Co-design Project Research Articles

Co-design practice in higher education: practice theory insights into collaborative curriculum development

ABSTRACT Higher education curricula require regular renewal. Varied expertise is needed to meet the multi-faceted challenges of curriculum development, hence the importance of collaborative approaches. Co-design is one approach to curriculum making as a relational practice, with evidence showing it can improve pedagogical quality and stakeholder involvement via a collaborative ethos that breaks through constraints of individual imagination and assumptions. The actual doing of co-design in higher education remains largely undocumented, limiting our understanding of this crucial feature of contemporary pedagogical innovation and development. This paper combines the theory of practice architectures with practitioner inquiry to explore three co-design projects within a large curriculum transformation initiative at an Australian university. Each involved a course coordinator, educational developer and learning designer working with tutors, students, industry representatives and media producers. Analysis focuses on how co-design team members connected their own actions to those of others, and how they collectively accomplished things that could not have been achieved alone. Identifying these highlights co-design as a process of learning, coming to practise differently, shaped by the site at which it unfolds, but also reshaping this wider context. This analysis sheds new conceptual light on the black box of co-design as enacted in higher education.

Championing student participation in co-designing digital education resources: A student experience

The aim of this contemporary piece is to discuss the student experience of co-design and the process involved in the co-creation of developing digital educational resources. A discussion of the need for digital educational resources in the era of pre-registration nursing students being digital natives is explored and the potential benefits or barriers for nursing education and practice are outlined. The need for co-design as a methodology in nurse education which is inclusive of the student-led role is discussed and a personal account of student experience will be detailed. By focusing on the student voice this article aims to provide a first-hand experience of working alongside academic and educational research teams, whilst also promoting student participation within co-design projects further than simply tokenistic involvement, highlighting the comprehensive benefits associated for all. The importance of support, knowledge sharing, and effective communication will be detailed to allow other students to gain insight and empower them to participate in a co-designed project should it arise in their university education.

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.

Co-Design of a Digital Health Tool for Use by Individuals With Opioid Use Disorder: App4Independence (A4i-O).

Opioid use disorder (OUD) has arguably the highest mortality rate of mental health conditions; opiate-related deaths are identified as the number one cause of accidental deaths in Canada and the United States. Specialized care for OUD is often described as lacking, fractured, and with frequent periods of disengagement. Digital health strategies may support connection to evidence-based resources even during periods of disengagement. However, sustained engagement in digital interventions remains a barrier, and as such, experts recommend using co-design approaches to develop interventions. The current study outlines the results from a qualitative co-design project that engaged 6 lived experts and 8 clinical experts in a series of focus groups and interviews to adapt an existing intervention for use in OUD. Focus groups and interviews were recorded and transcribed before undergoing thematic analysis. This co-design process is the first stage of a larger project that will lead to the development of a novel digital health intervention for OUD populations. Transcripts underwent thematic analysis, and themes were divided into Crosscutting Themes, Feasibility and Engagement, and Specific Features. Each theme was divided into specific subthemes, which were reviewed by the design team and informed the design of the digital health platform. Key resulting directions included creating a psychologically safe digital space, curating resources for OUD as a multifaceted condition, and being mindful of barriers to implementation from both lived and clinical expert perspectives. Specific features are discussed in detail in the article. Lived experts and clinicians strongly supported integrating digital tools into OUD care. Ongoing work is needed to better understand the role of technology in existing OUD structures as well as the implementation of key features such as digital peer support and creating effective and safe social connections. This study also validates co-design as an essential step in digital health development.

Recovery and Renewal of Co-Design Approaches in Health: Protocol for a Realist Synthesis.

The COVID-19 pandemic significantly transformed the landscape of work and collaboration, impacting design research methodologies and techniques. Co-design approaches have been both negatively and positively affected by the pandemic, prompting a need to investigate and understand the extent of these impacts, changes, and adaptations, specifically in the health sector. Despite the challenges that the pandemic imposed on conducting co-design and related projects, it also encouraged a re-evaluation of co-design practices, leading to innovative solutions and techniques. Designers and researchers have explored alternative ways to engage stakeholders and end users, leveraging digital workshops and participatory digital platforms. These adaptations have the potential to enhance inclusivity, allowing for a wider range of individuals to contribute their perspectives and insights through co-design and thus contribute to healthcare change. This study aims to explore the impacts of the pandemic on co-design and related practices, focusing on co-design practices in healthcare that have been gained, adapted, or enhanced, with a specific focus on issues of equity, diversity, and inclusion. The study uses a realist synthesis methodology to identify and analyze the effects of the pandemic on co-design approaches in health, drawing on a range of sources including first-person experiences, gray literature, and academic literature. A community of practice in co-design in health will be engaged to support this process. By examining the experiences and insights of professionals, practitioners, and communities who were actively involved in co-design and have navigated the challenges and opportunities of the pandemic, we can gain a deeper understanding of the strategies, tools, and techniques that have facilitated effective co-design during the pandemic, contributing to building resilience and capacity in co-design in health beyond the pandemic. By involving community partners, community of practice (research), and design practitioners, we expect closer proximity to practice with capacity building occurring through the realist process, thus enabling rapid adoption and refinement of new techniques or insights that emerge. Ultimately, this research will contribute to the advancement of co-design methodologies and inform the future of co-design in health. DERR1-10.2196/58318.

