Final degree project - Marianna Espinós by EU ERAM

New ways of understanding food. Designing an eating experience to improve nutrition and mealtime in oncologic paediatry patients.

Marianna EspinĂłs Blasco June 2016 The University School Eram, part of the University of Girona Audiovisuals and Multimedia degree Final Degree Project Project Tutor: Marc Plana Sant Joan de DĂŠu Tutor (Practical phase): Jordi Navarra

Dedication

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This Project, originated from my curiosity and interest in the potential of food, topic in which I would have never noticed if it had not been for Marc Silvestre Carbรณ; cooker and passionate for food as a material with infinite possibilities, who made me meet this world and take part of it. Allow me once again to express my appreciation.

Acknowledgments

The completion of this Final Degree Project would not have been possible without the help and support of crucial people. I would like to thank the support given by Marc Plana, for his orientation and backing during all the process of this Final Degree Project. The consistent work would not be possible without his tutoring task but also his lectures. A big acknowledgment goes to Jordi Navarra, to accept me as a member of his lab and giving me the chance to develop the practical part of this project at Sant Joan de Déu Foundation. Furthermore, I would like showing appreciation to Rosa Espinós and Christian C.Oste, for giving me their opinion about my research and for the painful task of reviewing my English. And finally, my biggest thank goes to my family, friends and acquaintances – specially to Anna Galindo, Ferran Altarriba, Natàlia Palau, Andrea Palau, Olga Fernandez, Janis Gómez and Júlia Miró- who have give me opinions, ideas and energy to keep going with the project.

Abstract

This research focuses on designing an experience to improve nutrition and mealtime of children and teenagers with cancer. Specifically, the aim of this research is to explore, firstly, the possibilities of food â&#x20AC;&#x201C; as a material with potential to investigate in scientific fields, such as neurogastronomy, but also to take part in an artistic installation - and new ways of understanding it and, secondly, to apply this knowledge to creating an experience where this potential is exploited. In the first place, the present investigation concentrates on understanding what food is, how it is seen in our culture â&#x20AC;&#x201C;the Occidental culture-, and why this conceptualization is changing. The main driver of this modification is the discovery of food as a multisensory element that stimulates nearly all of the sensory modalities (e.g., including vision, touch and audition) at the same time and, furthermore, its possibilities as an applied art. In the second place, I will describe a practice-oriented development of work focused on creating an new experience to test the theses developed in the first part of the present work. In this second section, we will see how to make use of the multisensory and the artistic characteristics of food, creating a new design to improve nutrition and eating experience in a field where food is a topic of paramount relevance.

General Introduction

The original idea of this project was developed in Berlin, December 2014, after viewing an exhibition about Lázlo Moholy-Nagy in Bauhaus (Oliver A.I Botar, 2014) named

‘Sensory

training’. A section of the exhibition, made me realize all senses potential, not only sight and hearing. It aroused my curiosity and I started investigating about senses perception. In addition, a key moment was in an exhibition in the London Science museum, called ‘Cravings: Can your food control you?’, where I discovered multisensory perception of food. This leads to known in depth what is food, why the main perspective is changing and how is possible to apply this changes to make it beneficial. Ferran Adrià, Spanish chef considered one of the best chefs of the world this last decade has revolutionized the gastronomy concept (Piedrahita, 2012), and said that: “Cooking is the most multisensory art. I try to stimulate every sense”. That quote was my starting point to formulate a hypothesis to investigate. In the beginning, Ferran Adrià considers food an art – if cooking is an art, food becomes a masterpiece-, which means that we can find in it an aesthetic component. Additionally, he describes cooking art as a multisensory fact because all senses participate in the experience. In my opinion, food is a kind of art but it will not be included as a Fine art because of its functional utility. Also I agree with the multisensory factor that food has in human’s perception, largely because it is a proven scientific fact (Spence and Piqueras-Fiszman, 2014; Grodon M.Shepered, 2012). There are two hypotheses, based on my introductory paragraph of what topics I am interested in, that define main objectives of these research objectives. First of all, hypothesis 1 will be a theoretical investigation in order to classify and comprehend the topic of the project (phase 1). Hypothesis 1: Could food be a multisensory applied art, which some designers entitled as Food design? On the second place, born hypothesis 2 born to verify if first conjecture is applicable; that is to say, enforce hypothesis 1 to a practical development. To sum it up, hypothesis 2 is going to formulate the starting point for the practical part (phase 2).

vii Hypothesis 2: Could it be possible to use the aesthetic aspects of food and multisensory perception to create an experience able to improve nutrition â&#x20AC;&#x201C;and the mealtime- in children with cancer undertaking chemotherapy?

Methodology

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To develop this project there is adopted a theoretical-practical methodology, used to answer questions formulated in both hypotheses aforementioned. Both phases have a theoretical research because the main idea is to verify if hypothesis is true, or not, doing an in-depth research. However, phase 1, as a academic research using literature, is written using APA format (Explorable.com, 2016); this format requires writing in an impersonal way, abstaining from using pronouns like "I" or "we" statements. Hypothesis 1 investigation is developed using only books and articles, in analogic and digital support, so it can be considered as a literature based research methodology; this part is used to know what is food, why is changing and which directions can take. On the other hand, phase 2 is a research done taking part of a project that is being developed in Sant Joan de Déu Foundation, more specifically in the Experimental psychology and brain disorders laboratory ‘labjordinavarra’. It could be seen like a ‘journal’ about task done as a member of the lab, also to know how to put in practice hypothesis 2; that can be, basically, demonstrate thorough practical work the artistic and multisensory capacity of food, which can be applicable to benefit nutrition and mealtime of kids and teenagers with cancer. For that reason this part it is written in first person, with a more informal writing. Despite of that, it continues using APA format to cite references and other format patterns, such as font size or text alignment. Furthermore, in this phase, there is a detailed explanation about the methodology used for developing the practical part of the project: Design thinking, a process that applies creative problem solving methods and tools, which facilitate dialog, define problems, generate ideas and obtain solutions.

Table of contents Phase 1: Literature-based research

Introduction……………………………………………………………………… 1

Chapter 1

What is food: How culture has built what food is? ………………………….. 5 1.1 Food experience constituents…………………………………….………

1.2 Food in philosophy………………………………………………………. 7 1.3 Food and culture.……………………………………………….………... 7 1.3.1. The cultural side of food…………………………………………..

1.3.2. Taste pleasure; responsibility choice; anthropologic

vision.……………………………………………………………… 8 1.3.3. The amount of food……………………………………………….. 9 1.3.4. Food, language and identity……………………………………….

1.3.5 Identity and interchange. Tradition and origins……………………

1.4 Conclusion…………………………………………………….................

Chapter 2

What art is: How culture has built what art is and why it does not incorporate food………………………………………………………………...

2.1 Historical roots and current concepts to define art……………………...

2.2 Aesthetic concepts.……………………………………………………...

2.3 Food as an applied art…………………………………………………...

2.3.1 Limitations of food in fine arts field……………………………….

2.3.2 Cognitive dimension of food………………………………………. 17 2.3.3 Can food be an art? ………………………………………………... 17 2.3.4 Ferran Adrià contribution to see Food as an Art…………………... 18 2.4 Conclusions.…………………………………………………………….. 19

Chapter 3

The multisensory perception of food: what direction is food research

taking now………………………………...…………………………………….. 21 3.1 The brain …………………………...…………………………………...

3.1.1 Neurogastronomy…………………………...…...………………… 22 3.1.2 Gastrophisics: the new science of the table………………………..

3.2 The perception of food is fundamentally multisensory.………………...

3.2.1 Senses Perception…………………...…...………………………… 24 3.2.1.1 Smell…………………………...………………………...

3.2.1.2 Taste…………………………...…………………………

3.2.1.3 Touch (oral somatosensory) …………………………….. 27 3.2.1.4 Hearing…………………………...……………………… 27 3.2.1.5 Sight…………………………...…………………………

3.3.Conclusion…………………………...………………………………….

Chapter 4

Food Design: a new way to understand and design food..…………………….. 30 4.1 A critical approach about culture meaning………...…………………….

4.2 Food Design Definitions………...…………………………………….…

4.3 Food Design and the five senses………...……………………………….

4.3.1 Smell and taste impact in the Design of Food………...…………...

4.3.2 Touch sense when eating ………...………………………………... 35 4.3.3 Eyesight and food design ………...………………………………..

4.3.4 Sound: the hearing and the food design………...………………….

4.4 Food design into sub-disciplines ………...…………………………….....

4.5 Conclusion for hypothesis 1………...…………………………………….

Chapter 5.

Conclusion phase 1………...……………………………………...…...……...... 40

5.1 Conclusion for next steps ………...……………………………....……… Phase 2

General Introduction to Practical phase.………...…………………………….. 43 Employing Food Design as a multisensory applied art……...…………………... 43 Introduction……...…………………………………...……...…………………. 47 Chapter 1

General Information (Literature research) ……...…………………………...

1. About Cancer……...…………………………………..........................……..

1.1. Treatments against cancer.……...………………………..………………

1.2. How cancer affect children and teenagers……...………………………... 52 1.3. Cancer and Nutrition in Children and teenagers under chemotherapy….

2. Sant Joan de Déu and Oncologic Paediatry……...……………………………

3. Psychology of human development ……...…………………………………...

3.1. My point of view about how children and teenagers live experiences…..

3.2. Piaget stages…...…………………………………..........………………..

Chapter 2

Design Research (Comprehension) ……...…………………………………..... 60 1. Planning of the Design Research phase……...………………………………..

2. Ethnography tool in Sant Joan de Déu Project ……...………………………..

2.1. Conclusions from Ethnography tool……...…………………………...…

2.2. Empathy map……………………………………………..……………… 73 3. Design research conclusions……...…………………………………..............

Chapter 3

Ideation………………………...........…...……………...………………………

1. Game as an experience……...…………………………………...................…. 79 1.1. Current and emerging game trends………………………………………

1.2. Aspects to take into account about games……………………………….. 83 1.2.1 Game patterns………………………….…………………………... 84

1.2.2 Type of players………………………….…..……………………... 84 1.2.3 Activit loops……………………………………..………………....

1.2.4 Game elements……………………………………………………..

1.2.5 Games analysis……………………………………..……………… 87 2. Factors to take into account…………………………………………………...

2.1 Association……………………..……………………………………........

2.2 Experimenting with senses: vision……………………………………......

2.3 The wow factor (surprise factor).…………………………………………

2.4 Creative thinking spiral………………………..…...……………………..

3. Ideation tools……………………………………........……………………….. 95 4. Brainstorming.……………………………………..………………………...... 96 5. My proposal.…...………..……………………..............……………………...

104

Chapter 4

Implementation and next steps.……………………………………..…………

112

Phase 3

Self-evaluation about the Final Degree Project………………………………. 113 1. Solving hypothesis………………...…………………………………….

113

2. Creativity self-evaluation…………………………...………………….

114

3. Self-evaluation about the Final Degree Project………………………. 116 References list…………………………………………………………………… 119 Phase 1……………………………………………...……………………...........

119

Bibliography……………………………………………………………... 119 Webgraphy……………………………………………………………….

121

Phase 2…………………………………………………………………………... 124 Bibliography……………………………………………………………... 124 Webgraphy……………………………………………………………….

125

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Other references………………………………………………………………...

130

Courses……………………………………………………………….......

130

Conferences….………………………………………………………....... 130 Exhibitions……………………………………………………………….

130

Bibliography……………………………………………………………... 131 Webgraphy……………………………………………………………….

131

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Tables list Phase 1 …………….. Phase 2 Table1. Table about people to do the Design Research (February-March) Figures list Phase 1 Figure 1: Guixé, Martí (2013) Souvenir From The Past. [figure] © Inga Knölke / Imagekontainer Figure 2: Coques del mossèn (2016). The bread baked with wood. [figure] Recovered from: http://www.cocadelmossen.cat/que-fem-el-pa.html Figure 3: Osias Beert, ( c. 1610.) Still life with oysters. [figure] Staatsgalerie, Stuttgart.Recovered from: https://es.wikipedia.org/wiki/Pintura_barroca_de_Flandes#/media/File:Osias_Beert__Oysters_1610.jpg Figure 4: Gay, Jessica (2016). Charles Spence picture for the article ‘Taste is multisensory’. [figure]. Recovered from: http://www.foodbev.com/news/interview-taste-a-multisensoryperception-says-experimental-psychologist/ Figure 5: Spence and Piqueras-Fizerman (2012 pag. 185. Figure 6.1). Multisensory flavor perception, emphasizing the important role played by food-eating sounds. [figure]. Ed. Wiley Blackwell.

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Figure 6: Housley, Sara (2010). Eating designer Marije Vogelzand visual scheme. [figure].

Recovered from: https://sarahhousley.wordpress.com/2010/11/25/marije-vogelzang-on-changing-how-we-thinkabout-food/ Figure 7: Aol magazine (2016). Finished dish. . [figure]. Recovered from: https://es.pinterest.com/pin/466333736392172881/ Phase 2 Figure 2.1: Hsjdbcn.org (2016) Sant Joan de Déu Logo. [Figure] Available at: https://cascaufape.files.wordpress.com/2013/12/hospital-sant-joan-deu-macaco.jpg Figure 2.2: Espinós, Marianna (2016). Literature research notes. [Figure] Figure 2.3: Espinós, Marianna (2016). Design research tools, co-creation figures. [Figure] Figure 2.4: Team of the current project (2016). Image of tray opened with the meal for children in Sant Joan de Déu hospital [Figure] Picture done with Sant Joan de Déu project team and allowed by the Hospital staff. Figure 2.5: Team of the current project (2016). Image of a meal for children in Sant Joan de Déu hospital [Figure] Picture done with Sant Joan de Déu project team and allowed by the Hospital staff. Figure 2.6: Team of the current project (2016). Election menu in Sant Joan de Déu hospital [Figure] Picture done with Sant Joan de Déu project team and allowed by the Hospital staff. Figure 2.7: Espinós, Marianna (2016). Circle of cancer and its treatments bad effects on children. [Figure].

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Figure 2.8: Espinós, Marianna (2016). Ideation notes and tests. [Figure].

Figure 2.9: a. Anon (2016). Table about differences between game concepts from ‘gamasutra’ website. [Figure] Available at: http://www.gamasutra.com/blogs/AndrzejMarczewski/20130311/188218/Whats_the_difference_ between_Ga Figure 2.10: Buke, B (2014). Gamification, Video Games and Rewards Programs. [Figure]. Figure 2.11. Zampollo, Francesca. M. Kniffin, Kevin. Wansink, Brian. Shimizu, Mitsuru. (2011). Different possible entrée positions on round plates. [Figure]. Figure 2.12: MIT Media Lab (2007). The Creative thinking spiral. [Figure]. Figure 2.13: López, Dani and Morillo, Valentina (2015). From the sofa to the kitchen. [Figure]. Figure 2.14: Zentner, Jorge and Cabasssa, Mariona (2008). Illustration of book ‘Kitchen tales’ cover. [Figure]. Figure 2.15: Correll (2015). Book ‘Doodling for foodies’cover. [Figure]. Figure 2.16: Correll (2015). Illustration that is nside ‘Doodling for foodies’ book. [Figure]. Figure 2.17: The Creativity Hub (2013) Story cubes picture. [Figure]. Figure 2.18: The Creativity Hub (2013). Picture of a commercial about Food story cubes, from the

article

‘Play

With

Your

Food,

It's

good

for

you’.

[Image].

Available

at:

https://www.storycubes.com/blog/play-with-your-food-it-s-good-for-you Figure 2.19: Marinva (2013). Sr. Potato , picture form FAROS article. [Figure]. Available at: http://faros.hsjdbcn.org/es/recomendacion/sr-potato-clasico-juego-hacer-volar-imaginacion

xvii Figure 2.20: ‘Nutrition: vital impulse’ exhibition (2015-2016). Japanese pyramid. [Figure]. Figure 2. 21: INAMO restaurant (2015) Picture of the interactive table from INAMO restaurant [Figure]. Available at: http://www.inamo-restaurant.com/gallery.php Figure 2.22: Japanese style (2014). Kyara-ben food drawing. [Figure]. Available at: http://www.japanstyle.info/11/entry38935.html Figure 2.23: Emplatando (2012) Food with messages. [Figure]. Available at: http://www.emplatando.com/mensaje-en-el-fondo_2314/mensaje-en-el-fondo-del-plato Figure 2.24: Carrera (2015). Nutritional hopscotch, ideated by Aleix Brosel, from the food guide for children with cancer. [Figure]. Figure 2.25: Roca, Maria and Espinós, Marianna (2015) Aliment pyramid. [Figure]. Figure 2.26: Espinós, Marianna (2016). Illustration about game elements: the dices and the information card. [Figure]. Figure 2.27: Espinós, Marianna (2016). Faces ‘How to eat’ dice. [Figure]. Figure 2.28: Espinós, Marianna (2016). Card with the explanation of ‘How to eat’ dice. [Figure]. Figure 2.29: Espinós, Marianna (2016). Illustration of the dices rolling. [Figure]. Figure 2.30: Espinós, Marianna (2016). The dice results. [Figure]. Figure 2.31: Espinós, Marianna (2016). Example of a creation from dices results. [Figure].

xviii Figure 2.32: Tarik Kizilkaya/Getty (2016). Sharing food on Instagram. [Figure]. Available at:

http://simmerandboil.cookinglight.com/2016/03/14/study-sharing-your-healthy-food-on-

instagram-makes-it-taste-better/ Figure 2.33: Guia del niĂąo (2016). Kid playing with a mobile phone. [Figure]. Available at: http://www.guiadelnino.com

Phase 1

1 Phase 1 Introduction ‘Gastronomy is living popularity moment: our food becomes fashion and chefs are the newest TV evangelists. We can find reports and newspaper sections, magazines and courses of all types’. Experimenta nº 67/68 The main focus of this investigation is to understand what is food, why is changing and what directions is taking, specifically around its multisensory perception and artistic capabilities, to exploit potential and use it to give creative solutions from design discipline. As it is said in the nº 67/68 of the design magazine Experimenta (Food Design, 2015), food is evolving to a new concept, far from what we, occidental society, had understood until today. Food Design is the title that Experimenta nº 67/68 -a platform specialized in design, architecture and visual communication- gives to that evolution. It is a hot off the press concept, which has the definition in an opening debate. Furthermore, it covers a large amount of disciplines, which influences the process and the result of food. Down below there are introduced points of the research, done to conclude if the hypothesis 1, formulated in the general introduction - Could food be a multisensory applied art, which some designers entitled as Food design? -, can have a positive feedback, verifying if it is true or null. First of all, design concept is going to be defined as the general discipline where food will be included, using Cox quote (Thecreativeindustries.co.uk, 2016) that described as: ‘Design is what links creativity and innovation. It shapes ideas to become practical and attractive propositions for users or customers. Design may be described as creativity deployed to a specific end’.

2 Design has functional criterions but also it takes into account aesthetic factors. In that way, Food Design can be interpreted, as Francesca Zampollo (P.h.D in Food Design thinking) said, as: ‘The design (Gestaltung) of edible objects, this includes all processes – from the cultivation/breeding to the preparation of food – and all decisions that are taken to determine food as an object; more precisely the design of taste, consistency, texture, surface, the sound of chewing, smell and all other object properties’ Ifooddesign.org (2016). It is going to cover nutritional needs; food has a functional part that involves human perception, but in addition it achieves aesthetic requirements. Food Design born as a result of the ways that people understand eating and how food perception is evolving. Companies such as Philips – a technology company, focused on improving people's lives through meaningful innovation- is setting up multisensory gastronomy projects, working with chefs like Arzak, and understanding that: “FOOD takes a provocative and unconventional look at areas that could have a profound effect on Figure 1: Souvenir From The Past

the way we eat and source our food 15-20 years from now” (Design.philips.com, 2015).

