Stefan Elbers

128 Chapter 5 our hypothesis. Moreover, the techniques steered the conversations beyond stakeholders' primary responses, often resulting in a detailed account of their personal experiences with the treatment program and of their attempts to integrate treatment insights into their personal environment. In addition, system maps, personas, and prototypes enabled nonexperts to actively participate in design activities. A possible explanation for the successful engagement of stakeholders during the project is that experienced co-designers constantly translated hypotheses and abstract ideas into provotypes or prototypes. This method is particularly useful to provoke user reactions or to rapidly visualize an idea, which evokes interactions with an actual object rather than reflections on past experiences of hypothetical situations (Sanders & Stappers, 2014). In addition, the used co-design materials helped to transform each location where co-design activities took place (e.g., treatment facility or patient home) into a workshop environment that stimulated active participating and emphasized equality between all participants. This is especially important for health care settings, where conventional power relationships between patients and HCPs threaten effective cooperation during design activities (Boyd et al., 2012; Donetto et al., 2015). With respect to stakeholder involvement, many different patients, HCPs, researchers, students, and designers participated during the study, which was also in line with our hypothesis. The stakeholder interactions mostly consisted of independent design activities that required low commitment and little effort. In contrast, the members of the core team remained active throughout the project, which increasingly created an imbalance in knowledge and involvement between the core team and other participants in co-design activities. This may explain why the role of the stakeholders gradually shifted from “user as partner”—where all participants within the sessions contributed as equals in the design activities—towards “users as subject”—where participants mainly provided expert opinions or performed delimited tasks (e.g., usability testing) (Sanders & Stappers, 2008). Consequently, the concepts underlying the intervention have been thoroughly grounded in stakeholder input and expertise, but the applicability of the current workbook operationalization within the treatment programs requires further testing to examine whether the current strategies fit patient preferences and can be integrated in treatment programs in the form of the current prototype. This project shows similarities to the experience-based co-design (EBCD) approach, which aims to improve health care services by actively involving stakeholders to collect knowledge and experiences, to set priorities, and to develop solutions (Donetto et al., 2015; Robert et al., 2015). Although this project did not follow the 6 stages of EBCD, the overall objectives as well as the systematic partnership with patients, HCPs, designers, and researchers are alike. A notable difference was the focus within this project on actual prototype development