Development and Evaluation of a Framework for Authentic Online Co-Design: Partnership-Focussed Principles-Driven Online Co-Design.

Co-design in health research involves patient and public involvement and engagement (PPIE) in intervention or service design. Traditionally, co-design is undertaken in-person; however, exploring online delivery is warranted. PPIE in co-design must be considered carefully, and assumptions that in-person approaches will transition automatically to an online environment should be avoided. Currently, there are a lack of evidence-informed approaches to facilitating co-design online. This study aimed to develop and evaluate a framework for authentically adapting health research co-design into an online environment. The initial framework was developed through a literature review, synthesis of in-person co-design principles, and alignment of online strategies. The framework was then applied to a co-design project with 10 participants across relevant PPIE groups (end-users [n = 4], clinicians [n = 2], coaches [n = 2] and clinician-researchers [n = 2]). Participants' experiences of the online co-design process were evaluated via a mixed-methods design using surveys and semi-structured interviews. Evaluation data were analysed using descriptive statistics and reflexive thematic analysis to inform a revised framework. The developed framework, Partnership-focussed Principles-driven Online co-Design (P-POD) was used to design eight 90 min online co-design workshops. Evaluation data involved 46 survey responses, and eight participants were interviewed on project completion. Survey data indicated that the process was satisfying, engaging and adhered to the P-POD framework. Themes derived from interview data describe a respectful and collaborative online culture, valuing of diverse perspectives and space for healthy debate, how power was perceived as being shared but not equal and multiple definitions of success within and beyond the process. A final, refined P-POD framework is presented. With evaluation of the initial P-POD framework showing evidence of adherence to co-design principles, positive participant experiences and goal achievement for both the project and the participants, the refined P-POD framework may be used and evaluated within future intervention or service design. This study involved the participants (end-users, clinicians and service providers) in the co-design process described, interpretation of the results through member-checking interview responses, assisting in development of the final framework and as co-authors for this manuscript.

Sharing knowledge without borders: Collaboration between U.S. business and law students and Spanish translation students

Collaboration between technical and professional (TP) writers in English as a second language is important for successful communication. This is evident in legal documents in both English and Spanish, where accuracy and clarity are paramount. However, achieving this is challenging because law students often lack effective writing tools, and translation students may lack the required encyclopedic knowledge. The present paper describes a co-designed exchange project between U.S. students in business and law and students of legal translation at a university in Spain. This paper aims to determine potential improvements in students’ encyclopedic and conceptual knowledge of this specialized language and their translation performance after the collaboration intervention. To evaluate these aspects, three textual items were targeted: terminological, nominal and, what we call, substitutional density. Our results indicate that peer collaboration helped Spanish students acquire encyclopedic knowledge in the field and avoid repetitive terms in their translations, leading to greater textual cohesion through the use of general language, synonyms and hypernyms. Other aspects of this peer collaboration as well as follow-up approaches to consolidate the observed effects are needed.

Becoming a co-designer: the change in participants’ perceived self-efficacy during a co-design process

ABSTRACT Perceived self-efficacy is an integral part of a capability set that allows participants to transform design capabilities into the functioning of doing design. However, existing research investigating the change in participants’ perceived self-efficacy during a co-design process is inadequate. Therefore, this paper aims to demonstrate the changeability of participants’ perceived self-efficacy and its changing trajectory in a co-design process. The findings are extracted from a remote co-design project with older people, employing generative toolkits and culture probes, to address loneliness in later life. It has been discovered that the participants who successfully completed the co-design process experienced an increase in their perceived self-efficacy, following a U-shaped model. Furthermore, the depth of the U-shaped curve is contingent on how well the co-design process is designed to align with participants’ embodied knowledge and skills. The findings of this paper address the inadequate discussion of the change in participants’ perceived self-efficacy in co-design methodological literature. The introduced U-shaped model can equip co-design researchers and practitioners with the ability to anticipate and prepare for potential situations arising from changes in participants’ perceived self-efficacy during co-design processes.

