Evidence-based guidelines provide clinicians with best practice recommendations but not the means to implement them. Although co-design is increasingly promoted as a way to improve implementation there is frequently insufficient detail provided to understand its contribution. The presented case study addresses this by providing a detailed account of how a specific co-design approach contributed to an improving back pain education project in line with national guidance.
The aim was to use creative co-design to produce prototype evidence-based back pain educational resources that were sensitive to context.
Assemble a group of relevant stakeholders for a series of workshops.
Use creative activities that encourage divergent and convergent thinking to iteratively understand the problem and develop prototype solutions.
Thematically analyse outputs of each workshop to determine content of subsequent workshops.
Present a final prototype ready for implementation.
This approach produced an innovative system of thematically linked back pain educational resources that were contextually sensitive, evidence-based and ready for implementation.
Research knowledge was successfully blended with stakeholder experiential knowledge.
The creative methods helped diverse stakeholders develop trusting relationships and ensured everyone’s experiences and ideas were included.
The process of co-creation and the objects created had vital roles in surfacing and understanding stakeholder knowledge, promoting innovation and facilitating implementation.
The design process facilitated an evolving understanding of a complex problem alongside prototype development.
It is recommended that these methods be considered by other project teams.
Physical distancing in response to the global pandemic has posed the challenge of if and how co-design work could continue without face-to-face interactions. One of the authors (SK) set up an open-access online document for researchers to share suggestions about how this challenge could be overcome (Knowles et al, 2020). This was widely shared and commented on, demonstrating that researchers were anxious to ensure co-design activities were not abandoned in an effort to control the spread of COVID-19.
Reflecting on the suggestions and questions added to the document, one anxiety in particular stood out: ‘Which platform should I use?’. The document’s main focus became an expanding list of different digital meeting packages, and the pros and cons of each (considering cost, security, recording options, popularity, and more). Despite SK frequently condensing this section, as of January 2021 it runs to seven pages (almost half the document). By contrast, a suggestion (instigated by JL) to explore (non-digital) cultural probes did not provoke further discussion.
The document is evidence of how committed researchers were to ensuring co-design continues. But the focus was largely on how to replicate common co-design events, such as face-to-face workshops, via online meeting platforms. This may have been pragmatically driven; researchers had access to computers and meeting software. But it also suggests a missed opportunity to expand our repertoire of co-design tools and think more creatively about how (remote) co-design could happen out in the world, as part of people’s lives, distinct from how co-design typically looks in research. Rather than consider how co-design might look beyond a university meeting room, digital platforms put meetings inside people’s homes and the realities of digital exclusion were largely unaccounted for.