Vol.:(0123456789)
Jou nal o Heal hca e In o ma ics Resea ch
h ps://doi.o g/10.1007/s41666-025-00199-4
RESEARCH ARTICLE
Key Componen s o Pa icipa o y Design Wo kshops
o Digi al Heal h Solu ions: Nominal G oup Technique
andFeasibili y S udy
Ke s inDenecke1· Oc a ioRi e a‑Rome o2,3· GuidoGiun i4,5·
Ka inVanHol en6· EliaGaba on7
Recei ed: 6 Feb ua y 2025 / Re ised: 19 Ap il 2025 / Accep ed: 5 May 2025
© The Au ho (s) 2025
Abs ac
Pa icipa o y design (PD) is an essen ial me hod in he de elopmen o digi al heal h
solu ions since i p omises o inc ease accep ance, usabili y, and us in he de el-
oped solu ion. Al hough ca e ul planning and p epa a ion is c ucial o he success
o PD wo kshops, a amewo k o key componen s o conside is s ill missing. The
objec i e o his wo k is o de elop such amewo k en iched wi h examples o
aspec s o be conside ed when planning and conduc ing PD wo kshops o designing
and de eloping digi al in e en ions in heal hca e. We applied he nominal g oup
echnique wi h ou pa icipan s wi h backg ounds in compu e science, heal h
in o ma ics, psychology, and social an h opology o iden i y key componen s o PD
wo kshops. The esul ing amewo k was applied by an expe in PD o a case o a
digi al heal h solu ion o a igue sel -managemen o mul iple scle osis. The easi-
bili y and applicabili y o he amewo k and i s sho comings we e assessed. As a
esul , a amewo k consis ing o i e main ca ego ies and a o al o 36 ac o s we e
assigned and de ined in ela ion o he ca ego ies. The ca ego ies a e pa icipa o y
p ocess, in ol ed pe sons and hei oles, wo kshop de ini ion, se ing, p i acy and
e hics, including egula ions. The applica ion o he amewo k o he es case dem-
ons a ed he easibili y and applicabili y o he sugges ed amewo k as well as he
sho comings o he analyzed PD p ocess. This amewo k p o ides p ac ical guid-
ance while highligh ing he complexi y o PD wo kshops, encou aging hei b oad
adop ion, c i ical e lec ion, and con inuous e inemen . I has po en ial o imp o e
he conduc o PD wo kshops and, in his way, po en ial o imp o e usabili y, accep -
ance, and use ulness o digi al heal h solu ions. In u u e wo k, he use pe spec i e
could be used o ex end he amewo k.
Keywo ds Pa icipa o y design· Wo kshop· Digi al heal h· F amewo k·
Co-design· Co-p oduc ion
Ex ended au ho in o ma ion a ailable on he las page o he a icle
Jou nal o Heal hca e In o ma ics Resea ch
Abb e ia ions
MS Mul iple scle osis
PD Pa icipa o y design
PPI Pa ien and public in ol emen
1 In oduc ion
The use o digi al ools such as apps, social media, websi es, and cha bo s is becom-
ing inc easingly common in heal hca e, pa icula ly in men al heal h, bu also in
o he a eas o heal hca e dealing wi h a wide ange o heal h challenges [1–3]. This
end is d i en by he po en ial o digi al heal h solu ions o enhance pa ien ca e
[4], imp o e heal h ou comes, and educe heal hca e cos s [5]. Howe e , he e is a
ecognized isk ha digi al heal h solu ions could ac ually exace ba e inequali ies
in he popula ion, o example in e ms o access, digi al li e acy, o language ba -
ie s [6]. Pa icipa o y design (PD) and co-design p ac ices a e c i ical o add ess-
ing hese isks al eady in he de elopmen o digi al heal h solu ions [7, 8]. PD is a
b oad me hodology ha in ol es ep esen a i es o u u e use g oups and expe s
o ensu e ha he solu ions a e easy o use, use ul, and aligned wi h he needs and
p e e ences o he a ge use s. This app oach is essen ial o ga he ing insigh s, gen-
e a ing ideas, and co-c ea ing solu ions ha a e con ex ually app op ia e and use -
cen e ed [9]. I is based on he con ic ion ha he speci ic expe ise ha use s b ing
is a “ alid o m o knowledge” ha adds aluable in o ma ion o p o essional knowl-
edge [10].
