Tackling Ageing Continence through Theory Tools and Technology (TACT3) is a three-year study that is focused on the issues of continence management for an ageing population. The consortium of researchers is lead by Brunel University and is funded under the New Dynamics of Ageing programme. The study consists of developing user-led assistive devices for continence management (Brunel University, The University of Manchester, BioMed HTC, Bristol Urological Institute and University of the West of England investigating services for those seeking help and advice for continence concerns (The University Sheffield, Dalarna Research Institute and Dalarna University ) and challenging the environmental barriers to continence (Royal College of Art Helen Hamlyn Centre).

For many older people, the fear of incontinence is second only to dementia. Whilst estimates of incontinence vary, it is suggested that up to 60% of women and 30% of men, over the age of 40, express some form of continence concern. Although some urinary function may diminish with age, it is not a direct result of the ageing process, but may be exasperated by medical conditions associated with age, such as heart failure, some forms of cancer and Parkinson’s and Alzheimer’s disease. However, ageing can make a direct impact on continence management, due to changes in physical mobility that makes current toilet provision difficult to access with regards to transferring on and off the WC pan. In addition, reaching the toilet in time may be of concern for many people with limited mobility.

Such concerns with using toilet facilities are especially prevalent for many older people when they leave their homes. Previous research suggests that many people limit the amount of time they are away from home for fear of being ‘caught short’, without access to suitable toilet provision (Hanson et al., 2007). In contrast, many people who identify where satisfactory toilets are, return to the same areas time and again for fear of venturing into unfamiliar towns and neighbourhoods, not knowing the location of adequate toilets. Researchers Kitchen and Law (2001) have described such restriction of movement as being held by ‘the bladder’s leash’. Yet despite a growing actively ageing population, research undertaken by Help the Aged has identified that current public toilet provision in the UK continues to decline (HTA, 2007). The facilities operated by local authorities are, despite sometimes having a poor reputation as spaces of anti-social behaviour, still popular among members of the public with the convenience and anonymity they provide. Many people feel embarrassed to have to ask permission from a business owner, to use toilet facilities. Many businesses, aware of an area’s lack of public toilets, deter such requests by displaying ‘toilets for customers only’ signs.

Design research, currently being undertaken by the Royal College of Art Helen Hamlyn Centre, has focused on the barriers in the built environment to continence management for an ageing population, namely access to publicly available toilets (‘publicly available toilets’ is a term coined by Gerry Brophy, County Architectural Liaison Officer, Hertfordshire Constabulary and identifies toilets provision in both the public [local authority] and private sector [shopping centres, train stations and businesses]. The research is centred in the philosophy of people-centred design, which puts the knowledge, perceptions and experiences of people at the forefront of the design process. The three-year project has identified two key stakeholder groups within the area of toilet provision, members of the public and the providers of publicly available toilets.

Initially, the project was focused on investigating the continence concerns with regards to access to toilets of people aged over 50. However, after an initial consultation with the New Dynamics of Ageing Older People’s Reference Group, the researchers were encouraged to expand the research methodology to include people of all ages. Thus, following epidemiological research in the built environment that has focused on a ‘lifecourse’ approach, the research constructed a methodology that would focus on the toileting needs of those aged one to 101.

Telephone interviews were conducted with people representing each year of age. These interviews helped the researchers define the key concerns of the interviewees and map these concerns to identify if there were any noticeable differences between ages (whilst recognising that some concerns may differ by gender, the research did not record distinct gender differences between interviewees). Through this mapping process, the three main concerns that were shared between the interviewees were identified as being; the cleanliness of the toilet facilities, information about the facilities such as location, accessibility and opening times, and finally the type of provision being offered such as unisex automatic facilities and community toilet schemes.

All interviewees were invited to further engage in the research process through participation in design workshops. These day-long workshops, followed two design research methodologies. Firstly, the researchers developed design responses to the issues of hygiene, location and provision type, to act as ‘design provocations’ that stimulated debate and discussion and helped focus the design brief. Secondly, the researchers instigated a participatory design game in which the workshop contributors worked in teams to design their ideal toilet facility. This method stimulated discussion and creativity between the participants. In addition, due to the mix of participants, both through age and ability, the participatory approach generated a deeper understanding of the complexity of the participants’ needs with regards to accessing and using publicly available toilets.

