Co-design Workshops Research Articles

A Community-based Whole Life Carbon Assessment: Case study of a London estate community plan

In the attempt to adhere to the UK’s 2050 Net-Zero Strategy, more attention has been given to energy-centric decision-making over the regeneration of housing estates. Whole Life Carbon Assessment (WLCA) is the methodology used for the evaluation of the overall carbon dioxide equivalent (CO2e) emissions of building projects over their lifecycle. The WLCA studies are mostly not understood by different stakeholders and are less effective in reducing the Global Warming Potential (GWP) impacts in the development of regeneration scenarios. This paper is part of a larger study on a multistakeholder lifecycle-based sustainability assessment framework and aims to further explore whether retrofitting can outperform the existing and new build scenarios for lower GWP impacts, and intends to examine the use of WLCA for the development of a regeneration scenario. The research consists of a single-case case study employing co-design workshops, surveys, and WLCA experiments. The community’s preferred regeneration scenario has been developed through knowledge mobility and co-design workshops with the members of the community and a UCL team of designers and researchers. The WLCA of different regeneration scenarios (existing building, different refurbishment scenarios, and a previously approved redevelopment scheme) has been conducted using the data from desk-based research, site surveys, building regulations, retrofit case studies and guidelines, and the planning documents of the council’s previously approved new build scheme. The results of the WLCA support the current studies in favour of the refurbishment scenarios over the demolition and rebuilding of the estate, and make a case for the necessity of understanding the GWP in design development to reduce the GWP of regeneration scenarios.

Co-Designing a Mobile-Based Game to Improve Misinformation Resistance and Vaccine Knowledge in Uganda, Kenya, and Rwanda

Misinformation can decrease public confidence in vaccines, and reduce vaccination intent and uptake. One strategy for countering these negative impacts comes from inoculation theory. Similar to biological vaccination, inoculation theory posits that exposure to a weakened form of misinformation can develop cognitive immunity, reducing the likelihood of being misled. Online games offer an interactive, technology-driven, and scalable solution using an active form of inoculation that engages and incentivizes players to build resilience against misinformation. We document the development of the critical thinking game Cranky Uncle Vaccine. The game applies research findings from inoculation theory, critical thinking, humor in science communication, and serious games. The game content was iterated through a series of co-design workshops in Kampala (Uganda), Kitale (Kenya), and Kigali (Rwanda). Workshop participants offered feedback on cartoon character design, gameplay experience, and the game’s content, helping to make the game more culturally relevant and avoid unintended consequences in East African countries. Our co-design methodology offers an approach for further adaptation of the Cranky Uncle Vaccine game to other regions, as well as a template for developing locally relevant interventions to counter future infodemics.

Introducing sheep for agroecological weed management on banana plantations in Guadeloupe: A co-design process with farmers

CONTEXTIn Guadeloupe, the use of a persistent pesticide (chlordecone) contaminated one third of the island's agricultural soils, causing a major environmental crisis. In the aftermath, banana farmers significantly changed their management practices to decrease their pesticide use. With the support of research, farmers have tested and adopted various agroecological practices, such as planting cover crops and using vitroplants and fallow. However, the use of animals to decrease pesticide use on banana plantations has not yet been explored. OBJECTIVEThis study aimed to co-design agroecological cropping systems that integrate animals as an alternative means to manage weeds. METHODSThe study was based on co-design workshops involving farmers, advisors and scientists, a survey of local practices of integrating animals within cropping systems, on-farm experiments with four farmers during which a total of 20 four-month-old male lambs were introduced within their cropping systems, and reflexive monitoring two and six months after the end of the experiments. RESULTS AND CONCLUSIONSThe introduction of sheep into cropping systems was the option deemed the most promising after three co-design workshops. Animals already were integrated into some banana-based farming systems in the study area, but this integration mainly consisted of cattle grazing on fallow land. The on-farm experiments highlighted that sheep made it possible to reduce the herbaceous cover on banana plantations by almost 60%. The growth performance of the lambs allowed by the herbaceous cover was within the range observed for this breed when reared on pastures (50–139 g/day). In this experiment, the lambs were not reared for meat, since the animals were, unsurprisingly, contaminated by chlordecone. The farmers appreciated that the practice enabled them to eliminate a labor-intensive activity (removing by hand the vines around the banana pseudo-stem) and radically reduce brush cutting. Piloted by a technical institution providing farmers technical support, initial changes in the broader socio-technical regime were observed. SIGNIFICANCEThis study highlights a co-design process of agroecological cropping systems involving agronomists, animal scientists, and farmers that led to an innovative, animal-based method of managing weeds within banana cropping systems with positive preliminary adoption outcomes as new farmers start using the practice. Inspired by similar efforts in vineyards, cereal and oil palm plantations, it is one of the first attempts to introduce sheep into banana cropping systems. The challenge is now to support this adoption at the territorial scale through possible cooperation between breeders and farmers, the training of farmers, and finding a means to ensure the safety of sheep.

