Training healthcare professionals and 3D creators for the empowerment of people with disabilities: perspectives from the DEEP Project

Participants

A total of 40 service providers participated in the follow-up focus group, 30 from Italy and 10 from Spain. A service provider in this study is defined as an individual from a range of disciplines that collaborates in a professional manner to support individuals with a disability. Examples of service providers that participated in the study were health professionals (medical doctors, physical therapists, psychologists, speech therapists, occupational therapists) and 3D makers.

The participants work in different organizations, while their clients often range from children and adolescents to adults. Their working environments range from rehabilitation centers, non-profit organizations, private practice, hospitals, and health care settings.

Procedure

Two follow-up meetings were held involving 30 service providers who participated in the training (15 for each meeting).

Each participant described, in a dedicated space, a situation that represented a change in their own attitude and ability to motivate appropriately using the categories of the Trans-theoretical Motivational Model, toward one or more patients with disabilities. Then, the trainer proposed a follow-up question to test the degree of skill learned in relation to the motivational and prosocial models.

Data collection

This study took place as the last part of the DEEP program. For a better overview of the project structure, the phases of the DEEP program are detailed in Table 2.

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Table 2.

DEEP program phases.

Phase	Content
1. Training course	- Disability and the bio-psycho-social model. - Prosocial communication model and prosociality. - Trans-theoretical model and the stages of change - The benefits of technology in the world of disability - The role of 3D printing in the world of disability
2. Implementation	- Introduction and setup of 3D printing technology in the classroom. - Hands-on training sessions for students to design and print assistive devices. - Integration of 3D-printed devices into daily activities and feedback collection.
3. Follow-up meetings	- Aimed at assessing the impact of phases one and two through focus groups.
4. Supervision meetings	- Regular check-ins with instructors and students to monitor progress and address challenges.
5. Lab activities	- Practical sessions where students can experiment with 3D printing technology. - Projects focused on creating customized assistive devices for specific disabilities. - Collaborative workshops to encourage innovation and problem-solving.

4 weeks after the end of the DEEP training, follow-up sessions in the format of a focus group took place. Sessions were guided by a trainer and a facilitator, ensuring that discussions remained open, focused, and productive while also gathering data. For each country, a total of two follow-up sessions (each lasting 3 h) were carried out with 15 participants per meeting. This setting enabled the participants to share their views, reflect on their practices, and provide feedback on the training they received.

The focus groups were guided by the following questions: [1] How has your relationship with people with disabilities improved after the DEEP training? What has changed or will change in the near future? [2] What is your current feeling about integrating 3D technology into your practice? What are the pros and cons of using the technology? [3] How do you feel about networking and co-design with others? Who would you consider suitable to be involved in your activities in the future? [4] How do you feel about your work and tasks after the training? What has changed? and [5] Is there anything you would like to add? The participants were asked to reflect on and discuss those questions. Their insights were crucial for evaluating the effectiveness of the DEEP project and identifying areas for improvement. ³⁷

The trainer and facilitator of each focus group maintained reflective notes, including quotes, which were anonymized for use in the analysis.

Data analysis

The data collected were reviewed and analyzed by one coder per country using the thematic analysis proposed by Ref. 38. Data analysis included a systematic and iterative process of inductive coding, emphasizing immersion in the data and continuous reflection between the coders. ³⁶ The focus was to uncover shared meanings in the participants’ perspectives, while acknowledging researcher subjectivity as a valuable tool for analyzing and interpreting the data. The data analysis resulted in four themes that are explained in the results section.

To minimize researcher bias and ensure the trustworthiness of the findings, the thematic analysis was performed by coders who did not participate in the facilitation of the DEEP training sessions. This independent coding process followed a double-blind approach to the extent possible within the research team. Discrepancies in theme identification were resolved through consensus meetings. Furthermore, the analysis adhered to the principle of negative case analysis, actively searching for and documenting participants’ frustrations, technical setbacks, and perceived limitations of 3D printing in their clinical practice, thereby ensuring a balanced representation of the data.

Changes in behavior and professional identity

This theme encompasses the participants’ perceptions of changes in their behavior and professional identity when interacting with people with disabilities. A participant from Spain reflected: (HP1) “It has been a very interesting experience because it has allowed us to fulfill ourselves as people and professionals.” This statement embodies this theme, highlighting the personal and professional growth that the participants experienced throughout the program. Two subthemes were identified: (a) Emotional and relational changes and (b) Professional development.

Collaborative and multidisciplinary approaches

The DEEP program emphasized the importance of collaborative and multidisciplinary approaches in supporting individuals with disabilities. This theme captures the participants’ insights on the value of involving various professionals and users to create a comprehensive and effective support system when employing 3D technologies.

The Italian participants recognized the advantage of involving a diverse range of service providers and users, such as makers (3D printing experts), designers, therapists, individuals with disabilities, and their families. They highlighted the importance of working together to achieve a holistic approach and create unique, useful, and sustainable solutions. This multidisciplinary collaboration helped address different aspects of care, from technical solutions to emotional and social support.

