From Hospital to Home: Applying a Co-Design Approach to Determine the Key Components of an Intervention to Support Transition-To-Home After Stroke.

BACKGROUND: People with stroke and their families face numerous challenges as they leave hospital to return home, often experiencing multifaceted unmet needs and feelings of abandonment. The essential elements of an intervention intended to support transition-to-home after stroke are unclear. OBJECTIVE: The aim of the project was to engage in a co-design process to identify the key components of a pragmatic intervention to inform a transition-to-home support pathway following stroke. MATERIALS AND METHODS: The study was conducted using a co-design process engaging multiple stakeholders, including 12 people with stroke, 6 caregivers, 26 healthcare professionals and 6 individuals from stroke organisations in a series of three workshops, facilitated by the primary researcher, a wider team of researchers and an individual with lived experience of stroke. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the aim of the workshops. Data collection involved observations during workshops, followed by summarising of findings and reaching group consensus agreement on outputs. Facilitated consensus on a prioritisation task resulted in the final output. RESULTS: The co-design group identified 10 key intervention components of a transition-to-home support pathway following stroke. These components focussed on enhancing collaboration, streamlining transition processes and facilitating post-discharge support. While a stroke coordinator was considered a top priority, increased cross-setting information sharing and community in-reach, where community-based healthcare staff extended their services into hospital settings to provide continuity care, were considered most feasible to implement. CONCLUSION: The co-design approach, involving a multi-stakeholder group and strengthened by patient and public involvement, ensured that the identified transition-to-home intervention components are meaningful and relevant for people with stroke and their families. Further co-design workshops are required to refine, and feasibility test the components for generalisability within the wider Irish healthcare setting. PATIENT OR PUBLIC CONTRIBUTION: Individuals who have experienced a stroke actively contributed to shaping the methodological design of this study and the ethics process. They engaged in the analysis of co-design outputs and provided input for the discussion and recommendations regarding future research. An individual who had experienced a stroke formed part of the research team, co-facilitating the co-design workshops and co-authoring this article.

Students' perspectives from co-designed, lived experience eating disorders education: A qualitative inquiry.

BACKGROUND: There is an intricate connection between eating disorders and trauma. Despite this, traditional eating disorders education for health professions has not taken a trauma-informed approach. AIM: We aimed to explore the reflections of graduate entry dietetic and undergraduate nursing students who participated in a trauma-informed, co-designed education innovation that focussed on an individual's storied lived experience. METHODS: We applied an interpretive lens in this qualitative inquiry-based study. Graduate entry dietetic and undergraduate nursing students participated in this study. The lived experience, co-designed workshops (n = 35) were embedded in the curricula with an optional follow-up discussion with the lived experience and academic educators. Students were asked to write their key reflections on a sticky note at the end of the workshop. Thematic analysis of the student reflections was completed by the research team including the lived experience educator and academics. RESULTS: A total of 442 sticky notes were collected; 145 from the dietetic and 297 from the nursing students. Analysis of the dietetic and nursing students' reflections generated six themes: 1) Do no harm, 2) Seeing beyond the diagnosis, 3) Language matters, 4) Humanise the relationship, 5) Recovery in the context of healing, and 6) Significance of hope. There was consistency across the reflections for the two different disciplines. CONCLUSIONS: Co-designed lived experience eating disorders education that honours the living experiences and complexities of eating disorders can deepen health profession students' understandings of how they can work with, rather than against, people living with and recovering from eating disorders through a trauma-informed approach.

Understanding the influences on hospital discharge decision-making from patient, carer and staff perspectives.

