How doctors can lead the way in their communities: Co-creation, the Indian community and organ donation registration.

BACKGROUND AND AIMS: Transplant success rates can increase when organs and tissues are matched within ethnic communities, but how well are the processes around organ donation understood by discrete ethnic communities in Australia? We investigated this in relation to one ethnic group, the Australian-Indian community in Sydney. METHODS: A culturally appropriate survey and dissemination strategy was co-created with Indian community members through an Advisory Panel. Items were informed by a thematic analysis of cultural beliefs shared through the advisory panel discussions and measured awareness and practices associated with organ donation and transplantation and beliefs about organ donation and registration. Donation information was provided at the end. RESULTS: Two hundred and thirty-eight participants completed the survey. Hinduism along with Tamil and Gujarati were the most frequently identified religious and cultural backgrounds. The processes around organ donation were not well known, and Australian Organ Donor Register registration rates were below the national average. Principal component analysis revealed positive, social, medical trust, concerns, and cardiac and brain death belief factors. Doctors played a key role in generating trust in the donation system, decisions about organ donation were embedded in family and community, and family discussion was related to increased registration. Registered participants reported higher scores on medical trust beliefs, which also predicted family discussion. CONCLUSION: The information needed to understand the process of organ donation and registration in Australia is not embedded in this community, highlighting the need for programmes to be tailored to each culturally diverse community rather than culturally diverse communites in general. Doctors and the advisory panels are pivotal in this process.

Protocol of a randomized controlled trial into guided internet-delivered cognitive behavioral therapy for insomnia in autistic adults (i-Sleep Autism).

BACKGROUND: Sleep problems, especially insomnia, are prevalent among autistic adults, affecting about 60 %, and significantly impact their quality of life. Internet-based cognitive behavioral therapy for insomnia (iCBT-I) could provide accessible and scalable treatment. Given the unique sensory- and information processing, and social challenges at play in autism, a tailored treatment approach may be essential to tackle sleep problems. Yet, interventions developed and tested specifically for autistic adults were scarce. Addressing this gap is crucial to meet the urgent need for effective insomnia treatments in this population. METHODS: With this two-arm, parallel, superiority randomized controlled trial, we will assess the effectiveness of a guided iCBT-I intervention for adults (N = 160) with autism and insomnia (i-Sleep Autism). In co-creation, i-Sleep Autism has been adjusted from an existing intervention (i-Sleep). Inclusion criteria are: age ≥ 18, an ASD diagnosis, and at least sub-threshold insomnia (Insomnia Severity Index ≥10). Participants are randomly assigned to either i-Sleep Autism or an information only waitlist control condition (online psychoeducation and sleep hygiene). After 6 weeks, the control group receives the intervention. Insomnia severity is the primary outcome. Secondary outcomes include pre-sleep arousal, general mental health, depression, anxiety, daily functioning, and quality of life. Assessments will occur at baseline, mid-intervention (3 weeks), post-intervention (6 weeks), and at 6-month follow-up (the intervention group). Linear mixed-effect regression models are employed to evaluate the effectiveness of i-Sleep Autism, alongside exploration of potential moderators and mediators. CONCLUSION: This trial can reveal whether autistic adults with insomnia benefit from a guided e-health intervention. TRIAL REGISTRATION: NL-OMON56692.

Doctor interaction behavior, patient participation in value co-creation and patient satisfaction: cross-sectional survey in a tertiary-level hospital from Guangzhou, China.

Value co-creation can be defined as the joint benefit that is created by patients and medical service providers through the integration of their respective resources. Participation and interaction between doctors and patients can generate an outcome that benefits both sides. Relevant studies of value co-creation in the healthcare field are limited. This study established hypotheses to explore the association between doctor interaction behavior, patient participation in value co-creation, and patient satisfaction. A cross-sectional survey was conducted with 637 patients (outpatients and inpatients) at a tertiary-level hospital in Guangzhou, China. The analysis result indicated that doctor interaction behavior could stimulate patient participation in value co-creation then increase patient satisfaction. The standardized total effect, direct effect, and indirect effect were 0.641 (95%CI: 0.055 ~ 0.067), 0.546 (95%CI: 0.044 ~ 0.059), and 0.095 (95%CI: 0.032 ~ 0.166), respectively. Patient participation in value co-creation mediated the relationship between doctor interaction behavior and patient satisfaction. Among the different dimensions of doctor interaction behavior, access, risk assessment and transparency dimensions were associated with positive patient participation in value co-creation. During the treatment process, doctor interaction and patient participation can get satisfying results.

Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study.

BACKGROUND: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. OBJECTIVE: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. METHODS: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. RESULTS: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) "Medication safety reflexive spaces" focused on social and health care assistants. CONCLUSIONS: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43538.

The Dilemmas and Opportunities of Co-Creating Health Interventions to Fit Local Contexts: An Ethnographic Study on the Adaptation of Clinical Guidelines in Tanzania.

INTRODUCTION: Healthcare providers' role in co-creating health interventions and implementation strategies has evolved significantly, and yet, there is little documentation of this from low-resource settings. This study aims to share the dilemmas of engaging healthcare providers in co-creating locally adapted clinical guidelines for maternity facilities in Dar es Salaam, Tanzania, and strategies used to address them. METHODS: An ethnographic study explored the co-creation of locally adapted clinical guidelines for childbirth care within five maternity facilities in Dar es Salaam. Participant observations were conducted during 11 co-creation workshops. Six in-depth interviews explored participant experiences. Data were analyzed using Attride-Stirling's thematic network analysis framework. RESULTS: The analysis revealed four themes representing dilemmas in the co-creation process and strategies to improve co-creation: (i) navigating diverse contexts: adapting a single set of guidelines to various, diverse facilities was challenging; this was addressed through engaging in dialogue and flexibility while adjusting care practices. (ii) Competing knowledge systems and sources: differing knowledge sources between researchers and healthcare providers challenged discussions on recommended practices. However, validating scientific recommendations with practical care experience in this context helped bridge this gap. (iii) Fostering meaningful participation: participation was time-consuming for some. However, early stakeholder engagement and facility-led participant selection facilitated the meaningful involvement of healthcare providers. (iv) Power imbalances: power dynamics influenced the co-creation process; involving stakeholders in planning and co-facilitating workshops helped mitigate these imbalances and encourage more equal participation. CONCLUSION: Navigating contextual variation, differences in knowledge systems, meaningful participation and power dynamics were key challenges in the co-creation process. However, reflexivity, open and honest dialogue with stakeholders and early engagement enhanced the co-creation process. Co-creating locally adapted clinical guidelines with frontline healthcare workers and scientific experts is essential for feasibility and safety. Further research is needed to explore context specificity, decision-making and the efficacy of co-creation in low-resource settings. PATIENT OR PUBLIC CONTRIBUTION: Healthcare providers and health managers from five maternity facilities who participated in the co-creation process were actively involved in this study by providing their consent to be interviewed about their experiences of participation. CLINICAL TRIAL REGISTRATION: This study is a substudy within the PartoMa project. PartoMa is a registered clinical trial with the trial registration number NCT04685668. PartoMa's date of initial trial registration is 28 December 2020.

A community-centric model for conference co-creation: the world conference on CDG for patients, families and professionals.

BACKGROUND: Patient and public co-creation and involvement in health initiatives have been witnessing great expansion in recent years. From healthcare to research settings, collaborative approaches are becoming increasingly prevalent and diverse, especially in the field of rare diseases which faces complex challenges. Conference development and implementation, however, have been primarily guided by passive, information-sharing models. There is a need for conferences to evolve towards more inclusive, interactive, collaborative, and problem-solving platforms. Here, we aimed to report on a pioneer model, emphasizing a community partnership approach to conference co-creation that takes the World Conference on Congenital Glycosylation Disorders (CDG) as an exemplary case. METHODS: To answer the need to overcome the lack of access to high-quality information which limits CDG diagnosis, research and treatment options, the World CDG Organization has been refining a community-centric model for conference co-creation. Focusing on the 5th edition of the conference, data on stakeholders' preferences was collected using an online survey and a poll to define the conference agenda, guide its development and select optimal dates for an all-stakeholder inclusive, relevant and participatory event. RESULTS: We describe the complexities of the community-centric conference co-creation model, detailing its refined methodology and the outcomes achieved. The model is grounded on a participative approach to promote people-centered research and care for CDG patients. The involvement of the public in the conference co-creation and in participatory methods allowed the generation of knowledge on community needs and preferences. CONCLUSION: This paper describes a reliable, highly adaptable conference co-creation model that fosters community-building, disseminates understandable information, and serves as a borderless platform to incentivize multiple stakeholder collaborations towards CDG research and drug development. We argue this is a reproducible model that can be endorsed and more widely adopted by other disease communities and events.