Useful shortcuts: Using design heuristics for consent and permission in smart home devices

Prior research in smart home privacy highlights significant issues with how users understand, permit, and consent to data use. Some of the underlying issues point to unclear data protection regulations, lack of design principles, and dark patterns. In this paper, we explore heuristics (also called “mental shortcuts” or “rules of thumb”) as a means to address security and privacy design challenges in smart homes. First, we systematically analyze an existing body of data on smart homes to derive a set of heuristics for the design of consent and permission. Second, we apply these heuristics in four participatory co-design workshops (n = 14) and report on their use. Third, we analyze the use of the heuristics through thematic analysis highlighting heuristic application, purpose, and effectiveness in successful and unsuccessful design outcomes. We conclude with a discussion of the wider challenges, opportunities, and future work for improving design practices for consent in smart homes.

Communicating evidence synthesis: co-designing summary formats with end users

Abstract Background Evidence syntheses are essential to the creation of evidence-based guidelines that guide health care. Findings from our recent mixed methods systematic review (MMSR) identified no gold standard format for communicating summaries of evidence syntheses to guideline development groups. This is important as these groups are comprised of patients, healthcare providers, policymakers, etc., who all have different expertise, perspectives and priorities. Our overall aim is to develop evidence-informed prototype summary formats for use in guideline development. To inform this process, we held online co-design focus group workshops shaped by findings from our MMSR. Methods We held six focus groups with 30 participants involved in developing guidelines and/or evidence synthesis (February - March 2023). The topic guide was informed by the MMSR -- focusing on recommendations with mixed methods support, ≥3 supporting studies, and those prioritised by an expert advisory group through a pragmatic prioritisation exercise using the MoSCoW method (Must, Should, Could, and Will not haves). Focus groups were recorded and transcripts were analysed using a directed content analysis. Results Participants suggested a “less-is-more” structured approach that minimises methodological steps and statistical data, promoting accessibility to all audiences by judicious use of links to the full technical report. They emphasized the importance of concise consistently-presented formats which emphasize key messages, flag readers to indicators of trust in the producers (i.e., logos, websites, and conflict of interest statements), and highlight the quality of evidence. Conclusions Project findings are informing the creation of accessible and actionable guidance on best-practices for creating summary formats. Next steps involve user-testing prototype formats through semi-structured interviews which will then be integrated into the National Clinical Guideline development process in Ireland. Key messages • Co-design workshops delineated key aspects of effective and acceptable evidence synthesis summary formats to help create reproducible format templates for use in clinical guideline development. • Creating summary formats accessible to all guideline development group members will promote better communication and translation of research evidence into recommendations and practice.

Co-design with Integrated Care Teams: Establishing Information Needs.

