1 Introduction

The ideas presented in this chapter were developed as part of a doctoral project to design appropriate personalized strategies for ludic communication between people with dementia and those in their close social circle, while inviting them to participate in the process (Branco 2018). The research questioned how the values of person-centered care (Brooker 2007; Killick and Allan 2001; Kitwood 1997) based on respecting and maintaining personhood and social relationships could be used and reflected in the designed artefacts and in the configuration of participatory design processes involving people with dementia.

2 Personhood and Positive Person Work

The concept of personhood, originally associated with dementia care by Kitwood (1997), refers to a relational sense of self which is conveyed by others, highlighting that we can only be truly a person if we are recognized as such by others, and that our sense of self is maintained through being in relationships, and thus in communication. Kitwood (1997, pp. 89–92) described ten types of interaction toward people with dementia that address their psychological needs, preserve personhood, and enhance well-being, naming them Positive Person Work. He viewed this approach as being in opposition to Malignant Social Psychology (Kitwood 1997, pp. 45–49), a group of 17 interactions that he perceived as a threat to personhood. Positive Person Work includes recognition, negotiation, collaboration, play, timalation (referring to sensorial stimulation), celebration, relaxation, validation, holding, and facilitation. In fact, Kitwood (1997) mentioned two more interactions: creation and giving. While the first ten are initiated by the carer, positioning the person with dementia as a receiver, the second two arise spontaneously from the person with dementia, to whom the carer should respond in an empathic and encouraging way. In this chapter, we focus on these initial ten interactions.

2.1 Designing for Positive Person Work

The relationship between humans and material objects are described by Verbeek (2012) as mediation. In his view, ‘material objects play a role in the relations between humans and their world, helping to give shape to the nature of their experiences and activities’ (p. 167), and that ‘an intervention in the material world is always an intervention in the human world’ (p. 172). Likewise, Niedderer (2007) discusses the role potential artefacts have in mediating social interaction, suggesting a triangulated interaction. Among other design research concerned with designing for positive experiences and subjective well-being (Hassenzahl 2010; Pohlmeyer and Desmet 2017), Pohlmeyer (2013) analyzes possible roles that design can have in promoting happiness. She recognizes artefacts as direct sources of happiness; artefacts as enablers of an activity that contributes to well-being; artefacts as symbolic representations of something valuable to people; and artefacts as support and encouragement to motivate and guide people to happiness-enhancing activities.

Drawing on these ideas, we propose three main functions that artefacts can have in promoting Positive Person Work interactions (Fig. 8.1): (1) artefacts can act as symbols, if their pragmatic and hedonic attributes correspond and symbolically suggest the values and attitudes inherent to the Positive Person Work interactions; (2) artefacts can be catalysts of Positive Person Work, providing the interactions directly to the person with dementia; and (3) artefacts can support others to initiate Positive Person Work with the person with dementia, mediating these interactions and acting as vehicles for communication.

Fig. 8.1
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Roles of artefacts in promoting Positive Person Work

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It is important to note that although artefacts might have the potential to promote these interactions, and thus positive experiences for people with dementia and those taking part in the interaction, the experience also depends on how each individual person perceives and uses the artefact. Desmet and Hekkert suggest ‘Experience is not a property of the product but the outcome of human-product interaction, and therefore dependent on what temporal and dispositional characteristics the user brings into the interaction’ (2007, p. 7). We begin by providing an overview of the ten Positive Person Work interactions and reflecting on how artefacts can promote these interactions.

