Co-design Experience Research Articles

Minga as a placemaking tool in peripheral neighbourhoods. Co-design experience in Calderon, Quito*

ABSTRACT This article explores the role of local vernacular socio-spatial practices in co-design and placemaking in Calderon, a peripheral urban parish in Quito, Ecuador. Using a case-study method and transformative paradigm theory, the research employs a mixed-methods approach for data collection and analysis. The focus is on ‘Minga’, a collaborative community effort manifested in two forms: ‘community mingas’ organised autonomously by communities, and ‘megamingas’ coordinated by public institutions. Community mingas enhance residents’ sense of belonging and pride, empowering them in shaping public spaces through a bottom-up approach. In contrast, megamingas exhibit top-down organisation with limited community engagement, raising concerns about social impacts. The study underscores mingas’ potential for social cohesion, cultural expression, and sustainable development in urban design. It emphasises the nuanced understanding needed for fostering active participation and addresses challenges such as sustaining community ownership. Despite yielding immediate benefits in public space enhancement, sustaining long-term engagement is crucial. The study concludes that mingas offer a valuable avenue for residents to actively contribute to public space improvement, fostering shared responsibility and long-term sustainable development in low-income neighbourhoods.

Improving the communication of multifactorial cancer risk assessment results for different audiences: a co-design process.

Multifactorial cancer risk prediction tools, such as CanRisk, are increasingly being incorporated into routine healthcare. Understanding risk information and communicating risk is challenging and healthcare professionals rely substantially on the outputs of risk prediction tools to communicate results. This work aimed to produce a new CanRisk report so users can directly access key information and communicate risk estimates effectively. Over a 13-month period, we led an 8-step co-design process with patients, the public, and healthcare professionals. Steps comprised 1) think aloud testing of the original CanRisk report; 2) structured feedback on the original report; 3) literature review; 4) development of a new report prototype; 5) first round of structured feedback; 6) updating the new report prototype; 7) second round of structured feedback; and 8) finalising and publishing the new CanRisk report. We received 56 sets of feedback from 34 stakeholders. Overall, the original CanRisk report was not suitable for patients and the public. Building on the feedback, the new report has an overview of the information presented: section one summarises key information for individuals; sections two and three present information for healthcare professionals in different settings. New features also include explanatory text, definitions, graphs, keys and tables to support the interpretation of the information. This co-design experience shows the value of collaboration for the successful communication of complex health information. As a result, the new CanRisk report has the potential to better support shared decision-making processes about cancer risk management across clinical settings.

Developing an AI Tool to Derive Social Determinants of Health for Primary Care Patients: Qualitative Findings From a Codesign Workshop.

Information about social determinants of health (SDOH) is essential for primary care clinicians in the delivery of equitable, comprehensive care, as well as for program planning and resource allocation. SDOH are rarely captured consistently in clinical settings, however. Artificial intelligence (AI) could potentially fill these data gaps, but it needs to be designed collaboratively and thoughtfully. We report on a codesign process with primary care clinicians to understand how an AI tool could be developed, implemented, and used in practice. We conducted semistructured, 50-minute workshops with a large urban family health team in Toronto, Ontario, Canada asking their feedback on a proposed AI-based tool used to derive patient SDOH from electronic health record data. An inductive thematic analysis was used to describe participants' perspectives regarding the implementation and use of the proposed tool. Fifteen participants contributed across 4 workshops. Most patient SDOH information was not available or was difficult to find in their electronic health record. Discussions focused on 3 areas related to the implementation and use of an AI tool to derive social data: people, process, and technology. Participants recommended starting with 1 or 2 social determinants (income and housing were suggested as priorities) and emphasized the need for adequate resources, staff, and training materials. They noted many challenges, including how to discuss the use of AI with patients and how to confirm their social needs identified by the AI tool. Our codesign experience provides guidance from end users on the appropriate and meaningful design and implementation of an AI-based tool for social data in primary care.

Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study

BackgroundDischarge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication.MethodsThe study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16–24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies.ResultsTwo discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12–24 h of discharge.ConclusionsThe interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.