Pedagogical framework for cultivating children's data agency and creative abilities in the age of AI

The integration of artificial intelligence (AI) topics into K–12 school curricula is a relatively new but crucial challenge faced by education systems worldwide. Attempts to address this challenge are hindered by a serious lack of curriculum materials and tools to aid teachers in teaching AI. This article introduces the theoretical foundations and design principles for implementing co-design projects in AI education, empirically tested in 12 Finnish classrooms. The article describes a project where 4th- and 7th-graders (N = 213) explored the basics of AI by creating their own AI-driven applications. Additionally, a framework for distributed scaffolding is presented, aiming to foster children's agency, understanding, creativity, and ethical awareness in the age of AI.

Qualitative Exploration of Speech Pathologists' Experiences and Priorities for Aphasia Service Design: Initial Stage of an Experience-Based Co-Design Project to Improve Aphasia Services.

Stroke survivors with aphasia (impaired language/communication) have poor outcomes and gaps in the clinical implementation of best practice contribute to this. Little is known, however, about speech pathologist perspectives on the touchpoints (key moments shaping experiences) in the clinical care pathway that have the greatest impact on service delivery nor how this varies by geographical location. We explored the experiences of speech pathologists who provide aphasia services to establish priorities for improvement and design. This is the initial experience gathering and priority identification stage of an experience-based co-design (EBCD) project. Speech pathologists were recruited from 21 geographically diverse Hospital and Health Services in Queensland, Australia. Speech pathologists working in acute, rehabilitation and community services shared positive and negative experiences of delivering aphasia care in interviews and focus groups. Experiential data were analysed using qualitative thematic analysis to determine touchpoints. Priorities for service design were identified using an adapted nominal group technique. Speech pathologists (n = 62) participated in 16 focus groups and nine interviews and shared 132 experiences of delivering aphasia care. Providing care in teams with poor awareness of the impacts of aphasia was identified as a key challenge, as poor patient-provider communication was perceived to increase risk of adverse outcomes for patients. Speech pathologists identified areas for improvement related to their own professional needs (e.g., greater access to clinical supervision); collaborative health care (e.g., better coordination and interdisciplinary care to increase therapy time); and the service context and environment (e.g., psychological services able to support diverse communication needs). Speech pathologist delivery of aphasia services could be improved through increased access to clinical supervision, opportunities for peer debriefing and interdisciplinary care. Priorities for service design varied by geographical location and included: education to support care transitions (remote areas), improved referral pathways and service linkage (regional areas) and dedicated aphasia staffing (metropolitan areas). A consumer advisory committee comprising people with aphasia (n = 3, authors K.M., K.D. and B.A.), their significant others (n = 2, authors J.D. and P.M.), and a Cultural Capability Officer (author G.B.) guided this research. The team: (1) reviewed participant information; (2) co-designed surveys and workshop resources; (3) copresented research outcomes and contributed to publications. Research questions and study design (e.g., analysis methods and assessment measures) were developed by the research team (authors L.A., V.J.P., D.A.C. and S.J.W.).

P.016 Re-norming medical education: centering patient experience and diverse bodies in Lumbar Puncture (LP) instruction

Background: Medical curricula are often created with limited patient and student input and underrepresent certain body types. Traditional medical education often prepares learners to perform procedures, such as lumbar punctures (LPs), on a young white able-bodied 70kg male. When approaching diverse patients, this educational gap can lead to medical learners’ lack of confidence, skill, and knowledge, resulting in poor patient experiences. Methods: This co-design project involves patient and student input. We interviewed five patients who underwent LPs and explored their experience through a trauma-informed approach. To visualize landmarking across body types, we recruited nine volunteers of diverse body sizes, ages, tattoos, and skin colour (Fitzpatrick Scale). Incorporating patient narratives, as well as videos and photographs showing landmarking on diverse bodies, we crafted an online LP instructional module. Focus groups of 6-10 students will be held to collect student perception of the effectiveness of the module. Results: Our learning module and related media will be built into Western University’s Undergraduate Medical Education curriculum, available under a Creative Commons license through the Western Health Education Media Library. Conclusions: Integrating patient experience and student feedback, we are developing a comprehensive educational tool to better equip medical learners to deliver patient-centered LPs across diverse body types.