2.2 Designing for Recognition

In this context, Recognition refers to the acknowledgement of the person with dementia as a person, and the affirmation of her or his own uniqueness (Brooker 2007; Kitwood 1997; Van Weert et al. 2006). Designing for recognition implies that what is designed demonstrates respect and dignity for the person, both in the proposed use and mediated interactions, and aesthetically. Recognition can be used as a design strategy to affirm the person’s identity and uniqueness. Artefacts can be triggers to support talking about identity and idiosyncrasies. This can be further reinforced if artefacts invite and allow for personalization, such as including the person’s names, emphasizing her or his characteristics and virtues, using known references, and promoting activities that are meaningful. The use of references, from the past or from popular culture, to elicit autobiographical memories is a frequent strategy in designing for people with dementia, especially if the aim is to engage them in activities and conversation. Here, recognition is related to reminiscence, ‘the voluntary or involuntary action of recollecting memories from one’s past’ (Afonso et al. 2016, p. 2), which consists of ‘making deliberate attempts to trigger memories of the past and use them as a vehicle for communication in the present. Reminiscence provides opportunities for people to communicate about their memories in their own way’ (Bruce and Schweitzer 2008, p. 170). These interventions regularly use artefacts as a stimulus to start conversations and trigger memories, thus making it easily understandable why design would explore it.

2.3 Designing for Facilitation

Facilitation is about enabling action by noticing what is missing and supporting people to perform activities that otherwise would be difficult to achieve (Brooker 2007; Kitwood 1997), maintaining their abilities, supporting independence, and creating a sense of agency. Facilitation also refers to enabling the creation of meaning, which according to Hassenzahl (2010), lies in the hedonic characteristics of an artefact (i.e., its aesthetics, attractiveness, capacity to stimulate and to communicate one’s identity). In fact, Hughes (2014) describes people with dementia as ‘aesthetic beings’, referring to their embodied engagement with all the dimensions of the world, not only through understanding, but also through the senses. Designing for people with dementia can be envisaged as an opportunity for supporting this aesthetic approach and creating aesthetic experiences. In addition, aesthetic decisions can support functionality and ease of use, by making artefacts culturally and personally relevant and less stigmatizing: creating a familiar and recognizable appearance; utilizing contrasting colors to help to distinguish different elements; creating consistency among different elements; emphasizing the essential functions and features and avoiding unnecessary complexity (Gowans et al. 2007; Pullin 2009; Timlin and Rysenbry 2010; Zeisel 2009).

It is important to envisage possibilities and uses that can support differing abilities, across the progression of dementia, and to understand what can be helpful and enabling, or confronting and diminishing. For example, while a person in more advanced stages of dementia might need a specific artefact to undertake a certain activity, someone in the early stages might find the same artefact stigmatizing. This might, therefore, require the design of different solutions or artefacts to adapt to these changes. Artefacts that assist care and support the carer also fit into this concept of facilitation.

2.4 Designing for Negotiation

Negotiation consists of providing opportunities for exercising control and choice (Brooker 2007; Kitwood 1997), through being consulted about needs and preferences in daily life, or through stimulating personal and creative expression (Allan 2001).

Artefacts can play a role in triggering conversation and create space for dialog (Wallace et al. 2013) and can be catalysts of choice, despite the difficulties in communicating verbally, understanding, and remembering. The ability to recognize rather than remember is key and so multiple-choice formats are often less compromising and easier for people with dementia (Sabat 2014). Artefacts can be designed to provide several options and possibilities, allowing people to choose and can include elements that can be moved around, offer different aesthetic possibilities such as color, or provide different possibilities for use. Another way of designing for negotiation is to leave space in artefacts to stimulate self-expression and creativity or that support artistic activities (Killick and Craig 2011).

2.5 Designing for Collaboration

Collaboration means working together, involving the person with dementia ‘as full as equal partner’ (Brooker 2007, p. 94), instead of being a passive receiver of care. In the original definition by Kitwood (1997), facilitation and collaboration are interrelated. However, we chose to differentiate them, by emphasizing the enablement of people with dementia to undertake actions in facilitation and highlighting the promotion of joint actions in collaboration. Here, artefacts promote moments of togetherness and enable the person with dementia to participate in shared activities such as practical daily tasks or leisure. Designing experiences that involve cooperation, such as teamwork or artefacts that require interdependence, such as when the artefact needs more than one person to use or activate it, are possible ways to design for collaboration. Games are good examples of products that prompt social interaction and sense of togetherness, across different generations (Wildevuur et al. 2013). While inappropriate game experiences, which sometimes might be too challenging and competitive, may lead to frustration, appropriate games have the potential to improve the quality of life of people with dementia (Anderiesen et al. 2015).

