Co-design Activities Research Articles

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

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

Improving assessment for work-based learning and degree apprenticeships in business through a co-designed peer review process

Involving students in peer review has substantial benefits for students’ learning and development and, more pragmatically, for staff workload. This paper reports on a student-led effort to co-design a peer review formative assessment task. The assessment is part of a personal development module within a higher education degree apprenticeship programme delivered via blended mode by a business school in South-East England. This case study on student-staff partnership offers a description of the process and a reflection on the impacts from both the student and staff perspective. It suggests that student co-design and peer review activities complement work-based learning, effectively bringing the prior experiences and academic skills of mature/professional students into the classroom.

Co-creating the experience of consent for newborn genome sequencing (The Generation Study).

The Generation Study (GS) aims to recruit 100,000 newborns in England to evaluate the utility and feasibility of using whole genome sequencing to screen for rare conditions that can be treated in early childhood; enable wider research to support further discovery in genomics and health; and explore the potential of storing an individual's genome over their lifetime. The GS incorporates complexities of consent in newborn screening, genomic medicine, and healthcare research, and there is a gap in exploring how to implement existing recommendations. Participant involvement has been shown to improve the implementation of processes and materials in healthcare. This paper describes how the GS team leveraged this through Design Research (DR) methodologies to develop the GS consent experience. Over a two-year period, 9 rounds of DR were undertaken with expectant and recent parents and a chosen partner (n=105). Each round consisted of semi-structured interviews and a range of co-design and usability testing activities. DR activities highlighted areas for consideration when consent materials and processes. We describe common barriers and enablers across three stages of consent: awareness, consideration, and making an informed decision. As well as ensuring participants fully understand pros and cons of taking part, materials should consider pre-existing assumptions or misconceptions which may discourage parents from learning about the GS. Involving parents in co-creation has broadened the perspective of what constitutes informed decision-making for newborn genome sequencing. Iterative rounds of research and design can provide tangible paths forward, supporting the successful implementation of informed decision-making.

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

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

Improving childhood cancer care in South Africa using the Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool

Aim Using the St. Jude Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool, the South African Association of Paediatric Haematology Oncology (SAAPHO) collaborated with St Jude Children’s Research Hospital to evaluate the delivery of health services and provide evidence-based assessments to inform and prioritise action plans to improve childhood cancer care. Methods PrOFILE was used to assess paediatric oncology care in thirteen public-sector hospitals comprehensively. Following that, representatives from each of the thirteen public-sector hospitals and from SAAPHO, the National Department of Health, the World Health Organization, St. Jude Global, and Childhood Cancer Foundation South Africa participated in a national stakeholder prioritisation workshop. Participants were assigned one of the PrOFILE components (Context, Workforce, Diagnostics, Multidisciplinary Team, Therapy, or Patients and Outcomes), forming six working groups to assess, map, and evaluate childhood cancer topics. Using a modified implementation mapping approach and through participation in structured co-designed activities, each group designed multi-level health interventions: prioritising initiatives identified by the SAAPHO, setting goals for each priority, co-designing project-specific logic models, reviewing potential barriers to implementation, and developing a post-workshop agenda. Results Individual hospital reports and a national aggregate report were compiled to discuss opportunities and priorities. The goal of the workshop was to utilise evidence-based assessments to achieve, a) objective assessment data to inform prioritisation exercises conducted by stakeholders, and b) priorities and action plans to inform childhood cancer control activities and demonstrate national organisation, human resources capabilities, and technical support to improve childhood cancer care. Through structured discussion and voting, six priority areas were identified and assigned to working groups: redrafting the organisation’s constitution, standardising multidisciplinary reporting, developing protocols and treatment guidelines, establishing fever-management guidelines, strengthening chemotherapy safety practices, and enhancing hospital-based cancer registries. Conclusions An implementation map enabled stakeholders to develop actionable plans, the success of which is demonstrated by the active implementation of the identified priorities by the focused working groups. This could serve as a model for countries with identified priorities but need more means to implement them. Based on mapping and outputs from the PrOFILE workshop, the NDoH will facilitate the creation of a childhood cancer committee to sustain progress on the key themes and priorities identified through the PrOFILE mapping process.

Modified Oral Health Assessment Tool (M-OHAT) for Residential Aged Care: A Co-Design Protocol

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment.

