Enabling Abilities by Universal

Design: Mapping Academic 21

Initiatives

Turid Borgestrand Øien, Sidse Grangaard,

Jon Dag Rasmussen, Nanet Mathiasen,
and Victoria Lygum

Abstract expert, (3) systematisation of user needs and

(4) use of knowledge or a tool from another
The concept of Universal Design (UD) em-
field. To conclude, these findings illustrate
braces the diversity of user needs in relation to that planning and designing our future built
both the built environment as well as design environment is a shared responsibility and
products. The concept also addresses the
involves a range of stakeholders. The review
current agenda of “Leave No One Behind” shows attempts of bridging ideology and
and UD can be seen as a framework for design practice. However, to see the different
architectural practice and architectural
studies as a patchwork across research and
research to operationalise UN Sustainable design, could help us evolve the field by
Development Goals. Though, there is a gap standing shoulder by shoulder to reach even
between the theoretical elements of UD and
further regarding inclusivity.
the practicing world of design and architec-
ture. Several research initiatives have operated Keywords
within this intersection of architectural prac-
tice and research, trying to bridge the

Universal design Literature review

research-practice gap. Based on a systematic


Inclusivity Design ideology Design
literature review this paper addresses the practice
questions: How do the initiatives aim to
exceed a traditional user perspective, and by
which means do they engage with abilities and 21.1 Introduction
disabilities? How is the gap between design
ideology and architectural practice opera- In line with the United Nations 2030 Agenda
tionalised in these academic initiatives? Four (UN 2015) encompassing the sustainability
overall tendencies were discovered across the development goals and the pledge to “Leave no
sources: (1) use of the seven principles of UD, one behind”, the scope of inclusivity gain trac-
(2) user involvement or involvement of an tion in society due to several issues including an
aging population, increasing obesity and cultural
diversity (Steinfeld and Smith 2012).
T. B. Øien (&)
S. Grangaard
J. D. Rasmussen
Addressing these issues from an architectural
N. Mathiasen
V. Lygum stance is a challenge as the architectural practice
Department of the Built Environment, Aalborg is a complex context to navigate, with a wide
University, Copenhagen, Denmark
variety of projects, stakeholders and agendas.
e-mail: tuo@build.aau.dk

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 281
M. Mostafa et al. (eds.), Design for Inclusivity, Sustainable Development Goals Series,
https://doi.org/10.1007/978-3-031-36302-3_21
282 T. B. Øien et al.

Because in the framework of the individual seven principles (Cornell et al. 1997), and the
project, inclusivity is up against measures of eight goals (Steinfeld and Maisel 2012).
functionality and time-cost-efficiency (Zallio and However, despite being a “pervasive inter-
Clarkson 2021). Hence, design ideologies as disciplinary design methodology” (Steinfeld and
Universal Design (UD), Inclusive Design Smith 2012, p. 2540) in branches as product
(ID) and Design for All (DfA) have been design and industrial design, UD has still not
developed to embrace the diversity of user needs been fully implemented in engineering and
and are frequently used as synonyms among a architectural design. Professionals working
variety of different design procedures, both within the field of UD have criticised it for being
industry-established and tailored by the specific too abstract to apply as a process methodology or
practice (ibid.). The concept of UD was coined in tool in practice (Erdtman et al. 2021). Further-
the 1980’ies as a “[…] way of designing a more, the inclusive design ideologies have not
building or facility, at little or no extra cost, so it been fully integrated in architectural curricula
is both attractive and functional for all people, (Tauke et al. 2016). They are often confused with
disabled or not” (Mace 1985 p. 147). Today UD the paradigm of accessibility e.g. in continuous
is integrated in UN statements as designs and professional development (Shea et al. 2018) or
built environments “usable by all people, to the only seen relevant in relation to contexts of care,
greatest extent possible, without the need for e.g. hospitals and assisted living facilities (Van
adaptation or specialised design” (UN General der Linden et al. 2016). Consequently, there is a
Assembly 2007 article 2). However, Story et al gap between the ideological and meta-theoretical
(1998) argued that UD should be considered a elements of UD and the practicing world of
process rather than a result, as it was unrealistic design and architecture (Ielegems and Froyen
to design solutions that everyone could use. The 2014).
notion of UD as a process was emphasised in the One of the reasons for the inertia in the field in
work of the Global Universal Design Commis- making the built environment applicable by a
sion and later integrated in the work of WHO. much larger group of users, can be found in the
Here UD is described as “a process that increases management and transfer of knowledge between
usability, safety, health, and social participation practice and academia (Kirkeby 2015). How
through design and services that respond to the context-dependent and context-independent
diversity of people and abilities” (WHO 2011). knowledge is operationalised in each of the
Furthermore, it is described as a dynamic way of professional fields of practice, where user per-
thinking and working with design, a process that spectives and inclusivity ideally should be gui-
enables designers to create environments that ded by a dialogue between architectural research
accommodate and embrace the myriad different and architectural design practice. Where ideolo-
types of users that are represented in our diverse gies as inclusion and UD are used as inspirational
and ever-changing societies (Steinfeld and Mai- and context-independent metaphors supporting
sel 2012). Beyond the traditional categories of and qualifying the process, while context-
disabilities, UD holds a broader focus on abilities dependent knowledge is used to guide the prac-
where functional impairments can also be tem- tical problem-solving of the design process.
porary due to e.g. injury, socially or economi- Kirkeby (ibid.) emphasises the transformation of
cally vulnerable living situations, economic knowledge at stake in the design process as the
restrictions, medication, pregnancy or being a design solution and problem are identified and
caregiver to a disabled family member—where processed in parallel. And more particularly, for
“circumstances of everyday life reduce human knowledge to be implemented in this process and
abilities all the time” (Steinfeld and Smith 2012). across different contexts, it must be transferable.
To ease application for architectural practitioners However, the knowledge that design practition-
there have been different efforts of concretising ers typically apply in their design process range
the design philosophy of UD, as seen in the from random, but context-specific exemplars to
21 Enabling Abilities by Universal Design: Mapping Academic Initiatives 283

