The role of product development in the battle against product-related stigma – a literature review

Abstract

Stigma may be the Achilles’ heel of Inclusive Design, having a variety of negative effects on the user, e.g. anxiety or depression. From a product development (PD) perspective, such negative user stigmatisation can lead to the rejection of a product. PD cannot defeat stigma itself, but it can make a valuable contribution by reducing product-related stigma. Joining the battle, this contribution analyses the role of PD and identifies supports that help to reduce stigma in the respective context using an initial and a systematic literature review. The role of PD is split into four categories addressing the need to fulfil specific demands (reduce stigma and improve personal well-being), exploit potentials (see design as a tool, use the power of product semantics and design for our future selves), solve current problems (lack of knowledge and not taking the user seriously) and manage boundary conditions (complexity of stigma and the stigma-sensitivity of products). Individual, process, educational solutions or general strategies are supports that help meeting those expectations. Due to different challenges, there is still a need for action to improve those supports to deliver specific design recommendations and reduce the lack of knowledge.

KEYWORDS:

• Inclusive design
• stigma
• support
• product design
• systematic literature review

Introduction

Although Inclusive Design (ID), Universal Design (UD) and Design for All (DfA) slightly differ in their focus, they are all essentially trying to address a wide range of users with only one product (Goodman-Deane, Langdon, and Clarkson 2010). These approaches are constantly evolving towards a broader understanding of true diversity and user needs (cf. e.g. Waller et al. 2015; Steinfeld 2013) and suggest good solutions to integrate users’ requirements but yet do not guarantee success on the market. On the one hand, to enable a concept of ‘one size fits many’, heterogeneous user groups need to be treated equally. This requires anonymisation and homogenisation of the users’ needs (Jacobson 2014), which often results in neutral product designs (Rønneberg Næss and Øritsland 2009). Such neutrality is rarely appealing to the users, which often leads to a lack of users’ acceptance. On the other hand, the context in which ID/UD/DfA is used is challenging. In many cases, the addressed products are assistive devices, which often link the prejudice of abnormality to the user (Bispo and Branco 2009). Both mentioned challenges may lead to negative user stigmatisation favouring product rejection (Rønneberg Næss and Øritsland 2009). Stockton (2009) even states that stigma is the Achilles’ heel of ID. Joining the battle against stigma, this paper generally analyses the role of product development in managing product-related stigma and how existing supports can contribute to it.

The concept of stigma is hereby versatile and complex. Goffman (1963) coined the term from a sociological perspective and described it as an attribute that extensively discredits a person to be tainted and discounted instead of normal. Such attributes are often personal like a fault in character or physical abomination. Recent literature starts to open up the discussion about the cause of stigma and includes other influencing factors. van Brakel (2006) adds, for instance, attitudes, discriminatory practices, services, media and materials. Bichard, Coleman, and Langdon (2007) instead, understand stigma not only as an attribute but a behaviour triggered by the environment, personal circumstances or even a product. Vaes (2019) also identifies the product as a driver of stigma and introduces the concept of product-related stigma (see Figure 1). Whether a user is stigmatised by another person (stigmatiser) depends on the whole context of product usage including the user, the situation, culture, the stigmatiser and the product. Each aspect has different influencing factors:

• the user: having or not having coping strategies, having stereotypical behaviour, personality, personal values (Vaes 2014) etc.

• the situation/environment: social context (Shinohara and Wobbrock 2011), people involved or not (Vaes 2019), where the whole situation takes place (Major and O’Brien 2005) etc.

• culture: cultural background of user/stigmatiser (Major and O’Brien 2005), cultural differences of user/stigmatiser (Yuker 1994) etc.

• the stigmatiser: personality, personal background, attitudes and values (Vaes 2014), available information about the context (Yuker 1994) etc.

• the product: visibility (Vaes 2014), type of product (Parette and Scherer 2004), stigma sensitivity (Vaes, Stappers, and Standaert 2016) etc.

Figure 1. Concept of product-related stigma, own illustration based on (Vaes 2019).

If users are stigmatised, the consequences are mostly negative. In general, the behaviour of the surrounding people towards the ones being stigmatised changes in an inappropriate manner (cf. Brookes 1998; Crocker, Major, and Steele 1998; Carneiro et al. 2015). Hereby, different reactions occur – people are, for example, laughed at (cf. Carneiro et al. 2015), insulted (cf. Vaes 2014) or simply less appreciated (cf. Gaffney 2010). This altered behaviour against people can also change their psychological well-being, e.g. in form of a reduced self-confidence (cf. Bichard, Coleman, and Langdon 2007; Shinohara and Wobbrock 2011), a changed self-awareness (cf. Wright 1983; Major and O’Brien 2005; Vaes 2014), a loss of self-esteem (cf. Crandall and Coleman 1992; Corrigan and Watson 2002; Major and O’Brien 2005; Shinohara and Wobbrock 2011; Vaes 2014), anxiety (cf. Crandall and Coleman 1992; Parette and Scherer 2004; Vaes 2019), depression (cf. Crandall and Coleman 1992) and many more.