In recent years, there has been a growing trend towards involving patients and the public in healthcare and research, transforming traditional conferences that follow a one-way information-sharing approach into inclusive and interactive platforms. This study presents a unique conference co-creation model established by the World Congenital Disorders of Glycosylation (CDG) Organization that emphasizes partnership with the community in its design and implementation. Besides involving the community in the planning phase, the model also uses other participatory methods. The 5th World Conference on CDG, held in 2021, serves as a prime example of this approach. The resulting community partnership model is shown to produce outcomes tailored to community needs, promoting people-centered research and care. This model is reproducible and easily adaptable by other disease communities and events to promote collaboration and problem-solving.

Co-Designing a Conversational Agent With Older Adults With Chronic Obstructive Pulmonary Disease Who Age in Place: Qualitative Study.

BACKGROUND: As a reaction to the global demographic increase in older adults (aged 60+ years), policy makers call for initiatives to enable healthy aging. This includes a focus on person-centered care and access to long-term care for older adults, such as developing different services and digital health technologies. This can enable patients to engage in their health and reduce the burden on the health care systems and health care professionals. The European Union project Smart Inclusive Living Environments (SMILE) focuses on well-being and aging in place using new digital health technologies. The novelty of the SMILE project is the use of a cocreational approach focused on the needs and preferences of older adults with chronic obstructive pulmonary disease (COPD) in technology development, to enhance access, adaptation, and usability and to reduce stigma. OBJECTIVE: The study aimed to describe the perspective, needs, and preferences of older adults living with COPD in the context of the design and development of a conversational agent. METHODS: This study carried out a data-driven thematic analysis of interview data from 11 cocreation workshops with 33 older adults living with COPD. RESULTS: The three particular features that the workshop participants wanted to implement in a new technology were (1) a "my health" function, to use technology to manage and learn more about their condition; (2) a "daily activities" function, including an overview and information about social and physical activities in their local area; and (3) a "sleep" function, to manage circadian rhythm and enhance sleep quality, for example, through online video guides. In total, 2 overarching themes were identified for the 3 functions: measurements, which were actively discussed and received mixed interest among the participants, and health literacy, due to an overall interest in learning more about their condition in relation to everyday life. CONCLUSIONS: The future design of digital health technology must embrace the complexities of the everyday life of an older adult living with COPD and cater to their needs and preferences. Measurements should be optional and personalized, and digital solutions should be used as a supplement to health care professionals, not as substitute.

No need to be rebellious: placemaking and value co-creation in the skateboarding City of Malmö.

During the last 20 years, Malmö has developed into an internationally recognised skateboarding destination and a valued skateboarding place for local and regional skaters. In contrast to many cities, skateboarding and skateboarders have been appreciated and embraced in public planning and development. The aim of the paper is to discuss the development and identity of Malmö as a skateboarding city through the lens of the concepts of placemaking and value co-creation, and-not least-through the narratives of six persons with different relations to skateboarding and Malmö. The paper shows that the City of Malmö has engaged with local skateboarding communities through several initiatives that have fostered a collaborative relationship. The non-profit association Bryggeriet, a skateboard high school, an active skateboarding community, and the City of Malmö are all involved in the placemaking and co-creation of Malmö as a skateboarding city. The city's approach to skateboarding involves a bottom-up strategy, engaging non-experts in the development of spaces, reflecting a shift from traditional top-down models towards a co-creation model in order to create synergetic outcomes. Malmö's transformation into a skateboarding city is characterised by the integration of skateboarding into the urban fabric, showcasing a welcoming attitude. The paper underscores the dynamic interplay between physical, imagined, and lived spaces in urban skateboarding culture. However, it also demonstrates how a successful and professionalised model for introducing the skateboarders' interests into the corridors of power risks undermining the link to, and the engagement of, the new generation of grassroots skaters, and maybe also the edgy, rebellious character of skateboarding.