context-independent industry standards and free design and accessibility. Searches were
Building Regulations. The operationalisation of carried out using singular keywords and were
user knowledge has most often been unsystem- also combined in links comprising two and three
atic, and the knowledge of practicing UD has not of the identified keywords. The result consisted
been articulated, documented or accumulated primarily of conference papers. The collected
across the individual projects. Instead of reading material amounted to a total number of 3289 hits
research reports or articles, the practitioners want on the keyword of universal design in Scopus
to engage with the researcher 1:1, inviting the alone. Furthermore, the combined keyword
expert to the table (ibid.). Thus, Kirkeby points at searches in Scopus, along with the supplemen-
that, the dialogical in-person attendance of the tary searches in the complementary databases
researcher and the shared “reflection in action” and resources, contributed with a small quantity
concerning the specific task (p. 544) is an of novel findings and a body of recurring and
opportunity for a new kind of cooperation. Thus, previously identified material. The criteria for
she suggests that to ease implementation, including papers were that they had undergone a
research should focus more on context- peer-review process and were subsequently
dependent knowledge. deemed suitable for publication in a scientific
In recent years, several research initiatives publishing channel. Overall, a total of 4837
have operated within this intersection of archi- documents were found, of which a vast amount
tectural practice and research, trying to bridge the was excluded due to duplications or assessed out
research-practice gap, developing frameworks, of scope, based on an initial screening of title,
tools or methods for incorporating user knowl- keywords and abstract. Following the identifica-
edge and to support more inclusive designs. In tion of articles and papers that were initially
this paper we investigate initiatives that focus on evaluated and deemed appropriate in continua-
the design process and assess them in relation to tion of our research questions, the abstracts were
their focus, approach and outcome by posing the distributed in the group of authors for further
following questions: How do the initiatives aim scrutiny and a more thorough examination. This
to exceed a traditional user perspective, and by reading resulted in the formulation of 6 prelimi-
which means do they engage with abilities (and nary working clusters comprising learning/
disabilities)? And how is the gap between design teaching, user and environment, process/
ideology and architectural practice opera- method/tool/policy, examples on buildings/build
tionalised in these academic initiatives? environments/cities, status in the field and theo-
retical articles/review articles. Each of the 44
papers categorised in the cluster process/method/
21.2 Materials and Methods tool/policy was classified regarding what phase
of the construction process they addressed:
In this section, we account for the methodologi- mindset/program/predesign (sketching)/engi-
cal approach applied in the review and working neering design/occupancy phase/redesign. Papers
process. From November 2020 to December on space-mapping; specific design solutions and
2020 a systematic literature search was con- occupancy were excluded, resulting in 25 sour-
ducted using primarily the scientific database ces for the full review. At this point of the work,
Scopus with supplementary and minor searches the documents were distributed among a group of
in Avery Index of Architectural Studies, as well four reviewers, and the papers were delegated to
as library engine searches and general web a primary reader. In the first round of coding,
searches. The search strategy included the key- each paper was given a short description and
words universal design; architecture; built supplied with descriptive keywords (e.g. “tool”,
environment and landscape, and an array of “proposal of a new model” etc.) in order to
cluster concepts related to UD; design for all, characterise and systematise the sample. Some of
inclusive architecture, inclusive design, barrier the literature could potentially belong to two or
284 T. B. Øien et al.