The two main challenges from the perspective of product development are the lack of product acceptance (cf. Goffman 1963; Louise-Bender, Kim, and Weiner 2002; Jacobson 2014) as well as the products’ rejection (cf. Louise-Bender, Kim, and Weiner 2002; Parette and Scherer 2004; Rønneberg Næss and Øritsland 2009; Bichard, Coleman, and Langdon 2007; Shinohara and Wobbrock 2011; Jacobson 2014; Steinfeld and Smith 2012). Assistive technologies, such as wheelchairs, hearing aids, walkers, etc., are affected in particular, as they are often linked to disabilities and limitations (Parette and Scherer 2004), with which the user does not necessarily want to be associated. Besides the product type, the product shape (cf. Scherer 2000; Bichard, Coleman, and Langdon 2007; Shinohara and Wobbrock 2011; Vaes 2014; Jacobson 2014; Carneiro et al. 2018) and its visibility (cf. Bispo and Branco 2009; Vaes 2014) are of great importance. Stigma-sensitive products designed to be used invisibly usually do not cause stigmatisation. Contrary, products wouldn’t need to be hidden if the user feels safe and confident while using them (Vaes 2014). In some cases, hiding a product is not even possible, e.g. if the user needs a wheelchair. How stigma is perceived and how it is dealt with also depends on the user him/herself. If there are enough coping resources, he or she can successfully handle the stigma (Major and O’Brien 2005). However, if these resources are missing, the already mentioned negative effects may occur.

The battle against stigma is a complex, highly interdisciplinary challenge that product development alone certainly cannot solve. However, companies do have a social responsibility towards the users of their products. Product development can make a contribution to overcome stigma by trying to minimise the product-related stigma. In order to achieve this goal, there are already several methods available that contribute to different stages of the design process. Besides those that accompany the whole process and the product’s evaluation, approaches that support the designer during early design stages, like planning and clarifying the task, are especially useful to provide necessary information. Moreover, they sensitise the designer about product-related stigma and how to reduce it. Approaches that focus on the development process include, for instance, the design for social acceptance (Shinohara and Wobbrock 2011) or ability-based design (Wobbrock et al. 2011). The measurement of stigma can be carried out by using a questionnaire (Carneiro et al. 2018), the Product Appraisal Model for Stigma (Vaes 2019) or validated experimental techniques like observations (e.g. Vaes, Stappers, and Standaert 2016). Recommendations towards the design of products to reduce stigma are often provided via general strategies such as strengthening the individual identity of the product (Green 2009; Vaes 2019).

The main objective of this paper is the discussion whether product development is able to reduce product-related stigma with help of the currently available support. Thus, the three research questions that are going to be examined are as follows:

1. Which expectations and demands towards product development and its role in the battle against stigma do exist?

2. Which supports do exist?

3. Can product development satisfy the expectations by using the existing supports?

Methods

To properly answer the prior defined research questions an initial and a systematic literature review were conducted (see Figure 2). Hereby, the scope of the initial review was more open than the systematic one as it was meant to generally gain understanding about the role of product development in the context of stigmatisation. The systematic review additionally identified existing supports to reduce product-related stigma. After that, the findings from both literature reviews were compared to discuss whether product development is able to satisfy the expectations with the supports available. Both reviews were conducted by the corresponding author, discussed by all authors and consider literature published until May 2020.

Figure 2. Overview of used methods and its connection to the three research questions.

Initial literature review

The search within the initial literature review was conducted in Scopus as it is the largest database for abstracts of peer-reviewed literature. The search included scientific journal contributions, books and conference proceedings written in English. The search string examined title, abstract and keywords for the terms ‘product development’ and ‘stigma’. Synonyms and different spellings were also considered leading to the final string: ‘TITLE-ABS-KEY ((“product development” OR “engineering design” OR “product design” OR “design”) AND (“stigma” OR “stigmatization” OR “stigmatisation”))’. The paper selection started by reading the title and abstracts. To identify a paper as relevant, the inclusion criteria ‘the contribution generally deals with stigma in the context of product development’ must be met. If this was the case, the full paper was read and re-evaluated according to the inclusion criteria. The final set of contributions was further examined regarding the expected role of product development in the battle against stigma to provide answers to research question one. Thus, the authors screened the papers in terms of directly expressed expectations, demands and wishes towards product development as well as indirectly mentioned problems that necessarily be solved or potential that is not sufficiently utilised. All of the individual statements were listed, subsequently sorted according to their meaning and finally merged into four different categories.

Systematic literature review

After gaining a general understanding about stigma in the respective context, the systematic literature review identified specific supports to reduce or overcome product-related stigma. Similar to the initial literature review, Scopus was the main source of contributing literature. To crosscheck the findings, the global citation database Web of Science was used. Again, the search included scientific journal contributions, books and conference proceedings written in English. The search string is illustrated in Figure 3.

Figure 3. Search string within the systematic literature review.

Inclusion criteria consisted of two aspects, which both have to be met: on the one hand, the context has to be product development and on the other hand, there is at least one support against user stigma mentioned. The exclusion criteria was vice versa. Either the wrong context or the lack of a support mentioned, led to the exclusion of the contribution. The selection procedure within the review included four steps:

1. Preselection 1: read title, keywords and abstract | include paper if inclusion criteria ‘existing context of product development’ fits

2. Preselection 2: reread keywords and abstract | include if inclusion criteria ‘at least one support against user stigma is mentioned’ fits

3. Final Selection: read instruction and conclusion | include if both inclusion criteria fit

4. Read full paper | re-evaluation due to inclusion criteria

Within the systematic literature review, 31 contributions were identified (see Figure 4). Besides the contributions from Scopus and Web of Science, six external papers were added due to recommendations by other researchers or citations. All papers have an academic background. None of the authors mentioned cooperation with industry. However, many papers include use cases and studies in addition to basic literature reviews. An overview of the 31 contributions including the methods used is given in detail in the Appendix.

