Chatterbox: A Participation-Driven Tool for Inclusive
Content Creation
Jessie Both
11210419
Universiteit van Amsterdam
Celine Van Der Geer Joey Schouten
11059648 10218572
Universiteit van Amsterdam Universiteit van Amsterdam
1. INTRODUCTION
The University Medical Center Utrecht (UMC) is the hos-
pital associated with Utrecht University, which makes it an
important medical facility for advanced health care and re-
search. Until December 2016, the UMC distributed a news-
paper containing information regarding both patient stories
and the activities of the hospital. However, a lack of feed-
back on the effectiveness of the publication along with the
high costs associated with it has caused the UMC to dis-
continue the newspaper. The UMC wishes to replace the
newspaper with a new method of communication. In addi-
tion, the municipality of Utrecht, in association with Mira
Media, wishes to address any issues present in the commu-
nication with regards to inclusivity as part of their inclusiv-
ity and anti-polarisation campaign named Utrecht Zijn We
Samen1 . This report deals with the process and eventual
prototype of the development of a concept to address these
needs of the UMC and Mira Media.
2. THEORETICAL NOTIONS
2.1 Framing
Framing is about creating value and a novel point of view
from which a challenge can be tackled. In this case, the
problem space entails various of requirements as a result
of dealing with two clients and their different perspective,
namely Mira Media and the UMC. The means of communi-
cation used by UMC towards the general public have been
mostly in the form of a newspaper from the hospital named
Hoegaathet? 2 . However, the UMC is also active on social
media and provides medical and formal client information
via their official website. The other client, Mira Media, is
committed to increasing inclusiveness by use of media to
encourage intercultural dialogue and social cohesion.
The first step in the creation of the frame for this broad prob-
lem space was to define the central themes. In our challenge,
we have adopted the perspective of the UMC, and as such,
we focus on their needs. The understanding of these needs
can be categorized into four levels of insight, as the model
in Figure 1 illustrates [7].
1
Literally translates to Utrecht We Are Together.
2
Lit. How are you doing? Spaces between the words have
been omitted as a style choice.
Danielle Duijst
11266988
Universiteit van Amsterdam
Chris Verbeek
11264128
Universiteit van Amsterdam
An important level in this model is the why level, which
is divided into two parts in the model, namely goals and
themes. The goals represent the reasons why users would
want a given product or solution and themes are the mean-
ings that drive these goals. With the current means of com-
munication, the UMC is not able to reach the entirety of
their audience. In addition, the UMC wishes to make it-
self known for the best overall health care on a regional
level and for their focus points, such as ADHD3 and cardio-
vascular diseases, on a national level. As there is no such
thing as bad care in the Netherlands, the UMC is forced
to compete with other well-specialized and highly regarded
hospitals, which requires the UMC to develop their brand.
As mentioned, the themes are the meanings which drive the
goal of reaching every citizen of Utrecht. As such, it was pos-
sible to categorize the goals into two overarching themes,
namely inclusiveness and interaction. We believe that in-
clusiveness is an important overall theme in this challenge.
Unfortunately, the newspaper from the UMC had presented
a rather one-sided reflection of society as opposed to a more
inclusive view. Having taken the wishes of Mira Media into
account, as well as our own beliefs regarding this topic, we
believe it is important to take special care to include every
citizen of Utrecht. The other theme, interaction, deals with
bridging the gap between the hospital and the citizens of
Utrecht. The patterns and meanings found in these themes
can be used to create frames or to reframe a standpoint or
situation. We believe it is necessary to establish this con-
nection to create awareness and encourage active interaction
between the UMC and the citizens of Utrecht. In this case,
the UMC serves as a provider of medical information and the
citizens of Utrecht as participants by providing the knowl-
edge that they want. With this information, we framed our
case and came up with the following main question for this
challenge: How and what should the UMC communicate in
order to reach every citizen of Utrecht?
