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Abstract

This study protocol discusses the co-design and co-development of a social media health promotion program for young women. The program aims to disseminate evidence-based health information and promote healthy behaviours among young women aged 18–24 years. The evidence-base for social media interventions is explored, with examples of successful health promotion programs using social media platforms for example, Facebook. The social media health promotion program has been developed in four phases, including a literature review, interviews and workshops with young women, dietitians, digital marketers and marketing and nutrition academics, co-design and development of the program, and a feasibility study. The feasibility study will be using a mixed-methods approach, including surveys, focus groups, and social media analytics. Overall, this protocol highlights the potential of social media as a platform for promoting health behaviours among young adults and provides a framework for the co-design and co-development of evidence-based health promotion programs using social media.

Keywords

social media health promotion young women co-design

Introduction

Every day, young adults aged 18–26 years (Generation Z) in the Asia Pacific region spend an average of 2 and a half hours on social media (SM) ((GWI), 2023c). Regarding accessibility and reach, SM is a promising option for health promotion and the dissemination of evidence-based health information. Recent wellness trends demonstrate a growing interest among the younger generation in implementing healthy behaviours, evidenced by an 11% global growth in interest in vegan food, and a growth of 23% in the number of global consumers who ‘never eat fast food’ since 2019 ((GWI), 2023a). Interest in health goes beyond nutrition, however, with 70% of consumers stating that mental health awareness is important to them, and growing efforts to ‘try new things of importance’ and ‘explore the world around us’ were observed, with an increase of 8% and 6% respectively in these behaviours since 2022 ((GWI), 2023b).

The evidence-base for social media interventions is rapidly growing. Recent efforts have demonstrated the feasibility and usability of SM platforms when it comes to changing behaviours. Facebook has been used in a multitude of ways, including as a health coach for college students in the United States, a platform for diabetes health promotion in Norway, and for disseminating tobacco control content to reduce smoking rates among Australian Aboriginal and Torres Strait Islander people (Gabarron et al., 2018; Hefler et al., 2019; Merchant et al., 2014). Organisational use is also common, with SM gaining acknowledgement for its utility in mass health promotion (Stellefson et al., 2020). Various health promotion agencies and organisations have utilised novel social platforms to raise awareness and disseminate evidence-based health information. Recent campaign examples include the Ice Bucket Challenge for awareness of amyotrophic lateral sclerosis (ALS), #ThisGirlCan for the encouragement of inclusive physical activity, and ‘It’s Okay to Not Be Okay’ for mental health advocacy (Roy & Malloy, 2023). The effectiveness of SM interventions on health via meta-analysis and meta-regression indicate significant effects on adult body weight, sexual health behaviours, general wellbeing and other health indicators such as daily step counts (Hunter et al., 2019; Loh et al., 2023; Vereen et al., 2023). Despite promising results, most authors conclude that gaps remain within the novel evidence-base of SM health promotion and intervention.

For younger generations, it is important to consider a recent shift in SM awareness and perceptions of the platforms as potentially harmful, as well as useful and entertaining. There are growing efforts to limit social media use and use SM ‘less than usual’, with an increase of 15% and 11% in these behaviours respectively since last assessed in 2022 ((GWI), 2023b). Regarding Instagram, a platform commonly favoured by younger generations, the likelihood of encountering misinformation or exposure to harmful nutrition-related content is high. A recent review of the quality of online nutrition information across social media and various websites was found to be low and often inaccurate (Denniss et al., 2023b). A content analysis of over 100,000 nutrition-related Instagram posts in Australia indicates SM site Instagram may be a useful setting for health promotion, however, popular content such as ‘body goals’ and recipe sharing that utilises moralising language around food (e.g., ‘guilt-free dessert’) are concerning (Denniss et al., 2023a).

There are strong links to social media use, body image issues, and poor food relationships (de Vries et al., 2016; Fardouly & Vartanian, 2016; Rounsefell et al., 2020). Associations have been found amongst youth between body dissatisfaction and a ‘drive for thinness’ with the frequency of comparing one’s own physical appearance to that of people followed on social media (Jiotsa et al., 2021). Researchers note education, not weight, as a confounding factor in this relationship. There is need for a greater presence of health professionals across apps commonly used by young people. Explorations into the ability of health professionals to utilise similar communication methods to those of health influencers to increase the evidence-base – and subsequent health literacy - on popular apps such as Instagram and TikTok is needed. Considering this, we intend co-develop a health promotion intervention for young women to be delivered on SM.