2.6 Designing for Play

Play refers to spontaneity and self-expression (Kitwood 1997), and it is related to creativity, fun, and humor (Brooker 2007), which often have an important role in dealing with the adversities of dementia. Play can also stimulate imagination, positive enjoyment and active engagement, while promoting connectedness and bonding with others (Killick 2012). In order to design for play, artefacts need to promote fun through playful and sensorial experiences, encourage self-expression such as the sharing of stories, opinions, interpretations, feelings, or be related to artistic or creative activities. Caillois (1961) differentiates two types of play suggesting that paidia is free and spontaneous play and ludus is a more structured, game-like kind of play. Both can be taken into account and combined in designing for people with dementia.

While it is important that artefacts have familiar and recognizable appearances to facilitate understanding and use, ambiguous and versatile artefacts might trigger curiosity and openness, as they do not imply a right or wrong way to use them (Gaver 2009). Furthermore, deliberately designing an artefact that makes space for appropriation can be a way to add personalized, idiosyncratic elements that are relevant and meaningful for the person with dementia. Artefacts that allow spontaneous exploration with one’s hands, involving fiddling and fidgeting, can be pleasurable particularly for people with advanced dementia (Treadaway et al. 2019). While, as mentioned, competitive games are not always suitable for people with dementia, the structure, rules, and material elements of the game can prompt playful activities, moments of sharing, and creative self-expression. For example, simple operational rules can guide action and challenge people to participate; turn-taking can ensure equal participation in a collective activity, supporting more passive players to contribute; behavioral rules can encourage a playful and open attitude, as well as role-playing; and game materials can be things-to-think-with, and help to bridge gaps in communication (Brandt 2011).

2.7 Designing for Timalation

Timalation is a term coined by Kitwood which involves the provision of sensuous and sensory stimulation, without requiring intellectual understanding: ‘The significance of this kind of interaction is that it can provide contact, reassurance and pleasure, while making very few demands’ (Kitwood 1997, p. 91). Artefacts can be used as catalysts for sensorial stimulation, designing sensorial elements to provide a more active and energetic stimulation or in calmer moments, helping people to slow down and relax (Treadaway et al. 2015). Artefacts can support communication between persons with dementia and others, helping carers to develop a sensitivity to communicate non-verbally (Treadaway et al. 2019). Additionally, they can support embodied selfhood, ‘the idea that bodily habits, gestures, and actions support and convey humanness and individuality’ (Kontos 2014, p. 123).

Designing for timalation also means that the sensorial aspects of products need to be emphasized. It is also possible to consider the senses in relation to all kinds of products, placing attention on the textures and smell of materials, possible sounds arising from the use of the artefact, as well as the visual elements, so that artefacts can have rich sensory qualities, despite their function (Lupton and Lipps 2018; Sonneveld and Schifferstein 2008). However, overstimulation needs also to be considered.

2.8 Designing for Celebration

Celebration does not only refer to special occasions, but the experience of joy at any moment in life by promoting a friendly atmosphere. According to Kitwood (1997), this is a form of interaction where the differences between people with or without a diagnosis become less noticeable. Brooker (2007) suggests celebration is also ‘recognizing, supporting and taking delight in the skills and achievements of the participant’ (p. 92). Creating artefacts that enhance celebratory moments and focus on celebrating the person and what is meaningful to her or him, as well as her or his achievements, can be ways of designing for celebration. Furthermore, using humor, surprise, fun, and music can support the experience of celebration and joy through artefacts.

