Co-design Process Research Articles

Circles of port sustainability: A novel method combining global comparability and local relatability in performance assessment

Ports are increasingly ‘greening’ operations to protect their ‘license to operate’ by integrating social-environmental considerations into their management and reporting on their sustainability performance. In this research, we develop a novel method for port sustainability performance (PSP) assessment that combines science-based knowledge with place-based contextualisation. Specifically, we address a recognised challenge of combining global (‘top-down’) techno-scientifically oriented indicators with place-based locally relatable (‘bottom-up’) contexts in sustainability performance, in addition to addressing limitations encountered in empirical verification. First, a critical evaluation of the international literature on port sustainability assessments is undertaken to distil commonalities in global performance indicators, and to identify typical frames used in the design of sustainability performance indices. We apply this learning, together with place-based experiential knowledge, to develop a science-based framework for a Port Sustainability Performance (PSP) Index that is explicitly aligned with the Sustainability Development Goals (SDGs). We then apply a co-design process to demonstrate local customisation of the index to derive place-based quantifiable measures and targets. Further, for easy-to-use empirical verification, a simple spreadsheet is applied to develop a flexible weighted scoring matrix. The matrix uses place-based rating systems for selected measures and associated targets, and aggregates allocated scores into informative outputs. Finally, the concept of Circles of Sustainability is adapted for ports to visually display sustainability performance, in alignment with related SDGs. This research contributes to bridging the science-practice divide in reporting on port sustainability performance.

Co-design as participation: Creating meaningful pathways for collaboration in flood risk adaptation in Ohkay Owingeh Pueblo

Considering the detrimental effects caused by wildfires in New Mexico, there is a pressing need for the development of innovative hazard adaptation and mitigation strategies. Community-based approaches in hazard response have the potential to harness the power of co-design and the incorporation of traditional knowledge to help make conventional research and design process considerably less extractive. In this paper, we explore the elements of community based, bottom-up approaches that can support successful outcomes, in contrast to centralized top-down approaches. By offering a critical perspective of the idea that projects defined as bottom-up are inherently more effective than those that are top-down, we aim to amend a common participatory design framework, the double-diamond design method, and present a community-engaged framework on flood risk adaptation with the co-design of an environmental data dashboard to address this gap. This can be mitigated by employing a more human-centered design approach as a baseline, and further amending it to center community. We employed a series of workshops in Ohkay Owingeh Pueblo, in New Mexico, to integrate local knowledge. The goal of these workshops was to design an environmental data dashboard that would eventually serve as a point of information gathering and dissemination for the Pueblo. The workshops featured activities that worked to decolonize the process of co-design and put the Pueblo's needs at the center of the dashboard design process. The workshops allowed for participation in a variety of modalities – visual, verbal, auditory – giving community members space to lead and participate in many different formats.

A Modular XR Collaborative Platform for Occupational Safety and Health Training: A Case Study in Circular Logistics Facilities

Over the past few years, safety and health have become major concerns in the warehouse and logistics sectors. Each year, warehouse fatalities, injuries, and accidents cause unrecoverable losses and huge financial costs. In spite of all the advancements in methods, tools, equipment, and regulations, the number of accidents, especially fatal ones, has not subsided significantly. As a result, safety professionals and researchers have explored new and innovative ways to combat this problem. In the circular logistics facility (CLF) industry, located inside warehouses and providing human muscle-oriented services to maintain pallets, both short-term safety incidents and long-term health concerns are present. Long-term health training is rarely discussed in the literature compared to short-term safety training. This is because health issues are more complex than safety issues, since biological outcomes may take time to develop, are affected by multiple resources, and cumulative injuries may occur. This paper contributes to warehouse health and safety by designing and developing a modular XR collaborative training and testing platform (MXC-P). The co-design process is applied to design each module in the MXC-P. Three main modules related to health and safety training for CLF were considered, namely personal protection equipment, pallet handling, and pallet repairing. On this platform, a virtual interactive world provides a solid hands-on training environment and generates syntactic data for evaluating long-term health risks. On the other hand, collaborative and modular environments provide a solution to geographically distributed systems, allowing employees to connect and train remotely. The effectiveness of the MXC-P is compared with traditional safety training in a pilot study. Based on the results, we can establish that the MXC-P is effective in teaching and testing hazard identification situations, especially those relating to short-term health. The results also indicate that trainees’ recall of knowledge would improve with the MXC-P. In addition to this, the MXC-P can also be used to test and evaluate a new system and generate syntactic data for evaluating long-term health.