Understanding experiences, unmet needs and priorities related to post-stroke aphasia care: stage one of an experience-based co-design project

ObjectivePeople with post-stroke aphasia (language/communication impairment) and their supporters report mixed satisfaction with stroke and aphasia care. To date, however, their journey of care and the key service interactions that...

StudyWell: a co-design project for enhancing student mental health and wellbeing through service design and relational welfare

AbstractStudents mental health is declining. StudyWell is a project aiming at positive impact on student mental health in student cities in Norway; by integrating relational welfare with service design, and the study environment as a starting point. We discussfour implementation challenges: First, co-design depends on a shared mindset across disciplinary boundaries. Secondly, balancing the lenses of individuals, community, system and future require facilitation. Thirdly, societal impact requires continuous partner anchoring. Finally, approaches must not further pathologize university student.

Promising directions for human-robot interactions defined by older adults.

Introduction: Older adults are engaging more and more with voice-based agent and social robot technologies, and roboticists are increasingly designing interactions for these systems with older adults in mind. Older adults are often not included in these design processes, yet there are many opportunities for older adults to collaborate with design teams to design future robot interactions and help guide directions for robot development. Methods: Through a year-long co-design project, we collaborated with 28 older adults to understand the key focus areas that older adults see promise in for older adult-robot interaction in their everyday lives and how they would like these interactions to be designed. This paper describes and explores the robot-interaction guidelines and future directions identified by older adults, specifically investigating the change and trajectory of these guidelines through the course of the co-design process from the initial interview to the design guideline generation session to the final interview. Results were analyzed through an adapted ethnographic decision tree modeling approach to understand older adults' decision making surrounding the various focus areas and guidelines for social robots. Results: Overall, over the course of the co-design process between the beginning and end, older adults developed a better understanding of the robot that translated to them being more certain of their attitudes of how they would like a robot to engage with them in their lives. Older adults were more accepting of transactional functions such as reminders and scheduling and less open to functions that would involve sharing sensitive information and tracking and/or monitoring of them, expressing concerns around surveillance. There was some promise in robot interactions for connecting with others, body signal monitoring, and emotional wellness, though older adults brought up concerns around autonomy, privacy, and naturalness of the interaction with a robot that need to be further explored. Discussion: This work provides guidance for future interaction development for robots that are being designed to interact with older adults and highlights areas that need to be further investigated with older adults to understand how best to design for user concerns.

Designing for Communities with Communities: A Public Library Codesign Project

ABSTRACT Codesigning public library spaces is often limited to consulting with end-users rather than giving them a role as actual co-designers. This article advocates for more genuine codesign of public library spaces and critically examines the prevalent challenges in achieving true codesign in public library developments. The article introduces a two-year Australian Research Council Linkage research project, ‘Designing for Communities with Communities’. The project aims to provide public library staff with a set of codesign tools they can adapt for their own particular projects. Using comparative case studies, the project will also identify the challenges of integrating codesign into the development of public library spaces, and key factors in the effectiveness of projects that seek their communities’ inputs and engagement. This article introduces the theory of participatory and codesign, and sets out the basic conceptual framework for the project. It also reports on its initial stages, including preliminary interviews with key protagonists and preliminary user surveys about existing spaces. Moreover, the article discusses the design of the case studies’ community workshops, where most of the actual codesigning will take place, with an extensive discussion and analysis of the activities that could be included in these workshops.

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.

An exploration of the experiences and self-generated strategies used when navigating everyday life with Long Covid