Similarly, the Spanish participants appreciated the collaborative approach between users and service providers, acknowledging the benefits of adapting 3D tools to the users’ particular needs. They considered bringing together different perspectives and expertise to be crucial for developing innovative, inclusive, and practical user-centered solutions: “In a world of increasingly complex problems, collaboration between users and professionals can be essential and helpful.”

User-centered and inclusive practices

(MK5) commented that the DEEP program influenced them to practice a user-centered approach and actively offer services with social inclusion in mind and a commitment to breaking some of the barriers that users might face. This theme encompasses the importance of involving people with disabilities in the decision-making processes and designing solutions that promote autonomy, usefulness, and sustainability.

The Italian participants expressed that they became more aware of fostering a respectful environment where users’ limitations, needs, intentions, and preferences are considered. Additionally, they recognized the importance of involving not only users with disabilities but also their families in order to design unique and adapted solutions that emphasize usefulness, specificity, sustainability, and beauty, where design quality and the aesthetic component become a vehicle and value to promote social inclusion.

The Spanish participants highlighted the empowering effect of involving users in the decision-making process for the creation and design of the products they need when using 3D technologies. (MK5) noted, “It is a professional mistake to make decisions for the other person,” emphasizing the importance of promoting autonomy in the interactions with the users. Moreover, the participants commented on the importance of considering the possible needs of individuals with disabilities in advance and suggested creating protocols or adapted manuals to meet those needs, ensuring that the users understand the working process. For example, they suggested creating an adapted 3D printing manual to clearly explain all the steps involved in printing the design.

Additionally, the participants considered that DEEP training contributes to raising awareness of the social prejudices and preconceived ideas that people with disabilities still encounter. They perceived that the training contributes to building a more inclusive society by breaking down the barriers that still exist for this community. For example, users who benefit from the training said:

(User 1) “This type of training helps us better understand our limitations. Personally, it has helped me to see how 3D printing can make my day- to-day life easier, and to be part of the process and to collaborate on what I need.”

Involving users with disabilities in the 3D printer project has been crucial. Their insights ensure that the designs meet real needs, enhancing usability and accessibility. By incorporating their feedback, the project can create more effective and personalized solutions. This collaboration not only empowers users but also drives innovation, making the technology truly inclusive.

Implementation challenges

Only the Spanish participants pointed out challenges that might appear in the implementation of 3D technologies in the context of disability support. First, the participants reflected on the substantial lack of knowledge about people with disabilities, indicating a need for comprehensive and practical training opportunities to provide better services to this community. Second, the participants considered that one significant barrier is the cost of and access to 3D printers. Despite the innovative potential of this technology, the participants expressed that it remains expensive and not widely available for some service providers and users, making it difficult for many to take full advantage of its benefits. Participants noted that, despite the benefits, the time required for 3D printing remains a significant barrier.

Lastly, some participants noted the lack of opportunities to apply 3D technologies in their practice, such as psychologists. (HP 9) “As a psychologist, I see the potential, but I find it difficult to find real opportunities to apply 3D technology in my daily clinical practice; it feels like the tools aren’t yet designed for our specific field.”

In response to the second research question, the data from both cohorts reveals a high degree of consistency in the core transformative effects of the DEEP training, alongside specific divergent nuances regarding implementation and the scope of social inclusion.

The findings indicate that the DEEP training outcomes were largely consistent across both cultural and institutional contexts. Participants from both Italy and Spain experienced a paradigm shift in professional identity. Both groups transitioned from traditional, top-down service provision to a more empathetic, user-centered mindset.

Shaping professional roles in disability care

The results show that the DEEP training brought about significant changes in how participants perceived their professional roles, with shifts reported in both emotional and relational aspects of their interactions with individuals with disabilities. Both Italian and Spanish participants highlighted the development of empathy, reflective thinking, and better communication as key outcomes of the training, reinforcing previous studies that underscore the importance of socio-emotional skills in health care settings.^39–42 The training empowered professionals to adopt a more inclusive, user-centered approach, which stands in contrast to more traditional models of care.

However, differences emerged in the way the participants from each country interpreted these changes. The experiences from the Italian participants were more focused on professional responsibility specifically in terms of fostering autonomy and inclusivity for individuals with disabilities. In contrast, the Spanish participants reported that the training opened up new professional avenues, including the consideration of legal and safety aspects of 3D printing in health care, suggesting that while both groups experienced transformation, the specific outcomes varied based on their professional and unique contexts.^43,44

These findings suggest that the DEEP training, with its focus on integrating 3D printing technologies into disability care, facilitated stronger bonds and deeper engagement between service providers and users. This encouraged professionals to move beyond addressing functional needs, emphasizing autonomy, participation, and dignity, which in turn contributed to promoting social inclusion.^2,9,10,16

Regarding the Transtheoretical Model (TTM), the DEEP training acted as a catalyst for movement through the stages of change. Participants who initially reported skepticism or lack of awareness (precontemplation) shifted towards contemplation after the first modules. Furthermore, the collaborative co-design phase was particularly effective in moving healthcare professionals into the action stage, as evidenced by their direct involvement in creating assistive devices. For instance, the transition from “understanding the potential” to “implementing solutions” aligns with the TTM’s self-efficacy construct, where participants gained the confidence necessary to integrate 3D technology into their daily clinical practice.

