Co-design Process Research Articles

Sustainability requires the integration of farmer knowledge, scientific advancements, and comprehensive innovation.

This viewpoint paper emphasises the need to diversify food production methods to simultaneously combat hunger and reduce environmental problems. The recommendations of the UN Food System Summit 2021 relate primarily to (i) the conservation of natural ecosystems, (ii) the sustainable management of existing agricultural land while increasing productivity and (iii) the restoration of already degraded land. Europe in particular faces unique challenges, such as reducing pollution and promoting organic farming up to 25 percent of the agricultural land area while maintaining food production. Ongoing efforts aim to create a transparent, fair and multi-level regulatory framework to support the Green Deal. The implementation of the Corporate Sustainability Reporting Directive (CSRD), which will sooner or later affect a larger proportion of European farmers, should support the transition. Science and innovation play a central role in this, as they are the cornerstones on which sustainable food systems are built. It is imperative that farmers actively participate in the co-design processes and utilise their wealth of experience and creativity to drive these innovations forward. A crucial aspect of the transition to sustainability is changing consumption patterns to limit food waste and reduce meat consumption. While this transition is essential, it is not without its formidable challenges. Diversification of agriculture, encompassing a spectrum of established techniques, is touted as a promising approach to achieving sustainability without sacrificing productivity. Furthermore, integrating truly sustainable agricultural practices with cutting-edge innovations, including new genomic techniques, has the potential to be a transformative solution.

Optimising co-design processes in telemedicine innovation-developing a telemedical solution for emergency medical services.

Stakeholder engagement plays a vital role in driving advancements in product development. This imperative now extends to the healthcare domain, driven by the scarcity of healthcare professionals and the pressing demand for effective solutions. Through the application of design thinking and co-design methodologies, this study endeavours to promote comprehensive stakeholder involvement, creating streamlined processes and adaptable templates geared towards fostering innovative solutions for tele-emergency medicine. In this study design thinking and co-design methods are developed, adapted, and tested, to create effective tools and demonstrate their application. This is part of a process involving stakeholders and lead users to develop a telemedicine solution for emergency medical services. This research is descriptive in kind, offering a transparent and holistic portrayal of the co-design process. The rural region of Burgenland in Austria was chosen for this study, with the challenges of its weak infrastructure offering valuable insights. The tools were tested in co-design workshops, with the participants continuously observed by the research team. Seventeen healthcare professionals, emergency medical technicians and academics participated in a co-design process to develop a telemedicine solution for emergency medical services. The results section presents practical co-creative healthcare innovation tools and templates that have been shown to facilitate the co-design process. The study developed and applied co-design elements for the creation of a prototype concept for telemedicine in emergency medicine and offers valuable insights for similar projects involving diverse stakeholders. It shows that structured co-design activities help all stakeholders to jointly create solutions that meet the overall needs.

Promoting health literacy of older post-discharge patients in general practice - Creation of the GP-MATE communication tool through co-design

ObjectiveWork with older patients and their carers to co-design a tool that improves patient - general practice communication and continuity of care following discharge of an older person from hospital. MethodsExperience Based Co-Design with three teams of six to seven lay people (older patients and their carers), each supported by a corresponding general practice group. The process included an implementation-focused event with participants using the intervention in a live role-play. ResultsCo-design generated a patient-held tool (GP-MATE) that focuses on four areas of post-discharge care: carers/caring; continuity; medication safety and information power. Access to general practice for patients/carers post-discharge was considered to be vital to improving communication. Discussion and conclusionThe co-design process enabled patients and carers to be involved through all stages of intervention development, ensuring relevance and alignment. Practice implicationsThe intervention is uniquely suited to general practice, comprehensive yet brief enough to be usable within a 20-minute consultation. While the domains of GP-MATE compare well with existing care transitions literature, it will be important to assess impact on already busy practice schedules and impact on care.