Figure 4. Selection of contributions during the systematic literature review.

The final set of 31 relevant contributions was then examined regarding the identification of supports to reduce or overcome product-related stigma. For this purpose, the authors listed and classified the type of support. Reliability of the contributions was mainly evaluated by assessing the methods used and the underlying data of the supports (cf. Appendix).

Results

The role of product development

Within the initial literature review, 85 relevant contributions were identified and analysed regarding the expectations towards product development. Those demands not merely come from scientists and their understanding of the topic, but also directly from people frequently facing stigma. Interviewed in various studies, they give unique insights into what is actually going wrong from the user’s perspective. We, as product developers, are often not personally affected and therefore unaware and not enough sensitised towards such a tangible topic. However, combining all different views and studies from the initial literature review, four main categories were derived to answer research question one (see Figure 5).

Figure 5. Main expectations towards product development in the context of product-related stigma.

Specific demands to be fulfilled

Reduce stigma

One of the main demands is the direct and goal-oriented reduction of stigma (Bichard, Coleman, and Langdon 2007). Thereby, different factors play a role, for instance access. People like to have good accessibility without perceived stigma (Covington 1999), regardless of whether or not personal limitations exist (Shinohara and Wobbrock 2011). Another important factor is aesthetics and usability. Functionality, reliability and safety are often top priority for stigma-sensitive products (e.g. assistive technology) (McCreadie and Tinker 2005). Unfortunately, it is not taken into account that such a product will never work well if it is neither accepted nor applied by the user (Jacobson 2014). Therefore, it is important to focus on an appealing and aesthetical design as well (Bichard, Coleman, and Langdon 2007; Li, Lee, and Xu 2020). A high level of product attractiveness can additionally contribute to the user’s identification with the product and can thus increase the user’s self-esteem and self-expression (Scherer 2000). This helps to address the personal level of the users, which in the end strengthens their self-confidence and empower them to deal with stigma more easily (Vaes 2014). The prevention of physical confronting moments, like people not being able to use a product because it is too heavy, is equally important (Vaes 2019). To achieve this, a good usability is necessary – especially for older people, who often suffer from physical impairments (Steinfeld and Smith 2012). Usability alone does not automatically ensure good user experience (Rebelo et al. 2012) and, depending on the resulting product design, can also have a negative impact on stigma. In the end, sufficient functionality should be the basis for a product with an equally good usability and an emotionally appealing product design (Scherer 2000). Thus, stigmatisation can be effectively reduced and a good user experience can be achieved. Another factor to reduce stigma is the need for social communication for products (Volonté 2010), i.e. the message a product sends out to society. Hereby, it is the responsibility of the product developer to enable a balance between his/her technical point of view and the social and personal values of the user (Vaes 2014).

Improve personal well-being

The second main demand is the improvement of a user’s personal well-being (Jensen 2009). Triggering emotions can be one possible solution to achieve this task. Products usually evoke emotions during their usage. Understanding the type of emotion enhances a better understanding of stigma (Jacobson 2014). For instance, it is more advisable to evoke positive emotions than negative ones to fight stigma (Sharp, Preece, and Rogers 2019). Such emotions can be realised, e.g. by an emotionally appealing product design tailored for the user, which, as already mentioned, can in turn lead to an increased self-confidence of the user. Personal well-being can also be increased by treating every person – disabled or not – equally (cf. Wobbrock et al. 2011; Shinohara and Wobbrock 2011). The product must therefore be able to provide users a sense of normality – let it be the pure existence of the product or which meaning is projected on the user during its usage.

Potentials to be exploited

‘Design as a tool’

One main potential in the battle against stigma is design itself with its numerous powerful and established tools. It was already mentioned, that it is beneficial to balance usability and aesthetics. If it is properly used, design has the potential to reconcile the tension between both tasks and bring them successfully together (Marti and Giusti 2011). Individual users can use the resulting products in turn as a tool to better fit into society or simply to better experience everyday life (Louise-Bender, Kim, and Weiner 2002).

Use the power of product semantics

The second main potential is the power of product semantics. Demirbilek and Sener (2003) explain product semantics as ‘an attempt to identify appropriate visual, tactile and auditory messages and incorporate them into product design. […] It combines various disciplines, such as art, ergonomics, semiotics, communication, logic, philosophy, and psychology’. Using product semantics properly may lead to an emotionally appealing and intuitively usable product (Demirbilek and Sener 2003). Depending on the message being conveyed, the attractiveness of the product can be increased or reduced (Crilly, Moultrie, and Clarkson 2004). A mobile phone designed for people with motor disabilities might have big buttons and a clunky look for accessibility purposes and robustness. Yet, the message received by an average person seeing someone using the phone is not ‘this is a robust phone’ but rather ‘there is something wrong with the user’. This might not be negative at all, but it does change the way others interact with the user. Product development must be aware of the values a product transmits. This potential is vast, given that product development can also specifically influence values and attitudes through product design in a positive way (Olander 2011). Technology and design can thus also be used as ‘mediators of disability’ to break old structures and create new ones (Anderberg 2005).

Design for our future selves

Designing against stigma particularly supports people being different, e.g. because they have a different mindset, altered physical abilities or they are just getting older. In the end, anybody, including ourselves, can be affected independent of age and sex. With approaches like ID/UD/DfA, there already are methods having the potential to design for our future selves (Vaes 2014). This potential is not yet being exploited in practice because they are simply not used sufficiently. There are even attempts to extend the UD by an eighth principle, the principle of user equality to reduce stigma (Kaletsch 2009). Further alternatives for expansions of UD are emerging taking stigma into account, e.g. emotional universal design (Olander 2011). Even if these approaches are not yet established, the potential still exists and should be explored.

Current problems to be solved

Lack of knowledge

One major problem in the battle against stigma is the lack of knowledge about stigma, its influences and effects in product development. For example, the developer is often neither aware of the needs of people with altered abilities nor of how they can and should be integrated into the development process (Vaes 2014). A lack of knowledge occurs about the context of use and how affected people perceive a stigmatising product usage (Jacobson 2014). In the end, this may lead to a false perception of the actual user’s experience (Brookes 1991). This problem intensifies, if the developer and the user have strong discrepancies in their cultural values and personal preferences (Parette and Scherer 2004).

Not taking the user seriously

Another huge problem is that the product developer not always takes the user and his or her needs seriously (Jacobson 2014). Disabled people are especially endangered of being stigmatised during product usage as they are dependent on assistive devices. Those products often lag behind modern technological standards (Shinohara and Wobbrock 2011). Some only focus on ergonomics (Bispo and Branco 2009; Vaes 2019), others are unnecessarily difficult to use (Vaes 2014). Aesthetic demands and personal preferences, instead, are rarely taken into account (Shinohara and Wobbrock 2011; Vaes 2019). These are all factors that encourage stigma and must be eliminated.

Boundary conditions to be managed

Complexity of stigma

The first boundary condition is the complexity of the whole topic. For example, product semantics is mentioned as a great potential to face stigma, but it is not always under the sole control of the developer (Bispo and Branco 2009). Assistive technologies often communicate vulnerability or functional limitations (cf. Luborsky 1993; Parette and Scherer 2004). This association also arises from society, which makes it difficult for product development to change such established structures. In addition, products are rarely developed in a neutral way because they are usually designed by the same people in society who stigmatise (Sheldon 2014). Furthermore, a product alone is not solely responsible for the stigmatisation. Other influencing factors, like the situation or the cultural background, also play a role (Vaes 2014). Even multiple stigmatisation is possible due to social status, gender or ethnicity, etc. (Hanson 2004; Vaes 2014).

Stigma-sensitivity of products

Another boundary condition that needs to be managed is the stigma-sensitivity of products. Some products are more likely to stigmatise the user than others. Protective, assistive and medical devices, for instance, have a higher sensitivity than e.g. sports equipment (cf. Bispo and Branco 2009; Vaes 2014). Reducing stigma is much more difficult in these cases, but all the more important. Therefore, product development must decisively fight stigma in these product categories.

Existing supports to reduce product-related stigma and its benefits and challenges

The supports identified during the systematic literature review were clustered into four categories: individual solutions, education, approaches addressing the development process and general strategies (see Figure 6). The last-mentioned were not solely extracted out of the 31 papers but also from various contributions of the initial literature study as these strategies were often mentioned in short paragraphs, but not published as an independent support.

Figure 6. Overview of supports. Development process according to Pahl et al. (2007).

Individual solutions

There are different individual solutions, which are applicable throughout the whole product development process (see Table 1). In the early stages of product development, the available supports mostly aim for identifying requirements that have a connection to stigma. The developer can then adjust the relevant parameters in order to minimise product-related stigma. During the evaluation, measuring stigma is the main task, since this identifies the need for additional iterations in case the product-related stigma remains too high. However, there are also solutions that can be used independent throughout the whole development process.

Table 1. Overview of individual solutions.

Planning and clarifying the task

Identifying requirements with

the kano model (Brandl et al. 2017) qualitative approaches like tea parties, focus groups, observation, contextual inquiry, ethnography etc. (Bright and Coventry 2013; McCarthy, Ramírez, and Robinson 2017) the Reversed MoSCoW Method (Spiru et al. 2019) the Feature Matrix (Woodcock, Osmond, and Holliday 2020)

Evaluation

Measuring stigma with

the Divergency (Abel and Satterfield 2018) and the Connectivity Model (Kang and Satterfield 2009) Perceived Stigmatization Questionnaire (Lawrence et al. 2010) Environmental psychology method ‘room effect’ (Renda et al. 2016) Product Appraisal Model for Stigma (Vaes 2019)

Measuring appraisal using focus groups (McNeill and Coventry 2015)

Throughout the whole process

Design guideline for assistive devices (Bright and Coventry 2013) Method to combine co-design and additive manufacturing (Gherardini et al. 2020) Participatory design through workshops (McCarthy, Ramírez, and Robinson 2017) MATUROLIFE (smart materials in e-textiles) (Moody and Cobley 2020) Design for Social Accessibility using method cards (Shinohara 2017) Product Appraisal Model for Stigma and Product Intervention Model for Stigma (Vaes 2019) Empathic Design (Thomas and McDonagh 2013)

The main benefit of the individual solutions is their independence from existing product development processes. Hence, companies can easily integrate single or a set of individual solutions that fit best into their own processes. Furthermore, in many of the presented solutions, the product developer interacts with real users (e.g. Gherardini et al. 2020; McCarthy, Ramírez, and Robinson 2017; Bright and Coventry 2013). On the one hand, this may sensitise the developers to better understand the problems of those being actually stigmatised. On the other hand, such data is usually biased and there is no guarantee whether the statements of the individuals are equally important to the entire target group. Additionally, finding the ‘right’ user is mandatory. In the context of stigmatisation, we have to look at people being stigmatised. As lead users might be disabled, it will be quite challenging to find people that are in fact able to contribute, e.g. in co-designing or qualitative approaches like focus groups (cf. Gherardini et al. 2020). We need to be aware, that working with a stigmatised person might require more time, costs and experience than classical user integration.

In addition, some individual solutions also lack a sufficient focus on stigma. While some supports are specifically designed to address stigma (e.g. Lawrence et al. 2010; Vaes 2019), there are others who see its reduction merely as a positive side effect (e.g. Bright and Coventry 2013; Spiru et al. 2019; Woodcock, Osmond, and Holliday 2020). This shows that although awareness of the issue is slowly increasing, it is still very low. A more practical problem is the accessibility of the solutions. Some solutions are very well documented and can easily be adapted. Lawrence et al. (2010), for instance, provide the perceived stigmatisation questionnaire in the Appendix of their paper. Vaes (2019) uses gamification to convey information in an understandable and playful manner. However, there are also publications in which it is not clear where some of the information comes from. Abel and Satterfield (2018), for example, get their input data for the introduced divergency model from a research survey tool based on the connectivity model. It remains unclear, how this research survey tool actually works and how data is collected. This means that further effort is needed before the method can actually be used. Furthermore, qualitative approaches (like focus groups, observation, ethnography etc.) require experience to develop a study design as well as conduct the study with participants. Moreover, due to the lack of industrial applications, it is difficult to assess the actual usefulness of the methods in the respective context of product-related user stigma.

Education

Educational solutions currently relate exclusively to the training of university students. Thereby, Schneider, McDonagh, and Thomas (2013) introduce a co-designing course with disabled and non-disabled. Vaes, Corremans, and Moons (2011) teach empathy in different design stages, whereas Torkildsby and Vaes (2019) combine critical design workshops with the stigma-free design toolkit by Vaes (2019).

Educational solutions are beneficial as they increase the understanding and sensitisation of future designers, who bring knowledge into the company and thus can create change. But right now, there are only a few universities providing such courses. Therefore, the number of taught students is very small. The existing courses are also not contributing to the current misunderstanding of stigma since only university students are trained but not designers that currently work in industry. Thus, the existing situation remains unchanged.

Development process

Process solutions usually address a variety of users and can be applied to a vast amount of different products. Tools and methods used inside these processes often integrate the user directly leading to benefits and challenges that are already mentioned (see individual solutions). Besides classical approaches like ID/UD/DfA, there are also novel process solutions or extensions of those existing (see Table 2).

Table 2. Overview of process solutions.

Process solutions

Classical methods like ID/UD (Bichard, Coleman, and Langdon 2007; Wu et al. 2014) (Invisible) Design for All (Molenbroek, Groothuizen, and de Bruin 2011) Special needs in pleasure-based product design (Attaianese 2011) Emotional Universal Design (Choi 2006)/ Universal Design with emotional satisfaction (Zöller and Wartzack 2017) User-centred inclusive design process (Hyung et al. 2013) Aesthetically-minded design for assistive devices (Marti and Giusti 2011) Ability-based design (Wobbrock et al. 2011)

However, most of the mentioned extensions of classical approaches like UD/ID/DfA are very unspecific and rather theoretical constructs without having been used in an industrial context yet. The concept by Zöller and Wartzack (2017) to add emotional satisfaction factors to the classical UD approach, for instance, was neither further developed nor used in an industrial context. Therefore, it remains a theoretical construct that is not easily adaptable by companies. This is not the only reason why it is difficult for companies to implement such processes. They may have to redesign their own development process, which can be extremely expensive. Moreover, success is not guaranteed and difficult to measure. There is also a kind of misunderstanding of the terms UD/ID/DfA. As the resulting products out of these process solutions often transport negative associations (e.g. neutral design), also the terms themselves are stigmatised negatively.

General strategies

Various strategies for reducing product-related stigma are mentioned in contributions dealing with the issue of stigma (see Table 3). The strategies were divided into three main categories: product intervention, user empowerment and cultural intervention (cf. Vaes 2019).

Table 3. Overview of general strategies.

Product intervention

Use camouflage or disguise (Bispo and Branco 2009; Green 2009; Jacobson 2014; McCarthy, Ramírez, and Robinson 2017; Vaes 2019; Vaes et al. 2012; de Barros, Duarte, and Cruz 2011; Partheniadis and Stavrakis 2019) Create a diversion of attention (Jacobson 2014; Vaes 2019; Stockton 2009) Strengthen the product’s individual identity (Green 2009; McCarthy, Ramírez, and Robinson 2017; Vaes 2019) Strengthen the product’s group or institutional identity (Vaes 2019) Strengthen the product’s brand identity (Stockton 2009; McCarthy, Ramírez, and Robinson 2017; Vaes 2019) Increase the product’s social power (McCarthy, Ramírez, and Robinson 2017) Eliminate physically or mentally confronting moments, e.g. by adapting mainstream (Bispo and Branco 2009; Stockton 2009; Grieg, Keitsch, and Boks 2014; Vaes 2019) Create additional benefits and experiences (Jacobson 2014; Vaes 2019) Manage frequency and intensity of product use (Vaes 2019) Redesign product significance through advances in materials and technology (Vaes 2019) Change the meaning of the product and create symbolism (Bispo and Branco 2009; Vaes, Stappers, and Standaert 2012; McCarthy, Ramírez, and Robinson 2017) Create meaningful interactions with other products (Vaes 2019) Use technological change (i.e. function remains, product design changes) (Stockton 2009) Create functional desire (Stockton 2009) Provide more choice and opportunities for personalisation (McCarthy, Ramírez, and Robinson 2017) Balance functionality and aesthetics (Bichard, Coleman, and Langdon 2007)

User empowerment

Make sure the product provides extra abilities for the product user (Vaes 2019) Boost the user’s social skill (Vaes 2019) Directly name the stigma (Green 2009) Raise the users’ self-confidence while minimising the level of psychological and emotional distress (Partheniadis and Stavrakis 2019) Empower the identification of the user with the product (Vaes, Stappers, and Standaert 2012; Jacobson 2014) Enable the user to use the product without any problems (Vaes, Stappers, and Standaert 2012)

Cultural intervention

Use campaigns or interventions to address the issue of user stigma (Vaes 2019) Manage social visibility or product endorsement (Vaes 2019) Create a picture of normality (Bispo and Branco 2009) Redesign the socio-social context (Vaes, Stappers, and Standaert 2012) Provide educational services (Stockton 2009) Extend interpretation of what are assistive devices (Grieg, Keitsch, and Boks 2014)

As the strategies are very general, they can be applied to a huge variety of different products. Applying them may improve the understanding of stigma and how to avoid it. This results in a better sensitisation of the product developer. Yet, the developer still needs prior knowledge to implement a strategy as there are no specific design recommendations and no information about the relevance of different strategies in different contexts. For instance, if a hearing aid offers the possibility to hide it, this is hardly possible for a wheelchair. Different product types require different strategies. Even a combination of different strategies can be beneficial. However, there is no weighting or ranking between the strategies. It is also unclear to what extend strategies depend on the context and especially the users and their individual preferences. In an interview conducted by Shinohara (2017), for example, one participant perceived it ‘pleasant when conversations focus on mainstream technology that one can use right along with one’s peers’. Another participant of the interview instead prefers products to be attractive:

I like things attractive. Whatever adaptive equipment, I want it to look nice. […] And, as a blind person, yeah, maybe I don’t see it, but other people see it, and I want it to be, you know, just as glamorous as the next guy.

Furthermore, some of the strategies lack sufficient underlying data. Reliable data is, for example, provided by Vaes; Vaes (2019, 2014) as he has conducted larger studies (mostly observation, field studies) to identify relevant strategies. Yet, there are limitations as those studies used students as participants. It is not examined whether a more diverse group of participants might have reacted differently or experienced stigma differently. Strategies from other researchers seem reasonable, especially as many strategies are mentioned repeatedly by different researchers, but they still have to be proven right.

Discussion

In the following, we discuss whether the identified supports satisfy the expectations towards product development. To fulfil the specifically mentioned demands of reducing stigma and improving personal well-being, process solutions might be beneficial. However, this does cause several problems, especially the often criticised neutral design resulting from classical process solutions contradicts the desire for an emotionally appealing product design combined with good usability. Besides, the already mentioned challenges of using process solutions are very high (see section development process). A better support is offered by the use of strategies as well as some of the individual solutions (e.g. requirements/measuring stigma). However, by using them, the product developer only receives general implications instead of concrete recommendations for product design. This requires a certain degree of a priori knowledge that is often not available. The lack of background knowledge is also problematic when it comes to the desire to improve personal well-being. Here it is important to integrate tangible factors into the product design. For example, especially positive emotions should be evoked while using the product. Such soft aspects, however, have only recently been accepted as an important part of product development, if even at all. In other disciplines, however, there are approaches that can be used. One example is the research area of Affective Engineering, which is dealing with how affective user needs can be transformed into perceptible product design elements (cf. e.g. Aziz, Husni, and Jamaludin 2010; Norman 2005). In addition, the field of positive design explicitly tries to evoke certain emotions during product use (cf. e.g. Desmet 2002; Desmet and Pohlmeyer 2013). In the context of stigmatisation, such approaches have been little known so far. One reason for this may be the great interdisciplinarity of the topic. This makes it, of course, very challenging in the first instance, but it can contribute greatly to reducing stigma if methods from different research areas are better linked and used in the respective context.

