research paper on design theory

• DOI: 10.1007/s00163-017-0275-2
• Corpus ID: 59264939

Design theory: a foundation of a new paradigm for design science and engineering

• A. Hatchuel , P. Le Masson , +1 author E. Subrahmanian
• Published in Research in Engineering… 10 November 2017
• Engineering

65 Citations

Beyond the old game design: a new design paradigm in game studies through c-k theory.

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Design theory: an invitation for a quilt of perspectives

Engineering design principles as patterns of relationships in frame creation, design science in operations management: conceptual foundations and literature analysis, desenvolvimento científico em design science para a engenharia de produção: formulações conceituais e análise empírica, requirements and characteristics for the development and selection of design methods, innovative design on the shop floor of the saint-nazaire airbus factory, dynamics of innovative concepts in exploratory projects: managing consistency between originality, collaboration and strategy, mixing oil with water: framing and theorizing in management research informed by design science, 162 references, design theory: history, state of the art and advancements, design theories as languages of the unknown: insights from the german roots of systematic design (1840–1960).

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The Interplay between Creativity Issues and Design Theories: A New Perspective for Design Management Studies?

Creativity theories and scientific discovery: a study of c-k theory and infused design, a systematic approach of design theories using generativeness and robustness, 10 years of c–k theory: a survey on the academic and industrial impacts of a design theory, creativity and scientific discovery with infused design and its analysis with c–k theory, design problems and design paradoxes, a new approach of innovative design : an introduction to c-k theory., infused design. i. theory, related papers.

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Introduction, section snippets, references (71), cited by (138).

Thinking Skills and Creativity

Theoretical foundations of design thinking – a constructivism learning approach to design thinking.

• • A constructivism learning approach to Design Thinking was proposed.
• • A taxonomy of constructivism learning tenets was developed.
• • Tenets of constructivism were mapped to different stages of the Design Thinking process.
• • A comprehensive teaching-learning pedagogy for Design Thinking through the application of constructivism theory was offered.
• • A constructivism tenets-design thinking dashboard to link constructivism to the design thinking process was created.

How do we link the tenets of constructivist learning theory with the Design Thinking teaching-learning process for MBA students? Based on the research question stated above, we define two research objectives (RO) as enumerated below: RO1: To embed principles of constructivist theory into teaching various phases of the Design Thinking process . This objective is accomplished by constructing twelve tenets of constructivist learning theory and mapping the various activities across the phases of Design Thinking process to these principles RO2: To propose a comprehensive teaching pedagogy for Design Thinking This objective is accomplished by detailing activities in all phases of the design thinking process

Review of literature

Research method, conclusions and future direction(s), credit authorship contribution statement, acknowledgement, the effects of analogical and metaphorical reasoning on design thinking, creativity & innovation in business 2010 teaching the application of design thinking to business, procedia-social and behavioral sciences, rethinking project management education: a humanistic approach based on design thinking, procedia computer science, are teachers’ ratings of students’ creativity related to students’ divergent thinking a meta-analysis, teaching design thinking: expanding horizons in design education, facilitating design thinking: a comparison of design expertise, think-maps: teaching design thinking in design education, design studies, how to create a realistic customer journey map, business horizons, self-regulated learning processes vary as a function of epistemic beliefs and contexts: mixed method evidence from eye tracking and concurrent and retrospective reports, learning and instruction, developing qualitative research questions: a reflective process, international journal of qualitative studies in education, constructivism learning theory: a paradigm for teaching and learning, iosr journal of research & method in education, constructivism as a referent for reforming science education, constructivism and education, why design thinking in it business management program an exploratory study on students’ design thinking learning experience, international journal of information and communication technology education (ijicte), a rhizomatic learning process to create collective knowledge in entrepreneurship education: open innovation and collaboration beyond boundaries, management learning, qualitative research for education, in search of understanding: the case for constructivist classrooms, design thinking, harvard business review, the act of discovery, harvard educational review, wicked problems in design thinking, design issues, a warm embrace that saves lives, rapid prototyping google glass, designerly ways of knowing: design discipline versus design science, what works and does not work in a self-management intervention for people with chronic pain qualitative systematic review and meta-synthesis, physical therapy, constructivism: the career and technical education perspective, journal of vocational and technical education, design thinking and how it will change management education: an interview and discussion, academy of management learning and education, space: a psychological model for use within cognitive behavioural coaching, therapy and stress management, the coaching psychologist, designing personas with empathy map, did you know shift happens, the need for design thinking in business schools, looking in classrooms, applying design thinking principles to curricular development in medical education, aem education and training, is it time to regrow the grow model issues related to teaching coaching session structures.

• M.C. Hoepfl (1997)

Seven goals for the design of constructivist learning environments

Constructivist learning environments: case studies in instructional design, steve jobs' 2005 stanford commencement address, the development of learning innovation to enhance higher order thinking skills for students in thailand junior high schools, impact of design thinking in higher education: a multi-actor perspective on problem solving and creativity, exploring structural relations among computer self-efficacy, perceived immersion, and intention to use virtual reality training systems, the metaverse in education: definition, framework, features, potential applications, challenges, and future research topics, role of education, training, and e-learning in sustainable employment generation and social empowerment in saudi arabia, an innovative framework for teaching/learning technical courses in architectural education.

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Design-based research: What it is and why it matters to studying online learning

• Cite this article
• https://doi.org/10.1080/00461520.2022.2079128

Design and research: Two ways to make change in the world

Challenges of online learning design and research, three paradigms that link science and action, knowledge creation in design, design-based research methods.

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The ever-changing nature of online learning foregrounds the limits of separating research from design. In this article, we take the difficulty of making generalizable conclusions about designed environments as a core challenge of studying the educational psychology of online learning environments. We argue that both research and design can independently produce empirically derived knowledge, and we examine some of the configurations that allow us to simultaneously invent and study designed online learning environments. We revisit design-based research (DBR) methods and their epistemology, and discuss how they contribute various types of usable knowledge. Rather than compromising objectivity, we argue for how design researchers can acknowledge their intent and, in so doing, promote ways in which research and design can not only produce better interventions but also transform people and systems.

The contingency of artificial phenomena has always created doubts as to whether they fall properly within the compass of science. Sometimes these doubts are directed at the… difficulty of disentangling prescription from description. This seems to me not to be the real difficulty. The genuine problem is to show how empirical propositions can be made at all about systems that, given different circumstances, might be quite other than they are. (Simon, Citation 1969 , p. x)

Educational psychology has helped bridge the gap between the understanding of the human mind and the inherently applied field of education, in which educators must continuously make decisions about their teaching and learning aims. The theory of action in this relationship is simple: if people better understand how the mind works, they can better shape teaching to meet its constraints. The presumed division of labor has researchers in educational psychology “(i) adopting a psychological perspective to human problems; (ii) uncovering mediating/psychological variables which link particular situations with specific outcomes; (iii) employing psychological knowledge to create explanatory models of complex human problems; (iv) using evidence based strategies for change; and (v) sharing and promoting big ideas from psychology” (Cameron, Citation 2006 , p. 289), while others develop and enact instruction, ideally using insights from psychologists.

However, psychology research does not completely specify how to optimally educate (although some brave people have claimed otherwise). Even if psychological theory could specify thinking as well as Newton’s laws can specify the movement of objects, the thorny problem of defining initial conditions (e.g., prior knowledge, affective state, etc.) would still exist. Even when researchers zoom out and squint a bit, they still confront aspects of complexity that make solving for a desired end state impossible. Though researchers might cycle through different levels of abstraction or different attempts to take initial conditions into account, they still come up against a challenge of changing descriptive or predictive models into actionable information . The problems of designing and studying online learning environments exemplify these challenges. In this article, we describe how design-based research (DBR) methods are uniquely positioned to address the complex challenges of balancing educational and psychological research goals and design efforts to achieve actionable information about online learning environments.

Initial enthusiasm about online learning among educators stemmed from the freedoms it presents: freedom to avoid typical place and time constraints, to make learning more interactive, to design micro-affordances of learner engagement, to broaden access to the best teaching, and to use technology to record behaviors at a fine-grained level impractical in offline learning. This enthusiasm, however, was met with the several challenges inherent in real-world learning environments. Take the case of the massive shift from physical classrooms to online spaces during the COVID-19 pandemic, where a plethora of challenges became evident: from low student engagement, to inequitable access to devices, to rote transposition of instructionist pedagogies to the online environment (Greenhow et al., Citation 2022 /this issue). Online learning in the pandemic changed almost every characteristic of school as people knew it, and challenged how educators, students and families experienced fairly established ideas such as attention, involvement, and the social connections schools typically promote.