Wo kshops a e no sepa a e om PD, bu a he one o i s co e mechanisms,
p o iding a s uc u ed and collabo a i e en i onmen whe e a ious s akeholde s,
including end-use s, designe s, and expe s, can ac i ely pa icipa e in he design
p ocess [11]. In PD, he goal is o in ol e all ele an pa ies in shaping he inal
p oduc o in e en ion [8]. Pa icipa o y wo kshops o e a s uc u ed pla o m o
ga he ing insigh s, gene a ing ideas, and co-c ea ing solu ions [11]. They use a ange
o mechanisms o acili a e communica ion, os e c ea i i y, and enable s akehold-
e s o sha e hei pe spec i es, p e e ences, and needs di ec ly [11]. By engaging
pa icipan s in wo kshops, designe s can ensu e ha he esul ing designs a e mo e
use ul, use -cen e ed, con ex ually app op ia e, and aligned wi h he needs and p e -
e ences o he a ge use s. The e o e, wo kshops a e highly ele an in PD, as hey
enable meaning ul collabo a ion and co-design e o s [11].
When i comes o digi al heal h, PD becomes e en mo e c i ical o ensu e ha
hese in e en ions a e e ec i e, cul u ally sensi i e, and accessible [8, 12]. By
embedding he unique pe spec i es and needs o end-use s, esea che s and s ake-
holde s om an ea ly s age o he design p ocess, PD p omo es solu ions ha eso-
na e deeply wi h use s’ expe iences and needs [8, 12]. This inc eases bo h each,
up ake, and engagemen , po en ially leading o g ea e in e en ion e ec i eness
[13, 14]. A e iew on digi al app oaches o he pa icipa o y de elopmen o heal h-
ela ed in e en ions p esen ed by Doe wald e al. [15] only ocuses on digi ally con-
duc ed wo kshops. Ou wo k goes beyond and conside s any PD wo kshop aimed a
designing o de eloping digi al heal h solu ions, conduc ed in pe son o digi al. We
Jou nal o Heal hca e In o ma ics Resea ch
a e no e iewing app oaches, bu iden i ying key componen s o hei success ul
conduc and de eloping a guideline as a p ac ical ool o conside ing hese compo-
nen s in PD wo kshops.
Despi e he g owing use o PD in heal hca e, he e is a lack o comp ehensi e
guidelines o planning and deli e ing PD wo kshops. Exis ing s udies o en epo
on speci ic me hodologies and logis ical aspec s bu do no p o ide a s anda dized
amewo k o he design and deli e y o PD wo kshops. Fo example, esea ch on
digi al men al heal h in e en ions ha e p oposed a ious amewo ks o guidelines
o in eg a ing e idence-based app oaches o co-designing men al heal h in e en-
ions. Examples o hese amewo ks include he one p oposed by he “A Young
and Well Coope a i e Resea ch Cen e” o codesigning online you h men al heal h
in e en ions [8]. This p oposed amewo k includes six componen s: iden i y (e.g.,
iden i y he p oblem om he pe spec i e o young people and he e idence base);
de ine (e.g., iden i y he bene icia ies and de ine he p oblem space and objec i es
wi h hem); posi ion (e.g., unde s and how he in e en ion needs o be posi ioned
and amed in o de o ha e an impac o young people and ele ance o young peo-
ple); concep (e.g., iden i y, gene a e and e alua e po en ial concep s ha ep esen
wha he in e en ion needs o be and do o engage young people and deli e app o-
p ia e men al heal h and wellbeing ou comes), c ea e (e.g., e ol e, build and e ine
an in e en ion ha is use ul and usable by young people and sa e and e ec i e om
men al heal h and wellbeing pe spec i e); and use (e.g., deli e , use, e alua e and
i e a e he in e en ion based on how young people expe ience and use he in e en-
ion and i s impac ) [8]. A e iew lis ed a se ies o bes p ac ices and ecommen-
da ions o unde aking PD o digi al men al heal h in e en ions speci ically wi h
indigenous young people [16]. Sugges ed bes p ac ices a e s uc u ed along ou
pilla s: go e nance (i.e., add ess a need iden i ied by he communi y); engagemen
(i.e., engage young people in an i e a i e p ocess design, de elopmen and e iew);
pa ne ships (i.e., c ea e an en i onmen o mu ual lea ning o ensu e capaci y
s eng hening); and knowledge ansla ion (i.e., demons a e bene icial ou comes o
indi iduals and communi y) [16].
The IDEAS (in eg a e, design, assess, sha e) amewo k guides a esea che
h ough he ull li e cycle o an mHeal h p ojec [17]. Fa ao e al. combined he
In o ma ion Sys ems Resea ch amewo k wi h design hinking p inciples as a
amewo k o mHeal h applica ion design [18]. Ano he s udy e e ed o he use o
Design and E alua ion o Digi al Heal h In e en ions (DEDHI) amewo k [19] o
planning wo kshops aimed a adap ing a g oup-based in e en ion o auma [20].