BACKGROUND: Gaps in discharge planning are experienced by 41% of hospital patients in Australia. There is an established body of knowledge regarding the features of the discharge process that need to be improved to avoid subsequent hospital readmission and enhance the discharge experience. However, many of these studies have focused solely on factors related to unplanned hospital readmissions and there has been limited success in operationalising improvements to the discharge process. The aim of this study was to explore and describe the factors that influence the decision to discharge adult medical patients from hospital, from patient, carer and staff perspectives. METHODS: A qualitative descriptive study was conducted in one acute medical ward in Melbourne, Australia. The study data were collected by observations of clinical practice and semi-structured interviews with patients, carers and staff. Participants were: i) English-speaking adults identified for discharge home, ii) patient carers, and iii) staff involved in the discharge process. Observation data were analysed using content analysis and interviews data were analysed using thematic analysis. RESULTS: Twenty-one discharges were observed, and 65 participants were interviewed: 21 patients, two carers, and 42 staff. Most patients (76%) were identified as being ready for discharge during morning medical rounds, and 90% of discharge decisions were made collaboratively by the medical team and the patient. Carers were observed to be notified in 15 discharges by the patient (n = 8), doctors (n = 4), or nursing staff (n = 3). Five themes were constructed from thematic analysis of interviews: Readiness for Home, Fragmented Collaboration, Health Literacy, Unrealistic Expectations, and Care beyond Discharge. A collaborative team and supportive carers were considered to enhance risk assessment and discharge planning, however fragmented communication between clinicians, and between clinicians and patients/carers was a barrier to discharge decision-making. CONCLUSIONS: Our study highlights the need for a more coordinated approach to discharge decision-making that optimises communication with patients and carers and multidisciplinary workflows and reduces fragmentation. The importance of patient-centred care and a personalised approach to care are well established. However, there is a need to design systems to customise the entirety of the patient journey, including the approach to discharge decision making.

Co-producing and co-assessing a new service solution for enhancing health and social care integration: a participatory research protocol.

BACKGROUND: This paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023. METHODS: This upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops. DISCUSSION: This protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other's resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings.

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

BACKGROUND: Co-designing healthcare interventions is gaining recognition as a novel and collaborative method. Co-design involves end-users from the start, ensuring that an intervention best meets their needs. Despite its potential benefits, this approach is not yet widely used in developing clinical interventions within intensive care units where the perspectives of patients, family members, and clinicians are crucial. OBJECTIVE: To describe the application, benefits and challenges of the Double Diamond model to co-design a digital family-led voice reorientation intervention for delirium prevention and management in critically ill adult patients. METHODS: The co-design process was guided by the Double Diamond model over a period of 12 months. Development involved patients, family members, and nursing and medical staff as co-designers and decision-makers in the iterative development of the intervention. Data from field notes and group meetings were audio recorded, transcribed verbatim, and content analysed at each phase, which were then presented to the co-designers for verification and refinement. FINDINGS: Co-designers included people with lived experience of the ICU as patients (n = 5) and family members (n = 1) and clinical experts (nursing staff n = 3; medical staff n = 3). Co-designers were highly engaged and reported positive experiences and collaboration in the co-design process. Sharing the diversity of their own personal ICU experiences was found to be beneficial as it not only validated individual feelings but also strengthened intervention development. Differences in interpretations and meanings of the voice messages proposed as part of the intervention were challenging. Maintaining sufficient focus on each phase of the Double Diamond was difficult due to the complexity of the context in which the intervention was being co-designed and the resulting challenges of maintaining the engagement of the co-designers throughout the process. CONCLUSIONS: There were benefits and challenges of engaging people with lived experience in an intensive care unit as co-designers through the Double Diamond design process to develop a digital family-led intervention for delirium prevention and management. Overall, applying the Double Diamond to co-design a clinical intervention is recommended, whereby the collaboration process benefits patients, family members, and clinical staff. REGISTRATION NUMBER: ACTRN12622001568707; ANZCTR - Registration.

Improving the communication of multifactorial cancer risk assessment results for different audiences: a co-design process.

