Stefan Elbers

122 Chapter 5 insights, and incorporation of stakeholder input. We defined stakeholder involvement as the commitment to participate in the development project, to collaborate with other stakeholders during design activities, and to actively participate during these sessions. Generation of insights referred to the extent by which co-design activities resulted in an increased understanding of the problem of interest that could inform subsequent development activities. Incorporation of stakeholder needs was defined as the extent by which prototypes were based on stakeholder perceptions, judgments, and evaluations from co-design activities. Furthermore, we adopted the Double Diamond model to describe the design process along 4 development stages (Design Council, 2015). The Double Diamond model contains 2 sequences of diverging and converging (Figure 1). In diverging phases, choice options and discrepancies are created; in the converging phases, these ideas are refined and considered to make design choices with respect to the prototype. In the first diamond, the “Discover” (diverging) and “Define” (converging) phases relate to acquiring insights on what to design. In the second diamond, the “Develop” and “Deliver” relate to further exploring the ideas on how to optimally design the final concepts. To illustrate how co-design contributed to the intervention development at each phase, we combined all data sources to provide both a descriptive overview and an in-depth reflection with respect to our main themes. In addition, Appendix 1 provides a chronological overview of the development process and includes examples of co-design methods, data segments, and pictures of co-design activities. RESULTS Phase 1: “Discover’” Description. In the “Discover” phase, we aimed to generate a deeper understanding of factors influencing relapse after successful rehabilitation. The primary activities took place over a period of 11 months and consisted of 3 kick-off sessions, 20 stakeholder interviews (12 HCPs, 8 patients), and a student design project. In the first kick-off session, representatives from all consortium partners were present to discuss the project planning and to decide how co-design would be implemented throughout the project. Representatives also participated in co-creation by using their professional and personal experiences to formulate initial ideas on relapse (see page 3 of Appendix 1). These activities were repeated during introductory visits by the core team at the 2 participating pain treatment centers. During these visits, the core team also observed multiple treatment sessions and were given a detailed explanation about dose and content of the included treatment modalities. Subsequently, 20 semistructured interviews of approximately 1 hour were conducted and transcribed (see page 4 in Appendix 1). During the final activity of