Co-design Workshops Research Articles

Co-design of a behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe medicines that are no longer needed or are risky to continue in hospital.

Trials of hospital deprescribing interventions have demonstrated limited changes in practitioner behaviour. Our previous research characterised four barriers and one enabler to geriatricians and pharmacists deprescribing in hospital that require addressing by a behaviour change intervention. Six behaviour change techniques (BCTs) have also been selected by the target audience using the hospital Deprescribing Implementation Framework (hDIF). This research aimed to co-design and operationalise the content, mode of delivery and duration/intensity of the six selected BCTs to develop the CompreHensive geriAtRician-led MEdication Review (CHARMER) deprescribing intervention. We established co-design panels at three hospitals representing contextual factors likely to influence CHARMER implementation. Panels comprised geriatricians, pharmacists and other hospital staff likely to be involved in implementation. We convened two rounds of co-design workshops with each hospital to design a prototype for each BCT, which went for feedback at a final workshop attended by all three hospital panels. The six BCTs were co-designed into an intervention comprising:(1&2) Pharmacists' workshop with pros and cons of deprescribing activities, and videos of salient patient cases3 Regular geriatrician and pharmacist deprescribing briefings4 Videos of geriatricians navigating challenging deprescribing consultations5 Hospital deprescribing action plan6 Dashboard to benchmark deprescribing activitiesAutomated prompts to flag high-risk patients for deprescribing and a primary and secondary care deprescribing forum were proposed as additional BCTs by stakeholders. These were later excluded as they were not fidelitous to the theoretical determinants of geriatricians' and pharmacists' deprescribing behaviours. This study illustrates the integration of theory and co-design methodology with the target audience and staff likely to be involved in implementation of a hospital deprescribing behaviour change intervention. The development of an intervention that remains faithful to the underpinning mechanisms of action of behaviour change is a strength of this approach.

From design to action: participatory approach to capacity building needs for local overdose response plans

BackgroundIn response to the rise in opioid-related deaths, communities across Ontario have developed opioid or overdose response plans to address issues at the local level. Public Health Ontario (PHO) leads the Community Opioid / Overdose Capacity Building (COM-CAP) project, which aims to reduce overdose-related harms at the community level by working with communities to identify, develop, and evaluate capacity building supports for local needs around overdose planning. The ‘From Design to Action’ co-design workshop used a participatory design approach to engage communities in identifying the requirements for capacity building support.MethodsA participatory approach (co-design) provided opportunity for collaborative discussion around capacity building needs at the community level. The co-design workshop included three structured collaborative activities to 1) prioritize scenarios that illustrated various challenges associated with community overdose response planning, 2) prioritize the challenges within each scenario and 3) prioritize the supports to address each of these challenges. It was conducted with fifty-two participants involved in opioid/overdose-related response plans in Ontario. Participatory materials were informed by the results of a situational assessment (SA) data gathering process, including survey, interview, and focus group data. A voting system, including dot stickers and discussion notes, was applied to identify priority supports and delivery mechanisms.ResultsAt the workshop, key challenges and top-priority supports were identified, for development and implementation. The prioritized challenges were organized into five categories of capacity building supports addressing: 1) stigma & equity; 2) trust-based relationships, consensus building & on-going communication; 3) knowledge development & on-going access to information and data; 4) tailored strategies and plan adaptation to changing structures and local context; and 5) structural enablers and responsive governance.ConclusionUsing a participatory approach, the workshop provided an opportunity for sharing, generating, and mobilizing knowledge to address research-practice gaps at the community level for opioid response planning. The application of health design methods such as the ‘From Design to Action’ co-design workshop supports teams to gain a deeper understanding of needs for capacity building as well as illustrating the application of participatory approaches in identifying capacity building needs for complex public health issues such as the overdose crisis.

Unpacking the Cinderella black box of complex intervention development through the Partners at Care Transitions (PACT) programme of research.