Determining the Acceptability of Targeted Apps for High-Risk Alcohol Consumption in Nurses: A Qualitative Study

Aim To determine the acceptability of targeted apps and provide recommendations for the implementation of and app addressing high risk alcohol use to nurses. Design A qualitative descriptive study design, using the Behavioural Change Wheel implementation framework. Methods Semi-structured interviews with 42 Australian nurses were subject to structural coding using the Capability, Opportunity, and Motivation (COM-B) model linked to the Behaviour Change Wheel. Qualitative data has been reported using the COREQ framework. Results Most participants agreed that targeted apps would appeal to nurses, provided specific design considerations were included. These considerations related to privacy and confidentiality, strategies to target the app to nurses across wide age and experience ranges and identified the need for a considered campaign to both launch the app and position it with existing interventions for high-risk alcohol use. Conclusions Our findings indicate that a targeted app to reduce high-risk alcohol consumption could be acceptable to nurses, however the needs to include specific components suitable for nurses. We recommend further research into specific components of a targeted app, leading to a co-design process where nurses can determine app components and function. Summary of relevance High-risk alcohol consumption has been shown to be an issue amongst nurses. Targeted apps have been shown to have an effect in addressing high-risk alcohol consumption among specific groups. However, consideration for privacy of data provided to the app must be considered, especially given the link between disciplinary action, loss of role identity, and nurse suicide. This paper indicates that nurses would accept a targeted app, subject to specific design considerations, particularly related to confidentiality.

Co-designing an interprofessional digital education resource on delirium: a student-led approach

BackgroundInterprofessional education is crucial for healthcare students to develop collaborative skills and provide effective patient care. However, opportunities for interprofessional learning are often limited in healthcare curricula. The present study aimed to engage students from different health professions in co-designing an educational resource on delirium recognition and management through an interprofessional lens and explore their experiences of this process.MethodsTwo co-design workshops were conducted with students from medicine, nursing, pharmacy, and occupational therapy programmes at two universities across the island of Ireland. Focus groups were held following these workshops to explore students’ experiences of the co-design process. The workshops involved a range of activities, including theme generation, scenario development, resource creation (podcasts, simulations), and focus group discussions. Data from focus groups were analysed thematically.ResultsA total of 19 students participated across the two workshops. Three themes were identified: (1) Relationship development, where students identified the benefits of co-creating the resource and valued the flexibility, collaboration, and social aspects of the co-design approach; (2) Interprofessional collaboration, which challenged students’ assumptions about other disciplines, fostered teamwork and communication, and highlighted the need for early and continuous interprofessional learning; (3) Professional growth, with students reporting increased confidence in managing delirium, working with other professions, and engaging in novel experiences like podcasting and simulation.ConclusionsThe co-design process facilitated interprofessional collaboration, peer learning, and personal growth among healthcare students. Students appreciated the opportunity to co-create an educational resource while developing interprofessional skills. The study demonstrates the potential of co-design as a methodology for enhancing interprofessional education and promoting effective teamwork in healthcare.

Enhancing Offender Rehabilitation Through Co-Designed Controlled-Environment Agriculture in an Australian Maximum Security Prison

This research explores the application of controlled-environment agriculture (CEA) in an Australian maximum security prison, aiming to enhance inmate health and wellbeing through improved diet. The implementation of a medium-scale greenhouse demonstrates how CEA can effectively increase the availability of fresh produce in prison settings. By engaging inmates and correctional staff in a co-design process, the project not only promotes better nutrition but also fosters community involvement and empowerment among the participants. This inclusive approach facilitates the development of innovative and practical solutions, transforming the prison environment and encouraging rehabilitation through active participation and skills development.

Development and evaluation of an online education module to improve clinician knowledge and management of eating disorders in the peripartum: a pre-post survey study

ObjectiveEating disorders (EDs) comprise a range of illnesses characterised by disordered eating, distressing thoughts, and changes in weight. EDs in the perinatal period are a growing concern. Maternity staff receive little training in this area and often report feeling ill-equipped to recognise or respond to presentations of ED during this time. The study aimed to develop and evaluate an online educational module for clinicians and support workers to improve knowledge of EDs in the perinatal period.MethodEducation modules were developed using a co-design process with consumer advocates, peer support workers, clinicians, and experts. Consumer perspectives, evidence-based videos, activities, and text relating to screening, management, monitoring and referral of perinatal individuals with EDs were included in the module. Quantitative and qualitative data from pre- and post- surveys were used to evaluate changes in knowledge and confidence before and after completing the module, and to assess staff satisfaction, usability, and obtain feedback for improvement.ResultsUse of the online education module significantly increased staff knowledge of EDs in the perinatal period. Participants also felt more confident in discussing the topic with patients, screening, supporting, and referring a person with ED in the perinatal period. Participants also reported the module was engaging and easy-to-use.ConclusionsFindings indicate that the ED online education module is an engaging and easy-to-use tool for improving the knowledge and skills of the healthcare workforce, thereby improving patient care and health outcomes. The development of additional online resources for clinicians would be beneficial for increasing staff capability and improving patient services.