In order to understand Food Design concept and why it have appeared, that is say the main objective of this research - understand what is food, why is changing and what directions is taking, to exploit its potential-, chapters are developed analyzing food from past to future. It means, firstly, know how societies comprehend what is food, according to past influences; in other words, interpret how culture has built what is it and know, under Ferran Adrià ideas aforementioned in the quote, if food could be a multisensory art.

3 Chapter one of this research is focused on explaining food, using as a main reference “Making sense of taste” (Korsmeyer, 1999), book wrote by the philosopher Carolyn Korsmeyer and “Food is culture” (Montanari, 2006), book from the current professor of Medieval History at Bologna and expert in food studies Massimo Montanari. Besides to recognize food as a design discipline, we also need to realize that food is a kind of applied art. In that way, second chapter expounds how culture has built what is art, and why it does not incorporate food. In order to answer how art can be defined, it has being used as a reference “The oxford handbook of aesthetics” (Levinson, 2003), wrote by the philosophy professor Jerrold Levinson. As well, some articles from other philosophers have been very useful too, such as Hannah Ardent reflections about art (Ardent, 2014), or the philosophy magazine from UAB (Universitat Autònoma de Barcelona) called Disturbis (Disturbis.esteticauab.org, 2016), specifically the nº12 dedicated to food aesthetics. This chapter also is supported by Carolyn Korsmeyer book (Korsmeyer, 1999), mentioned in the previous paragraph, and her reflections about food relationship with art. Moreover, Food Design is linked with human food perception. In that way, it is needed to spell out about the multisensory science of food, which is one of the factors, which born a little more than 4 years ago, that are making grow up food to be categorized in a design discipline. That’s because some scientific realize that our eating action is more than a natural instinct to survive (Spencer and Piqueras Fizerman, 2014; Grodon M.Shepered, 2012). Third chapter is focused on multisensory perception of food investigation, found in the book entitled “The perfect meal. The multisensory science of food and dining” that is written by Charles Spence, experimental psychologist at Oxford University, and Betina Piqueras, experimental psychologist in Wageningen University. Once food topic is introduced, clarifying what is it and what it involves, forth chapter is concentrated on Food Design. Whereas it is a difficult concept to be defined, the main idea of this chapter is to have a rough meaning of what it can be; further, to look for a definition interesting and suitable for this specific project. This section is the essential part of the investigation, which first chapters were introducing, that gives more keys to

4 answer the hypothesis 1 and make emerge hypothesis 2 possibilities. It is needed to figure out what food and art were, in order to understand why food design appears. Decisively, this chapter is a reflection of the topics mentioned before and develops the hypothesis 1 to verify it. The idea of this unit is to conclude that Food Design is not only a new tendency because it is here to stay (Zampollo, 2016). Finally, at the end of the investigation there is a reflection about hypothesis 1 conclusion. And, also, hypothesis 2 is proposed. Last paragraph consists to reveal that Food design is not only for Michelin restaurants, although is the place were it was born, and as a consequence for well-heeled people. It can be very useful to make a social change, and to help in health and nutrition issues using as an example Sant Joan de DĂŠu project (Phase 2, practical part of this Final Degree project).

5 Chapter 1 What is food: How culture has built what food is?

Figure 2: The bread baked with wood. Coques del mosĂ¨n

In this section there is an analysis of food meaning in our culture, seen as a basic element for human survival and not its multisensory or artistic properties. Firstly, there are discussed the components of a taste experience. Then it continues introducing Food and its perception in philosophical terms; the fact that food is, on first instance, functional element for humans in western tradition. Then a leap is made into ancient Greece to classify food and the perception of it â&#x20AC;&#x201C; taste- in a lower perception step, far from having a human superior rationality. Finally, the transformation of food makes thought about the significance that our culture gives to it until now. That is to say that culture reveal what food means. 1.1 Food experience constituents When people eat, there are many factors that influence human perception; one of them, the most logical, is body participation and the senses perception. Nevertheless, there are other aspects that usually people are not aware, such as psychological state, and that are equally important. Eat and the way to perceive food can be very complex because of the amount of elements that participate on it. Food experience can change depending on the readiness to eat and, usually, people acting depend on the craving or thirst. Because of that, sometimes it is said that hunger is an impulsive reaction.

6 It is possible to describe taste experiences analyzing the elements that participate in it (Korsmeyer, 1999): a). Body: there are the corporal and stationary elements. It is possible to find universal elements – like the sweet inclination, which is related by the predilection that human’s body has to eat fruit as a surviving instinct that becomes from humans evolution- or relative, becoming an individual choice. b). Hunger: the feeling of hunger is a human condition in which a person wants food to obtain basic nutritional needs. In a meal, there are considered the physical and the psychological state before the food intake. c). Culture: cultural factors, that can be defined as ‘established beliefs, values, traditions, laws and languages of a nation or society’ (Encyclopedia.com, 2016), play a fundamental role at the time to define food as appetizing, good, edible, such as other characteristics. It depends on the group of people and sometimes it is overcome by the experience; people can enjoy with things that at past were not edible and now become foodstuff. It also includes interdictions, such as in rituals where some food pieces are not desired to eat. However, culture will be treated more in depth in 1.3 point of this chapter. d). Tongue – and other elements near it-: voluntary objects of taste that direct the attention to people body states; It can be defined as ‘inside body’ perception, which starts with mouth, tongue, noise, and includes throat and other digestive system elements. e). Object: it is the item that people choose as the element that is going to be swallowed; this becomes from the exterior world and will be inside mouth. When people taste something, at the same time, they are learning something about the world. f). Pleasure – or upset-: there are the adjectives of people’s experience, which can become from the tongue or from cultural facts. When the choice decides the appropriate adjectives, food becomes voluntary objects.

7 1.2 Food in philosophy This section contains the reflection about how thinkers have classified food perception. To understand why food, and taste perception, was not a topic which had a lot of philosophy studies behind –as compared with sight or hearing perceptionthere are evaluated the reasons of preferential philosophy terms: a) Eating and Food are temporal and ephemeral. It is a pleasure that we consume and philosophy prefers eternal issues. b) Food is perceived and appreciate individually and philosophy gives a preference to universal terms c) A theorist study of food, and its perception, is in conflict with the way that we use food, which is practical; and philosophy is a theorist discipline. Sometimes theory ignores credence, customs and social values; this is a very negative aspect because practices, such as traditions or customs, have largely built culture. This is a topic from the point described below, focused in the thought that food is a cultural fact. 1.3 Food and culture ‘Cereals with milk’ is the food combination that some people from Europe have as a breakfast. But if it is asked someone from China, surely they will answer ‘porridge’ that means boiled rice, which they sometimes combine it with some vegetables, tofu or peanuts among other things. This example shows that food combinations or sequence, such as solid or liquids merger, the tools that are used to eat or the time spent on determinate foodstuff, are guidelines that become as a result of costumes or traditions. The culture of a given society determines how they behave with food. Food has occupied a prominent place in sociologic and anthropologic studies. Eat is an activity that take a greatest portion of people’s time and, furthermore, is an essential aspect of individual and social life. The section about food and culture is based on a book from Massimo Montanari currently professor of medieval history and alimentation history in the University of

8 Bologna, called “Food is culture” (Montanari, M. 2006). It gives a vision that becomes from anthropology and sociology, such as a historic analysis, that helps to understand cultural factors in food. 1.3.1 The cultural side of food Massimo Montanari introduces his book doing a series of reflections, whereby food and eat are configured as a decisive element in the human identity. According to the professor, the idea of eat is related to nature, but this relationship is confused and ambiguous. The essential value of humans food system is the result and the representation of cultural processes that anticipated nature domestication, transformation and reinterpretation. Montanari raises the following affirmations, through which ‘food is culture’: -

When it is produced: as long as humans not only use what they found in the nature –product- because they address their ambition to create, superposing production to catch activity.

When it is being prepared: because after acquiring the products, humans use fire and technology to transform it, which is expressed in cooking practice.

When it is being consumed: because humans, who can eat whatever, choose specific food by using individual or social judgment. Also, it is involved an economic selection criteria and nutritive needs or symbolic values. 1.3.2 Taste pleasure; responsibility choice; anthropologic vision.

Food is not good or bad in absolute terms. Massimo Montanari says that taste is a cultural product and someone teaches us to recognize food characteristics. Taste definition takes part of cultural heritage in human societies. It is possible to find two distinctions of ‘taste’ term: taste as ‘tongue’ (palate and brain) individual sensation or, also, as a ‘sensorial value’ of what is good or bad. Montanari wondered whether all food behavior required a choice. As an answer, the anthropologist Marvin Harris, who defended materialism (it is an investigation line,

9 which comes from sociology and anthropology, and gives priority to material conditions, basically, as the cause of sociocultural differences and similarities. Harris, 1968), said that the selection procedure is a ‘balance between practice benefits and costs’. This explanation only is useful when it is being referred to people who have a low economic level, and there is a link with their hunger. In that case, their choice comes from the facility to obtain a product, the suitability conserve and simply elaboration. But if it is reversed, the social dimension and prosperous social class is concerned, then forming the taste selection procedure seems to flip side: unusual and foreign food is the object of desire. In the psychology and physiology sphere, the pleasure and the upset of taste usually is included in the investigations. It seems to be a universal predilection, based on genetic facts, to sweet things. It is a point of view that comes from human’s evolution because, in the nature, sweet was a mature fruit equivalent, which is a source of nutrition. Therefore, it was a surviving instinct that builds sweet preference. Also, there are some inclinations that come from item identification. If it is known what is going to be eaten, the experience becomes more enjoyable; Arthur Danto, an American art critic and philosopher, has a quote that can support this affirmation: ‘the importance of a correct identification of an object can affect a lot of pleasures, such as artworks, sex and food’ (Danto, 1964). However, it is true that humans can eat different kinds of food, and people have the faculty to try things that are far from what they consider usual. Flavor tastes can be expanded because people have the ability to educate the palate, which can almost be considered a human exclusively characteristic. 1.3.3 The amount of food Montanari, based on an extensive documentation period about alimentation history – specifically in Europe-, said that in the Middle Age, the food and abundance in a table were a sign of affluent and powerful distinguish people. It justifies their reality, where first concern was how to find resources. All societies and traditional cultures

10 are marked by hunger or hunger fear. Therefore, food demand was functional: reflected in quantity need and, afterwards, quality desired. An example is the aesthetic ideal of body’s beauty during XVII and XVIII centuries, where robust figures were admired (i.e. artwork ‘The three graces’, Rubens, 1630-1635). 1.3.4 Food, language and identity ‘Tell me what do you eat and I will tell you who are you’, Brillant-Savarin, 1825. The perspective of Brillant-Savarin’s quote refers to psychology and behavior that people have when eating. The way that people eat reveals their individual personality and character but, furthermore, it determines their social class. In contemporary centuries, consumption and life style were linked with social hierarchy. Montanari said that food was defined as an “exquisite” cultural reality. People social vocation can be translated in gestures done when eating, so it is possible to know from what social status people come from. Food abundance usually means nutritive value of food but, contradictorily, abundance of food can be shared with groups of people (family, friends…) and this is used as a life metaphor: ‘eat together, live together’. An example to that claim is found in traditional language from Romania, where ‘go home’ means ‘enter to the kitchen’. Table is a life metaphor and, moreover, represents the fact of take part of a group and the relationships that are constructed inside it. 1.3.5 Identity and interchange. Traditions and origins. Montanari propose to do a comparison between the ways to eat, those that are found in different societies, and the conventions that are currently in verbal language. Food and language that are inside a society connote communication codes, which express symbolic values and meanings from the nature. Food system contains and transposes culture to the people in the same manner as speaking language. It is an identity

11 instrument but, furthermore, it can be seen as one of the first ways to be brought into contact with different cultures. After all, food not only say who people is and from where –because of that, ‘food is culture’-, but rather culture says the meaning of food. Because of the explanation in the above paragraph, it is possible to say that food identities and cultures are the fruit of history; often are also influenced by environmental and geographic situations. Identity does not exist in the origin, however it is at the end of the overview. Montanari said that food culture could be metaphorically compared with a plant: ‘it is being expanded, while is placing its roots in faraway places; the product is in the surface, visible and clear, and that are the people. The roots are underneath, widespread, numerous and dispersed: these are the history that has built this group of people’. 1.4 Conclusion As a conclusion of this chapter it is possible to affirm that food is not only a practical product, which humans use under survival instinct; it was a preconception from occidental culture that only contemplates this functional side of food. However, it is seen that food have potential to become more. So, in that way, food turns into an interesting topic to study because it can take new paths. As Korsemeyer said in her book: ‘regardless tradition and its context, tastes are not significance carriers – and neither are colors from the tube of paint- there are all kinds of significance that become part of food experiences and, sometimes, emerge from social context where we eat, and others, are inside equity flavors’. Quote found in Korsmeyer, C (1999). For that reason, taste is similar to other sensorial experiences, such as taking a look at a picture from the Greece in Ancient ages, and found that it can have a meaning faculty. Or, on the other hand, on an eating situation people takes into account, amount other things, food visual aspect so aesthetics is present when someone is eating. This means that there is something that Food can share with art. In addition, it

12 also affirms that food is not only functional. In next chapter, it is analyzed what art is and why food was not considered as a kind of art.

13 Chapter 2 What art is: How culture has built what art is and why it does not incorporate food.

Figure 3: Still life with oysters

This chapter defines art, as a concept that culture and societies have built. Jerrold Levinson, professor of Philosophy at the University of Maryland with a research focused on the aesthetics of music, did a formula to define art. Despite of that, Levinson said: â&#x20AC;&#x2DC;I was not attempting to define the concept on art, but rather the concept of art, which have at given art. The concept of art has certainly changed over timeâ&#x20AC;&#x2122; (Currie, 2010). In that section it is reviewed how culture built what art is, understanding this study as the definition of art arriving to our time. Also, there is another section about aesthetics, the philosophy branch that studies some notions and judgments about the nature of art. This investigation is focused on conclude why food, Gastronomy as the discipline name, is not included as a fine art and why it is inside the applied arts group. 2.1 Historical roots and current concepts to define art If a jump is done to the ancient Greece, It is possible to see a first art classification. It is not possible to found earliest Greek philosophers, such as Plato or Aristotle, definitions of what art is; however, things like poetry, painting, music and architecture, which came to be classified as fine arts had been previously described. Anyway, the well-known Greek philosophers made a hierarchic categorization, named as a classic classification of fine arts: they divided it using the term major art â&#x20AC;&#x201C; whose characteristics where make

14 people enjoy the artworks using sight and hearing- which were architecture, sculpture, painting, music, recitation and dance, and the minor arts - with taste, touch and smell senses participation- that could be found in perfumery and gastronomy. That is because, in almost all the occidental philosophies, the distance between object and preceptor subject was considered a moral, cognitive and aesthetic advantage. First attempts to define art are found in the Renaissance, with Kant (German philosopher, who is considered the central figure of modern philosophy) as a philosopher who studied the topic. According to Kant, which has the truly lasting influence on contemporary theories, fine arts were ‘arts of representation where the beautiful objects invoke a disinterested pleasure’. On that way, Kant is giving one of the reasons, that will be studied more in detail in the points below: why Food can not be inside an aesthetic judgment; that’s because the relationship between human body and the object has a practical function, using an example, as satisfying hunger or thirst. Currently the concept ‘art’ is generally used ‘to talk about forms, practices or institutions’ (Levinson, J. 2003). Although, if the question ‘Is that art?’ is posed, usually it will refer to an individual item as an artwork, which will be characterized as a single type of property. So, it is possible to say that art is a concept, which includes human creations, to express a particular vision of the world, which can be real or imagined. Also, as it is seen in Kant quote, art is related by a ‘disinterested pleasure’ (Zangwill, 2003). 2.2 Aesthetic concepts Aesthetic is the philosophy domain that studies the art qualities, such as beauty or the sublime. However, aesthetic definition is a difficult challenge because it is more than what is said in this first sentence. It is a transversal concept because it is everywhere, such an object design, fashion or an interior design. Furthermore, aesthetic do a reflection about why something exists as an aesthetic experience; another interesting aspect of aesthetics, that will help in this investigation, is the art philosophy, which make questions like ‘what art is’ or ‘what makes something be art’.

15 Next reflections were done using as a reference a debate about aesthetics, done at TVE2 and moderated by Juanjo Pardo (Pozo, 2011). Beauty, a concept that could be also called aesthetic value, is just a part of aesthetic. It is because the aesthetic concept also includes ugly, tragic or comic; this aesthetic value is not instrumental or practical, and this is the characteristic that differentiates this value from moral character and scientific interests. Finally, there is another concept from aesthetics, which is important for the current investigation: the aesthetic taste and its relation with taste senses. The term ‘taste’ is used in a metaphoric way to underscore the ability of discern -either beauty and other aesthetic qualities-; it is a way of comprehension, since it evaluates an specific object. The object can be experienced directly through a first hand knowledge and, later, the subjective feelings, which are derived. In occidental philosophy, there is a definition done by Voltaire and Addison (they were two writers and philosophers, from France, who strongly influenced 18th-century taste and people opinion), where aesthetic taste is defined as ‘the capacity of perceive beauty qualities and discriminate between the sophisticated differences of the objects distinguished by us’ (Krosemeyer, 1999). Taste implies to try the flavor or quality of something by taking some into the mouth. Taste, as the literal sense, seems a comfortable and adequate concept to put into words the appreciative perception of art. The aesthetic discourse born in the European philosophy, from XVIII century, and evolve to reach a period where taste and aesthetic taste were in the same level; However a lot of examples of beauty appreciation become from sight perception, the operation of a real perceptive reaction is the same as taste organs: aesthetic taste presupposes a natural aptitude to perceive qualities, which make possible to enjoy the aesthetic pleasure. But there is a particular moment where taste and aesthetic taste come in conflict: aesthetic reactions need necessarily pleasure presence. Nonetheless, aesthetic judgments about beauty and art values are more than simply subjective perceptions. It is presupposed that taste objects, as food or drink, are only useful to human body; that means too fleeting to be in the same classification and theory as art works; this topic is

16 going to be discussed in the next point, as a fact that influenced the reason why food was not included as a fine art. 2.3 Food as an applied art Carolyn Krosemeyer (Krosemeyer, 1999) defends the aesthetic potential of food and the discriminatory capacity of taste sense. Even though, she thinks that it is a mistake to mix fine arts and food in the same classification. Reasons, which were mentioned before, are nutritive characteristics of food and surviving function. In this point, there is a subdivision done to conclude that food can be an applied art. 2.3.1 Limitations of food in fine arts field The philosopher Elisabeth Telfer (is a honoraris causa researcher from Glasgow University; from her Works we can highlight ‘Food for thought: Philosophy and food’), defends that food can be a kind of art, even though it cannot be considered a fine art. According to Telfer, the medium to represent food shows four limitations; there are just a recognition of natural characteristics, which forbid food to reach the fine arts level: 1. The range of expressions that food can have is more limited than fine arts mediums. 2. Food is a temporary medium. Telfer said that ‘food can not aspire to have the detailed attention during a long period of time that canonize more sophisticated products and more perdurable mediums, like pictures or poems’ (Krosemeyer, 1999). 3. Food does not have any meaning, opposed to almost all the literature and plastic arts. 4. Food can not express emotions. Carolyn Korsmeyer says that in order to affirm that food can be an art, it is needed to look beyond degustation pleasure and to work on taste symbolism topic; in addition, asking the cognitive dimension of taste and food, discussed in next section, will help to find the relationship between art and food.