Complex intervention development has been described as the 'Cinderella' black box in health services research. Greater transparency in the intervention development process is urgently needed to help reduce research waste. We applied a new consensus-based framework for complex intervention development to our programme of research, in which we developed an intervention to improve the safety and experience of care transitions for older people. Through this process, we aimed to reflect on the framework's utility for intervention development and identify any important gaps within it to support its continued development. The framework was a useful tool for transparent reporting of the process of complex intervention development. We identified potential 'action' gaps in the framework including 'consolidation of evidence' and 'development of principles' that could bracket and steer decision-making in the process. We consider that the level of transparency demonstrated in this report, aided through use of the framework, is essential in the quest for reducing research waste. We have involved our dedicated patient and public involvement group in all work packages of this programme of research. Specifically, they attended and contributed to co-design workshops and contributed to finalizing the intervention for the pilot evaluation. Staff also participated by attending co-design workshops, helping us to prioritize content ideas for the intervention and supporting the development of intervention components outside of the workshops.

Co-design workshops for cultural landscape planning

In the last twenty years, citizen participation has become a formal requirement in landscape and heritage planning all over Europe. The European Landscape Convention (2000), in particular, encourages public participation in defining landscape heritage values and identifying strategies for its protection, management and planning. However, despite the development of various participatory methods, citizen participation in landscape planning remains rarely applied in practice. With an empirical case study, the research presented in this article tries to bridge the gap between theory and practice, evaluating a methodology in which citizens, stakeholders, planners, and heritage experts are invited to co-design a spatial strategy for local cultural landscape valorisation.

What counts as nature in designing environmental links to health education curriculum in initial teacher education?

ABSTRACT In this paper we report on a teacher education co-design project that explored Australian pre-service primary generalist teachers’ ideations of the pedagogical links between health education and nature. As part of their coursework in a Master of Teaching degree at an Australian University, students were invited to design a Victorian Curriculum: Health and Physical Education (VC:HPE) activity that connected primary curriculum (F-6) with nature. We conducted a 3-hour suite of online learning activities and prompts using Zoom, Padlet and Moodle. The data consists of the students’ curriculum design artefacts as well as recordings of the group discussions and non-assessment-based presentations of their work. Drawing on theories of child-nature interaction, we present an analysis of the ways in which n = 72 pre-service teachers across 18 groups of 4–5 educators conceptualised links between ‘nature’ and HPE across their activity designs. Prior to the workshop, the majority of pre-service teachers had not previously considered links between the HPE learning area and nature. Through the activities of the co-design workshop, students were surprised with the variety of pedagogical possibilities that were able to be made. There was much student discussion about the possibilities and limitations of balancing safety and risk in their nature-based activity designs. We present a thematic analysis of the quality of student-nature interactions in the groups’ learning designs through: (i) exploration; (ii) embodiment; (iii) cultivation; (iv) appropriation; and (v) representation. The analysis and discussion has implications for the way quality health education is linked to nature-based learning environments, teacher education and contemporary curriculum enactment that incorporates nature and the environment as part of the learning design.

Development of a toolkit to improve interprofessional collaboration and integration in primary care using qualitative interviews and co-design workshops.

Despite numerous attempts to improve interprofessional collaboration and integration (IPCI) in primary care, patients, care providers, researchers, and governments are still looking for tools and guidance to do this more efficiently. To address these issues, we decided to develop a generic toolkit, based on sociocracy and psychological safety principles, to guide care providers in their collaboration within and outside their practice. Finally, we reasoned that, in order to obtain integrated primary care, different strategies should be combined. Development of the toolkit consisted of a multiyear co-development process. Data originating from 65 care providers, through 13 in-depth interviews and five focus groups were analysed and subsequently evaluated in eight co-design workshop sessions, organised with a total of 40 academics, lecturers, care providers and members of the Flemish patient association. Findings from the qualitative interviews and co-design workshops were gradually, and inductively adapted and transformed into the content for the IPCI toolkit. Ten themes were identified: (i) awareness of the importance of interprofessional collaboration, (ii) the need for a self-assessment tool to measure team performance, (iii) preparing a team to use the toolkit, (iv) enhancing psychological safety, (v) developing and determining consultation techniques, (vi) shared decision making, (vii) developing workgroups to tackle specific (neighbourhood) problems, (viii) how to work patient-centred, (ix) how to integrate a new team member, and (x) getting ready to implement the IPCI toolkit. From these themes, we developed a generic toolkit, consisting of eight modules. In this paper, we describe the multiyear co-development process of a generic toolkit for the improvement of interprofessional collaboration. Inspired by a mix of interventions from in and outside healthcare, a modular open toolkit was produced that includes aspects of Sociocracy, concepts as psychological safety, a self-assessment tool and other modules concerned with meetings, decision-making, integrating new team members and population health. Upon implementation, evaluation and further development and improvement, this compounded intervention should have a beneficial effect on the complex problem of interprofessional collaboration in primary care.