BackgroundAround one in ten people who contract Covid-19 report ongoing symptoms or ‘Long Covid’. Without any known interventions to cure the condition, forms of self-management are routinely prescribed by healthcare professionals and described by people with the condition. However, there is limited research exploring what strategies are used to navigate everyday life with Long Covid, and experiences that initiate development of these strategies. Our study aimed to explore the range and influence of self-generated strategies used by people with Long Covid to navigate everyday life within the context of their own condition.MethodsForming part of the Long Covid Personalised Self-managemenT support co-design and EvaluatioN (LISTEN) project, we conducted a qualitative study using narrative interviews with adults who were not hospitalised with Covid-19. Participants aged over 18 years, who self-identified with Long Covid, were recruited from England and Wales. Data were analysed with patient contributors using a reflexive thematic analysis.ResultsEighteen participants (mean age = 44 years, SD = 13 years) took part in interviews held between December 2021 and February 2022. Themes were constructed which depicted 1) the landscape behind the Long Covid experience and 2) the everyday experience of participants’ Long Covid. The everyday experience comprised a combination of physical, emotional, and social factors, forming three sub-themes: centrality of physical symptoms, navigating ‘experts’ and the ‘true colour’ of personal communities, and a rollercoaster of psychological ambiguity). The third theme, personal strategies to manage everyday life was constructed from participants’ unique presentations and self-generated solutions to manage everyday life. This comprised five sub-themes: seeking reassurance and knowledge, developing greater self-awareness through monitoring, trial and error of ‘safe’ ideas, building in pleasure and comfort, and prioritising ‘me’.ConclusionsAmong this sample of adults with Long Covid, their experiences highlighted the unpredictable nature of the condition but also the use of creative and wide ranging self-generated strategies. The results offer people with Long Covid, and healthcare professionals supporting them, an overview of the collective evidence relating to individuals' self-management which can enable ways to live ‘better’ and regain some sense of identity whilst facing the impact of a debilitating, episodic condition.Trial registrationLISTEN ISRCTN36407216.

Co-designing a personalised care plan for patients with rectal cancer: reflections and practical learnings

BackgroundConsumer involvement is considered an essential component of contemporary cancer research, with a movement towards participatory methods, to the benefit of consumers and researchers. Overall, in-depth research on participant experiences and perceptions of their co-designer role—and how these may (or may not) change during a co-design project—is limited. The purpose of this paper was to synthesise the reflective accounts of consumers, project staff, and a researcher who partnered on a project to develop a personalised care plan template, with the aim of generating guidance for others looking to partner with consumers in health and medical research. Here, our team of researchers, project staff, and consumers reflect on the experience of working together using Gibbs’ Reflective Cycle, which was completed by team members with responses then undergoing inductive data analysis.ResultsReflections are categorised under three core themes: (1) setting up the group and building relationships (2) measuring the value of consumer involvement, and (3) potential challenges for consumer involvement. Through reflection on our experiences of co-design, our team developed and identified practical strategies that contributed to the success of our partnership. These include setting expectations as a group; having experienced consumers on the team; having regular, pre-scheduled meetings that run to time; and working to overcome challenges identified by the group such as power imbalances, time commitment, and lack of diversity.ConclusionThese practical reflections on creating a safe and supportive environment in which genuine consumer involvement can take place could inform other institutions and researchers looking to work meaningfully with consumers in research.

Development of a Cancer Pathway Support Guide for Patients and Carers: A Codesign Project

Background. Cancer diagnosis is a complex and multifaceted process that can be stressful and anxiety-provoking for patients. Evidence-based tools and information aids that can be used for guiding and supporting patients during cancer investigations and after diagnosis are limited. This paper presents a user-centred codesign project that aims to develop a cancer pathway support tool for patients, carers, and healthcare professionals. Method. A mixed-method codesign approach was used including prototype development (January–March 2022), three online codesign workshops (April–June 2022), one-to-one feedback, and beta testing informed by the standardised Theoretical Framework of Acceptability (TFA) questionnaire (July–October 2022). Nine individuals with lived experience of cancer contributed to the project and are referred to as codesigners. Results. The codesigners valued the potential importance of a tool that can be used by the patients and carers if they want specific information about cancer investigations, diagnosis, and treatment. The ability to select what they need as opposed to long leaflets and generating their own questions for the healthcare providers were highlighted as important aspects of improving patient care. The tool was collectively designed to provide clear definitions of the cancer care pathway and easily accessible links from trusted resources and includes practical information to minimise the burden that can be experienced from preparation for appointments and tests. Beta testing results with a small sample of potential users including patients, carers, and healthcare providers (n = 23) showed high acceptability of the guide (range = 7–35, mean = 28.52, and standard deviation = 3.88) based on the TFA questionnaire. Conclusion. A cancer pathway support tool called “Your Cancer Pathway Support Guide (YCPSG)” was developed as a result of an iterative codesign process aiming to improve patient experience and outcomes for people referred on a suspected cancer pathway or who have been diagnosed with cancer. The tool provides information and support in both digital and PDF formats. Further studies are needed to evaluate the potential impact of “Your Cancer Pathway Support Guide” on patient outcomes and experience and the wider system.

Empowering Ontario’s long-term care residents to shape the place they call home: a codesign protocol

BackgroundCanada’s long-term care (LTC) homes were founded on an institutional model that viewed residents as passive recipients of care. Many homes continue to follow this model leaving residents removed from...