“We are all just humans participating”: the role of an embodied approach, virtual space and artistic media in shaping participants’ experience in a co–design process

ABSTRACT Integrating multiple perspectives is key to successful co-design, yet often hampered by communication gaps arising from different epistemological backgrounds and lived experiences. This challenge is amplified when the design problem centres around experiences that are difficult articulate in words, such as those in Parkinson’s disease (PD). To explore alternative strategies for communication between diverse PD stakeholders, Piece of Mind brought together neuroscientists, performing artists and individuals with lived experience to co-create an interdisciplinary performance grounded in scientific and experiential knowledge. Participants met on Zoom over nine months, in which creative, embodied approaches were used to share scientific concepts, facilitate discussion, and identify key issues for the performance. We built on emergent themes through virtual and in-studio collaborations, culminating in a 45-min filmed and live performance. We conducted semi-structured interviews with a subset of participants regarding their co-design experience and take-aways, to identify elements of process, space and materials contributing to its success. We found that an embodied approach, in virtual space and incorporating multiple artistic media, enabled participants to leave their comfort zones and disciplinary boundaries to engage with one another through curiosity and generosity – and consider how these conditions facilitated disparate starting points to converge towards a common goal.

Co-designing positive behaviour support (PBS+PLUS) training resources: a qualitative study of people with ABI, close-others, and clinicians' experiences.

Background Challenging behaviours are often a significant difficulty faced following acquired brain injury (ABI), for which PBS+PLUS (a Positive Behaviour Support framework) is an effective intervention. Clinicians report experiencing a range of barriers to supporting behaviour change for individuals with ABI and require tailored resources to support the implementation of PBS+PLUS. This study aimed to describe the process of co-designing a PBS+PLUS intervention guidebook and podcast series together with individuals with ABI, close-others, and clinicians, and qualitatively examine co-design experiences. Methods The Knowledge-To-Action Framework was followed to support the translation of PBS+PLUS into clinical practice. Participants with ABI (n = 4), close-others (n = 7), and clinicians (n = 3) participated in focus groups contributing to the development of a PBS+PLUS intervention guidebook and podcast series. Following completion of the groups, qualitative interviews were conducted to understand participants' perspectives of the co-design experience. Transcripts were analysed using reflexive thematic analysis. Results Co-design processes are described, and participants provided practical suggestions for co-design and the dissemination of developed resources. Two core themes encapsulating four sub-themes were identified. Firstly, 'Esteeming Experiences ' described the person-driven approach of co-design whereby participants felt supported and connected with other contributors and facilitators through sharing their perspectives. Secondly, 'Empowerment ' reflected participants' increased confidence and skills in applying PBS+PLUS. Conclusions Overall, participants endorsed the therapeutic benefits of co-design engagement and high utility of PBS+PLUS resources. This study adds to the growing literature supporting the use of co-design methodology within clinical implementation, and is inclusive of individuals with ABI, close-others, and clinicians.

Experiences of participants in the co-design of a community-based health service for people with high healthcare service use

BackgroundIncorporating perspectives of health consumers, healthcare workers, policy makers and stakeholders through co-design is essential to design services that are fit for purpose. However, the experiences of co-design participants are poorly understood. The aim of this study is to explore the experiences and perceptions of people involved in the co-design of a new service for people with high healthcare service utilisation.MethodsA methodology informed by the principles of grounded theory was used in this qualitative study to evaluate the experiences and perceptions of co-design participants. Participants were healthcare professionals, health managers and leaders and health consumers involved in the co-design of the new service in Tasmania, Australia. Semi-structured interviews were conducted, and data were iteratively and concurrently collected and analysed using constant comparative analysis. Audio/audio-visual recordings of interviews were transcribed verbatim. Transcripts, memos, and an audit trail were coded for experiences and perspectives of participants.ResultsThere were thirteen participants (5 health professionals, 6 health managers and leaders, and 2 health consumers). Codes were collapsed into six sub-themes and six themes. Themes were bureaucracy hinders co-design, importance of consumers and diversity, importance of a common purpose, relationships are integral, participants expectations inform their co-design experience and learning from co-design.ConclusionMost participants reported positive aspects such as having a common purpose, valuing relationships, and having a personal motivation for participating in co-design. However, there were factors which hindered the adaptation of co-design principles and the co-design process. Our research highlights that bureaucracy can hinder co-design, that including people with lived experience is essential and the need to consider various types of diversity when assembling co-design teams. Future co-design projects could use these findings to improve the co-design experience for participants, and ultimately the outcome for communities.

