An interdisciplinary study has found that there is already a substantial body of research and knowledge on sustainable continence care. At the same time, the new study shows that most existing research focuses on individual parts of the care system rather than the system as a whole. As a result, valuable knowledge often remains disconnected. This points to significant untapped potential in the interplay between materials, care practices and waste management.
When a diaper raises a systems question
A disposable diaper is an everyday product in elderly care – and a surprisingly good example of why sustainability in healthcare cannot be achieved through better materials alone. That is the conclusion of a new research article from the University of Southern Denmark and Kolding School of Design, published in the respected journal Sustainable Production and Consumption.
The study was carried out by two PhD researchers, ethnologist Victoria Ankerstjerne from Kolding School of Design and engineer Ruby Bubinek from the University of Southern Denmark, together with colleagues. They reviewed an extensive body of research into sustainable continence care to explore where existing knowledge might reveal synergies and opportunities for improving products while also learning from care practices.
There is good reason to take a closer look. By 2050, the EU is expected to have almost 40 million more citizens aged 65 and over than it did in 2019. Longer lives bring a growing need for care and care products, and continence care is one of the areas likely to expand. Developing more sustainable products and approaches to waste treatment is therefore becoming increasingly important.
“Continence care that uses fewer resources requires better products, but it also requires us to understand the practices those products are part of,” says Victoria Ankerstjerne of Kolding School of Design.
We were looking for where change could happen
The researchers set out to identify the points at which sustainable interventions might overlap. They reviewed 306 scientific studies published between 2014 and 2024, covering the entire journey from material selection and manufacturing to care practices, prevention and waste management.
The eye-opening moment came when it became clear that there was less to celebrate than they had expected.
Of the 306 studies, more than half focused on environmental factors, around a third on social aspects, and just over a tenth on economic considerations. The remainder covered overlaps between these three categories. Yet only four of the 306 studies took a genuinely systems-oriented approach.
For the authors, this was a striking finding.
“We had expected to find a body of knowledge showing opportunities across the system. Instead, we found many studies looking at individual parts, but very few connecting them. That means both industry and research risk overlooking synergies – or simply shifting an environmental burden from one part of the system to another,” says Ruby Bubinek from the Department of Green Technology at the University of Southern Denmark.
When the dots remain unconnected
In fact, this is an interesting finding for future research and development, because there may be untapped opportunities within the research collaboration Socio-Technical Transition for a Circular Diaper System in 2030, which brings together the University of Southern Denmark, Kolding School of Design and a number of partners from public authorities and industry.
The review did not reveal a lack of research. On the contrary, there is a substantial body of knowledge on materials, products, care, prevention and waste. The problem is that these areas are largely studied separately.
Victoria Ankerstjerne and Morten Krogh Petersen are a PhD researcher and Associate Professor respectively at Kolding School of Design, where they are affiliated with the school’s LAB for Sustainability and Design.
Photo: Maximillian Schmidauer
It is a little like a connect-the-dots drawing: you cannot tell whether the picture is a giraffe or a rocket until the dots have been joined. The same applies to the system that collectively shapes more sustainable care. Materials are one dot. The working routines of care staff are another. The needs of residents, economics, transport and waste management are others again.
Ultimately, the solutions we find may depend on where we choose to begin looking, Ruby Bubinek explains:
“Where we start looking can influence the kind of solution our discipline arrives at. A technical solution to a technical problem may appear sustainable if, as an engineer, you look at the material in isolation. But that solution may simply create another dot with no connection to areas such as everyday practice in care homes or the existing waste system. Looking at the research we analysed, we can see many dots – and very few connections.”
A wealth of knowledge in the corridors
The work has also prompted an important reflection for the two PhD researchers: had they worked separately, each within their own field of expertise, they might have missed the opportunity to strengthen the research by working across disciplines.
Following this collaboration, the next step is likely to involve joint projects in which research partners and stakeholders from across the value chain are involved from the outset.
The University of Southern Denmark can broaden its life-cycle work by incorporating care practices, while Kolding School of Design can investigate prevention and local adaptations.
“We are not going to speak exactly the same professional language, and we do not need to. Collaboration can shift our perspectives and make us ask different questions from those that focus solely on technical optimisation,” Victoria Ankerstjerne explains.
For the design researcher, this became particularly clear through ethnographic fieldwork carried out in Danish care homes as part of the project, where she explored the everyday practices surrounding the use of diapers.
“The opportunities begin in the everyday realities of care. Practices and small changes in how daily routines are organised may also contribute to more sustainable continence care. In that sense, there is a wealth of knowledge in the corridors of Danish care homes. If we connect the knowledge and experience of care staff with academic expertise, it can become a starting point for new solutions and new research.
“From a design perspective, many new dots have appeared that could begin to outline a more sustainable future. Together with environmental engineers and colleagues from other disciplines, I look forward to connecting more of them in the work ahead,” says Victoria Ankerstjerne.
In other words, new research can begin here.
PhD researcher Ruby Bubinek from the Department of Green Technology at the University of Southern Denmark is the lead author of the new publication.
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