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

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          Abstract

          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.

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          Most cited references53

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          Using thematic analysis in psychology

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            Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

            Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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              Using the framework method for the analysis of qualitative data in multi-disciplinary health research

              Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                January 2021
                20 January 2021
                : 23
                : 1
                : e18462
                Affiliations
                [1 ] Research Group Lifestyle and Health Utrecht University of Applied Sciences Utrecht Netherlands
                [2 ] Department of Rehabilitation Medicine Faculty of Health, Life Sciences and Medicine Maastricht University Maastricht Netherlands
                [3 ] Co-design Research Group Utrecht University of Applied Sciences Utrecht Netherlands
                [4 ] Research Group Psychology of Sustainable Cities Amsterdam University of Applied Sciences Amsterdam Netherlands
                [5 ] OnePlanet Research Center imec The Netherlands Wageningen Netherlands
                Author notes
                Corresponding Author: Stefan Elbers stefan.elbers@ 123456hu.nl
                Author information
                https://orcid.org/0000-0002-8928-4307
                https://orcid.org/0000-0001-6656-5221
                https://orcid.org/0000-0003-2448-9480
                https://orcid.org/0000-0002-5920-4126
                https://orcid.org/0000-0001-5592-2879
                https://orcid.org/0000-0001-8781-5445
                Article
                v23i1e18462
                10.2196/18462
                7857944
                33470937
                267e4880-2103-4b01-824b-a7ad44251515
                ©Stefan Elbers, Christa van Gessel, Reint Jan Renes, Remko van der Lugt, Harriët Wittink, Sander Hermsen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.01.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 27 February 2020
                : 20 April 2020
                : 16 June 2020
                : 23 November 2020
                Categories
                Original Paper
                Original Paper

                Medicine
                co-design,participatory design,chronic pain,intervention development,rehabilitation,behavior change,relapse,prevention

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