{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:57:39Z","timestamp":1787338659562,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the experiences of participants in the co\u2010design of a community\u2010based health service for people with frequent hospital admissions with regard to the design process and its outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>Qualitative semi\u2010structured interview study with co\u2010design participants who participated in co\u2010design meetings during service implementation. Co\u2010design members were healthcare workers, healthcare consumer representatives, and staff in health services management or leadership roles. Co\u2010design activities consisted of online meetings, out\u2010of\u2010session communication and two facilitated face\u2010to\u2010face workshops, which included case studies and small group activities. Health consumer representatives were also contacted out of session to enable them to contribute anything that they thought was important. An interview guide was used, which covered participants' experiences and perceptions of aspects and outcomes of the co\u2010design process during service implementation. Interviews were online, audio\u2010visually recorded, transcribed verbatim, and checked for accuracy. Two investigators independently and iteratively analysed data using components of grounded theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Inclusion criteria were being involved in the co\u2010design process during service design and service implementation, or being involved in the co\u2010design process after service design, and attending two or more meetings. After applying these criteria, eight people were approached, of whom five agreed to participate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants were interviewed between December 2023 and February 2024. Two themes were identified: (i) fluctuations in co\u2010design activity impacted engagement and (ii) continuity of co\u2010design processes across service design and service implementation. These themes are integrated into the final theoretical proposition: continuity in co\u2010design is essential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The continuity of people and the continuity of the application of co\u2010design processes are essential to ensure there is a link between design, implementation and evaluation; a \u2018break in the chain\u2019 can impact service implementation. People using co\u2010design could consider ways to maintain engagement during fluctuations in co\u2010design activity. Strategies to minimise co\u2010design team membership turnover may be needed, or, where turnover is unavoidable, ways to effectively onboard new co\u2010design participants. The continuation of co\u2010design processes from service design to service implementation may help ensure that there is a link between the co\u2010design phases. Lack of continuity of co\u2010design processes may lead to a lack of consistent application of co\u2010design principles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>This was an exploration of the experiences of co\u2010design participants involved in the design of a new service during the implementation of the service. The co\u2010design team included representatives from a university, primary healthcare, acute care services and health consumers. This study was informed by previous qualitative interviews with co\u2010design participants, including two health consumers. These interviews were undertaken during the design phase of the co\u2010design, and their findings were presented to co\u2010design participants (written plain language and an oral presentation), and they gave feedback on these. Two co\u2010design participants were regularly involved in discussions about the research methods, in particular, recruitment and timing of the research. A written summary of the findings from interviews during service implementation was shared with participants, who had an opportunity to provide feedback. One co\u2010design participant contributed to the \u2018Discussion\u2019 section of the manuscript, in particular the implications arising from this study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70436","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T08:47:14Z","timestamp":1758271634000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Continuity Is Essential: The Experiences of Co\u2010Design Participants During the Implementation of a New Health Service"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6306-4840","authenticated-orcid":false,"given":"Deirdre","family":"McGowan","sequence":"first","affiliation":[{"name":"Menzies Institute for Medical Research University of Tasmania Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9721-9225","authenticated-orcid":false,"given":"Claire","family":"Morley","sequence":"additional","affiliation":[{"name":"School of Nursing, College of Health and Medicine University of Tasmania Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Hansen","sequence":"additional","affiliation":[{"name":"School of Social Sciences University of Tasmania Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Shaw","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research University of Tasmania Hobart Australia"},{"name":"KP Health Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Winzenberg","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research University of Tasmania Hobart Australia"},{"name":"Primary Health Tasmania Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"e_1_2_14_2_1","volume-title":"Management of High\u2010Need, High\u2010Cost Patients: A \u201cBest Fit\u201d Framework Synthesis, Realist Review, and Systematic Review Comparative Effectiveness Review No. 246. 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