BACKGROUND: Multifactorial cancer risk prediction tools, such as CanRisk, are increasingly being incorporated into routine healthcare. Understanding risk information and communicating risk is challenging and healthcare professionals rely substantially on the outputs of risk prediction tools to communicate results. This work aimed to produce a new CanRisk report so users can directly access key information and communicate risk estimates effectively. METHODS: Over a 13-month period, we led an 8-step co-design process with patients, the public, and healthcare professionals. Steps comprised 1) think aloud testing of the original CanRisk report; 2) structured feedback on the original report; 3) literature review; 4) development of a new report prototype; 5) first round of structured feedback; 6) updating the new report prototype; 7) second round of structured feedback; and 8) finalising and publishing the new CanRisk report. RESULTS: We received 56 sets of feedback from 34 stakeholders. Overall, the original CanRisk report was not suitable for patients and the public. Building on the feedback, the new report has an overview of the information presented: section one summarises key information for individuals; sections two and three present information for healthcare professionals in different settings. New features also include explanatory text, definitions, graphs, keys and tables to support the interpretation of the information. DISCUSSION: This co-design experience shows the value of collaboration for the successful communication of complex health information. As a result, the new CanRisk report has the potential to better support shared decision-making processes about cancer risk management across clinical settings.

Co-Designing Nurse Practitioner Roles in a Tertiary Hospital: A Qualitative Exploration of Patterns and Underlying Dynamics.

AIMS: To explore patterns and dynamics during the co-design process of nurse practitioners' role development in three departments in a Belgian tertiary hospital. DESIGN: Participatory action research was utilised in conjunction with principles of a Grounded Theory approach to explore patterns and dynamics. METHODS: Sixteen meetings were conducted between January and June 2021 with interdisciplinary teams to develop the roles. Thirteen exploratory interviews were held with the stakeholders involved between March and June 2022. All meetings and interviews were recorded and transcribed verbatim. Data were systematically analysed using researcher triangulation and thematic analysis. RESULTS: Stakeholders' initial conception of the nurse practitioner roles affected development. A dynamic interplay of individual, team-related and contextual (e.g., financial and legal) factors shaped these conceptions. Through co-design, stakeholders' conception evolved as insights were shared, misconceptions challenged and perspectives broadened. Physicians generally the developmental process, while nursing leadership was more fragmented. CONCLUSION: This study identifies patterns and dynamics in interdisciplinary teams during the developmental process. The key findings underpin the crucial role of stakeholders' conceptions, use of co-design and leadership in this process. Therefore, a thorough understanding of initial conceptions is ess, and efforts should be directed towards providing sufficient knowledge and experience to prevent misconceptions. Additionally, this study emphasises the significance of a balanced team composition that incorporates diverse conceptions of the role. Finally, actions should be taken to empower leadership among nurses. IMPACT: Identified dynamics offer insights for healthcare organisations developing nurse practitioner roles. Educational institutions can use these insights to enhance healthcare professionals' curricula, preparing healthcare professionals for evolving advanced nursing roles and leadership. Additionally, it emphasises the necessity for policy work to establish a legal framework for nurse practitioners in Belgium. REPORTING METHOD: The 'Standards for Reporting Qualitative Research' were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: This study did not involve direct participation from patients or the public.

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.

BACKGROUND: 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. METHODS: 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. FINDINGS: 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. CONCLUSIONS: 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.

The power of arts-based film interventions to encourage Black blood donors.

BACKGROUND: Blood services must consider innovative ways to encourage more Black people to donate to enhance the efficacy of treatments. We evaluate how two innovative arts-based approaches (co-designed and locally produced films and a large-scale Marvel Studios'/NHSBT collaboration) can achieve this by generalizing to a wider audience from their target audiences. STUDY DESIGN AND METHODS: Four co-designed short community films were produced in the United Kingdom: Comedy, Reciprocity, Donor-Recipient, and Sliding Doors. In Study 1 (N = 44: Black people), these films were evaluated in the target community in which they were produced. In Study 2 (N = 1237: Black = 638, White = 599), the community and Marvel Black Panther/NHSBT films were evaluated in a nontarget general population sample. Evaluations were in terms of campaign behavioral efficacy (e.g., willingness to donate, encourage others to donate) and affect. These analyses were segmented by donor status, age, and gender. RESULTS: Study 1 shows that the community groups rated the films very positively, with over 90% stating that they would be convinced to donate blood. Study 2 shows the results from the community films generalized to the general population, with the Black Panther film also rated positively in the general population. Three community films and the Black Panther film were rated equally positively. There were notable differences across generations and by donor status. DISCUSSION: The results highlight the power of arts-based approaches (both locally co-produced community films and franchise collaborations) in encouraging donors within their target audiences and, importantly, on the broader population.