Healthcare compassion interventions co-design and feasibility inquiry with clinicians and healthcare leaders in Aotearoa/New Zealand

Compassion in healthcare is valued by patients, healthcare professionals (HCPs), and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding ways to intervene remains limited. The aim of this study is to clarify compassion intervention needs in a diverse HCP workforce in public secondary healthcare in Aotearoa New Zealand (NZ) by utilising a co-design process. The co-design process involved a series of workshops with clinicians followed by in-depth interviews with healthcare leaders to derive input regarding feasibility and implementation. Reflexive thematic analysis was used to analyze the data. There was a great deal of interest in compassion interventions from healthcare professionals and leaders. However, for compassion interventions to be acceptable, feasible, and effective, compassion interventions design should be reimagined and reflected at each step of interventional design and implementation and span across organizational levels. Namely, the results of the study showed the preference for non-individual focused multi-level interventions to build bridges and connections. The desired compassion intervention components included practising connecting with others' humanity, improving compassion knowledge and relational and reflective skills, and cultural safety and anti-racism training. Experiential training embedded in models of cultural dialogue was the preferred interventional modality. Prioritising leadership as an intervention site was suggested to improve leadership's buy-in of compassion interventions and possibly serve as a starting point for transforming the broader culture, reviving interconnectedness in a healthcare system described as fragmented, disconnected, and alienating with compassion also acting as an equalizer of power.

Conceptualizing community data governance for race-related, population data: a scoping review and key informant interviews

ObjectiveThere is growing recognition of the importance of community data governance to build accountability of research institutions to communities. Our organization, a steward of health and administrative population-level data, has previously implemented community governance structures for Indigenous data. This scoping initiative explores development and implementation of an additional community governance structure for race-related data. ApproachWe conducted a scoping review of peer-reviewed and grey literature to identify existing practices of community data governance. We also conducted key informant interviews with thirteen racialized community stakeholders, who addressed open-ended questions on potential co-design processes as well as governance mandates, scopes, barriers, and facilitators. ResultsThe scoping review identified eight community data governance examples. Two of these pertained to race-related data, while the remaining six pertained to other data that identified “community” geographically, by disease condition, life stage, and/or economic circumstance. Governance structures were diverse, ranging from one-time crowd-design of a data-sharing agreement to quarterly meetings of a governing board to review project-level data requests. Key informant interviews provided four themes to guide implementation in the context of our organization: exploring organizational readiness, considering who should be involved, defining the scope and mandate, and drafting an approach and process. ConclusionWe are committed to implementing a community governance structure for race-related, population-level data. However, there are limited examples of similar structures in the existing literature. ImplicationsThe identified examples and the advice of community stakeholders will guide co-design of a preliminary structure, scope, and mandate for community governance of race-related, population-level data.

Bridging Implementation Science and Human-Centered Design: Developing Tailored Interventions for Healthier Eating in Restaurants

AbstractRestaurants are important institutions in the communities’ economy with the potential to promote healthier foods but have been under-engaged in public health nutrition efforts. In particular, independently owned, minority-serving and minority-owned restaurants, remain under-represented in nutrition promotion efforts despite disproportionate burdens of diet-related health outcomes among minority populations. Addressing this gap in engagement, we undertook a process of co-designing and implementing healthy eating-focused interventions in two Latin American restaurants in New York City, combining the Behavior Change Wheel intervention development framework with a Human-Centered Design approach. Restaurant owners and chefs were involved in the research synthesis and solution development processes, resulting in two tailored interventions. This paper describes this co-development process and offers reflections and lessons regarding: (1) implementation research in community settings, (2) the application of Human-Centered Design to promote the uptake of community-based interventions on food and health equity, and (3) the combined use of Human-Centered Design and Implementation science in these complex community settings.

