Innovation in Pain Rehabilitation Using Co-Design Methods During the Development of a Relapse Prevention Intervention: Case Study

Background Many intervention development projects fail to bridge the gap from basic research to clinical practice. Instead of theory-based approaches to intervention development, co-design prioritizes the end users’ perspective as well as continuous collaboration between stakeholders, designers, and researchers throughout the project. This alternative approach to the development of interventions is expected to promote the adaptation to existing treatment activities and to be responsive to the requirements of end users. Objective The first objective was to provide an overview of all activities that were employed during the course of a research project to develop a relapse prevention intervention for interdisciplinary pain treatment programs. The second objective was to examine how co-design may contribute to stakeholder involvement, generation of relevant insights and ideas, and incorporation of stakeholder input into the intervention design. Methods We performed an embedded single case study and used the double diamond model to describe the process of intervention development. Using all available data sources, we also performed deductive content analysis to reflect on this process. Results By critically reviewing the value and function of a co-design project with respect to idea generation, stakeholder involvement, and incorporation of stakeholder input into the intervention design, we demonstrated how co-design shaped the transition from ideas, via concepts, to a prototype for a relapse prevention intervention. Conclusions Structural use of co-design throughout the project resulted in many different participating stakeholders and stimulating design activities. As a consequence, the majority of the components of the final prototype can be traced back to the information that stakeholders provided during the project. Although this illustrates how co-design facilitates the integration of contextual information into the intervention design, further experimental testing is required to evaluate to what extent this approach ultimately leads to improved usability as well as patient outcomes in the context of clinical practice.

An illustration of the kick-off sessions, including location visits, the first consortium meeting, and the formulation of stakeholders' initial ideas on relapse. For this purpose, we used a patient journey, that not only facilitated the generation of insights, but also transformed the room into a design space.

Empty Journey map
Example of a generative technique that facilitated participants to share their initial ideas and experiences that were related to relapse. Time (before, during and after treatment) is depicted on the x-axis, and important stakeholders (i.e. patient, healthcare providers and their immediate social system) are depicted on the y-axis. Phase 1 'discover'

Kick off
Illustration of stakeholder interviews, including the 'ambiguous images' that were used during the introduction, journey maps and a an assignment to write down a personal desire ("wouldn't it be nice if …") related to improving the care for patients with chronic pain. Patient were interviewed in their personal context.

Student design projects
Overview of analysing sessions with the core teams to organize and cluster the interview and kick-off data. Relevant data segments were placed on post-its and organized around emerging insights and clustered in overarching themes, in shared within the team.

System map
The system map for the first Hoe weet je wanneer je hulp moet vragen? Wat is de ondergrens? En waar? Sommigen spreken over groene en rode pijn. De patient moet weten wanneer en waar hulp te vragen. Maar wat als dokters andere dingen zeggen dan het geleerde bij de revalidatie? Hoe hier op te reageren?
Dat het systeem persoonlijk aan te passen moest zijn was al snel duidelijk. The DIY toolkit contains various means to capture and store relevant treatment insights. These means are grouped by the corresponding type of storage: visually (e.g. a picture); by text (e.g. an associated quote); or by sound (e.g. a voice recording). The toolkit also provides suggestions for how to store the insights after treatment and how to share this information with significant others or healthcare providers.

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Afbeelding 29 'Toolbox 'DIY steuntje in de rug'' The Solapp application provides patients with the opportunity to describe important personal values and subsequently formulate related personal goals. The application provides a structure where patients can gradually progress towards each goal by means of planning specific 'steps' .

Intervention components
Check 4: Is there someone that you can ask for help?
Check 2: How confident are you that you successfully attain this goal?
The chances of success are higher, If you are confident in that your own capabilities. If you estimate that goal attainment will take more than 6 months, we recommend to divide the goal into multiple subgoals. Describe the first subgoal below:

YES NO
Check 1: How important is this goal for you?
The chances of success are smaller, If the goal is not important to you.