Engaging athletes as research participants. A document analysis of published sport science literature.

Sport science practitioners utilise findings from peer reviewed research to inform practice. Fewer studies are conducted with high performance athletes, however, than those involving recreationally active participants. Noting that research findings from recreational athletes may not be generalisable to the elite, there is a need to engage the latter cohort in research with better potential to influence health and performance. This study identified methods used to engage and recruit highly trained, elite and world class athletes as research participants. A document analysis was conducted using a purposive sample of peer-reviewed sport science literature. All articles published in 2022 from 18 highly ranked sport science journals were screened for inclusion. Studies investigating athletes ranked as highly trained/national level or above were included. All details related to participant recruitment were extracted from included articles, with the content being coded and thematically analysed using an interpretivist approach. A total of 439 studies from the 2356 screened were included in the analysis. Five primary themes of recruitment strategies were identified, beneath an overarching strategy of purposeful, convenience sampling. Recruitment themes related to the use of a gatekeeper, the research environment providing convenient access to athletes, promoting the study electronically, utilising professional networks and recruiting at training or competition. Engaging athletes through a gatekeeper is a prominent strategy to involve elite athletes in research. It is suggested that researchers work collaboratively with team or organisation personnel to promote recruitment, creating co-designed approaches that address issues most relevant to athletes and staff.

Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study.

BACKGROUND: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. OBJECTIVE: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. METHODS: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. RESULTS: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. CONCLUSIONS: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. TRIAL REGISTRATION: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56957.

Identifying research priorities and essential elements of palliative care services for people facing malignant brain tumors: A participatory co-design approach.

Background: Primary malignant brain tumors (ie, brain cancer) impact the quality of life (QoL) for patients and care partners in disease-specific ways involving cognition and communication. Palliative care (PC) addresses patient/care partner QoL, but it is not known how PC may address the unique needs of brain cancer patients. The purpose of this project was to identify brain cancer PC research priorities using participatory co-design methods. Methods: Participatory co-design included the formation of a longitudinal, collaborative advisory group, engagement frameworks, design-thinking processes, and social media-based engagement over a 1-year period. Community-identified brain cancer QoL needs and research priorities were mapped to proposed "essential elements" of brain cancer PC services. Results: We engaged an estimated 500 patients, care partners, healthcare professionals, and others with an interest in QoL and PC services for people with malignant brain tumors. Research priorities included testing the early introduction of PC services designed to address the unique QoL needs of brain cancer patients and care partners. Essential elements of brain cancer PC include: (1) addressing brain cancer patients' unique range of QoL needs and concerns, which change over time, (2) tailoring existing services and approaches to patient needs and concerns, (3) enhancing the involvement of interprofessional care team members, and (4) optimizing timing for PC services. This was the first participatory research effort exploring brain cancer patient and care partner QoL needs and PC services. Conclusions: The brain tumor community calls for research testing PC service models for patients that incorporate the "essential elements" of palliative care.

Co-designing planning interventions to facilitate participation in mail-out bowel cancer screening.

BACKGROUND: Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. METHODS: Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. RESULTS: Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. CONCLUSIONS: These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.

Translating research evidence into youth behavioral health policy and action: using a community-engaged storyboard approach.