Co-design has been cited as playing a major role in the future of effective integrated care, however, there is a lack of reporting and reflection on the methods used. Information sharing is fundamental when working in integrated care, however sharing across professions, service settings and localities can be complex. Through co-design, we seek to establish a shared understanding of information needs within a newly formed integrated care team. In doing so we aim to inform future practice in the understanding of co-design. Co-design Workshop 1 (N = 24 participants, plus 6 facilitators), collected 'Current Position' understanding of service information needs. Co-design Workshop 2 (N = 18 participants, plus 6 facilitators) sought a 'Future Position' understanding, identifying solutions and next steps for establishing information-need solutions. Reflection on the co-design process was conducted to inform future co-design practices. Identified was a wide range of future service information needs under the themes of Culture Building, Health System Needs, and Processes. We conclude with 4 key learning points on co-designing. 1. Ensure simplicity in format. 2. Interdisciplinary co-design and co-facilitation of workshops are beneficial. 3. Planning and preparation are key. 4. Co-designing can enhance communication for service improvement.

Video analysis of communication by physiotherapists and patients in video consultations: a qualitative study using conversation analysis

ObjectivesTo investigate the challenges of doing physical examinations and exercises by video, and the communication strategies used by physiotherapists and patients to overcome them. DesignA qualitative study of talk and social actions, examining the verbal and non-verbal communication practices used by patients and physiotherapists. Video consultations between physiotherapists and patients were video recorded using MS Teams, transcribed and analysed in detail using Conversation Analysis. SettingVideo consultations were recorded in three specialist settings (long-term pain, orthopaedics, and neuromuscular rehabilitation) across two NHS hospitals. Participants15 adult patients (10 female, 5 male; aged 20-77) with a scheduled video consultation. ResultsExaminations and exercises retain-->were successfully accomplished in all 15 consultations. Two key challenges were identified for physiotherapists and patients when doing video assessments: (1) managing safety and clinical risk, and (2) making exercises and movements visible. Challenges were addressed by through communication practices that were patient-centred and tailored to the video context (e.g., explaining how to frame the body to the camera or adjust the camera to make the body visible). ConclusionsVideo is being used by physiotherapists to consult with their patients. This can work well, but tailored communication strategies are critical to help participants overcome the challenges of remote physical examinations and exercises. Contribution of the PaperThis paper is a first to use video-based analysis to determine the challenges of video consulting for doing remote assessments and exercises in physiotherapy settings. It demonstrates how patients and physiotherapists use communication strategies to raise concerns around safety and visibility and how they overcome these concerns.

Co-designing a theory-informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community-based participatory research study (LISOLO MALAMU).

Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, accessand low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviourmodel to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD:7.5)years in theUnited Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivationsand social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablementand environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.

Co-designing a housing and livelihood toolkit with low-income older people for future housing in Klong Toey, Bangkok, Thailand

ABSTRACT The purpose of this article is to examine the co-design process of a research project which was implemented to support an initiative led by low-income older people in Klong Toey, Bangkok. The primary objective was to co-produce a design toolkit that can guide the development of live–work housing for low-income older people in Klong Toey. A three-day co-design workshop was held with local stakeholders to develop design alternatives for the prevailing live–work activities identified as a part of the field study. Within the framework of co-design methodology, the researchers engaged with the users as facilitators and translators to produce design options that informed the toolkit. The toolkit was developed under the overarching AgeingHood project, inspired by the unique housing and livelihood needs of the older people of Klong Toey, who often run small businesses from their own homes. It was conceived out of the understanding that ageing, housing and livelihood are interrelated aspects of the lives of low-income older people in this area of Bangkok. In addition to the toolkit, the project also led to impacts such as supporting residents’ live–work needs assessment and positive engagement and collaborative working with various local stakeholders.

Digital storytelling intervention to enhance social connections and participation for people with mild cognitive impairment: a research protocol.