Understanding the experiences of older adult participants and individuals involved in the delivery of a physical activity programme based on participatory approaches: A qualitative analysis.

The present study aimed to understand the experiences of older adult participants and service deliverers involved in a UK-based physical activity programme, developed using participatory approaches. Focus groups and one-to-one interviews were conducted with 34 older adults (aged 55+ years) and 13 service providers. Inductive thematic analysis was conducted, structured using the framework approach. Four themes were identified: (1) Co-designed activities met needs and encouraged attendance; (2) engagement and access of programme activities; (3) enjoyment and perceived benefits of sessions; and (4) support needs of individuals delivering activities. Co-designed activities appeared to meet participant needs and instil a sense of ownership of the programme. Feeling able to relate to other participants seemed important and of potential relevance to attracting older adults to the programme. Peer support may help to increase confidence in attending sessions; place-based approaches (using resources in local communities) and a flexible approach to involvement also seemed to facilitate engagement. Enjoyment of the programme appeared to be enhanced through activity variety and opportunity for socializing, with a sense of community being created through the support and encouragement of fellow participants. It was considered important that volunteers had appropriate recognition and ongoing support. These findings suggest that using participatory approaches may facilitate enjoyment and sustained engagement of older adults. Provision based on local community assets may contribute to sustainability of services. However, providing ongoing support is imperative, requiring further costs and resources over the longer-term.

Women of Influence: interdisciplinary participatory approaches to understanding female leadership in the Peruvian Amazon

The Mujeres que influyen (Women of Influence) project is a collaboration between researchers at University of East Anglia and PUCP, and young women from the Junín area of Peru who are members of the National Council of Indigenous Women of Peru. It takes its starting point from an acknowledgement that although women play a fundamental role in the preservation of biodiversity and ancestral knowledge, these contributions often go unrecognized and underdeveloped (Ketty Marcelo, 2018), to the detriment of the very culture and environment that should be preserved. Our women-led participatory project, uses film (production, screening, analysis) to highlight the potential and importance for active and organised participation by these young women in their communities in order to protect and nurture their natural resources. Working alongside Asháninka and Yanesha young women, we seek to demonstrate the value of young female involvement in community decision-making, addressing the cultural and societal inequalities that may disrupt their path to leadership and influence. In this paper, we focus on the methods developed in the project, particularly the value of participatory video production as a form of activism, with the outputs serving as creative manifestos in themselves. The co-designed activities have led us to reframe fieldwork as auto-ethnographic digital collaborations that have sought to disrupt power hierarchies and facilitate the co-production of new knowledge. We reflect on how our Indigenous partners have helped us rethink issues of sustainability, resilience and alternative strategies to respond to gender dynamics, political ecologies and environmental challenges.

Experimenting urban living lab methodology on circular economy co-design activities in some Italian urban territories

The Urban Living Lab (ULL) is both a methodology and a place where different actors of a territory can collaborate with the aim of urban transformation and sustainable development. This paper briefly introduces a methodological framework, that combines stakeholder engagement and co-design process on Circular Economy (CE) ideas and projects. The structure of the methodological framework foresees four main phases: scouting and analysis of the territorial context, listening and exploration, participation and execution. The main objective of this paper focuses on the application and experimentation of the same ULL methodology framework in four different Italian urban territories (Anguillara Sabazia in the metropolitan area of Rome, Bologna, Taranto and Venosa, a small town in southern Italy), to highlight how the ULL is an effective approach for stakeholder engagement and co-design processes aiming to the transition toward CE. The discussion section of the four ULL cases highlights the main results of the co-design process: the ideation of project proposals of CE activities suitable for implementation in the reference urban territories. The four ULL cases have shown how the same methodological steps can be applied in urban areas with different geographical, territorial and socio-economic characteristics, with comparable results in terms of activating processes of engagement and co-design within the communities living there. In conclusion, experimenting the proposed methodological framework in each of the four urban areas, despite their differing characteristics, it has stimulated the growth of cultural capital and community ties. This was achieved through the exchange of different skills and the collaborative contributions of multidisciplinary teams, resulting in increased collective awareness.

Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people

BackgroundClustering and co-occurring of family adversities, including mental health problems, substance use, domestic violence and abuse, as well as poverty can increase health and behavioural risks for children, which persist throughout the life course. Yet, interventions that acknowledge and account for the complex interactive nature of such risks are limited. This study aimed to develop intervention principles based on reflections from mothers, fathers, and young people who experience multiple and interacting adversities. These principles will show how family members perceive an intervention may bring about positive change and highlight key insights into design and delivery.MethodsA series of six co-design workshops with mothers, fathers, and young people who experienced multiple and interacting adversities (n = 41) were iteratively conducted across two regions in England (London and North-East) by four researchers. Workshop content and co-design activities were informed by advisory groups. Data from facilitator notes and activities were analysed thematically, resulting in a set of intervention principles.ResultsThe intervention principles highlighted that: (1) to reduce isolation and loneliness parents and young people wanted to be connected to services, resources, and peer support networks within their local community, particularly by a knowledgeable and friendly community worker; (2) to address feelings of being misunderstood, parents and young people wanted the development of specialised trauma informed training for practitioners and to have the space to build trusting, gradual, and non-stigmatising relationships with practitioners; and (3) to address the needs and strengths of individual family members, mothers, fathers, and young people wanted separate, tailored, and confidential support.ConclusionsThe current study has important implications for practice in supporting families that experience multiple and interacting adversities. The intervention principles from this study share common characteristics with other intervention models currently on offer in the United Kingdom, including social prescribing, but go beyond these to holistically consider the whole families’ needs, environments, and circumstances. There should be particular focus on the child’s as well as the mothers’ and fathers’ needs, independently of the family unit. Further refinement and piloting of the developing intervention are needed.

Telling Tales: Using Vignettes to Overcome Optimism Bias in Farm Health and Safety Attitudinal Studies

ABSTRACT Objective Measuring attitudes of farmers to safe farming practices using quantitative causal relationship approaches is central to improving understanding of (un)safe practices. This knowledge is important in the development of effective farm safety interventions. However, the accuracy of quantitative attitudinal studies in explaining farmers’ decision-making faces a potential measurement challenge, i.e. a high level of optimism bias. In this paper, we present research that develops and tests farm safety attitudinal questions that are framed around “real-life” farming practices with the objective of reducing optimism bias. Methods We apply construal level theory (CLT) to support the design of vignettes that reflect common risk scenarios faced by farmers. Applying qualitative analysis of 274 fatal farm incidents that occurred in Ireland between 2004 and 2018 we identify the occupational behaviors (what farmers do), social (who are farmers), spatial (where farming takes place), and temporal (when farming happens) dimensions of risks resulting in most deaths. The results informed subsequent co-design activities with farm safety experts and farm advisors to develop “real-life” scenarios, attitudinal questions, and response options. The questionnaire was piloted and subsequently implemented to collect data from a sample of 381 farmers with either tractors or livestock. The results of the survey were compared to previous attitudinal research on farmer’s attitudes to safety in Ireland to establish if there was as follows: i) increased variance in the responses, and ii) a statistically significant difference in the attitudes of respondents compared to the results reported in previous studies. Results The findings established that when farmers were provided with real-life scenarios, their responses were less optimistic and more varied, i.e. there was a greater range of responses, compared to previous studies. Conclusion Applying CTL to the development of attitudinal survey instruments anchors attitudinal questions within farming specific occupational, social, spatial, and temporal contexts. The use of vignettes that draw on real-life scenarios offers the potential for improved design of surveys that seek to understand farmer/worker practices. The results suggest that this approach can improve the measurement of attitudes to farm safety.

"When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners.

Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers. Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design. 21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care. Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.

Co-designing cybersecurity-related stories with children: Perceptions on cybersecurity risks and parental involvement

Co-designing and co-creating technology have recently received much attention in the child-computer interaction (CCI) community. However, there has yet to be much work to explore the co-designing aspect in the field of children’s cybersecurity awareness and parental involvement. With this study, we present the results of a co-design activity with ten children between 9 and 12 years to explore how children think about different cybersecurity issues and parents’ roles in those cybersecurity-related situations. Our findings show that children expect various adult roles to provide support to ensure their safety online and especially expect their parents to take a supportive role in cybersecurity experiences by informing them about the risks, offering suggestions on mitigating or protective measures, and helping them take protective measures or actions against any entity posing the risks. Our study contributes to understanding children’s perceptions of cybersecurity and parental involvement through storytelling.