Introduction: There is nationwide shortage of child and adolescent behavioral health providers. Lack of diversity in the mental health care profession compounds workforce capacity issues, contributing to greater disparities in treatment access and engagement for youth from historically disenfranchised communities. Strategies are needed to foster cross-sector alignment to inform policy which can improve mental health care access and reduce disparities. This current case study details a specific research-practice-policy partnership strategy, storyboarding, as a method to engage community partners in Washington State to deliberate on information drawn from research on non-specialist models of child and adolescent mental health care to support the behavioral workforce expansion. Method: Research evidence from a scoping literature review on non-specialist models of child and adolescent mental health care was shared via storyboards with community partners to inform policy efforts around the behavioral health workforce expansion. In Phase 1, community members with lived experience and clinical expertise contributed to the storyboard design process. In Phase 2, a broader community partner group shared their perspectives on the models of care presented in the storyboards via Qualtrics survey with open-ended questions. Listening sessions were also held with non-English speaking refugee and immigrant communities to elicit feedback on whether these models of care would meet their needs. Qualitative data was coded to explore emerging themes using a rapid deductive approach. Results: Community partners shared mixed responses to models of care presented from the research literature. Immigrant and refugee communities explicitly stated these existing models would not fit their context. Regarding partnership strategy success, the smaller community partner group was engaged in the storyboard design process. The broader community interacted with and provided detailed responses to the models of care presented in the storyboards. Success was also reflected in community partners' continued participation in the next stage of the project. Discussion: Findings demonstrate how storyboarding can be effectively used to translate research evidence into accessible information to promote community partner engagement and capture community voice in policy processes. More work is needed exploring how such methods can be used to increase the use of research evidence in policy and practice spaces.

A stakeholder co-design approach to designing a dental service for adults experiencing homelessness.

Introduction: The homeless population faces a "cliff edge of inequality" when trying to access essential dental services. There are several additional barriers to accessing dental care in comparison to the general population and the heterogeneous nature of patients presents a significant challenge when designing dental services to meet their needs. Following the Smile4Life report in 2009, there is limited up-to-date and population-specific evidence available for the optimal model of service delivery. Aim: This study aimed to co-design principles for a prospective dental service for adults experiencing homelessness. Methods: A qualitative methodology was used to incorporate experts-by-experience into elements of co-designing a dental service for adults experiencing homelessness. The study combined elements of an experienced-based co-design framework for healthcare innovation with community-based participatory research. Focus groups with people experiencing homelessness and healthcare practitioners were conducted to identify principles for any prospective dental service, as well as several barriers and enablers to establishing a homeless dental service. The findings were transcribed and analysed using thematic analysis on Nvivo software. Results: From the qualitative analysis five key themes emerged: (1) Impact and expectations of oral health while experiencing homelessness, (2) Barriers to accessing dental care; (3) Practitioner's views about homelessness and access to care; (4) Barriers to designing a homeless service and (5) Enablers for co-designing a new model of dental care delivery for the homeless population.Five key principles for a new model of homeless dental service were identified: (i) Services designed to address the needs of patients; (ii) Services delivered in a safe and welcoming environment (iii) Training and consistency of staff; (iv) Focus on dental education (v) Developing peer mentoring and peer support. Conclusion: While the barriers to accessing dental care while homeless are well established and understood by healthcare practitioners, more work is required to gain consensus on the most effective way to deliver an innovative a sustainable dental service for patients experiencing homelessness. Previous negative experiences, lack of readily available information on services and barriers to access in the current system could be addressed by developing peer mentors within the homeless community, empowering individuals to share their knowledge and skills to support others in improving their oral health.

Capitalizing on Community Groups to Improve Women's Resilience to Maternal and Child Health Challenges: Protocol for a Human-Centered Design Study in Tanzania.

BACKGROUND: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. OBJECTIVE: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. METHODS: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women's engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. RESULTS: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women's resilience and readiness to handle MCH challenges will be generated. CONCLUSIONS: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54323.

Co-designing a vaping cessation program for Australian young adults: A conceptual model.