Promoting disability empowerment and inclusion through prosocial behaviors and user-centered approach

Prosocial behaviors, such as empathy, cooperation, and solidarity, were consistently cited by the participants as crucial elements in their interactions with individuals with disabilities. The DEEP training placed a strong emphasis on these behaviors, which aligns with the existing literature on the importance of prosociality in health care.^28,30,45 In both countries, prosocial behaviors were identified as essential for establishing trust, ensuring user autonomy, and enhancing the overall quality of care.

In particular, the concept of active listening and empathy was repeatedly highlighted by both Italian and Spanish participants as fundamental to their interactions with users during the co-design process of assistive devices. Italian participants focused on creating environments where users felt heard and respected, which aligns with broader frameworks of inclusive care.^13,16 Spanish participants, on the other hand, emphasized the role of empathy in understanding the lived experiences of users, allowing them to better adapt their strategies to meet users’ challenges and goals.^4,17,46

The emphasis on prosocial behaviors and a user-centered approach not only improved the immediate care provided but also contributed to the creation of more inclusive environments, where users felt empowered to actively participate in decisions related to their care. This underscores the broader impact of prosociality in fostering long-term user engagement and adherence to co-designed solutions for assistive care.^3,19,20,30

Promoting team-based approaches in 3D printing for assistive technology

The participants from both Italy and Spain recognized the value of multidisciplinary collaboration in implementing 3D printing technologies for disability care. This aligns with broader research advocating inter-professional cooperation to ensure that assistive technologies are tailored to the specific needs of individuals with disabilities.^3,4,7

The role of makers, health care providers, and users in the co-design process was seen as critical in ensuring that assistive devices were both functional and integrated into users’ daily lives.

While collaboration was emphasized in both countries, subtle differences in approach were observed. The Italian participants highlighted the importance of involving a diverse range of professionals, such as designers and therapists, alongside families, to co-design solutions that were not only useful but also aesthetically pleasing. This reflects a more holistic approach to disability care, where technical and emotional factors are equally considered.^7,13,15,18

The Spanish participants, on the other hand, were more focused on developing clear protocols and manuals to ensure that users could easily understand and engage with 3D printing technologies. This underscored the need for having well-prepared materials to improve user comprehension and support collaboration.^47,48

These variations suggest that cultural and systemic differences influence how collaboration is perceived and implemented in each country. While the DEEP training successfully fostered collaboration, further exploration into how these collaborative dynamics differ across cultural contexts would provide deeper insights into effective implementation strategies for 3D printing in disability care.

These variations provide a direct answer to the second research question regarding the differences between cohorts. Specifically, the Italian cohort prioritized a relational-aesthetic approach, where the visual dignity of the object is considered essential for social inclusion. In contrast, the Spanish cohort adopted a procedural-structural approach, focusing on technical empowerment through manuals and expressing greater concern for the economic and legal barriers of the system.

The above should not be analyzed in isolation, as it stems from deeply rooted socio-institutional contexts within each country’s maker ecosystem. In Italy, the emphasis on design aesthetics reflects a cultural heritage applied to the healthcare sector, where the healthcare system operates through regional and community-based models that prioritize personalized, local, and empathetic care over bureaucratic rigidity. Conversely, the Spanish collective’s distinct focus on procedural manuals, structural barriers, and regulations reflects the highly formalized and centralized nature of its National Health Service, where integrating clinical innovations demands compliance with strict data protection laws, safety certifications, and institutional regulations. Recognizing these differences demonstrates that applying a one-size-fits-all strategy for the future scalability and implementation of the DEEP program would be counterproductive; hence, the key to consolidating this framework lies in tailoring it to the particularities of each institution. Consequently, effectively expanding the program in Italy would require investing in service design and empathy-based guidelines that optimize the emotional connection between makers, families, and therapists. In contrast, expansion in Spain will depend on equipping professionals with formal tools to overcome structural limitations, including legal compliance templates, manufacturing protocols, and cost-benefit analysis models.

Challenges in adopting 3D printing for disability care

Despite the potential of 3D printing in disability care, the Spanish participants identified barriers that required attention. While 3D printing is often associated with relatively low production costs, ⁶ the participants expressed their concerns about financial constraints and the limited access to this technology in their work environments. These challenges point to the need for additional investment and support to make 3D printing more accessible for both users and service providers.

Additionally, the participants acknowledged limited opportunities to incorporate 3D technologies into their daily practices. Some highlighted the lack of infrastructure to support the integration of 3D printing in their work. This suggests that while the DEEP training was effective in raising awareness and fostering collaboration, systemic barriers still hinder the widespread adoption of these technologies in disability care. Although the participants did not specifically address the time and human resource demands involved in co-design, as highlighted by Ref. 2, these factors are important avenues for future investigation.

Limitations

A limitation of this study is the imbalance between the Italian (n = 30) and Spanish (n = 10) samples. While this disparity may affect the depth of the comparative analysis, the qualitative nature of the study allowed for a rich exploration of themes across both contexts. Future research should aim for more balanced cohorts to further explore regional nuances.