Clinician acceptability of an antibiotic prescribing knowledge support system for primary care: a mixed-method evaluation of features and context

BackgroundOverprescribing of antibiotics is a major concern as it contributes to antimicrobial resistance. Research has found highly variable antibiotic prescribing in (UK) primary care, and to support more effective stewardship, the BRIT Project (Building Rapid Interventions to optimise prescribing) is implementing an eHealth Knowledge Support System. This will provide unique individualised analytics information to clinicians and patients at the point of care. The objective of the current study was to gauge the acceptability of the system to prescribing healthcare professionals and highlight factors to maximise intervention uptake.MethodsTwo mixed-method co-design workshops were held online with primary care prescribing healthcare professionals (n = 16). Usefulness ratings of example features were collected using online polls and online whiteboards. Verbal discussion and textual comments were analysed thematically using inductive (participant-centred) and deductive perspectives (using the Theoretical Framework of Acceptability).ResultsHierarchical thematic coding generated three overarching themes relevant to intervention use and development. Clinician concerns (focal issues) were safe prescribing, accessible information, autonomy, avoiding duplication, technical issues and time. Requirements were ease and efficiency of use, integration of systems, patient-centeredness, personalisation, and training. Important features of the system included extraction of pertinent information from patient records (such as antibiotic prescribing history), recommended actions, personalised treatment, risk indicators and electronic patient communication leaflets. Anticipated acceptability and intention to use the knowledge support system was moderate to high. Time was identified as a focal cost/ burden, but this would be outweighed if the system improved patient outcomes and increased prescribing confidence.ConclusionClinicians anticipate that an eHealth knowledge support system will be a useful and acceptable way to optimise antibiotic prescribing at the point of care. The mixed method workshop highlighted issues to assist person-centred eHealth intervention development, such as the value of communicating patient outcomes. Important features were identified including the ability to efficiently extract and summarise pertinent information from the patient records, provide explainable and transparent risk information, and personalised information to support patient communication. The Theoretical Framework of Acceptability enabled structured, theoretically sound feedback and creation of a profile to benchmark future evaluations. This may encourage a consistent user-focused approach to guide future eHealth intervention development.

495 Developing deprescribing resources for older people with polypharmacy living in primary care: using co-design and logic modelling