Interventions utilizing the principles of digital storytelling can improve cognitive ability by cultivating positive emotions and framing a new way to enhance social participation among people with mild cognitive impairment. However, existing research has understudied group-based storytelling, focusing instead on building individual stories and connections with family and friends. In response to this research gap, this paper proposes co-designing a digital storytelling intervention for people with Mild Cognitive Impairment (MCI) to enhance their social participation and build meaningful connections. We will conduct two co-design workshops with people with MCI (n = 12), their caregivers (n = 4-12), and therapists (n = 5) in Beijing, China, to facilitate the co-development of the digital storytelling application. During the first workshop, we will utilize card sorting and voting to define potential facilitators of social participation, identifying the abilities people with MCI want to improve through storytelling. During the second workshop, we will build on these findings to facilitate people with MCI and their caregivers to visualize the interfaces. After reflexive thematic analysis of the co-design workshops, we will develop a digital storytelling application and test its usability and efficacy among people with MCI and therapists, respectively. A single-blinded field test will be conducted with 20 community-dwelling adults with MCI (Age: 65+). The testing will consist of an intervention group of 10 participants who use the co-designed digital storytelling intervention and a control group of 10 participants who will not use the co-designed intervention on the waiting list. The intervention period will extend over 7 weeks, with individual intervention sessions lasting 30 min. We will evaluate its efficacy in terms of social participation, social connectedness, self-efficacy, subjective sense of happiness, and user experience of people with MCI. This study will examine an innovative digital storytelling intervention to enhance social participation among people with MCI. This study is expected to advance the concept of community-centric social groups in social health service contexts by integrating technological solutions with the self-identified needs and lived experiences of people with MCI, increasing the motivation of people with MCI to cultivate social participation. Swinburne University of Technology's Human Research Ethics Committee gave ethics approval for this research (Approval Number: 20226525-11105; Date: 26/09/2022). Our findings shall be reported in peer-reviewed journal articles and at relevant conferences.

Co-design of a digital app "WhatMatters" to support person-centred care: A critical reflection.

People with dementia often do not receive optimal person-centred care (PCC) in care settings. Family members can play a vital role as care partners to support the person with dementia with their psychosocial needs. Participatory research that includes the perspectives of those with lived experience is essential for developing high-quality dementia care and practices. Throughout 2021-2022, a mobile app, called WhatMatters, was co-developed to provide easy-to-access and personalised support for people with dementia in hospitals and long-term care homes, with input from patients/residents, family partners and healthcare staff. This article discusses and critically reflects on the experiences of patients/residents, family partners, and healthcare staff involved in the co-design process. For the app development, we applied a participatory co-design approach, guided by a User Experience (UX) model. The process involved co-design workshops and user testing sessions with users (patients/residents, family partners, healthcare staff) to co-develop the WhatMatters prototype. We also conducted focus groups and one on one interviews with staff and caregiver participants to explore their experiences. Our research team, which also included patient partners, took part in regular team meetings during the app's development, where we discussed and reflected on the co-design process. Reflexive thematic analysis was performed to identify themes that represent the challenges and rewarding experiences of the users involved in the co-design process, which guided our overall reflective process. Our reflective analysis identified five themes (1) clarifying the co-design process, (2) ensuring inclusive collaborations of various users, and (3) supporting expression of emotion in a virtual environment, (4) feeling a sense of achievement and (5) feeling valued. WhatMatters offers potential for providing personally relevant and engaging resources in dementia care. Including the voices of relevant users is crucial to ensure meaningful benefits for patients/residents. We offer insights and lessons learned about the co-design process, and explore the challenges of involving people with lived experiences of dementia in co-design work, particularly during the pandemic.

Leveraging folklore and fantasy to promote small destinations: the case of Visit Wales

ABSTRACT This paper analyses how folklore can be harnessed by destination management organizations (DMOs) and related agencies through story-telling, screen tourism and product development. It presents a two-stage study, which explores policy suggestions proposed at a United Kingdom Parliamentary Committee Inquiry into Wales’s international marketing. An online survey was conducted with international students, as representative of tourists open to less familiar destinations and well-represented amongst fantasy fans, to test the appeal of a differentiation strategy for Wales incorporating folklore. Having established the market potential of folklore, a co-design workshop was held with 36 tourism and creative sector stakeholders to discuss the challenges of leveraging legends and fantasy film locations to attract international visitors. The paper discusses the tourism policy and practice opportunities of adopting this strategy for the folklore-rich but resource-constrained small destination of Wales. It concludes with insights, which have relevance for similar national DMOs and related agencies.