Aims

This paper describes the protocol for the first four phases of the co-design and co-creation of a university-led health promotion program for young women called the Daily Health Coach (DHC). The overarching objective is to identify and engage with relevant stakeholders including dietitians, nutrition researchers, and end-users (EU) to determine the needs for a social media health promotion programme for young women. The reporting of this protocol follows similar publications, as well as guidance from the Health Cascade Network (Cascade, 2022; Lawless et al., 2020; Mitchell et al., 2017; Thabrew et al., 2017).

Theoretical Framework

The theoretical framework (Figure 1) for the co-design and co-development of a novel social media health promotion program for young women involves a combination of theories and evidence-based models such as the health belief model, self-determination theory (SDT), participatory design and behaviour change techniques using the COM-B model as well as peer-reviewed evidence from effective health-related interventions in this population using behaviour change strategies (Carney et al., 2016; Deci & Ryan, 2012; Kilanowski, 2017; Norman & Conner, 2017; Ryan et al., 2008; West & Michie, 2020).

Figure 1.

Theoretical framework for the co-design and co-development of the Daily Health Coach.

This study will employ an iterative participatory design process to co-design, co-create, and test a social media health promotion programme for young women in NZ. Co-design, as outlined by the Centre of Social Impact (Knode), is “person-centred, aims to develop practical, real-world solutions and makes ideas, experiences and possibilities visible and tangible” (Burkett, 2012). True participatory methods are transparent, inclusive of multiple perspectives, and are led by stakeholder insights and ideas rather than traditional ridged research methods. Health interventions that utilise participatory design and its descendant methods have been shown to benefit stakeholders, researchers, and research outputs (Slattery et al., 2020). A recently identified short-coming across co-creation literature is the description of collaborative methods used, which tend to be poorly defined (Eyles et al., 2016; Messiha et al., 2023). This highlights the need for co-creation protocols, particularly in health research, where collaborative methods are of high importance to ensure meaningful and effective outputs.

Guidance used for the participatory process includes a framework for the participatory design of evidence-based online youth mental health interventions from the Young and Well Cooperative Research Centre, as well as NPC’s implementation and evaluation toolkit (Man Mcleod, 2019; Hagen et al., 2012). Both resources recommend beginning co-design processes with discovery and identification of the issue from the EU perspective. Expert focus groups and interviews will determine the research gap and health issue from the field perspective, before EU workshops explore issues from the perspective of young women.

Introducing the Daily Health Coach

To our knowledge, the DHC intervention will be the first in NZ to convert the communication techniques of influencers for the dissemination of evidence-based health information to young women belonging to Generation Z. Content and SM strategy will be informed by insights from expert and EU discussions, as well as best practice guidelines for nutrition and physical activity, taking a non-diet approach innkeeping with the Health At Every Size (HAES) paradigm (Clifford et al., 2015; Penney & Kirk, 2015).

Materials and Methods

Study Design

The Daily Health Coach research process will consist of five key phases (Figure 1). The final phase will be outlined in a separate publication. The fluidity of co-design makes for a dynamic and adaptable study framework which may be subject to change as the research progresses. The process may not be linear, with the revisiting of previous phases a likelihood to iteratively develop the intervention.

Research Sampling Strategy

A representative sample of young women aged 18–24 years will be recruited to participate in co-design workshops. Participants will be recruited using targeted advertisements on SM pages (Facebook, Instagram, Twitter, LinkedIn). Advertisements in the form of SM ‘stories’ and ‘posts’ will be shared with a wide audience through university and researcher channels. Detailed targeting is an option available in the ‘audience’ section of ad set creation that will allow the researcher team to refine the group of people (e.g., 18–24 years, female-identifying, located in New Zealand) to whom the targeted ads will be shown. The research advertisements will direct prospective participants to the study website and an online survey to screen for eligibility. A sample of participants for the co-design workshops that is representative of the New Zealand population is a key focus. Community health organisations Toi Tangata and The Fono in Auckland will lead engagement processes with potential Māori and Pasifika participants respectively. Snowball sampling methodology will be used to recruit additional participants should we receive limited expressions of interest, whereby the student researcher and PI may ask current participants to contact additional potential participants and pass on the student researchers’ contact details (Parker et al., 2019).