The pandemic also highlighted the protean arrangements of online learning. What online learning means in practice may vary greatly from context to context, and even from classroom to classroom (Greenhow et al., Citation 2022 /this issue; Heinrich et al., Citation 2019 ; Lee & Hannafin, Citation 2016 ). Online learning varies tremendously, ranging from individual computer-assisted instruction (Fletcher-Flinn & Gravatt, Citation 1995 ), to asynchronous, interactive learning settings, to synchronous interactions (Hiltz & Goldman, Citation 2004 ), to teleconferencing-based models (Finkelstein, Citation 2006 ), to endemic, informal interactions on social media that support learning in communities of interest (Greenhow, Sonnevend, & Agur, Citation 2016 ), to communities of inquiry (Shea et al., Citation 2022 /this issue), to computer-supported collaborative learning in which interactions may be a mix of synchronous and asynchronous, but often heavily mediated (Cress et al., Citation 2021 ). All of these models are subject to rapid technological change, and more importantly, rapid changes in the practices of using technology. Take, for example, pre and post COVID-19 educational uses of Zoom: the platform itself evolved rapidly during the pandemic, with new features such as self-selecting breakout rooms and live closed-captioning, while simultaneously, familiarity with and conventions for the platform progressed, with new etiquette arising around everything from video muting to turn-taking norms.

Additionally, any configuration of online learning may be blended with face-to-face interactions, making the study of such hybrid learning environments even more challenging. The adoption of hybrid (or “blended”) learning models is being increasingly recommended by and adopted by policymakers, from K-12 schools to higher education institutions (Greenhow et al., Citation 2022 /this issue; Poirier et al., Citation 2019 ; Tate & Warschauer, Citation 2022 /this issue). But how exactly one approaches such heterogeneous, ever-changing configurations to draw well-grounded conclusions remains a question. For example, how are online and in-person components of instruction organized in relation to each other? Do instructors “flip” the classroom (e.g., requiring learners to engage with materials available online prior to a lesson), thus altering the “schedule, style, and difficulty level students are accustomed to” (Poirier et al., Citation 2019 , p. 4)? The vast differences in both the contexts of application, and in the potential design features of the online learning environment as implemented, make it difficult to know how to generalize empirical findings, and/or recontextualize them to new circumstances. These diverse arrangements reveal some of the Herculean challenges of producing rigorous empirical knowledge about online learning environments.

Conducting a multitude of studies about the psychology of online learning in Zoom in 2019 could have advanced understanding of, as Cameron ( Citation 2006 ) suggests, “mediating/psychological variables which link particular situations with specific outcomes,” “explanatory models of complex human problems,” or “using evidence-based strategies for change” (p. 289). Even if such studies had helped arrive at both explanations and evidence suggesting particular strategies for change, researchers and practitioners would still have been ill-prepared for online learning in the pandemic, because as Simon ( Citation 1969 ) pointed out, they would be trying to make empirical claims about “systems that, given different circumstances, might be quite other than they are” (p. x). Would models have taken into account the challenges of children at home with distracted parents working online alongside them, or of learners and educators coping with trauma? What about microcultures emerging within particular online classrooms, highly influenced by how a teacher might adapt to a rapidly changing pandemic situation? Would the research community have been able to grasp how interest-driven groups connect outside of the formal borders of instruction to further learn and specialize? Any research effort would have needed to encompass both intentional components of a designed environment but also exogenous components such as the trauma produced by the pandemic, and inherited, endogenous, and rapidly changing elements such as Zoom’s interface changes or emerging practices ( Citation Tabak, 2004 ).

The complexities of online learning reveal the pitfalls of lack of mutuality between research and design. On the one hand, online learning is a complex system in the mathematical sense: identification of variables and initial conditions in sufficient detail to enable robust comprehensive predictions is impossible. On the other hand, the research challenge of disentangling enduring psychological phenomena from how they manifest within rapidly changing instructional technologies makes it hard to know whether the results of a study should be treated as a finding on the unchanging nature of human learning or as an evaluation of an intervention at a moment in time that will never be duplicated.

Furthermore, considering how technology evolves, research often focuses on either rapid changes in software itself or on technology-mediated culture. But a third aspect is at least as important but even more ephemeral than the broader cultural or technological zeitgeist: how to best deploy the technology of the day? For example, consider pandemic-era innovation of icebreaker games like scavenger hunts for online learners within their respective homes: such an activity can have profound effects on whether the class feels like it exists only on a screen or feels embedded in real life, and might similarly give some students stress as aspects of their home life are exposed. Prior research is not equipped to predict prospectively whether such an innovation will work or how to tweak it until it does. Sandoval ( Citation 2004 ) saw this as the problem of how enacted designs “embody” conjectures about either interventions or learning. Design is how those highly situated systems are studied and this directly challenges the goals of developing generalizable knowledge (Kali & Hoadley, Citation 2020 ). As Cuban ( Citation 2003 ) noted, when people take essentialist stances toward technology, they tend to overlook the systems in which the technology is embedded and the other ways in which learning environments are constructed. Neither the technology, nor people’s behavior with it, are fixed, and this challenges a program of finding a simple answer to the question “What works?.”

“The real essence of the problem is found in an organic connection between the two extreme terms—between the theorist and the practical worker—through the medium of the linking science. The decisive matter is the extent to which the ideas of the theorist actually project themselves, through the kind offices of the middleman, into the consciousness of the practitioner.” (Dewey, Citation 1890/2003 , p. 136)

When researchers attempt to link an empirical scientific stance to prescription, they run across three important conceptual paradigms. First, and most obvious, is the engineering or applied science stance. Consider bridge construction, for example. Scientific knowledge describes constraints on what types of structures will stand. Engineering principles can be used to analyze any proposed structure to predict whether it will meet its specifications or to solve specific problems such as coming up with a structure for a particular site or location. Should there be aspects of the plan that require new knowledge, applied science stands ready to fill in the gap (e.g., how deep is the bedrock in a particular location?). However, what about larger questions, like deciding whether a bridge is needed in the first place, or how much money should be spent to engineer a safer bridge? Similar dilemmas would apply to our online education scenario: for instance, how would one build an alternative to Zoom that provides a greater sense of social connection?

A second paradigm prioritizes the question of human values , which Aristotle termed phronesis (Flyvbjerg, Citation 2001 ). No amount of engineering can tell us what outcomes to seek when trying to take science from description to prescription. Attempts to "scientize" human values are linked to technocratic approaches and they famously fall flat. Problems that inherently engage human political complexities can be thought of as "wicked" (Rittel & Webber, Citation 1973 ): even when goals are well-specified, scientifically derived solutions may flop because goals are filtered through human subjectivity. Flyvbjerg ( Citation 2001 ) described this issue as a crisis in social science: as scientists, social scientists confuse their epistemologies when they treat values as akin to natural phenomena that can be determined with experimental, positivistic scientific methods. Instead, exploring human experiences and values can be done through the methods of the humanities and other interpretivist or relativistic ways of building knowledge. Consensus building—for instance, on whether or not to develop and deploy new affordances of an online learning platform—is neither an engineering problem nor a scientific one, even if it is something scientists and engineers must concern themselves with. Subtly, if researchers pretend that their research is value-neutral, they end up obscuring values that get deeply embedded in the research itself (Stevenson, Citation 1989 ; Vakil et al., Citation 2016 ). Accordingly, the question of whether virtual or hybrid classes in the pandemic should focus on traditional learning objectives or balance them with socio-emotional well-being (Archambault et al., Citation 2022 /this issue) is a choice among values that engineering research cannot answer, but that could be explored using humanistic, political, or other phronesis -centric stances.

A third paradigm is the paradigm of design

Simon (1987/ Citation 1995 ) made a distinction between two cognitive modes: problem solving , in which a person uses a repertoire of known methods to reach a solution, and design , in which problem finding and definition are as important as solutions, where outcomes may not be predictable, and in which a person may need to go beyond their existing repertoire of methods. Design often serves to negotiate between the paradigms of goals and values, and engineering and science. In the case of our bridge, design serves to respond to not only the engineering constraints of making the bridge stand, but also the human concerns such as how to ensure the bridge might serve a wide audience, or how to consider environmental impact. Design can produce novel ways of aligning values and engineered decisions. In the case of Zoom-based classes, design serves to respond not only to the constraints of developing materials and activities to be delivered, but also the more value-centric concerns of deciding when and how to set aside those objectives in favor of overriding values such as empathy in the face of trauma, or redefining assessment goals in the face of pandemic-related changes to schooling. In short, design moves beyond problem solving, to include elements of problem finding, creativity and invention (Ko, Citation 2020 ; Norman, Citation 2013 ). In the next section, we delve into how design might produce knowledge that is generalizable in very different ways than scientific, positivistic knowledge.

Good design is empirical, but is it research? Argyris and Schön ( Citation 1991 ) characterized design as a profession: designers must take both the scientific knowledge of the field and intimate knowledge of the particular situation through a process of professional judgment to make their decisions particular to the case at hand, just as a lawyer does in a court case or a doctor does with a patient. Designers typically gather information to support their design processes: everything from needs analysis to examining relevant design examples to better understanding the context of design (Bednar & Welch, Citation 2009 ; Raven & Flanders, Citation 1996 ). Next, the designer must realize and iterate their designs. This process entails gathering data about the properties of proposed designs and anticipating impacts within a system. This is what Schön ( Citation 1992 ) called see-move-see : if someone considers rearranging furniture in their home, they can partially envision the outcome of a particular rearrangement, but often gain additional insight by trying an arrangement out. Sometimes design involves more complex evaluation, either based on "hard" criteria, like evaluating whether a particular new feature in online classes would be supported by learners’ devices, or sometimes based on "soft" criteria, like getting public feedback on the esthetics of a new visual interface. Taken together these forms of empirical work are often called design research (Laurel, Citation 2003 ). Professionals like instructional designers or teachers must align known patterns and psychological findings with the particulars of the context and individual learners.

