  The popularity of 3D printed assistive technology has led to the emergence of
new ecosystems of care, where multiple stakeholders (makers, clinicians, and
recipients with disabilities) work toward creating new upper limb prosthetic
devices. However, despite the increasing growth, we currently know little about
the differences between these care ecosystems. Medical regulations and the
prevailing culture have greatly impacted how ecosystems are structured and
stakeholders work together, including whether clinicians and makers
collaborate. To better understand these care ecosystems, we interviewed a range
of stakeholders from multiple countries, including Brazil, Chile, Costa Rica,
France, India, Mexico, and the U.S. Our broad analysis allowed us to uncover
different working examples of how multiple stakeholders collaborate within
these care ecosystems and the main challenges they face. Through our study, we
were able to uncover that the ecosystems with multi-stakeholder collaborations
exist (something prior work had not seen), and these ecosystems showed
increased success and impact. We also identified some of the key follow-up
practices to reduce device abandonment. Of particular importance are to have
ecosystems put in place follow up practices that integrate formal agreements
and compensations for participation (which do not need to be just monetary). We
identified that these features helped to ensure multi-stakeholder involvement
and ecosystem sustainability. We finished the paper with socio-technical
recommendations to create vibrant care ecosystems that include multiple
stakeholders in the production of 3D printed assistive devices.