These exis ing amewo ks a e ele an o PD o digi al heal h solu ions; how-
e e , hey do no p o ide speci ic guidance on how o conduc PD wo kshops in
he a ea o digi al heal h. To ou knowledge, he e is a lack o s uc u ed guidelines
o e ec i ely planning and conduc ing PD wo kshops in his sensi i e and com-
plex a ea. Se e al s udies ha ha e used pa icipa o y wo kshops o designing digi-
al heal h solu ions epo on he me hods used, ocusing on he ac i i ies ha hey
planned, he s akeholde engagemen , o logis ical aspec s wi hou o e ing a com-
p ehensi e amewo k o s anda dized guidelines [18, 21–25]. Since some ele an
aspec s o he PD p ocess a e no epo ed in hese amewo ks, esea che s seeking
o use PD in digi al heal h solu ions ace signi ican challenges in eplica ing and
Jou nal o Heal hca e In o ma ics Resea ch
adap ing hese app oaches. In addi ion, e ec i e planning and acili a ion o a PD
wo kshop a e c i ical o ensu e ha pa icipa ion meaning ully in o ms he design
p ocess a he han becoming a supe icial exe cise. In his con ex , he amewo k
p esen ed he e p o ides a s uc u ed me hod o designing pa icipa o y ac i i ies
wi hin he implemen a ion p ocess.
A amewo k o conduc ing PD wo kshops in digi al heal h is essen ial o se -
e al easons. While PD me hodology p o ides he o e a ching app oach, wo k-
shops a e he main medium o s akeholde in ol emen and co-c ea ion. In addi-
ion o he challenges ha any PD wo kshop can p esen , wo king wi h ulne able
popula ions p esen s unique challenges. E hical and p i acy conside a ions mus be
pa amoun , and pa icipa o y wo kshops mus be conduc ed wi h compassion, os-
e ing a sa e and suppo i e en i onmen . This s udy aims o de elop a amewo k
en iched wi h p ac ical examples o he key componen s o PD wo kshops ha lead
o success ul digi al heal h solu ions. In doing so, i aims o p o ide a guide ha
suppo s he implemen a ion o PD wo kshops whe e pa icipa ion is uly a he
o e on and whe e, as a esul , PD imp o es he e ec i eness and use accep ance
o digi al heal h solu ions, ul ima ely con ibu ing o be e heal h ou comes and use
sa is ac ion.
2 Me hods
2.1 F amewo k De elopmen Me hodology
To achie e ou goal, we conduc ed a wo-s eps app oach: Fi s , we iden i ied key
componen s o PD wo kshops using he nominal g oup echnique [26, 27] (see
Fig.1). Second, we de ined and speci ied he iden i ied key componen s by g oup
discussion.
The nominal g oup echnique is a s uc u ed app oach ha os e s consensus
among pa icipan s, commonly employed o p io i y se ing in heal hca e and
esea ch [26]. Fo ou in-pe son mee ing, we in ol ed one social an h opologis , one
psychologis , and wo compu e scien is s. All pe sons a e expe ienced in design-
ing digi al heal h solu ions and in using pa icipa o y me hods o his pu pose. In
a i s ound, hese ou pa icipan s applied silen gene a ion [27] and collec ed
indi idually key ac o s o PD wo kshops based on hei expe ience in designing,
conduc ing, o pa icipa ing in PD wo kshops ( ime ame 10 min). The g oup con-
duc ed he ound- obin sha ing o collec and display all ac o s. Then, hey elabo-
a ed and cla i ied he collec ed ac o s (sha ing phase), wi h new componen s added
as needed du ing his p ocess. Speci ically, each pa icipan explained hei ac o s,
while he o he pa icipan s lis ened ca e ully. All ac o s we e collec ed a a Mi o
boa d [28]. In he ollowing discussions, all ac o s we e ca ego ized, new ac o s
we e included, and edundan ac o s we e emo ed (g oup discussion). The indi-
idual ac o s and ca ego ies we e speci ied in de ail wi h he aim o eaching a
common unde s anding in o de o inally o mula e de ini ions. The e o e, he ou
esea che s wen h ough all he ac o s again oge he , ag eed on he labels, and
Jou nal o Heal hca e In o ma ics Resea ch
checked he assignmen s o ca ego ies. A o ing was conduc ed o assess consensus.