Creating Stronger Design Systems for Collaboration: Skills, Resources, and Practices Needed to Support an Effective Co-Design Experience

This paper describes a design case that addressed a healthcare training need for clinicians and administrators about Value-Based Care (VBC) through the design, development, implementation, and evaluation of seven massive open online courses (MOOCs). The context was an industry-academic partnership that linked subject matter experts in VBC with university faculty and designers. Courses were developed using a co-design approach to provide multiple perspectives on the issues involved, ensure the accuracy of the content, and enhance the alignment between the design and stakeholders’ needs. The team worked collaboratively to define the opportunity, brainstorm ideas, prototype solutions, evaluate prototypes based on identified needs, and ultimately design online educational experiences for a wide variety of learners in different healthcare contexts. This paper shares lessons learned about creating stronger design systems for collaboration in the areas of selecting and supporting co-design teams, fostering collaborative learning environments, and modeling collaboration in the instructional design process. Reflections about this design case underscored the importance of forming relationships among team members, which was a key outcome of the co-design structure and, facilitated the communication and psychological safety needed to support the iterative cycles of feedback during course development.

Agile manifesto of non-formal education for older adults - a co-design experience

ABSTRACT In educational gerontology, non-formal education emerges as a possibility for lifelong learning because it is more flexible and less bureaucratic than formal education. In this context, agile culture offers a potential strategy to enhance non-formal education. While there are four manifestos for agile culture in education, their application in later life is lacking in the literature. The objective is to discuss the agile culture in education and present the concept of the agile manifesto for non-formal education in later life. A co-design process was conducted to develop this manifesto, in which specialists in education, educational gerontology and agile culture, as well as an older person, participated in an active and collaborative way. The manifesto, which has four values and 18 principles, will serve as a guide for educators who intend to develop educational activities based on agile culture, for older adults, in the non-formal instance. It is proposed that the agile culture of non-formal education for older adults is fundamentally about collaboration, democracy, independence and autonomy, considering the needs of everyday life, as well as the multidimensionality and heterogeneity of those involved.

Gigamaps as enabling tools for envisioning futures

Entrepreneurial ecosystems have gained attention for fostering innovation and sustainable transition. However, their complexity poses challenges, especially when different companies co-design for future making toward sustainable transition strategies implementation. Systemic Design (SD) offers potential solutions, employing system mapping tools like Gigamaps, that use visual synthesis to support effectively the participatory processes.
 This article aims to present a formalized protocol for the use of Gigamaps as a co-design tool to trigger dialogues among industrial stakeholders, facilitating entrepreneurial ecosystem transition.
 Through a case study from the master’s degree SD course at Politecnico di Torino, the article will present a Gigamaps-driven co-design experience in an entrepreneurial ecosystem.
 Finally, the study limitation and the need for systems-thinking and complex science-based methods to support the implementation of those envisioned scenarios are stated.

Co-Designing an Accessible Gym: Inviting ‘Others’ to the Public

This study aimed to explore the experience of co-designing an accessible gym at Seoul National University. A team of six members engaged in three workshop sessions to create a more accessible environment for people with diverse disabilities. Three themes emerged from the qualitative analysis of the co-design experience. The study’s results highlighted the need to co-create products and environments with people with lived experience to ensure accessibility inclusive of people with various physical conditions. Also, the co-design process was found to help the design team members with disabilities perceive themselves as capable of exerting power over their environment.

Modeling Mass Customization Level in Apparel and Textile Design Field

Mass customization is a new approach to manufacturing and providing services that is revolutionizing business and mainly in textile and apparel field.
 How can we model the mass customization level? In this study we will present a review of the mass customization concept in textile and apparel field, and some key success factors such as modular product design.
 It presents also a framework, aiming to develop the mass customization for textile and apparel industries, by reviewing and modeling the mass customization strategy by assessing the mass production level and the co-design experience level and by presenting some scales to classify the mass customization level.

