Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework

Background Factors beyond Cardiac Rehabilitation (CR) service continue to negatively impact CR attendance and programme completion. Intrapersonal, socioeconomic, health perception/co-morbidity and logistical factors can have a significant impact on CR uptake. During the COVID-19 pandemic many services reconsidered their approach and utilised novel but more flexible delivery solutions (1). As clinical services remodel post-COVID we sought to incorporate the patient perspective. Purpose To identify and co-design strategies to improve engagement with CR. Methods Experience Based Co-Design (EBCD) is a Codesign methodology that incorporates the experiences of patients, caregivers and service providers (2). The project involved staff, patients and caregivers linked to CR across the region. In an iterative process, a literature review followed by focus groups and co-design workshops were conducted by the research team during 2019-2021. Results The co-design workshops identified numerous multifaceted issues in relation to engagement with CR. These can be described in three distinct themes. Communicate Misunderstandings about CR content and efficacy persist amongst patients and the public. Health Care Professionals must streamline, and focus information provided to patients in order to highlight the multifaceted benefits of CR, a patient-led information video for patients and public was produced and shared through CR networks. Support Patients require additional emotional and social support following a cardiac event. Significant concerns described by patients relate to family, work, socialising and future health. A supportive, facilitated discussion was warranted and a brief cardiac intervention (CABIN) was developed and will be tested in a feasibility trial. Integrate Following COVID-19 patients are more receptive to hybrid approaches to delivering CR. Diverse options for delivery of CR should be integrated into standard practice. Patient suggestions included online learning modules, social exercise, video libraries, online support meetings, text chat facilities, and regionally specific webpages. The study resulted in three key outputs; a short regional information video, a regional webpage and the brief supportive intervention, CABIN. Conclusion Co-designing with staff and patients provides relevant and important information about highlighting the importance of and accessing and delivering a service which can be incorporated into future service changes.

Approximately one in five Australians who undergo total knee replacement (TKR) experience persistent postoperative pain. There are currently no known effective and cost-effective multidisciplinary models of care in Australia to address this. We are developing the 'Early Pain Intervention after Knee Replacement' (EPIK) model of care, adapted from 'Support and Treatment After Replacement' (STAR) care pathway. STAR was developed in the United Kingdom (UK) and shown to be effective and cost-effective in the UK context. Extensive consumer and clinician engagement informed the development of the EPIK model of care, tailored to the Australian health system and geographical context to address this critical gap. To co-design the 'Early Pain Intervention after Knee replacement' (EPIK) model of care for people with persistent pain after TKR. We used Experience-Based Co-Design (EBCD) methodology to co-design EPIK, a telehealth model of care providing remote care coordination for people with persistent pain after TKR. Three online Zoom workshops were conducted with key stakeholders, including consumers with lived experience, clinicians (orthopaedic surgeons, physiotherapists, general practitioners, psychologists and a rehabilitation physician), and EPIK investigators. Workshop 1 explored consumer perspectives on the EPIK model of care assessment and follow-up. Workshop 2 determined the feasibility and roles of clinicians in the EPIK model of care delivery. Workshop 3 brought together consumers, clinicians, and researchers to refine and finalise the EPIK model of care. Using EBCD methodology and inductive framework analysis, themes were derived iteratively. Across consumer and clinician workshops, consensus was reached through facilitated discussions where stakeholders actively contributed to prioritisation activities and iterative refinement of model components. Twenty-one individuals participated in the workshops, comprising nine consumers and 12 clinicians from the Australian Capital Territory, New South Wales, Tasmania, and Western Australia, alongside five EPIK Investigators. Workshop 1 with consumers highlighted the need for clearer definition of communication processes, patient education and coaching strategies, and the role of the EPIK care coordinator to ensure consistent information and coordinated support throughout the model of care delivery. Workshop 2 with clinicians focused on telehealth assessments, escalation of clinical pathways, referrals, and psychological support. The final workshop reached consensus on its components and delivery, emphasising the importance of patient advocacy, reassurance and continuity of personalised care. Through meaningful end-user involvement, co-design informed the development of the EPIK model of care. The effectiveness, cost-effectiveness and safety of EPIK will be evaluated in a randomised controlled trial. Two consumer co-authors (T.G. and B.L.) guided the development of the preliminary model of care and trial protocol. Consumers with lived experience of persistent pain after TKR participated throughout the co-design process. ACTRN12625001029482p (Australian and New Zealand Clinical Trials Registry). Registered on 17 September 2025.

