A creative co-design workshop based on the UPTURN Study at this year’s international behaviour change conference

From Columbia to South Africa, we gathered in Lisbon to explore co-design

Twenty-six participants from 10 countries joined us in Lisbon last month to get practical hands-on experience of using creative co-design methods and to consider how best to use these methods along-side the behaviour change wheel. UPTURN Behavioural Scientist Dr Amanda Moore was joined by Dr Ana Gama (NOVA School of Public Health, Lisbon) to deliver an activity-packed, full-day workshop. It was great to use our experiences and data from UPTURN to help guide the practical activities and explore the thorny question of how best to integrate a participatory co-design mind set with more rigid behavioural science intervention design frameworks to develop effective, co-designed interventions.

Co-design as a participatory approach

Co-design is central to the ethos of the UPTURN study. There’s a lot of confusion about the ‘co-’ words! To echo the most common framing of co-design and co-production, co-design is a category within the co-production umbrella that follows pre-determined steps of a collaborative design process with the end goal of designing a specific product or service (1). The 4 key principles of co-production apply to co-design – a sharing of power, use of participatory methods to ensure equitable engagement of all stakeholders, a relationship mindset to build a long-term partnership (one thing co-design isn’t, is a group of researchers nipping in to do a workshop with a community and then disappearing again!) and a mindset of building capacity of all partners (2). What differentiates co-design from co-production more generally, is the use of a defined design-led process to develop a specific service or product. On the UPTURN study our definition of co-design is:

“Bringing together lived experience and professional expertise to work in equal partnership to develop a defined service or product using a specified participatory design-led process.” (UPTURN Study, 2024)

Central to the ethos of co-design is to work in partnership with the individuals the service is intended to support, throughout the design process. Crucially, when considering working with people from minoritised ethnic groups, who may face barriers associated with language or health literacy, we must consider developing creative ways to capture lived experience stories and involve people in the process in an accessible way. That means working hard to engage those facing the greatest inequities and thinking beyond traditional qualitative methods, such as interviews and focus groups.

Co-design follows the Design Council double diamond approach of moving from exploration the problem space, through to defining the problem or scope, and ideating, prototyping and testing potential solutions, iterating and refining your ideas. It is an adaptive, flexible, creative approach where ideas are developed from collective input of the co-design team.

Figure 1: Schematic representation of the double-diamond design process (Modified from Lewrick 2020 and the Design Council)

The importance of developing interventions in a theoretical informed way

From a behaviour science perspective, we know that interventions are more likely to be effective if they are theoretically informed (3, 4). The Behaviour Change Wheel (5) is a framework for developing interventions, which synthesises 19 behaviour change frameworks. It is a useful step-by-step framework to take the intervention designer from specifying the behaviour, carrying out a behavioural diagnosis, through to choosing appropriate intervention functions and associated evidence-based behaviour change techniques (BCTs) to inform the choice of intervention components. Developing your intervention in this way allows the documentation of the theory of change from the understanding of barriers and enablers influencing the performance of the behaviour, through to the mechanisms of actions through which your intervention will bring about change, to the linked core active ingredients of the intervention – the BCTs, such as Goal setting or Social comparison. This clear evidence chain of the theory of change of the intervention allows interventions to be replicated and evaluated much more easily as there is a clear understanding of how the intervention is intended to change the behaviour in question (see Figure 2). In UPTURN we have used the Behaviour Change Wheel to understand the barriers and enablers to engaging with PR and identify potential behaviour change techniques to address these.  This formed the basis of the design brief for our series of co-design workshops.

Figure 2: Summary of COM-B and the Behaviour Change Wheel Process (Michie 2014)

Practical activities based on the UPTURN data

Our Lisbon workshop participants used UPTURN as a case study throughout the day. This included reviewing some of the findings of the exploratory UPTURN research, in terms of the barriers and enablers to engagement and attendance at PR and role playing using our UPTURN co-design personas, developed from the UPTURN data.

Figure 3: Barriers and Enablers to PR - data from the UPTURN study

Activities involved engagement with a range of generative co-design methods including plasticine modelling to explore lived experiences of COPD, structured brainstorming, journey mapping of the COPD patient journey to PR and running a feedback grid session to gain user feedback on intervention components.

Outcomes and creating a network to support intervention designers

The session was over-subscribed and one participant reported ‘a truly hands-on and insightful session’, that was ‘absolutely mind-blowing’. Takeaways included: ‘co-design means shared power not just consultation; positive strength-based approaches enhance community engagement and ownership; and trust takes time but is essential for meaningful change’.

The group were so engaged we have decided to set up a practitioner network – The Co-design for Behaviour Change Network. Our new network meets quarterly and is an opportunity to collaborate and share learning.  You can join the network to learn about our seminars and to have access to resources here: https://forms.office.com/e/p8XyF2PP35

References

1.             Robert G, Locock L, Williams O, Cornwell J, Donetto S, Goodrich J. Co-Producing and Co-Designing. Cambridge: Cambridge University Press; 2022. Available from: https://www.cambridge.org/core/product/157832BBAE1448211365D396CD110900.

2.             McKercher KA. Beyond sticky notes. Cammeraygal: Inscope Books; 2020.

3.             Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009; 4:40.

4.             Michie S, Webb TL, Sniehotta FF. The importance of making explicit links between theoretical constructs and behaviour change techniques. Addiction. 2010; 105:1897-8.

5.             Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science. 2011; 6:1-12.