Abstract
Despite the increased recognition of health disparities and recent strides taken to improve health care accessibility, a legacy of discrimination against minorities and patients who do not mirror the image of the “standard patient” in the United States still endures to this day. In this undergraduate thesis portfolio, two projects associated with intentionality in health care are presented. Firstly, the technical component of the portfolio explores the development of an expansion mechanism for bariatric chairs to better seat patients of larger size. While the prevalence of adults with a body mass index (BMI) of over 40 in the United States is increasing (Emmerich et al., 2024), many artifacts—such as hospital chairs—within the health care setting remain the same as before. Secondly, the sociotechnical component of the portfolio examines barriers in health care access and quality for Indigenous Americans in the contiguous United States, as well as the potential of community-involved public health collaborations in improving Indigenous health. Together, these projects emphasize the importance in the health care field of ethical engineering and design with patients in mind. When the intentionality behind improving human health is overlooked or assumed to be superfluous, the burden of inadequate care ultimately falls on the patients themselves.
The technical capstone project investigates the development of an expansion mechanism for bariatric chairs used in the hospital setting to promote patient mobility and minimize adverse health effects from unsuitable seating. Standard hospital chair sizes pose a problem to larger patients—both in terms of weight capacity and comfortably fitting in the chair. While bariatric chairs have entered the market, accessibility for the bariatric population is still insufficient. While bariatric chairs have been developed to accommodate weight capacities of up to 1000 lb, current seat widths remain fixed at 31 in. for models such as the Shuttle Agiliti B (Agiliti, n.d.). For patients of larger size, the seat width is too narrow, which can lead to skin pinching, pressure sores, and other complications. The design proposed in the technical paper is informed by the mechanism of expansion for bariatric hospital beds at UVA Health. Computer-aided design was used to create the expansion mechanism, and finite element analysis simulations were performed to evaluate weight capacity and operation under working conditions. Ultimately, the development of more accommodating bariatric chairs is not just a matter of practicality and mitigation of health complications for patients of larger size; it is also a matter of facilitating patient equality and dignity as they receive care (Wignall, 2008).
The STS research paper critically examines the barriers to accessible and inclusive health care for Indigenous Americans residing in the contiguous United States. Numerous health disparities affect Indigenous communities disproportionately compared to their White counterparts, such as diabetes or tuberculosis, despite broad advances in the care of these conditions. Insufficiencies in current health care infrastructure can be traced back to the colonization and erasure of Indigenous peoples, which has historically been reinforced legislatively on the federal level; this legacy has also established a sense of mistrust in the health care system. Select case studies of community-based participatory research (CBPR) health initiatives are analyzed through the lens of the framework of situated intervention, as proposed by Dutch scholar Teun Zuiderent-Jerak. In CPBR, the fostering of open dialogue between Indigenous community members and researchers as parties with equal say is crucial in the development of culturally-grounded health initiatives that serve to address specific community health concerns. Ultimately, Indigenous health equity cannot be achieved independently from the intentional involvement and empowerment of Indigenous communities.
Both the technical and STS projects aim to emphasize the necessity of intentional and inclusive design in the health care setting. The integration of these projects has given me a deeper understanding of the systemic, multi-faceted issues that plague health care access and quality today. There exists an underlying infrastructure of marginalization of patients who do not meet the norm, borne of a history of prioritizing the average White American man. While the technical capstone encouraged the application of practical skills I have developed over the course of my undergraduate years at UVA, the STS research paper allowed me to more critically analyze the shortcomings of the system we experience today and how these shortcomings disproportionately affect the non-average patient. I believe that the research performed for this portfolio over the course of the academic year has emphasized the interdependence of ethics and engineering across all disciplines, including the furthering of health equity.
