Enhancing universal design through co-design: perceptions of practice, process and outcomes

The aging population is growing drastically all over the world. With the advent of the global era, universal design is garnering considerable interest, as the number of multicultural families is increasing, and various user classes are being created. In addition, with the advances in construction technology, architectural design is becoming more diverse, and convenience facilities are also getting distributed in various ways. As a result, more buildings need to apply universal design, indicating that various architectural information and universal design for the user class are required. Various data are needed for universal design evaluation, but there is a limit to evaluating with two-dimensional (2D) drawings. However, the limitations of 2D drawings can be overcome via building information modeling (BIM) combined with architectural data, which remarkably simplifies the universal design evaluation. This study was conducted with the aim to analyze architectural information by extracting architectural elements necessary for universal design evaluation from BIM data. It was confirmed that the calculations for universal design evaluation can be performed by 3D shape or attribute analysis using BIM data and computer programming. In order to create an automated evaluation algorithm for universal design, the evaluation methods were classified according to the universal design evaluation guide, based on building users and user diversity. In addition, even if the evaluation methods were the same by location, different points were classified by location, and evaluation items and information necessary for the evaluation were organized by category for each facility. Through this classification, we created an algorithm with seven types of methods for extracting the BIM data and comparing them by evaluation method for an automated analysis. In addition, an analysis was performed directly on the BIM design sample model using an automated evaluation algorithm. Although there were various architectural objects in the design data, evaluation was possible using algorithms. By applying the universal design evaluation and BIM data evaluation methods, we could confirm that the BIM-based universal design automation evaluation method prevents human error and is thus superior to the existing evaluation methods. Further, the automation evaluation method can contribute to BIM activation as the BIM data can be used in various studies such as design certification evaluation and automation analysis.

This research investigated how co-design processes with autistic people were implemented by a museum to enhance its usability. Using a qualitative approach, the researchers interviewed four employees of Australia’s largest public museum organisation and two employees of an autism advocacy organisation that had partnered with the museum to improve usability for autistic people and their families. Four major themes were identified: (1) Museums Victoria prioritises usability for all people; (2) co-design is more than consultation; (3) collaborative, iterative, and flexible co-design should occur throughout design stages; and (4) there are challenges, but co-design leads to positive outcomes. Findings strongly support the participation of autistic people in the co-design of museum facilities and highlight factors that facilitate this process. Participants reported improved design outcomes, increased knowledge, and positive emotional experiences as outcomes gained from co-design. Findings also suggest that an autism-friendly approach to design can enhance universal design of public buildings.

Current research on digital applications to support the mental health and well-being of foster youth is limited to theoretical applications for transition-aged foster youth and support platforms developed without intentional input from foster youth themselves. Centering the lived expertise of foster youth in digital solutions is crucial to dismantling barriers to care, leading to an increase in service access and improving mental health outcomes. Co-design centers the intended end users during the design process, creating a direct relationship between potential users and developers. This methodology holds promise for creating tools centered on foster youth, yet little is known about the co-design experience for foster youth. Understanding foster youth's experience with co-design is crucial to identifying best practices, knowledge of which is currently limited. The aim of this paper is to reflect on the experiences of 4 foster youth involved in the co-design of FostrSpace, a mobile app designed through a collaboration among foster youth in the San Francisco Bay Area; clinicians and academics from the Juvenile Justice Behavioral Health research team at the University of California, San Francisco; and Chorus Innovations, a rapid technology development platform specializing in participatory design practices. Key recommendations for co-designing with foster youth were generated with reference to these reflections. A duoethnography study was conducted over a 1-month period with the 4 transition-aged former foster youth co-designers of FostrSpace via written reflections and a single in-person roundtable discussion. Reflections were coded and analyzed via reflexive thematic analysis. In total, 4 main themes were identified from coding of the duoethnography reflections: power and control, resource navigation, building community and safe spaces, and identity. Themes of power and control and resource navigation highlighted the challenges FostrSpace co-designers experienced trying to access basic needs, support from caregivers, and mental health resources as foster youth and former foster youth. Discussions pertaining to building community and safe spaces highlighted the positive effect of foster youth communities on co-designers, and discussions related to identity revealed the complexities associated with understanding and embracing foster youth identity. This duoethnography study highlights the importance of centering the lived expertise of co-designers throughout the app development process. As the digital health field increasingly shifts toward using co-design methods to develop digital mental health technologies for underserved youth populations, we offer recommendations for researchers seeking to ethically and effectively engage youth co-designers. Actively reflecting throughout the co-design process, finding creative ways to engage in power-sharing practices to build community, and ensuring mutual benefit among co-designers are some of the recommended core components to address when co-designing behavioral health technologies for youth.