All o ed ac o s we e included in he inal e sion.
2.2 F amewo k Tes Case
The easibili y and applicabili y o he amewo k we e assessed by an expe in PD
who was no in ol ed in he p ocess o de ining he amewo k. This expe is a
medical doc o , an expe in digi al heal h, and has s ong expe ience in PD. Fi s ,
his esea che e iewed he amewo k and p o ided eedback on unde s andabili y
o he ca ego ies and key componen s de ined, missing componen s and ele ance.
Then, his esea che was asked o e lec on how he PD p ocess ollowed in he es
case migh ha e changed based on he knowledge gene a ed and lessons lea ned in
each pa icipa o y wo kshop de eloped in he p ojec i his amewo k had been
employed.
The amewo k was explo ed by applying i o he case o a digi al heal h solu-
ion o a igue sel -managemen o mul iple scle osis (MS) called mo e s amina
[29–31]. Mo e s amina is a gami ied a igue sel -managemen solu ion de eloped
h ough an i e a i e use -cen e ed design ha ollowed an e idence-d i en app oach
[30, 32] guided by pa ien and public in ol emen (PPI) p ocess [33]. Quali a i e
s udies wi h heal hca e p o essionals and people wi h MS we e used o iden i y
Fig. 1 The nominal g oup echnique was applied o collec ac o s ele an o PD wo kshops and ca -
ego ize he ac o s
Jou nal o Heal hca e In o ma ics Resea ch
needs o digi al heal h [34]; sys ema ic e iews explo ed he mHeal h landscape
[35, 36]; ea ly heal h echnology assessmen in o med de elopmen [37]; and he
alue o heal hca e p o essionals was explo ed [38]. Finally, i s easibili y and usa-
bili y we e es ed h ough eal wo ld use wi h people wi h MS [39].
While mo e s amina is p ima ily a ool o managing physical symp oms o MS,
i add esses a igue, a common symp om in bo h MS and many men al heal h con-
di ions, showing he amewo k’s po en ial o be applied o o he heal h con ex s.
I s impac in educing a igue, s ess, and imp o ing quali y o li e all con ibu e o
be e men al heal h ou comes o i s use s. The design and de elopmen p ocess o
mo e s amina is p esen ed ch onologically o p o ide con ex , ollowed by an analy-
sis o how he di e en elemen s o he amewo k migh ha e modi ied i s design
and de elopmen .
3 Resul s
3.1 Key Componen s o PD Wo kshops
The silen gene a ion and ound- obin phases led o en ca ego ies which a e en i-
onmen al ac o s, planning, se ing, da a collec ion and analysis, ec ui men and
selec ion, pa icipa o y p ocess, egula ions, pa icipan , wo kshop conduc o s, and
esponsible pe son. In he cla i ica ion phase, we did some changes o hese ini-
ial ca ego ies o emo e edundancies and ensu e cla i y and consis ency o he
ca ego ies:
• The ca ego y “planning” was changed o “wo kshop de ini ion.”
• “En i onmen al ac o s” was emo ed as ca ego y and added as ac o o “se -
ing.”
• “Da a collec ion and analysis” was mo ed o he ca ego y “wo kshop de ini ion.”
All ac o s we e conside ed ele an o be included in he amewo k in he o -
ing ac i i y. The sugges ed inal amewo k o PD consis s o i e ca ego ies ha
a e lis ed and de ined in Table1. In he ollowing subsec ions, we a e desc ibing he
ac o s pe ca ego y.
3.2 Pa icipa o y P ocess
The ca ego y “pa icipa o y p ocess” consis s o 13 ac o s o be add essed: plu al-
i y o opinions, plu ali y o expe ise, jus i ica ion o he app oach, owne ship, join
ules, join e minology, con idence in pa icipan s, p i acy p o ec ion, pa icipa ion
ba ie s, social ields o powe , impac o s a us and oles, expec a ion managemen ,
and join goals.