A Grounded Theory and Collaborative Design Approach to Disability Storytelling on TikTok

This developing dissertation explores the use of TikTok as a platform for individual and collective storytelling and information creation practices – within a specific online health community of people experiencing painful, invisible, and difficult to diagnose central sensitivity syndromes (CSSs) – to understand and support these embodied, creative, and collective information behaviors. Ongoing data collection indicates that people with CSSs are using TikTok affordances to tell and scaffold complex micro-stories about their expertise and social experiences of disability: by employing iconographic elements to make disability visual; intimate cinematography; audio, visual, and community-specific mimetic options; and platform-specific novel feature use. The research design draws upon critical disabilities studies (CDS) sensitizing concepts. A constructivist grounded theory approach will be employed, by theoretically sampling TikTok micro-videos, their top comments, and, by the time of this presentation, conducting semi-structured interviews with CSS TikTok community members. This poster also discusses these preliminary results, as well as a novel initial sampling approach which addresses both the hashtag and algorithmic logics of the platform, and an implementation of feminist ethics of care in research methods. Then, three codesign workshops with individuals experiencing CSSs will develop creative storytelling materials that can be utilized in various contexts. These workshops promote the inclusion of disabled community members as co-designers and aim to co-design physical and digital storytelling resources such as prompts, templates, and TikTok features.These findings expand storytelling theory into the health domain, introduce and define algorithmically mediated online health communities, and promote critical disability studies perspectives in information science.

Sandwich Robot for Computational Thinking: Reflections from testing with high school pupils

Our study discusses results from testing and co-designing Sandwich Robot, a game on algorithmic thinking targeting beginner programmers. The player composes code from a minimal set of blocks, to make a robotic character gather ingredients for a sandwich, following a specific order; the gameplay is similar to other Computational Thinking (CT) games like Karel the Robot or LightBot. The latest prototype of the game has been tested with three classes of 15-20 pupils from a technical high school in Denmark. The test was conducted in collaboration with their teacher in the subject Informatik, which focuses on CT and basic programming, and ended with a co-design workshop.
 Our results shows that pupils were interest in the basic concept behind our game, they generally described our game as “fun”. Pupils and their teacher saw learning potential in the game, as a tool for understanding algorithmic thinking, but also for refining their learning at later stages. This expanded the role we envisioned for our game, leading us to rethink its relation to the pupils’ learning process. On-going and future work involves addressing pupils’ feedback and providing a level editor to allow Kahoot-style challenges. Our main contribution provides an exemplar of how the thinking behind algorithmic problem-solving can be transposed into game mechanics, embodied in a casual game, and how a non-technical narrative can support beginners learning CT.

Bridging the Gap Between Designers and Users

In this paper, we describe our approach to bridging the designer-user gap by engaging 20 older adults in codesign workshops to generatively re-imagine health-related voice agent (VA) design for voice user interfaces (VUI) for older adults, by older adults. Drawing on recent research in Library and Information Science (LIS), we describe codesign as a method, as well as how the 20 older adults perceived codesign in our two case studies of health-related VA design for health learning and exercise. Older adult codesigners perceived codesign as transformative, enjoyable, educational, and useful. We also share specific experiential recommendations of strategies for conducting codesign, including strategies for transitioning from expert to facilitator, creating experience-based questions, probing for deeper design ideation and priorities, and ways of approaching codesign through humility and care. We describe the codesign method’s generative benefits in our two case studies and encourage LIS researchers to consider including codesign methods in their research.

How a co-design process led to more contextually relevant family planning interventions in emerging urban settings in Eastern Uganda.