INTRODUCTION: Australian young adults (YA) report difficulties in quitting vaping. This study sought to understand what a vaping cessation program should look like from the perspective of current and former vapers, and professionals/experts involved in this health space, to inform the development of a conceptual model. METHODS: Data collection was informed by Social Cognitive Theory using co-design methodology to explore vaping cessation. Interactive workshops and semi-structured interviews were held online between March 2023-January 2024, with data from participants' narratives and written materials thematically analysed. RESULTS: YAs (18-24 years) identifying as current or former vapers (n=15) and health professionals/experts'(n=13) insights informed the model framework, incorporating three main elements based on environmental, personal and behavioural factors shaping vaping cessation. Four design considerations were identified; the program needs to be affordable, accessible, appropriate and adaptable. YAs expressed a strong preference to share their quitting journey with peers, endorsing a digital forum providing a hybrid framework of support. CONCLUSIONS: Vaping cessation is nuanced and complex requiring a multi-faceted approach targeted to the specific needs of the young adult population. IMPLICATIONS: The findings can be used to inform the development of a vaping cessation program tailored to young adults in Australia and other similar contexts. Young adults perceived sharing the quitting journey and being inspired by the lived experience of others as critical components for successful vaping cessation. Social Cognitive Theory is demonstrated to be a valuable behaviour change framework for understanding vaping cessation and should be considered in future research of intervention development.

Evaluation of research co-design in health: a systematic overview of reviews and development of a framework.

BACKGROUND: Co-design with consumers and healthcare professionals is widely used in applied health research. While this approach appears to be ethically the right thing to do, a rigorous evaluation of its process and impact is frequently missing. Evaluation of research co-design is important to identify areas of improvement in the methods and processes, as well as to determine whether research co-design leads to better outcomes. We aimed to build on current literature to develop a framework to assist researchers with the evaluation of co-design processes and impacts. METHODS: A multifaceted, iterative approach, including three steps, was undertaken to develop a Co-design Evaluation Framework: 1) A systematic overview of reviews; 2) Stakeholder panel meetings to discuss and debate findings from the overview of reviews and 3) Consensus meeting with stakeholder panel. The systematic overview of reviews included relevant papers published between 2000 and 2022. OVID (Medline, Embase, PsycINFO), EBSCOhost (Cinahl) and the Cochrane Database of Systematic reviews were searched for papers that reported co-design evaluation or outcomes in health research. Extracted data was inductively analysed and evaluation themes were identified. Review findings were presented to a stakeholder panel, including consumers, healthcare professionals and researchers, to interpret and critique. A consensus meeting, including a nominal group technique, was applied to agree upon the Co-design Evaluation Framework. RESULTS: A total of 51 reviews were included in the systematic overview of reviews. Fifteen evaluation themes were identified and grouped into the following seven clusters: People (within co-design group), group processes, research processes, co-design context, people (outside co-design group), system and sustainment. If evaluation methods were mentioned, they mainly included qualitative data, informal consumer feedback and researchers' reflections. The Co-Design Evaluation Framework used a tree metaphor to represent the processes and people in the co-design group (below-ground), underpinning system- and people-level outcomes beyond the co-design group (above-ground). To evaluate research co-design, researchers may wish to consider any or all components in the tree. CONCLUSIONS: The Co-Design Evaluation Framework has been collaboratively developed with various stakeholders to be used prospectively (planning for evaluation), concurrently (making adjustments during the co-design process) and retrospectively (reviewing past co-design efforts to inform future activities).

Co-designing a motivational interviewing training platform to enhance oncology healthcare professional communication.

Background: Oncology healthcare professionals (HCPs) using motivational interviewing may motivate and support patients with chronic illness to adhere to medications. Research of online motivational interviewing training focusing on medication adherence in cancer is limited. Objective: Co-design, develop, and preliminarily evaluate a motivational interviewing training platform (MITP) for oncology HCPs focused on medication adherence. Methods: We used co-design and design science research methodology to develop and test the MITP in two phases: 1) program co-design and development and 2) interactive platform design and development. Results: HCPs expressed a high demand for a practical and tailored motivational interviewing training. MITP is an online three-hour training comprising education, roleplay videos, and formative assessments. MITP was reported to be acceptable, usable, and useful by users. Innovation: This study used a novel approach combining co-design and design science research methodology, and digital media to develop a flexible and acceptable online motivational interviewing training focused on medication adherence in cancer. Discussion and conclusion: Applied rigorous methodology ensured the MITP was developed to address knowledge gaps and the needs of oncology HCPs for supporting patient adherence, and to be usable and useful. Study findings may inform future research on online motivational interviewing training and its potential impact on medication adherence.