Plu ali y o opinions e e s o he inclusion and espec ul conside a ion o a
wide ange o pe spec i es, ideas, and iewpoin s om all pa icipan s wi hin a PD
wo kshop. This means ha all opinions a e gi en equal weigh . To ealize his, an
Jou nal o Heal hca e In o ma ics Resea ch
Table 1 The main ca ego ies o he amewo k o PD consis o i e ca ego ies
Pa icipa o y p ocess This ca ego y comp ises ac o s ha migh impac he pa icipa ion o pa icipan s,
including pa icipa ion ba ie s, plu ali y o opinions, and kind o expe ise
(di e si y)
• Plu ali y o opinion
• Plu ali y o expe ise
• Jus i ica ion o he app oach
• Owne ship
• Join ules
• Join e minology
• Join goals
• Con idence in pa icipan s
• P i acy p o ec ion
• Pa icipa ion ba ie s
• Social ields o powe
• Impac o s a us and oles
• Expec a ion managemen
In ol ed pe sons and hei oles This ca ego y includes he di e en pe sons in ol ed in a PD wo kshop including
hei oles, cha ac e is ics, mo i a ion, and li e acy
• Pa icipan cha ac e is ics
• Pa icipan mo i a ion
• Li e acy (heal h li e acy, digi al li e acy)
• Empowe men o pa icipan
Wo kshop de ini ion This ca ego y includes all o ganiza ional aspec s ela ed o he PD wo kshop. Fo
example, he pu pose and goals o be achie ed, s uc u e o he wo kshop, budg-
e ing, o selec ion o sui able me hods
• Pu pose
• Goals
• Pa icipa o y planning
• Role de ini ion and asks
• Speci ic needs
• Inclusion/exclusion c i e ia
• Valida ion o inclusion/exclusion c i e ia
• Wo kshop s uc u e
• Selec ion o sui able me hods
• Selec ion and p epa a ion o ma e ial
• Speci ica ion o he se ing
• Agenda
• Budge ing, i s check
• Budge ing, second check
Jou nal o Heal hca e In o ma ics Resea ch
Each ca ego y comp ises se e al ac o s
Table 1 (con inued)
Se ing This ca ego y desc ibes he en i onmen o he PD wo kshop, including he app o-
p ia e ma e ial, expec a ion managemen , and en i onmen al ac o s
• A ailabili y o app op ia e ma e ial
• En i onmen al ac o s
P i acy and e hics including egula ions This ca ego y includes aspec s ela ed o e hics, e hics app o al, and e lec ion on
possible e hical issues as well as egula o y compliance o he wo kshop
• E hical conside a ions
• E hics app o al
• Regula ion compliance
Jou nal o Heal hca e In o ma ics Resea ch
en i onmen has o be c ea ed whe e di e se opinions a e welcomed and alued and
acili a e open discussions o ensu e all oices a e hea d.
Plu ali y o expe ise e e s o he inclusion and in eg a ion o di e se ypes o
knowledge, skills, and pe spec i es om a wide ange o pa icipan s. This concep
is c ucial o os e ing a holis ic and comp ehensi e app oach o he PD p ocess.
I also poin s o he goal o di e si y, i.e., we migh include use s wi h he same
ch onic condi ion bu wi h di e en socioeconomic s a us o o he di e si y c i e ia
ha migh be ele an . When plu ali y o expe ise (i.e., di e si y) is no achie ed,
his mus be e lec ed and jus i ied.
Jus i ica ion o he app oach comp ises an explana ion why applying a PD p o-
cess is equi ed o achie ing he gi en aim o answe ing a gi en esea ch ques ion.
I also includes o ensu e ha pa icipan s unde s and he bene i s and goals o he
app oach.
Owne ship is a ac o ha should be achie ed in he pa icipan s o PD wo k-
shops as i is a sense o esponsibili y, engagemen , and in e es ha pa ici-
pan s eel owa d he p ocess and ou comes o he wo kshop. This is essen ial o
achie e ele an ou comes and engagemen o he pa icipan s. Pa icipan s should
be encou aged o ake owne ship o he p ocess and ou comes and be in ol ed in
decision-making.
Join ules a e a se o ag eed-upon guidelines and p inciples ha go e n he
beha io , in e ac ions, and p ocesses wi hin he PD wo kshop. These ules a e, a
bes , collabo a i ely de eloped and, a minimum, accep ed by all pa icipan s o
ensu e a espec ul, p oduc i e, and inclusi e en i onmen . All pa icipan s should
ollow join goals. These a e sha ed objec i es and desi ed ou comes ha a e col-
lec i ely es ablished and ag eed upon by all pa icipan s. These goals guide he col-
labo a i e e o s and ensu e ha e e yone is wo king owa d common pu poses.
A join e minology is essen ial o ensu ing unde s anding. I comp ises a sha ed
se o e ms and de ini ions ha a e unde s ood and used by all pa icipan s. This
common language helps ensu e clea and e ec i e communica ion, educes misun-
de s andings, and p omo es a cohesi e unde s anding o key concep s and p ocesses.
The ac o con idence in pa icipan s e e s o he us and belie in he abili ies,
insigh s, and con ibu ions o all indi iduals in ol ed. This could be os e ed by p o-
iding suppo and encou agemen o boos pa icipan ’s con idence.