more categories as it addressed different elements another framework is based on a case study of
in the defined thematic clusters. However, we open space in three Asian cities in relation to
decided that they would only figure in one cat- people with visual impairments. The seven
egory. In addition, and as a result of the focussed principles of UD and its 29 sub-points (Cornell
reading carried out at this point, four of the et al. 1997) are applied in a content analysis of
previously identified 25 sources were excluded documents, the evaluation of the spaces and the
from further investigation, landing at a total of 21 subsequent comparison of the three cities. Yet
papers. The last part of the review process con- another paper suggests a new design philosophy:
sisted of readings and re-readings leading ‘universal safety and design’. The original seven
towards discussion, analysis and the insights UD principles are used as a starting point in the
presented below. development of a basic guideline for product
design focussing on the products themselves but
also productivity and the working conditions for
21.3 Results the workers acknowledging that the age of the
workers will increase (Kim and Jeong 2020).
Across the 21 sources, published in the years This guideline is composed of six principles:
between 2005 and 2020, four overall tendencies physical support, flexibility, accessibility, ensur-
were discovered in the reviewed literature: ing safety and health, diversity and inclusion, and
(1) use of the seven principles of UD (2) user sustainability. Another paper describes the
involvement or involvement of an expert, development of a model for the design of
(3) systemisation of user needs and (4) use of Assistive Technology projects related to the
knowledge or a tool from another field. In the physical environment. The model is based on a
following section, the four tendencies are fusion of the principles of usability and the seven
presented. principles of UD combined with five categories
from Gibson’s sensory system in order to inte-
grate knowledge about the human sensory sys-
21.3.1 The Seven UD Principles tem into design practice (Livramento da Silva
et al. 2019). Based on a literature review, another
A tendency in the reviewed literature is, not paper (Mosca and Capalongo 2020) presents the
surprisingly as we deal with Universal Design, seven UD principles together with five other
the use of the seven principles of UD. In three of concepts and their criteria including e.g. the eight
the five papers in this category, the seven prin- goals formulated by Steinfeld and Maisel (2012).
ciples are integrated and used directly as a Thus, a Multi-Criteria Analysis concludes that
structure for a tool while they play a more basic they all intend to encompass three types of
role and are applied together with other concepts qualities: physical-spatial, sensory-cognitive and
in the two remaining papers. In the first paper, social. Based on this structure of categories, a
the authors’ interpretation of the seven principles model composed of criteria and indicators is
is presented aiming at raising awareness about developed. What characterises this cluster of
human diversity in the design process concerning papers is the ‘personalisation’ of the seven UD
bus rapid transit. The framework is completed principles in the development of an adapted and
with the suggestion of four initiatives to enhance expanded version aiming at the creation of a kind
the goal focussing on operationalisation, best of usability or tangibility in the design process
practices, production of knowledge about user when evaluating a design solution. Unfortu-
experiences, and creation of an understanding of nately, the papers do not explain how their
the complexity of identity systems (Bitterman models or frameworks should be used in the
and Hess 2008). In a paper by Siu et al. (2019), design process.
21 Enabling Abilities by Universal Design: Mapping Academic Initiatives 285