17 2.3.2 Cognitive dimension of food Carolyn Korsmeyer proposes a cognitive theory from the philosopher Nelson Goodman (was a philosopher from United States, known for his works on mereology, induction problem, unrealism and aesthetic), to understand the cognitive dimension of food. Although he does not mention food, the treatment of symbols and aesthetic characteristics enable to think about people comprehension of aesthetic in food, going beyond sensorial pleasure. Goodman gives different categories to understand the aesthetic of food, which are representation and exemplification â&#x20AC;&#x201C;also there is expression in his theory, but it do not interest in that analysis-. Talking about representative food, it is possible to find symbolic functions on it. That fact, allows removing theories saying that food does not possess one of the most important characteristics of art: give knowledge and reflections about life and the world. Examples of representative food are Gummy bears or Easter eggs. Moreover, the most solid example is food that takes part of a ceremony. The other point that Goodman proposes is the exemplification; concept that can be understood as the symbolic relationship between properties owned by an object but, at the same time, it refers to that property. In other words, exemplification goes beyond taste experience in order to be in depth of the food meanings. People absorb from culture and usually are difficult to perceive food significance. 2.3.3 Can food be an art? To answer the question formulated from the title, the opinion of the anthropologist Mary Douglas could be very useful: â&#x20AC;&#x2DC;The visual function of food and its occasional nutrition untying can be sufficient reason to classify certain types of food inside decorative artsâ&#x20AC;&#x2122; (quote from Mary Douglas mentioned at Krosemeyer, 1999). Douglas observed and said that most of the cooking plasticity is related to dishes decoration; it seems that decorative capacity of food is known, accepted and admired.

18 Another important point, which Douglas notes, is the consideration that food can be a communication system: ‘If food have to be regard as a kind of art, it will be accurate to design and ask questions that are formulated also to other art expressions. After distinguish, in first instance, what kind of art is food in a specific culture, thereupon it would be correct to ask oneself the parallelism between local culinary art and other cultures culinary arts’. Douglas suggests that sensorial characteristics of food set up a large aesthetic aspect. Food has its own distinctive control patterns, such as textures, smells, tastes and colors. But there are some occasions where food can find other artistic forms. 2.3.4 Ferran Adrià contribution to see Food as an Art On the magazine Disturbis nº12, there is an article from Juan Arturo Piedrahita called “All you can eat…” (Piedrahita, 2012), which make a reflection about Ferran Adrià innovation in gastronomy. Also it talks about Adrià quote, where he afirm food that what he cooks is a work art. In addition, the article reflects about the paths that food can take to be seen as a kind of art. The article begins with the cultural discussion written in Documenta (is a known exhibition of modern and contemporary art where there are the artist’s with more influence on modern art), done in Kassel in 2007, about the new field in art world: gastronomy. The participation of Ferran Adrià in one of the most recognized art exhibitions raised food and cooking in a higher new level. However, Piedrahita provides an interesting view for the investigation done in this chapter. Ferran Adrià work, an edible artwork, is the starting point on a new cultural speech but with an old formula. As in vanguard traditions, Adrià’s work uses ‘the emphasis of newest as an original way, the pieces of desire building as unique elements and the constant discussion if it is art or not’ (J.A Piedrahita, 2012). The chef used elements from cooking world, which are in the collective imagination, preparing them in an unrecognizable manner and in a space that never before was used for this purpose. Piedrahita does not solve if what Ferran Adrià is doing is art or if it is not; but he

19 thinks about what the chef elaborated: “Ferran reflects about the domestic certainty and establishes, in the imaginary of things, other possible ways to do (…) in the popular process to assume, as possible and valuable, a way never seen until now and whose assimilation allows an intuitive way for searching alternatives to understand cooking’. In conclusion, elBulli (restaurant where Ferran Adrià develop his work. Adrià, Ferran et. al. 2012) established his contemporary value in the domestic circumstance of cooking and its alteration; he built a new approach to understand the ways to interpret food, the manipulation of it -cooking- and the manner to show the aliments, their presentation. 2.4 Conclusion The aesthetic characteristics of food arise from the practice. Parties, ceremonies and other occasions are where it is shown food significance, as it is explained in the Goodman theory about cognitive dimension applied on food. Also, with Mary Douglas reflection, it is possible to put food inside ‘Food design’ category, being an applied art like graphic design or interior design, as it is seen in the next chapter. That fact leads to conclude that food – and actions surrounding- cannot be considered a fine art. As Carolyn Krosemeyer said, there are two important differences between food and fine arts: aesthetic food functions exceeding its own characteristics and, in addition, food and art not showing traditions or parallel stories. In occidental tradition, art concept is developed opposed to applied or decorative arts. The philosopher Hannah Harden, on the article “The permanence of the world and the work of art” (Arendt, Hannah. 2014), talks about artworks as: ‘objects lacking of strict utility’ and, furthermore, that ‘have to be unique, because they are not interchangeable but are a challenge to the common denominator for everything, that is the money’. An artwork is not to be used. For that reason, food will never be in the fine art category because it has a functional component. However, Ardent, in the

20 same article, said that ordinary objects are under an aesthetic judgment: “all that exists has an appearance”. Food with an attractive appearance also has a functional reason: increase the appetite. Finally, with Ferran Adrià contribution, food, as a concept and product, is in a developing process so it can be seen as an art, as the chef said in the quote mentioned in the introduction ‘Cooking is the most multisensory art…’ , but it has a lot of paths to explore. What is true is that the famous chef has revolutionized the world of food and cooking, giving carte blanche to other disciplines to interpret and develop it.

21 Chapter 3 The multisensory perception of food: what direction is food research taking now.

Figure 4: Charles Spence picture for the article ‘Taste is multisensory’.

This chapter wants to expose the research done about the multisensory perception of food. It reveals if it is true Ferran Adrià’s quote, “Cooking is the most multisensory art. I try to stimulate every senses”, exposed in hypitesis1; it is discussed if food has multisensory proprieties that make it to become an interesting product, with a lot of possibilities. To sketch ongoing scientific investigations about food, and how it is perceived, more indepth it is used the book “The perfect meal. The multisensory science of food and dining” (Spence, C. & Piqueras-Fiszman, B. 2014). As it is said in the title, the book deals with the scientific side of multisensory perception of food. Currently, in the Oxford dictionary (Oxforddictionaries.com, 2016), perception is defined as “The ability to see, hear, or become aware of something through the senses: the normal limits to human perception”. It shows that taste perception is not highlighted, nor touch and smell. An explanation about this fact, seen in chapters above, is that taste – and as a consequence food- was seen as a natural, impulsive and inferior instinct because it responds to hunger. Taste sense sometimes acts without being influenced by reason; otherwise, taste is linked to a pleasure response. However, sight and hear are well appreciated and considered as reason senses, reason why both are included in perception description.

22 To argue against those affirmations that classify senses using a hierarchic structure, Korsmayer (Korsmayer, 1999) said that it is needed to investigate using scientific criterions for taste perception. Philosophic judgments, which we have seen in preceding chapters, currently walk simultaneously with scientific researches. 3.1 The brain In almost all the bites that I do, I do, in the back of my mind appears the same question: who is enjoying it? It is my brain or in really it is me? Jeffery Steingarten, gastronomic critic from North America. A lot of scientific disciplines have emerged to understand which factors are influencing peopleâ&#x20AC;&#x2122;s mind during a meal; the intention is to give an answer in front of the new multisensory experiences that. Gastronomic restaurants, most of them inside Michelin star guides, are a clear example of multisensory perception investigations. The following points, explain disciplines that born from this innovations in food and the relationship that have with sciences field. 3.1.1 Neurogastronomy Neurogastronomy is a newest term, defined as â&#x20AC;&#x153;the study of how the brain creates the perception of flavor, and how it matters for human culture. It includes all the disciplines relevant to eating, including chefs and the culinary arts, molecular biology, neuroscience, psychology, human evolution, and child development, especially brain mechanisms involved in learning and memory, emotions, motivation, and rewardâ&#x20AC;? (Gordon M. Shepered, 2012). The name of that scientific discipline was born at the beginning of the twenty-one century. It was created by the professor Gordon Shephered (from Yale School od medicine, 2006-2012; is a neuroscientist who works on experimental and theoretical research on how neurons are organized into microcircuits to carry out the functional operations of the nervous system).

23 At present, researchers from that area, neurograstronomy, have started deepen on the parts of the brain that are more vibrant when people decide if a new ingredients combination like them or not (Spence & Piqueras-Fizerman, 2012). As a result of first observations, scientists realize that food is really one of the most effective stimuli on terms of brain activity modulation. When people feel hungry it becomes a very clear fact: there is a neuroimage study, where hungry participants had a metabolism increment when it is shown to them food and they could smell their favorite food. On this basis, it is possible to speculate if there is any link between neuronal changes and psychological ones, which appear when a person look, or smells, an appetizing dinner plate; also gastroporn (in means images of tempting food meals, among other definitions of the term related to food appearance), growth and make experts speculate about the importance of food perception. Certainly, the considerable raising of food appearance is a tendency linked to the emerging Nouvelle cuisine movement (or molecular gastronomy, concepts that make reference to the new “art and science” from the table; It can be defined as “the work of extract ingredients essence, playing with senses and textures.). As it is found in Apicius collection (roman books collection about cooking), it is said that “the first taste is done by the eyes”, the half attractive of some food can become from the presentation. A example that shows success of this scientific branch, can be seen with chefs as Heston Blumental (The Fat Duck, UK) or Adoni Aduriz (Mugaritz, Basque Country), whose research in psychology and neurology fields to include scientific elements, and create remarkable culinary experiences, is very famous. As a conclusion, Neurogastronomy can be considered the discipline that helps to understand, a little bit more, the role of food in the organization and awareness of human brain. 3.1.2 Gastrophisics: the new science of the table “Why we hate some food that others love?” Around the research of an answer to this question, and thinking over the taste experience, Gastrophisics appeared. First time that the term surfaced was in the magazine called

24 ‘New Scientist’ on 2005. The concept refers to the variety of tools, techniques and ways of thinking about taste experiences in a meal. Their function is eavulate the impact of different factors that interact in the multisensory meal experience. Some chefs, like Charles Michel (Franco-Colombian, chef currently in the UK), use Gastrophisics knowledge as a key to their taste experience creations process. 3.2 The perception of food is fundamentally multisensory “Eat is the only thing that includes all the senses” Heston Bluemntal, Tasting menu from 2004, The fat Duck restaurant, Bray UK Thanks to different scientific studies (Psy.ox.ac.uk, 2016), it is know with precision that eat, as well as flavor perception, is one of the most multisensory experiences from people in their day to day. A big number of chefs have started to work incorporating and stimulating senses, in a manner that their meals became multisensory experiences. An example can be the dishes prepared in restaurants such as Alinea, Mugaritz, El Celler de Can Roca or Noma. 3.2.1 Senses Perception In the next figure (Figure 6.1 Spence and Piqueras-Fizerman, 2012) it is possible to see the multisensory flavor perception. Outside the box, there is external information that can influence flavor perception, with the expectations that can be sent by flavor, aroma and/or taste of food or drink. There is emphasized the role of food-eating sounds and, also, orthonasal and retronasal olfaction are distinguished having unique and separate roles. Inside the box are shown four interceptive sensory inputs, combined though a process of multisensory integration to deliver flavor percepts.

Figure 5: Multisensory flavor perception, emphasizing the important roleplayed by food-eating sounds. Spence, Charles and Piqueras-Fizerman, Bettina

Next points expose the importance of senses â&#x20AC;&#x201C; taste, smell, sight, hearing and touch- in a gustatory experience. Furthermore, it is highlighted which sense predominates in a meal at appropriate stages. 3.2.1.1 Smell To analyze olfactory sense it is important to know in detail how it works. Smell sense is the responsible for detecting and processing odors. It is possible to differentiate two sensorial systems (Girbert, 2008): on one side the orthonasal system, related with the inhalation of external odors, and the retronasal, which is associated with odors detection that come from the food that we have in the mouth. An increasing number of investigations highlight the importance in the moment to differentiate both systems in perceptive and subjective level (Nollet, Leo M.L. & Toldra, Fidel. 2015). When people think in a specific food and eating, it is easy to conclude that many times it is difficult to differentiate between flavors and odors. As a matter of fact, some investigators estimate that olfactory sense contributes between 80 and 90 % of what people assign to taste (Gordon M. Shepered, 2012). Perhaps, it is common to

26 think that is a relative fact, and guess that a French cheese fits more in those percentages than other meals. But it is true that some people often are not sure if is taste or smell contribution. Also, there are extereoreceptive signals – which are in charge of receive and answer stimulus that became from out of the field- that influence a meal perception. Before going to eat and drink, people do a previous analysis that allows them to have an idea of the taste, where orthonasal system participates with an important role. If people perceive the same that was expected, where contribute rethronasal system, the multisensory integration will give pleasure. 3.2.1.2 Taste The gustatory system is the sensory of taste sense. Generally, there is the opinion that people are sensitive to a basic number of flavors, including sweet, salt, sour, bitter, umami and metallic. Traditionally, researchers thought that each flavor receptors where distributed asymmetrically beyond human tongue surface (Spence and Piqueras-Fiszman, 2014). However, actually it is known that there are some receptors –not specific for the flavors mentioned above- around the tongue evenly distributed. Because of that, it is possible to say that humans are sensitive to more than basic flavors. Taste is the sense that enables to see marked differences between sensorial receptors that people have. Taste buds from every person contain a specific number of gustatory cells. There are 16 different variables on the density of taste buds in people; that means a broad range of different opinions about a flavor, depending of the sensibility of gustative stimulus (Miller, JR & Reedy, JR, 1999). There is a 25% of people considered “supertasters”, that often respond with more sensibility to bitter taste, 50% of the population are “medium tasters”, while the other 25 % can be contemplate as little sensible to taste.

27 3.2.1.3 Touch (oral somatosensory) Somatosensory system is responsible to the conscious perception of touch, pressure, pain, temperature, position, movement, and vibration, which arise from the muscles, joints, skin, and fascia. It plays an important role in the moment to determinate food temperature or the texture of it. Latest investigations (Spence and Piqueras-Fiszman, 2014) around this topic suggest that tactile signals have a strong act to recognize in a meal the gustatory experiences inside oral cavity. Oral texture, the feeling that is found inside mouth, of food a taste can affect on how we experiment multisensory. An example is a research done a long time ago (Zhu, Y., Hsu, W. H., & Hollis, J. H. 2013), where it is suggested that increase viscosity in food minimize taste perception. Currently, thanks to technological progress, it is possible to say that it is a fact that becomes from the natural psychology. 3.2.1.4 Hearing The sense of auditory perception has the ability to perceive sound by detecting vibrations - changes in the pressure of the surrounding medium through time, over an organ such as the ear. It is possible to think that there is no link between taste perception and sound but: could someone deal with the challenge to eat a fry potato without making noise? To know what the effect of sound in food is, and how people perceive it, there is an example of a research (Zampini, M. & Spence, C. 2004) done in an Oxford laboratory. It is demonstrate the influence of sound when eating something, in that case potaoe chips. The investigation participants bit 180 fried potatoes and they qualified the perception of fresh and crispy of each. To do the experiment Pringles potatoes were used, because their size is almost equal. The sounds of the potato bites were recorded by a microphone, manipulated and emitted through the earphones that each participant had. Potatoes were better qualified â&#x20AC;&#x201C; more fresh

28 and crispy- when the sound was increased. In such a way, researchers could demonstrate that sound on aliments contribute significantly on food perception. 3.2.1.5 Sight Visual perception is the capacity that humans have to interpret the surrounding environment by processing information that is contained in visible light (Wikipedia, 2014). One of the most typical studies, which may be found in more than 200 articles, is the influence of changing the color of food and how it changes our taste perception. And it is a well-established fact (Zampini M & Spence C. 2012). However, visual perception on food is a complex topic because there is also the plate –and cutlery- influence. Food presentation is designed to make it appetizing or, what is more, made mouth watering with just looking it. Currently there are a lot of investigations (Spence, C et. al. (2015) that work on how to know the influence of the dish - color, texture, size or appearance-. These investigations demonstrate that the object – surface where food is placed before eating it- can contribute as a visual input for the multisensory experience of food. Finally, it is also important the appearance of food – how is it distributed, the variety of colors or the shapes- which means a combination of all the elements that participate in the presentation and the functional aspect. To do an exemplification of it, there is a work of the Franco-Colombian Chef Charles Michel, called “A taste of Kandisnky” inspired on Kandisnky (an influential Russian painter and art theorist; one of his more famous art compositions is the stage of work called Compositions, where he was painting using music as a reference) art theory to compose his dishes (Michel et al. 2014). 3.3 Conclusion As it is seen in this chapter, food perception as a multisensory fact is proved by scientific investigations. That characteristic makes food grow to a new

29 level. However food has a functional role, its perception is more complex and investigations in this field have a lot of potential. The way to understand food has changed because multisensory gives to it some new manners to enjoy, experience and feel food and eating situations. Finally, as a conclusion, it is possible to affirm that the multisensory perception of food will be explored as a multidisciplinary concept, using some examples of disciplines that could comprise it such as science, psychology, gastronomy or design.

30 Chapter 4 Food Design: a new way to understand and design food.

Figure 6: Eating designer Marije Vogelzand visual scheme. Housley, Sara ‘People do not want to substitute food, as astronauts do, taking pills, because in everyday life we need to eat good food as a psychological essential (…) –Peopledo not just expect food to fill our tummies, it also indulges our senses, we want to relish it (…) After all, food does not only serve survival, but also provokes lust and temptation”. Stummerer and Hablesreiter, (Stummerer et al., 2010. P.23) With this introductory quote, it is possible to say that food and eating can give enjoyment and not only be a survival action. Also, there is a cultural fact that determines the way to interpret it. After the investigation done in the first three chapters, it is possible to conclude that the cultural way to understand and design food is changing. And these changes have a name: food design. First of all, in this chapter, there is a short critical approach about the meaning of the concept ‘culture’, using the reflections from a book called ‘Religion without religion’ (Corbi, 1996). Design was born from people needs, which are defined from the culture of a particular society or human group. For that reason, it can be appropriate to specify the definition of culture that stands up this chapter, and all this project.

31 Secondly, this unit deals with ‘food design’ concept, trying to define it and to specify which areas are included this discipline. It is used Francesca Zampollo reflections are used as well as some investigation, supported with the book “Food Design XL” (Stummerer et al., 2010). Also, some very current magazines such as Experimenta (Experimenta 2015) and Elisava magazine (Elisava; decodificando el diseño, 2015), renewed in design world, served as a backing to develop the chapter. To sum up, the main objective of this chapter is to conclude resolving the hypothesis 1: “Could food be a multisensory applied art, which some designers entitled as Food design?” The idea of the research developed down below, is to develop a research to verify that Food Design is an applied and multisensory art, still in its developmental phase, with a lot of points to be successful. 4.1 A critical approach about culture meaning Culture can be defined, as Corbi (Corbi, 1996) said, as:

‘A peculiar form that

determinates human living condition’. Humans live in an environment and the way to behave with it is its culture. In such a way, culture can be understood as a tool for humans to survive, build their habitat and be adapted. So culture determines the ‘surviving’ biologic functions: eat, defend, procreate and communicate; these functions also have innate forms to perceive and behave, which give to humans the way to understand what it is real. It is possible to say that every human group believes that their culture is a reality pattern –and with no doubt it excludes other cultural systems-. For functional needs – survivalevery cultural system, with their own system of values, determines how people should think, feel and do. Finally, one way to be adapted with the settings without having to modify genetics or morphology is the ‘language’; that –language- can be understood as a biological invention that humans need to interact with the environment. A communicative relationship mediates the access to real life.