P i acy p o ec ion consis s o measu es and p ac ices implemen ed o sa egua d
he pe sonal and sensi i e in o ma ion o all pa icipan s. All sensi i e in o ma ion
should be handled wi h ca e and con iden iali y.
Inclusion o all pa icipan s is essen ial. This is e lec ed by he ac o pa icipa-
ion ba ie s. These include any obs acles o challenges ha p e en o hinde indi-
iduals om ully engaging in he wo kshop ac i i ies. These ba ie s can a ec he
inclusi i y, e ec i eness, and o e all success o he wo kshop.
Addi ionally, social ields o powe , i.e., social ela ions and hei impac on
he dynamics be ween pa icipan s, need o be conside ed collec i ely, i.e., by all
pa icipan s.
Impac o s a us and oles e e s o ac o s ha a e ela ed o ole and s a us mod-
els and how hey in luence he pa icipan s’ in e ac ion in he wo kshop (e.g., hie -
a chies in hospi al s a ). The impac o s a us and oles should be acknowledged,
Jou nal o Heal hca e In o ma ics Resea ch
5 Discussion
5.1 P incipal Resul s
This pape in oduces a comp ehensi e amewo k ha ou lines essen ial compo-
nen s o designing a PD wo kshop aimed a c ea ing and de eloping digi al heal h
solu ions. The amewo k encompasses i e ca ego ies and 36 key componen s,
add essing he pa icipa o y p ocess, he oles and con ibu ions o in ol ed indi-
iduals, wo kshop planning and s uc u e, con ex ual se ing, and conside a ions o
p i acy and e hics. A checklis is p o ided as p ac ical ool o conside ing hese key
componen s in he PD wo kshop planning and conduc (see Appendix 1).
5.2 Applica ion o heF amewo k o heDigi al Solu ion Mo e S amina
The e alua ion o he amewo k in he es case demons a ed i s easibili y and
p ac ical applicabili y. In his con ex , he lead esea che iden i ied se e al chal-
lenges ha a ose du ing he design p ocess o mo e s amina ha could ha e been
an icipa ed and add essed i he p oposed amewo k had been implemen ed. Spe-
ci ically, hese challenges ela e o aspec s ha a e c ucial o os e ing a common
unde s anding be ween he esea ch o de elopmen eam, use s and domain expe s.
Al hough he mo e s amina eam aimed o include he pe spec i es o use s and
expe s in hei de elopmen p ocess, hei ea ly in ol emen in he wo kshop plan-
ning was lacking. This omission limi ed he oppo uni ies o pa icipan s o a icu-
la e hei needs, he eby unde mining he pa icipa o y na u e o he p ocess.
5.3 Compa ison wi hP io Wo k
A mul i ude o s udies ha e epo ed he impo ance o in ol ing s akeholde s in he
design p ocess o digi al heal h solu ions and in e en ions [33, 40–42]. The ben-
e i s o using hese PD me hods ha e led many s udies ocusing on he design o
hese ypes o solu ions o in e en ions o use hese ypes o pa icipa o y me hods.
Al hough he e a e se e al design amewo ks ha a e equen ly used in he design
o digi al heal h solu ions o in e en ions [17, 18, 25, 43–46], mos o hese es ab-
lish high-le el aspec s, such as he s ages o he design p ocess o conc e e me hods
o pa icipa ion in speci ic domains. The p oposed amewo k goes a s ep u he
by iden i ying key componen s o he design o a speci ic pa icipa o y ac i i y
in he design o digi al heal h solu ions o in e en ions. These conside a ions a e
in line wi h ecommenda ions om o he s udies [42, 47–49]. In his ega d, Vial
e al. ecommend explaining he a ionale behind adop ing a human-cen e ed design
app oach, which is aligning wi h he “jus i ica ion o he app oach” componen in
ou amewo k [42, 49]. Voo heis e al. add essed pa icipan cha ac e is ics, join
e minology, plu ali y o expe ise, and e hics in hei wo k [48]. Las ly, Y iaho
e al. sha ed insigh s om in ol ing pa ien s in digi al heal h esea ch, ocusing on
pa icipan cha ac e is ics, plu ali y o expe ise, join e minology, ole de ini ions,
Jou nal o Heal hca e In o ma ics Resea ch
and pa icipa ion ba ie s [47]. The amewo k p esen ed he e in eg a es hese ac-
o s and pu s hem in a sys ema ic o de o gi e guidance o hose planning and lead-
ing a PD wo kshop.