Abstract Introduction Proactive deprescribing – identifying and discontinuing medicines where harms outweigh benefits (1) – can minimise problematic polypharmacy, but it has not been routinely implemented into practice and can have risks. There are complex barriers and facilitators to deprescribing, however there is little evidence about how to overcome such barriers or promote facilitators and what resources are needed to safely and routinely implement deprescribing in primary care. Aim To co-design deprescribing resources that aid the implementation of safe and routine deprescribing in primary care. Methods Community-dwelling patients aged ≥65 years taking ≥5 medicines, community pharmacists, primary care pharmacists and GPs were invited to co-design workshops conducted in July 2022. Participants were recruited through social media and research networks. This project did not require formal ethical approval as it was a service improvement initiative. Two online workshops were facilitated using Microsoft Teams and Miro boards and were supported by a Patient and Public Involvement representative. The first workshop comprised a briefing about findings from a scoping review, systematic review and interview study with patients and healthcare professionals about deprescribing implementation, followed by idea generation through group activities. Potential resources identified were collated and, through discussions with the wider research team, two were prioritised to be further developed. The second workshop used storyboards to further understand and add detail to how the resources chosen would aid the implementation of routine and safe deprescribing in primary care. A logic model was then developed for the resource developed in the workshop. Results Five patients, two GPs, one primary care pharmacist and one community pharmacist took part. In the first workshop, participants identified:(a) patients were suitable advocates for their own health and could initiate conversations about medicines necessity but may need prompts or suggested questions to do so; and (b) community pharmacist follow-up with patients post-deprescribing could help ensure safe deprescribing and facilitate appraisal of deprescribing for future learning. In the second workshop, five questions patients could ask healthcare professionals during everyday interactions and two questions patients could ask during a medication review were developed to stimulate conversations on the necessity of medicines. A storyboard about how community pharmacy could act as a safety net post-deprescribing was developed and refined, following the workshop, into a Real World Logic Model (2) to explain how this safety net could work, the safety net context, and the anticipated outcomes. Conclusion Patients may be able to stimulate conversations on medicine necessity leading to routine deprescribing, whilst community pharmacists could potentially help ensure deprescribing safety. Questions were developed to empower patients to raise the issue of medicines necessity, and a logic model demonstrating community pharmacists as a deprescribing safety net were developed to aid safe and routine deprescribing in primary care. The co-participation of patients and healthcare professionals ensured that both groups’ values and priorities informed intervention development. However, the acceptability and usability of the co-designed interventions cannot be known until feasibility testing has been conducted.

Adaptation of ACTivate Your Wellbeing, a Digital Health and Well-being Program for Young Persons: Co-design Approach.

ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons' mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses. This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years. A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2. Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention. Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more.

475 Co-designing an intervention to support safe medicines self-management for older people living with frailty and polypharmacy

Abstract Introduction Older people face numerous challenges and safety risks when managing multiple medicines. They are required to cope with complex and changing regimens and co-ordinate input from multiple healthcare professionals. If not well managed, medicines can cause harm, and older people are more susceptible to errors. Some older people can devise and implement strategies to manage their medicines, e.g. creating checklists, ensuring timely supplies, solving problems, and seeking help (1). However, no interventions address the multiple tasks polypharmacy patients must perform to safely manage their regimens. Aim To develop an intervention to support medicines self-management for older people living with frailty and polypharmacy using experience-based co-design (EBCD) (2). Methods Following video or audio-recorded qualitative interviews with 32 older people taking 5 or more medicines, a ‘trigger film’ of patients’ medicines management experiences was produced and used during EBCD to facilitate priority setting. Separate meetings were held (1) with 16 staff (2 GPs, 4 GP practice administrators, 4 GP practice pharmacists, 1 practice lead, 2 senior nurses, 2 pharmacy technicians, 1 community pharmacist) and (2) with 13 patients and 2 family members, followed by a joint meeting with 8 older people and 9 staff where a shared set of three priorities was agreed. Two subsequent co-design workshops with 6 patients, 2 family members and 7 staff developed three candidate interventions. Workshop 1 explored key themes from the trigger film to develop solutions. Workshop 2 reviewed solutions and further developed design ideas. Intervention components were merged and those addressing patient safety challenges were retained to form the prototype intervention. Ethical approval was obtained for the interviews included in the trigger film, but not required for EBCD. EBCD meetings and workshops were conducted as quality improvement: people involved were collaborators, personal information was not captured, discussions were not recorded or analysed. Results Co-design priorities were to support patients in: day-to-day practical medicines management; understanding the wider medicines management system; communication with healthcare teams. The three solutions were: a quick-start guide to managing multiple medicines including talking about medicines and managing new routines; tips and tricks to support day-to-day management, including planning and adherence tools; a tool supporting preparation for medication reviews and asking questions about medicines. After merging intervention components and identifying those addressing medicines-self-management patient safety challenges, five areas were retained for the prototype intervention: checking what you get; keeping on top of supplies; monitoring how you take your medicines; times when problems are more likely; and how do I know if I need help? Discussion/Conclusion Through EBCD patients and staff worked together to improve people’s experiences of managing medicines and to enhance safety. The prototype intervention addresses five areas where older people with complex medicines regimens require support. The intervention requires feasibility testing and subsequent robust evaluation. Strengths and limitations: • A variety of staff roles joined the co-design, offering multiple different perspectives on medicines management • EBCD meetings and workshops were run online to avoid Covid infections. This may have excluded older people with no access to internet.

