{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:19:11Z","timestamp":1787797151613,"version":"build-2784847793"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Involving patients and the public in healthcare research, development and innovation is becoming mandatory. Co\u2010design is a structured approach to collaboratively investigating and finding solutions to complex problems that brings together relevant actors and interest groups. Including experiences and insights from patients and the public in multi\u2010actor co\u2010design processes can help to generate and evaluate solutions to complex problems. While toolkits support co\u2010design project organisation, little is known about the relational work required when facilitating co\u2010design workshops, especially in healthcare, where professionals often learn facilitation skills \u2018on the job\u2019. Reflective accounts are scarce, despite the complexity and unpredictability of co\u2010design. Based on reflective conversations between two co\u2010design workshop facilitators, this article explores co\u2010design facilitation as relational work and offers a conceptual model to guide reflection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Authors B.H. and K.C. facilitated five co\u2010design workshops involving people living with chronic pain between September 2023 and January 2024. Within 24\u2009h of each workshop, individual reflective interviews (B.H.,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095; K.C.,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095) and dyadic reflective discussions between the two authors (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095) about the learning and insights gained from the workshop facilitation were recorded. The average length of the interviews and dyadic discussion was approximately 18\u2009min. The data were automatically transcribed and analysed in a reflexive thematic analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Facilitation required managing unpredictability alongside structural considerations. Three interconnected themes were identified: (1) the planning, evaluation and learning space; (2) the workshop\u2010holding space, comprising structural, emotional, physical and activation subspaces and (3) the tacit space. We present an overarching theme and conceptual reflection model: \u2018Holding complex spaces through relational work\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings show that co\u2010design facilitation is demanding relational work that involves continuous interpretation and awareness. The conceptual model provides a flexible reflective tool for understanding facilitation complexity, rather than a procedural guide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case study shows that co\u2010design facilitators must hold complex, unpredictable relational spaces. While toolkits offer useful structure, facilitation hinges on navigating relational dynamics. Our conceptual reflection model provides a flexible way to understand this complexity through interconnected spaces and to support reflective skill development. Developed in chronic pain contexts, the model may be transferable to other healthcare settings; future work should examine its value for facilitator training in co\u2010design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Two patient representatives are co\u2010authors of this publication and provided critical input on the findings and their interpretation. Both have been co\u2010researchers in the reported co\u2010design project since its inception and contributed throughout study planning, workshop delivery, the reflective analysis and reporting of results in the current study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70752","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T06:22:35Z","timestamp":1783146155000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Holding Complex Spaces Through Relational Work: A Qualitative Descriptive Study of Co\u2010Design Facilitation"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4047-350X","authenticated-orcid":false,"given":"B.","family":"Heckemann","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine Sahlgrenska University Hospital\/\u00d6stra Gothenburg Sweden"},{"name":"Institute of Health and Care Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1035-2734","authenticated-orcid":false,"given":"E.","family":"Varkey","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy and Physiotherapy Sahlgrenska University Hospital\/\u00d6stra Gothenburg Sweden"},{"name":"Department of Health and Rehabilitation\/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6941-6096","authenticated-orcid":false,"given":"P.","family":"Andr\u00e9ll","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine Sahlgrenska University Hospital\/\u00d6stra Gothenburg Sweden"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6111-8377","authenticated-orcid":false,"given":"A.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine Sahlgrenska University Hospital\/\u00d6stra Gothenburg Sweden"},{"name":"Institute of Health and Care Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Johannsson","sequence":"additional","affiliation":[{"name":"Patient Representative Levande Bibliotek (Living Library) Gothenburg Region V\u00e4stra G\u00f6taland Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Forslund","sequence":"additional","affiliation":[{"name":"Patient Representative Levande Bibliotek (Living Library) Gothenburg Region V\u00e4stra G\u00f6taland Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8796-343X","authenticated-orcid":false,"given":"K.","family":"Cern\u00e1","sequence":"additional","affiliation":[{"name":"School of Information Technology Halmstad University Halmstad Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40900-023-00490-x"},{"key":"e_1_2_18_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00558-0"},{"key":"e_1_2_18_4_1","unstructured":"V\u00e5rd\u2010 och omsorgsanalys [Swedish Agency for Health and Care Services Analysis] En f\u00f6r alla. Erfarenheter av patientmedverkan i styrning och ledning av h\u00e4lso\u2010 och sjukv\u00e5rden. [One for All. Experiences of Patient Participation in the Governance and Management of Health and Medical Care.] V\u00e5rd\u2010 och omsorgsanalys 2024 https:\/\/www.vardanalys.se\/rapporter\/en-for-alla\/."