21.3.2 User/Expert Involvement in which given design projects are developed and
implemented. Therefore, as the authors argue in
In this category, the reviewed literature explores different manners, knowledge of user and expert
approaches towards the acquisition and integra- experience constitute a highly important foun-
tion of user and expert knowledge in the process dation for the development of successful inclu-
of working with UD. As a common outset, the sion in the built environment.
research reflects an aim to strengthen and Different methodological approaches towards
develop the level of inclusivity within built the acquisition of these types of knowledge are
environments. By acknowledging and gathering suggested in the articles. One is the development
perspectives and experiences from groups of of (fictional) personas applicable as a tool for
actual and potential users (Gossett et al. 2009; visualising diversity among future users in the
Siddall et al. 2011), user participants in design design stages (Siddall et al. 2011). Ask (2016)
processes (Broffman 2015; Gossett et al. 2009), describes how representatives for various user
stakeholders (Ask 2016), as well as from a range groups are engaged during consecutive meetings
of different experts (Heylighen et al. 2016; Ver- and feedback sessions along a design process to
meersch et al. 2018), the ambition is to produce inform the work of architects. While Heylighen
knowledge applicable in the design process. et al. (2016) apply explorative approaches
Common to the literature in this category is the towards the engagement of user-experts with
strive to decrease distances between the creative diverse impairments to assist and inform the
work carried out by architects during design redesign of an existing building. Another ambi-
stages, and the end users for whom the final tion is to create inclusive design among aborig-
design must be suited, appropriate, supportive inal peoples of Australia, and to overcome
and applicable. The argument posed is that cultural and linguistic differences between users
insights from e.g. disability studies and other and designers in the process. Thus, Broffman
relevant disciplines very rarely find their way to (2015) proposes the application of a visual and
mainstream architecture and construction pro- story-based methodology responsive to the
cesses even though conducted market studies diverse cosmologies and worldviews of the users
reveal interest in the idea of user and expert and the architects, respectively. In another con-
involvement (Vermeersch et al. 2018). Further- text, Vermeersch et al. (2018) suggest the facil-
more, the implementation of inclusive design itation of a participatory workshop to include the
strategies is challenged by barriers such as views and needs of future users. An example of a
overall economic factors and a lack of economic more consistent and holistic design approach
incentives towards including perspectives of founded in the philosophy of UD is presented by
people with functional impairments and other Gossett et al. (2009). They explore and describe
‘minorities’ (e.g. Heylighen et al. 2016). Other the decision-making process during the con-
barriers are complex policy, local languages, struction of a new office building in Chicago
cultural differences, and the effect of diverse housing a disability-rights organisation.
cosmological understandings and traditions at
play in given settings (Broffman 2015). These are
significant problems, as well as great opportuni- 21.3.3 Systematising User Needs
ties, in the operationalisation of universal design
within the architectural practice: They point to a The demand to include human needs in the
crucial need for deeper empirical understandings design process has led to the development of
of particular people, their needs as users of different tools and methods to generate, organise
architectural space and solutions, and of the and use information. As an example, on a macro,
broader socio-cultural and socio-spatial contexts meso and micro level a UD pattern tool put
286 T. B. Øien et al.