Interfacing triple bottom line sustainability and metropolitan governance: An empirical exploration of stakeholder value co-creation and conflict.

The importance of metropolitan governance and stakeholder collaboration in sustainable urban development (SUD) is well recognized. However, collaboration among stakeholders is dynamic, and the relationship between metropolitan governance and stakeholder dynamics, including value co-creation and conflict, remains underexplored. This study aims to address this gap by examining the causal relationships among metropolitan governance, stakeholder value co-creation and conflict through the lens of the triple bottom line (TBL) of sustainability. Using a questionnaire survey, this study collected 467 valid responses through a combination of probability and quota sampling and analyzed the data using Structural Equation Modeling. The results indicated that stakeholder value co-creation is positively influenced by TBL dimensions and metropolitan governance, thereby simultaneously promoting SUD and generating potential conflicts that constrain SUD. The study further evaluated the effectiveness of stakeholder value co-creation as a mediating variable and found that it has a unique suppressing effect on the relationship between environmental sustainability and conflict. The findings suggested that environmental sustainability-driven governance initiatives are crucial to containing conflict and fostering value co-creation among stakeholders. Theoretically, this study enriches the discourse on SUD literature by quantifying the interactions between TBL, metropolitan governance and stakeholder dynamics. Practically, it provides certain implications for relevant practitioners by proposing an argument that governance initiatives can be aligned with the shifting priorities toward environmental sustainability.

A participatory research to assess how a student citizens' assembly can facilitate the co-creation of nutrition interventions in higher education settings.

BACKGROUND: The transition period from adolescence to early adulthood is critical for developing new nutritional behaviors, making higher education students an important target group for public health nutrition interventions. Given the complexity of nutrition-related behaviors and their various determinants, involving the student population (the future beneficiaries of interventions) and the partners engaged in their implementation when designing campus nutrition interventions is essential. Citizens' assemblies are deliberative processes which are more and more frequently organized to co-create solutions to complex problems. This study aims 1) to design and implement a student citizens' assembly using participatory research methods, 2) to describe its process and evaluate its transferability, 3) to evaluate changes in dietary habits, knowledge and citizen practices among students participating in this assembly. METHODS: This study will take place at a French university (University Sorbonne Paris Nord, USPN) located in socio-economically disadvantaged suburbs of Paris. The student citizens' assembly will gather a mini-public of 30 students enrolled at the time of the study and a co-creation team of academic and non-academic partners involved in student life, nutrition, physical activity, or public policies. The aim of the assembly is to co-create a set of concrete proposals that would enhance USPN students' access to sustainable diets and physical activity. The protocol is based on a continuous process evaluation and a pre-post design among the mini-public. A mixed-method framework combining quantitative and qualitative approaches will be developed. This study will make use of (i) field observations of the intervention process and transferability, (ii) data collected by questionnaires on pre- and post- dietary habits, knowledge and citizen practices of the mini-public, and (iii) pre-post interviews with a subsample of the same mini-public. DISCUSSION: Relying on participatory research methods, this study will provide new insights into involving higher education students and diverse partners in co-creating campus nutrition interventions. Through the collaborative work of researchers, higher education students, university representatives, public institutions, and local and community actors, this study will provide evidence-based guidance for designing innovative and contextually-relevant nutrition interventions in the higher education setting. TRIAL REGISTRATION: This research was registered at the ClinicalTrial.gov (NCT06580795; registration date: 2024-08-30; https://www. CLINICALTRIALS: gov/study/NCT06580795 ).

Ethical implications in using robots among older adults living with dementia.

