Chapter 5 134 innovation process brings about several challenges. HCD practitioners acknowledge the challenge of equitably including the experience and expertise of all participants in the design process. While the importance of creative interdisciplinary collaborations between various disciplines in healthcare is increasing, it is still a relatively new and complex phenomenon.[117] Each stakeholder brings their own motivations, attitudes, priorities and incentives to the process and such differences will influence the cocreative space and interpersonal interactions. HCD practitioners should reflect critically on the participatory methods that they intend to apply, considering the possible contribution of each participant to the design process to facilitate effective use of their expertise and experiences.[16] This is particularly important when working with vulnerable patient groups or healthcare professionals with limited time to participate in co-design sessions.[118] An earlier study suggested that HCD processes can rely too much on anecdotal evidence of key stakeholders who might not fully understand what they want and need.[119] A more strategic application of HCD, however, aims at identifying themes that describe people’s deeper needs and values, rather than their wishes and desires, and using those themes to inform the creation of innovative strategies and solutions. [120] Field studies with the employment of qualitative methods, such as observations, to study key stakeholders and their activities in their own environment, could offer a valid alternative.[121] Additionally, it is essential for HCD practitioners to take power dimensions and agency of different stakeholders into account, especially during co-design sessions. To achieve inclusive design processes, intersectional aspects should be considered for stakeholder engagement and methodological choices, such as: gender identity, class, sexuality, geography, age, and disability/ability.[122], [123] Reflective project planning aids and frameworks for involving patients and public in research and design projects should be employed to guarantee meaningful engagement of stakeholders and to facilitate democratic design processes.[124], [125] Study limitations At present, the MMAT is the most comprehensive tool available for appraising of multi-method studies.[126] Even though the MMAT is a tool that allows for the critical appraisal of most common types of study designs, the tool seems less appropriate for HCD, DT and UCD due to the inclusion of multiple research and design cycles and often limited word space to describe the applied methodologies and methodological choices in detail. To our knowledge, there is no appropriate tool available yet for critical appraisal of design studies in health research.
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