32 As a conclusion, culture can be considered as world interpretation models with a system of values that motivates and organizes human’s survival. Eating is a biological need but every culture gives to it a value. In the quote ‘in the act of eating there is pleasure’ (Stummerer et al., 2010. pag 23) there is a cultural interpretation. As it is said in the previous chapters – chapter 1 and 2- food is like a language, so it can be interpreted as a communication code that humans use to be adapted with their environment. Next points develop ‘food design’ concept, which can be understood as a new way that people have to interact, which means behave and perceive, with food and the act of eating. But this concept has appeared in a specific culture, with determinate behavior values, and can not work –or have sense- in other cultural systems. 4.2 Food Design Definitions ‘The vast knowledge of food design -which implies interdisciplinary, multidisciplinary and transdisciplinary matters- conceives the term definition a challenge’ Zampollo, 2015. Pag 3-9). In the editorial for the Food Design-themed issue, about Hospitality and Society (a.Zampollo 2015), Zampollo put together a variety of Food Design definitions, given from different professionals specialized in the field. Designers and chefs had tried to define the term, and sometimes depending on their specialization the focus of the definition changes. Next paragraphs show some definitions that are interesting for this research.

a) In the ‘designers’ field, definitions chosen show the focus of the professional based on food itself: ‘Food Design is the design (Gestaltung) of edible objects, this includes all processes – from the cultivation/breeding to the preparation of food – and all decisions that are taken to determine food as an object; more precisely the design of taste, consistency, texture, surface, the sound of chewing, smell and all other object properties’. Sonja Stummerer and Martin Hablesreiter – Studio Honey and Bunny Authors of Food Design XL (2010) and Eat Design (2013) ‘Food design is the design of food, which is thought, perceived, contextualized, ritualized, implemented and consumed as an object’. Martí Guixé Generalist Designer b) In the ‘gastronomy’ world, the chef James Briscione, from America (Birminham, Alabama), emphasizes the cooking in the Food Design definition: Food Design is where the craft of cooking begins. Every dish begins as an idea – a scent, an image, a feeling – that is ultimately built, refined and polished into a memorable bite. James Briscione – Chef Director of Culinary Development at the Institute of Culinary Education in NewYork Finally, there is the definition of Anna Cerrocchi, the organizer of the first Food Design competition and exhibition in 2001 -which considers herself as an expert in the field- who interprets Food Design as a process. Zampollo agrees with her definition, pointing out that Food Design firstly means Design.

34 Food Design is a design process based on users needs, that modify one or more features of the food and/or of the objects, tools, and ways linked to its consumption, in order to improve the physical and mental fruition of food itself. Anna Cerrocchi Founder of ONE Off Studio, Lecturer at Turin Polytechnic, Italy. As it is possible to see, Food Design is an emerging discipline full of potential and possibilities in different fields. The variety of definitions show how the concept can take different meanings; it can be seen from different angles and can be considered an interesting discipline to develop. 4.3 Food Design and the five senses The question that food – and actions that involve food- can be considered multisensory is developed and solved, in a scientific way, into the previous chapters (chapter 3, Spence, C. and Piqueras-Fiszman, B. 2014). This point wants to highlight the multisensory attributes from design point of view. In the book ‘Food Design XL’ (Stummerer et al., 2010. pag 23), previously introduced, there is a chapter entitled ‘the five senses and their impact on the design of food’. The authors agree with the fact that when people say that something tastes good, they are assimilating what it is perceived by the other senses. Down below, there are discussed some examples that show the importance of the senses when food – and the different ways to interact with it- is going to be designed. 4.3.1 Smell and taste impact in the Design of Food Smell and taste are early senses that people relate, in the first instance, with food and when eating. Both are the factors that make people mouths water, as it is explained in Chapter 3 with scientific support. Stummerer and Hablesreiter (Stummerer et al., 2010. p. 32) said that, designers who work with flavor and smell are dealing with the scent of food. An example given by the authors is about the relationship between the European country and strawberry flavor. It is not

35 possible to add in all produced yoghurt, real strawberry because the demand of this ingredient is huge. Manufacturers use aromatic substances in food, so it is possible to argue that: “Artificial flavors are part and parcel of our every-day life, they have changed the way we experience taste with lasting effect” Stummerer et al., (2010. p 32). To conclude it, it is necessary to say that designers place great importance on how people experience food due to smell and taste; there is a continuous work on it to make better products and, in addition, try to cover successfully the market demand. 4.3.2 Touch sense when eating Sense of touch is also involved in how people perceive food. Cutlery can be an example, but in many parts of the world people still eat using hands; for example sushi, traditional Japanese food, has to be eaten using hands. Also in western world there are different aliments that usually people eat by using hands, for example popcorn, eaten in cinemas, is a finger food whose crunchy texture is very appreciated. Eating with hands can be fun, “especially because our education normally does not permit it”. Furthermore, “Finger food intensifies the contact between food and the eater, thus enhancing sensory experience” (Stummerer et al., 2010. Pag 39). On the other hand, mouth has some tactile abilities that respond with sensitivity to pressure, pain and temperature -as say Profesor Gisla Gneich, a Breme-based perceptual psychologist (Stummerer et al., 2010. Pag 39). Other information that humans can feel with their mouth is consistency and texture, but also qualities like rough, smooth, elastic, crumbly, crispy or soft. Sense of touch help to decide if something that is eaten is disgusting or savory; but also it can determine if we are allowed to it eat or not. An example (Stummerer et al., 2010. P. 39), can be when people try a soft potato chip; it will be turned down immediately because its consistency means that it is not good.

36 4.3.3 Eyesight and food design Sometimes, before trying food, people just use their eyes because it is possible to speculate if something will taste good or not; if it is appetizing, mouth will start watering. The perception of the dish is based on esthetics criteria because ‘if it is satisfied optically, this intensifies the pleasure, food then tastes better, even if, in reality, it only looks different’ (Stummerer et al., 2010. Pag 39). ‘What do we perceive as optically is appealing in food?’ ask Stummerer and Hablesreiter (Stummerer et al., 2010. Pag 39). The answer can be decisive for food designers. The esthetic perception will change depending from the culture of people. Although, sometimes it is possible to apply same design criteria from other design areas, such as Graphic design or fashion; thus general rule to work and have success can be found in different specialties. An example of the cultural factor is that generally people prefer dishes with variety of colors and shapes. The reason of this comes from the fact that a historical diversity means also luxury, and the more ingredients the more sophisticated and expensive dish (Montanari, M. 2006). Finally, eyesight can contribute on scanning food in order to say if it is safe and healthy, or not. An example is that using “optical impression of color, consistency and surface we are able to assess how fresh food is” (Stummerer et al., 2010. Pag 84). 4.3.4 Sound: the hearing and the food design Ears, through the hearing can send to human body information about if a food is tasty or not. However, there is a cultural distinction between two groups of people and how sound is perceived (Stummerer et al., 2010. Pag 103): there are ‘people who love active, powerful and light sound backdrops and people who prefer sonorous, dark and soft tones – very simplified, those who hear overtones and those who hear key tones’. To reach the success when designing food, the sound pattern has to be successful for both groups. Also, it is possible to find pleasure from sound patterns. As in optical criteria, “the more diversity of sounds, the better tastes the food” (Stummerer et al., 2010. Pag 103).

37 An example of a sound designer is Friederich Blunter, German acoustic expert specialized in the sound design of food products, who is currently working in the creation of an ice cream that works like a record player. He is using different ingredients to create a variety of sounds. Blunter said that 30 to 40 different sound patterns can be distinguished and can be produced (Stummerer et al., 2010. Pag 103). As it has been developed in this point, the sound of food becomes a sub-discipline with many possibilities to explore. 4.4 Food design into sub-disciplines Francesca Zampollo, who theorized about design processes applied to food, categorized â&#x20AC;&#x2DC;Food Designâ&#x20AC;&#x2122; in different disciplines in order to make the concept more comprehensible. There are different specializations, which depend on the knowledge of the professionals who work at them. She considers that there are six sub-disciplines (Zampollo, 2013. pag 158-171): a) Design about food: it contemplates objects that take their inspiration to be designed from food. Sometimes food can help to emphasize, reinterpret or inspire a product message. An example can be found in cosmetics world, were there is chocolate body cream that acquires the tactile properties of the food. b) Design with food: it is the kind of design, which properly performs chefs that transform raw material to create something that didnâ&#x20AC;&#x2122;t exist before. This design involves how to reinvent food, as it is, and how to stimulate food experience using a sensorial expectative transgression. c) Design for food: this branch of design deals with food products that are used to cut, hack, mix, contain, store, cook and conserve food. Packaging is not only a food container as it is a communication medium too. d) Food space design or interior Design for food: as the name of this discipline said, it considers the interior project where to design food: the characteristics of the environmental space, materials, colors, lighting, temperature and music. Interior architecture to food is dedicated mainly as space projects, such as

38 kitchens, patisseries, bars and restaurants. Some concerns have to be taken into account to acquire food knowledge before design an interior: how aliments are prepared to create a specific surface or, furthermore, understood the food experience dynamic having in mind lighting, or, among other things, temperature and colors that are more appropriate in its environment to have a better result. e) Food product design: this discipline is closer to the idea of a designer who takes part of the industrial process. It takes into consideration the comestible products, which are manufactured, in a large scale. An example is Pringles potatoes, which are designed to create a gustative experience but, besides, the process has add to make the flavor endure. f) Eating design: this discipline is about an eating situation. That kind of design looks at all the angles and situations when people are interacting with food. It can be a very broad definition; therefore, eating in a restaurant is only one possibility. An example of eating desing showing how far it can reach, is find in Marije Vogelzang proposals (b. Zampollo, Francesca. 2015); such as her Veggie Bling Bling party where she tried to achieve that her daughter eat vegetables. 4.5 Conclusion for hypothesis 1 â&#x20AC;&#x2DC;Could food be a multisensory applied art, which some designers entitled as Food design?â&#x20AC;&#x2122; Doing an analysis of the research done during this phase, realized using literature research, hypothesis 1 can be solved; it is possible to see how people interaction with food is changing, because there is an inquiry that comes from the past to present, and future speculations, about food. That change is a result of cultural facts, society development that never stops. First chapters show how food, and the act of eating, was seen in past. Change starts in 3rd chapter, where it is explained the multisensory characteristic of food,

39 scientifically confirmed in Charles Spence and Betina Piqueras study. However, research on that aspect is new and has less than 5 years old. Finally, last chapter, where Food Design concept is evaluated, confirms that food is becoming an applied art, which can be compared with fashion or Graphic design. But also highlights food potential that can be reflected in a lot of disciplines. As a conclusion, this chapter puts together all the research ideas, developed along this theorist investigation, to confirm that hypothesis 1 can be verified.

40 Chapter 5. Conclusion phase 1

Figure 7: Finished dish. Aol magazine

After the research done in the previous 4 chapters, and subsequently having solved the hypothesis one, there is a summary to conclude all concepts worked and close the questions of every chapter. First of all, first chapter covers what significance has put culture to food. To sum it up, it is said that, that until now food and eating situations were understood as a need for human survival. However, there are more other aspects, than the functional as a nutritive element, which food could cover because of food meaning or the multisensory perception of it. Secondly, there is an investigation about what is art is and why food can not be inside fine arts; however, the conclusion clarifies that it can be seen as an applied art, such as interior design or fashion design, after using reflections from anthropologists, like Mary Douglas, or with Ferran AdriĂ contributions. It highlights that it is important to remember functional factor of food, which also can be used as a strong point, even though as everything material in that world it has have aesthetic aspects to take into account. Third chapter explains the multisensory perception of food in a scientific way,

41 giving the key of the food potential and explaining why now it is becoming a trending topic. Science progresses have shown new ways to perceive food, which have converted it in an interesting element to research. To sum up, using multisensory characteristics, food can change the way of how societies understand it and the way they experiment with it. Last but not least, Food Design term is analyzed in the 4th chapter, taking into account this concept inside the culture where it is beginning to appear. The discipline is explained with definitions and a categorization. Also, there is included the multisensory contribution on food but seen with the designer eyes. Food can become a design branch. However, it is a new field and there is much more to discover. The parameters of the discipline need to be developed. Last chapter, supported by the conclusions from the early chapters, solves hypothesis1.

5.1 Conclusion for next steps Once food and eating situations are considered belonging to the design world, in order to begin the second phase of this project, I started asking myself a new and more practical hypothesis that puts into practice what I have scheduled. The question was born when taking a look on the magnitude of fields that food design can be comprised. However, I started thinking on new fields, different situations that can include eating while they need an improvement. While doing the research, and asking myself of daily situations, I found that people who are suffering painful illness, and usually having to stay during long periods at the hospital, need to eat, as every human, but in their situation doing it well is basic to improve their condition and, when possible, overpass the illness. Although, eating becomes a handicap and it is difficult to do it in a correct way; for that reason it becomes a big problem if it is not done properly.

42 This is the case of cancer patients. One of the secondary effects of chemotherapy is that patients lose, or have altered, their flavor and smell perception. That made me start thinking on the way to apply multisensory perception of food and born an approach to hypothesis 2 born: ‘Could it be possible to use aesthetic aspects of food and multisensory perception and, through food design, create an experience –eating design- to improve the nutrition of people with undertaking chemotherapy treatment (cancer) and who present an altered – or nullified- the perception of taste and smell by sight, hearing and touch as a stimulus?’

Phase 2

43 Introduction to Practical phase Employing Food Design as a multisensory applied art The second phase is intended to employ food design as a multisensory applied art, that is to say, to answer a more applied hypothesis that has its origin in hypothesis 1 goal (p.1 - 4) in order to answer same objectives: to understand what is food and why it is changing and what directions it is taking inside applied art disciplines, and, at the same time, to exploit the possibilities of multisensory integration and to use them to provide creative solutions for specific problems. The approach to hypothesis 2, mentioned before in phase 1 was: ‘Could it be possible to use aesthetic aspects of food and multisensory perception and, through food design, create an experience –eating design- to improve the nutrition of people with undertaking chemotherapy treatment and who present an altered – or nullifiedperception of taste and smell by sight, hearing and touch as a stimulus?’ As it is said in the conclusion of 1st phase of the present work, the first approach to Hypothesis 2 was the results of asking if there was a field, outside pure gastronomy and the world of Michelin stars, where food design could make an improvement to people's needs. After some personal research, I realized that people who suffer cancer need to eat, as every human, but face serious difficulties when doing so because of chemotherapy treatment and the secondary effects that can interfere with food ingest. In other words, eating becomes a big problem and a dramatic situation for many cancer patients undergoing chemotherapy. I was totally lost in nutritional and medical aspects of food so I decided that, before keep going with this initial idea, I had to contact with specialists from closer fields to define the topic needs and my opportunities. First of all, I did an interview with a professional from the dietetics and nutrition world (See interview in Annex 4), called Natàlia Palau – specialized in clinical

44 nutrition, as she had studied ‘Human nutrition and dietetics’, also having a Master's degree in ‘Metabolism and nutrition’-. She told me that the approach to hypothesis 2 could be a first step to improve clinical nutrition; so she encouraged me to develop my initial idea further. Moreover, she also told me that malnutrition represents a very difficult problem in hospitals because patients (and not only people with cancer under chemotherapy treatment) do not generally want to eat. She said to me that ‘it will not be a miracle’ but maybe it will solve something. On top of this, in order to know more about nutrition, and to feel more involved with the topic, I did a summer specialization course in UOC (Annex 5) called ‘Nutrition, health and wellness: food as medicine’. It is an introductory course that explains the basic principles of human nutrition and, furthermore, invites to reflect on the evolution of the concept of nutrition and its radical modification in the last decades. Secondly, in the medical sphere, I interviewed Anna Galindo, medical student at the UB. She told me that the approach to hypothesis 2 could have interesting results; however, she proposed me to narrow the focus of my research because ‘patients with cancer’ represented a too vast field. She suggested me to work with pediatric cancer, because of my experience working with kids in summer campus and she sent me some information about Vall d’Hebron Oncology pediatric unit, which was recently renewed (EFE / Barcelona, 2015). Indeed, my previous knowledge, working with kids in the leisure time education field, may turn out to be very useful to create and develop an activity around food. She also suggested me to select a specific cancer and treatment because secondary effects are quite different depending on the kind of chemotherapy used. Another person with whom I kept in touch at this intial stage of phase 2, was Ferran Altarriba, a new media researcher and specialized in interaction design and Gamification. Currently he is investigating the links between Gastronomy and Gamification. Altarriba made me realize that my hypothesis needed to add a clear ‘motivation’ and that this motivation was somehow related to the multisensory nature of perception. At this point, I realized that I was designing an experience. For that

45 reason, I started researching Eating design (Zampollo, Francesca. 2013), a new area that introduces design in every activity related to food. With these new insights I reformulated hypothesis 2: Could it be possible to use the aesthetic aspects of food and multisensory perception to create an experience able to improve nutrition –and the mealtime- in children with cancer undertaking chemotherapy? Even though, the turning point of this project was when I got in touch with Prof. Charles Spence, experimental psychologist at the University of Oxford and author of the book ‘The perfect meal. The multisensory science of food and dining. (Spence and Piqueras-Fiszman, 2014) that I used during first investigation. I mentioned my approach (and hypothesis 2) to Charles Spence and he put me in contact with Jordi Navarra, PhD in Experimental psychology and former member of Spence's lab at Oxford, who currently works, as a researcher, at Hospital Sant Joan de Déu. Jordi Navarra had just received funding to work on a project entitled “Fighting against malnutrition in children under chemotherapy treatment”. This is an ongoing project financed by the Spanish Association Against Cancer (AECC), which categorized it as ‘special project’ (trad. ‘Proyectos singulares’ in Spanish). He accepted me as a trainee student and, furthermore, we have signed an agreement

called

‘Educational

cooperation

program

University

and

Business/Institution’ (see in Annex 3). My agreement was for 6 months (January 1st to June 30th of 2016). Personally I thought that taking part of his team gave me the keys to develop successfully the practical part of my Final Degree Project. For that reason, phase 2 coincide in some points with the same research done in San Joan de Déu by Jordi Navarra's multidisciplinary team.

46 Finally, it is noteworthy that, since February 1st, I have also been involved in the Patient Experience Department at Hospital Sant Joan de DĂŠu (ExperiĂ¨ncia del pacient), being a volunteer as an apprentice of Cristina Bustillo (Chief experienced officer in this field at the hospital since march 2015). This role also provide me with a great opportunity to develop first phases of this project.

