014).

Designresearchhas,also,previouslyengagedinspecialisedareas,suchasMotorNeuroneDisease,tocodesignanddeveloppatient-acceptableneck-supportproducts(CraigandChamberlain,2017);cerebralpalsyandrheumatoidarthritisforthedevelopmentofanatomicallypersonalisedfootorthoses(Paterson,etal.,2017);strokeandbiomechanicsforthecodesignofmotionvisualisationofcomplexinterventions(MacDonald,2017).However,combiningmicrobiologywithdesignresearchwithinadevelopingcountrycontextgoesbeyondthetraditionalboundariesofdesignresearchintheareasofhealthandmedicine.

PartoftherationalebehindthemarriageofdesignresearchwithmicrobiologyintheDustBunnyproject,liesinthedifficultyofconductingdetailedstudieswithinthehome,incomparisonwithdataavailablefromotherenvironmentssuchashospitals(Stanwell-SmithandBloomfield,2004)andduetotheprivateandmorallyboundnatureofthesubjectofhygiene(Curtisetal.,2003).Furthermore,theworkproposedinthispaperarguesthatthereisaneedtoshiftthehealthcaremodelofdiseaseinfectionsfromtreatmenttoprevention.Itthereforeproposesthatbystudyinghouseholdhygienepractices,withtheaimofreducingbacterialinfectioninthehomeenvironment,theresultantpreventativeinterventionswillinturnreduceexposuretobacterialpathogensminimizingthegrowthofAMR.

3.Methodology3.1CombiningDesignwithMicrobiologyResearchMethodsDustBunnyemploysandcombinesqualitativedesignresearchmethodswithquantitativemicrobiologyresearchmethods.Theseinclude:hardcopysurveystoobtainabroaderspectrumofrespondersandpictureofhygienepracticesacrossarangeofdifferenthouseholdsinGhanaandtohelprecruitasub-sampleofhouseholdsforamoredetailedstudy;designethnographymethods(observations,etc.)tocollectmorein-depthinformationforidentifyingthecurrentlocalhygienepracticesacrossdifferentsocio-economicurbanandruralhouseholdsinGhana;culturalprobes,tohelpprovideadeeperunderstandingofhouseholdculturalpracticesandbeliefsbetween‘dust’and‘germs’,andbetween‘cleanliness’and‘hygiene';interviews,toelicitrichdatatohelpestablishthe

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impactofhouseholdbeliefs(exploredbytheculturalprobes)ondomestichygienepractices;codesignworkshopswiththecommunityofhouseholdsinvolvedintheresearchandexpertsinordertoconsiderhowtobestmakesafehygienepracticespartsofdailyroutinethataresustainedbysocialnorms(seeFigure1).

Figure1.DustBunnyresearchframeworkandplan.

ThedesignofallresearchmethodsandmaterialareledbyresearchersintheUKinconsultationwithresearchersinGhana.MostfieldresearchisconductedinGhanabyresearchersatourpartnerresearchinstitution.Wehavedesignedandrecentlyranasurvey(n=251)acrossdifferentdomesticenvironments(i.e.urbanvsrural,privatevscommunaldwellings)andarangeofsocialscales(i.e.low,low-middle,middle,upper)withinAccra,Ghana.Throughtheface-to-facesurveyprocesswehaverecruited12householdsforourdesignethnographicstudy(acrossurbanandruraldomesticenvironments,privateandcommunalhouseenvironments,low,low-middle,middleanduppersocialscales).

Wearealsocurrentlycollectingdustsamplesfromeachstudyhouseholdtoassessbacterialdiversity,includingthepresenceofinfectiousbacteriaandtoassessthedegreeofAMRinthosebacteria.ThedustwillbesubjectedtoDNAextractionanddiversityassessedbydeepsequencingusingthelatesttechnologiesandbioinformaticanalysistodescribethecomparativediversityofbacteriainthehouseholds.Furthermore,polymerasechainreaction(PCR)amplificationofDNAfromthesampleswillbeusedtoidentify5specificantibioticresistancegenesrepresentingestablishedandemergingresistances.MicrobiologicalCulturewillbeperformedusingselectiveantibioticgrowthmediatolinkAMRtobacterialspecies.