Understanding and using experiences of social care to guide service improvements: translating a co-design approach from health to social care.

Background: Local authorities need to find new ways of collecting and using data on social care users' experiences to improve service design and quality. Here we draw on and adapt an approach used in the healthcare improvement field, accelerated experience-based co-design, to see if it can be translated to social care. We use loneliness support as our exemplar. Objectives: To understand how loneliness is understood and experienced by members of the public and characterised by social care and voluntary sector staff; to identify service improvements around loneliness support; to explore whether accelerated experience-based co-design is effective in social care; and to produce new resources for publication on Socialcaretalk.org. Design and methods: Discovery phase: in-depth interviews with a diverse sample of people in terms of demographic characteristics with experience of loneliness, and 20 social care and voluntary staff who provided loneliness support. Production of a catalyst film from the public interview data set. Co-design phase: exploring whether the accelerated experience-based co-design approach is effective in one local authority area via a series of three workshops to agree shared priorities for improving loneliness support (one workshop for staff, another for people with experience of local loneliness support, and a third, joint workshop), followed by 7-monthly meetings by two co-design groups to work on priority improvements. A process evaluation of the co-design phase was conducted using interviews, ethnographic observation, questionnaires and other written material. Results: Accelerated experience-based co-design demonstrated strong potential for use in social care. Diverse experiences of participants and fuzzy boundaries around social care compared to health care widened the scope of what could be considered a service improvement priority. Co-design groups focused on supporting people to return to pre-pandemic activities and developing a vulnerable passenger 'gold standard' award for taxi drivers. This work generated short-term 'wins' and longer-term legacies. Participants felt empowered by the process and prospect of change, and local lead organisations committed to take the work forward. Conclusions: Using an exemplar, loneliness support, that does not correspond to a single pathway allowed us to comprehensively explore the use of accelerated experience-based co-design, and we found it can be adapted for use in social care. We produced recommendations for the future use of the approach in social care which include identifying people or organisations who could have responsibility for implementing improvements, and allowing time for coalition-building, developing trusted relationships and understanding different perspectives. Limitations: COVID-19 temporarily affected the capacity of the local authority Project Lead to set up the intervention. Pandemic work pressures led to smaller numbers of participating staff and had a knock-on effect on recruitment. Staff turnover within Doncaster Council created further challenges. Future work: Exploring the approach using a single pathway, such as assessing eligibility for care and support, could add additional insights into its transferability to social care. Trial registration: This trial is registered as Current Controlled Trials ISRCTN98646409. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128616) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 27. See the NIHR Funding and Awards website for further award information.

Local councils need to find new ways of using people's experiences of social care to improve services. We explored whether a way of improving health services can improve social care services. 'Experience-based co-design' is a complicated name. It means working with people who use health or social care services to improve that service, and interviewing people as part of this process. Accelerated experience-based co-design uses existing interviews instead of new interviews. To see if the approach works in social care, we chose the topic of loneliness because many of us experience loneliness. We worked with Doncaster City Council because it has been focusing on loneliness. We interviewed 37 people across England and recorded what they said about loneliness. We made a film about their experiences that showed examples of good or poor care. We call these touch points. We held three workshops in Doncaster. Workshop 1 was with people who work in social care as paid workers or volunteers, and workshop 2 was with people who use social care services. In both workshops, people made a list of types of support that needed improvement. Both groups attended workshop 3, watched the film and decided what to focus on from the two lists. Two groups were set up to work on improving support for loneliness in Doncaster. Each group met seven times. One focused on taxi services, and the other group focused on supporting people to do activities they did before the pandemic. A researcher attended these meetings and talked with everyone involved to see how this approach worked. At the end, there was a celebration event. We found that loneliness is complicated. We found the approach to improving support does work in social care, but it needs some changes because social care is not like health care. We suggest ways the approach can be done differently.