Universal design process is a multi-constraint task due to many user requirements and the complexities caused by the interaction of the requirements in developing design solutions. Since all universal design requirements cannot be equally satisfied, a designer must determine the relative importance and implementation order of each requirement. Prioritisation of requirements is needed, not just to ignore the least important but also to guide designers while coping with dependencies, conflicts and trade-offs between multi-attribute requirements simultaneously. Thus, this study proposes a priority-based approach for satisfying diverse users’ needs, capabilities and expectations in a design process conducted in a computer environment. The planning game technique and the analytic hierarchy process technique using a cost–value approach are the two techniques that are applied in prioritising the diverse requirements. The derived priority information is incorporated into a CAD interface with a developed plug-in tool. A universal kitchen design is chosen as a case study for the priority-based approach. The results of the acceptability studies indicate that the proposed plug-in tool is found useful, understandable, efficient, helpful and satisfactory in universal design process and can be developed for various architectural design applications.

Purpose To synthesise current literature regarding applications of universal design (UD) to built environments that promote social participation, identify areas of agreement and areas requiring further attention and development. Occupations refer to personally meaningful activities, which people need, want or must do as part of their daily life. Materials and methods Recently published literature (January 2011–December 2017) relevant to UD and built environments, and pertaining to any discipline or professional area, were identified via a systematic search of databases in the EbscoHOST platform. The person–environment–occupation (PEO) model was chosen as a theoretical framework for the review, which included a sample of 33 peer reviewed journal articles. Results The current discourse is driven more by description, discussion, and commentary than empirical approaches; although, a combination of quantitative, qualitative, and mixed methods approaches was employed. Much of the current discourse on UD and the built environment focuses on the person and the environment, with the occupations carried out in built environments and the interaction between these domains not referred to in much detail. Conclusions Including occupations, social participation, multi- and trans-disciplinary collaboration, and multicultural perspectives in the ongoing discourse around UD would enable the concept to reach its full potential as a medium for social justice. Implications for Rehabilitation The universal design (UD) process must account for the occupations that people perform in the built environment. Multi-disciplinary research and development, using multiple methods, is the most appropriate approach to investigate the application of UD to the built environment. Key areas of contention within the current discourse include meaningful inclusion of non-professional stakeholders, tensions between embracing and eliminating diversity and how professional education should be delivered.

introduction Patient engagement (PE) is increasingly recognized as an essential component of medicine development, yet there remains limited empirical evidence on its value from the patient perspective. Existing literature points to benefits such as empowerment, improved trial design, and greater acceptability, but challenges around communication, authenticity, and sustainability persist. Objectives This study explored the perceived value, challenges, and strategies for effective PE from the perspective of patients, carers, and patient advocates involved in medicines development. Methods A qualitative study was conducted using semi-structured interviews on Microsoft Teams. Participants were recruited via LinkedIn and academic networks if they had lived experience of a health condition, caregiving responsibilities, or advocacy roles and had engaged with the pharmaceutical industry. Twenty-two interviews were conducted online between 23 April and 26 November 2024, recorded, transcribed, and analyzed using reflexive thematic analysis. Results Six overarching themes and 23 sub-themes were identified covering participants’ understanding, motivations, initiatives, value, challenges and strategies for being involved. Engagement was valued for enhancing clinical trial outcomes, personal empowerment, and community support. Challenges included structural barriers, tokenism, lack of feedback, and inconsistent practices across companies and patient organizations. Strategies to improve PE emphasized clear communication, simplification and formalization of processes, greater inclusivity, capacity building, and stronger alliances among advocacy groups. Participants also highlighted the need for fair compensation and balancing regulation with meaningful involvement. Conclusions Patients perceive PE as transformative when authentic, inclusive, and supported by transparent communication. Addressing structural inconsistencies, recognizing diverse patient identities, and prioritizing relational over transactional approaches are critical for embedding meaningful and sustainable PE in medicine development.

Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context.

The aim of this study is to explore the burdens on siblings prior to their siblings’ deaths. A qualitative approach using reflexive thematic analysis was chosen. Fourteen interviews were conducted. The research question for this study is as follows: What did the bereaved siblings’ efforts consist of while their siblings with problematic substance use were alive? The interviews had a retrospective focus; hence, participants were asked to discuss the time prior to their siblings’ drug‐related death. Three different tasks were identified using reflexive thematic analysis: (1) emotional support, (2) social inclusion and (3) practical support. The findings of this study are discussed in relation to homoeostasis. Homoeostasis refers to an understanding of the family as a system in which family rules contribute to maintaining the status quo.