A methodological framework for the implementation of urban living lab on circular economy co-design activities

Circular Economy (CE) has the potential to tackle many of the challenges we are facing nowadays. It represents nothing less than a paradigm shift, as closing and shortening material loops means adopting completely new ways of producing and consuming. In the European Union, CE is a key strategy to achieve climate neutrality target by 2050, to face the biodiversity crisis, to guarantee economic growth and social wellbeing, within planet boundaries, in accordance with the UN Sustainable Development Goals. Stakeholders’ engagement is a crucial point of the transition pathway based on a systemic approach through a co-creation process. Urban areas are the main field of the circular transition process in which all the urban actors, i.e., public institutions, academic and research bodies, economic operators, citizens and civil organizations, are involved. An effective operational tool to realize stakeholders’ involvement and co-creation processes is the methodological approach of Urban Living Labs (ULLs). Although ULLs have already been tested and implemented worldwide, there is no description of a step-by-step methodology to implement ULLs aimed at co-creation of project ideas on CE, to be realized in a specific territory. This paper aims to define a methodological framework for implementing ULLs focused on co-designing CE activities. The proposed methodology is based on four main phases: (i) scouting and analysis of the territorial context, (ii) listening and exploration, (iii) participation, (iv) execution. A detailed description of each phase as well as the first application of this framework in different urban communities are presented.

The Role of Service Design and Co-design in the Lifecycle of Online Communities: Cases from the Chinese Service Design Community

COVID-19 and technological advances have made online communication more common, which has increased the number of online communities. However, online communities tend to rise and fall rapidly, and maintaining active participants is vital to online community survival and development. While online communities connect many diverse participants, they also add to the complexity of the network and challenge participants to collaborate and participate. Despite the widespread use of service design and co-design for collaborating and participating in offline communities, there have been few studies examining their application and contribution online. This study uses participatory action research as a methodology. It takes China's online community, Chinese Service Design Community (CSDC), as a research object, analyses its development process from 2019 to 2022, and combines the online community life cycle proposed by Iriberri and Leroy as an analytical model to illustrate how service design and co-design activities can contribute to the community's transition from "inception" to "maturity" (Iriberri & Leroy, 2009). In addition, it also explores how service design and co-design can help to produce the ‘legacy’ for the long-term development of online communities by reflecting on the influences of the 'heroes' of online communities.

Codesigning Online Continuing Medical Education on Social Health Integration and Social Risk-Informed Care for Primary Care Providers.

Adapting clinical care decisions for patient-reported social risks is essential to social health integration and patient-centered care. Most research in this area focuses on awareness and assistance (social-needs-targeted care), such as screening and referral to food, financial, and other resources. Limited evidence for adjustment strategies (social risk-informed care) or adapting care for social risks made it difficult for Kaiser Permanente to implement new initiatives. This article describes a codesign process to build a novel, adjustment-focused continuing medical education course. The authors codeveloped the online continuing medical education course with patients and clinicians using user-centered design. Transcripts from codesign activities were coded and analyzed by thematic analysis to identify major themes, including perceptions of social risk-informed care and barriers to care adjustment. Practical hurdles for implementing social risk-informed care emerged, including clinicians' concerns about the ethics of adjustment as substandard care, particularly without robust assistance activities. However, patients expressed a desire for their care to be adapted to their social circumstances, to allow for more realistic care plans. Implementation barriers identified from the codesign were addressed through an interactive, case-study approach. Existing evidence on contextualized care and shared decision making informed a general framework for primary care providers to engage in awareness and adjustment activities, paired with 3 interactive case studies based on real-world, clinician-supplied scenarios. The authors recommend that multiple stakeholder perspectives be incorporated during the development of social health integration initiatives, particularly adjustment. Education complemented by active, nuanced, flexible implementation strategies may be necessary for the successful uptake of care-delivery-based social health integration activities.