The aging of the world's population due to accelerating demographic shift on all continents is causing increasing pressure worldwide, giving rise to a "crisis of care" or "care wave." The increase in longevity is resulting in an increase in chronic diseases (such as dementia), an increase in care needs to perform the activities of daily living, and situations of isolation and profound loneliness among older adults. These circumstances are opening the debate on the need to use technology, such as robots, to improve the wellbeing of older adults and their caregivers. The aim of this paper is to address the ethical questions in using social and companion robots for people with dementia, such as concerning consent, the replacement of human care, the potential for increased dependency, and the burden on caregivers. Involving older adults and other stakeholders offers the potential to pursue robotics to support older people while also ensuring a strong ethical commitment. The study is a review of high-impact articles on the topic of the use of social and companion robots with older people with dementia.

Adapting Group Model Building for Mental Healthcare: A Participatory Co-Design Approach.

Countries around the world are experiencing both a growing need for mental health services and major gaps in the delivery of mental healthcare. The World Health Organisation's 2022 report on mental health emphasised co-designed and systems-level innovations responsive to the voice of those with lived experience. However, evidence for implementing such methodologies is sparse. Group model building (GMB), a participatory systems-based approach, has been used in various fields, but its application is limited within mental healthcare settings. It is recognised as a valuable tool for engaging stakeholders, including those with lived experience, in understanding and redesigning health systems and services. The participatory approach aligns with the mental health sector's shift towards co-design and person-centred care. This study assessed the acceptability of GMB as a method for co-design within mental healthcare, aiming to explore its potential for meaningful collaborative improvement and systems-level insights. Participants from a regional Mental Health and Drug and Alcohol Service (MHDAS) engaged in GMB workshops and focus groups. Eighteen individuals, including lived experience workers and healthcare professionals, provided feedback that informed adjustments to the workshops' design, language, timing and facilitation techniques, enhancing GMB's relevance for mental health co-design. The findings demonstrate the value and acceptability of the adapted GMB process in acute mental healthcare, marking a significant step towards evidence-based, person-centred service improvement. This study highlights the potential effectiveness of participatory methods in identifying and addressing systemic challenges, paving the way for future mental health reforms. Future work will focus on implementing and evaluating co-designed interventions, aiming for more inclusive and effective mental healthcare and advancing innovation and reform in the field.

Cocreation of social value: A tripartite game analysis with Chinese state-owned enterprises as an example.

In the context of the digital economy era, it is urgent for Chinese state-owned enterprises (SOEs) to engage in social value cocreation activities. The government and consumers' roles in SOEs' social value cocreation system cannot be ignored. Therefore, it is necessary to explore the tripartite social value cocreation model involving the government, SOEs, and consumers. In this respect, this study constructs a tripartite evolutionary game model of the government, SOEs, and consumers, and explores the influencing factors and evolutionary mechanism of the system overall. Matlab software is used to analyze the simulation data. The results reveal that the prerequisite for SOEs' successful social value cocreation is that consumers receive additional social value benefits greater than the level of improvement in social welfare. The allocation coefficient of consumers' additional social value benefits, the degree of the government's digital empowerment subsidy, and the level of the punishment for SOEs that violate the government's cocreation requirements will accelerate the achievement of equilibrium in the social value cocreation system, without affecting the final equilibrium result. By analyzing the strategic choices and interactive relationships among the government, SOEs, and consumers in social value cocreation in-depth, this study offers suggestions to promote the government, SOEs, and consumers' participation in social value cocreation. This research contributes to clarifying SOEs' social value cocreation model and has significant implications for promoting enterprises' high-quality development.

A social cognitive theory of customer value co-creation behavior: evidence from healthcare.

PURPOSE: Customer value co-creation behavior is promising but undertheorized. To bridge this gap, this study examines the viability of a social cognitive theory positing that customers' value co-creation behavior is shaped by their co-creation experience, self-efficacy, and engagement. DESIGN/METHODOLOGY/APPROACH: Using healthcare as a case, a stratified random sample comprising 600 patients from 40 hospitals across eight metropolitan cities in an emerging economy was acquired and analyzed using co-variance-based structural equation modeling (CB-SEM). FINDINGS: Customers' co-creation experience has a positive impact on their co-creation self-efficacy, co-creation engagement, and value co-creation behavior. While co-creation self-efficacy and engagement have no direct influence on value co-creation behavior, they do serve as mediators between co-creation experience and value co-creation behavior, suggesting that when customers are provided with a co-creation experience, it enhances their co-creation self-efficacy and engagement, ultimately fostering value co-creation behavior. ORIGINALITY/VALUE: A theory of customer value co-creation behavior is established.