Stretching beyond our perceived boundaries: The role of speech-language pathology in realising autonomy through supported decision-making

Purpose Based on a 2022 Speech Pathology Australia National Conference keynote address, the author explores the concept of autonomy and how it can be reconceptualised for people with profound intellectual and multiple disability through supported decision-making. Method A collection of participatory action research studies with people with profound intellectual and multiple disability and their supporters are presented. Qualitative action research methodologies, including participatory observation, co-design workshops, and interviews, were used to explore supported decision-making for people with profound intellectual and multiple disability. Result The insights have been used to co-design (with supporters) a definition and practice framework to enhance the autonomy of people with profound intellectual and multiple disability. Conclusion Drawing on the construct of relational autonomy, readers are asked to reflect on their role as speech-language pathologists in enhancing autonomy of those they service, particularly people with profound intellectual and multiple disabilities. A definition of supported decision-making for people with profound intellectual and multiple disability along with a practice framework are offered. This body of work adds to a growing evidence base in supported decision-making, providing much needed practice guidance specifically relating to people with profound intellectual and multiple disability.

Protocol: How can people with social care needs be supported through processes of digital care navigation to access remote primary care? A multi-site case study in UK general practice of remote care as the 'new normal'.

Care navigation refers to support for patients accessing primary care and other related services. The expansion of digitally enabled care in the UK since the coronavirus disease 2019 (COVID-19) pandemic has led to a greater need for digital care navigation: supporting people to access primary care digitally and, if necessary, to help them find alternative non-digital routes of access. Support to patients with social care needs (including but not limited to those who are homeless and insecurely housed, living in residential care and supported by domiciliary carers) increasingly involves work to navigate primary care provided remotely and accessed digitally. There is little knowledge about how this work is being done. Care Navigation involves embedded researchers identifying digital care navigation for patients accessing services in 11 GP practices recruited to a linked study of remote primary care ( Remote care as the 'new normal?'). Digital care navigation will be studied through go-along (in-person or remote) interviews with a sample of 20 people offering formal (paid or voluntary) support, 6 national and regional stakeholders who plan, commission or provide digital care navigation and a focus group with 12 social prescribers engaged in digital care navigation. A co-design workshop with people working in, or commissioning, social care settings will consider how findings can inform improved digital care navigation, for example through the development of resources or guidance for care navigators. Findings are anticipated to include evidence of how digital care navigation is practised, the work that is done to support patients in accessing remote primary care, and how this work is shaped by material resources and variations in the configuration of services and infrastructure. New explanations of the work needed to navigate digital care will inform policy and service developments aimed at helping patients benefit from remote primary care.

Co-designing an Integrated Health and Social Care Hub With and for Families Experiencing Adversity.

Integrated care research often fails to adequately describe co-design methods. This article outlines the process, principles and tools to co-design an integrated health and social care Hub for families experiencing adversity. The Child and Family Hub was co-designed in four stages: (1) partnership building and stakeholder engagement, (2) formative research, (3) persona development and (4) co-design workshops and consultations. Local families, community members and intersectoral practitioners were engaged at each stage. The co-design workshops employed a human-centred design process and were evaluated using the Public and Patient Engagement Evaluation Tool (PEET). 121 family participants and 80 practitioners were engaged in the Hub's co-design. The PEET highlighted the co-design team's satisfaction achieved by community members working alongside practitioners to generate mutual learning. Resourcing was a key challenge. Human-centred design offered a systematic process and tools for integrating formative evidence with lived and professional experience in the Hub's co-design. Applying community engagement principles meant that a diverse range of stakeholders were engaged across all stages of the project which built trust in and local ownership of the Hub model. Co-design research with families experiencing adversity should attend to language, engagement methods, team composition and resourcing decisions.