Data Collection and Storage

Audio transcripts will be downloaded, cleaned, and stored in a password-protected folder on a university-managed storage system (Research Drive Storage) accessible only via a university UPI and two-factor authentication code. Audio transcripts will be generated by conferencing software Zoom. To ensure the transcripts are verbatim, the student researcher will listen to all transcripts, cleaning and deidentifying the documents in the process. It is in this way that participant confidentiality will be upheld, with each participant being assigned an alphanumeric code upon enrolment and only stated as such in all data collected. No video data will be captured, however, screenshots of activities such as digital whiteboards may be collected for further analysis, as well as de-identified notes by the research team. After a minimum of six years, data will be securely removed from all storage folders and university systems.

Data Quality Control

Audio recordings eliminate the need to rely on the power of recall. Data quality will be upheld by ensuring transcripts are verbatim. There is risk of bias with the translation of audio recordings, arising from subconscious translator influence on transcripts, subjective prioritisation of content to translate, and/or inaccuracy in the recording of information due to low-quality audio data (McMullin, 2023). To prevent this, transcripts will be generated predominately by the recording software itself, before ensuring all software-generated errors are corrected prior to analysis. Further, participants will not be offered an opportunity to read or review transcripts or notes, as these documents may contain identifiable statements and the sharing of documentation increases the risk of inaccurate translation.

Data Collection Limitations and Challenges

Data collection teams with diverse skill sets and backgrounds are preferable to limit confirmation bias and common data collection errors such as equipment failure and transcription inaccuracies (Easton et al., 2000). The student researcher and PI will be responsible for collecting, translating, and analysing all qualitative data. Despite steps taken to reduce an erroneous or biased data set, the small research team overseeing the participatory development of the Daily Health Coach may increase the likelihood of mistranslation or collection error(s). To ensure the developed program is authentic to the needs and desires of co-designers, opportunities will be offered to participants following the co-creation of content to evaluate and provide feedback on the created program. This provides an important opportunity to address any misalignments in perspectives, interpreted values, and research conclusions with end users.

Study Population

Six dietitians, one nutrition researcher, three digital marketers, and two marketing academics will be invited to participate in Phase 1 of the research. Nineteen young women aged 18–24 years will be invited to participate in EU workshops. Ten student dietitians of the same demographic at a large urban university in Auckland, New Zealand will be offered a public health placement involving the creation of content for the DHC intervention. All EU participants of the co-design workshops will be invited to co-create content, as well as attend a progress presentation and feedback session six months following the workshops to evaluate co-created content.

Inclusion Criteria

To participate in the EU workshops, young women must meet age criteria (18–24 years), be a New Zealand resident, be familiar with social media, be able to give consent and speak fluent English.

Exclusion Criteria

Young women will be required to complete a screening questionnaire (the revised 2018 Three Factor Eating Questionnaire TFEQ-r18) prior to enrolment in the participatory phase. Young women with TFEQ-r18 scores higher than 75% will not be excluded but will be sent trigger warnings in the form of emails prior to workshops based on topics covered in the workshops such as body image issues, restrictive eating, and food relationships.

Participatory Methods

The key objectives of the focus groups, interviews, and co-design workshops are to understand (1) how the program should be delivered, (2) who should deliver the program, (3) which social media components might work best, and (4) what nutrition behaviours the program should aim to change. All interviews, focus groups, and workshops will be held on conferencing software Zoom (Version: 5.14.10) (“Zoom Video Communications, Inc.,” 2012-2023).

Phase One

The research will initiate with expert focus groups and interviews (Figure 2). The purpose of this phase is to ascertain expert opinion on health promotion using social media from a health and marketing perspective. Expert interviews with digital marketers and marketing academics will be central to understanding the optimisation and challenges of social media algorithms. For the focus groups, we anticipate the participation of up to seven nutrition experts, including dietitians and nutrition researchers. We aim to hold two sessions, with a maximum of four experts in each group. The sessions will follow a moderation guide aligned with the NPC toolkit for co-design and are estimated to last up to 90 min. This guide will include questions according to focus group objectives such as the role of social media in young people’s lives, pertinent nutrition issues for young people, and development of topics and questions to address in Phase Two.

Figure 2.