Development of Modified Ride-On-Cars for Children with Mobility Impairments

Introduction: The ability to move independently is an integral part of a child's development. Children with motor impairments often experience significant challenges with moving independently, resulting in expensive powered wheelchairs being purchased or having caregivers push them in strollers or wheelchairs. The purpose of this research is to adapt motorized ride-on-cars to enable children with motor impairments to explore their environment independently. Engineers, physiotherapists, and occupational therapists co-designed customized ride-on-cars with 10 children and their caregivers to support each child’s individual needs. Methods: Physiotherapists and occupational therapists led an initial diagnostic session to assess each child’s clinical needs. The engineers then brainstormed and implemented solutions. On the final day of testing, physiotherapists and occupational therapists conducted one further clinical assessment and made final changes. This process was repeated for 10 children ages 1-3 years old who had been identified as having mobility impairment. Results: The final cars were designed to minimize cost, weight, and size while prioritizing each child’s ability to operate the car independently and safely. The main modifications included replacing the original gas pedal with an assistive switch and constructing a support frame to ensure the child’s safety. Additional modifications such as adding a steering T-bar, adding LED lights, and varying the switch location were also implemented for specific children. Each modified car was tested to ensure client safety and car durability. Client feedback was positive, and caregivers expressed how their modified car will increase mobility for their child. Conclusions: The results from this iterative co-design process emphasize the importance of team assessment and implementation when creating assistive devices. It shows that modifying standard off-the-shelf toys to the specific needs of children with disabilities can be successful and improve their quality of life.

Co-designing a Whole-school Solution Focused Programme With Students, Staff, and Parents and Carers to Improve Communication and Wellbeing

Schools are witnessing rapid increases in child mental wellbeing problems and demand cannot be met by specialist mental health services. School staff are not currently trained in approaches to support wellbeing, however upskilling staff in solution focused approaches offers a promising approach to improve communication and wellbeing. Whole-school approaches are recommended and programmes developed through co-design can promote greater acceptance and buy-in from staff and students. Aim: To co-design a whole-school solution focused programme with students, staff, parents and carers at a large, all-through school in England. Methods: the programme was developed using primarily qualitative methods informed by the human-centred design approach. Staff interviews (n=10), student focus groups (n=3), and extensive engagement work over a two-year period explored stakeholder needs. Subsequently, student and staff co-design workshops (n=4) aimed to develop the programme structure, content, and implementation strategy. Results: 101 participants contributed to the co-design process (65 staff; 21 students; 15 parents). Priorities included supporting staff to effectively manage behaviour and improving student-staff communication and overall school climate. A multi-component programme based on solution focused principles was developed, including whole-school activities, plus individual student work. A study testing the prototype is warranted.

Housing customization: envisioning an interface to support co-design processes

PurposeThere are several studies showing that end-users' participation in the architectural design process of houses is critical to their satisfaction (e.g. Önder et al., 2010; Ammar et al., 2013). Housing that is not adjusted to inhabitants' needs leads to modification works (Davidson et al., 2007) that could be avoided if their design was defined from the beginning with their participation. Digital technologies, such as 3D interactive visualization, benefit co-design processes by helping non-specialists better understand space and design possibilities (Salter et al., 2009; Schroth et al., 2006). However, the available literature shows that existing co-design digital tools were not developed based on potential users’ requirements. This paper aims to define the user requirements of a co-design tool for housing customization.Design/methodology/approachInterviews were conducted to gather information on how participatory processes occur in housing cooperatives and identify how potential users can collaborate in the design definition of their houses using a digital tool.FindingsThe interviews were analyzed, and requirements were defined.Originality/valueThis work contributes to the advancement of knowledge since the tool is defined based on requirements collected from potential end-users. By using a user-centered approach, the tool can contribute to more effective and informed collaboration.

Co-designing a digital family-led intervention for delirium prevention and management in adult critically ill patients: An application of the double diamond design process