Unified Effort: Developing a Mixed Reality Serious Game for Collaborative Crisis Management Training

Abstract: Crises and disasters include both predictable and unpredictable events. In a turbulent world that has recently experienced a pandemic and wars, and is increasingly affected by climate change, there is a growing need to develop effective public crisis management capabilities. Emergency preparedness is a critical foundation for crisis management. Training and exercises are essential components of preparedness and are becoming increasingly relevant for a wide range of organisations in society. To achieve a unified response to threatening events, a wide range of actors - with different backgrounds, objectives, competencies and organisational frameworks - must overcome the challenges of working together. To address this complex situation, forums for knowledge sharing and learning are required. Serious games in mixed reality can be used as a platform for collaborative training and serve as such a forum. Mixed reality systems connect virtual and physical reality, providing users with a sense of immersion, engagement and interaction in both environments. The aim of this paper is to design a short, serious game for collaboration training with two command levels in a mixed reality. Theories of crisis management, along with related research on serious games design, create the framework for the game. The game content was further developed in a co-design process with selected professionals. This paper describes the development of the “Unified Effort” game. The serious game is designed for basic training of municipalities and county offices in soft skills such as communication, situational awareness and group decision making. The game is not intended to replace hard skills such as procedural training and field drills, but can be used as a supplement to this type of training.

ParaVerse: co-design of a parachute rehearsal and training virtual-reality enhanced simulator for the Australian Defence Force: combining a generative co-design framework and an agile approach to development

While co-design methods are crucial for developing digital educational interventions that are user-centred, contextually relevant, inclusive, and effective in meeting the diverse needs of learners and educators, little attention has been paid to the potential value of co-design processes for digital application development in the Defence context. This research gauged the efficacy of combining a generative co-design framework making use of agile and iterative co-design principles in an applied research and development project. The project produced an immersive virtual reality based digital solution in collaboration with the Australian Defence Force Special Operations Command (SOCOMD) Army. Specifically, the ParaVerse project sought to develop a solution considering the advanced Tactics, Techniques and Procedures (TTPs) relevant to special operations soldiers for advanced parachute training. A Defence advisory group consisting of a series of subject matter experts was formulated to consult with the research and development team over the course of the co-design process. End-user testing with 35 SOCOMD personnel demonstrated the value of the ParaVerse application for SOCOMD personnel, speaking to the success of the leveraged generative co-design model. End-users rated ParaVerse as having greater capacity to influence education and training practices for SOCOMD and Defence generally in comparison to a pre-existing virtual parachute simulator. ParaVerse was also rated higher for satisfaction and useability and was associated with fewer instances of motion sickness. The Generative Co-Design Framework leveraged for this research provides one roadmap on how to integrate end-users in innovation design, particularly for projects working across the nexus of Defence and academia.

Cultural adaptations of the WHO iSupport for dementia: A scoping review.

The World Health Organisation (WHO) has developed iSupport for Dementia, a self-paced online training programme for caregivers of people with dementia which is adaptable to different cultural contexts. This scoping review aims to understand the iSupport adaptation process in different countries and provide recommendations for future adaptations. A systematic search was done in electronic databases such as Pubmed, MEDLINE, APA PsycINFO, and EMBASE to obtain relevant publications up to 18 February 2024. Only full-text publications describing iSupport cultural adaptation process were included. The publications obtained were reviewed using the Cultural Adaptation Process framework. Thirteen publications from ten studies were eligible for inclusion. Based on the Cultural Adaptation Process framework, the steps undertaken in the studies were grouped into: (i) setting the stage, (ii) initial adaptation, and (iii) adaptation iterations. The three significant players in this process are the intervention developer (researchers), the cultural adaptation specialist (researchers, caregivers, and dementia care professionals), and the target community (caregivers). In the publications reviewed, cultural adaptation was mostly undertaken using a co-design process between researchers, caregivers, and dementia care professionals deciding on necessary modifications. iSupport for Dementia is a versatile programme to support caregivers and is readily available for adaptation to different cultural settings. It is essential to engage caregivers early in co-designing its cultural adaptations to ensure their needs can be met by this online tool.