Thedesignethnography,whichhasalreadycommenced,willbefollowedbyculturalprobesbeingdeployedinparticipatinghouseholds(n=12).AftertheculturalprobesarecompletedaseconddustsamplingwillbetakenandsubjectedtoDNAanalysisasdescribedabovetoassessthecomparativestabilityandrobustnessoftheresultsobtainedinthefirstbacterialsurvey.

Thequalitativeandquantitativedatawillbeanalysedusingthematicanalysis(BraunandClarke,2006)anddatatriangulation(Denzin,2012)andsynthesizedtoproducepersonasandstoryboardsof

Identify- Survey (i)

- Design Ethnography (iii)

- Dust sampling I (v)

Design Ethnography Co-Design

Establish- Cultural probes (iii)

- Interviews (iv)- Personas (viii)

- Dust sampling II (v)

Co-design- Co-design Wks (vi)

- Prototyping (viii)- Storyboards (viii)

Validate- Thought leadership

Workshops (ix)- Dissemination activi-

ties

DiscoverIndentify hygiene

practicesMonth 1 - 8

DefineEstablish household

hygiene beliefsMonth 9 - 15

DevelopCo-design hygiene

practicesMonth 16 - 20

DeliverValidate & disseminate

hygiene practicesMonth 20 - 24

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hygienepracticesfordifferentcommunitiesandhomeenvironments.Thesewillbefurtherenrichedbyaseriesofcodesignworkshops.Thehygienepracticesandideasofhowtobestdisseminatethemtocommunitieswillbeexploredbytheresearchteamthroughprototypingandtheco-creationofvisualmaterial.ThesematerialsandhygienepracticeswillbepresentedatlocalchampionsworkshopinGhanaforfeedbackandvalidation.

Lastly,followingthemorallyboundnatureoftheresearchsubject,ethicalprocedureshavebeenembeddedinthemethodologydesign.TheseincludeadheringtotheethicspolicybothatLancasterUniversityandatNoguchiMemorialInstituteforMedicalResearchinGhana,bysubmittingethicsapplicationtobothEthicsCommittees.Ethicsreviewwasalsoincorporatedthatmonitorsstudyethicsassessmenttwiceayearandanannualethicsstudyreport.

4.Findings4.1SurveyThesurveydataiscurrentlybeinganalysedbyaGhanaiandatascientist,howeversomesimpleanalysishasbeensharedbelowtodemonstratethebreadthofthesurveyandaspectsofourapproach.

ThesurveywasconductedbyfourfemaledatacollectorsintheAccraGreaterRegion’sAdentaMunicipalAssembly,GaEastMunicipalAssembly,andtheLaNkwantanangMunicipalAssembly.Itfocusedonrespondentswhohadeitherheldresponsibilityfordirectinghouseholdcleaning99.60%(n=250)orwhohadidentifiedthemselvesastheprimarycleanerofthehouseholdforaperiodoverthreeyears90.44%(n=227).Thehouseholdersvisitedwereacrossthesocio-economicspectrum,withhousingbreakingdownasfollows;16.33%detachedhouses,11.55%semi-detachedhouses,31.47%flatsorapartmentsand38.25%roomsincompoundhouses.Therespondents(n=251)rangedfrom18to83yearsoldandwere85.66%(n=215)femaleand13.94%(n=35)male,withoneundeclared(0.40%).

Thesurveyengagedwithanethnically,religiouslyandeducationallydiversesetofrespondentsacrossthesocio-economicspectrum.Theethnicgroupingswerereported,asfollows;Akan41.04%,Ewe27.09%,Ga/Dangme11.95%(theindigenousethnicgroupingoftheregion),Mole-Dagbani5.18%,andOther14.34%.Thereligiousaffiliationswerereported,asfollows;PentecostalorCharismatic32.67%,Presbyterian17.93%,Islam12.75%,Catholic7.57%,Methodist4.78%,Protestant1.59%,andOtherChristian15.54%.Educationalattendancewasbroadlyspreadwithrespondentsreportingattendanceasfollows;Primary7.97%,Middle7.97%,JSS/JHS13.55%,Secondary14.34%,SSS/SHS17.13%,andHigher34.26%.