Understanding health information can be difficult, which can limit people's ability to manage their health and adopt healthy practices, leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative designed to support clear conversations between health service providers and users. The initiative incorporated Teach-back, Chunk and Check, Simple Language, and Open Questions, alongside implementation support from a health literacy officer. A concurrent mixed-methods evaluation was conducted across two health programmes serving a population of approximately one million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors within a regional government authority. The evaluation comprised five components: (1) Surveys of 110 service providers' perceptions of the training; (2) Observations of 11 service providers before and after training; (3) Two focus groups with 11 service providers six months post-training; (4) Change in 73 service users' health literacy levels using two domains of the Health Literacy Questionnaire; (5) Change in service users' health and wellbeing between baseline and programme completion. Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed. Both programmes were delivered in group settings. Teach-back was reported to be challenging to apply in this context but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was helpful but difficult to deliver to busy teams. Service users' health literacy levels improved by the end of their programme, but there was no evidence that the initiative improved health and wellbeing outcomes. For example, no significant difference was observed in the primary outcome for Weight Management participants in the intervention group compared with controls (0.2kg, - 2.3 to 1.9; p = 0.84). In this small evaluation, the initiative was well received and enhanced service providers' communication skills. Further evaluation of a strengthened initiative should focus on controlled before-and-after designs using larger samples to determine the effect on service users' health literacy and health and wellbeing outcomes.

IntroductionThe Independent Review of the Mental Health Act (MHA) in England and Wales confirmed increasing levels of compulsory detentions, especially for racialised communities. This research aims to: (a) understand the...

The HUSK projects, involving collaboration between service users, providers, educators, and researchers, coincided with the reorganization of national government services (NAV). The NAV reorganization brought together employment services, social insurance, and municipal social service benefits, and called for a service model where users would be empowered to influence the provision of services. In this analysis of the HUSK cases the authors focus on the relationship between the service user and the service provider, identifying themes in two broad domains: concepts of the individual that included the service user and the service provider and concepts of the relationship that included power, role, activity, interaction, and communication. Within each theme, the analysis highlights the transition from a traditional or historical state to a new or desired state and draws upon some of the classic literature that frames the encounters between service users and providers.

BackgroundAn integrated chronic disease management (ICDM) model was introduced by the National Department of Health in South Africa to tackle the dual burden of HIV/AIDS and non-communicable diseases. One of the aims of the ICDM model is to reduce HIV-related stigma. This paper describes the viewpoints of service users and providers on HIV stigma in an ICDM model in rural South Africa.Materials and methodsA content analysis of HIV stigmatisation in seven primary health care (PHC) facilities and their catchment communities was conducted in 2013 in the rural Agincourt sub-district, South Africa. Eight Focus Group Discussions were used to obtain data from 61 purposively selected participants who were 18 years and above. Seven In-Depth Interviews were conducted with the nurses-in-charge of the facilities. The transcripts were inductively analysed using MAXQDA 2018 qualitative software.ResultsThe emerging themes were HIV stigma, HIV testing and reproductive health-related concerns. Both service providers and users perceived implementation of the ICDM model may have led to reduced HIV stigma in the facilities. On the other hand, service users and providers thought HIV stigma increased in the communities because community members thought that home-based carers visited the homes of People living with HIV. Service users thought that routine HIV testing, intended for pregnant women, was linked with unwanted pregnancies among adolescents who wanted to use contraceptives but refused to take an HIV test as a precondition for receiving contraceptives.ConclusionsAlthough the ICDM model was perceived to have contributed to reducing HIV stigma in the health facilities, it was linked with stigma in the communities. This has implications for practice in the community component of the ICDM model in the study setting and elsewhere in South Africa.

