Chapter 5 132 effectiveness according to medical evidence-based standards. The creation of a new product, system, or service to improve health might be considered an outcome from a design perspective but would not be considered a health outcome from a scientific perspective.[13], [14] In the literature a scientific method is described as a strategy to understand the nature of a phenomenon, whereas a design method is a strategy to invent things of value. According to this distinction, science is analytical, and design is constructive, and therefore it is difficult to assess both methods according to the same standard.[20] Yet, according to Frey et al (2006), many of the validation techniques found in medicine could be used for the validation of design methods. For example, where medicine uses animal models and clinical trials to test medical treatments, detailed simulations and controlled field experiments of design methods could be developed for the explicit purpose of evaluating design methodologies.[109] This logical, empiristic approach towards the evaluation of design methods fits well with e.g. the field of engineering design, which is based on mathematical modelling, since it is mostly appropriate for closed, objective problems that can lead to binary (yes/no) answers. However, HCD approaches often address open, complex problems that involve both objective and subjective elements without a single “correct” answer. For design methods addressing open complex problems, a relativist validation approach that gradually builds confidence in the usefulness of methods can be considered a more appropriate paradigm.[110] A relativist approach to design claims no absolute objectivity for methods or models, but it assumes that a valid method or model is only one of many possible ways of measuring or describing a real situation. In a relativist approach to design methods, validity becomes a matter of practical use and contextual functionality, rather than formal and universal accuracy. Validity of design methods becomes a contextual, semiformal, and conversational process, because establishing models of usefulness is a conversational matter.[111] It is important to note that a relativist approach towards the evaluation of design methods does not antagonize the logical empiristic approach towards the evaluation of scientific research methods used in HCD processes. There is ongoing demand to develop a ‘design science’ with systematic and formalised design methods that adhere to the values of the empiristic scientific method: objectivity, rationality and universalism.[112], [113] Scientific design methods have been developed in engineering and computer science, however, there is limited evidence that the systematic use of design practices leads to measurable and reproducible results in health research.[112] Design researchers themselves still debate whether design conforms to a scientific activity or represents an academic discipline with a rigorous culture of its own.[20], [113] As a result, critical appraisal and best practice selections of design methods within health research remain challenging.
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