Although design research typically applies to the gathering of information that feeds into a creative process of design, design itself creates knowledge. Christopher Alexander et al. ( Citation 1977 ), in their groundbreaking work on design patterns, showed how the knowledge of skilled architects could be viewed as a cumulative set of patterns, a "pattern language" that could be used to express different designs. Each pattern represented a known partial solution to a category of problems, such that patterns were documented by describing the essential characteristics of a design solution, the circumstances under which they might be necessary, and links to other patterns that were frequently composed together. Considering the Argyris and Schön ( Citation 1991 ) framing of using judgment to apply general professional knowledge to particular situations, it is evident new patterns can be part of knowledge creation in design. Returning to our bridges, we could see a contribution to knowledge if a designer combines known patterns to solve a particular problem, like the suspension solution to the narrow opening at the San Francisco Bay. In this case, the contribution to the field’s knowledge is the particular reference point: the Golden Gate Bridge. But going in the direction of creating patterns, the Bonn-Nord bridge used a way to arrange cables that allowed other bridges to look unusually light and sweeping, making this an example of a novel pattern that was later used over and over by other designers. The pattern, rather than the instance, was the primary contribution in this case.

The type of knowledge creation that connects the general to the particular, and then creates new particulars that suggest the general, is often considered to be "unscientific"; not because it is not rooted in systematic, empirical discovery processes, but because it claims less generalizability than a law of nature that applies universally. One can envision similar knowledge creation in education, where a lesson design becomes the basis for a pattern that then can be disseminated or improved upon. For example, WebQuests—an early technology-based approach that integrated web inquiry activities into teaching and learning (Dodge, Citation 1995 )—began with examples that turned into widely replicated and studied patterns for online learning (Abbit & Ophus, Citation 2008 ).

Within education, the research and design landscapes encounter the three paradigms discussed previously: applied science, value-setting, and design. How do the paradigms interact, and what are the ways in which knowledge can be generated across all three? An initial goal might be to have robust replicable science with clear conditions of applicability of the scientific principles that could be applied to arbitrary value-derived goals through a predictable, optimizable form of engineering design. Occasionally, in education, this arrangement is possible, and both educational psychology and instructional design default to it (for an example, see Cook et al., Citation 2021 ). But with most learning through and with technology, science is less replicable and applicable (Dede, Citation 2005 ; Simon, Citation 1969 ). In addition, design is not predictive but iterative; it requires human judgment in context, and resists optimization because it is both particularized and ever-changing in response to shifts over time (Argyris & Schön, Citation 1991 ).

Design knowledge generalizes in very different ways than generalized scientific knowledge. Even if researchers abandon scientific modeling and prediction in favor of thumbs-up or thumbs-down evaluation, one probably will not know when two interventions are equivalent in all the ways that matter so that evaluation results can be used to generalize to new settings. In contrast, design knowledge explicitly arises from the conjunction of the general and the particular (Kali & Hoadley, Citation 2020 ; Nelson & Stolterman, Citation 2012 ), and can help fill the gap left by methods that depend on universality and complete generalizability (Maxwell, Citation 2004 ). In the next section, we examine various ways in which design and research activities can be arranged methodologically, and how these ways aid the study and creation of learning environments online.

Linking design and research in online learning

Before we can explore the variety of methods that allow researchers to build the kinds of knowledge they need, we present challenges facing a generalized, positivist approach to educational research. For example, in the late 20th Century, when studies proliferated to examine whether computer-based multimedia improved learning, results were highly inconsistent (Fletcher-Flinn & Gravatt, Citation 1995 ). Why? First, some learning environments, and some learners, may have benefited from multimedia and others may have not. Second, not all multimedia is equivalent; good studies on bad media designs muddied the waters. Third, conditions changed; what would an appropriate control condition be, especially as “business as usual” and multimedia use converged? Fourth, the tools, conventions, and expectations around multimedia held by learners were a moving target (e.g., the technical and cultural changes in video literacies after the introduction of YouTube). When the field finally did make progress in this area, it was on the ways in which people process multimedia cognitively, rendering further questions related to “multimedia” as nonsensical and shifting the research focus to enduring cognitive processes underlying multimedia learning rather than the media formats themselves (Mayer, Citation 1997 ). This shift led to research findings that were more robust and generalizable (for example, Moreno & Mayer, Citation 1999 ; Sweller, Citation 2011 ), and simultaneously harder to apply in design work, engaging the questions of what cognition a given multimedia artifact might engender for any specific audience and context (for example, Aronson et al., Citation 2013 ). Two key challenges are evident in this example: appropriate generalization and particularization. First, to make valid generalizations, education researchers need a good sense of what is important about the intervention and its context to do any comparison, whether by creating an appropriate control condition, or describing what the intervention represents in terms of theory. In online learning one may find it difficult to determine what the “treatment” is, or what aspects of an intervention are being changed or held constant in different cases. Interpreting results from any experiment requires opening the black box of the intervention, and understanding which elements of the outcomes are attributable to hypotheses or theories, and which ones are attributable to the particular design that was created from those theories. Second, getting the human psychology right but testing it with the wrong design (e.g., testing the learning impact of collaborative online gaming based on shoddy games that are not fun for participants) may create spurious results. In a designed environment, one needs the right particulars to have results than can be interpreted meaningfully.

In the learning sciences, various approaches have been developed to address these challenges, usually crossing disciplinary traditions (Hoadley, Citation 2018 ), and often triangulating via a range of approaches (Tobin & Ritchie, Citation 2012 ), from cognitive microgenetic methods (Schoenfeld et al., Citation 1993 ; Siegler & Crowley, Citation 1991 ), to thick cultural descriptions (Goldman et al., Citation 2014 ), to tools such as multimodal learning analytics (Blikstein, Citation 2013 ). More importantly, the learning sciences have adopted a variety of methods of research on and through design, linking methods of the past with new ways of building trustworthy and applicable theories (Hoadley, Citation 2018 ; Hung et al., Citation 2005 ). Perhaps earliest among these were “design experiments,” (Brown Citation 1992 ; Cobb et al., Citation 2003 ; Collins, Citation 1992 ), now more commonly termed “design-based research methods” (Design-based Research Collective, Citation 2003 ; Hoadley, Citation 2002 ; Sandoval & Bell, Citation 2004 ). In the sections that follow, we describe design-based research (henceforth, DBR) methods as a way to solve some of the challenges of knowledge production in the context of online learning, and provide a process model to help illustrate ways DBR can produce the types of knowledge needed to study online learning.

DBR attempts to understand the world by trying to change it, making it an interventionist research method. However, DBR problematizes the designed nature of interventions, recognizing that the intended design is different from what may be enacted in a complex social context, one in which both participants and designer-researchers have agency ( Citation Tabak, 2004 ). In DBR, hypotheses take a dualistic form as design conjectures , in which there are explicitly (at least) two degrees of freedom between inputs (context, initial conditions, participants and their histories, etc.) and final outcomes (Sandoval, Citation 2004 ). Generally, this dual linkage comes from joining a design proposition (i.e., this design should achieve specified goals or mediating processes) to a proposition about people (i.e., a testable prediction that the achievement of a set of goals should engage psychological processes in a way that supports or contradicts the theory being tested). Often, instead of comparing a treatment and a control group, DBR will compare treatments as iterations on a particular design. Thus, a DBR study on whether, say, an online community of inquiry has certain impacts on learning (Shea et al., Citation 2022 /this issue), would explicitly construct two arguments linking treatments to hypothesized outcomes—what elements would foster a community of inquiry, and how such community leads to particular learning outcomes. Such a study would proceed in a way that looks more like a design process than a simple laboratory experiment. Researchers would document the baseline, then collect data on multiple iterations as refined versions of the design are implemented in context. Throughout, the researcher would maintain a dual identity as a designer, favoring participant observation over total detachment, including tweaking the intervention to better match the design intent mid-implementation. This identity does not prevent the researcher from drawing conclusions about the research questions, but necessitates both a tentative stance toward generalizing any findings out of the context of exploration, and a humility toward making causal claims because attribution to either of the elements of the design conjectures is possible. Iteration allows systematic exploration of interpretations either through revised designs, embedded comparisons (e.g., A/B testing), reanalysis of earlier data, or shifts in the context of the research. Causal claims must be made tentatively and can only be made more strongly as further iterations and additional evidence rules out alternative interpretations.