BackgroundCo-designing healthcare interventions is gaining recognition as a novel and collaborative method. Co-design involves end-users from the start, ensuring that an intervention best meets their needs. Despite its potential benefits, this approach is not yet widely used in developing clinical interventions within intensive care units where the perspectives of patients, family members, and clinicians are crucial. ObjectiveTo describe the application, benefits and challenges of the Double Diamond model to co-design a digital family-led voice reorientation intervention for delirium prevention and management in critically ill adult patients. MethodsThe co-design process was guided by the Double Diamond model over a period of 12 months. Development involved patients, family members, and nursing and medical staff as co-designers and decision-makers in the iterative development of the intervention. Data from field notes and group meetings were audio recorded, transcribed verbatim, and content analysed at each phase, which were then presented to the co-designers for verification and refinement. FindingsCo-designers included people with lived experience of the ICU as patients (n = 5) and family members (n = 1) and clinical experts (nursing staff n = 3; medical staff n = 3). Co-designers were highly engaged and reported positive experiences and collaboration in the co-design process. Sharing the diversity of their own personal ICU experiences was found to be beneficial as it not only validated individual feelings but also strengthened intervention development. Differences in interpretations and meanings of the voice messages proposed as part of the intervention were challenging. Maintaining sufficient focus on each phase of the Double Diamond was difficult due to the complexity of the context in which the intervention was being co-designed and the resulting challenges of maintaining the engagement of the co-designers throughout the process. ConclusionsThere were benefits and challenges of engaging people with lived experience in an intensive care unit as co-designers through the Double Diamond design process to develop a digital family-led intervention for delirium prevention and management. Overall, applying the Double Diamond to co-design a clinical intervention is recommended, whereby the collaboration process benefits patients, family members, and clinical staff. Registration numberACTRN12622001568707; ANZCTR — Registration.

170 Collective creativity; promoting physical activity. Outlining a Co-design process for the development of Digital Physical Activity promotion initiatives for Autistic Adults

Abstract Purpose Autistic students at higher education institutions in Ireland have reported feelings of isolation, depression, and disengagement, all of which contribute to health disparities in this population. It is critical to address these issues, given the recent significant increase in the number of Autistic youths enrolling in higher education. To inform the development of acceptable and effective physical activity promotion programmes, we utilized a co-design process with the aim of co-creating a digital health intervention to promote physical activity among Autistic university students. Methods A co-design process [Design Thinking] was utilized for the development of the intervention. First, to empathize with participants, semi-structured interviews were held with Autistic adults. Interviews were recorded, transcribed verbatim, and analysed via reflexive thematic analysis. Actionable intervention targets were defined, and potential solutions ideated. The findings from the interviews informed the exploration and refinement of intervention ideas during co-design workshops. Workshops featured a multidisciplinary development team, including Autistic adults and experts in technology, physical activity promotion, and digital health. Results Three central themes were developed during analysis of the interview data: (1) “Psychological Factors” describing participants’ experiences and needs relating to routines, motivation, and self-consciousness/anxiety; (2), “E-Health Ideas and Needs” encapsulated the participants’ preferences and suggestions for digital health intervention components; and (3) “Supportive Spaces” encompassing the participants’ preferences relating to physical and social environments for physical activity. Individual interviews findings informed the ideation of digital health solutions for refinement in co-design workshops; these included interventions focusing on enhancing e-communication about physical activity opportunities on campus, the use of AI Chatbots for physical activity promotion; and the use of online social support groups. Conclusions Findings suggest Autistic adults face a variety of interrelated barriers to physical activity. The co-design process enabled the collective design of digital health interventions with the potential to overcome these barriers and support Autistic students to enjoy and more active, engaged University experience. Support/Funding Source Erasmus+ Sport grant

Codesign of a Quality Improvement Tool for Adults With Prolonged Critical Illness: A Modified Delphi Consensus Study.

Increasing numbers of patients experience a prolonged stay in intensive care. Yet existing quality improvement (QI) tools used to improve safety and standardize care are not designed for their specific needs. This may result in missed opportunities for care and contribute to worse outcomes. Following an experience-based codesign process, our objective was to build consensus on the most important actionable processes of care for inclusion in a QI tool for adults with prolonged critical illness. Items were identified from a previous systematic review and interviews with former patients, their care partners, and clinicians. Two rounds of an online modified Delphi survey were undertaken, and participants were asked to rate each item from 1 to 9 in terms of importance for effective care; where 1-3 was not important, 4-6 was important but not critical, and 7-9 was critically important for inclusion in the QI tool. A final consensus meeting was then moderated by an independent facilitator to further discuss and prioritize items. Carried out in the United Kingdom. Former patients who experienced a stay of over 7 days in intensive care, their family members and ICU staff. None. We recruited 116 participants: 63 healthcare professionals (54%), 45 patients (39%), and eight relatives (7%), to Delphi round 1, and retained 91 (78%) in round 2. Of the 39 items initially identified, 32 were voted "critically important" for inclusion in the QI tool by more than 70% of Delphi participants. These were prioritized further in a consensus meeting with 15 ICU clinicians, four former patients and one family member, and the final QI tool contains 25 items, including promoting patient and family involvement in decisions, providing continuity of care, and structured ventilator weaning and rehabilitation. Using experience-based codesign and rigorous consensus-building methods we identified important content for a QI tool for adults with prolonged critical illness. Work is underway to understand tool acceptability and optimum implementation strategies.