47 Phase 2

Figure 2.1: Sant Joan de Déu Logo. Hsjdbcn.org

Introduction This phase is a personal research on how to develop hypothesis 2 successfully. My research is linked to Jordi Navarra's project. Therefore, being a member of Dr. Navarra's team, and participating in his project developed at Hospital Sant Joan de Déu allowed me to pursue my research activities (there is a Memoir in annexes with more details about my tasks developed there. See ‘Memoir about my tasks done in Sant Joan de Déu project’, Annex 1). The main objective of Jordi Navarra’s project is to fight against malnutrition in children under chemotherapy treatment. In other words, make children with cancer eat successfully, thus increasing the chances to overcome this illness. The project has three different areas of investigation: 1. Multisensory integration of the food, conducted in close collaboration with Charles Spence and Fundació Alicia. 2. Product design, conducted with with Paul Nannen, an engineer and designer specialized in human products and who has a prototype of plates for cancer patients done as a final university project. 3. Other psychological aspects, including variables that go beyond perception, such as motivation, learning/memory or the level of satisfaction. In this area is where my intervention will take place, taking into account how to motivate children by designing an experience. The project was launched on 5th of November 2015, as it is possible to see in labjordinavarra website, and started on January 2016. The timeline expected was

48 to have the project in development during approximately 3 years; being the first year devoted to research, generate ideas and do first proposals (Planning of the full year, Annex 2) and, thereupon, during the second and third year, to test the first design prototypes in a pilot study to do some improvements, and finally test the ultimate versions of the designs and recipes in a sample of children and adolescents with cancer undergoing chemotherapy tretament at Sant Joan de Déu. The methodology used to develop the project is based on Design thinking, which is a creative solving method that uses several tools to facilitate dialogs, define problems, generate ideas and obtain solutions. More specifically, the methodology is called Service Design Thinking (Marc Stickdorn and Jakob Schneider, 2012), and it is similar to Design thinking but more focused on the design of experiences for people. This method was going to be useful to design an experience, for oncology pediatric patients, involving food and the act of eating. The activities developed during the design process are focused on the user and the ecosystem that surrounds him/her –the patient from an oncology pediatric unit-. Ecosystem –that means everything that is around the user, like familiars, friends but also places and activities- is very complex and the main characteristics are that it is dynamic, non lineal and unpredictable. Service Design Thinking will take into account the ‘stakeholders’ of the user, which comes from the today to foreseeing the future. That will give to the researcher needs and opportunities information to start designing for improvements. The method was proposed by Cristina Bustillo, head of Patient Experience department from Sant Joan de Déu hospital (a branch of Hospital Innovation department). However, my first suggestion was to use another method created by Francesca Zampollo, called Food Design Thinking, which is a branch of design thinking but specific to food design (About Food Design Thinking, Annex 6). The methodology used, Service Design thinking, has three well-defined phases. I will use these phases divide the subsequent chapters of phase 2:

49 a) Design research: this phase is useful to comprehend the user and the experience that he/she is living - how is influenced by the environment-. Tools, like ethnography, shadowing, interviews or co-creation, will help to determine ‘needs’ and ‘opportunity areas’. In the project ‘Ethnography’ will be the tool used, described down below. b) Ideation: this second phase is where the first insights about which are user needs and the opportunity areas to improve the situation are used, after the first outputs of the intial phase research are analyzed, to design creative solutions. The goal here is to transform the ‘experience’ into a game. c) Implementation: that is the result that solves the hypothesis tested; in our particular case, a pilot design: a proposal to solve malnutrition and the food intake stressful situation, changing it towards a more pleasant activity. Even though, first chapter of this phase is a literature review, done to know better the user and the environment, which investigates about: cancer and nutrition, Sant Joan de Déu and oncology pediatric and, finally, psychology of human development, to know better psych of kids and teenagers. The first chapter is a gathering of general information that I have considered basic to understand better the target of the project (children with cancer unertaking chemotherapy at Hospital Sant Joan de Déu). Finally, is it worthy to comment that some of the project activities conducted at Sant Joan de Déu (interviews and other field investigation techniques) are not fully described for privacy reasons. Some details regardin other parts of the project (e.g., some product designs) have also been omitted due to intellectual property rights. However, there is a memory, which has journal format, about my tasks developed in the project (Memoir about my tasks done in Sant Joan de Déu project, Annex 4) that allows knowing with more precision my intervention done in situ.

50 Chapter 1 General Information (Literature research)

Figure 2.2: Literature research notes. Espinós, Marianna.

Some literature review was conducted to know better certain aspects of the situation of the oncology paediatric patient and her/his environment. First of all, I searched some general information about cancer in order to know what is the illness is and, specifically, to recognise how it affects on nutrition and mealtime in kids and teenagers. Secondly, I looked for Sant Joan de Déu Hospital information, such as its philosophy and its patients' care model is. Even though, research is specially focused on oncology paediatric area. Finally, I briefly investigated the psychology of kids and teenagers, reviewing various theories on the psychology of the development; that information was useful to divide the target, taking age into account, and to know how experiences influence them differently. 1. About Cancer All this section about cancer is done using notes from various sources, but specifically from a working portfolio entitled ‘Caner and nutrition’ (Amaya Peñalva Arigrita, 2014-2015). I also used information form NIH cancer institute (National Cancer Institute, USA; 2016).

51 Cancer is a term that refers to a group of diseases where there is a mutation of cell growth. Cells that are affected grow and scatter freely through the body; that happens because mutation means a loss of normal cells growth control. Cancer can arise on whatever part of the body because there are cells on the organs and tissues have cells. The main problem is that when affected cells are divided they lose properties like apoptosis, a process of programmed cell death. In that case there is no balance between the growth of new cells and the death of old or defective cells. Cancers can scatter around the body using two mechanisms: - Invasions: cancer cells migrate to neighbouring tissue. - Metastasis: cancer cells migrate to distant organs. Causes of cancer, in addition to genetic predisposition -heritage-, it is possible to find 3 categories with principal factors: chemical substances (environmental factors like tobacco or alimentation), radiation (environmental factor like repeated exposure under solar rays) and a virus or bacterium. Finally, ageing increases the probability to suffer cancer; it is because cells had more time to mutate. There is a European code (Cancercode-europe.iarc.fr, 2016) with some advices to prevent cancer, evidently related to cancer causes. 1.1. Treatments against cancer There are different treatments to fight against cancer and sometimes it is used more than one at the same time; thatâ&#x20AC;&#x2122;s because cancer is a multimodal illness and it need multiple treatments can be needed. Combined with the treatments that are explained down below, experts recommend changes in lifestyle, healthy cuisine, eat food with beneficial properties, use nutritional supplements and do exercise. A summary of current cancer treatments is then presented bellow: a) Surgery: tumour removal as well as nearby tissues. It is done in very localized tumours and without metastasis. It can be combined with chemotherapy or radiation therapy.

52 b) Chemotherapy: cancer cells destruction using medication (drugs). This treatment is used to cure cancer -stop cells division or cause spontaneous cells death-, control cancer â&#x20AC;&#x201C;avoid cancer extension or cancer growth- and/or improve cancer symptoms as a palliative treatment. However, this treatment could affect healthy cells: as mouth cells, causing consequently mucositis â&#x20AC;&#x201C; mouth sores-, intestine cells, leading diarrhoea or bad absorption, and hair cells, causing alopecia (hair loss). Secondary effects can be, among others, fatigue, sickness and vomits, changes in flavour perception, mucositis, diarrhoea, constipation, lack of appetite or abdominal pain. c) Targeted therapy: acts in a certain way to kill specific cancer cells. d) Biological therapy: is the use of medications, or substances made by the body, to increase or restore the body's natural defenses against cancer. e) Radiation therapy: is a process that precisely sends high levels of radiation directly to the cancer cells. There are different grades, depending of the radiation, which the secondary effects are similar to chemotherapy ones: mucositis, dry mouth, loss of flavor, dysphagia -or swallowing defects-, sickness and vomits, diarrhoea or lack of appetite as the most commons. 1.2. How cancer affect children and teenagers Next information has been collected from Sant Joan de DĂŠu website oncology advices section (Hsjdbcn.org, 2016). Pediatric cancer, also called development cancer, is the term used for cancers that appear in people during childhood (0-21 years old). Usually their causes are not due to environmental factors nor to heritage. The origin of cancer in childhood is more related to unfortunate chance. For that reason, this illness is more frequent in adults while in children it is considered a rare disease. Although, the incidence in Spain is about 132 new cases per year per million of children -aged less than fifteen years old-; in another words, there are diagnosed 900 new cases of cancer in kids and teenagers in Spain every year.

53 About 75% of all pediatric tumors can be overcome, a big difference between adults tumors, with treatments currently available. This percentage reflects treatments progress in pediatric oncology departments. However, the possibility of healing depends on the kind of cancer, the presence of metastasis, tumor response to the treatment and age. Prognosis gets worse if there is a recurrence of the disease, despite previous treatment. 1.3.

Cancer

and

Nutrition

Children

and

teenagers

under

chemotherapy A healthy and balanced diet is a great help for people who are suffering cancer, especially in children and adolescents as they are in growth age. Good eating habits from the beginning will help to reduce treatment secondary effects treatment, such as changes in taste, mouth sores or lack of hunger. However, eating is a handicap and the risk of being underfed is very highbetween 6 and 50 % of kids who have cancer-. Nutritionists from Sant Joan de DĂŠu have prepared a guide (GutiĂŠrrez SĂĄnchez et al., 2015), where the information developed below is collected from. Most typical secondary effects, which have a negative impact on children and teenagers' nutrition, are described below: a) Weight-loss or hyporexia: it means loss of appetite and it is one of the most common symptoms. The use of some tricks, like experiment with new recipes or eat few but many times, can help a lot to reduce the lose of weight. b) Mucositis, oral thrush, inflammation of mouth and oesophagus: mouth sores usually appear in oral cavity and go along digestive tract; use some medicine can help to relieve pain but also diet have to be adapted; an example can be use ice before the ingest or eat a liquid diet. c) Dry mouth or xerostomia: it is an abnormal lack of saliva. A recommendation can be to drink a lot and eat food having a lot of liquid.

54 d) Taste disturbance: some people feel changes in flavour perception and start refusing food that previously they liked. It is advised to try a variety of recipes and enhance new flavours. e) Sickness and vomits: these are very common symptoms, although there are drugs to reduce them. It is very important to drink small amounts of liquid to avoid malnutrition. f) Diarrhoea: in that case it is very important to compensate liquid loss. Hydration is very necessary. g) Constipation: the absence of fruit and vegetables ingestion, lack of movement during hospitalization periods, specific medicine, and clinical situation of the patient can cause constipation. Dietetic and behaviour rules can help to improve this situation. h) Neutropenia (low bacterial levels diet is recommended): sometimes oncologic patients suffer from a depressed immunological system so their defence against infectious agents are decreased, which means that they have to eat a low bacterial levels diet. Eating low-microbial diet will reduce the risk of getting sick while immune system is weak. In that case is very important to have rules on care and hygiene to avoid contamination. An advice can be vegetables and fruits are fine as long as they are washed or cook food thoroughly. i) Oropharyngenal dysphagia: it means difficulty or impossibility to swallow; this symptom can appear with solid or liquid aliments. Diet will be adapted depending on the kind of tolerance. 2. Sant Joan de DĂŠu and Oncologic Pediatry Hospital Sant Joan de DĂŠu is a Barcelona childrenâ&#x20AC;&#x2122;s hospital, with paediatric assistance, gynecology and obstetrics specialties. It is the largest children's hospital in Spain, and one of the top 3 of their kind in Europe.

55 The philosophy of the hospital is ‘cure and care’ patients. This is the reason why it has a strategic plan called ‘Hospital amic’ (Friendly hospital); this plan is a way to try to make children feel as much comfortable as possible. This approach to clinical assistance has proven to be very successful. Some examples of this approach can be seen in the following services that they offer: art and music therapy, child life program, volunteer’s assistance, the use of dogs and robots, and hospital clowns or associations departments. Also there is another plan called ‘Hospital without pain’, in where Innovation department from the hospital, and specifically patient experience department, work hard to make patients have a satisfactorily stay. Hospital Sant Joan de Déu has top-ranked professionals specialized in oncologic paediatry; hospital makes great efforts to integrate specialized and interdisciplinary professionals, international referents, with best technology. Also, they place great importance on paediatric cancer research, having first pilot programs on, for example, preserving ovarian tissue. For these reasons, the hospital is currently offering best treatments available on child oncology. Presently, 175 new cases are diagnosed each year in Sant Joan de Déu. As it is said in the previous point about Nutrition and Cancer, oncology paediatric patients need good eating habits to fight better against cancer. Also these habits help to reduce secondary effects of treatments. Although oncology doctors give some advices to patients and their families, and adapted diets, usually they need the support of nutritionists from the hospital. After oncology specialists requests their assistance, nutritionists operate on food and nutrition evaluation and monitoring paediatric oncology patients. They work hard to adapt each person needs and encourage them to eat properly. 2.3 Psychology of human development Despite of the illness, the target of this investigation are kids and teenagers living a period of constant development. They are growing up and defining themselves. Patients’

56 age is 3 to 18 years old and, for this reason, I consider important to take into account Psychology of human development theories for the experience design. Firstly, there is a brief summary about my opinion on how experiences affect in children and teenagers development. Secondly, I deal with Piaget stages, to know somewhat the main characteristics of children and teenagers depending on their age. 3.1. My point of view about how children and teenagerâ&#x20AC;&#x2122;s live experiences To understand how experiences affect children and teenagers, firstly is necessary to know what is â&#x20AC;&#x2DC;Psychology of human developmentâ&#x20AC;&#x2122; (Adolfo Perinat, et .al, 2014). Development can be defined as a process along all the life cycle of humans; it can be studied from different perspectives, as people are a big net of different systems like actions, perceptions, mental representations, communication or emotions. However, psychology of human development has a complementary look to changes experimented in different process by people. Every process takes meaning in a context of an action or a stage. The fact that people change physically and psychically characteristics is evident. Although, there is a question currently in an open debate: are people the result of what nature and biology has done of us, or are we a product from our social and cultural environment? To answer this question there are two theories, with two different conceptual alternatives: - Genetic psychology, by Piaget - Theory of the origin of superior psychological process, by Vigotsky On the one hand, Piaget theory has a biological point of view and thinks that human development is natural and spontaneous. However, Vigotsky theory raises that changes are marked by social and cultural environment characteristics.

57 We can conclude that, as Vigotsky said, development could be seen as a unitary and global process where there is a confluence between biological factors, from Piaget theory, and social factors. As a conclusion, I would like to say that I agree on the affirmation that context where children are living through, and where they do their daily activities, become ways, sometimes alternatives, which should be designed to educate them. The target I am working, kids and teenagers who are suffering a cancer, is deprived of typical places and environments where children normally should be developed, like school, sports center, park where other kids playâ&#x20AC;Ś An hospital, and people who is there, becomes their context where they are going to be developed physically and psychically. For that reason, the experience that I am going to design is going to take into account the educational factor. It will be important for their correct development. 2.3.2 Piaget stages Hypothesis 2 is focused on work with child who is 3 to 18 years old. It is a big range and the experience to design has to be suitable for all ages. For that reason, there is a division done using Piaget theory of the Stages, in development psychology, with six stages. Down below there is a description of the stages that includes target ages (3 to 18 years old), with a list of the main characteristics: a) Preoperative operations stage (2-6 years). Thinking characteristics are: -

Representational and symbolic thinking: is the ability to think in symbols. For Piaget thought comes before language. For example, the ability to understand maps and after to interpret them.

Deferred imitation: they imitate something but not at the same time that they saw it.

Symbolic games/ pretended games: they perform activities like â&#x20AC;&#x2DC;pick up the

58 phone, dial the number and talkâ&#x20AC;&#x2122;. -

Establishment of symbolic function and the use of signs and symbols.

Release of now and here.

Realism: sometimes they confuse real world with imagination world/ mind world.

Difficulties to distinguish reality appearance: for example, if something looks like a monster it will be bad for them.

Transductive thinking: when two events casually start at the same time. Sometimes, reasoning does not have logic; for example, if during the morning they have broken their bike and at the afternoon their dog dies, they will think that it is their fault.

Incomprehension of preservation: they donâ&#x20AC;&#x2122;t understand the quantity concept because sometimes their eyes trick them. For example, if an object changes the appearance: they have water in a long glass and someone changes it to another type of recipient, they will not understand that is same quantity.

Egocentrism: they think that everyone see that it is the same like them. However there are critics about this thinking characteristics list in different aspects, which have to be considered:

There is a difference between things that children learn to do and their abilities.

Kids are different and, sometimes, they are able to do or not to do something because of individual abilities.

Piaget highlights childrenâ&#x20AC;&#x2122;s egocentrism: at 4-5 years old kids start understanding when someone lies, so they know different points of view.

Children know that fictional world and real world have different properties. b) The stage of concrete operations (6-12 years): down below there is a list with the main characteristics of this stage. - In this stage, thinking becomes more logical and less egocentric. - Internalized actions are integrated in an organized structure: operations,

59 such as preservation or classification. - Problems with abstract thinking. c) Stage of formal operations (12-16â&#x20AC;Ś years): below there is a list with the most relevant characteristics of this stage: - Their reasoning logical. - Ability to think about facts that have never happened. - Ability to predict or do hypothesis about future facts. - Ability to analyze the intrinsic logic of an argument. - Deductive reasoning: they think about probabilities and proportions. - Propositional logic. Piaget also did some contributions in education that could be interesting to take into account when developing the current project. There is another list of the things that thought of this author: -

Learning through action and discovering, investigation and planning problems.

The questioning that can appear when information transmission.

It is necessary to adapt contents to thinking level taking into account previous concepts from the teenager/kid.

The main objective of education is â&#x20AC;&#x2DC;learn to learnâ&#x20AC;&#x2122;.

Social interaction contributes in attenuate egocentrism.

The use of real and specific contexts helps to better understand better concepts.

60 Chapter 2: Design Research (Comprehension)

Figure 2.3: Design research tools, co-creation figures. Espinós, Marianna.

The main idea behind the Design research phase is to comprehend the target –patients from oncologic pediatry- and its environment to know their needs and the opportunity areas. The research to comprehend the target of the project, and solve hypothesis 2, have two parts: my tasks developed in Sant Joan de Déu with the project team, using the ethnography tools, and my personal investigation for the project, with the writing conclusions. For that reason, the chapter is divided in several subsections; mainly a first explanation about the Ethnography tool, used with all the team. Secondly there are my conclusions, taking into account the part of the project in which I was totally in charge: motivation and other psychological aspects (design an experience). The participants of the project, who are taking part of the design research, by doing interviews or being interviewed, but also giving contacts and making easy the project development, are mentioned down below: •

Principal investigator (PI) of the project: Jordi Navarra

•

Oncology: Maria Genoveva Correa Llano and Miguel Angel Flores Taico (sample definition and solving everyday issues such as how to do the ‘market research’ in the hospital, how to be interviewed and giving some contacts of the hospital staff).

61 •

Nutrition SJD: Natalia Egea and Mireia Termes (definition of how to evaluate nutritional needs of every patient and how to arrange it to the study, also giving contacts of other nutritionists to interview).

•

Product Design: Paul Nannen (study group needs and create designs execution as well as prototypes of elements like plates and cutlery) and Marianna Espinós (cowork with Paul Nannen, as a designer, and more specifically in charge of the game design).

•

Elaboration of recipes and other food needs (Fundación Alicia): Elena Roura and Andrea Gonzalez (elaboration of a variety of recipe versions, dishes and basic food elements).

•

Costumer Experience Strategist for Service Innovation: Cristina Bustillo.

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62 2. Ethnography tool at Sant Joan de Déu Project There are a lot of tools that can be used to obtain relevant information for solving a specific problem at the Service Design Thinking. Although, with HSJD project team, it was originally decided to use ‘ethnography tools’ (to have more information, see ‘Memoir about my tasks done in Sant Joan de Déu project’, Annex 4); the criterion was to get a variety of quantitative and qualitative information as a final result. Ethnography, as the science that studies people and cultures, is a field research focused on a personal study and it gives to the investigator first-hand information. The main characteristics of ethnography are: •

The researcher is moved to the place, in that case Sant Joan de Déu hospital, where the target that is going to be investigated is.

•

It implies conviviality and regular visits.

•

Dates are collected with organization and discipline.

•

The main objective is to meet, know, collect and explain the sociocultural reality of the community that is being investigated.

•

It requires specific techniques: qualitative, to describe and interpret situations, and quantitative, to identify trends. Techniques used in the current project, decided and designed with all the team, are described down below:

Interviews: they allow long answers and give qualitative information. The interviews were structured with a guideline, and had the topics that we wanted to talk about, but opened to the directions that could take the dialogue.

Context Mapping: tool that consists in make a workbook with some exercises in order to know the opinion of the user. It was used to interview kids –aged 3 to 11as a visual support.

Survey: tool to have quantitative information.

Observation: tool to describe the place – the hospital- and to know the environment of the patient.

63 Table about people taking part in the Design Research (February-March): 1- Interviews

Specialists

Oncologists (2) Geno (February 22th) Miguel (February 23th) Nurses (2) Montse (Match 16th) Clara (February 24th) Nursing Assistants (3) Silvia, Ana y Eva (March 7th) Nutritionists (2) Alejandra (March 1st) Lola (March 2nd) Volunteers (4) (March 8th) Medicine students (1) AgnĂ¨s (March 17th)

Families and patients

Teenagers (4) from 12 to 18 years old and their family (March 10th) Kids (4) from 3 to 11 years old and their Family (March 10th)

2. Context mapping

Kids (4) from 3 to 11 years old and they

family (March 7th, one week to do it).

Families

(See Context Mapping, Annex 7, for further information)

64 5. Poll

Families

Teenagers and kids from 3 to 18 years

old and their family.

4. Observations

Hospital places, kids and teenagers environment.

As it is said in the introduction of this phase it is not possible, for privacity reasons, to attach mateials such as transcriptions of the interviews. However, in Annex 8 (Interview Example), there is one of the templates used for inteviewing people, in that case, nursing assistants and volunteers interview, as an example to see what kind on questions were done with the team during the Design Research. 2.1. Conclusions from Ethnography Following up there are the conclusions drawn from ethnography tool. The main objective of this research was achieving a good nutrition in children who receive chemotherapy but, furthermore, made them have a better time during meals. In this project, the topics are analyzed according to the three investigation lines mentioned before: food aspects (Alicia foundation and nutritionists from Sant Joan de Déu), Design (Product designer) and psychology (Jordi Navarra’s Lab as Experimental psychologist team and my work, as being focused on the experience design). The next points of these conclusion are developed according to create an experience and solve hypothesis 2 and my part of the project, that is to say: ‘Use aesthetic aspects of food and multisensory perception that influences a meal, and create an experience to improve nutrition – and the mealtime- from oncologic paediatry children’.

65 Some of the points have a quote, as an example, using the information of interviews done to specialists (oncologists, nurses, nurse assistants, nutritionists and volunteers), families and patients; also there is added information and data from observations has been added. Main objective of the experience that will be designed: - About eating experience and the main objective of this design research: Medicine student: ‘Eating good is eating balanced, with all the basic nutrients, but also spending a good time eating’. Food aspects (aesthetic aspects and multisensory perception): a) General: secondary effects of chemotherapy are the cause that makes difficult the food ingest. Medicine student: ‘the main cause of malnutrition in children is chemotherapy by itself’. b) Smell: odors are mixed because of the dinner tray, which is a kind of ‘box’ or container where all the food is located (see image below). This fact usually causes some dislike, or even sickness, to kids and teenagers.

Figure 2.4: Image of tray opened with the meal for children in Sant Joan de Déu hospital

Teenager, patient: ‘when the tray is opened I almost vomit –because of the smell-’. Natalia, nutritionist from the project: ‘they open the tray in the bathroom to ventilate it’. c) Sight (visual aspects): it is important to show food in a visual appealing format because secondary effects of chemotherapy remove or modify food flavors and, also, cause a sensation of satiety. Lack of hunger makes them feel overwhelmed with a big dish full of food; for that reason they prefer small plates, like Spanish tapas, or a combination plate with a small amount of different foods. Teenager, patient: ‘usually food don’t have any taste, I eat because of its visual attractiveness’. d) Flavor: there is an alteration of flavor, which can be translated into more or less taste in aliments, and sometimes a metallic flavor. This a very common side effect called dysgeusia. Frequently, kids and teenagers only want to eat one kind of food, which often is ‘pasta’ combined with strong flavors. Mother of kid aged 9 years old: ‘mortadella has a metallic taste’. Parent of a kid aged 5 years old: ‘he loved to eat food with strong flavours such as ‘gazpacho’ and ‘salmorejo’’. Oncologist: ‘they only want to eat one foodstuff… Pasta, and eating only pasta during 6 months is not good’. e) Textures: some of the patients have ‘mucositis’, mouth scores resulting of chemotherapy, and, for that reason, the diet has to be adapted to be softer. However, usually kids prefer textures easy to eat or easy to be manipulated (like boiled vegetables that they can mash with a fork). Nutritionists: ‘we adapt the diet when they have mucositis because of mouth sores… however they prefer to eat croquetas and ice cream’. f) Tricks used:

67 -

Adding sauce: it is good for dissimulate flavors –usually to make them stronger-, for creating soft textures and making food more visually attractive (colorful). Nutritionist: ‘Sauce always helps: makes food more colorful and with pleasant textures, to hide the flavor…’ Parent of a kid aged 5 years old: ‘ with lack of hunger, the visual appearence of the food they had did not help… Even more with mucositis, when the diet was soft’. Nursing assistants: ‘make food visually more attractive, with a drawing at the bottom of the dish will help’.

Other Parents trick: bring to them food made at home in order to help kids eat something (but hospital staff doesn’t like this option because of an hygienic issue, as it can increase the risk of infection). Parent of a kid aged 5 years old: ‘we bring some food just trying to make him eat something’. Oncologist: ‘they bring food, following the patients demand, but I don’t know anything about hygienic rules of who prepare its preparation’.

g) Things to improve in food and mealtime that can be done (experience design factors): Nurse: ‘We are still light years away from satisfying the patient’s demands… However we have to remember that this is not a buffet, I see that food has a very poor presentation, is very repetitive and tasteless and we have the same fight every day’.

68 §

Presentation: the visual aspect is very important. As it is possible to see in the picture, the food is not very

colorful

and

attractive for kids.

Figure 2.5: Image of a meal for children in Sant Joan de Déu hospital.

Variety: work on different culinary techniques, recipes or ingredients can be used,

and

currently

not

considered. §

Possibility choices:

having

currently

kids

more and

teenagers can choose menus A or B, as it is seen in the picture, but the choices are very limited. Figure 2.6: Selected menu in Sant Joan de Déu hospital.

Food adjusted to age: some kids, and even some professionals, such as nursing assistants, said that food was not adequate to the age. Tricks to adapt it could be by making funniest presentations. Nurse auxiliary: ‘the problem is that the same menu is given to a kid aged 4 and a teenager aged 18’

Timetable: mealtime is too early –usually for teenagers because dinner, for example, is given at 20 h- and not when they are hungry.

69 §

Possibility to prepare their own tray: some of the patients show motivation on interacting with the meal. Teenagers can be persuaded to eat if they take part of the dish creation: Nutritionists: ‘teenagers would like to prepare their own dish, like putting aliments inside a shawarma/kebab’.

Experimentation with food: especially kids love to experiment with food, interacting and playing with it (for example making funny figures). Parent of a kid aged 5 years old: ’he loves to experiment, be likes to cook’.

Nutritional aspects (experience factors with meaning):

a) General: diet that is given to patients always is balanced and adapted to specific nutritional needs. b) Providing the kid with enough calories is the top priority to avoid weight loss and the reduction of muscle mass. Having a good ingest of appropriate nutrients will help to fight better against cancer and chemotherapy side effects. c) Food habits: there is a big influence from earlier habits. If the patients have certain preferences and there are some food that they want to eat and others that they do not sometimes it is because of the influence of habits that they had before, not due to the side effects of chemotherapy. Oncologist: ‘they do not want to eat vegetables because they didn’t do it before. We have to ask their previous eating habits’. d) Trick: sometimes nutritionists use storytelling to explain how important is to eat healthy and balanced, for example telling Messi diet. e) Solution to eat better in nutritional terms: formation is very important. Nutritionist: ‘It would be a good choice to have each group of macronutrients isolated… and make it with an explanation to the child about the role and the importance of each food group’. §

Families receive some information when the treatment starts. However, nutritionists do not have enough time to work on it. Usually their main worry

70 is to have kids and teenagers eating something, regardless of what; for that reason patients they don’t have healthy and balanced diets (they just eat what they want). §

There are false beliefs about food properties, such as anticancer aliments. Families receive some ambiguous information from the media or rumors, and sometimes this information is a bad influence.

Cultural level, origin or religion can impact negatively in diets; however, hospital adapts food like to halal for Muslims.

§ -

Language can make food education difficult. Psychology aspects (experience factors): Nutritionists: ‘it is important that mealtime has not to be a stressful activity; parents put some pressure on it because it is the only thing that they can control. This doesn’t help to make kids eat better’

a) Needs and concerns (general): the main concern is to overcome cancer – a hope of surviving or not having a relapse-. There is a constant worry on patients and families. Oncologist: ‘The main worry is if patient will die, then if there is a relapse possibility and if so, possibilities to survive. When these points are clarified, the third worry is what happens if they don’t eat anything’. b) Distraction: it is important reserve some space to forget about the life worries, to play and to try to have some fun, in spite of the illness. After all, they are kids. Medicine student: ‘kids’ entertainment is very important to make them feel good… However, unfortunately when they are admitted to a hospital they are more patients than kids’. c) Try to make patients and familiars be ‘like at home’. d) Food concern: families want to know what patients have to eat and what is healthier. Food is the only thing that families can have under control so they

71 put pressure on patients; it becomes an anguishing subject for patients and families. Nursing assistant: ‘in this area –oncologic paediatry- nutrition is very important…parents want to stay there and control what patients eat’ e) Food distraction: as it is said, mealtime is an stressful, overwhelming and a worrying situation. Currently, the hospital uses strategies such as distraction, and even if some specialist and familiars say that patients abuse of that (TV, mobile phone, laptop, play station…). Sometimes the patient speaks with the person –usually family- that accompany them. Nursing assistant: ‘they have the TV on and parents gives to them food without even noticing…’. f) Need of social support: §

Specialists personalized attention: currently they are focused professionally on the patient but there is insufficient time to attend them with psychological support. Nurse: ’for me the perfect future would be having more time with the patient, to strengthen their emotional and psychological needs’.

Families or volunteers support to accompany patients full time.

g) Lack of motivation: there is a spiral with psychology effects that make patients have a bad nutrition. Their situation makes them feel demotivated.

Figure 2.7: Circle of cancer and its treatments bad effects on children. [figure] Espinรณs, Marianna

h) Food and behavior depending on the group of ages (the classification is done according Psychology of human development literature): ยง

Under 3 years old (this group is not inside the target of this project but kids of 3 years old get closer) they begin trying different flavors.

ยง

3-11 years old: they have the experience of all of the above and a trace of bad habits done before. Usually it depends of the education received at home or at school. For kids, also, eat is a physiological action.

ยง

12 to 18 years old: they have the sense of taste defined. Also they are aware of their health situation, so they know the importance of eat. However, it is the period where usually there are more eating disorders.

73 2.2 Empathy map After using ethnography tool and having some results, I did an empathy map to know better the patients. This data are a support to organize the information that I collected about the user and allow draw a profile. Empathy map is a tool used in marketing. The reason of adopting it is that is a tool focused on an in-depth research of users, making designers emphasize with him or her. A)

What patient think/feel?

The main worry and thought that patients have into mind is to overcome the illness and have again a normal lifestyle. Cancer has changed their life: they have to stop going at school, stop meeting friends and playing with them or stop doing activities that they like to do, such as practicing sport. They spend almost all the time at hospital, with the treatment or being controlled. Their family is the only closer support â&#x20AC;&#x201C;also specialists but they are working and luckily some volunteers-, which usually is sad or stressed. Teenagers sometimes feel that they are guilty for making their family suffer and for having to change their lifestyle because of them. They are demotivated because of the general situation and, also, physically they donâ&#x20AC;&#x2122;t feel good because of secondary effects. There is a lot of incomprehension of the reason why they have the illness because, as it is said in the literature, cancer during childhood is casual. The lack of appreciation and/or motivation impacts on everything from their lifestyle, but the most dramatically consequences are in nutrition.

74 B)

What does patient listen?

Patient listens the adult world, family and hospital specialists, who are worried because of their illness. Survive is the main objective. Patients receive advices and opinions from hospital staff, specialists or volunteers. Also other patients, who are living similar situations, can be an influence of when the patient listen them. C)

What does patient see?

Patient sees a worried world. On the one hand, there is all the hospital situation, medical tests and treatments. But at hospital there are also positive things, like ‘Hospital amic’ program, that tries to make life in hospital better and more positive. Sant Joan de Déu is recognized for working hard on ‘cure and care’ patients. On the other hand there is their family: one of their parents, or relative, stop working to be near them as a support. Family is suffering but at the same time usually they are trying to do everything for the patient. D)

What does patient say/do?

Attitude of patient changes a lot but usually depends on their physical state: under the treatment, with secondary effects, they are more pessimistic than when they start feeling better. Hospital try to establish a confident relationship in order to facilitate that patients say what they need or feel. For example, in an eating situation there is a lot of dialogue between patients and nutritionists. It helps to give the specific diet’s needs.

75 E)

Efforts

Teenagers, elder kids and familiars have the fear of not overcome the illness; it is a constant threat. So efforts are focused on doing everything that is in their hands to survive. Also teenagers understand better what’s going on and try to respect hospital staff advices. Food is the only thing that families can control and sometimes becomes frustration. Mealtime is stressful because parents want that kids or teenagers eat and for them it is complicated (bad feeling, secondary effects…). However oncologists say that firstly is surviving and secondly eating well. F) Results The main wish is to survive and come back to lifestyle that they had before the illness. About eating, doing it well implies have a better response to the treatments. Also sometimes better ingest means success, but also to do a normal activity. Patients usually want to do things that other kids or teenagers want: they have a cancer but they are in their childhood and it’s important to try to make them to feel and live that. Have time to play, discover, experiment, use imagination, create, dream, share… it makes them feel better and more optimistic. 3. Design research conclusions The main idea of this section is to show first insights that allow to start working on the ideation phase. For that reason, the next reflection takes into account information from the previous Design research but also includes data from previous literature on research done in chapter 1.

76 First of all, and using mostly ideas from previous reflections on developmental psychology (see literature research, chaper1), I believe that it is worth talking about the relationship between game and children development here. There is an article, in FAROS website, entitled â&#x20AC;&#x2DC;Playâ&#x20AC;Ś A serious subject! The importance of games in child development.â&#x20AC;&#x2122; (a. Faros HSJBCN, 2016) where Imma Marin highlights the important value that playing has for children. In fact, playing games is an important source of a healthy and balanced developmental progress and learning. Playing is an activity that responds to children needs: curiosity and experimentation, which are the fundamental engine for learning. Playing makes increases satisfaction, and promotes self-improvement and happiness. But it can also be a stimulus to stimulate empathy among peers and a tool to externalize fears and concerns. Finally, games also have a social component, with coexistence guidelines, and can be an excuse for families to create a trusted environment. Another fact to take into account, and it is the conclusion from the program EYE Catalunya dedicated to innovation in education (Eye Catalunya, May 2016), is that games can help to reduce the importance and the seriousness of difficult situations. As food and nutrition becomes a real problem during the treatment of cancer, causing stress and worries both in families and patients, the use of games can also represent a psychological help for children and families, allowing them to enjoy meals, and improving, at the same time, nutrition in these patients. After this conclusion, hypothesis 2 will be addressed with this new idea of introducing games that can be played during the meal, as a motivational factor. Furthermore, the game experience would have to take into account different aspects, which have appeared during the ethnography-based research and the review of previous literature. The main objective of the game is to make the meal pleasant and to motivate kids and teenagers to eat. Eating is an activity done several times per day so it is important to ensure that kids have a good association with food. To achieve the purpose, I considered the following factors to design of the game:

77 -

Experimenting with food: the interaction with the ingredients using the senses, mostly visual perception. Also, to use the imagination in order to have, as a result, an attractive and personalized meal.

Nutritional education: there is a criterion on food choice to make the meal balanced and healthy. Storytelling can help motivating and giving a meaning to food intake.

Social support to help making mealtime pleasant. Take into account familiars, because they are, almost always, near children or teenagers and also suffer.

78 Chapter 3 Ideation

Figure 2.8: Ideation notes and tests. Espinós, Marianna. First of all, this phase takes the design research results previously obtained to start ideating creative solutions; having first conclusions, ‘design research conclusions’, that help to comprehend the target in order to see which are needs and opportunities to create the experience. This step, ideation, is for thinking in creative solutions to improve nutrition and meal in children and teenagers with cancer that are undertaking chemotherapy. There is the hypothesis reformulated, taking into account research insights: Could it be possible to use aesthetic aspects of food and multisensory perception that influences a meal, and create an experience that transforms eating as a game to experiment with food by the senses to improve nutrition – and the meal- from oncologic paediatry children? Next points are, firstly, a literature review about the game concept and how to work with it to design the experience; there is an explanation about gamification and a summary about the game elements to be taken into account. Secondly there is a brief research about other concepts to be considered: a psychology concept called association and, furthermore, a short overview about visual preferences of children on food plates presentation. In addition, there is a point that explains the surprise factor as an important stimulus.

79 Finally, there is a research about what creative theory could be suitable in order to involve in the game all the factors, which have appeared in the design research conclusion. 1. Game as an experience The experience that I wanted to design to motivate children is a game. A game is a basic right in the childhood and it has a lot of positive inputs before, during and after the activity. Despite of cancer, children need time to play and feel relaxed; also, playing make them to develop personal and social equilibrium (Xarxadretsinfants.cat, 2016). However, in order to design an experience that includes eating, gamification, a current and emerging concept is more suitable. It has a lot of definitions, and up to now none is accepted as the good one, but it can be understood as: the process of using game thinking and game dynamics, in activities that are not a game, to compromise/involve audience and solve problems (Zichermann. 2013). Even though, the gamification word contains the term â&#x20AC;&#x2DC;gameâ&#x20AC;&#x2122;, this will be firstly defined. There are many studies from children psychologists about the meaning of game. However, game takes into account many concepts, so the best way to define it is to use a list. Below there is a game Decalogue diffused by â&#x20AC;&#x2DC;Barcelona Juga project (bcnlab, 2016): 1.) A game is culture, as a transmission work of human knowledge; It is a tool to interpret the world through the mechanic of game metaphors. 2.) A game is a criterion: when people play, they take decisions; when choosing in a game helps people to know what they are able to do in real live. 3.) A game is fun: game objective is entertainment. It is to pretend and to act, without puting at risk anything essential, beyond victory or legitimacy in defeat.

80 4.) A game is a challenge, a personal progression. It does and improves people activities. There aren’t limits when people play and it is a constant sense of achievement. 5.) A game is equality: when a group of people accept to respect the regulation of a game, complicity between them is established. It doesn’t matter the sex, age or any other condition. The other player is like you. 6.) A game is experimentation: games make people think. It makes people learn about mistakes and success. Like sport trains the body, games train reason and comprise people emotions inside a security environment. 7.) A game is comprehension: when explaining its regulation to playmates, double exercise of social magisterium and comprehension is done. Explain what we have learned make people’s better comprehension. 8.) A game is sociability: sharing time and place for the pleasure to stay together; it is necessary, vital and every time it has more difficulties to do. Game gives to people quality time in a nice environment of personal communication. Game makes friends to be closer. 9.) A game is knowledge: playing awakes the desire to know more about the game topic. It can be surrounded in imaginary worlds; history or mathematic, games give knowledge and motivation to know more. 10.) A game is freedom: a game is not an obligation, so anyone can be playing for a purpose or a reason. Without the voluntary acceptation and sincere regulation there is not any game. Game is pleasure. Also, as it is said in an article form Juegaterapia foundation (Juegaterapia.org, 2016), entitled ‘The importance of the game as a curative element’ and written by the pediatric Dr. José Guiménez Martínez, a game in a hospital would perform the following functions: 1) Encouraging children/teenagers to cooperate with procedures between health workers and family members.

81 2) Helping to the structured time in the hospital: getting breaks in the monotony routine. 3) Providing sense of ‘normalcy’ and helping to reduce stressful feelings. 4) Helping to maintain the acquired educational levels, if games and toys that have a didactic function are used. The experience that is going to be created has a purpose: to make children and teenagers eat. There are new tendencies that apply game elements or games thinking to activities whitch are non-games, such as education or business. Eat is an activity that is not closer to games but that can be transformed. For that reason next point will explain new tendencies around games. 1.1. Current and emerging trends in gamification Currently there is an emergent tendency to use game or game elements in experiences, among other things, that traditionally do not have any connection between games.

Figure 2.9: Table about differences between game concepts from ‘gamasutra’ website. a. Anon

Concepts like gamification, playful design or serious game are increasingly heard in sectors such as business or education. A clear example it is seen at work, where there are new playful activities to have employers more happy, or at school, where games are being used to make learning as a fun experience and more effective.

82 It can be interesting to do a global glance to these concepts related by games, which are be to design the experience of this project. To do it, there are some websites used as reference because new concepts are emerging and they are too new to be consolidated (Slideshare.net, 2016.; a. Anon, 2016; b. Anon, 2016;). There are different terms, which look very similar but it is important to know theit distinction. Next points are going to define game thinking, gameful design, serious game and simulation. - Game thinking: is about using fun and game principles to design solutions to real world problems (Slideshare.net, 2016.). - Gameful Design: This terminology can be explained as the use of game thinking in an user’s experience; it alludes to the approach of the product/experience as a game, using its aesthetics and usability of it. So, there are not game elements but there is the essence of games, such as have fun or being entertained. An example to understand this, seen in ‘Gamasutra’ website (a. Anon, 2016), is the fail whale from Twitter. Rather than a boring old error message, when twitter is over its capacity, the Fail Whale it is shown to the user, which is a fun cartoon; this simple change makes the user interface is easier, nice and simple. - Serious Games: A serious game is a game with purpose –reason because of it cannot be a game, as it is seen in the first definition -. It has game elements, so when taking part of people feel like they are in a real game. However there is a purpose, outcome or message behind the game. A clear example about a serious game is in the education field. A real case can be seen in a project called ‘Llegendes de Girona’ (Gretice.udg.edu, 2016), where participants – children- take part of different legends around Girona. They have fun but, at the same time, they learn about the town. Also they acquire other abilities, like improve their reading comprehension, team working or history knowledge. Simulations: this concept is very similar to Serious Games; however, instead of having any message or purpose, simulations are designed to simulate

83 something in the real world. After having the concepts defined, such as game elements and new tendencies around games, I could say that I am going to use gamification to â&#x20AC;&#x2DC;make live as a game experience an activity that is not a gameâ&#x20AC;&#x2122;. There is a purpose: improve eating experience in children and teenagers with cancer, taking into account food ingested; but, also, considering motivation and enjoyment of this activity. 1. 2 Aspects to take into account about games: Gamification is a tool that can be useful to motivate, involve and engage people to achieve their objectives. As it is said in the analysis of the target, one of the main problems is demotivation of kids and teenagers. However, Gamification can achieve an attitude change because it takes the essential of games, which make things addictive, and apply it in other contexts (see figure 5).

Figure 2.10: Gamification, Video Games and Rewards Programs. Buke, B.

Although gamification is based in games, videogames are on what it is truly relevant; it is most often applied in a digital environment and thatâ&#x20AC;&#x2122;s because this is a way more accessible to a big audience. Despite of that, the experience that will be designed in that project is developed in analogical format.

84 Next points briefly explain game elements, using the information of a Final degree project entitled â&#x20AC;&#x2DC;Gamification in health appsâ&#x20AC;&#x2122; (Barraco Medina, Samuel. 2014-2015), for designing the experience: 1.2.1 Game patterns: There is a classification that divides game patters (Teixes, 2014: 28): it is paidia, free games that are expressive and with improvisation behavior, and ludus, game based in rules and concrete objectives. Although, every game has two faces: the spontaneous one and, also, a game under rules and objectives. Game typologies can coexist, because are not mutually exclusive. 1.2.2 Type of players: Knowing players profile can help on adapt game experience to a bigger target. Marczewski (2015) differentiates four categories of players; however that does not mean that a person feels identified exclusively with a unique feature and has no other. It is more like: `every person tends to exhibit traits from all four types when playing games, but many people tend to lean more heavily toward one of these typesâ&#x20AC;&#x2122; Kapp, K. (2012). -

Socializer: wants to interact with more players, being connected with others and interested in the gamified system, which helps on peoples interaction; this player is motivated by aspects of social connections.

Free spirit: likes to have autonomy inside the gamified system; player wants to observe and do things without limits inside the game.

Achievers: there are players that want to be the best or play better

85 than others getting things inside the gamified system. -

Philanthropists: want to feel part of something bigger, give things to others to feel themselves useful. The system that motivates them has to enrich others and be a part of a purpose. Finally, Marczewski’s, talks about another profile of user who is not ready to play, or wants to interrupt the game, which is called ‘disruptive’. The author, Marczewski (2015), highlights the importance of recognizing the different types of user aforementioned because: ‘most of the people who are entering to a gamified system do that for the rewards; however, the key is to turn this user intrinsically motivated as socialized, free spirit, achiever and philanthropists’.

1.2.3 Activity loops Activity loops, also known as cycles of activity, are explained as ‘one of the key elements in the design of a gamified system, as well as in games’ (Werbach & Hunter. 2014 ). That is because every action done during the game has consequences, such as motivation but also keep going with it. There are two types of loops: -

Involvement loops: it consists on having players or users involved in the game or the gamified system.

86 -

Progression loops: this kind of loops reflects the fact that the game experience will change while the player continues through it. There are four phases: a) Discovery b) Onboarding c) Scaffolding d) Mastery/Endgame

1.2.4 Game elements: Anna Sort, nurse and CEO from Playbenefit, said in an interview (Sort, 2016), that there are some key issues that stimulate users motivation and cause the effectiveness of a gamified system. These elements are: -

Discovery: is the fact of discovering the environment, in that case a gamified system. It is the first contact between the user and the system and, furthermore, how user gets familiarized with it.

Challenge: the call to compete can motivate if it is interesting and available for the user. The user has to feel that he/she is taking part of the game and has benefits of doing it well.

Self-expression: this element makes reference of any aspect from userâ&#x20AC;&#x2122;s ego. That means the system has to be personalize to users as well as to show what they do and to receive feedback.

Social environment: it gives tools to facilitate users interaction. Playing with friends or the possibility of sharing the content of a gamified system, can impact positively users motivation.

87 -

Narrative: this element can be understood as the storytelling, the explanation of a history. A successful gamified system needs to have a narrative developed in order to have the user feeling immersed in the game. 1.2.5 Games analysis: Following up different games related to food topics are briefly analyzed, as references to create the experience of this project. The recommendations of two websites, both from Sant Joan de Déu, are used in order to choose interesting games: FAROS, a website defined as a ‘health observatory for children and teenagers’ (Faros.hsjdbcn.org, 2016), and Guia metabólica, a website done by professionals and families linked wit inborn errors of metabolism –rare disease- (Guía Metabólica, 2016):

a) Toca Kitchen 2: ‘Cook is an art with Toca kitchen 2’ https://tocaboca.com/app/toca-kitchen-2/ App recommended at FAROS website to create new recipes, which can be tasty or disgusting, the idea is to see how guests eat the meal and their reactions. This app is more a toy than a game because there are no rules, no stress and no objectives; it’s a way to explore creatively the world of cooking. There are 12 different ingredients combined to prepare a recipe in 180 different ways, such as slice, boil, cook or fry. Technical characteristics: -

Age recommended: 4 years old and more

Platform: android, iOS

Price: between 1€ and 3€

Skills that promote: reasoning, memory, imagination and

88 creativity. Educative and health values This game encourages creativity and imagination. The main objective is creating original and fun recipes, all with the ingredients that are in the fridge. Also it fosters the respect because there is a huge range of characters and preferences. Finally, memory and reasoning when discovering new recipes and understand the diners. As it is said in FAROS article, entitled Toca Kitchen 2, an app to experiment in the kitchen and become a super chef!â&#x20AC;&#x2122; (b. Faros, 2016), this game has the advantage to make child, and families, discover new aliments, and new recipes to experiment with food and become game creations into a real kitchen. So that also can improve eating habits and strengthen the pleasure for cooking. Interesting references for this project (to design the game experience): this app could be a reference for this project in somehow but I would like to highlight two main aspects. Firstly, it is a kind of toy that looks for the freely self-expression of the children and their experimentation. Secondly, it looks for obtain children's attention on cooking but at the same time it teaches about aliments. b) â&#x20AC;&#x2DC;100 fruit and vegetablesâ&#x20AC;&#x2122; http://100thingsapp.com/fruits-vegetables-matching-game-app/ It is an app, more specifically a digital picture book that is a source of fruits and vegetables pictures. The main characteristic is that it is very colorful to make kids create a positive relationship with the aliment. It is a useful resource to learn vocabulary, discover colors and shapes, and improve child memory; in addition it promotes a

89 healthy diet and every image has a text or an audio that explains the aliment properties. Also it can be a sociable activity for the child and another person. -

Age recommended: from 8 years old

Platform: android, iOS

Price: 1’79 €

Skills that it promotes: vocabulary – also it is in a lot of languages-, memory, and knowledge about fruit and vegetables properties. Creators suggest to use it to prepare simple recipes like juices or salads. Interesting references for this project (to design the game experience): First of all, is very interesting the objective that authors of the game had about the positive association of fruits and vegetables using colorful and attractive pictures. Also, this game emphasizes the importance of playing as a social activity.

c) Save the PKU Planet http://www.pku.es/juegos/ PKU is an inborn metabolism error of phenylalanine, which means that kids that have it need a controlled diet because different aliments that can hurt them (for more information see PKU website, a. PKU.es, 2016). The game ‘Save the PKU planet’ was promoted by PKU 14-82 project, made to fight against PKU; there is a very interesting website with PKU explanations, advices and some formative sections for parents and specialists but also for kids with games. Furthermore this project is part of the work carried out by an investigation team who is working on how to innovate teaching about PKU.

90 Interesting references for this project (to design the game experience): The storytelling is all inspired in things that affect PKU illness; it is very useful to explain the problems and difficulties that PKU can produce, using the game as an excuse. Children who play this game are enjoying the adventure but, at the same time, are learning, for example, which are the aliments that are dangerous for them. 2. Factors to take into account: 2.1 Association After analyzing Design research results, I realized that I was forgetting to mention a very important psychological concept: association. Jordi Navarra, experimental psychologist and coordinator of Sant Joan de Déu project, introduced me that concept at the beginning of the design research; also, I did some exploration and I found a conference in internet from Helena Matute (Matute, 2016), experimental psychologist, where she talked about ‘association’ as a concept related with food. To understand better the term ‘association’, and before linking it with food and the interesting aspects for this investigation, both psychologists talked about association using as an example Paulov’s Dog Model (McLeod, 2016). Humans, like Paulov dogs, learn to associate food with experiences that have lived before. For this reason, taste is not the only thing that participates in a meal, because everything that is around it matters. Previous experiences related by food are very significant for improving mealtime. Helena Matute, in the speech done in Naukas festival, put as an example four aspects to take into account in an activity that involves food, depending of ‘association’ concept; two have been studied before (phase 1 research, multisensory perception of food and food design), color and sound, but context and food name are also interesting:

91 A) Context: it is essential to learn. An example is a dish done by Eneko Atxa; a cuttlefish dish, which has some seaside decoration to make the costumer feel closer to the place where the fish was caught, where about is the essence of the dish recipe. B) Name variations: name influences and this fact can be seen in mushrooms names. People think that a mushroom is more tasty or toxic depending of its name. As a conclusion, understand that the target of this project –children and teenagers who are under chemotherapy- have bad associations with food as a result of secondary effects of treatments that they receive. However, it is possible to change this situation making new associations thanks to good experiences or locking for a reminding of previous to the illness. 2.2 Experimenting with senses: vision. As it is said in Design research conclusion, senses that interact on eating, such as smell and taste, are altered because of cancer treatments effects. For that reason, to design the game is preferable to take into account sight perception, as a basis for motivating. There is an article called ‘Food plating preferences of children: the importance of presentation on desire for diversity’, (Zampollo, Francesca. M. Kniffin, Kevin. Wansink, Brian. Shimizu, Mitsuru. 2011). The group of researchers wrote that article did some tests, with a sample of ages from 5 to 12 years old, to: ‘demonstrate that people appear to be significantly influenced by the shape, size and visual appearance of food that is presented to them’. Have a visual support will help, firstly, to fight with the lack of hunger and then to eat variety of food; some kids, who have cancer, eat only one aliment during the treatment, for example pasta, and they need other nutrients. Researchers say that: ‘Children and adults tend to consume more food when

92 there is a greater variety of optionsâ&#x20AC;&#x2122; (e.g. differently colored). This will be a helping factor in order to have a balanced and healthy diet. The aspects to consider from the study, and to use in the game later, are listed down below: -

Children prefer more colors and more components: kids want 6 different food colors and 7 food components.

Uncrowned but disorganized: kids prefer an empty space, and tend to prefer food presentations that are disorganized; but there is an exemption: when the food makes a design â&#x20AC;&#x201C;a figure-.

Meal position in a plate: children preferences in a round plate are having main components on the lower-right segment and in oval plates on the left portion.

Figure 2.11. Different possible entrĂŠe

positions

plates. Zampollo et. al.

2.3 The wow factor (surprise factor) The surprise factor, or wow factor, is a concept that comes from the literature and is used to create emotion and expectative, entertaining and interactive experiences. It is a technique firstly used in storytelling but it is used too in some videogames to have players expectants.

round

93 This concept appeared when interviewing Natàlia Palau (Interview to Natàlia Palau, nutritionist -transcription in Catalan-, Annex 1); she did a reflection, written down bellow, in a moment that we were talking about improving food presentation in hospitals: ‘But what if this good presentation, similar to Michelin star restaurants for example, also becomes routine; as it is to say, if food from hospital stops having currently appearance, not very tasty, to be presented in a better way like in a restaurant. We could need a surprise factor, to put aside routine, and make food always be appetizing’. What she emphasized about food from hospitals was the need of a factor that made mealtime different every day. This is because hospitalized children sometimes spend inside it a lot of time, sometimes more than a full month without going out from there. 2.4 Creative thinking spiral Looking for a creative solution, I did a research about games that highly consider users interaction; at this way I found the theoretical base to design the game experience: Creative thinking spiral. This is a theoretical proposal done by Mitchael Resnick –teacher, programmer, journalist, computer specialist and physicist- who leader Lifelong Kindergarten in MIT (Llk.media.mit.edu, 2016). An example of application

that

works

under

Creative

thinking

spiral

Scratch

(Scratch.mit.edu, 2016); the slogan of scratch is the next one: Create stories, games, and animations. Share with others around the world.

Figure 2.12: The Creative thinking spiral. MIT Media Lab.

The idea is to start with imagination: what do they want to do, in this case with game ‘rules’ that help to start ideating. When ideas come, it’s the moment to create something and to play with it – in my opinion, create and play can be mixed actions-. Finally share what was built, either face to face or thought social media; this latest action will give rise to reflect about the process, improve what was created or create something new. The proposal for the design of the game experience in order to solve hypothesis 2 is: A) Imagine: firstly give some advises, taking into account nutritional education, and have some rules in order to experiment with the meal using the senses. B) Create: use advices and rules given to start creating. C) Play: use the creation done and start playing, enjoy experimenting with food. Also, and most important, try compositions eating. D) Share: use networks to share creations and receive feedbacks of creations.

95 E) Reflects: think about the experience and have new ideas for next times to play. 3. Ideation tools Aside from the research during the ideation phase, I used some tools to ha ve the information more visual and comprehensive (Servicedesigntools.org. 2016); I worked with some concepts that I though that could be useful to design the experience. Tools are explained down below and the graphics or images done are in the annexes, also mentioned thereupon. -

Journey Map: this tool, as name express, is its name expresses, is a graph that describes a journey of a user â&#x20AC;&#x201C;a patient, in this project-. There are represented the different touch-points that have to be investigated and worked to create the experience. There are some highlighted points where interactis the user with the experience, in this case the game. I prepared a journey map taking into account, specifically, mealtime of children who is currently in Sant Joan de DĂŠu oncology pediatric department (Journey map, Annex 9).

Mind map: this is a visual tool of summaries about important elements of the project and their connections or possible connections. Mind maps start with the problem that has to be solved or the main objective, that is in the center, and around the starting point words and drawings are used in order to build a system of thoughts. There are some mind maps used to put in order concepts and ideas to design a game (Mind maps, Annex 10).

Mood boards: this tool is a visual composition, done using pictures or other visual materials such as info-graphics, which propose an atmosphere by giving its generic perception. It is a very useful tool to explain some values from the experience that are difficult to be described by words. More info about this technique: http://www.lifeclever.com/5-reasons-to-designwith-mood-boards/

96 For this project do mood boards were very useful to clarify visually some ideas that I had in my mind (Mood boards, Annex 11). 4. Brainstorming After having the first ideation done, using the tools mentioned above, and having the concepts more clear, I did a brainstorming to create the game experience. Brainstorming is a creative tool that combines a relaxed and informal approach to a problem solving with lateral thinking (Mindtools.com, 2016). It encourages coming up with thoughts and ideas that, firstly, can seem crazy; however, this ideas that seem don’t have any filter, can make a creative jump to other better ideas. In the Annex (Brainstorming, Annex 12) there is the brainstorming done, which originated the next list of 10 first ideas. 1. Food game series: Create a game using a project called ‘From the sofa to the kitchen’, that shows recipes from TV series, as a reference,.

Figure 2.13: From the sofa to the kitchen. López, Dani and Morillo, Valentina

More info att: http://libro.delsofaalacocina.com Idea: use the food that appears in TV series, shows… as a motivation. Imitate and create similar recipes. Usually kids at the hospital only can do few things and stay a lot of time in front of TV. Also they feel with little energy and prefer to be laying in bed. Another example is an app for kids, where famous sportsmen or sportswomen, such as football players, explains why they eat healthy and tell a recipe. This app

97 is called ‘Eat for goals’ and it is a very good example, and a reference, about how to motivate children to eat well and furthermore give to them some nutritional formation. See how it works: www.youtube.com/watch?v=mCxUx7k7XYs 2. Food tales: Storytelling with the book ‘Kichen tales’ by Jorge Zentner, which explain worldwide recipes around with a narrative. This book is an example of creating stories about food.

Figure 2.14: Illustration of book ‘Kitchen tales’ cover. Zentner, Jorge and Cabasssa, Mariona

Storytelling can make kids be immersed inside new worlds and forget their illness for a moment. Furthermore, the book aforementioned talks about recipes from the entire world; it could be a way to discover new cultures. 3. Game to become a foodie: foodies’ book to make a personal diary about food eaten at hospital in a creative way. Create new recipes and annotate them and do fun activities about food to establish a positive relationship.

Figure 2.15: Book ‘Doodling for foodies’cover Correll.

Figure 2.16: Illustration that is nside ‘Doodling for foodies’ book. Correll.

The book entitled ‘Doodling for foodies’ (Correll, 2015) is a collection of activities aimed at food lovers. 4. Create food stories: Use ‘Storycubs’ as a reference to create a game about alternative ways for experiment and interact with food. Storycub is a game, specially focused on young children but able for everyone no matter the age, to create stories using dices:

Figure 2.17: Story cubes picture. The creativity Hub.

The players, rolling 9 dices, have to create stories. Every face of a dice has a drawing of a place, an object or an activity. Currently there are a lot of Storycubs packs about different topics. For example, there are Actions storycubs or voyages

99 but also from characters and their fiction stories such as Moomins or Super Man cubs. There is a later storycub version to use during a meal with next slogan: Roll the dice, tell a story and then eat it, it’s as simple as that. There is an article entitled ‘Play With Your Food, It's good for you’, which gives some very interesting information

create

the

experience of this project. Figure 2.18: Picture of a commercial about Food story cubes, from the article ‘Play With Your Food, It's good for you’. The Creativity Hub.

More information about storycubes eating version at: https://www.storycubes.com/blog/play-with-your-food-it-s-good-for-you 5. Personalize food: Mr. Potato game using food as the elements for its creation.

Figure 2.19: Sr. Potato , picture form FAROS article. Marinva.

It is difficult to have never played with Mr. Potato or a game with similar characteristics. It is a classic game that awakes curiosity, imagination and interaction. It makes players enjoy creating their own version of Mr. Potatoe.

100 With this classic game, is possible to affirm, that people love to interact and customize things but, on the other hand, sometimes people need a ‘little help’ to make arouse imagination. More information about the game and the benefits of it: http://faros.hsjdbcn.org/es/recomendacion/sr-potato-clasico-juego-hacer-volarimaginacion 6. Nutritional pyramids game: use different nutritional pyramids (pyramids of the world, exhibition ‘Nutrition: vital impulse’) as the rules to create a recipe/their dish. There is a part of the exhibition ‘Nutrition: vital impulse’ dedicated to different nutritional pyramids designed worldwide. It could be the theme of the game, or an element, but also a way to learn bout nutritional aspects.

Figure 2.20: Japanese pyramid. ‘Nutrition: vital impulse’ exhibition.

In the images there are the pyramid from Japan (left) and the Mediterranean pyramid (right).

101

7. Meet the cook: game to meet the cooker and how is working, using as a reference Inamo, a Sushi restaurant in London. A way for people to feel closer to food is to cook it or to know who has done it. There is a restaurant in London called INAMO, that defines itself as an ‘interactive Asian fusion’; this is because there is an interactive table that gives, to the costumer the possibility to choose there and, furthermore, to see the kitchen and how people are working there. Figure 2. 21: Picture of the interactive table from INAMO restaurant. INAMO restaurant.

8. Pictionary game: like in ‘Pictionary’, know what you are cooking (shapes, images)… Or another option is to do pictures or drawing with the food itself, and for example send messages. In this case, food could become a kind of toy. This idea could help to make kids having a better association with food and also with the mealtime. Pictionary is a guessing word game invented by Robert Angel with graphic design by Gary Everson and first published in 1985 by Angel Games Inc. The game is played with teams with players trying to identify specific words from their teammates' drawings (Ravulur, 1997). It is a game destined to children and adults. Furthermore it can be used to have fun but also to learn a language. What is very interesting from Pictionary, and useful in this project, is the interaction between players, in this case with food as the object to express/create something and the possibility to decide objective levels.

102

Figure 2.22: Kyara-ben food drawing. Japanese style.

A reference could be the â&#x20AC;&#x2DC;Kayara-benâ&#x20AC;&#x2122;, drawings created from Japanese mums to make them kids eat better (PlayGround, 2016). 9. Plate with messages: put a message or a drawing in the bottom of the plate and make children discover it.

Figure 2.23: Food with messages. Emplatando.

103 This idea can be a challenge for children and teenagers: make them discover what is at the bottom of the plate; it could be a message from the hospital team but also from parents, brothers or sisters, family in general or even friends. 10. Nutritional hopscotch: use nutritional hopscotch, ideated by Aleix Brosel, to create a challenge in the game This game proposal, ideated by Aleix Brosel, was designed to be inside a food guide for children with cancer (Carrera, 2015). Nutritional hopscotch appears near the edge of each secondary effect and is used to illustrate what foods are most favorable to respective effect. Foods that are recommended, or those that are more suitable, will be highlighted in brighter colors than which are not recommended (it does not mean they are banned) that will be displayed in black and white. Hopscotch consists of seven boxes, each of which includes the corresponding food group. However this tool is far from the nutritional pyramid, because its main objective is make children eat. It is interesting in this game, first of all, the use of a game to make nutritional information closer to kids. It works using the food pyramid, and it is a challenge for kids without pressures because the purpose is make kids eat. Figure 2.24: Nutritional hopscotch, ideated by Aleix Brosel, from the food guide for children with cancer. Carrera.

104 5. My proposal This is a proposal to create a game experience during mealtime. As it is said previously, in the introduction of this phase 2, the project where this game is going to take place will be developed during three years. For that reason, the next game proposal is just a sketch of the game. After the brainstorming, I created the game to be used during the project at HSJD, using different ideas as reference. However, the biggest influence came from Story cubes game. Down bellow there is the exposition of how the game could be (also there are some draws in annexes: Game dices, Annex 15). The main idea of the game is to make children, kids and teenagers, enjoy their meal and, as a consequence, improve nutrition. Objective 1: cover nutritional needs (pyramid challenge). Objective 2: enjoy the meal (dices game). I used the Creative Spiral Thinking to do a first game proposal and draw up guidelines (Proposal schema, annex 13). Eating time as a game experience is designed taking into account 3 aspects, mentioned in Design Research: -

Nutrition: give formation about nutritional aspects.

Experimentation: interact with food and senses.

Socialization: interact with someone who is accompanying mealtime.

Furthermore, game takes into account that kids and teenagers are in a hospital and for that reason they can feel under control all the time. In that aspect, the game will try to throw out the rules; players have the control, they can create their own experiences having a personal interpretations and ways to play. The game designed will have dices with different activities or topics to make kids and teenagers interact with food during the meal. The next points describe the game itself, providing with ideas and proposals about how to develop it:

105 Steep 1: Have an FOOD PYRAMID (give to kids and teenagers a draw or a picture of it) as a guideline to know how much food is enough to eat adequately. Pyramid will be used as a challenge to eat, giving a point value to the different aliments. Children could do a points ranking to get over every meal, trying to have minimum of 20 points per meal. Also, having this could be useful to know how the aliment pyramid works.

Figure 2.25: Aliment pyramid. Roca, Maria and Espinรณs, Marianna.

Aliment pyramid, which could be used just like a reference, is necessary to count points and also make kids understand if they are taking nutrients correctly or not. Children could interact with food having knowledge about the importance of it. Steep 2: Take the dices, created specially for the game, and use the respective cards to know every dice function. There are different dices, which have the aim to make kids and teenagers interact with food experimenting and be socialized with the person who is accompanying them during the meal. Every dice have different icons drawn in faces, which are about a specific topic, and there is a card for dice to explain icon meaning and possibilities to play with it. As it is said, every dice have a topic and it allows kids and teenagers decide which dice is more interesting for them to play, which means a way to interact with food and with the

106 person who is accompanying them. If kids are young, parents will have more influence on the game than if they are teenagers.

Senses

Dice topic

Food Situation

Face 1 (+ explanation) Face 2 (+ explanation) Face 3 (+ explanation) ‘How to eat’

Social dice

Face 4 (+ explanation) Face 5 (+ explanation) Face 6 (+ explanation)

Food Interaction

Storytelling/ topic

Suggestion: _______________ __________________________

e.g. Image

Extra power dice

e.g. Image

Figure 2.26: Illustration about game elements: the dices and the information card. Espinós, Marianna.

As it is seen in figure 2.26, there are seven dices (this number could change, as it is said it is just a proposal about how to do the game) and every dice have a theme -senses, ‘How to eat’, food interaction, food situation, social dice, storytelling/topic dice and extra power dice-, which are decided after Design research inputs and using ‘Thoughts for food’ (ideation tool for food designers, more information in Annex 6, that is about Food Design thinking). Themes of 6 dices will have influence on mealtime but not in aliments. That is because children from Sant Joan de Déu hospital have a basal menu, given by the nutritionist team, which have been studied and personalized for their needs. Only one dice, entitled ‘Extra power dice’, is about aliments and is to make menu have more calories; usually kids need extra calories because of their situation – cancer and treatments to fight with it- and there are different nutritional recommendations, used to create dice faces.

107 In annex 16 (Game dices, Annex 15) there is an explanation about every dice and respective card. Even dough, following down there is an example to understand better how it works:

Figure 2.27: Faces of ‘How to eat’ dice. Espinós, Marianna.

Every dice face has an icon drawn, which is an activity or a concept, and it depends on the dice topic. In the example there are the faces of the dice about ‘How to eat’.

108

Figure 2.28: Card with the explanation of ‘How to eat’ dice. Espinós, Marianna.

The idea is to have a card for every dice with an explanation about the meaning of icons (as it is possible to see in figure 2.28). Furthermore, cards have a suggestion with visual examples about how to use the dice. Steep 3: ROLL and IMAGINE: After decide which dices the player want to use, that can be all together, next step is rolling the dices and start imagining.

Figure 2.29: Illustration of the dices rolling. Espinós, Marianna.

109 Steep 4: CREATE and PLAY with dice results (or, another option, is to decide which faces are more interesting to do creations and use it). E.g. Using three dices:

Sight

Use hands

E.g. Using one dice

Connect

Using Sticks

Figure 2.30: The dice results. Espinós, Marianna.

Steep 5: the player has to count points after doing the creation, using the aliments pyramid as a reference. Also there are the possibilities to put a title or do an attractive explanation… and don’t forget to take a picture before eating it! x 10 (sauce, extra power!) 4 pt 6 pt 6 pt 4 pt 4 pt

4 pt Figure 2.31: Example of a creation from dices results. Espinós, Marianna.

Reed Riding Hood = 38pt

Forest

Add mayonese or sauce

Speak

Sight

110 As it is possible to see in figure 28, there are a lot of combinations with infinite results to make meal more attractive but also to enjoy with it. Down below, there are few examples of possible creations with the dices, images from the mood boards ideation tool, which is in Annexes (Mood boards, Annex 11):

Steep 6: SHARE results. After doing a creation, or living an enjoyable experience with food, could be interesting to share it using a network. An example could be Instagram, app that allows people to share pictures and videos with an explanation but also to comment other people posts. Another option could be do a specific app for dices game, which offer to players the possibility to post their food creations and explain the experience with dices.

Figure 2.32: Sharing food on Instagram. Tarik Kizilkaya/Getty

111 Steep 7: REFLECT looking for other people results and get inspired. As it is said in previous point, could be nice to share results. An example is using instagram, with what could be possible to do a #hashtag for people who were using dices to find others experience.

Figure 2.33: Kid playing with a mobile phone. Guia del niĂąo.

112 Chapter 4: Implementation and next steps The implementation phase, as the realization or execution of a design, takes more time inside the real project done in Sant Joan de Déu foundation, than foreseen, approximately 2 years extra. As it is said in the introduction of this phase 2, the project coordinated by Jordi Navarra will need 3 years to be realized and my participation correspond to the first 6 months. It means that this practical phase, same as the development of the practical phase of this Final Degree Project, coincide with Design Research in SJD Foundation. June 2016 is the starting point of the ideation process with Sant Joan de Déu foundation team, after a break during summer months, it will keep going in September. First operational pilots are expected to start on November 2016, one year after the launch of the project idea. As far as I am concerned, my idea is to continue inside the team, despite this project – Final degree project- ends, to design the experience and see if all this investigation comes true. However, this is a decision to be taken during next months.

Phase 3

113 Phase 3 Self-evaluation about the Final Degree Project 1. Solving hypothesis The main objective of this research was to understand what is food is, why it is changing and what directions it is taking, by investigating multisensory perception and artistic characteristics of it, to exploiting its potential and use it to give creative solutions from design discipline. First of all, reflect about food topic. In recent years, impacts of food revolution have invaded TV shows and/or social networks, such as instagram. New concepts like ‘food porn’ or ‘foodie’ are on everyone’s lips today. Reasons of the growth of this movement around food, among other things and as a personal opinion, are closely linked to scientific researches that have streghthen food potential. Food leaves the kitchen and goes towards laboratories. But not only that because is also gaining ground inside art galleries. Even though, it seems to me that firstly was a scientific revolution – mostly occasioned by Ferran Adrià and his food ‘tests’ inside El Bulli restaurant-that shows material possibilities, which impress the world. Once food becomes a material with manipulation capabilities, which go beyond the functional side of food and the operations to make it comestible aesthetics start playing an important role. After that introduction about the topic, the hypothesis is presented in order to know if it will remind valid: Hypothesis 1: Could food be a multisensory applied art, which some designers entitled as Food design? And the answer is hypothesis 2, and the development of it in Sant Joan de Déu project: Could it be possible to use the aesthetic aspects of food and multisensory perception to create an experience able to improve nutrition –and the mealtime- in children with cancer undertaking chemotherapy? However phase 2 didn’t end implementing the game that could improve malnutrition problem on oncology pediatric children; after all the research done and

114 my participation in a real project that takes into account these aspects it is possible to affirm positively the question raised by my hypothesis. I would like to share my thoughts after the work developed: it is possible to start changing and see with another ‘eyes’ what are all food possibilities. Food can jump to artistic contexts or to scientific fields. But, in my opinion, the most interesting aspect is to continue giving importance to the functional value of food and use new categorization, food in a design branch, as a multisensory applied art, as an opportunity area to cover needs. Design, as everything that exists, can be taken in by appearances but also can be seen as a tool for positives changes; it can drive society to a most sustainable world and food, as an essential resource that people can’t live without, will be a key element. 2. Creativity self-evaluation The idea emerges after first investigation, phase 1, and looking for how to employ food design as a multisensory applied art. Creativity borns, in my opinion, when I decide to use the research knowledge to solve a real problem, that is say, put far away from Michelin star restaurants; the reason is because I think that this new movement of modernist cuisine, more sophisticated and expensive, has a positive side and can be useful in different fields. In my case I focused the investigation in solve a problem from health field, and the originality arise in the way to deal with it. However, food topic is growing in importance inside design discipline. To take a case in point, an example of food design as a field with a lot of possibilities can be seen in the inaugural speech of FADfest –the Barcelona Festival of All Design 2016- entitled ‘Sustainable Food Design’. With that example I want to say that there are other possibilities and ways to deal with food topic inside design discipline. Down bellow I will briefly analyze how I used creativity during phase phase 2, taking into account the background from phase 1 as a theorist investigation. That is say, creativity indicators are going to be explained from practical phase, which have as an objective solve malnutrition and bad situation on mealtime of children with cancer.

115 In this project creativity is used as a solving problem tool, being developed in Sant Joan de Déu hospital and in particular at oncologic pediatry section. Methodology used, design thinking, allowed me to have some knowledge, after design research, to start ideation. Also, with phase 1 research I had some positive insights, such as multisensory perception of food and also food designers theories – highlight Marije Vogelzang philosophy, as a eating designer, and her quote "Eating design is to design from the verb 'to eat'.”, which helps me a lot for the ideation process-. Fluency of ideas was easy at first, because there was a large amount of it, but difficult when ideation have started because there where a lot of concepts and reflections on my mind. I had a lot of ideas but put in order all of it was a hard challenge. However, there was a brainstorming of ideas that makes me choose one of them, as a main reference, and do a combination with other positive things from other ideas. I have a good feeling with the result, which as it is said is only a proposal with which work. Flexibility of the idea, as a combination of different fields and the use of qualitative criterions, is in the idea itself because of the multidisciplinary character of the problem that is going to be solved. There will be some scientific influences, with objective criterions, but also creative solutions from design field will be used. On the other hand, there will be a lot of restrictions occasioned by the hospital, like security and hygienic rules- and other aspects from the illness. The elaboration of the idea, despite of not being a final proposal, was a hard work of putting in order thoughts of what I had on my mind, mostly from phase 1 research, combined with insights from the design research done in Sant Joan de Déu. Finally, about innovation, first of all emphasize that concepts like food design, multisensory perception but also patient experience are very new. Fields with which I worked these months have emerged recently to put solutions to new problems; it is because humanity is in constant evolution. So as far as I am concerned, innovation can be seen in the topic of the idea, in the kind of team which whom I was working – a multidisciplinary team- and in the game proposal.

116 3. Self-Evaluation Results show the work that is done on the back; usually a successful result has a solid background, which works as a supportive. As far as I am concerned, the research is the key to success in a project. For that reason, I have focused my efforts most of the time investigating and also taking decisions about investigation lines. Furthermore, be aware that never is too late to acquire more knowledge and continue, is the base to jump start ideas with potential to become success. In general terms, the greatest lessons learnt that I have assumed after the realization of this project is the importance of curiosity, which allows never stop learning and continue looking for new things; but also perseverance, that makes me be constant and keep going with the work. Phase 1 Never would I have imagined, when I was in Berlin, intrigued with Moholy-Navy perception interventions, that I will be immersed in studying the way that people perceive and understand food, as a project classified inside a design discipline. Even though, the truth is that after having received first insights and start searching information about perception, it was only a matter of being aware of things that were happening around me and take opportunities. I did some research before in topics, such as synesthesia or â&#x20AC;&#x2DC;tactilismoâ&#x20AC;&#x2122;, which are linked by perception. What is true is that there were two ideas that have never went away of my mind, as key things that my research had to include: firstly, perception, as a topic that intrigued me, and in the second place a social aspect, do an investigation to work on a social improvement (for example, with synesthesia I did some research about how it affects to people with autism and what opportunities it could have helpping this people as a way of communication). The development of first phase was done with a lot of curiosity, investigating perception from the broadest context: the multisensory perception of food. After finding this topic, research became a hard work to link concepts, and to not be comprehensive in things that were more superficial for the issue that I was working. Sometimes the hardest moment

117 was when taking decisions. However, the most difficult part was to understand ‘culture’ concept to apply it along the research. Its definition is complex and extensive.. I needed to do a parallel research, using sociology references, to know, in depth, culture meaning and to elaborate my interpretation. From my point of view, phase 1 investigation, in addition to the concepts and theories that I have learned, has given me some experience on how to do a research. Phase 2 From this phase, first of all talk about my role in the team. Upon arriving to Sant Joan de Déu foundation, to take part of the team, I had a lot of motivation and illusion. Also some nerves thinking about who does what in a multidisciplinary project work, what kind of challenges I would find and what new abilities I would learn. During the months that I have been working in the project, there were moments for everything. Time to acquire new skills, most of them around nutrition and health topics and also to know new methods of work. As positive points, highlight the multidisciplinary characteristic of the team. It has given to me a lot of knowledge about different topics and ways to work. I had never imagined myself inside a hospital, because of my studies characteristics, and it has opened to me a wide range of choices. Furthermore I feel having lived a personal growth, mostly because of the topic. Oncology pediatric situation is a difficult aspect to deal, because human condition makes us ask ourselves why that exists. However, and that’s my opinion, with questions without answer the best is to work strongly in order to any improvement possibility. The organization has been a point difficult to manage. Firstly I was full of work, non-stop weekends and a little bit saturated; at thas time I was doing another internship every morning so I was quite busy but last months things went slower. So I had the idea to do some ideation with the team, before reaching the deadline of this Final Degree Project. In addition, there was a workshop scheduled to be realized the first weeks of May, but for technical reasons –mostly because the survey, that had to be executed during March and

118 was not well designed and take us extra work (currently is being reviewed and is susceptible to change)- it will be done on the middle of June. About ideation, I had to work hard and do tasks a part from the group, which I hope will be used in the future; whiles sometimes I had the feeling that I hadnâ&#x20AC;&#x2122;t enough time to finish this project with a solid idea. I used some ideation tools but it is true that with groups in workshops can work in much mature way and usually results are better. Also in this phase -during April- I designed a survey focused on kids and teenagers target and their mealtime, but without taking into account the illness, the cancer. I wanted to know general eating situations that children and teenagers are living, the influence of nutritional education and eating habits and, furthermore, the possibilities of play a game in the mealtime that take into consideration the multisensory perception of food. For time reasons I couldnâ&#x20AC;&#x2122;t work a lot on it and at the end was just an intention, however it can be find in the annex (Game survey, Annex 14). After all, I am very grateful of the opportunity to take part of Sant Joan de dĂŠu project and I am pretty sure that the experience has given to me a lot of chances for the future. Furthermore, thanks to my participation in it, I have learned a lot, professionally but also in personal terms, and in my opinion it is also an added value.

119

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