As we work toward defining the DBR process and identifying its key characteristics, we should be clear about how DBR contrasts with dominant quantitative and qualitative traditions (see Table 1 ). In positivistic experimentation, there is a presumption that the researcher is flawless in specifying interventions that are implied by theory and hypotheses, and at accurately reporting experimental designs and data collected, but also that the research may be deeply biased in collecting data, analyzing data, or in some cases in implementing interventions or control groups. To manage these biases, techniques such as double-blind experiments and sophisticated statistical analysis are used to make science as objective as possible. In DBR, the agenda of the designers is seen as a positive force rather than a threat to validity; their intimate knowledge of the design rationale makes them relevant to ensure implementation fidelity and methodological alignment (Hoadley, Citation 2004 ) between “what we wanted to test,” “what we think we actually tested,” and “what we now think we should have been testing.” Because of this intimacy, the research (1) reports not only data collected, but narrates design moves, rationale, and other aspects of the design narrative (Hoadley, Citation 2002 ; Shavelson, Citation 2003 ); (2) collects data broadly to continuously check assumptions and for future retrospective analysis; and (3) keeps not only the implementation but inferences or generalizations contextualized and localized. In some ways, this stance starts looking like the stance of the qualitative researcher in an interpretivist tradition, in that the central role of the researcher-as-interpreter is acknowledged. Yet, in contrast to many qualitative methods, DBR researchers are interventionist and do not avoid positivistic generalizations or causal inference as end goals. Interventions may be used to achieve desired design outcomes, but also to probe human psychology, with a goal of building theory rather than just designed interventions. From a philosophical perspective, this aligns well with ideas of pragmatism (Legg & Hookway, Citation 2020 ), which might be summarized as “knowledge is as knowledge does,” in which all truth is subordinate to the action which it can motivate. In educational psychology, this might reasonably be called consequential validity (Messick, Citation 1998 ). Of note, the pragmatists were divided on whether human knowing was based on a singular reality (i.e., traditional positivism) or pluralist perspectives (i.e., more like ethnomethodology or other interpretivist traditions; see Table 1 ). Thus, DBR can be done in a way looking for a singular truth, or can encompass more perspectivity (Goldman, Citation 2004 ) by following a Deweyan idea of pragmatism.

Table 1. Comparing DBR with qualitative and experimental traditions.

Modeling the dbr process.

As a young research approach, DBR is still under construction. Several scholars have attempted to pin down defining characteristics, but all agree it involves studying flexible iterations of designed interventions in a naturalistic context (Anderson & Shattuck, Citation 2012 ; DBRC, Citation 2003 ; Wang & Hannafin, Citation 2005 ). In Figure 1 , we summarize and reorganize different descriptions of the overall DBR approach in one process model. (See Appendix for a discussion of how DBR relates to other similar methodologies.) This reorganization into a single process model supports our understanding of DBR and how to use it for studying real-world learning environments. By emphasizing the ways DBR produces knowledge, this model helps illustrate how DBR solves the problem of generalization and particularization in online learning research, identified above. In particular, the process model embraces four activities that help DBR researchers produce knowledge about online learning even in the face of its dependence on interactions between context and design enactments.

Figure 1. A process model for DBR.

Design-based scholars of different traditions typically depict a research endeavor as starting in what we term a grounding phase. Footnote 1 In this initial stage, researchers identify a theoretical gap or problem of practice they aim to investigate by creating and enacting a real-world intervention (Edelson, Citation 2002 ; Kali & Hoadley, Citation 2020 ), including developing a sense of the contexts in which that intervention might be tested. Grounding a project involves collecting data about current situations or implementations of a given intervention, analyzing them in light of contextual factors and theory to ultimately set the tension between what-is and what-might-be (Bednar & Welch, Citation 2009 ; Tatar, Citation 2007 ). This initial data collection may also include information about learners, specific domains, and historical data about previous experiences with existing solutions (Easterday et al., Citation 2018 ).

Grounding a DBR project also means making initial higher-level choices that will bound the scope and methods of a project. This means, for example, specifying stakeholders and their roles (i.e., consultant, co-designer, etc.), which in turn helps bound the perspectives and lenses the project will employ. This phase is crucial to setting the direction of a DBR project and ensuring that “there is something worth designing … and that the team has the resources to potentially succeed" (Easterday et al., Citation 2018 , p. 138).

Conjecturing

The next phase involves laying out an initial set of high-level conjectures that will guide the development and testing of a design. Considering that DBR involves the generation of "knowledge about which actions under what circumstances will lead to which kind of intended consequences" (Bakker, Citation 2018 , p. 47), conjecturing gives concretude to the problems identified in the grounding phase by tracing out a theory of action . It is therefore important, as proposed by Sandoval ( Citation 2014 ), to map this high-level theory of action involved in a DBR project. The mapping serves the purpose of capturing the research team’s idea about how particular embodiments might generate mediating processes that will, ultimately, lead learners into the hypothesized outcomes. Embodiments represent the various features of a design learning environment or intervention, such as functionalities, materials, associated tasks and structures, or imposed practices. But how might particular aspects or features of a design lead to the hypothesized outcomes? Following Sandoval’s ( Citation 2014 ) model, designs cannot lead directly to outcomes, but first produce key mediating processes.

Iterations are recurrent building-testing-reconjecturing cycles used to gain theoretical and practical insights about unclear or ill-structured aspects of a research project (Lewis et al., Citation 2020 ). Iterating means taking initial abstractions—such as psychological theories, hypothesized learning trajectories, broad design principles, etc.—and embodying them in concrete designs that will produce the anticipated mediating processes. In each cycle of iteration, researchers collect data about how participants use, talk about, create social structures, or even re-signify designs in their actual contexts of use. This data is then used to refine the initial conjectures about learning and to produce new designs that will ultimately test such hypotheses.

Successive iterations are the key methodological feature of a DBR project that allow researchers to make empirical claims about designed learning tools, artifacts, or interventions while they are being created and brought into play (Kali & Hoadley, Citation 2020 ). In each cycle, researchers collect new data, take into account unpredicted contextual requisites, adjust their designs (i.e., what aspect of the embodiment will need redesigning in the next cycle and why), and review their methods of implementation (e.g., participants’ roles, tasks, stimuli, etc.). DBR teams then register these realignments into new conjecture maps (Sandoval, Citation 2004 , Citation 2014 ), hypothesized learning trajectories (Bakker, Citation 2018 ), and/or thick design narratives (Hoadley, Citation 2002 ). It is precisely this intense and reflective act during each iteration that permits DBR researchers to produce new knowledge by adjusting the "fit between the theory, the design, and the enactment or implementation so as to best test the theoretical conjectures" (Kali & Hoadley, Citation 2020 , p. 1).

The act of building and testing something in a real-world context is an intense reflection-through-design practice (Schön, Citation 1992 ). Reflecting involves analyzing all data collected through the process, including formative evaluations and sequential conjecture maps (among many others) in light of initial hypotheses and learning theories. The ultimate goal of this phase is to allow the research team to explore which actions or circumstances might or might not have led to potential changes in the studied environment (Bakker, Citation 2018 ).

Domain Theories : Domain theories generalize a particular piece of a high-level, hypothesized learning theory (e.g., how online environments influence learning). DBR elicits domain theories about the context of the intervention or the outcomes permitted by the design (Edelson, Citation 2002 ).

Design Principles or Patterns : Design principles are generalized heuristics that respond to a particular learning problem, achieved by successive iteration and reconjecturing (Edelson, Citation 2002 ). Design patterns are generalized partial solutions for particular learning problems (Goodyear, Citation 2005 ; Pea & Lindgren, Citation 2008 ; Rohse & Anderson, Citation 2006 ). Whereas domain theories are capable of describing a phenomenon, design principles and patterns carry a prescriptive message about how and when learning environments need to be designed in certain ways to achieve the desired outcome in a particular context (Edelson, Citation 2002 ; Van den Akker, Citation 1999 ), with the caveat that "no two situations will be identical and that adaptation to local circumstances is always necessary" (Bakker, Citation 2018 , p. 52).

Design Processes : A design process is the prescriptive procedural knowledge that describes the particular methodology for achieving a type of design, which expertise is needed, and the roles that need to be played by individuals involved in the process (Edelson, Citation 2002 ).

Ontological Innovations : Throughout successive cycles of building and testing, design researchers might find situations that challenge current frameworks or assumptions about a domain or design. In this sense, ontological innovations are novel explanatory constructs, categories or taxonomies that help explain how something works (diSessa & Cobb, Citation 2004 ).

New Hypotheses : Sometimes design yields questions rather than answers (Brown, Citation 1992 ). Through iterative cycles, DBR researchers develop new hypotheses that may be the subject of future research endeavors (Shavelson et al., Citation 2003 ).

Design Researcher Transformative Learning (DRTL) : The immersive nature of DBR may also shape how researchers experience the notion of design knowledge (Kali, Citation 2016 ). DRTL describes a series of "a-ha moments" that enable design researchers to develop new conceptualizations of "how they position themselves as actors within the situation they are exploring" (Kali & Hoadley, Citation 2020 , p. 10).