Mapping causal networks from theories of change in sustainability projects: a software co-design process

Mapping causal networks from theories of change in sustainability projects: a software co-design process

Exploring the Effects of User-Agent and User-Designer Similarity in Virtual Human Design to Promote Mental Health Intentions for College Students

Virtual humans (i.e., embodied conversational agents) have the potential to support college students’ mental health, particularly in Science, Technology, Engineering, and Mathematics (STEM) fields where students are at a heightened risk of mental disorders such as anxiety and depression. A comprehensive understanding of students, considering their cultural characteristics, experiences, and expectations, is crucial for creating timely and effective virtual human interventions. To this end, we conducted a user study with 481 computer science students from a major university in North America, exploring how they co-designed virtual humans to support mental health conversations for students similar to them . Our findings suggest that computer science students who engage in co-design processes of virtual humans tend to create agents that closely resemble them demographically–agent-designer demographic similarity. Key factors influencing virtual human design included age, gender, ethnicity, and the matching between appearance and voice. We also observed that the demographic characteristics of virtual human designers, especially ethnicity and gender, tend to be associated with those of the virtual humans they designed. Finally, we provide insights concerning the impact of user-designer demographic similarity in virtual humans’ effectiveness in promoting mental health conversations when designers’ characteristics are shared explicitly or implicitly. Understanding how virtual humans’ characteristics serve users’ experiences in mental wellness conversations and the similarity-attraction effects between agents, users, and designers may help tailor virtual humans’ design to enhance their acceptance and increase their counseling effectiveness.

Qualitative evaluation of a package of implementation strategies codesigned to support the introduction of multiple micronutrient supplementation (MMS) for pregnant women in Bamako, Mali.

Mali national policy recommends that women take iron and folic acid supplements (IFA) from the time of the first antenatal care (ANC) visit, throughout pregnancyand during the first 3 months after delivery. In 2020, the World Health Organization (WHO) updated their ANC guidelines to recommend the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation of multiple micronutrient supplements (MMS) in the context of rigorous research, including implementation research. In Bamako, Mali, a codesign process was used to tailor antenatal care MMS packaging and counselling materials aimed at optimizing delivery and uptake of and adherence to MMS. This paper presents the codesign process along with the results of a post-intervention qualitative assessment to evaluate the behaviour change intervention. At the conclusion of the intervention, we conducted semistructured qualitative interviews with 24 women who had received the intervention and six pharmacy managers from the six health centres participating in the study. We conducted two focus groups with midwives who had delivered the intervention and two group discussions with family members of women who had received the intervention. Respondent perspectives reveal an easy experience transitioning from previously used IFA. Women and providers concur that the intervention counselling materials and visual aids were instrumental in influencing the perceived benefit and uptake of MMS. Family members play an influential role in pregnant women's decision-making regarding MMS uptake. MMSand the associated implementation strategies developed through the codesign process were found to be a highly acceptable intervention.

CoDesign of a digital intervention for parents with bipolar disorder informed by integrated knowledge translation principles.

To provide detailed information on the codesign of a digital intervention to support parents with bipolar disorder (BD) who have young children. Each step of this process is reported, as well as a detailed description of the final version of the intervention in line with the TIDieR framework. Clinical experience and lived experience experts participated in online workshops, meetings, and remote feedback requests, informed by Integrated Knowledge Translation (IKT) principles. The IKT research group responded to each phase of recommendations from the knowledge users. Five clinical experience experts and six lived experience experts engaged with the codesign process. Their recommendations for principles, content, look, and feel, and functionality of the digital intervention were structured over five iterative phases. This led to a final implemented design that was identified by the clinical and lived experience experts (referred to together as the knowledge users group) as genuinely reflecting their input. The IKT principles offer an accessible structure for engaging with clinical and lived experience experts throughout a codesign process, in this case for a digital intervention for parents with BD. The resulting intervention is described in detail for transparency to aid further evaluation and development and to help other teams planning codesign approaches to intervention development.

Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack.

Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors' research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual's condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use.

Utilising co-design to develop a lived experience informed personal safety tool within a mental health community rehabilitation setting.

Mental health personal safety tools aim to promote a recovery focus and empower an individualised approach to consumer care. These clinical tools are predominantly utilised in acute mental health settings with a person during or straight after a crisis. There is currently a gap in the literature regarding the preparation of personal safety tools in non-acute mental health settings. This descriptive article discusses the learnings and outcomes from a co-designed project that aimed to develop a personal safety tool suitable for a community mental health rehabilitation setting. Seven people with lived experience engaging within a mental health community-based rehabilitation service were recruited through convenience sampling to participate in the co-design project. A focus group approach was utilised during four group meetings to develop a personal safety tool template. Experiences and ideas about safety planning were transcribed during meetings and thematic analysis extracted key themes. Five steps underpinned the co-design process that included identifying the need, establishing the co-design group, planning, design and development, and review and closure. Consumer involvement commenced at step two of the co-design process. The completed personal safety tool was designed with consumer input and review. The personal safety tool consisted of nine intervention components. Four key themes emerged from focus group meetings that informed the content of the tool: (i) ensuring the personal safety tool is individualised and meaningful, (ii) promoting exploration of personal strengths and interests, (iii) enabling opportunities to learn self-management skills, and (iv) treating the personal safety tool as a dynamic and adaptable tool. Findings suggest that a personal safety tool targeted to a mental health community-based rehabilitation setting should have an individualised and preventative focus to mental health care. Embedding co-design principles can support opportunities for meaningful consumer engagement and establishing consumer and clinician partnerships.

The All Together Group: Co-Designing a Toolkit of Approaches and Resources for End-of-Life Care Planning With People With Intellectual Disabilities in Social Care Settings.

Support staff within social care settings have expressed a need for resources to facilitate end-of-life care planning with people with intellectual disabilities. This study aimed to co-design a preliminary toolkit of end-of-life care planning approaches and resources that can be implemented in adult social care services for people with intellectual disabilities. An adapted Experience-Based Co-Design process was applied to develop a toolkit for end-of-life care planning with people with intellectual disabilities. A co-design group (the 'All Together Group') met six times from January to October 2023. The group comprised nine people with intellectual disabilities (including four researchers with intellectual disabilities, who also co-facilitated the workshops), five family members, five intellectual disability support staff, two intellectual disability service managers,and five healthcare professionals. The All Together Group tested resources for and approaches to end-of-life care planning with people with intellectual disabilities, based on findings from a scoping review and a focus group study. Easy-read end-of-life care planning forms were deemed overwhelming and complicated, whilst visual and creative approaches were welcomed. Three new visual resources to support illness planning and funeral planning with people with intellectual disabilities were developed: (i) 'When I'm ill' thinking cards; (ii) 'Let's Talk About Funerals' conversation-starter pictures; and (iii) 'My funeral' planning cards. These three resources, alongside three positively evaluated existing resources, were included in a new toolkit for end-of-life care planning with people with intellectual disabilities. Through an iterative, flexible, inclusive,and comprehensive co-design process, a toolkit of three newly developed and three existing resources was created to facilitate support staff in doing end-of-life care planning with people with intellectual disabilities. Following a trialling process with support staff, the final toolkit was made freely available online. The research team included four researchers with intellectual disabilities (A.C., D.J., L.J., and R.K.-B). Researchers with intellectual disability have been part of every step of the research process; from study design to data collection and analysis to dissemination of study findings.Intellectual disability service provider representatives (M.W., N.P., and S.S.) were part of the co-design group as well. Two of these representatives were also co-applicants in the overall project (N.P. and S.S.). The co-design group included people with intellectual disabilities, families, intellectual disability support staffand health and social care professionals. The study was supported by a Research Advisory Group comprising a variety of stakeholders, including people with intellectual disabilities families, intellectual disability researchers, representatives from intellectual disability organisations,and policymakers.

Safety-netting strategies for primary and emergency care: a codesign study with patients, carers and clinicians in Sweden

ObjectivesTo codesign safety-netting strategies for primary and emergency care settings by integrating the experiences and ideas of patients, carers and clinicians.DesignA codesign process involving two focus group discussions, eight individual...