Interprofessional education aims to foster healthcare students’ ability to collaborate in interprofessional teams with the patients at the center of care as active participants. However, little is known about how patients experience this collaboration. Therefore, this study aimed to explore patients’ experiences of being involved in the interprofessional team of healthcare students at a clinical training ward in Sweden. A descriptive design with a qualitative approach was used. Data were collected through semi-structured individual interviews with 22 patients. Braun and Clarke’s reflexive thematic analysis was used. The main finding was that patients were only included as passive participants. Although most patients wanted to be involved, they were hindered due to their health condition or excluded from care planning and decision-making. The patients needed family members’ support to be involved. However, this need was not recognised by the interprofessional team of healthcare students. Patient involvement must be highlighted as an important component of interprofessional education initiatives. Further research is needed to explore family members’ perspectives on involvement in interprofessional training ward settings.

In recent years, with the continuous development of urbanisation, the proportion of interior design in public buildings has been increasing year by year. At the same time, there is a tendency in many places for the interior spaces of public buildings to be upscale and retro. This indicates that people are paying more and more attention to the spiritual aspect of their lives, in addition to the materialistic pursuit of enjoyment. The current phenomenon of overdecoration in society can lead to excessive luxury and wastefulness. In these wasteful interiors, the beauty of the building itself is lost. In addition, this type of interior design is not only expensive but also poses certain safety risks to some extent. In the modern society, public buildings are essential places for public activities. To be specific, they are closely linked to public services and social management attributes. As a result, public buildings usually play a decisive role in facilitating communication and cooperation between various persons. Thus, the construction requirements of public buildings are currently increasing and the structural shapes of buildings are becoming more complex. In addition, the level of technology and the use of public buildings are becoming increasingly demanding. As a result, it is quite important to examine how modern and emerging technologies can be applied to public building design in order to improve its effectiveness. At the same time, with the continuous and rapid development of China’s economy and the promotion of the concept of environmental protection, the greening of public buildings has become an object of concern and research. There are many different types of existing public buildings in China, and in the design process, the energy consumption of the building throughout its life cycle and its impact on the surrounding environment are not fully considered, resulting in problems such as high energy consumption and poor indoor comfort in the actual use of the building. However, the demolition and reconstruction of buildings can lead to waste of resources and environmental pollution. Therefore, it is feasible and necessary to study the application of green building technologies in the design of public buildings. This study models the effectiveness of public building interior design based on BIM technology from the perspective of integrated design as well as parametric design. This model enables the interior design of public buildings to become energy efficient, emission reducing, and environmentally sustainable. After all, the integration of architecture and interior design can reduce unnecessary decorative waste. In addition, this model can also respond to the government’s efforts to develop an ecological civilisation, creating a new way of living that is resource efficient.

In 2025, the film One Flew Over the Cuckoo's Nest turned 50 years old. Although the film has been subject to analysis over the years, its role in shaping the perceptions of professionals working in mental health has not yet been fully explored. The aim of this paper is to explore mental health staff's perspectives onOne Flew Over the Cuckoo's Nest on its 50th anniversary. Semi-structured interviews were conducted with 15 participants. The study was guided by a qualitative descriptive approach. Reflexive thematic analysis was used to analyse data. Five Themes were identified: Personal Reflections on First Viewing One Flew Over the Cuckoo's Nest, Consolidating Stereotypes and Reinforcing Stigma, The Shadow of Nurse Ratched, We Have Come a Long Way but We Still Have a Long Way to Go and The Legacy of One Flew Over the Cuckoo's Nest Today. Although the film's direct influence is waning, it still has some hold over the public's negative views of mental health care. Media campaigns, similar to those used to dispel myths about mental health challenges, should be used to promote better images of mental health staff and care environments, reducing stigma. While mental health care has come a long way since the release of One Flew Over the Cuckoo's Nest, further improvements are warranted, with an emphasis on reducing power dynamics and more focused mental health education.

Individuals living with multimorbidity and/or mental health issues, low education, socioeconomic status, and polypharmacy are often called complex patients. The complexity of their health and social care needs can make them prone to disease burden and suffering. Therefore, they frequently access health care services to seek guidance for managing their illness and suffering. The aim of this research was to describe the approaches used by nurses to alleviate the suffering of individuals with multimorbidity and complex needs in acute care settings. A qualitative descriptive approach. Semi-structured interviews were conducted with 19 nurses working in general, medical-surgical, specialized, and intensive care settings across five hospitals in Pakistan. Reflexive thematic analysis was used for analysis. Ethical approval was obtained from the Ethical Committee of Al-Nafees Medical College Islamabad, Pakistan. Four themes were generated: Deeper Exploration of Patients' Health-Illness Situation and Complexity, Prioritizing Patient Psychosocial and Emotional Needs, Instilling Hope and Encouragement in Patients, and Creating a Comforting Environment to Foster Sharing of felt needs. Nurses emphasized the need of deeper inquiry into patients illness situation and complexity to discern the impact of determinants on their well-being and develop care plans that are tailored to address psychosocial, emotional, and physical suffering of this patient population. Alleviation of patient suffering is integral to compassionate nursing care. Nurses use a multifaceted approach entailing sensitive understanding, recognizing sociocultural and structural determinants impact on patient situation, and individual and interdisciplinary altruistic actions to alleviate patient suffering.

Purpose To examine the lived experiences of adults who have received community-based rehabilitation (CBR) services in Australia or New Zealand for cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) and their support people. Participants’ recommendations for future models of care were also explored to enhance rehabilitation services for people with TBI. Method A qualitative descriptive approach grounded in phenomenology was used, whereby semi-structured interviews were conducted with each participant. A total of 28 interviews were completed, four in-person and 24 via video conferencing. Two participant groups were recruited: Adults with TBI; and their support people. Sixteen adults with a self-reported diagnosis of cognitive-communication disorder (CCD) following TBI who had received CBR and 12 support people were included. Interviews were analysed using reflexive thematic analysis. Result Four themes were identified by the participant groups indicating the core pillars of CBR models of care. They included the importance of: (a) accessible and inclusive CBR services; (b) specialised clinical skills and treatment approaches; the acknowledgment that (c) knowledge is power; and the significance of (d) peer networks and support. Conclusion This study further advances the evidence base of how services can be optimised to meet the complex needs of adults with CCDs following a TBI. Clinicians, researchers, and service providers should endeavour to incorporate the four core pillars outlined to enhance future CBR models of care for this clinical population.

Purpose The increasing demand for practice education placements in Ireland, driven by the growing need for allied health professionals, presents significant challenges. Over the past twenty years, the co-supervision model, which divides the supervision of a single student among two educators, has become more prevalent. This is largely due to its suitability for part-time therapists who wish to facilitate practice education placements. Despite its increasing use, the model has received less attention in occupational therapy than the one-to-one model, the two-to-one and the collaborative model. This paper aims to describe occupational therapy practice educators experiences of facilitating the co-supervision model of practice education. Design/methodology/approach Using a qualitative descriptive approach, semi-structured interviews were completed with nine occupational therapists to explore their experiences of using the co-supervision model. Data were analysed using Braun and Clarke’s six-phase reflexive thematic analysis. Rigour and trustworthiness were achieved through an audit trail, prolonged engagement with the data and ongoing team reflection on theme development. Findings Reflexive thematic analysis yielded five themes: (i) broad student learning opportunities in the co-supervision model, (ii) communication within collaborative relationships, (iii) co-supervision facilitates participation in the Practice Educator role, (iv) planning and self-preparation are essential and (v) the co-supervision model demands student self-management skills. Originality/value Providing contemporary nuanced evidence on practice educators’ perspectives of the co-supervision model in occupational therapy placements in an Irish context is essential in highlighting its potential as a promising alternative to other models in facilitating quality student placements.

Purpose: This paper proposes a management accounting framework for Small and Medium Enterprises (SMEs) operating in developing countries. The development of the framework was motivated by the existing low uptake of management accounting and inconsistent use of Management Accounting Practices (MAPs) by SMEs, especially in emerging economies. The model framework advanced in this paper is meant to regularise and systematise the use of MAPs by SMEs. Methodology: The study adopted a qualitative research approach using semi-structured interviews. A total of thirteen focus group meetings, nineteen face-to-face in-depth interviews and twenty-one key informant interviews were conducted in five provinces in Zimbabwe. Data was analysed following a reflexive thematic analysis through content analysis using Atlas. ti. Findings: The paper proposed a six staged systematic implementation method that makes the application of MAPs less cumbersome and easy to implement. The framework can be applied to other similar contexts in the Global South. It is highly recommended that SMEs should apply management accounting as it use promotes competitive advantage and success for an entity. Originality/Value: The framework is envisaged to increase the usage of management accounting among SMEs as well as reducing inconsistencies in the application of MAPs among SMEs.