2.2 Wicked Problems and Social Complexity
The UMC project is a clear example of a complex, or wicked,
problem. Wicked problems are problems that do not have
a specific solution but rather have a multitude of fitting so-
lutions. Like in the case of this project, there is no optimal
3
Attention Deficit Hyperactivity Disorder.
 Figure 1: Model displaying the various levels of insight regarding human needs [7].
solution. We chose to use abductive reasoning as our ap-
proach to tackle this issue, which is often associated with
design thinking, as we felt a traditional waterfall approach
would not suffice. Our main reasoning behind this deci-
sion is that we felt that using the linear process approach
would severely limit our creative process because this ap-
proach treats the process of solution creation as it were a
procedure of consecutive steps. When using this approach,
designers will get confronted with the irreversibility prob-
lem, as mentioned by Cath [2]; once a step in the linear pro-
cess is completed, we move on to the following step. This
irreversibility prevents the designer to iterate on parts of the
intended solution, which is, in wicked problems, an essential
continuous process.
In addition, we noticed that social complexity can play a
large role in wicked problems, by making it difficult to reach
collaborative success. Social complexity refers to the num-
ber of players who are involved in a project and the diversity
within; the more parties involved, the more socially complex
the situation becomes [3]. Our stakeholders each seemed to
have a different view on the problem. The main focus of
Mira Media is to make the communication outlets of the
UMC inclusive, while during meetings with the UMC, in-
clusive communication was not even mentioned once. As
we need to reconcile the different goals of both stakehold-
ers, this underlines that as more parties are involved in a
collaboration, the more socially complex the situation will
become.
2.3 Ethics
When applying ethics in practice, we should consider all the
major stakeholders of the project as these are the people
being affected significantly by the project. In our case the
main affected groups of people would be the UMC and Mira
Media, but also the users and us as a team. Ethical decisions
should be made by the users wherever possible. However,
when this is not possible, at least the algorithm, or solution
in our case, should be transparent and easy to identify [5].
We assessed three ideas based on the value these ideas would
add for the user. This judgement was based on tacit knowl-
edge, which is obtained by absorbing things from the sur-
roundings [1]. Based on this tacit knowledge we made as-
sumptions, namely that citizens of Utrecht would want to
have a look behind the scenes of the UMC to get a basic
understanding of how this hospital operates, to gain a gen-
eral impression of the daily lives of UMC employees, and to
be able to interact with the UMC by asking questions or
discussing relevant statements. Since we as designers have
a pragmatic need, we used a combination of casuistry and
communicative ethics. In casuistry, different cases are being
compared and the decision is based on that comparison. In
communicative ethics, a certain way of discourse is necessary
to solve complex problems [1].
We believe transparency plays an essential role when at-
tempting to connect citizens to the UMC while making these
citizens feel included. By being transparent, we can also pro-
vide the users with more information, and gain their trust.
Furthermore, by providing the users with better informa-
tion, their autonomy is increased; users are able to make a
better decision on which hospital to choose from when nec- 3. DESIGN PROCESS
essary and to make citizens trust the information the UMC
provides more. In addition, transparency can also create
3.1 Point of View
As we mentioned earlier, we had to deal with two separate
a bonding experience between the citizens of Utrecht and
stakeholders, namely Mira Media and the UMC. These two
the hospital. This decision comes out of a rights approach
parties both have different needs, which are difficult to align.
design thinking process, which means that this ethical ac-
Two meetings took place, one of which took place with all
tion respects the moral rights of those affected [8]. This
of the involved parties present, such as officials from the
approach supports the belief that humans have the right to
municipality of Utrecht in addition to Mira Media and the
choose freely and are able to determine what to do with their
UMC, and the other only with the Marketing and Commu-
lives. In this case, it means that they have the right to know
nications department of the UMC. This second meeting was
how the UMC is organized and have the possibility to ask
meant to ascertain the needs of the UMC itself.
questions or to provide a response.