It has been well documented that refugees with temporary visa status have poorer physical and mental health than immigrants on permanent visas. This study aimed to investigate the perspective of service providers on temporary visa experiences of refugees and asylum seekers, to examine the pathways between visa-related post-migration difficulties and poor health and implications for health promotion. Working across refugees and asylum seekers with multiple and varying pre-migration experiences and cultural influences, service providers contribute an important perspective of client experiences within the temporary visa system. A mixed-methods design was utilised with a quantitative survey of service providers working with refugees and asylum seekers (n = 36) and in-depth interviews (n = 12). Participants were recruited through service networks and snowball sampling. Survey data were analysed descriptively with R, and interview data were thematically analysed. Temporary visas, particularly short-term bridging visas, were identified as negatively affecting both mental and physical health through uncertainty, inconsistencies, service access transitions and family separation, with impacts via a range of social determinants and psychological states and behaviours. This study highlights the debilitating impacts of temporary visas on both mental and physical health, and the necessity to provide greater certainty to asylum seekers and refugees. SO WHAT?: Although the current Australian government has transferred many humanitarian temporary visa holders to permanent visas, temporary humanitarian visas remain available for use in the future. Moreover, many asylum seekers will remain on short-term bridging visas. The findings from this study stress the imperative of considering the mental and physical health consequences of immigration policy decisions for asylum-seeker and refugee populations. A deeper understanding of the interplay of components within the temporary visa pathway highlights multiple foci for future research and preventative intervention priorities.

In this study, we aimed to describe and evaluate the codesign of an intervention in general practice setting to help address navigation problems faced by the patients from the culturally and linguistically diverse (CALD) community in Australia. An experience-based codesign (EBCD) methodology was adopted using the Double Diamond design process. Two codesign workshops were conducted online with 13 participants including patients, their caregivers, health service providers, researchers, and other stakeholders. Workshops were audio-recorded, transcribed, and thematically analyzed. The codesign participants identified several navigation problems among CALD patients such as inadequate health literacy, cultural and language barriers, and difficulties with navigating health and social services. They believed that bilingual community navigators (BCNs; lay health workers from the same language or cultural background) could help them address these problems. However, this depended on BCNs being trained and supervised, with a clear role definition and manageable workloads, and not used as an interpreter. In undertaking the codesign process, we found that pre-workshop consultations were useful to ensure engagement, especially for consumers who participated more actively in group activities with service providers after these and their own separate small group discussions during the workshop. Overall, participants identified that BCNs could offer help in addressing the problems faced by the CALD patients in accessing care in general practice setting. The codesign process provided new insights into the navigation problems faced by CALD patients in accessing care and collaboratively developed a strategy for further testing and evaluation.

Introduction/background: The COVID-19 pandemic significantly impacted the availability of community support and resources to vulnerable populations, including persons experiencing homeless within the Regional Municipality of Durham, Ontario, Canada. In response, the Region developed pilot community hubs to address escalating unmet housing, healthcare and support needs. Why did you do it? The community hub evaluation project is a community-based research co-created by a research team from Ontario Tech University and community stakeholders to measure the community hubs' effectiveness in addressing service users' unmet needs during the COVID-19 pandemic. Who is it for? The project is relevant to healthcare and social service policymakers and service providers, service users, researchers, and community organizers involved in researching, funding, designing and delivering healthcare and social services for vulnerable populations. Who did you involve and engage with? The project collaborators comprised a research team from Ontario Tech University and an advisory committee of community hub staff members and service users convened by the research team. All aspects of the project’s design and implementation, including creating the data collection tools, participant recruitment, data collection, data analysis and developing the knowledge translation products, were completed in collaboration with the research advisory committee that met monthly. Service users on the advisory committee were compensated for their time and contribution. What did you do? A mixed-methods research design was used to explore the experiences of the community hub service users, staff members and subject matter experts. Service users were recruited from the community hubs. Staff members were recruited through virtual staff meetings. Face-to-face surveys were administered to 75 service users at the community hubs. Staff online surveys were self-administered by 15 direct service staff. Virtual interviews were conducted with five community hub managerial staff and two subject matter experts. Quantitative data were calculated using the SPSS statistical software. Qualitative data were analyzed using thematic analysis. What results did you get? What impact did you have? The integrated service model was described as saving service users’ lives. Adequate, core funding is required for the sustainability of the community hubs. Results from the evaluation provided the regional government with data to help inform its strategic priorities for vulnerable populations. What is the learning for the international audience? The needs of vulnerable populations including persons experiencing homelessness are deep and entrenched. Community hubs integrate a range of healthcare and social support services, including the social determinants of health that respond to service users’ immediate and emerging needs. What are the next steps? Knowledge translation through conferences, symposiums, presentations at regional sector tables and peer-reviewed publications. Collaborating with the community hubs to utilize the research findings to support improvement in future service design and delivery.

With increasing international migration, social workers have not only been confronted with growing diversity, but also with the effects of displacement, trauma and immigration controls in the lives of their service users. Although the ongoing debates on migration, migrant integration and social cohesion have facilitated a growing literature on, and demand for cultural competence in social work, little progress has been made to arrive at an agreement of what exactly is required from social workers in cross-cultural encounters. This paper draws from the qualitative element of a mixed-methods study on social workers’ experiences of cross-cultural practice conducted in Glasgow, Scotland in 2016. By focusing on social workers’ experiences of accommodating and negotiating cultural differences with asylum seekers, this paper illustrates how social workers are moving beyond the cultural lens in understanding difference and disadvantage. The findings suggest that whilst culture continues to influence social workers’ encounters with service users, addressing cultural conflicts requires social workers to understand the complex power relations which asylum seekers are subject to both within and beyond the care relationship. Practice perspectives on the challenges and successes in cross-cultural social work illustrate the interplay between cultural and structural considerations involved in social work with asylum seekers.

Development of a comprehensive model for the role of the rapid response team nurse

BackgroundChildren and families seeking asylum have significant unmet health needs. The Respond service was established in response to high numbers of families seeking asylum arriving in Camden (London, UK) in August 2021 and delivers hospital and community-based holistic assessment and infectious disease screening for this population. Families are seen in a joint appointment by a multidisciplinary team of adult and paediatric health professionals. We explored the priorities, barriers and experiences around healthcare access among families using the service and the acceptability and perceived effectiveness of a family-centred approach from the perspective of service users, service providers and key stakeholders.MethodsWe employed qualitative and quantitative approaches. Questionnaires and semistructured interviews were completed between July and September 2022. Questionnaires were built on Google Forms and Envoy Messenger (Healthcare Communications). Thematic analysis was performed and structured by key themes. Data were analysed with the assistance of NVivo.ResultsAccess to dental care, primary care and immunisations were identified as key priorities for families. Significant barriers of access to care included understanding (language), situation (temporary accommodation) and awareness (unfamiliarity with systems, digital poverty, signposting). The Respond family-centred model was positively received by service users, service providers and stakeholders. Benefits included the provision of holistic family-centred care and support, efficiency and value-for-money for the health service. Areas needing ongoing input were language barriers, educational support for staff and service users and continued collaboration and co-creation between service providers and service users.ConclusionRecognising the priorities and barriers identified in this study is crucial for enhancing access to and utilisation of services within this underserved community. The Respond family-centred model was well received and perceived as effective by service users, providers and stakeholders. It serves as a foundational framework for developing tailored services for children and families seeking asylum across the UK and internationally.