Youth experiences of co-designing a well-being intervention: reflections, learnings and recommendations

ABSTRACT Co-design and youth participatory action research are promising methodologies for increasing youth engagement in well-being interventions. The current study included 10 recent high school graduates employed as youth advisors to co-design a youth-friendly positive psychology intervention targeting the post-school transition. The youth advisors received foundational training in positive psychology, psychological needs theory and emerging adulthood. They held regular meetings to develop a Positive Transitions programme (PTP) text messaging intervention, informed by discussion of key themes, issues and relevant practical tips. This paper aims to examine the co-design process from the perspective of the youth advisors. Each youth advisor completed a survey, and six of the advisors also participated in a focus group exploring their co-design experiences. Youth advisors noted a range of personal benefits from the co-design experience including learning, enjoyment, teamwork, achievement, and pride. Areas for improvement included clarity of the project scope and the provision of support and feedback. Insights from this process are discussed, with the aim of guiding future work seeking to design youth-friendly well-being interventions.

Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience.

Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. The aims of this study are to describe the co-design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co-develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery-Oriented Practice Questionnaire (CROP-Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP-Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co-design experience; and (iv) creating the resource. Co-design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP-Q in teaching and practice is needed.

Children, young people and parent engagement in health intervention design and implementation: A scoping review.

Engaging children and young people (CYP) with and without their parents in health research has the potential to improve the development and implementation of health interventions. However, to our knowledge, the scope of engagement activities used with this population and barriers to their engagement is unknown. The objective of this review was to identify and describe CYP engagement with and without their parents in the development and/or implementation of health interventions. This scoping review included any primary research studies reporting on engaging CYP, with or without parents, in the design and/or implementation of health interventions. Healthcare professionals had to be involved over the course of the study and the study had to take place in either community, primary or tertiary care settings. The following databases were searched in May 2017, May 2020 and June 2021: Medline (OVID), CINAHL (EBSCO) and Embase (Elsevier). Two independent reviewers screened titles, abstracts and full-text articles and used a previously piloted extraction form to extract and summarize information from the included articles. Twenty-eight articles discussing twenty-four studies were included. CYP engagement throughout the research cycle was limited. There were no observed differences in the reported presence of engagement, types of interventions or outcomes of engagement between studies engaging CYP or CYP and parents. Studies engaging CYP and parents contained limited information on how these relationships affected outcomes of engagement. Engagement was enabled primarily by the maintenance of resources and relationships among stakeholders. Although CYP engagement often influenced health intervention and implementation design, they are inconsistently engaged across the research cycle. It is unclear whether parental involvement enhances CYP engagement. Future research should consider reporting guidelines to clarify the level of CYP and/or parent engagement, and enhance CYP engagement by fostering synergistic and sustainable partnerships with key stakeholders. A parent partner with codesign experience contributed to the creation of the research questions, screened titles, abstracts and full texts, helped with data extraction and provided feedback on the manuscript.

“This group… I felt like I was medicating myself from this cyberscam illness that was living with me.” A qualitative evaluation of co-designing cybersafety training resources with and for people with acquired brain injury

Purpose Whilst anyone can be scammed, individuals with acquired brain injury (ABI) may have unique risk factors to cyberscams for which tailored interventions are required. To address this, a co-design approach was utilised to develop cybersafety resources with people with living experience of ABI and scams. This study aimed to evaluate the co-design experience to inform future utilisation of co-design methods. Method Semi-structured qualitative interviews explored perceived benefits and challenges, level of support and the co-design process for people with ABI (n= 7) and an attendant care worker (ACW) (n= 1). Transcripts were analysed using a six-stage reflexive thematic analysis. Results Five themes were identified: “An Intervention Addressing Shame”; “Feeling Validated and Valued”; “Experiencing a ‘Profound Change Amongst a Group of Peers’”; ‘Gaining Stronger Scam Awareness’; and ‘Taking Ownership’. Adjustments to support communication, memory impairments and fatigue in the co-design process were recommended. Conclusions Participant reflections on the co-design process extended beyond resource design and highlighted therapeutic benefits of increased insight and emotional recovery from shame. Likely mechanisms underpinning these benefits were the peer group format and opportunities to make meaningful contributions. Despite identified challenges in facilitating co-design projects, the practical and emotional benefits reported by participants underscore the value of co-design with people with ABI. Implications for rehabilitation Individuals with acquired brain injury (ABI) may be at increased risk of cyberscams due to cognitive impairments, for which tailored cyberscam interventions are required. Using a co-design approach maximises the relevance of training resources for individuals with ABI. Using a collaborative co-design approach to developing cybersafety training resources may facilitate scam awareness and peer support. Support for communication, memory impairments and fatigue may be necessary in co-design efforts with people with ABI.