2.9 Designing for Relaxation

Relaxation consists of slowing down and creating a calm atmosphere (Brooker 2007; Kitwood 1997). Dementia symptoms can generate a lot of anxiety and agitation (Zeisel 2009), therefore people often need help to relax. Kitwood (1997) points out that some people with dementia are only able to relax when near others because of their high social needs. Artefacts can play a crucial role as catalysts of relaxation, mainly by providing comfort, warmness, and encouraging people to slow down, while being entertaining and appeasing. Friendly and familiar-looking artefacts can avoid stress, and a choice of soft tones and textures, that are pleasing to touch, or provide appropriate lighting can promote a relaxed environment (Bennett et al. 2016; Biamonti et al. 2014). Artefacts can also support carers in providing relaxation by inducing a calm atmosphere, or by suggesting to carers that they adapt to the pace of people with dementia. Even if slowing down is not the primary aim, the engagement in relaxation activities often makes people comfortable and at ease, distracting them from obsessive thoughts or behaviors (Branco 2018).

2.10 Designing for Holding

Holding ‘means to provide a safe psychological space, a container’ (Kitwood 1997, p. 91). Van Weert et al. (2006) adds empathy to the definition of holding so that the feelings of the person are accepted and responded to, with warmth and affection, and Brooker (2007) includes the provision of security and comfort as part of this kind of interaction. While promoting a relaxed environment, familiar and comfortable objects might foster a feeling of safety. Calming cues might help the person to reduce anxiety and feel secure. Personal belongings can also be reassuring and help to maintain some sense of autonomy (Treadaway et al. 2019). However, even if artefacts can be designed to promote a safe and comforting environment, holding is essentially a human interaction, which cannot be substituted for by artefacts. Therefore, it might be more relevant to design artefacts to support carers to provide this secure and comfortable environment. This can be done by either developing tools that help them to understand what and who causes the person to feel safe or unsafe, relaxed or stressed, and why, or by prompting collective activities that are suitable and pleasurable for the person. This approach encourages people with dementia to feel included and validated, which can be even more meaningful if occurring with those in their close social circle (Branco 2018).

2.11 Designing for Validation

Validation refers to the acknowledgement and sensitivity of the experience, emotions, and subjective truth of the other, and of responding accordingly, at a feelings level. It requires empathy to seek an understanding of a person’s frame of reference (Brooker 2007; Kitwood 1997). Similarly to holding and perhaps even more so, validation is a deep human interaction. An artefact can have a tender, affectionate appearance and language, and can be personalized, but for this kind of interaction people are needed. If artefacts create opportunities for people with dementia to be included in an activity, encouraging them to participate at their own pace and way, this might encourage others to listen and respect their contributions, relate to them, and validate them. Another approach consists of designing for empathy (Devecchi and Guerrini 2017; Gamman et al. 2015) and supporting carers to have an empathic and emotional understanding of the perspective of the person with dementia.

3 Codesigning with Positive Person Work

Along with design research about the participation of people with dementia in the design process (e.g., Branco et al. 2017; Hendriks et al. 2014, 2015, 2018; Kenning 2018; Lazar et al. 2017; Lindsay et al. 2012; Morrissey et al. 2017; Orpwood 2009; Wallace et al. 2013), studies about the involvement of people with dementia in research (Cowdell 2006, 2008; Dewing 2007), and research relating to communicating with people with dementia (Downs and Collins 2015; Killick and Allan 2001), Positive Person Work can be used in codesign processes involving people with dementia. For example:

  • Including people with dementia as active participants in the design process, showing respect, greeting participants by their name, being sensitive to how they communicate, observing, listening carefully and non-judgementally, are all ways of taking recognition into account.

  • Finding ways to facilitate participation through adapting the process to suit participants, setting up meetings that are not too long, having a warm and open attitude, avoiding activities that require abstract thinking, having good quality prototypes to try out, and redesigning tools and materials to support participation.