While85.26%ofrespondentsrecognisedustintheirroomsasacauseforconcernalessernumber,74.10%,believethereisaconnectionbetweendustandgerms.Additionally,asignificantnumberofrespondents,64.54%,considerthepresenceofdustinthehometobenormal.Thisisanissuethatwillneedtobeunpackedfurtherasweconsiderpotentialinterventionslaterintheproject.

Recognisingtheneedfortheprojecttodisseminateitsfindingsthesurveyinstrumentincludedasetofquestionscoveringtheleasingorownershipofanumberofservicesoritemssothatwecouldfurthergaugetheeconomicstatusofrespondentsandtoinformpotentialcommunicationstrategies.Thisknowledgeimmediatelybeginstoshapetheproject’soutputsanddisseminationplansaswe

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foundthat60.56%ofrespondentshavearadioand66.14%haveacolourTV,whileInternetaccessismorelimitedatonly20.32%despite65.34%ofrespondentshavingamobiletelephoneand27.89%haveacomputerortablet.

Theconceptsembeddedinthesurveyandtherelationshipsbetweenthemarecurrentlybeingvisualised,asarethedataarisingfromit,inordertobetterinformtheparticipantsofthecodesignworkshopstoberunlaterintheprocess.

4.2RapidEthnographyInthissectionwepresentinitialfindingsfromonehousehold,focusingontheethnographicaccountoftheobservationandparticipantobservation.Therapidethnographyincludesdatafrom12households,wehave,however,selectedheretopresentoneofthesetwelve,asthepaperfocusisnotontheethnographicdatafindings,buttheonthenatureandchallengesarisingfromthecollaborationacrossdisciplinesandgeographicalregions.

TheobservationtookplaceonasingledayinSeptemberforaperiodoftwohoursand25minutes.TheparticipantobservationtookplaceonasingledayinOctoberforaperiodofonehour.Theaccountsfocusonthecleaningpracticesthatthehouseholdconduct.Theparticipant,a37yearoldtrader,livedinacompoundhousethatopenedontoanunsurfacedcompoundwithanunsurfacedroadrunningalongside.Thedescriptionofcleaningpracticesfromtheobservationrevealedthepossibilitythatdiseasetransmissionmaypresentasanissueasthesametraditionalbroomwasusedtosweepfloorsfromthebedandthroughoutthehouseandthegroundoutsideandinthetoilet.Aspectsofthispracticewereconfirmedintheparticipantobservationsession,despitethesessionbeingcutshortbytheparticipant’sworkcommitments.

Compoundhousestendtosharecleaningresponsibilitiesbetweenmultipletenants.Forexample,inthisinstance,mosttenantssweepinfrontoftheentrancetotheirownroomandnotthewholecompound(seeFigure2).Thispracticemayindicateaneedtocodesignbothindividualcleaningpracticesandcommunalcleaningprocesses.

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Figure2.CompoundhouseexampleinGhana.

Theseinsightsaredrawnfromaninitialsummary,andcurrentlytheteamiswritingupdetailedethnographicaccountsandtriangulatingthedatabetweentheobservationandparticipantobservationsessions.

5.DiscussionDespiteusefulinsightsarisingfromthefindings,asthesearepreliminaryandgiventheconferencetracktheme,weselecttofocusthediscussiononhowDustBunnyischallengingtheboundariesofdesignthinking,instead.

Design,likemicrobiology,hastheabilitytoshiftthroughenormousamountsofinformationandprovideclaritythatallowsyoutoseesomethingdifferentlythateitherpre-existsoryoureinvent.Nevertheless,challengesandopportunitiesariseindependentlyinboththedesignandthemicrobiologicalstrategiesandwhencombiningthetwo.

Thefollowingsectionsarebasedonreflectionsfromthenon-designresearchersinvolvedintheproject,sharedinresponsetoashortquestionnairedistributedamongsttheteam.