Co-design in somewhere: the interpretations of interior design students on future architectural scenarios in metaverse

ABSTRACT With the development of technology, many sectors are being designed and produced from physical to digital form. Physical environments, in accordance with Maslow's hierarchy of needs, have started to be produced in digital environments and the metaverse is examined within the study. The aim of the study is to provide insights into the future conjuncture of the metaverse. A comprehensive case analysis was undertaken by focusing on analysing the design process and products of interior design students from Generation Z. According to the findings, the students designed metaverse environments as an individual and co-design activity. Also, the metaverse environment should not be perceived as completely isolated from physical environments in the real world, yet the priority given to human needs shows the difference in the metaverse environment compared to Maslow’s theory. These findings demonstrate the significance of incorporating individual and co-design decisions into the design of the metaverse environment by effectively addressing the human needs of its users.

Seamful XAI: Operationalizing Seamful Design in Explainable AI

Mistakes in AI systems are inevitable, arising from both technical limitations and sociotechnical gaps. While black-boxing AI systems can make the user experience seamless, hiding the seams risks disempowering users to mitigate fallouts from AI mistakes. Instead of hiding these AI imperfections, can we leverage them to help the user? While Explainable AI (XAI) has predominantly tackled algorithmic opaqueness, we propose that seamful design can foster AI explainability by revealing and leveraging sociotechnical and infrastructural mismatches. We introduce the concept of Seamful XAI by (1) conceptually transferring "seams" to the AI context and (2) developing a design process that helps stakeholders anticipate and design with seams. We explore this process with 43 AI practitioners and real end-users, using a scenario-based co-design activity informed by real-world use cases. We found that the Seamful XAI design process helped users foresee AI harms, identify underlying reasons (seams), locate them in the AI's lifecycle, learn how to leverage seamful information to improve XAI and user agency. We share empirical insights, implications, and reflections on how this process can help practitioners anticipate and craft seams in AI, how seamfulness can improve explainability, empower end-users, and facilitate Responsible AI.

Integrating Fundamental Movement Skills and Mathematics in Early Childhood: A Pilot Study.

This project involved a co-design process involving researchers and kindergarten teachers to produce learning activities that integrated fundamental movement skills (FMS) and mathematics. We piloted the co-designed activities (i.e., motor-math program) in a local kindergarten and examined the effects on FMS proficiency, mathematics skills, and accrued physical activity (PA). The participants comprised pupils (N = 39) from two matched kindergarten classes, in which we compared the motor-math program with typical mathematics lessons. All participants wore pedometers to measure their number of steps during class, one day per week. FMS proficiency (i.e., locomotor, object control) and mathematics skills (numeracy, geometry, math problem solving) were measured before and after implementation. Significant improvements in locomotor and object control skills were found only in the pilot group (p < 0.001); there were no differences in the changes in mathematics skills between the pilot and comparison groups. During implementation days, the participants in the pilot group accrued significantly greater step counts (p < 0.001) than those in the comparison group. Participating in the motor-math program appears to have benefits associated with improvements in FMS proficiency and accrued PA time, suggesting a promising potential for integrated activities as a means of PA promotion in kindergarten settings. Future work that examines the effects of the integration of movement with mathematics should consider randomization, greater sample size, and a longer intervention period.

Healthy and Inclusive Neighbourhoods: A Design Research Toolkit for the Promotion of Healthy Behaviours

Addressing urban health through the built environment requires cross-disciplinary approaches, where design plays a crucial role. Gaining insights from a design-led research perspective to find situated solutions for promoting healthy behaviours is a requirement that must be clarified. Therefore, we ask the following question: what kind of design research instruments may help in applying the urban health approach from a design-led perspective? With this research question, and to contribute to the mentioned issues to be clarified, this paper presents the application of a framework adopted in a local action research project, namely the Healthy Neighbourhoods Hub (HNH) research project. The HNH framework was used as a design research toolkit for collecting contextual data and identifying insights to build scenarios and strategies for all the involved design disciplines. Around 169 participants among local stakeholders and citizens in two case studies in the city of Florence (Italy) were involved in semi-structured interviews, Healthy Labs, and Open Space Lab. As a result, the participatory activities provided a wide variety of qualitative data, such as themes related to user needs (n = 15), critical issues and points of weakness (n = 32), potentialities and points of strength (n = 27), strategies (n = 38), design insights (n = 30), and a collection of 40 local projects (40 in 5 themes), that contributed to the subsequent co-design activities of the project. This richness suggests the potential of using the adopted resources to build the HNH Toolkit as a design research instrument for addressing urban health and gaining design knowledge for the promotion of healthy behaviours through the design of the built environment.