5.4 Implica ions o Resea ch andP ac ice
The p oposed amewo k suppo s esea che s in planning and conduc ing PD wo k-
shops aimed a de eloping digi al heal h solu ions, ensu ing ha all ele an aspec s
a e ho oughly add essed.
The p ac ical implica ions o he PD amewo k o de eloping digi al heal h
solu ions cen e on c ea ing an inclusi e, e hical, and s uc u ed en i onmen ha
ac i ely suppo s and alues pa icipan engagemen . P ac i ione s a e encou aged
o os e a cul u e o openness and mu ual espec , emb acing di e se opinions
and expe ise and ensu ing ha all oices a e hea d and alued. Clea communi-
ca ion o he wo kshop’s pu pose, goals and pa icipa o y app oach helps o build
us and alignmen , while join ly de eloped e minology, goals, and ules p omo e
sha ed unde s anding and commi men . By in ol ing pa icipan s in planning and
decision making, he p ocess os e s owne ship and empowe men , which inc eases
bo h engagemen and mo i a ion. A en ion o pa icipan s’ cha ac e is ics—such as
li e acy le els, backg ounds, mo i a ions, and speci ic needs—ensu es accessibil-
i y and ele ance, while a hough ul app oach o managing powe dynamics and
ole expec a ions p omo es equi able pa icipa ion. P ac ical aspec s such as de ining
oles and inclusion c i e ia, choosing app op ia e me hods and ma e ials, s uc u ing
he wo kshop, and main aining a conduci e en i onmen all con ibu e o smoo h
and e ec i e implemen a ion. E hical and legal conside a ions, including p i acy,
e hics app o al, and egula o y compliance, need o be p io i ized h oughou . Ul i-
ma ely, his amewo k emphasizes he impo ance o adap abili y, p epa a ion, and
pa icipan -cen e ed design o achie e meaning ul and impac ul ou comes in digi al
heal h inno a ion. These ecommenda ions a e p o ided as checklis in he Appen-
dix 1.
By adop ing he amewo k and p ac ical guidance, PD wo kshops can acili-
a e meaning ul pa icipa ion, enabling he pa icipa o y p ocess o p oduce p ac i-
cal, well-accep ed digi al solu ions. To be e ec i e, he wo kshop design p ocess
i sel mus be pa icipa o y om he ou se , ac i ely in ol ing use s and expe s.
Howe e , his app oach can be challenging, pa icula ly in esea ch p ojec s, as i
equi es addi ional esou ces and ime o align po en ially con lic ing indi idual
goals. In addi ion, he indings o his s udy can in o m he c ea ion o epo ing
guidelines o s udies using PD me hods in he de elopmen o digi al heal h solu-
ions o in e en ions, p omo ing anspa ency and consis ency in he applica ion o
hese me hods.
5.5 Limi a ions
This s udy has some limi a ions ha a e epo ed below. Fi s , he numbe o expe s
in ol ed in he de ini ion o he amewo k is small and has a limi ed expe ise
Jou nal o Heal hca e In o ma ics Resea ch
ep esen a ion, which may ha e limi ed he di e si y o pe spec i es and gene aliz-
abili y o he key componen s. The inclusion o u he expe s wi h di e en expe-
iences in he PD p ocess in digi al heal h and, in pa icula , o use expe s could
lead o he iden i ica ion o o he ac o s ha ha e no been included in he cu en
e sion o he amewo k ye . Fu he mo e, he amewo k was de eloped wi hou
di ec in ol emen o he a ge popula ion (i.e., use s o digi al heal h solu ions) and
he e o e po en ially no cap u ing eal-wo ld needs and p e e ences o he in ended
use s. On he o he hand, a alida ion has been pe o med based on he expe ience
o a single expe and only one p ojec . I is clea ha his canno ensu e he unde -
s andabili y and comple eness o he de ini ions and he amewo k. Mo e ex ensi e
alida ion is needed o ensu e comple eness. As he ele ance o PD o digi al heal h
solu ions is inc easingly ecognized, we belie e i is impo an o p o ide guidance
as he p oposed amewo k does, and o expand and imp o e i con inuously by
inco po a ing eal-wo ld expe iences om i s applica ion.
6 Conclusions
PD wo kshops a e a powe ul app oach o c ea ing digi al heal h solu ions ha
a e bo h needs-d i en and use -cen e ed. By d awing on he collec i e expe ise
o p o essionals expe ienced in PD wo kshops, his amewo k aims o p o ide
p ac ical guidance o o he s in he ield. I s ul ima e pu pose is o ensu e ha PD
wo kshops a e mo e closely aligned wi h pa icipa o y p inciples and a oid he
pi alls o okenism.