These six types of “findings” are dissimilar from those achieved either through positivistic or interpretivist qualitative research (Ryu, Citation 2020 ; Citation Tabak, 2004 ). Even domain theories, which may look similar to those produced by experimental psychology, are epistemologically different in that they represent tentative understandings with an explicit acknowledgment of an unknown degree of limited generalizability to other contexts or design variations. Yet, they align squarely with Deweyan ideas about the aims of inquiry:

“All the pragmatists, but most of all Dewey, challenge the sharp dichotomy that other philosophers draw between theoretical beliefs and practical deliberations. In some sense, all inquiry is practical, concerned with transforming and evaluating the features of situations in which we find ourselves.” (Legg & Hookway, Citation 2020 )

Applying the DBR process to studying and designing online learning

The reorganized DBR process model is especially useful for creating new knowledge about online learning. First, through grounding , the context of learning is documented and a baseline of theories and assumptions is established by researchers. For example, if DBR researchers were to study how to facilitate science learning in the pandemic Zoom-schools, they would first need to ground their understanding of this particular problem of practice. What key components of science learning went missing when schools moved to digital environments? How did students experience the sudden loss of fundamental socio-emotional supports for learning? How might one emulate the social interactions and collective inquiry of a physical lab in a purely virtual platform? Second, through conjecturing , theories of learning and instruction would be coordinated with respect to the particular context, and researchers would devise a map of conjectures. In our example, researchers could hypothesize that virtual labs that permit synchronous and collective manipulation of real-world, live single-cell organisms (as seen in Hossain et al., Citation 2018 , for example), working in conjunction with Zoom, might have served as embodiments, or the tangible part of an intervention. A map of conjectures would then link such labs to key mediating processes: by solving problems cooperatively and manipulating a living organism in real time, students would develop a solid conceptualization of and interest for the subject matter in question. This means DBR does not assume that a designed online environment is conducive to learning by itself. Instead, it theorizes a chain linking embodiments and mediating processes that might lead to the desired outcome.

Third, through iterating , these theoretically driven conjectures would be aligned with the unique practices of the particular online learning context and audience. Through successive iterations, researchers could introduce new elements that challenge, confirm or review initial conjectures and assumptions. In our online science lab example, how would students engage with computerized models of biological specimen behavior within the online science lab? Would they be more conducive to learning, and under what contextual conditions or corequisite supports? Finally, through reflecting , claims would be made about how general psychological learning processes and specific enacted designs-in-practice would create particular outcomes, with an eye toward appropriate generalization. For instance, could the individual experience with online science labs accentuate the gap in socio-emotional learning left when schools moved to remote instruction? What general principles, design patterns or new hypotheses related to how students learn with online science labs could be devised? As an illustration of our example, Hossain et al. ( Citation 2018 ) used DBR to test hypotheses about how students learn in a cloud-based biology lab that allows interactions with living single-cell organisms, as well as if the effort of building such an environment was justified when compared with computer simulations. Successive iterations of the online biology course led to new hypotheses (i.e., would group activities in online learning environments further facilitate learning? How?) and a key reflection: students advance their comprehension of biological phenomena when they are able to predict and compare computational modeling results with the behavior of real living specimens. In this case, DBR allowed researchers and practitioners alike to move away from simply inquiring "what works best" or producing rote comparisons between design features to dive deeper into a successive process of re-conjecturing about which embodiments and mediating processes would lead to learning in an online science lab.

Thus, this process model shows how DBR engages with and produces knowledge with four main categories of activity: grounding, conjecturing, iterating, and reflecting, each of which produces knowledge that helps to link across the paradigms of engineering, phronesis, and design. Within the context of online learning, the framing of design-based research methods helps address some of the challenges associated with more traditional applied science paradigms, including methodological alignment, sensitivity to dynamic contexts, tentative generalization, and turning insights into designed interventions. Each of the four categories of activity involves producing types of knowledge that sit between the particular and the general in ways that support further exploration both in research and design of online learning.

Design-based research methods are a thirty-year old tradition from the learning sciences that have been taken up in many domains as a way to study designed interventions that challenge the traditional relationship between research and design, as is the case with online learning. Key to the contribution and coherence of this method are different forms of knowledge, which lie less in the domain of positivistic truth statements and more in the domain of patterns, heuristics, and tentative generalizations. This aligns well with the philosophy of pragmatism as expressed by Dewey and others, in which the knowledge sought is actionable. Earlier versions of DBR emphasized the interrelationship between design, context, and inference, with strong attention to challenges of linking different parts of design conjectures in the interpretation of data. In the last fifteen years an increasing sophistication regarding sociocultural or sociopolitical systems that mediate outcomes has led to related approaches that focus more on social change, agency and equity, and practices rather than technologies, leading to approaches to reconcile DBR with mixed and action-research methods (e.g., Gutiérrez & Jurow, Citation 2016 , Ryu, Citation 2020 ).

More importantly, we see that on top of designs and findings as outcomes, there is the possibility of transforming systems, organizations, and, notably, transforming researchers and participants. Academic research in social sciences has predominantly treated knowledge as fungible: that is, that discoveries are usable by all if published well. Through a framework of design researcher’s transformative learning (Kali, Citation 2016 ) we see that research can serve a function of transforming researchers and participants themselves, creating ripple effects of design capacity more like the professional judgment of Argyris and Schön ( Citation 1991 ) or the usable knowledge described by Lindblom and Cohen ( Citation 1979 ). Researchers have not often thought about their own learning or knowledge management as key goals of research, but this may be an opportunity we face with current uses of design-oriented methods like DBR.

These properties of DBR make it particularly well suited for developing and studying online learning. Researchers in online learning often struggle with what aspects of their findings are generalizable or bound to a particular time, place, or community (Greenhow et al., Citation 2022 /this issue). Online learning technologies are often a moving target and, even without rapid evolution, are not monolithic. Because DBR can support contextualized and interventionist grounding, conjecturing, iterating, and reflecting, it is well suited to the ways scholars need to coordinate design-centric knowledge with psychological theories and claims. Incumbent on those using these novel methods is to help shape expectations about findings such that they are not taken for dogma or purely positivistic truth claims. Nonetheless, by holding their knowledge claims, and their own transformation as knowers, up to scrutiny, online learning researchers have tremendous opportunity to make research more consequential and to transform from current situations to better futures.

1 We term this phase grounding both to evoke the inductive stance of grounded theory (Strauss & Corbin, Citation 1994 ), and the linguistic idea of common ground (Clark, Citation 2020 ).

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Appendix: Disambiguating design-based research from related terms

Design-based research, although increasingly visible and used (Anderson & Shattuck, Citation 2012 ), still confuses many. This is partly due to inconsistent terminology; partly due to extant methods that share characteristics with DBR; and partly due to the adoption of stances from DBR in related methodologies (what Bell [ Citation 2004 ] calls a “manifold enterprise”). We take each of these in turn.

Other terminology for DBR

Design-based research as a term first appeared in 2002 (Hoadley, Citation 2002 ) and was explicitly a proposed replacement for the earlier term “design experiments” (Brown, Citation 1992 ; Collins, Citation 1992 ), which was confusingly similar to the concept of experimental design. In the early 2000s, some authors preferred terms such as “design studies” (e.g., Linn, Citation 2000 ) or “design research” (e.g., Edelson, Citation 2002 ), although these terms had both previously been used for other purposes (Gregory, Citation 1979 ).

Methods that share characteristics with DBR

Within the larger world of social science research methods, design-based research is similar to several other methodologies ( Table A1 ). Within instructional design and technology design alike is the notion of formative design evaluation (Edelson, Citation 2002 ), or simply formative evaluation (Martin, Citation 1979 ; Weston, Citation 1995 ). In formative evaluation, the top priority is improving an intervention through collecting and analyzing data to assess or improve a design, as contrasted with DBR which is positioned as research first, design second. Another related idea is that of developmental research (Bakker, Citation 2018 ), in which research and design go hand in hand to focus on questions of the sort “How can (a design goal) be promoted?,” albeit this was not thought of as a research methodology per se, but instead linked design and research through existing methods. On the research side, DBR shares characteristics with earlier research methods. Participatory action research (PAR; Anderson, Citation 2017 ) resembles DBR in that both engage researchers and participants in agenda setting. The main difference is the emphasis on iterative refinement and conjecture mapping with respect to designs; in this way PAR tends to engage more with phronesis than DBR.

Table A1. Methods that share characteristics with DBR.

Finally, “Design-based research” suggests a complementary term, “research-based design,” that describes how designers sometimes incorporate social science research into an overarching design goal, as when a team performs an ethnographic study to collect user needs for a product design process.

Methods linked to DBR

Several other methodologies relate to DBR more directly, either stemming from it or evolving in response to it ( Table A2 ). The first, Design-Based Implementation Research or DBIR (Penuel et al. Citation 2011 ) may be thought of as an offshoot from DBR when applied to problems of practice that relate to systems of education, tightly tied to the notion of Research-Practice Partnerships (Penuel et al., Citation 2015 ). DBR and DBIR share a contextualized, emergent, iterative approach to knowledge building, linked to a design process aimed at producing knowledge. The prototypical DBIR project, however, uses linkage between educational systems and practitioners and researchers not only to set a common research agenda and test and implement designed interventions, but also prioritizes understanding how those interventions scale within a partnership. A second method which emerges from DBR and other earlier traditions is social design experimentation (Gutiérrez & Jurow, Citation 2016 ) in which DBR is blended with ecological psychology approaches to social transformation for nondominant communities. Another related method is that of formative interventions (Engeström, Citation 2011 ) which draws on Vygotsky’s earlier notion of double stimulation (Sannino & Laitinen, Citation 2015 ). Central to formative interventions is treating participants’ agency as a necessary component of any design conjecture. Sannino & Engeström ( Citation 2017 ) operationalize formative intervention research in “change laboratories” which explicitly prioritize outcomes related to change in activity systems. In this sense, designed interventions often have shifts in individual and cultural activities and practices as their aim, and always with respect to transformation of a particular context. Another method, extended from earlier organizational science research, is the notion of improvement science in the context of networked improvement communities (Bryk et al., Citation 2015 ). In this configuration, research is again iterative and embedded in cycles of design, but there is an explicit focus on studying variation across people and settings, and change over time, and on attempting to primarily coordinate insights by looking not only within but across contexts.