forward problems that users encounter in the 21.3.4 Transferring a Tool

physical environment and suggests architectural from Another Academic
and technological solutions for inclusive design. Area
These empirically based solutions are proposed
with the intention of accommodating a diversity When architects and designers design the actual
of users with different functionalities in a multi- solutions, that offer the most equal access for a
tude of situations and contexts. The UD patterns diverse group of people and, the best possibility
are meant as a basis for discussing the quality of of taking part in society and its surrounding
different design solutions and to give design environment, they look for guidance. How to
guidance (Froyen et al. 2009; Verdonck and complete a thorough process that results in a
Froyen 2011). The authors suggest that inter- universally designed environment is an often-
views with user-experts and architects as well as posed question. One of the answers is straight-
case studies of real-life architectural projects forward: to reach out for well-known tools in
should be used to test this UD pattern tool and other areas and adjust them so that they fit within
develop it further (Verdonck and Froyen 2011). the new situation. The reviewed literature in this
Furthermore, a variety of methods and tools (e.g. category all describes the use of tools and
observation, participation, role playing) are methods from other fields of research to discuss
available to form a standardised approach in the how to achieve environments that can be char-
inclusive design process. The methods and tools acterised as UD. Designing for a vulnerable user
focus on collecting, analysing and applying group needs specific attention where knowledge
information on user perception and can be used about the users is of importance (Ielegems et al.
to cope with design issues. The standardised 2015, 2016). This approach is also present in the
approach is seen as an alternative to the use of discussion of a model emerging from software
standardised criteria and different methods and design (V-model). Based on a reinterpretation of
tools are still to be tested for advantages and this model it is discussed how to generate valu-
disadvantages (Lukman et al. 2014). Moreover, a able information concerning the design process
manual is proposed to support the design process by securing a closer link between the user and the
of spaces for all users. It should inspire and ease architects (Ielegems et al. 2015). In continuation
a design for all strategy and includes features on of this discussion, Afacan and Erbug (2009)
communication, organisation, understanding and place their discussion on how to test usability.
use. The attention is on understanding and Incorporating UD in an architectural design does
reflecting on the different users’ needs in differ- not automatically succeed in a fully accessible
ent types of circumstances and on informing on environment. Therefore, testing through an
existing relevant knowledge to develop creative interdisciplinary heuristic evaluation method is
solutions. The manual is still in development and suggested to help pinpoint where the design has
can be seen as the basis for an informative tool achieved its goal and where there are shortcom-
(Mosca et al. 2018). In general, the focus of the ings (ibid.). On a larger scale, Afacan and Afacan
tools and methods is on providing structured (2011) see a relationship between city planning
design information which makes it possible to —through the method of Mat urbanism, sus-
handle a variety of different user needs in the tainability and UD. This approach still must be
design process. They aim at going away from tested in real life.
standardised criteria and understanding the Integrating the concept of UD directly into the
“why” motivating creative and innovative solu- design process of 3D programs makes the design
tions. A common characteristic is that the tools of an accessible environment easy and efficient
and methods are still in the making and therefore for designers and architects in the design phase
not fully developed. (Ormerod and Newton 2005; Jarde and Valdez
21 Enabling Abilities by Universal Design: Mapping Academic Initiatives 287

2012). Two studies tested 3D model systems society (Kim and Jeong 2020), addressing the
incorporating guidelines and building codes human sensory system in design practice
related to UD. The result of the two tests is (Livramento da Silva et al. 2019) or embracing
described very differently. Jarde and Valdez the physical-spatial, sensory-cognitive and social
(2012) conclude that it is efficient and a very qualities of built environments (Mosca and
well-functioning tool to include UD guidelines in Capalongo 2020). Moreover, in addressing user
3D modelling. While Ormerod and Newton knowledge, some of the studies also demonstrate
(2005) do not find the integration satisfactory. a broader understanding of the user in the way
They see the concept of Universal Design as a they acknowledge the importance of needs, per-
holistic approach and the 3D program primarily spectives and experiences in reaching appropri-
succeeds in integrating the quantitative aspects ate, supportive and applicable design, including
but not the qualitative aspects. Conclusions like the complexity and diversity of local policies,
these that reflects two different interpretations of languages and culture. User knowledge can be
UD make it difficult to compare recommenda- enabled and supported by visual methodologies
tions. This furthermore points towards the (Broffman 2015) or by the development of fic-
importance of discussing the approach to and the tional personas (Siddall et al. 2011). Diversity in
understanding of the concept of UD. user information can be supported by multiplicity
Summing up, four categories or approaches of in both functionalities, situations and contexts,
how to operationalise user knowledge are present and human perception is a way to accommodate
in the literature, each reflecting a focus within the user experiences regardless of (dis)abilities
design process. The first category, ideologies, the (Froyen et al. 2009; Verdonck and Froyen 2011),
studies demonstrate that the focus on inclusive and design strategies target communication,
ideologies is channelled into the design process organisation, understanding and use (Mosca et al.
by developing their own versions of an ideo- 2018). In line with this, usability is also a point
logical tool or model. These attempts are often of departure for assessing and evaluating UD
based on the seven principles of UD. The second (Afacan and Erbug 2009).
category, involving users, focuses on gathering In relation to Kirkeby’s (2015) note on the use
knowledge about specific users to understand of context-independent and context-dependent
their position and challenges. The third category, knowledge in the design process the four ten-
systemising user needs, shows attempts to repu- dencies can be seen as levels of abstraction
diate from standards. Paradoxically, this positioned between the two types of knowledge:
approach could result in a creation of a new kind the context-dependent and the context-
of standardisation. And in the fourth category, independent knowledge.
transferring a tool from another academic area, All the initiatives demonstrate some level of
involves attempts to implement methodologies or transferring knowledge, however each of the
tools to operationalise UD, originating from papers is positioned in one of the different layers
other contexts than architectural design. of the user-ideology divine. None of the studies
concern the translation from the general to the
specific, or the other way around. A design
21.4 Discussion methodology of inclusivity would ideally use
both the qualitative knowledge of users, and the
Looking across the sample of studies reveals an academic knowledge base to guide and navigate
interesting patchwork of UD in practice. Con- the design process. However, despite that some
cerning the user perspectives, all the studies, by of the papers found inspiration in another field,
subscribing to the overall ideology of UD, or the coordination or continuation of knowledge
other corresponding approaches, support a base is not demonstrated in the studies reviewed.
broader perspective on users. Embedded in the Instead, each focussed on designing new models,
ideological approaches recognising the aging concepts, or methods. Similar tendency was
288 T. B. Øien et al.