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5.1Insights,ChallengesandOpportunitiesforDesignFormicrobiologistsgoingintotheprojecttheyrecognisedthatlimitingthesamplesizetoasmallnumberwouldexacerbatetheproblemoflinking“themicrobiologydatatopossiblehealthimpacts”(ResearcherOne:microbiologyresearcher).Asthesamplesizewasdictatedinpartbythefinancialscaleofthefunder’scall,onechallengefordesignmaybeinconvincinghumanitiesresearchfundingbodiesthatthehigherfinancialcostsofscientificprocesses,suchasthemicrobiologymethodsusedinthepilot,shouldbeaccountedfortoallow(design-ledtransdisciplinary)projectstobemoreexpansiveandsotheymightbecomemorethanfeasibilitystudies.

Theresearchersinvolvedheldseveralunderstandingsoftheroleandfunctionofdesignintheproject.Whileoneresearchernotedthebenefitbroughtaboutbyhowthedesign-ledapproachalteredthenatureofhowtheprojectmightunderstandcontext.

“Combiningmicrobiologywithdesigniscomplimentaryasdifferencesinmicrobiological/AMRprofilesmayreflectdifferencessocio-economicstatus,culturalpracticesandlocation.Microbiologicalmethodsaren’taffectedbutthestrengthliesinthequestionsthatcanbeaskedandthetargetingofthesamplingregime”(ResearcherOne).

Anotherresearcher,expandingonthepoint,recognisedtheopportunityfordesignresearchtohavepositivevaluefroman“epidemiology,publichealthperspective”asitcouldpotentiallyprovide“thebestopportunitytoadequatelyaddresspublichealthconcerns”(ResearcherTwo:epidemiology/microbiologyresearcher).

However,anotherresearcherfeltthattheapproachhadcreatedaninflexibleconstructthatdidnotallowforinterestingquestionstobefollowedupon,theyparticularlywantedtograpplewithparticipant’sresistancetoengagingwithparticularmethods,asking,

“Whysomepeoplewillliketoparticipateinthequestionnairesurveybutnotintheobservationalstudyincludingparticipantobservationsandtheculturalprobes?Whileotherswillparticipateinthesurveyandtheobservationbutresisttheculturalprobes?Convincingpeopletoopentheirhomeforobservationwasdifficult”(ResearcherThree:socialepidemiologyresearcher).

Theissueoffixednesshadnotbeenarticulatedasaprobleminprojectmeetings,andhopefullymorecanbedonetoaddressthesequestions,particularlyastheypointbacktopreviouslyacknowledgeddifficultiesinconductingdetailedhouseholdstudiesaroundthistopicarea.Thatthepointwasnotraisedpreviouslyalsodemonstratesaneedtobettermanageour“north-southcollaborationstothemakethemmutuallybeneficial”(ResearcherThree)andtoensurethatcriticalvoicesareabletoshapetheproject’sdevelopmentinatimelymanner.

“Boththechallengesandtheopportunitiesfordesignarisefromthedisciplinebeingwell-placedtoleadtransdisciplinarymixedmethodaction-orientatedevidence-basedresearchprogrammes”,

asResearcherFour(designresearcher)observes,inlinewithGibsonandOwens(2014)reflections.Advancingtheirreflection,theyspeculatethatbuildingabodyofdesign-ledtransdisciplinarywillbuilddisciplinaryandnon-disciplinarytrust,notingthat

“...ascollaborationsofthiskindcontinueboththeresearchmethodsofdesignandotherdisciplinesandtheresultingdatamaybeincreasinglyunderstoodandarticulatedasthematerialsofadesignresearchprocess.Thiswillhopefullyleadtogreaterconfidence,fromallparties,inresearchthatcrossesscienceanddesign.”