Israel has become a destination for asylum seekers. Asylum seekers often experience emotional distress, but have limited access to health services and rarely use psychiatric services. This study sought to understand and characterize the use of psychiatric versus medical services by asylum seekers in Israel. We compared the emotional distress, stressful life events and previous treatment consultations of 21 psychiatric service users (PSU) and 55 medical service users (MSU) at the Open Clinic of Physicians for Human Rights in Tel-Aviv. Participants completed a socio-demographic questionnaire, the General Health Questionnaire (GHQ-12), the Stressful Life Events Scale and the Health Care Utilization Questionnaire. PSU and MSU did not have significantly different levels of emotional distress. PSU reported significantly more stressful life events during the past year than MSU ( M = 5.81, SD 3.47 vs. M = 3.8, SD 2.35, p < 0.01). In comparison to MSU, PSU utilized more medical ( M = 4.33, SD 2.28) and non-medical ( M = 2.38, SD 1.92) services ( p < 0.001) than MSU. Asylum seekers who consulted multiple treatment agencies in the last year were 1.55 times more likely to seek psychiatric treatment than those who had consulted only a few treatment agencies. Emotional distress in asylum seekers appears to be under-diagnosed in the Open Clinic and under-treated by mental health professionals. To better detect this distress, a thorough screening is recommended at assessment. Collaboration with mental health professionals and community and religious leaders consulted in the past is important and can contribute to good health care outcomes in this population.

Connect North is an integrated social prescribing service for adults in the Northern Trust area. We engaged and involved service users and providers across statutory and community and voluntary sectors to review social prescribing services in the Northern Trust area and identify opportunities for improvement. The service name (Connect North) and branding were all co-produced with service users. During service implementation our service users also requested and co-created our most well used and appreciated resources including our link worker calling cards and service information leaflet. To assist with monitoring of the service our service users selected their preferred validated holistic needs assessment tool for incorporation within the pathway. A steering group was established with service user membership and a service user Co-Chair. Stakeholder workshops mapped out existing services and opportunities for improvement. Feedback from different stakeholder groups was consistent, reflecting the need for change through integration. Service users wanted an accessible and responsive service with an effective 1st point of contact offering Personalised help and support looking at the whole person rather than limiting input to a single point of focus (e.g. a specific condition/diagnosis). They did not want to repeat their story or be passed from pillar to post. Alarmingly service users were not aware of services which could benefit them and felt this was echoed by service providers and their potential referral agents. Asking for help amplified their feelings of shame and embarrassment. Our integrated model creates a central point of referral where clients are supported to complete a holistic assessment of their wellbeing needs, co-create their Personalised wellbeing plan and be connected to the right support with appropriate monitoring and tracking of progress. Service providers highlighted the need for a single accessible directory of services to reduce the burden and duplication to develop and maintain their own directories. Service users wanted to know what was available and to have easy access to this. Our Population Plus online directory of services is accessible to anyone with an internet enabled device. We now have an operational co-designed, integrated and accessible social prescribing service open to adults in the Northern Trust area. The service is provided in partnership across 2 sectors by 3 organisations. Information is available via Population Plus for everyone to self-serve or signpost others to. There is a shared responsibility to maintain this information. Link Workers offer one-to-one Personalised and holistic support for those clients who require it to support their health and wellbeing and the development of self-efficacy. Putting people at the heart of their health and care service is key to success and buy-in across all sectors. Their experiences and expectations enabled a collective focus on delivering what matters most to our people. An independent service evaluation to include user feedback is underway. Opportunities for service improvement continue to be identified and progressed. Using data captured we will be able to work with other partner agencies to identify and address gaps in services creating equity of access across our Trust area.

Mixed Reality (MR) technology has the potential to support the improvement of the service productivity by augmenting the experience and intuition of service users and providers. However, in order to make the MR technology including Augmented-Reality (AR) widespread in the service industry, it is necessary to raise the ease of the social implementation by reducing the costs on sensing and content management. In general, service cooperation and co-creative intelligence cycles are well-suited to establish a framework of load/cost sharing and functional enhancement among services and stakeholders. By applying such a framework to MR and AR, digital content and service-operation log can improve the performance of real-world sensing, and meanwhile the real-world sensing can contribute the efficiency of service operation, content gathering and authoring. In this paper, we introduce our own works to enjoy such synergy by facilitating cooperation among services such as pedestrian navigation, patrol inspection, interactive modeling, behavior analysis and service redesign based on MR, and also by co-creatively circulating knowledge among consumers, service providers, and other stakeholders.