Stefan Elbers

213 General discussion priorities, it is not only researchers but also other citizen representatives who ought to have influence in this process. This would require the adoption of co-design approaches in research projects. When evaluating this project from a democratic perspective, we consider the project planning and the extent of generative techniques as particular strengths. By ensuring that co-designwas spread over the entire duration of the 2-year project,we created touchpoints for end-users to exert influence at each development stage. Although this is a necessary condition, it is not sufficient to guarantee democratic co-design. According to Williams and colleagues (2020), “… having a seat at the meeting table does not guarantee an opportunity or the confidence to speak up, or that contributions made are officially recorded in meeting minutes, let alone give rise to the tangible influence on services or research ”. Indeed, there are signs that public involvement in health research can be narrowed down to limited influence on the project, ticking the box of public participation at minimal cost (Martin et al., 2018; Robert et al., 2020; Williams et al., 2020). Thus, it is important not only to involve stakeholders but also to actively empower them to express their experiences and ideas. The various generative techniques (methods, exercises and assignments to elicit implicit knowledge and latent needs), combined with the specific experiences of co-design researchers (who planned and facilitated each co-design activity), were important to ensure actual impact of the participants. A particular weakness in this respect was that time pressure in the final stage of the workbook development resulted in limited involvement of the patient population in that phase. Second, a technocratic rationale refers to the belief that other stakeholders have unique insights related to the problem under investigation that may improve the outcome of the project. As we outlined in Chapter 5, the final prototype and the AGRIPPA application were thoroughly based on the contributions of key stakeholder groups. As initial stages of intervention developments rarely receive scientific attention and are often underreported (Hoddinott, 2015), this chapter contributes by clarifying the activities that have led to the prototype. A step in the right direction comes from a new reporting checklist for intervention development. This outcome of a Delphi study includes an item on the extent to which stakeholders contributed to the development process, encouraging an explicit description of the actual methods used to include these stakeholders (Duncan et al., 2020; Staniszewska et al., 2017). When the results of the ongoing AGRIPPA trial are analysed, we will obtain further insights into the extent to which this co-designed intervention improves maintenance of outcomes in patients with chronic pain in IMPT programmes.