Voluntary, rights-based family planning upholds women's right to determine freely the number and spacing of their children. However, low-resource settings like Uganda still face a high unmet need for family planning. And, while urban areas are often indicated to have better access to health services, emerging evidence is revealing intra-urban socio-economic differentials in family planning utilization. To address the barriers to contraceptive use in these settings, understanding community-specific challenges and involving them in tailored intervention design is crucial. This paper describes the use of co-design, a human-centred design tool, to develop context-specific interventions that promote voluntary family planning in urban settings in Eastern Uganda. A five-stage co-design approach was used: 1) Empathize: primary data was collected to understand the problem and people involved, 2) Define: findings were shared with 56 participants in a three-day in-person co-design workshop, including community members, family planning service providers and leaders, 3) Ideate: workshop participants generated potential solutions, 4) Prototype: participants prioritized prototypes, and 5) Testing: user feedback was sought about the prototypes. A package of ten interventions was developed. Five interventions targeted demand-side barriers to family planning uptake, four targeted supply-side barriers, and one addressed leadership and governance barriers. Involving a diverse group of co-creators provided varied experiences and expertise to develop the interventions. Participants expressed satisfaction with their involvement in finding solutions to challenges in their communities. However, power imbalances and language barriers were identified by the participants as potential barriers to positive group dynamics and discussion quality. To address them, participants were separated into groups, and medical terminologies were simplified during brainstorming sessions. These changes improved participation and maximized the contributions of all participants. It is therefore important to consider participant characteristics and their potential impact on the process, especially when engaging diverse participant groups, and implement measures to mitigate their effects.

Towards Greater Inclusion and Accessibility for Physically Disabled Players in Location-Based Games

Most research on Location-Based Games (LBGs) has been conducted on non-disabled players, meaning the experiences of disabled players are not well understood and potentially overlooked. As such, this research aimed to address the following questions: 1). What are the barriers and needs of disabled LBGs players? 2). How can LBGs be made more inclusive and accessible? To address these questions, two studies were conducted in the form of an online qualitative questionnaire and a series of co-design workshops. Results articulate the needs, barriers, and desired features of 60 participants. Based on our findings and through the collaborative work with disabled players we articulate 4 guidelines for game designers and developers aimed at improving the accessibility of LBGs: 1) Adding avatar features that better represent disabled characteristics, 2). Providing different input options for phone interactions, 3) Allowing for disabled specific accounts and 4) Introducing a messenger feature to LBGs.

Reconsidering Priorities for Digital Maternal and Child Health: Community-centered Perspectives from South Africa

Especially in developing regions, parents are rarely given a direct voice in the design of digital maternal and child health (MCH) interventions. Instead, MCH needs and requirements are driven by organizations and health workers. In this research, we engage with both rural and urban parents and community leaders to better understand their challenges and priorities for digital MCH and propose a parent-centered agenda for human-computer interaction research. This paper reports on the community-based, digital MCH priorities identified in our research, and describes how we approached community discourse and co-design of digital initiatives for these priorities, through parent-centered workshops with low-resource South African communities. Furthermore, we provide the parent-centered design opportunities and tensions we discovered for digital MCH in South African contexts, such as designing for local contexts and languages, designing for accessibility and connectedness, and highlighting the underdeveloped digital MCH niches. Finally, we highlight the importance of including facilitators for co-design workshops, such as using intermediaries and design cards.

“We are Researchers, but we are also Humans”: Creating a Design Space for Managing Graduate Student Stress

Graduate students are facing a mental health crisis due to a combination of individual, community, and societal factors. Many existing stress management interventions engage with one factor at a time, typically focusing on providing a user with data about their stress state. We conducted co-design workshops with graduate students who work closely together to explore their strategies for managing stress and to learn about what types of technologies they envision to help address their stress. Using Ecological Systems Theory as an conceptual framework, our analysis of the designs and discussions from these workshops contributes an expanded design space for stress management—one that foregrounds the affordances and challenges of designing interventions that cut across ecological systems levels along with designs that approach stress management using a broader diversity of strategies: controlling, disconnecting, and normalizing stress. We argue that this expanded design space embraces a more holistic and human approach to designing stress management technologies.

Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach.

The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. The study used iterative cycles of planning, action, and reflection, whereby participants' experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users' needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users.