Co-creation of a massive open online course: An exploration of the motives and motive fulfillment of a faculty member and student co-instructors

We present a case study of a “by learners, for learners” approach to the co-design of a massive open online course (MOOC), on climate change. To learn about the motivations of a faculty member and students who participated in this process, we collected data through focus groups, interviews, and questionnaires. Three main motivations emerged: (1) The faculty member and student co-instructors sought to create accessible and practical resources to help individuals take action on climate change and (2) believed creating a MOOC was critical to career advancement. (3) The faculty member also hoped to involve students to improve their knowledge and skills, while creating a learner-centered MOOC on an ambitious timeline. Participants reported that the majority of their motivations were fulfilled and were generally satisfied with the resulting MOOC and overall co-design experience. This study offers new insights into the motivations that drive instructors to create MOOCs as well as into adopting the “student as partners” model for MOOC co-design.

Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development.

BackgroundThe proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development.ObjectiveDespite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems.MethodsTapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development.ResultsThe contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact.ConclusionsSystem designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.

Augmented Reality Mobile Application Co-Design Experience: Delineating the Nuances from the Lens of a System Developer

With the rapid development of educational tools, co-design has been on the rise. Co-design is instrumental in successful product development as it merges two key perspectives, namely consumers’ insights and professionals’ knowledge. The roles of users, designers, and developers are now blurred as educators have begun to construct their own tools for teaching based on problems and ideas conceived in their classrooms, thereby assuming roles as designers and to some extent, as developers. A more common practice in recent days is educators’ co-designing of tools with system developers to achieve their targeted goal. This study attempted to explore the process of co-designing an augmented reality (AR) mobile application and the role of a system developer in mediating the design process with non-designers, namely academic members of the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. This study further aimed to delineate the nuances of the AR mobile application co-design experience from the perspective of the system developer. Semi-structured interviews, observations, and document analyses were conducted to examine the detailed process of co-designing and developing the AR application as well as to understand the developer’s interaction with the consumers. The main findings of this study suggest that the waterfall model of the Software Development Life Cycle was in use during the co-design process. This cycle generally involves five stages, namely (i) planning, (ii) analysis, (iii) design, (iv) implementation, and (v) maintenance, which are iterative in nature. The designer’s role in mediating the co-design process encompassed balancing their knowledge and experience with the needs of consumers that do not necessarily match the designer’s expectations. This was achieved through (i) precise communication, (ii) commitment to the delivery and quality of the AR mobile application, as well as to building cohesive working relationships, and (iii) motivation to work with co-designers during the development process. The findings shed light on the value of co-design and the complex role of designers in mediating the design process with non-designers, which when accounted for, can lead to more feasible project development.

Co-Design with Older Adults: Examining and Reflecting on Collaboration with Aging Communities

Co-design methods have involved older adults in the design process to fill the knowledge gap that younger adult designers might encounter when designing for an aging population. A focus of co-design means establishing equal and equitable relationships between users and designers. To understand the factors that contribute to equal collaborations between older adults and student designers, we conducted 12 co-design sessions with 16 older adults and 11 student designers. We examined their interactions by adapting a framework initially aimed to understand the child-adult design partnership. We also analyzed student designers' reflections to understand their experiences and learnings from designing with older adults. Our findings demonstrate that developing a design partnership is complex. The framework helped surface factors like sharing life experiences and role ownership that influenced balanced or unbalanced interactions. Through the student designers' reflections, we found that student designers identified challenges they encountered and the assumptions they had about the older adult population. We believe that immersing students in a co-design experience with older adults and leveraging reflection activities provides an educational and meaningful experience to the design students.