Five-phase Daily Health Coach research process.

To understand the marketing aspect of the research, as well as the use of social media by health organisations and young people, interviews will be held with digital marketers and marketing academics. Three digital marketers and two marketing academics will be invited to attend an individual interview. Interviews will be conducted using a semi-structured interviewing technique. The duration of interviews is anticipated to be 45 min to an hour.

Phase Two

Phase One learnings will result in an outline for EU workshops. The purpose of the second phase is to discuss with young women their experiences, perspectives and aspirations regarding health, nutrition, and health promotion on social media. Three EU workshops be hosted with up to 20 young women to explore the meaning of wellbeing to young women, their use and perceptions of SM, and their ideas for a targeted social media health program. The number of participants in each workshop will be limited to 10 to aid equitable participation. The first workshop will involve activities such as a reflection on individual meanings of well-being, as well as barriers in establishing, achieving, and maintaining healthy behaviours.

The goal of the second workshop is to understand characteristics of influence and the use of social media from the perspective of EU, which often misaligns with research. We will achieve this by asking the cohort to look at various nutrition influencers across social media and share with us their organic thoughts on their content and delivery. We will then administer a brief survey asking about their use of social media, such as apps of preference and screentime.

In the final workshop, we will determine the information and content desires of the target group regarding health and nutrition and will be advised on social media platforms and content strategies for the programme. We will do this by placing EU in digital ‘breakout rooms’ to brainstorm what they believe the intervention should look like in terms of apps of use, aesthetic, type of content posted, frequency of contact by the research team, and ideas around cultural relevancy and general inclusivity.

Phase Three

The aim of the third phase is to co-create engaging and evidence-based content for the program with student dietitians. Ten student dietitians aged 18–24 years from the research university will be involved in the co-creation of content, forming part of their training in public health nutrition. Knowledge translation from conversations with experts and young women will inform the creation of a draft content planner for the 12-week social media intervention. Once the draft planner has been created, which will provide content suggestions for each day of the 12-week intervention, student dietitians will select content to create. Each student dietitian will be responsible for the creation of 7 days’ worth of content. The content planner will be adaptable; student dietitians will have the ability to modify content and suggest new content ideas for the intervention. Any remaining content will be created by the student researcher and offered to co-design participants as an opportunity for further involvement.

Phase Four

The final phase provides an opportunity to ensure co-created content accurately reflects the desires of EU and aligns with expert suggestions. All co-design participants will be invited to attend a feedback session, whereby 1 week of co-created content will be posted to the private Daily Health Coach Instagram feed. The content will remain on the site for a couple of days, allowing those proving feedback to view content and leave thoughts and suggestions under posts in comment sections, as replies to stories, or as direct messages. This feedback will be used to make any final changes to the content prior to the intervention beginning. Figure 3 summarises the expected timeline of the study phases.

Figure 3.

Expected timeline of study phases.

Outcome Measures

Due to the exploratory nature of the co-design process, the research team have decided not to pre-specify outcome measures for the early participatory phases of the study. Research outcomes will emerge as the research progresses and the needs for such a health promotion program become clear. The feasibility and early efficacy of the intervention will be trialled in late 2024.

Qualitative Data Analysis

The analysis of qualitative data will be guided by Braun & Clarke’s and Krueger & Casey’s data analysis strategies (Casey, 2014; Clarke, 2021). Thematic Analysis will be performed using NVivo qualitative research data analysis software for coding and thematic framework generation. The plan will consist of ten key steps (Table 1).

Table 1.

Plan for Qualitative Data Analysis.

1. The researcher(s) will familiarise themselves with the data. This will involve listening to the audio recordings and reading through the transcripts to get a general sense of the data. Any initial thoughts, impressions, or observations that come to mind will be noted. For initial data familiarisation, NVivo tools such as word frequency and cloud queries will be utilised to identify keywords

2. The researcher(s) will conduct an initial round of coding to identify all the meaningful segments of data that are relevant to the research question(s). This will involve highlighting using NVivo to tag sections of the data. The researchers will document all coding decisions in a shared codebook

3. Keywords identified will then be input into the mapping tools for a visual representation to begin identifying topics, themes, and ideas present in the data

4. A list of deductive codes will be generated from research questions and mapping tool functions. This list of deductive codes will be used for initial data coding

5. Inductive codes and additional deductive codes will be continually generated as coding takes place, resulting in a comprehensive list of inductive and deductive codes

6. The final code set will be sent to a second researcher for independent coding of the presented data. Once completed, the primary researcher will review the agreement between codes. Where there is significant disagreement, discrepancies will be discussed in a meeting set for this purpose

7. Once researchers have identified all the meaningful segments of data, the researchers will look for patterns, similarities, or connections among the codes they have identified, generating themes and theme descriptions

8. The researchers will review and refine any generated themes, ensuring they are distinct, meaningful, and relevant to the research question(s). The researcher(s) may need to adjust their coding scheme or go back to the data to gather additional evidence or examples to support the themes

9. Themes will be finalised, and data organised via tables, matrices, or mind maps to visualize the relationships among themes and the data that supports them. This will involve synthesizing the data across themes, identifying patterns or trends, or providing rich descriptions of the data

10. Researchers will write up the findings in a manuscript, including a clear description of the methods, the themes identified, and the evidence that supports them. The findings will be contextualised within the existing literature, and their implications for theory, practice, and future research will be discussed

Ethical Considerations and Quality Assurance

The co-design of the Daily Health Coach was approved by the Institutional Review Board.

Participant confidentiality will be upheld via de-identification of collected audio-data and notes. Any report or discussion of confidential information will be done in a way that does not identify the participant as the source of information. Only the principal investigator and student researchers will have access to identifiable data, which will be stored on a university-managed system.

EU will not be required to turn on their cameras at any stage during the co-design process. EU will be asked to keep all information discussed in the workshops, including information about other participants, confidential. Young women will be reimbursed for their participation with a supermarket voucher for each workshop attended. The agreed value of the vouchers will not be so large as to unduly induce individuals to consent to participate or constitute an employment relationship with the university. Young women will be made aware that their participation will not affect their relationship to the university.

Once all content has been created and feedback provided, the quality of content will be assessed prior to finalisation. In order to ensure content (including captions) are evidence-based and of a high-quality, the recently developed principals for health-related information on social media (PHRISM) will be used (Denniss et al., 2022). The thirteen principals (accuracy, credibility, readability, inclusivity, diversity, visual appeal, appropriate behavioural focus, appropriate use of language, hashtags and call to action, and risk avoidance) were developed to evaluate factors such as transparency, accuracy, and accessibility, and will help to ensure the DHC intervention makes for a meaningful contribution to online discourse and efforts to combat misinformation.

Results

Recruitment for the participatory phase of the study commended in August 2022 and recruitment of participants for the intervention phase of the study commenced in July 2023. Completion of intervention recruitment is anticipated to occur in September 2023 and analysis of results will be undertaken by August 2024. Findings of the participatory design process, as well as a comprehensive feasibility trial protocol, will be available in 2024. Feasibility trial results will be shared by the end of 2024.

Discussion

Contribution to the Field of Participatory Design

A collaborative approach to the development of the Daily Health Coach was chosen due to the established merits of co-design including the generation of well differentiated or targeted outputs reflective of user values. The iterative multi-phase framework described is aligned with best-practice recommendations for both participatory design and youth behaviour change methods. We posit the constantly evolving social platforms and their use by young people can only be understood via ongoing engagement and discussion with end-users. Thus, the need for co-design is clear. The fluid nature of participatory design allows for revision and amendment, owing to the use of the DHC development framework as an adaptable guide for the collaborative creation of other digital health tools with distinct population groups.

The digital food environment, including social media, is a space largely dominated by industry ingenuity and influencer voices. The enhanced presence of health professionals and organisations online is needed to combat misinformation, educate young people, and reinstate trust in health information provided via online forum. If proved efficacious, the Daily Health Coach will contribute to a growing body of literature advocating for health professionals to mirror the communication methods of influential individuals online to improve digital health literacy and off-screen health behaviours, which includes awareness around SM safety and links to distorted body image and health outcomes.

Qualitative Rigor

The study protocol outlines a comprehensive approach to developing a health promotion program targeted at young women, leveraging social media platforms. The protocol employs an iterative participatory design process for the co-design and co-development of the program (Campbell et al., 2021). This involves stakeholders’ insights and ideas leading the development rather than traditional rigid research methods. The study protocol emphasizes inclusivity, engaging various stakeholders like young women, dietitians, digital marketers, and marketing and nutrition academics. This diversity ensures the program is developed with a comprehensive understanding of the target audience’s needs and preferences (Burget et al., 2017). The feasibility study will use mixed methods, including surveys, focus groups, and social media analytics, providing a robust and multidimensional understanding of the program’s impact and effectiveness (Stewart et al., 2008). Measures are in place to ensure the quality and accuracy of data, including verbatim transcripts of audio recordings and the correction of software-generated errors before analysis. The protocol includes steps to engage participants actively in the development process, ensuring that the final program aligns closely with their needs and preferences (Campbell et al., 2021). The study uses a representative sample of young women and includes detailed targeting in social media advertisements to ensure a diverse and representative participant group. Audio transcripts will be downloaded, cleaned, and stored securely, maintaining participant confidentiality, and ensuring data integrity. The analysis of qualitative data will follow established strategies by Braun & Clarke (Clarke, 2021) and Krueger & Casey (Casey, 2014), involving thematic analysis using NVivo software. There are opportunities for participants to evaluate and provide feedback on the co-created content, allowing for adjustments and ensuring the program remains aligned with the target audience’s needs (Sauer et al., 2010). The study has ethical approval, and measures are in place to protect participant confidentiality. The quality of content will be assessed using principles for health-related information on social media (Denniss et al., 2023b; Squires et al., 2023). The protocol demonstrates a rigorous and comprehensive approach to developing a health promotion program using participatory design and mixed methods. It ensures qualitative rigor through diverse stakeholder engagement, robust data collection and analysis methods, and continuous feedback and evaluation mechanisms. This approach enhances the reliability and relevance of the developed program to the target audience.

Potential Limitations and Challenges

The online nature of the focus groups, interviews, and workshops may hinder rapport building opportunities and subsequent depth of conversation. The sensitive nature of conversational topics such as food relationships, body image, and restrictive eating behaviours may result in distress for some participants. The TFEQ-r18 will aid in the identification of participants who are more likely to find these conversations confronting. Common challenges in co-design such as the balancing of input and influence and tokenistic engagement have been considered. It is important to the research team to ensure workshop goals and roles in the research process are transparent. Each workshop will begin with an outline and clear objectives. Conversations will be moderated to ensure equitable input, and all participants will be contacted with results and updates on uses of data such as the final design of the DHC intervention and associated publications. Finally, researcher bias is common in co-design during the data analysis and interpretation process (Noble & Smith, 2015). Phase Four of the research involves opportunities for co-designers to see the DHC intervention ‘in action’ and provide feedback. This process will help to ensure knowledge has been translated authentically and is true to the needs of end users.

Conclusions

The double-edged sword of SM is the next Frontier in health promotion and offers promising potential in its ability to disseminate evidence-based information, advocate for health issues, inform health policy, and raise awareness (Roy & Malloy, 2023). Health promotion efforts across social platforms may need to balance dissemination with awareness of potential harms. Further research is needed into the use of communication strategies adopted on SM by health professionals to improve health behaviours of young people, increase the quality and accuracy of online health information, and reduce potential nutrition harms associated with prolonged use.

Footnotes

Authors’ Contributions

RR conceptualised the study. JM and RR collated, charted and analysed all data. JM was responsible for the writing of the manuscript, with review from RR, SP, and JK. All reviewing authors provided feedback on all sections of the review, including the abstract, background, methodology, results, and discussion. All feedback from all reviewers was incorporated.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

ORCID iD

Rajshri Roy

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Co-Designing a Social Media Health Promotion for Young Women: A Study Protocol

Abstract

Keywords

Introduction

Aims

Theoretical Framework

Introducing the Daily Health Coach

Materials and Methods

Study Design

Research Sampling Strategy

Data Collection and Storage

Data Quality Control

Data Collection Limitations and Challenges

Study Population

Inclusion Criteria

Exclusion Criteria

Participatory Methods

Phase One

Phase Two

Phase Three

Phase Four

Outcome Measures

Qualitative Data Analysis

Ethical Considerations and Quality Assurance

Results

Discussion

Contribution to the Field of Participatory Design

Qualitative Rigor

Potential Limitations and Challenges

Conclusions

Footnotes

Authors’ Contributions

Declaration of Conflicting Interests

Funding

Ethical Statement

ORCID iD

References