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5.2Insights,ChallengesandOpportunitiesforMicrobiologyCouplingmicrobiologywithdesignhasallowedacomplementarydesignapproachtoincludetheneedsofasocio-economicframeworkontopofmicrobiologythatmaydefinemicrobialdistributionandexposureindomesticdwellings.Thismeansthattheethnographyandculturalprobeactivitiescanbeusedtodirectandfocusthesamplingrequiredforthemicrobiology.Thereforethemicrobiologycanbetargetedatansweringquestionsthatarisefromthe‘design’.Ordinarilythesamplingwouldchoosehousesatrandomandsample.Howeverthrough‘design’onecantargetdwellingsthatarelinkedorofferdifferent‘practices’therebythedatageneratedcanrevealmoreaboutthepeoplethanthedwellingperse.

Fromanepidemiologyandpublichealthperspective,combiningknowledgefrommultiplesourcespresentsthebestopportunitytoadequatelyaddresspublichealthconcerns,suchasinthecaseofthisproject.Theuseofadesignresearchapproachtoaddressantimicrobialresistancemanagementatthehouseholdlevelwillprovideinsightsintothebehaviouralchallenges,andpromotebestpracticesforpublichealthimplementation.Thisisapracticethataddsmorevaluetothemicrobiologyaspectsoftheproject,whichwouldtypicallynotengagefurtherwithhouseholdsaftersamplinghasbeencompleted.

Itshouldbenoted,thatalthoughmicrobiologicalmethodsarenotdirectlyaffectedbypairingthemwithdesignresearchmethods,theyarestrengthened.ThisisbecausemorespecificandrelevantquestionsthatcanbeaskedregardingAMRandthetargetingofthesamplingregimeatahouseholdlevel.

Moreover,asalreadymentionedabove,akeychallengeislinkingthemicrobiologydatatopossiblehealthimpacts.Thelimitationhereisduetothesmallsamplesize.However,asthisafeasibilitystudyandwhatwelearnwillhelpusformulatealargermoreimpactfulstudyproposal.

5.3CombinedViewsCombiningdesignandmicrobiologycontributestothestrengthsofbothdisciplines,butalsohelpsinalleviatingsomeoftheweaknessesfoundineach.Moreprecisely,designresearchispredominantlyquantitative,typicallylackingquantitativedata.Dataprovidethesoughtafterevidence-basedcharacterisingpolicyanddecisionmakinginhealthcare.Althoughthereisanemergingapproachtohealthcaredesignresearch(Ulrichetal.,2008;AbrahamandKools,2012),thisisnotwidelyadoptedanditismainlyappliedinareasrelatedtothedesignofhealthcarefacilitiesandenvironments(McCullough,2010).

Microbiology,ontheotherhand,providesthehardevidenceintheformofquantitativedata,whichareestablishedthroughrigorousresearchcollectionandanalysismethods,aviewsharedbyhealthcareandmedicalprofessionals(Köseretal.,2012;Murrayetal.,2015;Kwongetal.,2015).Itdoesnot,however,includetherequiredtechniquestocommunicateitsfindingsinaformthatisnotonlyplausiblebutpersuasivetoo.Putitsimply,microbiologyresearchersarepowerfulanalystsbutweakstorytellers.

Storytellingisthenaturallanguageofpersuasion(Marris,1997;Moezzietal.,2017;Davidson,2017),sinceanystoryhastoinvolvebothasequenceofeventsandtheinterpretationoftheirmeaning.Designanddesignersaregenerallyverygoodstorytellersbutdonotoftenhavethenumberstoshow.Forpolicyandstrategyyouneedtohavethenumbers.Thusthecouplingofdesignwithmicrobiologyprovidesopportunitiesforstrengtheningbothandindevelopingevidencedinsightsthatmakeconvincingargumentsaroundourneedtoact.

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6.ConclusionFromclimatechangetoglobalhealth,wearefacingunprecedentedchallengesthatrequireamoreintegratedandtransdisciplinaryapproachtofindinginterventionsandsolutions.Design’sabilitytoengagerealpeopleandcommunities,understandeverydayproblemsandimplementthe‘right’solution,notjustthe‘newesttechnology’,enablesittoactasabridgebetweenotherdisciplines.

Asthedesigncommunity,alongwithotherresearchcommunities,arecalledupontotacklethecomplexglobalchallengeofimprovinghealthandwellbeing,ourresearcheffortsshouldfocusondevelopingstrategiesforpromotinghealthandpreventingillbeingofpopulationbeyondtheGlobalNorthintotheGlobalSouth.