  • Activities and materials can also be designed to promote negotiation, encouraging the exercise of choice, and providing opportunities for recognition rather than recall.

  • The collaboration of family members and formal caregivers is also important to encourage participation, interaction, and bonding, although it should be ensured that people with dementia still have space to contribute by themselves.

  • Codesign activities can constitute moments of fun and self-expression, thus embedding play.

  • Timalation relates to paying attention to non-verbal gestures and expressions, and what they communicate about how a person is feeling, and the use of tangible and sensorial materials.

  • Codesign activities should also focus on celebrating participants’ abilities, their life history and personal references, as well as congratulating and valuing their contributions.

  • It is important to ensure a relaxed and easy-going atmosphere, respecting the pace of participants.

  • Creating a comfortable, non-judgemental, and friendly environment, demonstrating a caring and comforting attitude are also ways to encourage the person to feel secure enough to participate, thus taking holding into consideration.

  • Validation demands an empathic attitude as shown:

    • during the planning, by understanding if what is being asked of participants is appropriate, and consulting family or formal carers about topics that might be confronting or elicit negative emotions;

    • during participatory events, by observing and paying attention to signs of tiredness, anxiety, boredom and or frustration and responding to participants’ reactions and feelings; and being open to stop or postpone a meeting if it is not a good day and the person wishes to, even if not all the goals for that sessions are fulfilled.

    • after the research project is finished, by planning exit strategies.

4 Positive Person Work as Evaluation

In the present research, a codesign process was carried out based on the ten themes of Positive Person Work. It involved people with dementia and their families, and yielded several artefacts, either designed from scratch for a particular person or family, or through the personalization of previously conceived artefacts. These outputs were produced and delivered to the participating families, as well as used in institutional settings. While it is not possible to provide details of the process here, it is useful to show how the themes of Positive Person Work can be used to evaluate the artefacts produced. Family members and healthcare professionals evaluated how the artefacts were used and experienced, based on interviews and on a card sorting exercise devised to understand if participants perceived and associated the Positive Person Work interactions with the artefacts. Interviewees were invited to select the interaction they associated with the artefact from a series of cards that contained details of each interaction, and to explain their choice (Fig. 8.2). In addition, healthcare professionals were asked to reflect on ways in which the artefacts mediated these interactions (Fig. 8.3), and acted as

Fig. 8.2
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Choosing interaction-cards for the Positive Person Work evaluation exercise

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Fig. 8.3
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Positive Person Work evaluation exercise, including the associated roles of artefacts in promoting Positive Person Work

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  1. 1.

    direct catalysts of the interaction with the person with dementia;

  2. 2.

    as support for the carers to deliver the interaction;

  3. 3.

    as a symbol of the values inherent in the interactions.

Although the sample was not large enough to draw specific conclusions, these exercises served as a basis for discussing and reflecting on the association between Positive Person Work and the design of artefacts for and with people with dementia. In order to illustrate this evaluation exercise based on Positive Person Work, we will focus on two of the products that were analyzed by family members and healthcare professionals:

  1. 1.

    The Board Game (Fig. 8.4) is a simple game that can be personalized. It was designed to provide opportunities for families to engage with their relative in a collective activity, by compiling details of some of the activities delivered by the institutions, and presenting them in an easy format to enable families to do them at home (Branco et al. 2015).

    Fig. 8.4
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    A personalized board game

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  2. 2.

    The Tactful Things (Fig. 8.5) consist of two artefacts that make use of textiles to deliver appropriate and appealing tactile and visual stimulation. These artefacts were designed to respond to a specific person’s need to touch and hold things with her hands, and to the observation of her particular gestures to sensory fabrics. They also referenced the person’s past devotion to knitting and lace-making (Branco et al. 2016).

