The U.S. National Institute of Health (NIH) 3D Print Exchange is a public, open-source repository for 3D printable medical device designs with contributions from clinicians, expert-amateur makers, and people from industry and academia. In response to the COVID-19 pandemic, the NIH formed a collection to foster submissions of low-cost, locally manufacturable personal protective equipment (PPE) . We evaluated the 623 submissions in this collection to understand: what makers contributed, how they were made, who made them, and key characteristics of their designs. We found an immediate design convergence to manufacturing-focused remixes of a few initial designs affiliated with NIH partners and major for-profit groups. The NIH worked to review safe, effective designs but was overloaded by manufacturing-focused design adaptations. Our work contributes insights into: the outcomes of distributed, community-based medical making; the features that the community accepted as “safe” making; and how platforms can support regulated maker activities in high-risk domains.

Meditation has become a popular option to manage stress. Though studies examine technologies to assist in meditation, few explore how technology supports development of such skills for independent practice. From a two-phase mixed-methods study, we contribute learner-centered insights from 36 participants in a virtual reality environment designed to teach meditation skills to novices. In Phase I, we gathered affective and behavioral learner needs from 21 meditation novices, experts, and instructors to synthesize insights for learning. We then designed ZenVR: an interactive system to deliver an eight-lesson meditation curriculum to support learners’ progress. In Phase II, we conducted a 6-week longitudinal lab-based evaluation with 15 novice meditation learners. We found statistically significant improvements in mindfulness and self-reported meditation ability. Their insights from a self-managed practice, two weeks after the study ended, offered opportunities to understand how technology can be designed to offer progressive support without creating dependence in technology-mediated meditation practice.

We present an ethnographic study of a maker community that conducted safety-driven medical making to deliver over 80,000 devices for use at medical facilities in response to the COVID-19 pandemic. To achieve this, the community had to balance their clinical value of safety with the maker value of broadened participation in design and production. We analyse their struggles and achievement through the artifacts they produced and the labors of key facilitators between diverse community members. Based on this analysis we provide insights into how medical maker communities, which are necessarily risk-averse and safety-oriented, can still support makers' grassroots efforts to care for their communities. Based on these findings, we recommend that design tools enable adaptation to a wider set of domains, rather than exclusively presenting information relevant to manufacturing. Further, we call for future work on the portability of designs across different types of printers which could enable broader participation in future maker efforts at this scale.

Making medical devices in healthcare settings engages practitioners in organizational innovation. Nurses improvise physical workarounds at the bedside in response to patient needs. Yet nurse-led problem-solving is rarely centralized in an emerging innovation ecosystem through medical making. We interviewed medical makers in six healthcare makerspaces to understand factors for nurse inclusion in the medical making ecosystem. Findings from 16 multi-stakeholder interviews with 6 facilitators and 10 nurses in the USA, reveal insights into nurse-led problem-solving with and without the use of physical prototyping (making) in formal innovation spaces with maker technologies. We report how a nurse's capacity for making is practice-driven to address in-patient discomfort, repair their own practice, and update standardized workflows. Most nurses iterate on low-tech solutions facing barriers to formal collaboration when they attempt to scale up. Their technical capabilities extend from innovation-centered resources (e.g., lab spaces, technologies), often with complete reliance on facilitators who have limited authority in the medical system. We contribute to themes around practice-based innovation, participation in technology design, and articulation work for collaborative innovation. From nurse makers' experiences, we discuss how nurse participation can be supported in healthcare technology design.

Medical making intersects opposing value systems of a medical “do no harm” ethos and makers’ drive to innovate. Since March 2020, online maker communities have formed to design, manufacture, and distribute personal protective equipment (PPE) and other medical devices needed to fight the COVID-19 pandemic. We present a participant observation study of 14 maker communities, which have developed differing driving principles for efforts with varied access to interdisciplinary expertise on online platforms that mutually shape collective action. Over time, these communities unintentionally align towards action-oriented or regulated practices because they often lack higher level insight and agency in choosing communication platforms. In response, we recommend: regulatory bodies to build coalitions with makers, online platforms to give communities more control over the presentation of information, and repositories to balance needs to distribute information while limiting the spread of misinformation.