In the second phase of the project, the researchers conducted one-to-one interviews with providers of publicly available toilets, some of whom had been identified by participants in the first phase of the research as exemplars of provision. In total, 20 providers were interviewed, representing local authority provision, department stores and transport interchanges. Representatives from publicly available toilet, design and support services were also interviewed. These included, architects associated with the British Standards, cleaning services and a representative of the London Olympics Organising Committee. Providers concerns primarily focused on issues of vandalism and misuse of the facilities, providing information about provision and justifying costs.

The providers were presented with personas created from the telephone interviews, which represented the needs of 4 distinct ‘users’ with continence and/or mobility concerns, to illustrate the diversity of needs of users. Personas included; a young women in her 20’s with irritable bowel syndrome, a man in his 30’s with a young family, a retired women who requires medication (See “Judith” below) and an older man in his 80’s whose mobility is limited to his local area.


Judith

The key joint issue shared between the users and providers of publicly available lavatories was that of information. Hence, the researchers decided to focus on this issue in the development of a design response. In her leading work on Public Toilet Design, Professor Clara Greed (2003) noted that current UK public toilet provision is ‘fractured’, with responsibility split between local authorities as well as internally between and private developments such as those at transport interchanges and shopping centres (these provision instances do not include department stores, supermarkets and food outlets as these forms of ‘private’ provision do not have a general access approach and can prevent access to toileting facilities from members of the public they deem to be undesirable). In the case of local authority provision, this has resulted in a ‘postcode lottery’, in which one area may have adequate public toilet provision, whilst another has none.

This ‘fractured’ responsibility in provision is reflected in information available about facilities. One possible solution to poor information is the development of smart phone applications in which members of the public can contribute information about toilets. However, once this information is loaded onto the smart phone application it is not checked and can therefore become mis-information if the facility closes, or the provider deems that toilets are ‘for customers only’. The research carried out an assessment of these applications, comparing information given on applications with information listed on a local authority’s website. Our study in the London Borough of Wandsworth showed the smart phone application highlighted 6 out of 56 available local authority toilet facilities (Knight & Bichard, 2011). Based on this initial finding, and the need to consolidate the information on toilet provision, the project is now developing ‘The Great British Public Toilet Map’.

Following the success of the Australian National Public Toilet Map http://www.toiletmap.gov.au/ developed by the Australian Government as part of its National Continence Management Strategy. The TACT3 project is now developing ‘The Great British Public Toilet Map’ website, a web-based map that will bring together all current information on public toilet provision owned and operated by UK local authorities. When the public search for a location, they will receive one of two responses - either information on the nearby toilets, if the council provides open toilet data, or a page suggesting how they can contact their local council to request that they participate in the project by releasing open data about their toilet facilities. The site will include current locations of toilets, operating times, type of provision such as an Automatic Public Convenience and additional amenities such as baby changing and accessibility (although theoretically information on accessibility should not need to be provided as all toilets should provide accessible provision under Part Three of the Disability Discrimination Act 2004). As each local authority should be updating their own websites with their toilet availability information it is hoped they could be encouraged to also provide data that can be used by ‘The Great British Public Toilet Map’ to enable its information to remain current and relevant. Essentially the site is a campaign tool to enable individuals to engage with their local councils on public toilets. As the project takes off, the site will become a useful toilet-finding tool. It is also hoped the map will aid planners to decide where to locate future public toilets ensuring a more even spread of provision throughout the country.

References:

Hanson J., Bichard J. and Greed C. (2007) The Accessible Toilet Design Resource. London: UCL / Vivacity.

Help the Aged (2007) ‘Nowhere to go’ Research Report. London: Help the Aged.

Kitchen R. And Law R. (2001) The socio-spatial construction of accessible public toilets. Urban Studies, 38 (2), 287-298.

Knight G. and Bichard J. (2011) Finding Public Toilets through Applications and Open Data in Proceedings of Include 2011. (forthcoming)