Withinthiscontext,theDustBunnyproject,explorestheglobalhealthcrisisofantimicrobialresistancebylookingathowtopreventbacterialinfectioninhomeenvironmentsinGhanaandtherebyreduceresistance.Thisisdonebychallengingthetraditionaldesignthinkingboundariesandbycombiningdesign-ledresearchandmicrobiologyinaninternationalcontext.Incorporatingdesignresearchinmicrobiologyandinpublichealth,inDustBunny,hasenabledinterdisciplinary,multidisciplinaryandtransdisciplinaryresearchquestionstobeaddressedthroughcollectiveresearchapproaches.

Theapproachadoptedhastheopportunitytoprovideaplatformforunderstandingcomplexissuesregardingmicrobiology(microbialresistance)andpublichealththroughengagingthecommunityofpractice.Doingthisfromvariousperspectives(design,socialscience,epidemiology/publichealthandmicrobiologicalperspectives)presentsthebestopportunitytoadequatelyaddressemergingpublichealthconcerns,suchasantimicrobialresistanceinthehomesetting.

Theinsightsgainedfromcombiningdesignandmicrobiologysuggestthattherearestillchallengestoaddressinenablingandsupportingsuchtransdisciplinarycollaborations.Furthermore,thereisstillworktobedoneonenhancingotherdisciplines’understandingsoftheroleandfunctionofdesigninsuchspecialistmedicalareas.Thereare,however,severalopportunitiesarisinginembeddingdesigninmicrobiologyresearch,suchasprovidinginsightsintothebehaviouralchallenges,promotingbestpracticesforpublichealthimplementationandimprovedtargetingofmicrobiologicalsamplingatthehouseholdlevel.Inaddition,wepositthatcouplingdesignandmicrobiologyenablesthestrengthsofonediscipline,counterbalancetheweaknessesfoundinanother;namelyevidence-base/dataindesignandstorytellinginmicrobiology.

Lastly,weenvisagethattheexperiencesandinsightsoutlinedinthispaper,willhelpotherdesignresearcherstoembarkontransdisciplinaryresearchthatchallengestheboundariesofdesigninnewspecialistmedicalareas.

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AbouttheAuthors:

EmmanuelTseklevesisaSeniorLectureratImaginationLancaster.Heleadsinternationalresearchindesigninteractionsforhealth,whichliesattheintersectionofglobalhealth,designforbehaviourchangeandtechnology.HeistheauthoroftheRoutledgeDesignforHealthbook.

AndyDarbyisaPhDCandidateatHighWireCentreforDoctoralTrainingandaResearchAssociatewithImaginationLancasteratLancasterUniversity,designingresearchtoolsforhouseholdstudiesinGhana.

CollinsAhorluisaSeniorResearchFellowinculturalepidemiology,socialscienceapproachesandcommunityengagementattheNoguchiMemorialInstituteforMedicalResearch.CollinsisaSocialEpidemiologistwhoseresearchworkscover,EpidemiologyandMedicalAnthropology/Sociology.

DziedzomDeSouzaisaSeniorResearchFellowattheParasitologyDepartmentattheNoguchiMemorialInstituteforMedicalResearch.Hisinterestsareinthemolecularbiologyofdiseasevectorsandparasites,medicalentomology,climatechangeandgeographicinformationsystems.

RogerPickupisaprofessorofenvironmentalmicrobiologyatthedepartmentofBiologicalandLifeSciencesatLancasterUniversity.Hisresearchinterestsliein'Environmentandhumanhealth'withexpertiseinmolecularmicrobialecology/environmentalmicrobiology.

DanielBoakyeisaprofessorattheParasitologyDepartmentattheNoguchiMemorialInstituteforMedicalResearch.

Acknowledgements:DustBunnywassupportedbytheArtsandHumanitiesResearchCouncil(Grantno:AH/R002177/1).WewouldliketothankallhouseholdstudyandsurveyparticipantsandinGhana.