Feasibility, Fidelity and Acceptability of a Person-Centred Care Transition Support Intervention for Stroke Survivors: A Non-Randomised Controlled Study.

Care transitions from hospital to home are a critical period for patients and their families, especially after a stroke. The aim of this study was to assess the feasibility, fidelity and acceptability of a co-designed care transition support for stroke survivors. A non-randomised controlled feasibility study recruiting patients who had had stroke and who were to be discharged home and referred to a neurorehabilitation team in primary healthcare was conducted. Data on the feasibility of recruitment and fidelity of the intervention were collected continuously during the study with screening lists and checklists. Data on the perceived quality of care transition were collected at 1-week post-discharge with the Care Transition Measure. Data on participant characteristics, disease-related data and outcomes were collected at baseline (hospitalisation), 1 week and 3 months post-discharge. Data on the acceptability of the intervention from the perspective of healthcare professionals were collected at 3 months using the Normalisation Measure Development Questionnaire. Altogether, 49 stroke survivors were included in the study: 28 in the intervention group and 21 in the control group. The recruitment and data collection of patient characteristics, disease-related data, functioning and outcomes were feasible. The fidelity of the intervention differed in relation to the different components of the co-designed care transition support. The intervention was acceptable from the perspective of healthcare professionals. Concerns were raised about the fidelity of the intervention. A positive direction of effects of the intervention on the perceived quality of the care transition was found. The study design, data collection, procedures and intervention were deemed feasible and acceptable. Modifications are needed to improve intervention fidelity by supporting healthcare professionals to apply the intervention. The feasibility study showed a positive direction of effect on perceived quality with the care transition, but a large-scale trial is needed to determine its effectiveness. Stroke survivors, significant others and healthcare professionals were involved in a co-design process, including the joint development of the intervention's components, contextual factors to consider, participant needs and important outcomes to target. ClinicalTrials.gov ID: NCT0292587.

Co-designing place-based co-located health and wellbeing infrastructure and services with high school students, educators, and health service providers

This research involved working with high school students, teachers, Guidance Officers/School Counsellors, and other stakeholders, to co-design a new Community Hub to be co-located at a high school in a high-priority community. This article describes the co-design processes undertaken to engage children and young people and adult stakeholders in the ideation and design phase of infrastructure and service development to support health and wellbeing needs of a high priority community (low service uptake/high health needs). The key insights developed from these engagement processes pointed a way forward for the next stages of infrastructure and service delivery development and led to the development of several visual depictions of the complexities of stakeholder interests. This article argues that meaningful engagement of potential future users of place-based integrated health and wellbeing services enables responsive infrastructure designs that meet future needs of both target communities and service providers.

Reflections on an Evidence Review Process to Inform the Co-Design of a Toolkit for Supporting End-of-Life Care Planning With People With Intellectual Disabilities.