Table A2. Other design-oriented approaches to research methods.

Each of these methods has roots predating DBR, and each might be considered an alternative to, a specialized version of, or a variant of DBR. Proponents of all four explicitly engage DBR literature, and all four help solve a problem left unresolved by early DBR literature: once one saturates an understanding of an intervention in a small number of contexts, how one aims for more transformative generalization. With DBIR and NICs, the question of scale and dissemination is prominent; with change labs and social design experimentation, lasting transformation of social structures is a goal. Also, all four have a greater emphasis on participant contributions to the design and research agenda (albeit in different forms) than DBR, whose early literature spoke of “engagement” but not power-sharing between researchers and participants. This seems to be a natural and productive evolution methodologically, since DBR’s tentative generalizations may not drive the change wished for without a structure for doing so.

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DRS2018 Research Papers

Design Justice: towards an intersectional feminist framework for design theory and practice

Sasha Costanza-Chock , Massachusetts Institute of Technology

Design is key to our collective liberation, but most design processes today reproduce inequalities structured by what Black feminist scholars call the matrix of domination. Intersecting inequalities are manifest at all levels of the design process. This paper builds upon the Design Justice Principles, developed by an emerging network of designers and community organizers, to propose a working definition of design justice: Design justice is a field of theory and practice that is concerned with how the design of objects and systems influences the distribution of risks, harms, and benefits among various groups of people. Design justice focuses on the ways that design reproduces, is reproduced by, and/or challenges the matrix of domination (white supremacy, heteropatriarchy, capitalism, and settler colonialism). Design justice is also a growing social movement that aims to ensure a more equitable distribution of design’s benefits and burdens; fair and meaningful participation in design decisions; and recognition of community-based design traditions, knowledge, and practices.

https://doi.org/10.21606/drs.2018.679

Costanza-Chock, S. (2018) Design Justice: towards an intersectional feminist framework for design theory and practice, in Storni, C., Leahy, K., McMahon, M., Lloyd, P. and Bohemia, E. (eds.), Design as a catalyst for change - DRS International Conference 2018 , 25-28 June, Limerick, Ireland. https://doi.org/10.21606/drs.2018.679

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Research on the method of force-locking and variable stiffness for continuum robot with the spinal-like configuration

• Technical Paper
• Published: 25 September 2024
• Volume 46 , article number  627 , ( 2024 )

Cite this article

• Gang Chen 1 , 2 ,
• Yutong Wu 2 ,
• Jianxiao Zheng 2 ,
• Hao Shi 3 ,
• Fuping Li 1 &
• Changgan Qin 1  

To solve the shortcomings of low stiffness brought by the high flexibility of continuum, but the variable stiffness method based on structure and phase change material has the problems of slow response and complex system, this paper takes the rope-driven flexible robotic arm as the research object, and proposes the design of spine-like continuum robot with force-locking variable stiffness arranged in the axial position, and investigates the performance of its variable stiffness. A reasonable structural design of the robot is obtained through bionic design and optimization of the bending structure. The theory's feasibility is analyzed based on tribology, and its variable stiffness system is simulated. The three joints and six degrees of freedom prototype are completed. Three experiments show that the method is fast responding, the stiffness of the robot is only controlled by adding an extra rope on the axis, and the structure is simple; and the comparison of the two configurations yields a continuum-raised robot configuration that is more suitable for the variable stiffness method proposed in this paper; and finally, the high flexibility is verified, and the relationship between stiffness and load and accuracy is verified. The research results make progress in the miniaturization, simplicity, and real-time performance of the variable stiffness method for continuum robots, which are helpful in the design of continuum robot configurations.

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Acknowledgements

This work supported by the Project(2023-JC-YB-313) supported by the Natural Science Basic Research Plan-General Project of Shaanxi Province; Project(2023-JC-YB-294) supported by the Natural Science Basic Research Plan-General Project of Shaanxi Province; Project(2022KXJ032) Shaanxi Province Qin Chuangyuan " Scientists + Engineers" Team Construction; Project (52002309) supported by the National Natural Science Foundation of China.

Natural Science Basic Research Plan-General Project of Shaanxi Provinces, 2023 − JC − YB − 313, Jianxiao zheng,2023-JC-YB-294, Jianxiao zheng, Shaanxi Province Qin Chuangyuan ", 2022KXJ032, Jianxiao zheng, National Natural Science Foundation of China, 52002309, Jianxiao zheng

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Jiaxing University, Jiaxing, 314000, China

Gang Chen, Fuping Li & Changgan Qin

Xi’an University of Architecture and Technology, Xi’an, 710055, China

Gang Chen, Yutong Wu & Jianxiao Zheng

Concrete Machinery Company, Zoomlion Heavy Industry Science & Technology Co., Ltd, Changsha, 410221, China

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Chen, G., Wu, Y., Zheng, J. et al. Research on the method of force-locking and variable stiffness for continuum robot with the spinal-like configuration. J Braz. Soc. Mech. Sci. Eng. 46 , 627 (2024). https://doi.org/10.1007/s40430-024-05130-3

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Published : 25 September 2024

DOI : https://doi.org/10.1007/s40430-024-05130-3

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• Published: 27 September 2024

Narrative Medicine: theory, clinical practice and education - a scoping review

• Ilaria Palla 1 ,
• Giuseppe Turchetti 1 &
• Stefania Polvani 2 , 3  

BMC Health Services Research volume  24 , Article number:  1116 ( 2024 ) Cite this article

Metrics details

The origin of Narrative Medicine dates back to more than 20 years ago at an international level. Narrative Medicine is not an alternative to evidence-based medicine, however these two approaches are integrated. Narrative Medicine is a methodology based on specific communication skills where storytelling is a fundamental tool to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Narrative Medicine, henceforth NM, represents a union between disease and illness between the doctor’s clinical knowledge and the patient’s experience. According to Byron Good, “we cannot have direct access to the experience of others’ illness , not even through in-depth investigations: one of the ways in which we can learn more from the experience of others is to listen to the stories of what has happened to other people.” Several studies have been published on NM; however, to the best of our knowledge, no scoping review of the literature has been performed.

This paper aims to map and synthetize studies on NM according to theory, clinical practice and education/training.

The scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist. A search was conducted in PubMed, APA PsycNet and Jstor. Two authors independently assessed the eligibility and methodological quality of the studies and extracted the data. This review refers to the period from 1998 to 2022.

A total of 843 abstracts were identified of which 274 papers were selected based on the title/abstract. A total of 152 papers in full text were evaluated and 76 were included in the review. Papers were classified according to three issues:

✘ Nineteen studies focused on the definition and concept of NM (Theoretical).

✘ Thirty-eight papers focused on the collection of stories, projects and case reports (Clinical practice).

✘ Nineteen papers focused on the implementation of the Narrative Medicine approach in the education and training of medical doctors (Education and training).

Conclusions

This scoping review presents an overview of the state of the art of the Narrative Medicine. It collect studies performed mainly in Italy and in the United States as these are the countries developing the Narrative Medicine approach in three identified areas, theoretical, clinical practice and education and training. This scoping review will help to promote the power of Narrative Medicine in all three areas supporting the development of methods to evaluate and to measure the Narrative Medicine approach using key performance indicators.

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Introduction

The role and involvement of patients in healthcare have changed, as has their relationship with healthcare professionals. The patient is no longer a passive subject but part of the healthcare process. Over the years, many approaches to patients’ involvement in healthcare have been developed in the literature, with significant differences in terms of concept and significance.

NM represents a focus on the patient’s needs and the empowerment of their active participation in the healthcare process.

Narrative Medicine enables patients to share their stories with healthcare professionals so that the latter can gain the necessary skills to recognize, interpret and relate to patients [ 1 ]. Stories of illness have an important impact on patients and their caregivers, healthcare professionals and organisational systems [ 2 ].

Trisha Greenhalgh, an academic in primary healthcare who trained as a General Practitioner, and Brian Hurwitz, an Emeritus Professor of Medicine and The Arts at King’s College (London) [ 3 , 4 ], affirmed that the core clinical skills in terms of listening, questioning, outlining, collecting, explaining and interpreting can provide a way of navigating among the very different worlds of patients and health professionals. These tasks need to be performed well because they can affect disease outcomes from the patient’s perspective and the scientific aspects of diagnosis and treatment.

In 2013, Rita Charon, a general internist and professor at Columbia University (New York), and Brian Hurwitz promoted “a narrative future for healthcare” , the first global conference on Narrative Based Medicine (NBM). The global conference took place in London in June 2013, where experts in humanities, social sciences and professionals interested in shaping a narrative future for healthcare discussed several topics, such as increasing the visibility of narrative-based concepts and methods; developing strategies that can influence traditional clinical institutions; spreading appreciation for the role of creativity in caring for the sick; articulating the risks of narrative practices in health care; providing a space for Narrative Medicine in the context of other fields, including personalized medicine; and sharing goals for training, research, and clinical care. The conference was the first important opportunity to share different points of view and perspectives at the global level involving several stakeholders with different backgrounds [ 5 ].