In order to come to a point of view on the project, to frame
it in a workable fashion, the initial project was split into
2.4 Critical Thinking two aspects, namely push and pull, which deal with the
At first, in the design community, it was thought that in cre- needs of the UMC itself and the needs of the citizens of
ative processes, divergent thinking would suffice. However, Utrecht respectively. We concerned ourselves with the pull
as explained by Villalba [9], convergent thinking by thinking aspect and viewed the UMC as our user to accommodate
critically about your ideas is an important aspect of creative their needs.
processes that helps designers to find correct and conven-
tional ideas. As described by Paul and Elder [6], critical The primary needs of the UMC are defined as follows:
thinking is the art of analysis and evaluation thinking with
a the intent to improve ideas. Forcing yourself to think crit-
ically about situations, decisions or other things that occur to deliver information about the UMC to those who do
during the design process helps identify the biases inherent not need medical care (i.e. not patients at the UMC),
in ideas and statements.
to facilitate and engage in societal discussions on med-
An example of when our team used critical thinking was ical themes such as euthanasia or the use of antibiotics,
when we decided to reframe an aspect of the given design
challenge. During the meetings with the stakeholders, we to deliver general information on healthy lifestyles and
sensed that they were hinting to the solution to their prob- food, such as in the case of allergies, for the prevention
lems being a website. As our goal is to connect the citizens of medical issues,
of the province of Utrecht and the UMC by using inclusive
communication, the main question that we raised about this and to promote the specialization of the UMC in areas
matter was: Is it possible to reach every Utrecht citizen such as cardiovascular diseases and ADHD.
with a website? We came to the conclusion that this is not
the case, as thirty percent users proved to be unable to use
These needs come together in a strategy which aims at sat-
digital services independently [4]. For us, this percentage is
isfying the overarching need of the UMC, namely to bet-
too high to ignore, especially because these people are often
ter position themselves in the regional and national market
elderly. As a vulnerable group due to their age, the elderly
by increasing their brand awareness among the citizens of
are more likely to have to spend time in the hospital than
Utrecht and beyond.
other groups. Therefore, we decided to endure that our solu-
tion should be facilitated in a way that, in theory, everyone
Finally, the needs of Mira Media, namely that all communi-
should be able to use the solution, and thus not rule out
cation takes place in an inclusive manner, have to be taken
thirty percent of the target audience. Whether these users
into account in order to satisfy the needs of the UMC: com-
are willing to use the solution is important, of course, but is
munication which does not exclude people from participat-
outside the scope of this project.
ing or from accessing information based on digital skills, cul-
tural background, or disabilities, among others, is required
Still, according to Villalba [9], critical thinking should prefer-
to both reach the entirety of the general public and to posi-
ably not be performed during the early stages of the design
tion the hospital as welcoming and inclusive.
process, as this will impose a limit on the creativity required
for the design process. When critical thinking is used at later
As a result, we can frame our point of view as follows: We
stages in the process, it is used to determine the originality
of the UMC, want to inform the citizens of Utrecht about
and usefulness of ideas. In retrospect, this is what happened
our research and give an expert view on trending news by
in our process when we came out of the ideation phase with
using inclusive communication.
three ideas. Initially, we believed that these ideas could all
be potential solutions. However, after we had another criti-
cal look at these ideas, we realized that all three ideas would 3.2 Competing Ideas
no longer be sufficient. Nevertheless, we decided to combine During the ideation phase, we explored a wide solution space
several elements of the original ideas into a new idea, which and generated a large quantity of ideas. However, taking
became the idea we later used for prototyping. feasibility and available time into consideration, we ended
up with three main ideas. This section elaborates on these
competing ideas.
3.2.1 Online Discussion Platform
We envisioned a online discussion platform where medical
experts of the UMC can stream a video in which they present
a specific medical topic (e.g. cardiovascular diseases, aller-
gies, ADHD). This live stream is available to anyone who is
interested in the topic, the presenting expert, or the UMC in
general. In reference to this stream, comments and questions
can be raised by the viewer, by posting these on our envi-
sioned online discussion platform (i.e. website or forum),
which can then be answered by medical experts of the UMC
or may even lead to a discussion amongst viewers. Addition-
ally, the streamed video will also be made publicly available
for viewers to watch it again or that members of the general
public, who missed the initial broadcast, are able to view it.
3.2.2 Online Medical Blog
Our second idea was to create an online medical blog where
visitors can read about a specific medical topic and select
whether they would like additional information on key terms,
either by making the text more in depth, for when a visitor
is already knowledgeable about the topic, or by making the
text easier to understand, if the visitor does not have prior
knowledge about the topic or does not understand certain
aspects.
3.2.3 Live Fact Checking Application
Our third idea was the development of a live fact checking
application; an application that would check specific state-
ments presented on television, e.g. on talkshows such as the
Dutch De Wereld Draait Door. For example, if someone
were to be making the claim that saturated fats are un-
healthy on television, the live fact checker would verify or
disprove this statement by letting a medical expert from the
UMC review it, comment on it, and subsequently present
the result to the viewer.
3.2.4 Reframing of Requirements
However, after carefully reviewing our point of view, we
came to the conclusion that our intended idea should:
be available in an offline setting due to the fact that
a large part of the population, who have to deal with
hospitals, e.g. the elderly, have difficulties with their
digital literacy;
protect the UMC brand;
be easy to distribute;
and allow for inclusiveness.
Based on these requirements, we came to the conclusion that
all of our previously mentioned ideas were no longer suitable.
Both the online discussion platform and blog would not be
available in an offline setting, thus being harder to reach
for certain audiences, and the discussion platform could po-
tentially harm the UMC brand, as visitors have the ability
to post whatever they want, including harmful comments
and unrelated questions. The third and final idea, the fact
checking application, was not viable due to feasibility issues,
as it would take too much time and resources to prototype
and implement. Therefore, we needed to create a completely
new concept which would fulfill all of the set requirements.
3.3 Prototype
With these requirements in mind, we came to a new concept:
the Chatterbox, displayed in Figure 2. We assumed that
citizens of Utrecht would feel connected with the hospital if
they would get to know the people who work there. That
is how we came to the idea of letting people engage with
the employees of the hospital by asking questions. As we
believe everyone should be able to participate, we started
thinking of offline solutions. Inspired by the Babbelbox of
the Dutch television show Man Bijt Hond, we thought we
could give everyone the opportunity to participate by cre-
ating a mobile recording unit which would allow people to
react to statements or questions regarding a given a med-
ical topic. These answers and comments are then used as
input for a documentary made in the hospital as an answer
to the questions posed. This allows the communication de-
partment of the UMC to regulate both the questions asked
and the answers given by the employees. The documentary
would then be made available both online and offline, such
as on public screens in train stations and waiting rooms at
the practices of general practitioners. The mobile recording
unit, i.e. the Chatterbox itself, can be placed in multiple
places in the region of Utrecht, for example a big square in
the city center or in the supermarket of a small village in
the province, as illustrated in Figure 3.
Figure 2: 3D-printed model of the Chatterbox, with
a figure of a man for scale.
We estimate that it should take about a month to create a
documentary, as indicated in Figure 4. The editor of the
documentary can select the responses and questions of the
citizens and then starts making a script for the documentary.
After filming with the employees of the hospital, the editor
can finish the documentary and send it to the distributors
of offline/public screens and post the video online.
As we have not been able to find precedents for the com-
bination of an analog solution with an online platform at
later stages, the concept is also scientifically interesting as
research on this specific topic has not been done before. A
scientific test of this concept would therefore contribute to
research on inclusive communication through analog solu-
tions. If the Chatterbox proves to be successful, it may not

Figure 3: Concept image of the mobile recording
unit of the Chatterbox as envisioned in a public
space, in this case a market.
only contribute to science, but should decrease polarisation
and segregation in society as well.
3.4 Main Learnings From Testing and User
Feedback
As part of our iterative design approach, we conducted two
evaluations of our concept, the first consisted of an user test
on the Dappermarkt in Amsterdam and the second was an
expert interview with one of the people who worked on the
original concept on which ours is based.
3.4.1 Test at Dappermarkt
Our goals were to interview a wide range of people about
their needs in finding medical information and to validate
whether people would make use of our concept, mainly whether
they would respond to statements and questions or pose
their own. Therefore, we went to the Dappermarkt in Am-
sterdam, as Amsterdam in general, is considered to be a
multicultural area. The area called Dapperbuurt features
a broad diversity of nationalities, many of which come to-
gether at the market.
We asked people who either spoke Dutch or English where
they generally find their medical information. They were
also asked whether they would like to discuss medical state-
ments on camera to a specialist. We encountered difficulties
with finding people that wanted to answer our questions,
and a lot of people spoke neither Dutch nor English. Our
group of participants was highly diverse however, as we ob-
served people with a variety of backgrounds such as Mo-
roccan, Turkish, Antillean, Indian, Surinamese, and various
Asian backgrounds. In addition, the people we asked also
differed in age and digital literacy.
Most people indicated that they tend to search on the In-
ternet for their medical information, i.e. use a search engine
such as Google. The second largest group indicated that
they would either visit or call their doctor to get their in-
formation. None of the people understood what we meant
with asking a specialist on camera, which brought us to the
conclusion that a simple explanation of the solution did not
cause people to fully grasp our concept.
3.4.2 Expert Interview
We were able to interview a person who worked with the
Babbelbox from Man Bijt Hond, the original concept on
which our solution is based. The goal of this interview was
mainly to identify important aspects to consider when work-
ing with a similar solution. Not unlike our concept, the
Babbelbox, as shown in Figure 5, is a mobile pillar, which
is put into diverse places, to ask a range of people about
their opinion or personal stories. The aspects that we dis-
cussed were the appearance and placement of the box, how
to engage people, how to create good statements, and the
advantages and limitations of this solution from their expe-
rience.
The following is a summary of the main learning points taken
from the interview with Andrea from Man Bijt Hond. The
appearance and placement of the box play a big role in en-
gaging people. The more official the box looks, the clearer
and more understandable the concept is to the user. Accord-
ing to our interviewee, even a simple banner would suffice
to explain the concept and people appreciate it when they
know what kind of company is involved. It appeared that
shopping centers are great places to put the box and engage
people, but it has to be kept in mind that explicit permission
from the shopping center is required.
Also, indoors use of the concept is recommended due to
weather constraints, and placing it in a central place has
proven positive for the engagement of people. According to
our interviewee, people require enthusiastic motivation from
the people working the concept in order for them to interact.
Another way to motivate people to participate is by putting
up a sign or banner which says for example: Give your
opinion on vaccinations here!.
Concerning the user response, it has to be made sure that
people state their opinions and stories briefly. It would also
be convenient to have an assistant present, who actually
knows about the content that is being discussed, e.g. a
spokesman of the UMC. Thinking about the answers people
could give beforehand, could also help with selecting par-
ticipants so that you are able to collect different opinions.
Besides opinions, personal stories are very effective in trans-
ferring a message or addressing viewers of the video.
The advantage of the Babbelbox is that you have the pos-
sibility to link it to a brand such as the UMC and create
a platform out of it. Simply filming people on the street,
may result in an aggressive association as opposed to a more
fun interviewing experience. A box really stands out in the
crowd, especially when it is branded with the UMC logo.
The Babbelbox has proven to be a successful and popu-
lar way to reach people, because you put the box on places
where all kinds of people come. People are always interested
in personal stories and you can encourage this with such a
concept. Also the Dutch newspaper De Telegraaf is exper-
imenting with a similar Praatpaal at the moment. More
companies think this concept has potential, therefore it is
worth trying out the concept.
Figure 4: Timeline displaying the various activities associated with the production process of the Chatterbox
concept.
Figure 5: The Babbelbox by Man Bijt Hond.
4. DISCUSSION AND CONCLUSION
In this report, we presented a critical reflection of our de-
sign process and the outcomes related to that design pro-
cess. At the start of this project, our focus was on solving
this problem regarding the conceptual and social contexts in
this design process. By using the design thinking method-
ology, we were able to build a concept solution for UMC.
This report described our process and presented our most
important findings and insights in this project.
The goal of our concept is to establish a connection and in-
teraction that bridges the gap between the UMC and the
citizens of Utrecht, by giving the citizens of Utrecht the op-
portunity to ask their questions, or to respond to the UMC,
thereby providing UMC with both feedback and individual
interests. This solution will provide the UMC with the con-
trol over the information they require, regarding the content
and presentation. We propose the idea of broadcasting a
short video or documentary every month, where UMC pro-
vides a topic of discussion, and where the citizens of Utrecht
can respond. By placing our concept in a crowded place such
as a shopping center or market, a lot of people can be in-
cluded and given the chance to participate in the making of
the video, while the UMC maintains control over the con-
tent.
It was important to discover whether people search for med-
ical information in the first place. As we found out, many
have the need and most of them search for it online. Al-
though, we were not able to test our concept due to time
constraints and feasibility of a prototype. Therefore, we
conducted an expert interview with a member of the news-
room from Man Bijt Hond to receive the information that
we needed. However, many possibilities have not yet been
explored and become therefore interesting avenues for future
work and inquiry.
5. RECOMMENDATIONS
Based on the outcomes of the design process, testing and
reflecting, we have several recommendations. To make the
Chatterbox successful, a small, but dedicated team should
be put in place at the location of the box. The team should
consist of someone with a media background, e.g. a cam-
eraman, to help with technical aspects such as visuals, au-
dio, and lighting. It has to be kept in mind that not only
technical knowledge is required, but that this person also
requires some experience in directing. It also needs to be
considered, that this person gathers and encourages people
to participate and provides these people with the needed in-
structions. This person could also be the person who will
create the script and edit the final video. It could be also
useful to have someone in the team who has knowledge of
the content of the statements, such as a spokesman from the
UMC.
[8] Velasquez, M., Moberg, D., Meyer, M., Shanks,
T., McLean, M., AndrAl, C., and Hanson, K.
Discussion and debate at markkula center for applied
ethics. Discussion, 2009.
[9] Villalba, E. Critical thinking. In Encyclopedia of
Creativity, M. Runco and S. Pritzker, Eds. Elsevier,
London, 2011, pp. 323325.

Besides an adequate team, the box itself should have a pro-

fessional appearance, via which the brand of the UMC and
the purpose of the box should be made clear. We also rec-
ommend to utilize folders containing information about the
future video. These folders can be handed out to partic-
ipants, providing them with the information they need to
find themselves in the end product and to share it on so-
cial media. Concerning the presentation of the final video,
we suggest it should be broadcast via the main website of
the UMC and advertised via social media. Finally, to uti-
lize this concept, a camera, audio equipment, lighting, and
editing software is requited.

6. FUTURE WORK
Despite the initial testing alongside the care which has been
taken to gather the expert opinion of those who have worked
with a similar concept in the past, much work can still be
done. The next step for this project would be to create a
pilot in order to accurately gauge user reception of the con-
cept. For this pilot, it is recommended to recreate the entire
experience, which includes constructing a full version of the
proposed device and a documentary. In the case of financial
constraints, it is possible to perform a discount version of the
project by using a life-size paper mock-up instead. If this pi-
lot proves effective enough, studies may be done to ascertain
where to best place the device to reach the most diverse au-
dience. Furthermore, research into which platforms are best
suited for the final products, such as regional television or
screens in local general practitioners aAZ waiting rooms in
addition to the Internet, would shed light on how to ensure
that the content reaches those who are not capable of using
the Internet.

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