‘HOW MUCH SPACE AM I SUPPOSED TO TAKE?’: UNDERSTANDING 'DIGITAL INCLUSION FOR INTERNATIONAL DEVELOPMENT' THROUGH FA'ASAMOA

It is widely held that efforts to achieve the United Nations’ 2030 Sustainable Development Goals must sit alongside efforts to achieve ‘universal’ digital inclusion (Graham, 2019). In Samoa, an independent island state in the Pacific, digital inclusion has been positioned as a key ‘international development’ agenda that will ‘leapfrog’ the nation into the 21st century. However, a similarly strong motivator has been fa’asamoa (the Samoan way) which, with its emphasis on relationally grounded action and knowledges, operates in tension with the underlying colonial constructs of ‘modernity’ evident within current 'Western' conceptualisations of ‘digital inclusion for international development’. In following Mignolo (2007), this paper details fa’asamoa-grounded perceptions and experiences of ‘digital inclusion for international development’ held by Samoan members of two Pasifika-led community organisations in Brisbane, Australia. The 'participants', as peer researchers, held a central position in designing and implementing the research agenda and objectives, further putting abstract conceptualisations of decolonisation into practice. Drawing on discussions and design artefacts created during a co-design workshop held in late-2021, this paper outlines how the peer researchers (consciously and unconsciously) navigate tensions between fa’asamoa and current 'Western' structures and practices of ‘digital inclusion for international development’ in their everyday and envisioned engagement with ICTs and digital technologies. In turn, this paper critically questions the effects of on-going 'Western' hegemonies in the construction of ‘modern’ subjectivities and the enactment of ‘modern’ life, and further offers critical insight into the role of technology in the discursive and practical conception of alternatives to ‘modernity/coloniality'.

CONNECTING IN CAPE YORK: EXPLORING DIGITAL INCLUSION AND ACCESS FOR LOW INCOME INDIGENOUS FAMILIES

Our presentation will discuss how our team of Indigenous and non-Indigenous developed a unique Indigenous research methodology to increase understanding of the digital inclusion challenges faced by low income Indigenous families living on Mornington Island, a remote Aboriginal community in remote Queensland, Australia. We discuss our methodology and findings of how low income Mornington Island Aboriginal families use the internet to access government and social services, education, e-health and e-commerce. This project employs Indigenous methodologies including yarning, participant photography, and co-design workshops to inform policies, practices and programs. Our results are interpreted within the growing body of decolonizing methodologies and Indigenous research, methods and methodologies. Informed by Martin’s (2009) Relatedness Theory, our data is considered through Aboriginal ways of being, doing and knowing, with Aboriginal axiology, epistemology and ontology forming a window through which we observe, analyse and interpret data. In this presentation, we will discuss how we as a blended research team: • facilitated Indigenous involvement in the research (starting with the development of the research concept and design) • engaged strongly with with Indigenous research and literature, both academic and community-based to interpret data and findings • engaged with and developed Indigenous methodologies to ensure the effectiveness and appropriateness of this research and • represented Indigenous authors and voices in analysis and communication of research results

Osteoarthritis consumers as co-researchers: identifying consumer insights to improve osteoarthritis management by co-designing translational research solutions

