Participatory Rapid Appraisal and Focus Groups to co-design technology-supported integrated care

BACKGROUND: Co-design methods, which create innovation tailored to the end-user needs and setting, are increasingly used to improve research uptake and impact. Peer review and methodologists have emphasised the need for early, meaningful, and continuous involvement of stakeholders, and the transparent and detailed reporting of co-design methods. The implementation of both complex interventions (such as an integrated care pathway), and technology, into healthcare is difficult and has high failure rates. Designing, implementing, and adapting interventions to ensure they work in the local context requires in-depth understanding of multiple end-users' needs, processes, and contexts. Achieving this requires early, meaningful, and continuous engagement between multiple end-users. This study aimed to contribute to co-design research by reporting the: 1) process used to develop and test Participatory Rapid Appraisal and Focus Groups methods to co-design integrated care. 2) details of how the method was applied in the GERONTE project. 3) core steps involved in this co-design method (to facilitate use and/ or adaptation of the method). AIM: The study aimed to develop, test, and evaluate a co-design method that: I. enabled early, continuous, and meaningful engagement of multiple end-users in different locations and across different design iterations. II. enabled timely feedback and checking between the end-users and design team. III. optimised end-users participation by being flexible in the time, duration, and method of data collection and feedback. MATERIALS AND METHODS: The Participatory Rapid Appraisal and Focus Group to co-design integrated care method was developed in four stages. The first stage involved defining the project's co-design needs and reviewing the co-design literature to identify how to meet these. GERONTE aimed to co-design, evaluate, and prepare for EU-wide deployment, an integrated technology-supported care pathway for older adults with cancer and other morbidities. Focus Groups and Participatory Rapid Appraisal, in combination, were chosen as an empirically-based and practical approach. Focus Groups (FG) provided a participatory-based way to collect data in order to identify and agree multiple stakeholders' needs and collective priorities. Participatory Rapid Appraisal (PRA) provided a timely way; to gain participant feedback on the data collected; and, to ensure accuracy in the data sent to the pathway and technology design teams. The second stage involved applying the method in the GERONTE Project (using meetings between the project team, technologists, and older adults to develop a co-design protocol for the project). The third stage involved the use, refinement, evaluation, and reporting of the co-design method. The fourth stage, evaluation of the method, is ongoing. RESULTS AND DISCUSSION: This study resulted in the development of a structured approach to using Participatory Rapid Appraisal and Focus Groups in combination to co-design technology-supported integrated care. This method is proposed as an evidenced-based, practical, user-friendly way to co-design (or adapt an existing design) an integrated technology-supported care pathway. This co-design method involves three cycles of design. Each cycle involves multidisciplinary FG to collect semi-structured data followed by rapid analysis and feedback of the FG data to the participants to design or refine the intervention.