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This study aimed to co\u2010design an evidence\u2010based, nurse\u2010led weight talk tool with service users and nursing staff, and to evaluate its acceptability and usability in low\u2010 and medium\u2010secure inpatient care. A multi\u2010stage, iterative design was undertaken. Initial evidence informed development, followed by a person\u2010centred co\u2010design process involving service users and staff through workshops, structured discussions and repeated feedback. The tool was subsequently evaluated using a think\u2010aloud approach with 19 nurse\u2013service user pairs, enabling real\u2010time exploration of usability, understanding, and emotional responses. Co\u2010design produced a structured, visually engaging tool tailored to the sensitivities and constraints of secure mental health settings. Service users and staff shaped key refinements, including simplified language, removal of potentially stigmatising elements, enhanced visual design, and the inclusion of structured opening and closing components to support psychologically safe conversations. Evaluation findings demonstrated high acceptability and usability. Service users valued the respectful, collaborative approach, while nurses reported increased confidence in addressing weight\u2010related issues. These findings highlight the value of co\u2010design as a method for developing acceptable, contextually relevant interventions for sensitive clinical topics. Embedding collaborative approaches within mental health nursing practice may strengthen therapeutic engagement and support more effective, person\u2010centred care across diverse international settings.<\/jats:p>","DOI":"10.1111\/inm.70346","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:30:31Z","timestamp":1789709431000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Engaging Service Users in Co\u2010Designing a Nurse\u2010Led Weight Talk Tool for Low\u2010 and Medium\u2010Secure Mental Health Inpatient Settings: A Participatory Intervention Development Study"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0053-5091","authenticated-orcid":false,"given":"Novia K. 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