Wi h i s i e main ca ego ies and nume ous ac o s, he amewo k no only o e s
conc e e ools and guidance bu also highligh s he inhe en complexi y o PD wo k-
shops— hei p ocesses, componen s, and impac . Impo an ly, he amewo k is
in ended o be a li ing ool ha will e ol e h ough widesp ead use, c i ical e lec-
ion, and collec i e e inemen . Such ongoing de elopmen would signal i s success
as a ca alys o pa icipa o y co-p oduc ion and inclusi e design, embodying he
e y p inciples i seeks o p omo e.
Supplemen a y In o ma ion The online e sion con ains supplemen a y ma e ial a ailable a h ps:// doi.
o g/ 10. 1007/ s41666- 025- 00199-4.
Acknowledgemen s The s udy was conduc ed wi hin a esea ch p ojec inanced by he Be n Uni e -
si y o Applied Sciences. This s udy was also ca ied ou as pa o he MyFa igue p ojec ha ecei ed
unding om he Spanish Minis y o Science, Inno a ion and Uni e si ies (P ojec G an PID-
2021-125528OB-I00 unded by MICIU/AEI/h ps:// doi. o g/ 10. 13039/ 50110 00110 33 and by FEDER,
UE).
In addi ion, he s udy was pa ly unded by he Eu opean Union’s Ho izon 2020 Resea ch and Inno a-
ion P og amme unde he Ma ie Skłodowska-Cu ie g an ag eemen No. 101034252. The publica ion
has also emana ed om esea ch suppo ed (in pa ) by a esea ch g an om Science Founda ion I eland
(SFI) unde G an Numbe 16/RC/3948.
Au ho Con ibu ion Concep ualiza ion: KD, EG, ORR, KVH Da a cu a ion: KD Funding acquisi ion:
KD, ORR, KVH In es iga ion: KD, EG, ORR, GG, KVH Me hodology: ORR Valida ion: GG W i ing –
o iginal d a : KD, EG, ORR, GG W i ing – e iew & edi ing: KVH, KD, EG, ORR, GG.
Jou nal o Heal hca e In o ma ics Resea ch
Funding Open access unding p o ided by Be n Uni e si y o Applied Sciences. The s udy was con-
duc ed wi hin a esea ch p ojec inanced by he Be n Uni e si y o Applied Sciences. This s udy was
also ca ied ou as pa o he MyFa igue p ojec ha ecei ed unding om he Spanish Minis y o Sci-
ence, Inno a ion and Uni e si ies (p ojec g an PID-2021-125528OB-I00 unded by MICIU/AEI/h ps://
doi.o g/10.13039/501100011033and by FEDER, UE).
In addi ion, he s udy was pa ly unded by he Eu opean Union’s Ho izon 2020 Resea ch and Inno a-
ion P og amme unde he Ma ie Skłodowska-Cu ie g an ag eemen no. 101034252. The publica ion
has also emana ed om esea ch suppo ed (in pa ) by a esea ch g an om Science Founda ion I eland
(SFI) unde g an numbe 16/RC/3948.
Da a A ailabili y No da ase s we e gene a ed o analysed du ing he cu en s udy.
Decla a ions
Compe ing In e es s The au ho s decla e no compe ing in e es s.
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Publishe ’s No e Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in published maps
and ins i u ional a ilia ions.
Au ho s and A ilia ions
Ke s inDenecke1· Oc a ioRi e a‑Rome o2,3· GuidoGiun i4,5·
Ka inVanHol en6· EliaGaba on7
* Ke s in Denecke
ke s in.deneck[email p o ec ed]
1 Depa men o Enginee ing andCompu e Science, Ins i u e Pa ien -Cen e ed Digi al Heal h,
Be n Uni e si y o Applied Sciences, Quellgasse 21, Biel2502, Swi ze land
2 Elec onic Technology Depa men , Uni e sidad de Se illa, Se ille, Spain
3 Ins i u o de Ingenie ía In o má ica (I3US), Uni e sidad de Se illa, Se ille, Spain
4 School o Medicine, T ini y College Dublin, Dublin, I eland
5 Facul y o Medicine, Uni e si y o Oulu, Oulu, Finland
6 School o Heal h P o essions, Compe ence Cen e Pa icipa o y Heal h Ca e, Be n Uni e si y
o Applied Sciences, Be n, Swi ze land
7 Depa men o Educa ion, ICT andLea ning, Øs old Uni e si y College, Halden, No way