    Fig. 8.5
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    The Tactful Things: crocheted rings and a poncho with different textures and colors

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When asked to associate the Positive Person Work interactions with the two artefacts, none of the participants had difficulties in selecting several. Some participants chose all the interactions they considered the artefact could mediate, even if they noted that the interactions could be hindered by the setting or how the use of the artefact was supported. Other participants selected only those that they believed were occurring more obviously through the use of the artefact. In considering both artefacts, recognition, holding, and relaxation were the interactions selected most often by participants.

Participants mainly associated recognition with the inclusion of personal content and activities, which was seen as a way to make it more meaningful and to validate the person with dementia. While The tactful things were created based on the gestures and preferences of a specific person, The board game allowed for personalization, promoting life history through references to people’s identity and stories:

…it makes her identify herself with the game, to see herself as a person. It stimulates the memories of who they truly are. (relative, family B, 24.03.2017)

Holding was associated with the comfort and relaxation provided by The Tactful Things and with familiar themes and activities in The Board Game. These were regarded as crucial in making people feel secure in participating, in the promotion of a comfortable and friendly environment and in playing with those who are close, by encouraging bonding, and the feeling of safety that can emerge from it:

The game ends up facilitating that [holding] due to the themes. … When he doesn’t control the game, he might feel insecure and inhibited. In the case of The Board Game, the themes are familiar to him. (relative C, family A, 05.03.2017)

The creation of an easy-going atmosphere was also regarded as being closely connected to relaxation. The ludic function of The Board Game was believed to directly contribute to making participants at ease, encouraging their participation without feeling judged, and constituting an entertaining occupation. However, it was noted that this is conditioned by how others facilitate the use of the artefacts. Participants believed The Tactful Things helped relaxation, due to the touch and warmth they provide, as well as the choice of soft and pleasant textures which were linked to comfort:

the fact that it promotes some comfort will help the person’s restlessness, and support the person to stay calmer, more relaxed. (psychologist A, 15.03.2017)

Timalation was an obvious choice for all participants regarding The Tactful Things, due to its multi-sensorial qualities. Nonetheless, timalation was also associated with The Board Game because of the variety of activities in the game, and the possibility offered for reminiscing indirectly impacting the senses.

Play was linked to the artefacts because of their ludic appeal, and the enjoyment observed when people used them. In the case of The Board Game, its potential to create a fun environment and enjoyable moments was emphasized. The playful appearance of the playing pieces and dice also contributed to creating a playful mood among the participants. In addition, the professionals also called attention to the possibility for personal expression that the game allowed, through some of the tasks and particularly the sharing of stories.

Facilitation was associated with the artefacts’ capacity to support the person in using their abilities. The Board Game was thought to unblock communication and promote the sharing of stories. The use of different types of prompts and cues, which need to be in part stimulated by the person conducting the activity, proposed themes that otherwise may not be talked about. The Tactful Things facilitated exploration, by supporting the natural need of people in more advanced stages of dementia to move and hold things with their hands.

Although The Board Game was thought to promote a joyful and convivial atmosphere due to its ludic function, a sense of celebration also relies on how the activity is conducted. Celebration was associated with people’s references and preferences, as well as to the development of artefacts that do not make cognitive demands, such as The Tactful Things, which rewarded all kinds of responses:

I also chose celebration because it is something that does not expect anything from the person on that task. Everything is possible. … Whatever she does will be positive and has value. (psychologist A, 15.03.2017)

Participants chose collaboration as an interaction occurring during the use of The Board Game because it promoted a collective activity that brings together groups of people, whereas The Tactful Things are more suited to individual use or just one carer. Participants agreed that The Board Game encouraged collaboration in a very natural way, because of its ice-breaking qualities, which supported group cohesion and well-being.