},{"key":"e_1_2_18_5_1","unstructured":"National Institute for Care and Health Research UK Standards for Public Involvement 2018 https:\/\/sites.google.com\/nihr.ac.uk\/pi-standards\/home."},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-7568(24)00010-2"},{"key":"e_1_2_18_7_1","unstructured":"T.ZamenopoulosandK.Alexiou \u201cCo\u2010Design as Collaborative Research. Bristol University\/AHRC Connected\u201dCommunities Programme 2018 https:\/\/oro.open.ac.uk\/58301\/."},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/25741292.2022.2157195"},{"key":"e_1_2_18_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2005.016527"},{"key":"e_1_2_18_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12888"},{"key":"e_1_2_18_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S403243"},{"key":"e_1_2_18_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-020-0528-9"},{"key":"e_1_2_18_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058390"},{"key":"e_1_2_18_14_1","unstructured":"Agency for Clinical Innovation. Co\u2010Design Toolkit: Ways of Working Together in Co\u2010Design. New South Wales Government 2021 https:\/\/aci.health.nsw.gov.au\/projects\/co-design\/working-together#menu."},{"key":"e_1_2_18_15_1","unstructured":"T.Holst Madsen. Process Facilitation & Co\u2010Design. Observatory of Public Sector Innovation. (n.d.) Accessed April 14 2026.https:\/\/oecd-opsi.org\/guide\/facilitation-and-codesign\/."},{"key":"e_1_2_18_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40900-021-00252-7"},{"key":"e_1_2_18_17_1","unstructured":"Observatory of Public Sector Innovation \u201cToolkits Archive. Observatory of Public Sector Innovation \u201d (n.d.) Accessed April 14 2026.https:\/\/oecd-opsi.org\/toolkits\/."},{"key":"e_1_2_18_18_1","doi-asserted-by":"publisher","DOI":"10.1145\/2347635.2347645"},{"key":"e_1_2_18_19_1","doi-asserted-by":"publisher","DOI":"10.1017\/pds.2022.108"},{"key":"e_1_2_18_20_1","doi-asserted-by":"publisher","DOI":"10.21278\/idc.2018.0141"},{"key":"e_1_2_18_21_1","first-page":"72","volume-title":"Design, User Experience, and Usability: Design for Emotion, Well\u2010Being and Health, Learning, and Culture","author":"Jumisko\u2010Pyykk\u00f6 S.","year":"2022"},{"key":"e_1_2_18_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sheji.2017.11.003"},{"key":"e_1_2_18_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13875"},{"key":"e_1_2_18_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/15710882.2025.2460037"},{"key":"e_1_2_18_25_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.1997.1997025396.x"},{"key":"e_1_2_18_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-014384"},{"key":"e_1_2_18_27_1","volume-title":"The Skilled Facilitator: A Comprehensive Resource for Consultants, Facilitators, Coaches, and Trainers","author":"Schwarz R. M.","year":"2017"},{"key":"e_1_2_18_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jade.12349"},{"key":"e_1_2_18_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/15710882.2024.2349578"},{"issue":"6","key":"e_1_2_18_30_1","first-page":"14\u201316","article-title":"A Process for Personal Theory Building","volume":"48","author":"Killion J.","year":"1991","journal-title":"Educational Leadership"},{"key":"e_1_2_18_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/16094069241257945"},{"key":"e_1_2_18_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12925"},{"key":"e_1_2_18_33_1","article-title":"PAS\u2010SAP \u2013 My Pain Survey \u2013 For Support and Partnership","author":"Heckemann B.","year":"2022","journal-title":"VGR Research Web; V\u00e4stra G\u00f6talands Region"},{"key":"e_1_2_18_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/capr.12360"},{"key":"e_1_2_18_35_1","unstructured":"Inclusive Design Research Centre \u201cCommunity\u2010led co\u2010design kit \u201d (n.d.) Accessed May 5 2026.https:\/\/co-design.inclusivedesign.ca\/."},{"key":"e_1_2_18_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ev.1427"},{"key":"e_1_2_18_37_1","first-page":"67","volume-title":"Proceedings of the 1996 ACM Conference on Computer Supported Cooperative Work \u2010 CSCW \u201996","author":"Harrison S.","year":"1996"},{"key":"e_1_2_18_38_1","doi-asserted-by":"publisher","DOI":"10.1145\/1180875.1180921"},{"key":"e_1_2_18_39_1","doi-asserted-by":"publisher","DOI":"10.1145\/3492831"},{"key":"e_1_2_18_40_1","volume-title":"Learning for Life: A Workshop Report","author":"Cerna K.","year":"2020"},{"key":"e_1_2_18_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/15710882.2020.1740279"},{"key":"e_1_2_18_42_1","doi-asserted-by":"publisher","DOI":"10.1080\/15710882.2014.881886"},{"key":"e_1_2_18_43_1","doi-asserted-by":"publisher","DOI":"10.21606\/nordes.2025.48"},{"key":"e_1_2_18_44_1","doi-asserted-by":"publisher","DOI":"10.35199\/ICDC.2020.24"},{"key":"e_1_2_18_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1545-5300.2001.4010100033.x"},{"key":"e_1_2_18_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13795"},{"key":"e_1_2_18_47_1","volume-title":"Strengths\u2010Based Approaches for Working with Individuals","author":"Pattoni L.","year":"2012"},{"key":"e_1_2_18_48_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41077-025-00352-4"},{"key":"e_1_2_18_49_1","doi-asserted-by":"publisher","DOI":"10.1080\/14780887.2020.1769238"},{"key":"e_1_2_18_50_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2024.2378912"}],"container-title":["Health Expectations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70752","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hex.70752","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70752","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:14:54Z","timestamp":1787796894000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hex.70752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":49,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/hex.70752"],"URL":"https:\/\/doi.org\/10.1111\/hex.70752","archive":["Portico"],"relation":{},"ISSN":["1369-6513","1369-7625"],"issn-type":[{"value":"1369-6513","type":"print"},{"value":"1369-7625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"assertion":[{"value":"2025-12-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70752"}}