There is growing recognition that healthcare inequalities faced by people with intellectual disabilities extend to their experiences at the end of life, resulting in calls for more inclusive research to help address these inequities. Our study aimed to address this through the co-design of a toolkit for supporting end-of-life care planning with people with intellectual disabilities. To inform the co-design process, we undertook an evidence review to identify existing tools, resources and approaches that were already being used in practice. Our evidence review comprised three components: (i) a rapid scoping review of the academic literature, (ii) a desk-based search of the grey literature and (iii) an online survey to capture unpublished resources that were distributed to services, professionals, third-sector organisations and family members. A longlist of existing materials was appraised using an adapted version of the AGREE II instrument, resulting in a shortlist that was shared with the co-design team. The evidence review played a critical role in the co-design of a new toolkit of end-of-life care resources for people with intellectual disabilities. However, AGREE II proved to be limited for our purposes. The survey was particularly useful in helping us identify resources, tools and approaches in current use. We identified evidence review processes that served to support co-design team activities and elements that were more problematic. We argue that evidence review practices might be enhanced to better aid co-design activities in health and care research, particularly for studies involving people with intellectual disabilities. This article reflects on an evidence review that was conducted as part of The Victoria and Stuart Project. People with intellectual disabilities were deeply involved at every stage of project design, delivery and dissemination. The project employed people with intellectual disabilities as members of the core research team. People with intellectual disabilities and family carers were members of the project co-design team and the project Advisory Group. The evidence review process itself was led by academic members of the research team with contributions from colleagues with intellectual disabilities via the Advisory Group and core research team. The findings from the evidence review were used by the co-design team to inform the development of an end-of-life care planning toolkit for people with intellectual disabilities.

Co-Designing Caregiver Support Groups: Rapid Review with a Non-Profit Organization

ABSTRACT This rapid review aims to synthesize literature on co-designing support groups for caregivers of older adults, focusing on how caregivers are involved in the co-design process. This synthesis is undertaken in collaboration with the Saskatoon Council on Aging to inform the development of caregiver support groups. Guided by the Cochrane Rapid Reviews Methods Group, this review follows a streamlined evidence synthesis approach. Our search strategy was run on June 5, 2023, on the MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and PsycINFO databases. Three studies met the inclusion criteria, highlighting the importance of comprehensive initiatives and peer support. Key findings include the necessity of tailoring support groups to caregivers’ specific needs and preferences, the combination of online and offline support, and the importance of cultural sensitivity in service design. Methodological approaches to co-design varied across studies, with each emphasizing the importance of iterative feedback loops and engagement with diverse caregiver groups. The review underscores the value of co-designed support groups in effectively meeting caregivers’ needs. Engaging caregivers in the design process ensures that support groups are tailored to their requirements and empowers them to shape their support systems. The insights from this review can guide future co-design efforts, enhancing caregiver support initiatives.

From Hospital to Home: Applying a Co-design Approach to Determine Key Components of an Intervention to Support Transition-to-Home After Stroke

Abstract Background When people with stroke transition from the hospital back to their homes, they and their families frequently experience multi-faceted unmet needs and feelings of abandonment. Uncertainty surrounds the fundamental components of an intervention intended to support transition-to-home after a stroke. The aim of this study was to utilise a co-design process to identify key components for a patient-centred support intervention facilitating the transition home after stroke, and to explore what might be feasible within a real-world context. Methods The primary researcher, a larger team of researchers, and an individual with lived experience of stroke facilitated a series of three workshops for 12 people with stroke, 6 caregivers, 26 healthcare professionals, and 6 representatives from stroke organisations. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the study aim. Data collection involved making observations during workshops, summarising findings, and reaching group consensus agreement on outputs. The final output was the consequence of facilitated consensus on a prioritisation task. Individuals with lived experience of stroke contributed to study design, ethics, and co-design outputs, providing input for future research and co-facilitating workshops with the research team. Results The co-design group identified 10 key intervention components to support people with stroke and their families during the transition from hospital-to-home. These components focussed on enhancing collaboration, streamlining transition processes, and facilitating post-discharge support. While a stroke coordinator was considered a top priority, increased cross-setting information sharing and community-based healthcare staff in-reach, were considered most feasible to implement. Conclusion The co-design approach, involving a multi-stakeholder group, was strengthened by patient and public involvement. This ensured that the identified transition-to-home intervention components are meaningful and relevant for people with stroke and their families. To further refine, and feasibility test the components for generalisability within the wider Irish healthcare context, additional co-design workshops are required.

Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study.

Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient-care team relationships and providing information to enable care tailored to individual needs and values. This study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting. We recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data. In total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients' key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner-IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium. This study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting.