present in a study of the practice of architecture excludes certain types of knowledge, adding to
published after our review was completed. Here the gap between research and practice.
Zallio and Clarkson (2021) suggest a new Our mapping shows a patchwork of concepts,
method to this practice: ‘The Inclusive Design methods and models, which would be interesting
Canvas v. 1.0’ comprises user journey, user to follow into their implementation in a situated
capabilities and user needs in relation to physical, architectural practice. To learn more about the
sensory, and cognitive abilities. Furthermore, a considerations and negotiations informing the use
new definition of Inclusive Design is introduced: of the design—as the proof of the pudding is in
the acronym of IDEA; Inclusion, Diversity, the eating. We do acknowledge that in the nature
Equity and Accessibility. Where academia holds of architectural design practices, there might not
a long tradition of transparency and developing be neither resources nor interest in sharing prac-
fields of research, it seems as if the research- tice knowledge 1:1. However, the lack of both
practice relation in these cases holds the char- knowledge and competences regarding how to
acteristics of the design practice, reinventing and reach the inclusivity in our built environment is
innovating rather than mobilising. Consequently, obvious. What we need in order to mobilise the
a relevant discussion to the field of inclusive field is perhaps to keep on operationalising
architecture is whether we need new concepts to knowledge across research and practice, between
understand and communicate the ideology to the general and the specific, and to make the
practice, or if we need to maintain a consistency translation from ideologies into a specific context
to enable, cultivate an operationalisation of the more explicit. Not by standardising the solutions
ideology, through the knowledge layers embed- but to recognise the means that scaffold these
ded in design practices, standards, tools and data. processes, and with the overall patchwork in
We praise the contributions for being active mind. Furthermore, we encourage that this dia-
and developing the field, and a reason for the logic encounter reaches beyond the personal
different scopes may be due to the format of the attendance of the researcher in the design pro-
scientific paper that primarily supports a delimi- cesses (Kirkeby 2015). In the way that both
tation of a specific case or problem. In this sense, researchers engage with the actual real-life pro-
each of the academic initiatives in bridging the cesses and frameworks for design and that
gap between design ideology and architectural architects and designers confer deeper with both
practice is only partly succeeding. Our own the ideological frameworks and the growing
scoping review demonstrates this type of focus: knowledge base on inclusion in academia. We
To assess and discuss the design process we have believe that the skill of the designer to synthesise,
deselected other phases and activities of the coordinating details and totality and coordinating
construction process. Reaching across the themes across the trajectory of time, would be the right fit
is complex and would require another format e.g. for facilitating more diverse user needs. Planning
a book or that we connect and coordinate and designing our future built environments are a
between the efforts taken. The design of the lit- shared responsibility and involve a range of
erature review was exclusively focussed on sci- stakeholders, where the studies reviewed shows
entific literature indexed in Scopus, which does attempts at bridging ideology and design solu-
not include textbooks, manuals or grey literature. tions. However, to see the different studies as a
The latter encompass materials produced and patchwork across research and design, could help
disseminated by organisations outside of the us expand and evolve the field in a way where we,
traditional commercial or academic publishing standing shoulder by shoulder can spot the
and distribution channels. In this sense the tra- shortcomings and the potential improvements and
ditional paradigm of the academic review also thereby reach even further regarding inclusivity.
21 Enabling Abilities by Universal Design: Mapping Academic Initiatives 289

21.5 Conclusion through Universal Design Patterns. Australas Med J 2

(13):199–203
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