Unprecedented maker efforts arose in response to COVID-19 medical supply gaps worldwide. Makers in the U.S., participated in peer-production activities to manufacture personal protective equipment (PPE). Whereas, medical makers, who innovate exclusively for points of care, pivoted towards safer, reliable PPE. What were their efforts to pivot medical maker infrastructure towards reliable production of safe equipment at higher volumes? We interviewed 13 medical makers as links between institutions, maker communities, and wider regional industry networks. These medical makers organized stopgap manufacturing in institutional spaces to resolve acute shortages (March–May) and chronic shortages (May–July). They act as intermediaries in efforts to prototype and produce devices under regulatory, material, and human constraints of a pandemic. We re-frame their making efforts as repair work to offer an alternate critical view of optimism around making for crisis. We contribute an understanding of these efforts to inform infrastructure design for making with purpose and safety leading to opportunities for community production of safe devices at scale.

Post-traumatic stress disorder (PTSD) disproportionately affects United States veterans, yet they may be reluctant to seek or engage in care. We interview 21 participants, including veterans with PTSD, clinicians who treat veterans and friends and family that support veterans through mental health ordeals. We investigate the military identity these veterans share. We explore how this may add to their reluctance in care-seeking behaviors. We also explore the roles of human and non-human intermediaries in ecologies of care and the potential for enhancing patient empowerment in current clinical treatment contexts. We discuss how military culture can be utilized in clinical care, how multiple perspectives can be leveraged to create a more holistic view of the patient, and finally, how veterans can be empowered during treatment. We conclude with recommendations for the design of sociotechnical systems that prioritize the above in support of the mental well-being of veterans with PTSD.

Adolescents with chronic conditions must work with family caregivers to manage their illness experiences. To explore how technology can support collaborative documentation of these experiences, we designed and distributed a paper diary probe kit in a two-week field deployment with 12 adolescent-parent dyads (24 participants). Three insights emerged from the study that highlight how technology can support shared illness management: 1) provide scaffolds to recognize physical and emotional experiences in the context of daily activities; 2) help families reconstruct patient experiences; and 3) adapt to individual preferences for capturing, representing and sharing experiences. We discuss opportunities for HCI research that follow from these findings and conclude by reflecting on the benefits and limitations of using diary probes with adolescent patients and their parental caregivers.

Maker culture is on the rise in healthcare with the adoption of consumer-grade fabrication technologies. However, little is known about the activities and resources involved in prototyping medical devices to improve patient care. In this paper, we refer to such activity asmedical making to report findings based on a qualitative study of stakeholder engagement in physical prototyping (making) experiences. We examine perspectives from diverse stakeholders including clinicians, engineers, administrators, and medical researchers. Through 18 semi-structured interviews with medical-makers in the US and Canada, we analyze making activity in medical settings. We find that medical makers share strategies to address risks, adopt labor roles, and acquire resources within traditional medical practice. Our findings outline how medical-makers mitigate risks for patient safety, collaborate with local and global stakeholder networks, and overcome constraints of co-location and material practices. We recommend a clinician-aided software system, partially-open repositories, and a collaborative skill-sharing social network to extend their strategies in support of medical making.

Teens with complex chronic illnesses have difficulty understanding and articulating symptoms such as pain and emotional distress. Yet, symptom communication plays a central role in clinical care and illness management. To understand how design can help overcome these challenges, we created a visual library of 72 sketched illustrations, informed by the Observations of Daily Living framework along with insights from 11 clinician interviews. We utilized our library with storyboarding techniques, free-form sketching, and interviews, in co-design sessions with 13 pairs of chronically-ill teens and their parents. We found that teens depicted symptoms as being interwoven with narratives of personal and social identity. Teens and parents were enthusiastic about collaboratively-generated, interactive storyboards as a tracking and communication mechanism, and suggested three ways in which they could aid in communication and coordination with informal and formal caregivers. In this paper, we detail these findings, to guide the design of tools for symptom-tracking and incorporation of patient-generated data into pediatric care.