The Global Care Ecosystems of 3D Printed Assistive Devices
Saiph Savage, Gabriela Marcu, Karina Caro, Hilda Chavez, Rosa I. Arriaga · 2022 · ACM Transactions on Accessible Computing · doi:10.1145/3537676
Summary
This study examines the global care ecosystems that have emerged around 3D printed assistive devices, focusing on upper limb prosthetics. The researchers conducted semi-structured interviews with 31 stakeholders from 10 different care ecosystems spanning seven countries: Brazil, Chile, Costa Rica, France, India, Mexico, and the United States. Participants included 6 clinicians, 9 makers, and 16 device recipients. The research fills a significant gap in understanding how 3D printed AT ecosystems function outside the US and Canada, where most prior research has been concentrated. The authors investigate how different healthcare systems, cultural contexts, and economic conditions shape the dynamics of these care ecosystems. They examine organizations like e-NABLE (a global network of volunteer makers producing 3D printed prosthetics) alongside clinical programs integrating 3D printing into rehabilitation services. The methodology involved 45-90 minute interviews exploring stakeholders' experiences, motivations, challenges, and perspectives on collaboration. Thematic analysis revealed five major themes: collaboration approaches within ecosystems, structural support mechanisms, identity formation among stakeholders, user perspectives on their devices, and the influence of maker culture. The study uniquely captures the interplay between medical institutions, volunteer maker networks, and device recipients across dramatically different healthcare contexts.
Key findings
The most successful care ecosystems featured robust multi-stakeholder collaboration involving clinicians, makers, and recipients working together throughout the device lifecycle. Ecosystems with clinical involvement showed better outcomes—clinicians provided expertise on fit, safety, and rehabilitation that makers alone could not offer. Device abandonment emerged as a critical concern, with follow-up care identified as essential for long-term device use. Ecosystems that maintained ongoing relationships between recipients and other stakeholders showed higher satisfaction and continued device use. Recipients who adopted a "growth mindset" from maker culture—viewing devices as iteratively improvable—reported greater satisfaction. The study identified "medical makers"—clinicians who also engage in fabrication—as particularly valuable bridges between medical and maker communities. Formal agreements and compensation mechanisms, while varying across contexts, helped sustain stakeholder participation. In some regions (notably India), monetary compensation for recipients was necessary to enable participation, while in others it risked undermining intrinsic motivation. Healthcare system differences profoundly shaped ecosystem dynamics. In countries with universal healthcare (France, Costa Rica), 3D printing supplemented rather than replaced traditional prosthetics. In the US, where insurance often doesn't cover prosthetics, 3D printing served as a primary option for many recipients.
Relevance
This research has significant implications for organizations developing or distributing 3D printed assistive technology globally. The finding that multi-stakeholder collaboration—not just maker enthusiasm—drives successful outcomes suggests that AT programs should actively integrate clinical expertise and recipient feedback throughout design and distribution. The study's recommendations for "storehouse" platforms that support cross-ecosystem collaboration offer a roadmap for improving existing resources like NIH 3D Print Exchange. Such platforms should include meta-data on safety, design variants, licensing, and follow-up protocols—information currently lacking in most repositories. For accessibility practitioners, the research highlights the importance of considering healthcare system context when evaluating AT solutions. A 3D printed device that works well in a system with robust follow-up care may fail in contexts where recipients lack access to ongoing support. The study also demonstrates that device abandonment is not simply a design problem but an ecosystem problem requiring sustained relationships and support structures.
Tags: 3D printing · assistive technology · prosthetics · maker movement · care ecosystems · global health · e-NABLE · upper limb prosthetics · multi-stakeholder collaboration