In the early 2000s, the first Italian experience of Narrative Medicine occurred in Florence with NaMe, a project endorsed by the Local Health Authority aimed at diffusing the culture of patient-centered medicine and integrating strategies to improve doctor‒patient communication in clinical practice [ 6 ]. This project was inspired by the articles of Hurwitz and Greenhalgh [ 3 , 4 ]. In addition, significant input was derived from Arthur Kleinman [ 7 ] and Byron Good [ 8 ], psychiatrists and anthropologists who studied medicine as a cultural system, as a set of symbolic meanings involving the story of the sick person. Health and illness represent the subjective experience of the person.

Kleinmann [ 7 ] defines three dimensions to explain the illness using three different significances:

✘ Disease: “only as an alteration in biological structure or functioning” .

✘ Illness: the subjective experience of suffering and discomfort.

✘ Sickness: the social representation.

Narrative Medicine can be used in several areas such as prevention, diagnosis, treatment, and rehabilitation; adherence to treatment; organization of the care team; awareness of the professional role and the emotional world by health and social workers; prevention of the burnout of professionals and caregivers; promotion and implementation of Patient Care Pathways (PCPs); and prevention of legal disputes and defensive medicine.

The Italian guidelines established by the National Institute of Health in 2015 [ 9 ] represent a fundamental step in the process of diffusion and implementation of Narrative Medicine in Italy and currently represents the only document. The guidelines define Narrative Medicine as an intervention methodology based on specific communication skills. Storytelling is a fundamental instrument for acquiring, understanding and integrating the different perspectives of those involved in the disease and in the healthcare process. Storytelling represents a moment of contact between a healthcare professional and the patient’s world. The story told involves people, those who narrate and those who listen. Telling stories is a way of transferring knowledge and experience, connecting, reflecting and feeling emotions.

In the last few years, several studies have been carried out with different objectives and perspectives, but no literature review on Medicine Narrative has been performed. We founded the study of Rui et al. [ 10 ] performing a bibliometric analysis of the literature on medical narratives published from 2011 to 2021 showing that the field of narrative medicine is dominated by a few countries. Respect to 736 studies included in the review, 48% (369) are performed in US and 98 papers in Italy.

The objective of scoping review was to map and synthetize studies on NM according to theory, clinical practice and education/training, three settings where NM was developed.

The research questions formulated: (1) What is Narrative Medicine?; (2) How is Narrative Medicine implemented in clinical practice?; (3) What is the role of Narrative Medicine in education and training for medical doctors?

The study protocol follows the PRISMA-ScR checklist (PRISMA extension for Scoping Reviews) but it is not registered (Additional file 1).

We included peer-reviewed papers published from 1998 to December 2022 written in Italian or in English. We excluded papers written in other languages. We included articles according to one of these issues: studies on theory of Narrative Medicine, on clinical practice or education/training of Narrative Medicine. We excluded books, case reports, reviews. To identify potentially relevant studies, the following databases were searched from 1998 to December 2022: PubMed, APA PsycNet and Jstor. The search strategy can be founded in Additional file 2. A data charting form was developed by two reviewers to define which variables can be extracted. The reviewers independently charted the data and discussed the results. We grouped the studies by type of application related to the Narrative Medicine and summarized objective, methods and reflections/conclusions. The scoping review maps the evidence on Narrative Medicine according one of the three fields of diffusion and implementation (Fig.  1 ). Furthermore, the studies classified in “theoretical field “are grouped in subcategories to explain in best way the concepts and permit a clearer and more streamlined reading.

Categories of Narrative Medicine

Review process

After removing duplicates, 843 abstracts from PubMed, Jstor and APA PsycNet were screened. A total of 274 papers were screened based on the abstracts, of which 122 were excluded. A total of 152 full texts were evaluated, and 76 were included in the review (Fig.  2 ).

PRISMA Flow-chart

The studies included were classified into the three fields where the Narrative Medicine is implemented:

✘ Theoretical studies: 19.

✘ Clinical Practice: 38.

✘ Education and training: 19.

The scoping review did not present the results of papers included but the main objectives and the methods used as the aim of the scoping review was to map the studies performed in terms of theory, clinical practice and education/training. We have tried to organize the studies published so far, making it increasingly clear how Narrative Medicine has developed.

Theoretical studies

This section presents the 19 selected theoretical studies grouped into subcategories (Additional file 3).

Narrative Medicine: advantages

In this section, we present seven papers that highlight the benefits of narrative medicine.

Of the seven papers considered, four were performed by Rita Charon emphasizing the value of Narrative Medicine in four different contexts. In the first [ 11 ], the study by Goupy et al. evaluated a Narrative Medicine elective course at the Paris-Descartes School of Medicine. In the second [ 12 ], Charon rewrote a patient’s family illness to demonstrate how medicine that respects the narrative dimension of illness and care can improve the care of individual patients, their colleagues and effective medical practice. The third paper [ 13 ] describes a visit to the Rothko Room at the Tate Modern in London as a pretext to emphasize how for narrative medicine, creativity is at the heart of health care and that the care of the sick is a work of art.

In the fourth [ 14 ], Charon provides the elements of narrative theory through a careful reading of the form and content of an excerpt from a medical record. This is part of an audio-recorded interview with a medical student and a reflection on a short section of a modernist novel to show how to determine the significance of patients’ situations.

According to Abettan [ 15 ], Narrative Medicine can play a key role in the reform of current medical practice, although to date, there has been little focus on how and why it can deliver results and be cost-effective.

Cenci [ 16 ] underlines that the existential objective of the patient is fundamental to know the person’s life project and how they would like to live their future years.

Zaharias [ 17 ], whose main sources are Charon and Launer, has published three articles on NM as a valid approach that, if practiced more widely by general practitioners, could significantly benefit both patients and doctors. If the patient’s condition is central, the NM shifts the doctor’s focus from the need to solve the problem to the need to understand. Consequently, the patient‒physician relationship is strengthened, and patients’ needs and concerns are addressed more effectively and with better results.

Narrative Medicine: the role of digital technologies

This section includes 3 papers on the role of digital technologies in Narrative Medicine. Digital narrative medicine is diffusing in care relationship as presents an opportunity for the patient and the clinician. The patient has more time to reflect on his/her needs and communicate in best way with the healthcare professionals. The clinician can access to more information as quantitative and qualitative information and data provided by the patient. These information represent an instrument for the clinician to personalize the care and respond to patient’s unmet needs.

The use of digital technologies, particularly the digital health storymap tool described by Cenci [ 16 ], for obtaining a multidisciplinary understanding of the patient’s medical history facilitates communication between the patient and caregiver. According to Charon [ 18 ], the relentless specialization and technologization of medicine damages the therapeutic importance of recognizing the context of patients’ lives and witnessing their suffering.

Rosti [ 19 ] affirms that e-health technologies will build new bridges and permit professionals to have more time to use narrative techniques with patients.

The increased use of digital technologies could reduce the opportunity for narrative contact but provide a starting point for discussion through the use of electronically transmitted patient pain diaries.

Narrative Medicine: integration with evidence-based medicine

Greenhalgh’s [ 20 ] and Rosti’s [ 19 ] studies address one of the most significant issues, the integration of Narrative Medicine with Evidence Based Medicine. Narrative Medicine is not an alternative to Evidence Based Medicine, they coexist and can complement each other in clinical practice.

Greenhalgh’s work [ 20 ] clearly shows how NM and EBM can be integrated. EBM requires an interpretative paradigm in which the patient experiences the disease in a unique and contextual way and the clinician can draw on all aspects of the evidence and thus arrive at an integrated clinical judgement.

Rosti [ 19 ] believes that even “evidence-based” physicians sustain the importance of competence and clinical judgement. Clinicians also need to rely on patients’ narratives to integrate more objective clinical results. Clinical methods are not without their limitations, which Narrative Medicine can help to overcome. Lederman [ 21 ] enphatises the importance of social sciences to analyze the stories and to improve the care.

Narrative-based Medicine: insidious

Three papers in this section focus on the possible risks of the Narrative Medicine approach. It is needing a more awareness on role of Narrative Medicine as a robust methodology.

The study by Kalitzus [ 22 ] shows how a narrative approach in medicine will be successful only if it has a positive effect on daily clinical practice instead of merely increasing existing problems.

Complex narratives on diseases published in biographies or collected by social scientists are useful only for training and research purposes. NM requires time and effort and cannot be considered the only important issue in medicine. According to Abettan [ 15 ], Narrative Medicine can make the treatment more personalised for each patient, but it is not the only way.

Zaharias [ 17 ] affirms that Narrative Medicine is often described simplistically as listening to the patient’s story, whereas it is much more common and requires special communication skills. Perhaps for these reasons, and despite its advantages, NM is not as widely practiced as it could be. Narrative skills are an integral part of practice and learning them takes time. As the author also states, “the healing power of storytelling is repeatedly attested to while evidence of effectiveness is scarce”. Lanphier [ 23 ] underlines the need to explain the term "narrative medicine" to avoid misunderstandings and to analyze the use of narrative as a tool.