To exploit the potential in the context of stigma, design as a tool, the use of product semantics and the possibility to design for our future selves are mentioned. Hereby, all three aspects interact with one another. In order to exploit the potential, they all have in common that existing methods must be accepted and applied. This is where several difficulties arise. On the one hand, many methods are not very accessible. Many strategies, for instance, are rarely structured or not published on basis of high-quality data. On the other hand, sometimes there is simply no suitable method that can be used. The consideration of product semantics is subject to this problem. Although it is mentioned in the context of single strategies, it remains unclear how it should be handled and used methodically.

Another expectation towards product development is to solve the current problem of having a lack of knowledge and not taking the user seriously. Those problems weren’t initially expected from the authors as, nowadays, more companies try to understand their users’ needs, e.g. by using user-centred design methods. Classic methods like observations or focus groups can even be found as part of the individual solutions (cf. Table 1). However, in order to sufficiently use them to address stigma, designers first need to be aware of this topic. As stigma is lacking a general sensitisation in product development, available solutions remain unused. Thus, it is important to raise awareness of this issue. Not only to close the knowledge gap but also to treat stigmatised users respectfully. Educational solutions can contribute the greatest benefit here. But there are still too few of them. Strategies and individual solutions, on the other hand, sometimes have a limited ability to improve the understanding, but such methods are usually merely used when there is already an awareness of the issue. In the end, it is a vicious circle that needs a lot of educational work to escape.

Considering the boundary conditions stigma entails (its complexity and stigma-sensitivity of products), the existing methods alone are not enough. Here, again, a change in awareness of what is necessary is important, which probably cannot be achieved solely by the education of future developers. At least, stigma-sensitivity can be identified by using the available evaluation methods for stigma. But still, as it is already mentioned before, without having at least small knowledge about stigma, the individual solutions and strategies are not easy to use and implement in the development process.

The discussion shows that not only the expectations towards product development varies but also the supports that are beneficial in the respective context. The results section provides a brief overview of the individual benefits and limitations of the supports and may be a starting point to choose the right method. Still, the decision which support is useful and efficient always remains highly individual and dependent on the use case. Independent of individual weaknesses of single supports, the biggest challenge is the developers’ unawareness in combination with unspecified support. However, these circumstances can be dealt with. The aim may not necessarily be to develop another full process solution, but rather to combine concrete methods with general strategies in a way that is easy to understand and entails a positive learning effect while using them. This effect is not intended to replace fundamental educational concepts for future designers. Quite the contrary, educational approaches have to be expanded and integrated as a standard module in classical engineering courses. Still, the concept of ‘learning by doing’ can also contribute to reducing the prevailing lack of knowledge. In this context, strategies must be further investigated and individual solutions must be further or newly developed so that they can both be connected. The interdisciplinarity of the topic should additionally be used as an opportunity to implement methods from other research areas in order to overcome stigma. Furthermore, stigma should not be dismissed as a casual side effect, because in the end it can be the difference between product use and rejection.

Concluding, stigma remains complex and product development will not win this battle alone. Reducing product-related stigma, however, is an efficient contribution to actively counteract it. This is also an important signal for all users living with stigma and its negative effects every day. Joining the battle against stigma, this contribution discovered the role of product development and the currently available supports to reduce product-related stigma. As it turns out, to be able to fulfil the various expectations product development is facing, supports need to be improved and misunderstanding about stigma needs to be reduced.

Tina Schröppel http://orcid.org/0000-0001-8063-0042

Jörg Miehling http://orcid.org/0000-0002-8610-1966

Sandro Wartzack http://orcid.org/0000-0002-0244-5033

Disclosure statement

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

Additional information

Funding

This work was supported by Deutsche Forschungsgemeinschaft: [grant number WA 2913/32-1].

Appendix:

Overview of contributions of the systematic literature review

Table

#	Author	Year	Titel	Methods	Source
1	Abel, T. D.; Satterfield, D.	2018	The Divergency Model: UX Research for and with Stigmatized and Idiosyncratic Populations	literature review	Scopus
2	Attaianese, E.	2011	Special needs in pleasure- based products design: A case study	use case of a telephone	Scopus
3	Bichard, J.-A.; Coleman, R.; Langdon, P.	2007	Does My Stigma Look Big in This? Considering Acceptability and Desirability in the Inclusive Design of Technology Products	literature review	Scopus
4	Brandl, C.; Rasche, P.; Bröhl, C.; Theis, S.; Wille, M.; Schlick, C. M.; Mertens, A.	2017	Incentives for the acceptance of mobility equipment by elderly people on the basis of the Kano model: A human factors perspective for initial contact with healthcare products	survey (n = 72)	Scopus
5	Bright, A. K.; Coventry, L.	2013	Assistive technology for older adults: Psychological and socio-emotional design requirements	3x technology tea parties (n = 6/6/7), 2x carer focus groups (n = 3/4), observation (n = 6)	Scopus
6	Choi, S.	2006	Emotional universal design – Beyond usability of products	use case of a blood pressure monitor conducted by 18 students	Scopus
7	Gherardini, F.; Mascia, M. T.; Bettelli, V.; Leali, F.	2019	A Co-Design Method for the Additive Manufacturing of Customised Assistive Devices for Hand Pathologies	use case of a can opener; individually co-designed with 8 different participants	Scopus
8	Gherardini, Francesco; Petruccioli, Andrea; Dalpadulo, Enrico; Bettelli, Valentina; Mascia, Maria Teresa; Leali, Francesco	2020	A Methodological Approach for the Design of Inclusive Assistive Devices by Integrating Co-design and Additive Manufacturing Technologies	use case of a 3D printed assisitve device for credit cards; individually co-designed with 1 participant	external from author
9	Grieg, J.; Keitsch, M. M.; Boks, C.	2014	Widening the interpretation of assistive devices – A designer’s approach to assistive technology	literature review	Scopus
10	Hyung, J. O.; Hyo, C. K.; Hwan, H.; Yong, G. J.	2013	User centered inclusive design process: A ‘situationally-induced impairments and disabilities’ perspective	case study of a mobile phone; interviews (n = 8)	Scopus
11	Kang, S.; Satterfield, D.	2009	Connectivity Model: Evaluating and Designing Social and Emotional Experiences	case study of food and experience; 5x focus groups (n = 5/5/5/5/5), survey (n = n/a)	external from citation
12	Kett, S. G.; Ringler, A.; Kamin, S.; Lang, F.; Wartzack, S.	2015	Critical appraisal of a tool for the measurement of user exclusion in product design	literature review	Web of Science
13	Lawrence, John W.; Rosenberg, Laura; Rimmer, Ruth B.; Thombs, Brett D.; Fauerbach, James A.	2010	Perceived Stigmatization and Social Comfort: Validating the Constructsand Their Measurement Among Pediatric Burn Survivors	survey (n = 716)	Web of Science
14	Marti, Patrizia; Giusti, Leonardo	2011	Bringing aesthetically-minded design to devices for disabilities	exploratory field trial (n = 12)	Scopus
15	McCarthy, G. M.; Ramírez, E.R.R.; Robinson, B. J.	2017	Participatory design to address stigma with Adolescents and young adults with type 1 diabetes	use case of a monitoring device for type 1 diabetes; workshop (n = 29)	Scopus
16	McNeill, A.; Coventry, L.	2015	An appraisal-based approach to the stigma of walker-use	5x focus group (n = 4–7)	Scopus
17	Molenbroek, J.F.M.; Groothuizen, T.J.J.; Bruin, R. de	2011	Design for all: Not excluded by design	literature review	Scopus
18	Moody, L.; Cobley, A. J.	2020	MATUROLIFE: Using advanced material science to develop the future of assistive technology	10x workshops (n = 94 participants in total)	Scopus
19	Renda, G.; Jackson, S.; Kuys, B.; Whitfield, T.W.A.	2016	The cutlery effect: do designed products for people with disabilities stigmatise them?	survey (n = 562)	Scopus
20	Schneider, Sheila M.; McDonagh, Deana; Thomas, Joyce K.	2013	Disability + relevant design: a portfolio of approaches	use case conducted by students in an university course; use case of a PalmGrip Utensil Holder (n = 1) and a crutch handgrip (n = 2)	Web of Science
21	Shinohara, Kristen	2017	Design for Social Accessibility: Incorporating Social Factors in the Design of Accessible Technologies	interviews (n = 25), diary entries (n = 25), design thinking course (2x university course, n = 42/36), 5x workshops (n = 15 participants in total)	external from initial literature review
22	Spiru, L.; Marzan, M.; Paul, C.; Velciu, M.; Garleanu, A.	2019	The reversed moscow method. a general framework for developing age-friendly technologies	field research (n = 148), interviews (n = 57)	Scopus
23	Stockton, Glynn	2009	Stigma: Addressing negative Associations in Product Design	literature review	external from initial literature review
24	Thomas, J.; McDonagh, D.	2013	Empathic design: Research strategies	different student projects (n = n/a)	Scopus
25	Torkildsby, A. B.; Vaes, K.	2019	Addressing the issue of stigma-free design through critical design workshops	workshop within university course (n = 15)	external from initial literature review
26	Vaes, K.	2019	Design for Empowerment, the Stigma-Free Design Toolkit	referencing university projects (n = 220)	Scopus
27	Vaes, K.; Jan, C.; Moons, I.	2011	Educational model for improved empathy ‘the pleasurable mask experience’	concept tests (n = 16)	Scopus
28	Vaes, K.; Stappers, P. J.; Standaert, A.; Desager, K.	2012	Contending stigma in product design using insights from social psychology as a stepping stone for design strategies	literature review	Scopus
29	Wobbrock, J.O.; Kane, S.K.; Gajos, K.Z.; Harada, S.; Froehlich, J.	2011	Ability-Based Design: Concept, Principles and Examples	analysis of 14 projects and the principles used within (n = n/a)	external from initial literature review
30	Woodcock, A.; Osmond, J.; Holliday, N.	2020	The development of a feature matrix for the design of assistive technology products for young older people	market analysis, product review, product developer survey (n = 5), interviews with designers (n = 7), co-creation workshops (n = n/a), focus groups and interviews (n = 103)	Scopus
31	Zöller, S. G.; Wartzack, S.	2017	Universal design-an old-fashioned paradigm?	literature review	Scopus