Grassroots learning through indigenous co-design for a Kvmemongen in Coastal Lake Budi, Chile

ABSTRACT Given calls to decolonise engagement with Indigenous communities, this article explores how allied researchers can participate in self-determined learning with Indigenous Peoples. Drawing on over a decade of experience within an action-research collective in a Mapuche context, the authors suggest that allied researchers can accompany Indigenous-led co-design in a manner that not only strengthens genuine Indigenous participation but also fosters mutual and collective learning from within the co-creative processes themselves. Lake Budi, a biocultural hotspot in the Pacific coast of Northern Patagonia, Chile, is a coastal wetland habitat for hundreds of endemic and migratory species and the ancestral homeland for the Mapuche-Lafkenche (∼15,000) who, through grassroots learning, are determining practical steps towards restoring their territory and its self-governance for kvmemongen. This Mapuche concept refers broadly to enacting forms of living well together, humans and non-humans. As allied participants in a Mapuche-led codesign collective since 2013, in this paper, we focus on exploring key “moments of mutual learning” within this longer-than-usual co-design process. Each of these moments involved collective learning that required interaction and feedback loops across diverse areas of expertise, made possible over longer and flexible rhythms and periods. Tools, protocols, and methods gradually take shape in such a process through mutual learning opportunities provided by relationship building, cultural immersion, community-led protocols, decision-making, and evaluation mechanisms. This work suggests a new understanding of the involvement of allied researchers in Indigenous-led co-design as an emerging and increasingly relevant form of grassroots mutual learning toward climate resilience.

Partnering with the woman who declines recommended maternity care: Development of a statewide guideline in Queensland, Australia.

Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal. To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care. Following a participatory co-design process involving consumer representatives, obstetricians, midwives, maternal fetal medicine specialists, neonatologists, health service executives, and legal and ethics experts, implementation of the resources was trialled in seven Queensland Health services using Improvement Science's Plan-Do-Study-Act cycles. Resources for Partnering with the woman who declines recommended maternity care have now been implemented statewide, in Queensland, including a guideline, two consumer information brochures (available in 11 languages), clinical form, flowcharts, consumer video, clinician education, and culturally capable First Nations resources. Central to these resources is an innovative shared clinical form, that is accessible online, may be initiated and carried by the woman, and where she can document her perspective as part of the clinical notes. Queensland is the first Australian jurisdiction, and perhaps internationally, to formally establish this kind of guidance in clinical practice. Such guidance is identified as an enabler of choice in the national Australian strategy Woman-centred care: Strategic directions for Australian maternity services.

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.

From Hospital to Home: Applying a Co-Design Approach to Determine the Key Components of an Intervention to Support Transition-To-Home After Stroke.

People with stroke and their families face numerous challenges as they leave hospital to return home, often experiencing multifaceted unmet needs and feelings of abandonment. The essential elements of an intervention intended to support transition-to-home after stroke are unclear. The aim of the project was to engage in a co-design process to identify the key components of a pragmatic intervention to inform a transition-to-home support pathway following stroke. The study was conducted using a co-design process engaging multiple stakeholders, including 12 people with stroke, 6 caregivers, 26 healthcare professionals and 6 individuals from stroke organisations in a series of three workshops, facilitated by the primary researcher, a wider team of researchers and an individual with lived experience of stroke. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the aim of the workshops. Data collection involved observations during workshops, followed by summarising of findings and reaching group consensus agreement on outputs. Facilitated consensus on a prioritisation task resulted in the final output. The co-design group identified 10 key intervention components of a transition-to-home support pathway following stroke. These components focussed on enhancing collaboration, streamlining transition processes and facilitating post-discharge support. While a stroke coordinator was considered a top priority, increased cross-setting information sharing and community in-reach, where community-based healthcare staff extended their services into hospital settings to provide continuity care, were considered most feasible to implement. The co-design approach, involving a multi-stakeholder group and strengthened by patient and public involvement, ensured that the identified transition-to-home intervention components are meaningful and relevant for people with stroke and their families. Further co-design workshops are required to refine, and feasibility test the components for generalisability within the wider Irish healthcare setting. Individuals who have experienced a stroke actively contributed to shaping the methodological design of this study and the ethics process. They engaged in the analysis of co-design outputs and provided input for the discussion and recommendations regarding future research. An individual who had experienced a stroke formed part of the research team, co-facilitating the co-design workshops and co-authoring this article.