Narrative Medicine: training

Liao et al. [ 24 ] presented a study aimed at helping students improve their relationships with patients by listening to them. These results, similar to those described by Charon [ 25 ], suggest that Narrative Medicine is worth recommending in academic training. The essay by O’Mahony [ 26 ] aims to provoke a debate on how and what the medical humanities should teach. Narratology and narrative medicine are linked to empathy.

Narrative Medicine: clinician-patient communication

Papers included within this category focus on the relationship between the clinician and patient, which is important in the healthcare context.

American healthcare institutions recognize the use of the Narrative Medicine approach to develop quality patient care. As a gastroenterologist at a health centre in Minnesota (US), Rian [ 27 ] concluded that the practice of Narrative Medicine should not be kept on the fringes of medicine as a hobby or ancillary treatment for the benefit of the patients but should be considered key to the healthcare process. Improving doctor‒patient communication merits more attention.

According to Rosti [ 19 ], NM can be seen as a tool to promote better communication. Although time constraints are often mentioned as an obstacle, the time needed to listen to patients is not excessive, and all healthcare professionals should consider giving patients more freedom from time constraints during consultations by encouraging them to talk about their experiences. The use of NM may also be associated with better diagnosis and treatment of pain.

Zaharias [ 28 ] underlines that communication skills are crucial. General practitioners can further develop the strong communication skills they already possess by practicing NM through neutrality, circular questions and hypotheses, and reflective skills.

Narrative Medicine: bioethics in qualitative research

The use of qualitative research in bioethics and narrative approaches to conducting and analysing qualitative interviews are becoming increasingly widespread. As Roest [ 29 ] states, this approach enables more “diagnostic thinking”. It is about promoting listening skills and the careful reading of people and healthcare practices, as well as quality criteria for the ethical evaluation of research and training.

• Clinical practice

In this classification, we included case studies performed in clinical care. We focused on methods used to guide the patients’ stories or narratives written by healthcare professionals. We analysed how Narrative Medicine has been implemented in clinical healthcare practice.

The studies included (38) were performed in the following countries: Italy (28), USA (4), Australia (1), Canada (1), China (1), Colombia (1), Norway (1), and several European countries (1) (Table  1 ). The main methods used were semi-structured interviews that guided the patient’s and physician’s narration [ 30 , 31 , 32 , 33 ], narrative diaries written by patients [ 34 ], and paper parallel charts (an instrument to integrate the patients’ stories in clinical practice) written by clinicians [ 34 , 35 , 36 ].

The studies underlined the usefulness of narrative medicine not only in qualitative research but also in integration with quantitative analysis. Gargiulo et al. [ 45 ] highlighted the importance of integrating narrative medicine and evidence-based approaches to improve therapeutic effectiveness and organizational pathways. Cappuccio et al. [ 36 ] affirmed that narrative medicine can be effective in supporting clinicians in their relationships with patients and caregivers.

Narrative Medicine is an important instrument for patients, caregivers and healthcare professionals [ 63 ]. Suter et al. [ 60 ] affirmed that patients’ stories can help other patients with similar experiences. The studies performed by Cercato [ 39 , 40 ] and Zocher [ 67 ] highlighted the role of digital diaries in the care process from the perspective of healthcare professionals and patients. Sansone et al. [ 55 ] highlighted that the use of diaries in the intensive care unit is helpful in facilitating communication between healthcare professionals and the family.

Education and training

This section includes studies on the role of Narrative Medicine in the education and training of medical students and healthcare professionals. The studies discuss the experiences, roles and programmes of the Narrative Medicine programme in education and training. Nineteen studies were carried out, 10 of which were in the USA (Table  2 ). Only two studies were carried out in Europe, 4 in Taiwan, 1 in Canada, 1 in Iran and 1 in Israel. Seven studies focused on the role of narrative medicine for healthcare professionals [ 68 , 69 , 70 , 71 , 72 , 73 , 74 ], and 11 were aimed at medical students from different disciplines. All studies underlined the positive role of Narrative Medicine in training. Chou et al. [ 75 ] affirmed that the new model of narrative medicine training, “community-based participatory narrative medicine”, which focuses on shared narrative work between healthcare trainees and patients, facilitates the formation of therapeutic patient-clinician relationships but also creates new opportunities to evaluate those relationships. Darayazadeh et al. [ 70 ] underlined the effectiveness of Narrative Medicine in improving students’ reflections and empathy with patients. Additionally, Lam et al. [ 76 ] highlighted that Narrative Medicine could be a useful tool for improving clinical empathy skills. The studies used different approaches to implement the Narrative Medicine method. Arntfield et al. [ 77 ] proposed three tools at different steps of the study (survey, focus group and open-ended questions). Chou et al. [ 75 ] asked participants to write a personal narrative. DasGupta and Charon [ 78 ] used a reflective writing exercise to analyse personal experiences of illness.

In this scoping review we identified 76 studies addressing dissemination and implementation of Narrative Medicine across three settings between 1998 and 2022. The studies performed by Hurwitz [ 3 ] and Greenhalgh [ 4 ] provide a path towards the Narrative Medicine affirm that sickness episodes are important milestones in patient life stories. Not only we live through storytelling, but often, with our doctor or nurse as a witness, we get sick, we improve, we get worse, we are stable and finally we also die through the story. affirms that the stories are often evocative and memorable. They are image rich, action packed and laden with emotions. Most people recall them better than they recall lists, graphs or numbers. Stories can convey important elements of nuance, including mood, tone and urgency. We learn through stories because the story form allows our existing schemas to be modified in the light of emerging experiential knowledge. The stories can capture tacit knowledge: in healthcare organizations they can bridge the gap between explicit, codified and formal knowledge (job descriptions, guidelines and protocols) and informal, not codified knowledge (knowing how to get things done in a particular organization or team, sometimes referred to as knowing the ropes). The “story” is the focal point in the studies related to the clinical practice as these discuss about the patient’s experience, illness story thought tools as questionnaires, narrative diary, chart parallels. The patient is an expert patient able to interact with the healthcare professionals, he/she had not a passive role; the patient is part of the process with the other involved stakeholders. Also, the Italian guidelines on Narrative Medicine [ 9 ] considers the storytelling as a fundamental instrument to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Storytelling represents the interaction between a healthcare professional and the patient’s world. According to this perspective, it is useful to educate in Narrative Medicine the healthcare professionals from the University to provide instruments to communicate and interact with their patients. Charon [ 11 ] emphasizes the role of training in narrative skills as an important tool permitting to physicians and medical students to improve their care. Charon [ 24 ] underlines that narrative training permits to explore the clinician’s attention to patients and to establish a relationship with patients, colleagues, and the self. The study of Liao [ 22 ] underlines that Narrative Medicine is worth recommending for healthcare education as resource for interdisciplinary collaboration among students from different discipline.

John Launer in The Art of Medicine. Narrative medicine , narrative practice , and the creation of meaning (2023) [ 87 ] affirm that Narrative Medicine could be complemented by the skills and pedagogy of narrative practice. In addition to the creation and study of words on the page, learners could bring their spoken accounts of their experiences at work and interview each other using narrative practice techniques. He also affirms that narrative practice and narrative medicine could both do more to build alliances with advocacy groups.

We have performed a picture of Narrative Medicine from its origin to today hoping that it will help to promote the power of Narrative Medicine in all three areas becoming increasingly integrated.

Strengths and limitations

The scoping review does not present the results of studies included but objectives, methodology and conclusions/suggestions as it aims to map the evidence related to the Narrative Medicine using a classification defined for the review. This classification had permit to make even clearer the “world” of Narrative Medicine and present a mapping.

English- and Italian-language articles were included because, as seen from the preceding pages, most of the studies were carried out in the United States and Italy.

This could be a limitation, as we may have excluded papers written in other languages. However, the United States and Italy are the countries where Narrative Medicine has developed the most.

The scoping review presents an overview of the literature considering three settings in which Narrative Medicine has emerged from its origins until today highlighting evidence in terms of theory, clinical practice, and education. Currently, a methodology to “measure” Narrative Medicine with indicators, a method assessing the effectiveness and promoting a greater diffusion of Narrative Medicine using objective and measurable indicators, is not available. Furthermore, the literature analysis doesn’t show an integration across three settings. We hope that the review will be a first step towards future projects in which it will be possible to measure Narrative Medicine according to an integrated approach between clinical practice and education/training.

Availability of data and materials

Availability of data and materials: All data generated or analysed during this study are included in this published article.

Abbreviations

• Narrative Medicine

Narrative-Based Medicine

Evidence-Based Medicine

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I.P. and S.P. carried out the scoping review, conceived the study, data collection process and drafted the manuscript. G.T. participated in the coordination of the study. All authors read, reviewed and approved the final manuscript.

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Palla, I., Turchetti, G. & Polvani, S. Narrative Medicine: theory, clinical practice and education - a scoping review. BMC Health Serv Res 24 , 1116 (2024). https://doi.org/10.1186/s12913-024-11530-x

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DOI : https://doi.org/10.1186/s12913-024-11530-x

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