Co-design is a consumer-driven approach that facilitates consumer participation in creating meaningful solutions to complex problems. Poor uptake of core management strategies for osteoarthritis suggests there is a missing link in translation between research and practice. We partnered with osteoarthritis consumers as 'co-researchers' to identify translational research solutions to improve uptake of core management strategies that are grounded in lived experiences. To transparently describe a theory-driven, generative co-design approach using an integrated conceptual framework to collaborate with consumers at the equal partnership level. We used co-design workshops with a non-hierarchical participatory framework. Three workshops with six co-researchers [2 female, mean age 68.7 (9.8) years, 3-30 years symptom duration] were conducted using activities to encourage creative thinking, promote deep reflection on personal/societal beliefs and minimise sensitivities around sharing personal beliefs (e.g., establishing a safe space, prompting questions, perspective-taking, counter-stereotypical exemplars). All six co-researchers actively participated in the workshops. Achievement of an equal collaborative partnership was evidenced by co-researchers challenging a project proposed by the research team and making alternative recommendations that have been implemented in prospective decision-making - representing a complete change in research focus driven by consumer input. A key suggested solution was to develop a scalable knowledge translation intervention that targets misconceptions about osteoarthritis and its management at the societal-level. Through an innovative co-design approach in partnership with co-researchers, we identified meaningful areas on which to focus translational research for osteoarthritis. Discordance between existing research priorities and novel solutions proposed by co-researchers highlights the value of co-design.

Co-designing drug alerts for health and community workers for an emerging early warning system in Victoria, Australia

BackgroundAlerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia.MethodsAn iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design.ResultsTimely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves ‘conduits’ for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be ‘shareable’ across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms.DiscussionAlerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems.

Medical device regulation: requirements for occupational therapists in The Netherlands who prescribe and manufacture custom-made devices

Purpose To interpret the Medical Device Regulation for occupational therapists in the Netherlands involved in prescribing and manufacturing custom-made assistive devices and to develop a roadmap for implementation. Materials and methods Four online iterative co-design workshops were organized under supervision of a senior quality manager to assist in the interpretation of the MDR framework with a focus on custom-made assistive devices; and to assist the implementation by generating guidelines and forms. The workshops for seven participating occupational therapists had an interactive character with Q&A, small and homework assignments, and oral evaluations. Next to occupational therapists, participants with different backgrounds joined such as 3D printing experts, engineers, managers, and researchers. Results The participants experienced the interpretation of the MDR as informative, but also as complex. Complying with the MDR requires considerable documentation activities that are currently not part of care professionals tasks. This initially raised concerns regarding implementation in daily practice. To facilitate the MDR implementation, forms were created and evaluated for a selected design case together with the participants for future reference. Additionally, instructions were given which forms should be filled out only once per organization, which forms could be reused for similar types of custom-made devices, and which forms should be filled out for each individual custom-made device. Conclusions This study provides practical guidelines and forms to support occupational therapists in the Netherlands to prescribe and manufacture custom-made medical devices complying with the MDR. It is recommended to involve engineers and/or quality managers in this process.

Adopting international recommendations to design a model for maternal health service to cope with pandemic disruption for Indonesian primary care

BackgroundLimited evidence is available as the reference for the model of care on providing maternity care in low-and-middle-income countries (LMICs) to cope with pandemic disruption. This study aimed to adopt international recommendations to develop the model of care with the context of Indonesian settings.MethodsFour codesign workshops and substitute interviews with stakeholders, covering the (i) exploration of service provision during the pandemic, (ii) adoption of international recommendations, (iii) designing and (iv) finalising model of care for maternal health services in primary care under the COVID-19 pandemic. The study took place in Yogyakarta Province Indonesia from July-November 2021. The participants were general practitioners, midwives, nurses, patients, and obstetricians. The data were analysed thematically.ResultsTwenty-three participants were recruited. As many as 23, 16, 14 and 16 participants participated in the first to fourth codesign workshops or substitute interviews. Key recommendations agreed upon in the workshop were health screening, maintaining antenatal-postnatal breastfeeding care, limiting visitors, using telemedicine, and creating a multidisciplinary team to provide the care. A model of care for improving maternal service was also agreed and received suggestions from the participants. Identified barriers to the recommendation implementation, such as the available clinical resources and negotiating providers’ authority in practice.ConclusionRecommendations and the model of care for improving maternity care in Indonesia are beneficial to be implemented in Indonesian primary care during the COVID-19 pandemic. Further research includes pilot studies to explore the acceptability of the model and recommendation implementation in practice.

Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit.

Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity.