Lighting assessment in low-vision rehabilitation: Implementing N-Lited

Lighting assessments have been part of low-vision rehabilitation for decades, but more structured and evidence-based approaches have emerged in recent years. In Denmark, a mixed-method semi-structured protocol for lighting assessment was developed and tested as a pilot study from 2017–2019, and it showed promising results, in that it improved the visually impaired participants’ quality of life. Innovations are often developed in pilot studies, but implementing new approaches across communities of practice poses difficulties due to both individual and organizational norms. N-Lited is an implementation project that entails the dissemination of knowledge and instructions as well as practical trials, and its protocol has been implemented in seven low-vision centers from 2022–2023. Based on participants’ observations, document analysis of the framework, and a midway evaluation that assessed the potential for scalability and diffusion, this paper discusses the learning and change processes in the interpretation and role of the lighting measurements and lighting assessments in this project. Beyond mere instrumental learning, the findings reveal that it is crucial to address how individuals learn how to explore and question the difficulties that reveal mismatches or reconfigurations of values, norms, and assumptions to ensure a successful implementation of the method. The changing role of lighting measurements, from instrumental to more reflective, also illustrates the importance of the practical application and learning-by-doing aspects that are essential for learning how to reflect and “think with the metrics.” Furthermore, metrics and tools are an important part of the community of practice’s shared language. The uncertainty of navigating between the uniformity of the protocol and the flexibility needed for incorporating the method into individual professionals’ practices and the various organizational contexts emphasizes the relevance of the process of learning how to manage methodological innovations in practice.


Introduction
The field of lighting research and design is constantly changing, which can be seen in the technological innovations made in terms of light sources, systems, and infrastructures as well as the changes in markets, consumers' needs, and political agendas.The current technological developments and sustainable transitions enabled by emerging and evolving practices constitute comprehensive learning spaces.Moreover, "scaling-out" or "scaling-up" centers around these transitions and learning processes in which individuals, technologies, and practices are engaged.These processes involve alterations to both cognitive (abstract) and physical (contextual) knowledge as well as the reconfiguration of both practices and socio-technical systems [1].Furthermore, change and transitions can also be driven by individuals gaining inspiration and learning new information from distant fields, as exemplified by the fields of low-vision rehabilitation (LVR) and lighting.Lighting has been an important aspect of LVR for decades [2], and recent developments in rehabilitation practices have been fundamentally influenced by the methodological approaches used in lighting design [3] and the introduction of lighting as a dynamic parameter in rehabilitation processes [4].From 2017-2019, the Center for Special Education (CSU) in Slagelse developed and tested a new framework for lighting assessment and intervention in the project entitled "Better Light, Better Living" (BLBL).The results were promising, in that the visually impaired participants' visual performance and quality of life improved significantly [5].Furthermore, in 2020, the low-vision consultants behind BLBL, in addition to a project manager, initiated a new project entitled "N-Lited," which is targeted toward applying the lighting assessment throughout the low-vision rehabilitation community, currently comprising seven of the 23 low-vision centers in Denmark.This project includes providing courses on lighting assessment and intervention, thereby providing extensive knowledge on lighting parameters that are relevant in this approach.However, despite the focused implementation efforts, scaling and sharing the method across the community of practice has been more complex than first expected.

Lighting in LVR
There have been several approaches to lighting assessments among low-vision consultants in Denmark.In the 1980s, the understanding of (residual) vision changed, in that it was previously understood as a more static condition but came to be seen as a more central and dynamic function that needed training and maintenance [6].The focus on maintaining individuals' visual function resulted in special aids and lighting being made a niche subject within the field in curricula for diploma programs on low-vision services.The knowledge and approaches to lighting have undergone large changes during these 40+ years, starting from a checklist of lux levels that were suitable for the different impairments and the technical lighting assessments that were used to measure the light distribution of rooms in systematized grid measurements.In a large proportion of the early years, lighting for the visually impaired primarily comprised expensive special aids for which these individuals would have to apply and be granted by national health systems, but they had to be classified as eligible.Furthermore, the curricula included theory on lighting physics and technology.However, as the field of rehabilitation has changed from a medical approach with a focus on diagnostics to a field with a broader bio-psycho-social approach that focuses on impairments as a phenomenon situated not in the individual but in their relation to their social and physical contexts, the curricula have changed.This has been a rather slow transition in the niche field of lighting, but courses from the past five years have included more context-specific assessments that are based on the issues experienced by visually impaired individuals in their everyday lives.

BLBL
The lighting assessment and intervention developed in the BLBL [5] focused on situated individuals and the importance of including the social and physical contexts in the rehabilitation process.BLBL was tested on 60 visually impaired participants from 2017-2019, situated both in the homes of the participants and the lighting laboratory at the clinic.First, the participants each engaged in a narrative interview in their homes, during which they described their everyday lives and the issues they were experiencing concerning the lighting in the different places in their home environments.Using the information attained from these interviews, as well as an occupational performance score, up to three activities were identified as appropriate for assessing lighting.These assessments comprised recording the location and position in which the activity occurred, with the setting being documented in terms of IOP Publishing doi:10.1088/1755-1315/1320/1/0120323 photographs and lux measurements.Moreover, in one of the activities, the participants' visual performance was tested through assessments in the form of sorting colors and tracing lines.These tests were then repeated after the intervention to measure its effect on the visually impaired participants.In addition, the participants completed a questionnaire on visual function before the intervention.Second, a lighting intervention was conducted in CSU's lighting laboratory, in which the participants were shown and tested alternative lighting solutions.The participants' preferences were determined, after which the recommendations were given to the participants for implementation in their homes.Third, a follow-up interview, either in-person or over the phone, was conducted with each participant after two to three months, and the questionnaire on visual function was repeated.The results of this pilot study showed significant improvement in the participants' visual function in several settings as well as an improvement in the performance measures of the chosen activities [5].

N-Lited
Due to the BLBL's success in significantly improving the participants' quality of life, an implementation project, entitled N-Lited, was launched in 2022 with the objective to implement and test the scalability of the BLBL's approach in seven of the 23 low-vision centers in Denmark.To ensure easy implementation of the method, the BLBL intervention underwent some adjustments: First, the N-Lited project did not include the BLBL's visual performance tests and questionnaires that were used to measure the effect of the intervention on the visually impaired participants; and second, to make the methods more accessible to immobile participants, N-Lited included a "mobile lighting laboratory," comprising a suitcase that was equipped with lamps and luminaires for smaller interventions that were more suitable for one-on-one testing in the participants' homes.The facilitation and education of the method was designed as a course program involving teaching and training the protocol in each of the organizational contexts.Moreover, an external midway evaluation of the course program was conducted to adjust and improve the methods, educational materials, and facilitator-learner dialogues.
This paper investigates the results from the N-Lited project, with a specific focus on the first steps of facilitation, learning, and changing processes within the implementation process as well as how the method was disseminated and received, including the resistance to and challenges in the social and organizational settings identified by individuals.Finally, the aspects relevant to the field of lighting are also discussed more broadly.

Theory
Change and transformation processes can be analyzed by investigating a practice as an entity as well as determining the aspects at stake in and between the three elements constituting a practice: material, competences, and meaning [7].Different practices complement and compete with one another, reproducing or reconfiguring these elements.For example, driving and maintenance are two complementing practices related to cars, but they comprise different materials, competences, and meanings.Likewise, instruments and tools used in professional practices are not neutral aspects as they shape the character of human-world relations through their use and interpretation.These instruments often produce quantitative measures that represent a physical phenomenon, and they are analyzed in terms of statistical estimations of averages, coverages, or accuracy.The development of running practices is currently being impacted by technologies that are developed to monitor performance, impact and be impacted by the meaning of sharing information and motivating others, thereby calling for new competences.These technologies, motivations, and competences that are involved in the use of these new applications can be monitored, the results of which can be shared with other practices, thereby further facilitating change [7].For the skilled practitioner, the tools used can be the instruments of action, allowing individuals to discern and respond to the ongoing activity by using their perceptual sensitivity [8].For example, a dentist's probe, serving as an extension of their hands and eyes, is used in examinations to assess the condition and texture of their patients' teeth and mouths [9].Technical measurements should be easy to conduct, reproducible, and enable these statistical analyses, but to work 1320 (2024) 012032 IOP Publishing doi:10.1088/1755-1315/1320/1/0120324 with measures qualitatively, meaning needs to be added, which is dependent on the specific context of interest [10].
To identify or establish this context-specific meaning in professional practices, reflexivity is key, which is defined as reflection as a process of creating meaning and conceptualizing knowledge from past experiences [11;12].This includes the tacit knowledge embodied in individuals, encultured in organizations, encoded in signs and symbols, and embedded in systemic routines and practices as well as how different types of knowledge are navigated and coordinated [13].Valuable information can be gained from prototyping or pilot testing.Furthermore, while scientific researchers aim for generalizability, reflective practitioners focus on situation-specific insights in which prototyping can be valuable for the learning process: "The utility of the prototype lies in its ability to generate explanation and experimentation in a new situation" [14].There are several unknowns in the in-depth investigation of the implementation processes for new technologies in the context of organizational learning and practical knowledge.First, learning processes in professional practices are social.Indeed, as colleagues often inform and educate each other, different generational versions of the same curricula can be used within the same community or even in the same organization.The individuals' different levels of expertise can be accommodated in the framework of participation [15], which entails acknowledging each person's learning style preferences [16] and, beyond the provision of information, providing tools for managing collaboration and learning.Facilitating group dynamics in which different levels of expertise and engagement are represented could necessitate the facilitator having to let go of some of the control to let individuals participate according to their levels as well as take control and responsibility [17].The success of this co-creation of practical knowledge largely depends on the group's social interactions and negotiations, and it requires the facilitator to be honest with the individuals on the team about the agenda of the course to help the team examine how to approach these collaborative processes [14].Second, the aforementioned instruments and tools as well as the language and narratives in the practices are relevant to the analysis as these shared technologies engage, focus, and coordinate the social structure's shared memory.Third, paying attention to the implementation process could also provide insights into the transformations that were enacted.The learning process impacts both apprentices and masters due to the individual and shared actions as well as the problem-solving in which they engage.This social community of practice both develops professional identity and reproduces and transforms the very community: "Learning, transformation, and change are always connected, and the status quo requires explanations as well as change" [15].

Methodology
To analyze the initial findings of N-Lited, an ethnographic case study was conducted, with the participants being observed and a document analysis of the project's work being conducted.The education materials, particularly the N-Lited manual [18], schemes, and PowerPoints, as well as more project-related documents, such as newsletters, the midway evaluation report [19], and the project description, were investigated.These documents contained text, diagrams, and photographs, being analyzed as inscriptions of "social facts," in that they were produced, shared, and used in socially organized ways [20].This analysis was conducted to uncover meaning, develop understanding, and determine insights relevant to the research problem [21] by investigating how approaches to lighting were practiced among the participants and in the framework provided.A document analysis entails tracking changes and developments in different versions of the same document [22], such as the different versions of the narrative interview guide developed throughout the project.The changes were identified as the substantive developments that occurred in the project [23] by examining a range of its newsletters.
To triangulate and supplement the project material, reports from a previous mapping of the community of practice [24] and a case study on BLBL [6] were employed as a representation of the status quo in the area, with the project manager's reflections on the low-vision consultants and the course activities they observed being used as supplementary material.Furthermore, both authors have participated in status meetings with the two low-vision consultants who were facilitating the course during this period, during which anomalies and issues were discussed in shared reflections.

Designing the course
This section discusses the material, demonstration, and testing of the method's first phase, the lighting assessment, and the interview.The first phase of the project entailed making the practice knowledge from BLBL explicit.While BLBL had been described in a more scientific manner in the researcher's articles and reports, this material did not describe the hows and whys in a way that supported the more tacit and practical knowledge, nor was it in Danish that could be easily interpreted by the practice.The course's curriculum, the presentation materials, and the first version of a manual that was later introduced were all used to disseminate the content in a way that it could be operationalized by the participants.The 40-page manual was drafted during the first months of the project, and it was based on the knowledge gained from the BLBL project and verified in dialogues with the participants.The manual detailed the process of the lighting assessment step by step, which was followed by an introduction to the concept of human lighting [18].The content was the point of departure for the educational courses, where the methods of lighting measurements were also taught to and tested by the participants.
The first step of the lighting assessment included a narrative interview guide that was used to inform the dialogue with the participants.The interview guide was developed during CSU's practical investigations of the BLBL model and was aimed at facilitating a conversation with the participants that allowed them to describe their experiences and challenges with everyday activities.The guide simultaneously worked as a motivation for making changes.A circular diagram was used to focus on the activities and situations in which the lighting conditions enabled or hindered the participants, and it was also employed to help the participants articulate their experiences and emotional perceptions of these situations in a non-linear manner.The quantitative assessments of the light were based on one of the problems tackled by the participants in the activity in which the lux, color rendering index, and Kelvin were measured using a luxmeter and spectrometer in the position in which the activity occurred.For example, in seated activities, the luxmeter was placed horizontally and pointed upwards on the surface of interest, such as on the dining table where the plate would be, to measure the level of light on this surface, while the light levels in the room would be measured at a height of 85 cm.In situations where the lighting should support a social setting, measurements were taken by aligning the luxmeter with the forehead of the other person in the interaction.The documentation consisted of two photograph types: a) an overview photograph of the scene from chest height at a wide angle if possible, and b) an activity photograph taken from the position of the given activity and at eye level to document the surroundings.The education materials included a template for a presentation application that was to be used on a tablet and on which the photographs could be directly combined with other measurements.
The parameters of human lighting included in the manual were determined according to Christiansen [25], who was a Danish lighting designer who described an approach to lighting that was practiced at the Lighting Laboratory at the Academy of Fine Arts in Copenhagen from the 1950s [6].In this approach, visual comfort [26] and the knowledge of seeing and assessing light go beyond physics and measurements by involving biology, psychophysics, and perception [27].The 20 parameters chosen for this project were sorted into three subcategories: a) primary parameters, b) vision discomfort, and c) perception of light impressions [19].The primary parameters included aspects of vision as an adaptation as well as aspects related to the physics or phenomenon of light (e.g., luminance, color, rendering, spectrum characteristics) and relational aspects of light (e.g., form, shadow, texture, contrasts, direction, and illuminance).The second category of vision comfort comprised glare (whether vision-impairing, uncomfortable, or indirect), flicker, noise, radiant heat, decomposition of material, and pathogenic, while the third subcategory of perception of light impression included the relation or fit of the luminaire and the space or place, spatial trajectory, colors, luminance variation, surfaces and coloration, and perceptual relationships between light, space, and behavior.
The courses included educational materials that described the method and provided instructions for the practical use of the different elements in terms of how to conduct a narrative interview or measure light in the analyzed activities of daily living.The project also involved facilitating the process of determining common incentives by and for the group of low-vision consultants, such as the value of following a protocol for structure and quality assurance as well as the new approach of providing knowledge on and recommendations to the visually impaired according to individual participants' perceptions and experiences with the quality of light in their everyday settings and activities and not just quantitative measures.The narrative interviews were chosen as a methodological tool as they allowed for this investigation.
The 14 low-vision consultants were educated over three days of training, dialogues, and practical lessons.The first two days comprised the participants being introduced to and practicing the narrative interview, thereby allowing for the incorporation of the visually impaired's perspectives on their daily activities and quality of life in relation to light.Moreover, the process for measuring light in specific activities was detailed through examples of where and how to measure it and why the measurements were necessary.Moreover, different lighting solutions to specific cases were presented.The vision consultants concluded the two days with practical training of visually impaired individuals in local nursing homes in the form of a lighting intervention after they learned about the N-Lited method.The third day of training was then conducted after a month of individual practice of the method in their own context, during which the consultants could address any doubts they had concerning the method.Furthermore, alternative procedures were discussed regarding the adaptation to the local setting, considering whether and to what extent the alternatives would still represent the N-Lited method.Throughout the project period, the participants could converse with CSU experts online, which was a service used every 14 days on average.

The midway evaluation
The objective of the midway evaluation was to support a knowledge foundation that enabled meaningful adaptation of the project throughout its duration and to gain an understanding of the method's dissemination [19].Six of the centers considered the demand for the service to be indirect when qualifying it, while one of the small centers did not see a need for lighting assessments to be implemented, due to advanced age, lack of action incentives, and energy-saving measures.The participants' personal and professional motivation to adhere to the methodology was evident as they found the approach time-consuming.Furthermore, the project had to be accommodated into the participants' daily schedules, and its nature was unfamiliar to some of them.
At the time of the evaluation that was conducted in 2023, only five of the seven centers had implemented the method in a total of 26 cases, at an average of five cases per center.However, not every center had practical experience.The interviews revealed that the recovery-based approach had gained traction among the centers, and the focus on the visually impaired's ability to act on the recommendations was especially valuable in the approach.Acknowledging that this was related to motivation, help from the social setting, and economic support increased the success of the intervention but also made the lighting assessment and intervention much more complex than previous approaches.The approach's implementation fidelity, denoting the degree to which an intervention is delivered as intended [19], was determined in relation to the framework and conditions, in which the management and consultants had the correct attitude toward and understanding of the project.Arrangements were put in place that allowed some of the consultants to conduct their initial lighting assessments in pairs and discuss and support each other through their shared experiences.The centers' management structures were allowed to support the consultants in the implementation of the approach in ways that worked for them and their own practices as long as they did not consume inappropriate time or resources from other citizen-oriented core tasks.Furthermore, the centers' management structures acknowledged their overall purpose in contributing to the development of the field of lighting within rehabilitation in terms of a common national practice for lighting assessments.However, the differences in financing between the low-vision centers impacted the organizations' flexibility regarding their core tasks.

Learning space
The learning space within the project was seen as a safe space characterized by an equal and respectful atmosphere in which dialogues between both the consultants and the facilitators as well as among the consultants allowed learning to occur.The practical and experience-based dialogues on the testing were particularly important for both determining the possibilities of luminaires and the demonstrations as well as allowing case experiences to be shared.
The turnover of professional knowledge was ensured when examples of applying the knowledge in practice were provided.This was followed by a proposal that included the facilitators' practical or participatory observations from conducting a real lighting assessment with a citizen.A range of questions arose when the lighting assessment was to be tested in their own practices that had different settings, activities, and impairments, but the demonstration bridged the gap between the facilitators' practical steps and theirs.
Establishing this reflective space was described as important for the implementation project, but the time needed to facilitate these kinds of processes depended on the consultants' existing knowledge as well as the values and norms of the participants, organizations, and communities [14].The participation framework that had a focus beyond providing information by considering the participants who were testing the protocol in their own settings and sharing their experiences, in addition to the management tools used in the collaboration and for learning, were both well-received.Moreover, the feedback from the midway evaluation indicated that there was a need for a larger focus on practical and experiencebased instructions and manuals as well as a forum for continuing the shared reflections on both the contextual and abstract knowledge required [1].Learning processes, such as the ones used in N-Lited, do not necessarily benefit from questioning all its elements.For systems that are working, contextual learning should be prioritized to sustain and continue the instrumental use of the tools, with questions about the meaning [10] of systems and processes that do not work within the current context being prioritized.
The tools for managing and navigating these different modes of learning could perhaps have been facilitated more closely as the time needed for learning, understanding, and executing the protocol was determined by each individual.This was also the case in terms of the timing for when these individuals felt ready to move on to the more abstract contributions of reflecting on how well the protocol worked in their specific contexts.However, as this was also a pilot study for the project group, the mere recognition of the difficulties in this progress was valuable knowledge.Furthermore, the first iterations were made using rules of thumb, recognizing the different transition steps between individual and organizational learning, and acknowledging the importance of aligning the participants' and facilitators' expectations at the beginning of the course.

Exploring the role of light measurement
The feedback from the midway evaluation showed that the low-vision consultants were challenged by the amount of information to remember, including the new way of "being present" in the lighting assessment.The close collaborative process of sharing the assessment with the visually impaired could not be learned fully in advance as this was a social process of assessing these individuals' issues in their everyday lives, so the consultants needed to trust the process and know that they could get the support they needed through the tools of inquiry provided.The midway evaluation focused heavily on recovery and rehabilitation and less on light, and we do not know much more about the way the lighting measurements were conducted.This challenge was perhaps also exacerbated by the different elements of the lighting assessment that represented both the quantitative and technical methods as well as the qualitative and social methods.The lux measurements had been a theme discussed in the development of BLBL as the project group was concerned that the measurements would be simplifications of the representation of light.In the transition from the home environment to the lighting laboratory, the lux measurements from the original BLBL were used as a baseline and a point of departure for testing alternative lighting.For the low-vision consultants who were more experienced with lighting assessments and interventions, the role of lux measurements was less important in their core lighting assessments as they employed more qualitative descriptions of the environmental settings.Thus, the luxmeter worked more as an instrument for action and assessment, enabling a reflective dialogue via the consultants' perceptual sensitivity [8].However, in N-Lited, these instruments and measures comprised an important aspect of the shared language [15] as signs or symbols that represented the physics of lighting and the conversations about the light in the narrative interview were closely intertwined with the specific context.If the participants were able to build the skills they needed to ensure effective perceptual sensitivity, the lux measurement essentially turned into a tool that provided reflections, which would be the basis for relating the quantitative and qualitative data.Therefore, the measurements resulted in facts; the stories provided meaning [10].Across the organizational contexts, lux measurements were still required by some municipalities as in funding applications, which was why the N-Lited approach included this wording in its methodology, in which the rules of thumb were applied in a way that would not ignore their uniqueness, ensuring robustness for each case that was different [12].Thus, technologies, language, and narratives were used to engage and focus the participants while also coordinating the shared knowledge of the navigation between the instrumental correction of errors in the technical rationales and the deeper learning and social change processes in rehabilitation.

Between novices and experts in the community of practice
All communities of practice span from the novice to the expert, but the combination of rehabilitation and lighting adds to the complexity in the spectrum of knowledge.The two low-vision consultants facilitating the course had been exploring lighting within their field for the preceding seven years, from the basic curricula to courses in lighting design as well as their own projects and research collaborations.Moreover, their background as occupational therapists meant that they combined the performance measures, their motivation, and the value of scientific knowledge that was then applied to their practices, even though this did not benefit the visually impaired directly.The consultants' diverse backgrounds, which comprised different levels of expertise in lighting, rehabilitation, or low-vision services, resulted in the need for a safe learning space that allowed open, respectful, and equal dialogue.The midway evaluation indicated that this was achieved in N-Lited and that valuable lessons and new knowledge were created by the consultants, outside of the facilitators' influence.
The missing link between the lighting measurements and the outcomes for the visually impaired participants was an inhibiting barrier for some of the participants: "The lighting assessment has no real value to the visually impaired participants before the recommendations are implemented" [19].The evaluation proposed that specifying how this project would directly contribute to improving both the consultants' and visually impaired participants' lives as well as providing the empirical documentation needed for the research purpose would counteract this barrier.
In the evaluation, a participant stated that it would be beneficial if the participants had the same level of knowledge due to the effectiveness of the learning situation.Time spent teaching them basic knowledge felt like a waste of time for the participants who already had the requisite knowledge and who were eager to test the method practically.However, as there are different types of knowledge across different specialties, a group of participants that was too homogenous would have perhaps resulted in fewer reflections and less knowledge creation across the team.Furthermore, the consultants acknowledged the need to promote the method among their colleagues who did not participate in N-Lited and to improve the basic knowledge of lighting provided in their basic education.
The implementation fidelity was also assessed in relation to the resources available, and it was found that it was not as much the professionals' engagement and competence but the barriers in the framework that impacted the implementation fidelity in some contexts.The current call for systematized approaches and evidence-based practices in rehabilitation stems from a New Public Management focus on performance measures and management that has been implemented in most public health services.In this political landscape, there are also embedded objectives that call for the opposite, in that they require more systematics and more citizen-oriented approaches [24].Thus, this is a complex setting, but the open collaborative nature of the project recognized the need for a forum in which joint discussions and IOP Publishing doi:10.1088/1755-1315/1320/1/0120329 sharing can be facilitated, where professionals can place themselves on the spectrum between 1:1 and fragmented implementation, thereby recognizing and navigating their positions in this changing landscape [14].For most of the consultants, N-Lited constituted both an educational experience and the first steps in organizational change toward a more recovery-based LVR approach by moving from technical rationales or medical models toward more holistic and bio-psychosocial models.

6.1.
The conflicting yet related objectives of N-Lited BLBL comprises a complex and multi-dimensional understanding of light, and it operationalizes different types of knowledge of light in terms of supporting the rehabilitation process, from a quantitative and measured approach to the tacit knowledge of light that is embedded and embodied in both the visually impaired participants' everyday lives [28] and the consultants' practical knowledge [3].BLBL represents a transition in lighting approaches within the field of LVR that has moved from understanding light from a technical physics standpoint to explaining it as a sensory and social phenomenon of great importance for perception and participation as well as determining individuals' capabilities within their everyday environments.With the pivot to a recovery-oriented rehabilitation approach, individuals' participation and their knowledge became the center of attention in the rehabilitation processes.Furthermore, examining the materials, competences, and meaning, the elements of practice [7], and the trajectory of change initiated by N-Lited has taught us a lot.
Implementation fidelity was one of the aspects assessed in the midway evaluation, which was measured by specifying the objectives and measures of the intervention.The double objective of both implementing an existing protocol and encouraging critical reflection was incorporated to enable ownership and engagement of the consultants, thereby allowing local adjustments to be made to the approach.However, the findings show that the two objectives also caused confusion, with the protocol, norms, and perhaps the facilitator-learner relationship being questioned.The report from the evaluation discussed the local adaptation in a spectrum between 1:1 execution to a more fragmented and random use of the protocol, which indicates that the evaluation focused on the implementation of the existing protocol.All the consultants followed the protocol quite strictly, at least in the initial phases, and after encouragement from the facilitators, they also reflected on how their approach would change after the project and how these changes would align with their specific contexts [10].The project group was aware of the organizational contexts' role in the success of the implementation and that the different professional backgrounds could impact how the protocol (and its information from the fields of psychology, occupational therapy, and lighting) aligned with their colleagues' practices.Consequently, after discussing the paradox of the two objectives and how much the protocol could be adjusted and still be considered "the protocol," some rules of thumb were determined for the implementation.Most importantly, the course participants should become intimately familiar with the method before they are allowed to adjust it too much.As a minimum, the entire systematized approach should follow two tenets: a) embrace the recovery-based focus, acknowledge the visually impaired individuals' knowledge as they are the experts in their lives and environments, and support and motivate their change processes; and b) include the alignment of lighting measurements.
These rules of thumb resulted in further discussions on what the minimum implementation measures would be for participants to still claim that they were using this method.For example, was it the narrative interview, the scoring, or the lighting assessment, and should it also include an actual lighting intervention?What if it was more a conversation than an actual assessment of the specific physical home environment?As the participating organizations comprised different organizational levels in the project [13], these adjustments and the subsequent learning processes aligned with different aspects of N-Lited.Therefore, the implementation included: a) a more systematized method (i.e., following a protocol); b) a new recovery-based approach to lighting (i.e., the role of light is seen within the social and physical context of the visually impaired and described in the narrative interview); c) a more collaborative and co-designed approach to recommendations and solutions (i.e., the user was seen as an expert); and d) a learning space and a learning process that had the potential to cause changes in the individual (both the consultant and, hopefully, the visually impaired participant), the organization, and across the community of practice.This change process initiated a reconfiguration of the practice, in which both the required abstract and contextual knowledge were changed [1].

Findings relevant to the field of lighting
Beyond the technical protocol, N-Lited involved a range of organizational shared and individual constructive learning iterations that allowed for the development of new competences and meaning [7].These elements are all related.Implementing initiatives in a community of practice or sharing and operationalizing knowledge leads to learning processes for individuals and, potentially, their organizations.Individuals represent different levels of knowledge in specific fields.Practical knowledge concerns both explicit and instrumental theory-in-use understanding, procedural knowledge as rules of thumb, and more tacit knowledge embodied in the routines of the practitioner or in the tools and schemas employed in their work.For many years, lighting in LVR has been a mono-discipline representing a technical rationality [12] or a niche for instrumental and technical problem-solving.However, the context of rehabilitation has resulted in new problem-solving techniques needing to be developed as this context ensures that lighting is no longer a solely technical matter but, by and large, a socio-technical issue.By combining new and existing knowledge in reflexive manners [11;12] the context-specific meaning is incorporated [10].The socio-technical approach formulated within rehabilitation practice in this case is also relevant to other interdisciplinary efforts, such as light and user quality in architecture, applications to user experiences, health and wellbeing, the United Nations Sustainability Development Goals, and the "Leave No One Behind" policy.
The low-vision consultants on each side of N-Lited, the facilitators and participants, all engaged in LVR and the use of lighting in this context.However, this course's objective centered around reconfiguring the competences and meanings of the role of lighting.By the end of the project, some of the participants were well on their way to using the method as an instrument of action [8], while others had found alternative workarounds or implemented certain elements of the method.The quantitative and qualitative approaches to lighting used herein were rooted within the field of lighting design.The facilitators of N-Lited shared a lot of their competence and understanding of meanings in the more qualitative approaches, while most of their colleagues embodied the more quantitative approaches to light, which was also the case for practitioners from other areas within lighting research.We considered bringing the case of N-Lited to the field of lighting research and design, thereby representing a crossfertilization between otherwise unrelated practices [7] and acting as an example of two practices that share interests in terms of the use of lighting as a professional asset and employing both quantitative and qualitative approaches.

Limitations and further research
As an ethnographic case study of the implementation of new methods for lighting assessments in rehabilitation practices, a limitation of the current study is the lack of observations of the participants conducting and reflecting on their performance of the light assessments, including the role of measurements.The documents in a document analysis represent specific points of time within a dynamic process, but do not provide sufficient detail for exploring the role of these artifacts and instruments [22].In fact, the mid-way evaluation hardly touched upon lighting at all, and this also illustrates the limitation of the documents, that there is often a thematic focus when knowledge is made explicit.In the evaluation, the rehabilitation and recovery processes of the visually impaired was the main scope, and the use of lighting merely a means for reaching this outcome.However, the participants' call for more one-on-one hands-on trial and error and for sharing case-experiences indicate that they have grasped a much more important lesson on light: understanding the embodied knowledge activated through action, the reflection on what the light 'does' for the other, and what role the measurement plays in this approach.We believe that such observations, across the group of participants could provide valuable insights on how the measurement is individually used within the specific setting and dialogue, its more general role IOP Publishing doi:10.1088/1755-1315/1320/1/01203211 as an inscription representing the current setting, and finally as part of a shared accumulated database of empirical project or research data.

Conclusion
This paper investigated the initial findings of the ongoing project, N-Lited, in which a new lighting assessment has been implemented in seven low-vision centers practicing LVR in Denmark.The midway evaluation showed that the participants' approaches to the lighting assessment involved both instrumental and more social inquiries into the physical and social contexts of visually impaired individuals.Beyond the socio-technical protocol and methodology, the project has allowed participants, their organizations, and their communities of practice to gain new knowledge.The facilitators have succeeded in creating a safe learning space across different competences and backgrounds as well as across different levels of background knowledge regarding lighting assessments.The reflectivity established to ensure ownership and facilitate learning among the consultants has enabled the participants to adjust their approaches to their organizational and local contexts.Thus, the reflexivity has also resulted in uncertainty in how to navigate between abstract and contextual learning as well as when to trust instrumental and step-by-step instructions and when to question and reflect on their effects.These findings have provided feedback on the project that has enhanced its determination of how to manage these methodological considerations while still allowing for uniformity and flexibility in future implementation processes.We are hopeful that these discussions on the competences and meanings attributed to lighting as well as the acts of measuring, assessing, and challenging existing practices could enable further cross-fertilization between practices that employ quantitative and qualitative approaches to lighting.