Recommendations Based on Lessons Learned

Codesign can result in a new or adapted program, a product, a campaign, or many other tangible items. Additionally, codesign has an impact on the people who participate. In ENSPIRE, we learned from doing the codesign with our teams and from conducting a rigorous evaluation with codesigners.

Here are some takeaways. Each includes a lesson learned, an action item, and a quote from our codesigner interviews (when available).

Codesigner contributions

Lesson learned: Codesigners were proud of their specific contributions to the content, messaging, and images included in the final products.

Action: Offer several ways that individuals can contribute to the product: words, ideas, images, music. If you use homework to gather input, make it easy for codesigners to share content/materials with facilitators.

A lot of the wording was mine. The video, the verbiage on the video I came up with. There was only one slide toward the end that I was struggling with the wording and we all collaborated on. But when we went over what I came up with, they were all like, ‘Sounds good.’ The theme that we ended up with was one that I had tossed out. So, I think I had a pretty good influence on how we steered the team, but they took the ball that I tossed and everybody ran with it. So, it wasn't just all me. I'm very humble about this. It was definitely a joint effort, but I think I had a nice strong influence on the direction that we went.”

Lesson learned: Some codesigners shared that they felt nervous about how they would fit with the group or what they could contribute. They felt more comfortable after getting to know the other codesigners and seeing their ideas incorporated in the codesign process.

Action: Plan activities to break the ice at the beginning and potentially continue team-building exercises in later sessions depending on how long your codesign runs.

It was really the fact that I felt like I was making a difference, like we were doing something really cool. Like I said, I was really nervous about it, but after the first session and getting to know everybody and then really starting to see it kind of come together, that made it easier.”

Personal benefit to being involved in codesign

Lesson learned: Codesigners learned information useful to themselves, their families, and their friends, and felt like they were making a difference. They also felt less isolated and more connected, and enjoyed the activities they did together.

Action: Considering that codesign is unfamiliar to many people, it could be helpful to mention some of these benefits when inviting people to join the codesign project.

Lesson learned: Hearing the stories and experiences of others helped codesigners feel encouraged and connected after going through the pandemic and feeling isolated. This concept has been described as common humanity in the mindfulness literature — the sense that others are experiencing similar struggles, so you aren’t alone.

Action: Build in enough time for codesigners to share with one another.

Working with the team, you listen to some of those stories that they've gone through — and a good number of them have had COVID, too — we had similar thoughts. It felt like we were kindred spirits, because a good many of them had COVID or had family members that had it. So, I felt that what we were doing was positive for us and to get the word out to other individuals.”

Lesson learned: Our codesigners liked getting to know each other, and some stayed in touch after codesign. They appreciated meeting staff who worked at other long-term care centers, having the chance to hear how others were doing and laughing together.

Action: Recognize that some codesigners may form friendships — if you create a welcoming atmosphere, you don’t have to do anything to make friendships happen!

The atmosphere was just made comfortable. The moment that you walked in, you were not intimidated. It was a relaxing and welcoming invite coming into the Zoom. It was ‘hellos, tell us something about yourself.’ I think once or twice it was reflecting on something that happened during your day that was positive. It was never the same opening every codesign — it was something different, something positive you did yesterday, or what you thought or whatever. So, just coming into it, it was kind of a laid-back ‘we want you to vent, open your mind, feel free, come in and join and relax.’ So, I definitely enjoyed the codesign.”

Lesson learned: Codesigners in ENSPIRE appreciated learning from each other and hearing each other’s stories.

Action: Ensure there is ample time for interaction and co-learning rather than including a lot of content that is presented or taught by facilitators!

The fact that all of us got to tell a little piece of our story, what we went through during COVID, whether it was that person got COVID or someone they loved got COVID — we got to tell those stories and then go back to our communities and give those pamphlets out. So, again, the coworkers could see what we went through and why we got vaccinated and got boosted. If it just encouraged one or two people, that's a lot to me, because that could save somebody's life."

Input from others not on your codesign teams

Lesson learned: Codesigners who are passionate enough about a health issue to choose to participate in codesign may not be representative of the target audience. In a project focused on designing materials, codesigners can benefit from peer input during the design process. This step could increase the impact of the materials.

Action: Create activities during which codesigners can gather input from their peers, such as our peer interview activity. You may also want to test your products with focus groups before mass dissemination of a final product.

I do believe we had one homework assignment to find out about our family, why they did not want to be vaccinated. That, to me, opened up my eyes when I asked my kids, ‘Why don't you guys want to get vaccinated?’ So, I enjoyed that as well.”

Skillful and compassionate facilitation

Lesson learned: Facilitators can create a collaborative and supportive environment for dynamic creation during codesign. Participants described how the facilitators created space for the team to share opinions and work together on the design without “interfering” in the work of codesign. This led to the codesign participants feeling that they truly did the work (as compared to only being consulted).

Action: Develop a curriculum in which facilitators share background and goals (that are jointly developed with communities when possible) and leave the creating to the codesigners.

They would lead the discussion, but they wouldn't take over. They let us then do the discussing and the designing and stuff. So, they were there just to keep us on track and keep us going, but they let us do the work.”

Lesson learned: Facilitators ensured participation from codesigners who had varying opinions and comfort levels with contributing in a group setting. Codesigners' opinions and ideas were solicited, respected, and incorporated into the codesign products.

Action: Create a respectful space for all to contribute — even when opinions differ. Co-creation of group agreements at the beginning of the first codesign session can help with this.

The way that they handled this one made it so somebody like me wanted to continue to come and socialize and express their feelings toward things or express their ideas. I think that's really important, and they should keep doing that — making it a safe place for people to go to bounce ideas off of. Because for something as controversial as the COVID vaccine, it can get heated, and I think they did a really good job making sure that everybody respected each other.”

Lesson learned: Work must get done. Facilitators provided guidance by keeping codesigners on task, organizing the sessions, answering questions, providing clarification, and taking notes.

Action: Use written curricula, audio-visual materials, and an accurate clock to stay on schedule. Be sure to thoroughly explain the process and goals up front, including the intended products, so codesigners have a framework in which to function.

They were really good about keeping us all on track, keeping some of the things to the front of our heads about this is what we're doing and keeping us from getting down a rabbit trail. But they also had a lot of really good thoughts and things and stuff for us to brainstorm about. They did a great job about keeping us where we needed to go, so we could wrap it up in the timeframe that we needed to, because we could have easily ended up down multiple trails and not accomplished anything.”

Lesson learned: Specific activities during sessions can keep codesigners engaged. These could be icebreakers, peer interviews, role-playing, or scavenger hunts. Such activities work both in person and online.

Action: Include engaging activities in each session and vary the format from week to week.

We did a virtual scavenger hunt which was kind of related to COVID — one of the items was hand sanitizer — but, again, who would have thought in a project like this we would have done a scavenger hunt? But believe it or not, everyone literally got up and ran around the house like chickens with their heads cut off, trying to participate. So, that's a prime example of some of the thinking-outside-the-box ideas that we had going on.”