Geodesign to advance boundary work in urban planning: A study in Stockholm focused on nature-based solutions.

Geodesign supports collaborative urban planning by managing 'boundaries' between diverse knowledge holders. However, there is a paucity of empirical evidence of its contribution to 'boundary work'. This paper aims to evaluate how a geodesign process facilitates knowledge co-production through boundary work and to assess the scientific credibility, political saliency, and procedural legitimacy of its outputs in urban planning. We propose a replicable geodesign framework to assess boundary work, and test it in a case study on urban transformations with nature-based solutions in the Skarpnäck district of Stockholm, Sweden. Findings indicate that all geodesign steps facilitated communication by promoting collective reasoning. Participants acknowledged contributions to knowledge co-production and decision-making by mediating between different perspectives. However, data quality and modeling simplicity were identified as critical factors affecting the outputs' perceived credibility. Future applications should include co-designing the geodesign process, improving capacity and skills, and facilitating more integrated planning.

[A practical model to implement the patient participation in tertiary hospitals (ICE model)]. / Un modelo práctico para implementar la participación de pacientes en hospitales terciarios (modelo ICE).

OBJECTIVE: Democratise healthcare and research through a model that ensures the participation of patients and professionals. METHOD: Weaknesses are analysed and corrections are articulated with a model through biweekly meetings between the hospital's citizen attention and healthcare management. RESULTS: The resulting model is proactive in nature, deployed between November-2021 and December-2023 and had three elements: Information, Co-creation and Strategy (ICE). The Information is materialized with: an Association Attention Office (AAO) and an Easy Reading Commission (ERC). Co-creation is organized through Stable Work Commissions (SWC) formed by professional-patient. The Strategy that is materialized through a Strategic Plan for institutional participation and a Strategic Committee for participation. The AAO has registered 304 entities and managed 112 projects. The ERC has evaluated 41 documents in 2023. 13SWCs related to therapeutic areas were generated where 108 professionals and 101 patient representatives participated and 42 objectives were agreed upon, working on templates for informative documents, guides or organizing informative days. The Strategic Participation Plan is translated into 8lines with objectives and actions, creating the Strategic Participation Committee as the governing body. CONCLUSIONS: The ICE-VH model is a replicable opportunity to implement patient and professional participation in any hospital and improve person-centered care by incorporating the values and preferences of all stakeholders.

Governance intricacies in implementing regional shared care records: A qualitative study in the national health service, England.

OBJECTIVES: This study explores the governance intricacies in establishing a large-scale information infrastructure for integrated care within the National Health Service of England. By focusing on the initial 5 years of a regional interoperability program, we examine the challenges and dynamics of creating a unified system across organizational boundaries. METHODS: A longitudinal multi-methods approach was utilized, collecting data through interviews with health and social care personnel involved in project governance, meeting observations, and document analysis. This provided an in-depth understanding of the processes and challenges of developing the regional interoperability program. RESULTS: This study reveals a dynamic negotiation process and evolving governance structures that must continuously adapt to integrate diverse systems. Key findings include challenges in reconciling multiplicity and heterogeneity, the importance of social learning and stakeholder adaptation, and the role of ongoing negotiation and collaborative group construction in implementing interorganizational infrastructures. CONCLUSION: This study underscores the necessity of continuous adaptation and negotiation among stakeholders in establishing effective governance of integrated care infrastructures. Social learning and active participation play pivotal roles in overcoming the challenges associated with system integration. Strategic insights from this research can guide stakeholders in developing sociotechnical solutions for digital interorganizational infrastructures in integrated care.

Relationships among para-social interaction, perceived benefits, community commitment, and customer citizenship behavior: Evidence from a social live-streaming platform.

