Stefan Elbers

125 Co-designing relapse prevention strategies the posters and extend them with their own ideas or with stimulus cards. This resulted in 121 notes and 42 cards that were added to the posters. In the second assignment, subgroups were made of participants with varying backgrounds. Each group was instructed to select 1 theme and use the available information to develop an intervention concept. A professional draftsman supported the session by immediately visualizing intervention ideas. The final part of the session consisted of a plenary session where all 5 concepts were presented. During the subsequent discussion, the concepts were compared, and various overarching topics emerged, including “maintaining the positive development after treatment” and “reflection and self-monitoring.” In a subsequent meeting, the steering committee merged these overarching topics into 2 concept ideas: positive reinforcement and direct feedback. The “Define” phase concluded with a design briefing, where the core team commissioned 3 students to develop these ideas into tangible rudimentary prototypes as part of their graduation project. Reflection. The final system map that included both posters and the card set provided a complete overview of the collected data. This presentation form stimulated participants to combine various insights to develop concept interventions. With respect to stakeholder involvement, the number of patients and HCPs was lower than originally planned. The duration of the session and traveling distance required participants to block a full day, which turned out to be difficult to organize. In line with our findings in phase 1, the co- design methods successfully engaged nonexperts in the design process. The assignment to create concept intervention ideas was concrete and tangible. The resulting 5 concepts were associated with earlier identified patient needs, were grounded in contextual information, and contained relevant insights on relapse prevention. For example, one concept idea focused on monitoring and recognizing early signals of relapse, which was based on stimulus cards (e.g., a research insight related to difficulties in unbiased self-monitoring of behavior), interview data (e.g., a quote from HCP on the possibility of daily feedback via eHealth), and newly added notes (e.g., patient feedback should always be related to patient- specific goals). However, only a fraction of the possible combinations of cards and system maps was explored during this session. Limited time and resources prevented organizing additional sessions to cross-validate the results and achieve saturation. Phase 3: “Develop” Description. During the 4 months of the “Develop” phase, students held 5 focus groups to regularly test their ideas with patients and HCPs (see page 11 in Appendix 1). For example, by discussing the role of personal values within the treatment program, the students found supporting evidence that these values were strongly related to treatment goals, which subsequently guided the operationalization of the valued-based action plan in one of the rudimentary prototypes. Based on stakeholder feedback and weekly evaluation