The presence of others and the dynamics of the activity are crucial in the development of validation. The space created for personal expression, and specifically the turn-taking aspect of The Board Game, encouraged people to listen, respect, and acknowledge the stories and choices of others. In the case of The Tactful Things, validation was related to the opportunities for interaction and non-verbal communication between the person with dementia and others that the artefacts permitted:

Although she doesn’t speak, there are other things that communicate at a higher level. It was noticeable that she understood that there was empathy and sensitivity towards her. She felt recognized. (psychologist E, 23.03.2017)

Finally, negotiation was the least selected interaction. According to the participants, neither The Board Game nor The Tactful Things offered many options for people to choose from. However, negotiation was associated to the presence of multiple-choice and with the opportunities for personal expression stimulated by the artefacts.

5 Conclusion

The values and strategies of each Positive Person Work interaction are combined and overlapped in a complex web of relations. This does not mean that all artefacts should include all interactions. For example, although sometimes play can be relaxing, these two interactions correspond to different forms of engaging, one more active and stimulating, the other calmer and more tranquil. Moreover, similar strategies can be used to reach different goals. For example, timalation can support both playful and relaxing interactions.

While initially the interactions related to artefacts are interpreted from the point of view of the designer, the evaluation brings the user’s perspective to the fore. In this project, this shift brought about important considerations and conclusions (see tables below Figs. 8.6 and 8.7). It was insightful to understand what design intentions became apparent and how they were perceived. For example, it was surprising that holding was one of the most favored interactions when, from a design point of view, it was more difficult to find design strategies to deliberately mediate and promote it through an artefact. Similarly, relaxation was associated with the use of all artefacts because they provided ludic occupation, whereas from the design perspective relaxation was mainly associated with the specific intention to slow down and relax.

Fig. 8.6
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Synthesis of main reflections on designing for Positive Person Work

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Fig. 8.7
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Synthesis of main reflections on codesigning with Positive Person Work in consideration

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The perspective of use also reinforced the role of the caregiver in ensuring a beneficial use of the artefact, and in promoting these interactions. Despite the value attributed to the artefacts, even when families were involved in the process, the artefacts were not sufficient to provide the experience of these interactions, and could even have undesired effects. The designed artefacts aimed to create opportunities for people to communicate; however, they always relied on caregivers in their use. In fact, the range of experiences in the use of artefacts shared by participants revealed the many different ways of approaching them. The artefacts were dependent on the operationalization of the activity and the capacity of the facilitator to adapt use, observe, and respond to people’s reactions. The institutional setting, that included healthcare professionals and more people with similar mental health conditions, facilitated a beneficial use of the artefacts. At home, while many families have the need and will to communicate and have meaningful moments with their relative, the setting, the emotional charge and the lack of sensitivity, among other reasons, make it more difficult to use the artefact in an enjoyable way. Many times, family members recognized that they were unsure of how to approach the artefact, and how to deal and respond to some reactions of their relatives.

In order to tackle these issues, it was proposed that different ways of using the artefacts are provided, from those with more to less demanding needs, so that carers are aware of different possibilities for use. In this way, they can adapt use to suit their relative with dementia, and not get attached to a particular way of using the artefact. Artefacts might be accompanied with simple recommendations on how to engage with a person with dementia in an activity, how to stimulate her or him to participate, how to respond, and what attitudes to avoid, among others. In this way, the artefacts could also be ways of sharing communication strategies, which can be of overall relevance when caring for someone with dementia (Downs & Collins 2015; Killick & Allan 2001).

This analysis of the artefacts by participants validated our proposal to associate the Positive Person Work interactions with the design of artefacts. Therefore, we believe that to have them in consideration in the design process is a valuable source of inspiration and a direction to contribute to a positive experience of use, as well as a way to gather discerning feedback on the outputs of design. Positive Person Work interactions can also be a useful and important guide for planning and involving people with dementia in codesign processes. Without intending to be prescriptive or to propose a single way of designing for people with dementia, these reflections are aimed at supporting a more conscious, ethical, and aesthetic approach to designing for and with people with dementia and their carers.