Encouraging online consumers to participate in the value enhancement process of products and stimulating users to engage in spontaneous and voluntary behaviors, the so-called Customer Citizenship Behaviors (CCBs), can significantly contribute to enhancing the competitiveness of online communities. Nowadays, there has been no systematic discussion on enhancing product value through value co-creation. Based on the Social Exchange Theory (SET), and take the current new type of online community, the social live-streaming community, as the research object, this study investigates how Para-social Interaction (PSI) between users and streamers affects users' perceived benefits, whether perceived benefits are related to users' community commitment and the relationship between community commitment and CCB from the perspective of value co-creation. Three hundred and forty-seven valid samples from China were obtained using TikTok and subsequently analyzed via Partial least squares structural equation modeling (PLS-SEM). The analysis results show that PSI positively influences users' perceived benefits, and among the perceived benefits, hedonic and self-esteem benefits can positively influence users' community commitment. When users' community commitment to live-streamers exists, it can effectively incentivize users to develop CCB. Theoretically, research findings enrich the study of online community value co-creation, para-social interaction, and citizenship behavior and provide recommendations for operating social live-streaming platforms.

Unlocking the power of socially assistive robotic nurses in hospitals through innovative living lab methodology.

Objectives: Pilot 5 utilizes AI and robotics to develop a robotic nurse assisting hospital staff in response to workforce shortages and rising care demands due to an aging population. This project aims to optimize resources, reduce errors, and improve patient satisfaction through personalized care. Methods: The Living Lab approach was implemented to split the study into sprints. The first split involves working with project partners and stakeholders to define the problem, brainstorm functionalities, and identify limitations (24 participants). The second split focuses on further requirement gathering, exploring real-world use cases, and considering ethical and privacy concerns (51 participants). Results: The project used iterative development cycles (5-8 months) to continuously improve the solution. Surveys revealed high satisfaction rates, with average scores of 4.0 and 3.6 for Sprints 1 and 2, respectively. Similarly, a team morale survey indicated a positive trend, with average scores of 7.6 and 8.18 for Sprints 1 and 2, respectively. Conclusion: Pilot 5 offers a promising solution to the evolving needs of modern hospitals. This study explores the integration of a social robotic system into nursing care to enhance quality and emphasizes stakeholder engagement, participatory design, and user-centered approaches in AI healthcare solutions.

Co-creation in healthcare and research to improve service delivery for young people with chronic pain.

Introduction: The process of co-creation can enable more effective, agile and integrated healthcare solutions achieving outcomes that effectively translate to healthcare delivery. Collaborative knowledge generation is particularly important in fields such as pediatric chronic pain where there is a complex interplay between biological, social, environmental, emotional, familial and school factors. The co-creation initiative described here was designed to amplify the voices of youth with chronic pain and their families and a variety of key stakeholders and generate novel approaches to the management of chronic pediatric pain in the setting of the South Australian Pediatric Chronic Pain Service. Methods: Stakeholders who were identified as influential in this ecosystem were allocated to 6 groups. A skilled facilitator co-prepared and delivered the workshop, engaging participants in three structured activities. Firstly, the challenges to service delivery were outlined, followed by the groups discussing what is currently working. The second activity involved lateral thinking without restrictions on time, resources or system to generate solutions to the key challenges presented. Finally, stakeholders were asked to agree on a generated solution from Activity 2 and build a case for actionable implementation of this solution. Data were summarised by the workshop facilitator and reflexive thematic analysis was used for coding and generating themes. Results: From Activity 1, six themes collectively demonstrated that stakeholders valued many of the existing strengths of the service delivery, but some areas such as pain education was undervalued. Activity 2 generated solutions from high-level ideas to more day-to- day management strategies. Each of six groups generated unique solutions to an identified challenge for Activity 3. Discussion: Engaging a wide variety of stakeholders in collaborative knowledge generation successfully provided the South Australian Pediatric Chronic Pain Service with a variety of novel, scalable solution across the healthcare continuum. Equally important is that this initiative helped to raise awareness about the complex issues faced in pediatric chronic pain care and helped to establish new partnerships that have led to enhanced service delivery.