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Breaking the cycle of declining physical function and physical activity can improve health and independence for people with long-term conditions. Services within primary care are well placed to empower individuals and communities to achieve this. However, the best approach is uncertain, and must consider needs of people with long-term conditions and complexities of service delivery. This study aimed to understand how to reduce decline in physical function and physical activity in people with long-term conditions. We used realist methods integrated with co-design to provide an explanatory account of what works (or does not), for whom and in what circumstances, to generate ideas about service innovation, and provide recommendations for primary care.\ud A key aspect was tracking evidence from different sources, presenting it creatively by converting it into physical games, enabling stakeholders to ‘play with’ and make-sense of it, to inform co-design work, enabling them to draw upon their own experiences and a wider understanding. \ud In this article, we focus on the game activities, adding to the co-design games’ literature and suggest that this expands participants’ knowledge base beyond their experiences, empowering them to contribute more to the process and creating a strong link between the realist and co-design methods.

Significant advances have been made in the field of adult prosthetic limbs. Conversely, paediatric limbs suffer from a ‘market failure’ situation; market forces are inadequate to stimulate product innovation. Children are left with inadequate limb provision at best aiming to minimize pain and discomfort rather than enable independence and quality of life.\ud In 2017, the UK Exchequer announced £1.5M one-off investment in child prosthetics, as a result of lobbying by charities and a small number of parents of children with lower limb loss. Half this investment was dedicated to the provision of ‘activity limbs’ (eg. running blades) for children, and half dedicated to research and innovation over a period of two years. The authors took a lead in the latter, with the aim to re-structure the market forces, catalysing innovation for more appropriate paediatric prosthetics.\ud NIHR Devices for Dignity MedTech Co-operative (D4D), supported by Lab4Living, established a network of key stakeholders based on principles of co-production (Greenhalgh et al. 2016). Details of the process, outputs and impact can be found elsewhere (Mills et al. 2019). This paper focuses on the politics, power and distinctive contributions defined by differing expertise, by which this collaboration was established, operated and sustained. We discuss the co-design methods that helped to achieve this and draw on evidence from the stakeholders and project outputs to demonstrate success of these methods.\ud We conclude by suggesting meaningful co-production isn’t necessarily about including everyone in all decisions, provide some tips for managing political relationships and power differences, and highlight the importance of valuing stakeholders for their (unique) expertise.

Special care dentistry (SCD) provides holistic oral service provision for people with complex health and care needs. These can include physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors. The level of disability within these population groups can vary, and a proportion of people will have multiple and overlapping impairments and/or medical conditions. This paper explores a number of possible research methods that may better reflect the diversity and challenges of this population group, where the emphasis is placed on co-production and co-design.

£8 billion pounds/year is spent on health related research and there is a responsibility to demonstrate a return on investment (Walshe & Davies 2013). Yet currently the translation of health services research knowledge into everyday practice remains a challenge (World Health Organisation, 2006). This challenge is known as the second knowledge translation gap (T2) or ‘campus to clinic’ gap (Greenhalgh & Wieringa 2011). \ud Knowledge is defined by Aristotle in three distinct forms: episteme (facts), techne (skills) and phronesis (practical wisdom). In the context of health services research ‘knowledge’ is often interchangeable with ‘evidence’ and is defined as ‘research evidence’, ‘clinical experience’, ‘patient experience’ and ‘information about the local context’ (Rycroft-Malone et al. 2004). \ud ‘Translation’ has many broad interpretations, with the process element being described as ‘transfer’, ‘exchange’, ‘brokering’, ‘utilisation’, ‘implementation’ and most recently ‘mobilisation’. \ud This gap has given rise to a focused scientific field of study specifically exploring implementation, and resulted in models of factors affecting the implementation of research knowledge into everyday practice. \ud In this research, the author started from the position that implementation is not a science but a practice; a practice that shares many similar traits with design practice. And therefore design practice can offer suggestions as to how to improve implementation of health research knowledge into practice.\ud A review of concepts underpinning participatory design and design practice was conducted and compared to the consolidated framework complied by Damschroder et al (2009). This created two distinct descriptions that were overlaid. This paper presents these and the similarities and differences between the two are discussed to present an argument for the use of design practice to support the implementation of health services research knowledge into everyday practice.

There are growing pressures (political, legislative and environmental) to increase material recovery through recycling. There are two basic recycling schemes in the UK; kerbside and bring-site schemes. With current kerbside schemes, when a householder becomes unable, through age, illness or disability, to physically move their waste containers (bins,boxes or bags) onto the pavement for collection, the refuse collection service provider will\ud enter the property premises, take the containers out to the refuse collection vehicle (RCV), empty them before returning them to the starting point. Obviously, with bring sites, people travel to the site and place the recycling in the banks themselves.\ud With an ageing population, increasing numbers of older people are requiring specialist recycling services. These are likely to become more time consuming and costly\ud as household numbers increase. Bring sites have obvious limitations for older people with their limited mobility and reduce strength. To date little or no previous research has been undertaken about barriers to recycling for older people and the implications to waste management providers of an ageing population. This paper describes initial work\ud beginning to assess this problem within Lab4Living at Sheffield Hallam University (SHU).In this positioning paper, we examine literature regarding barriers to recycling and relationships with age. We outline a hypothetical scenario for the impact of the ageing population on future material recovery rates in the UK, present the initial results of a survey and we describe the potential role that design can play to eliminate these barriers and our activities within this area in our project; ‘The Grey Areas of Green Design’.

Social equality demands a shift in attitude, away from treating older people and people with disabilities as special cases requiring special design solutions, and towards enabling them to have equal access to any product or service through a more inclusive approach to the\ud design of buildings, public spaces and, more recently, products and services. This is not just important for social equality but also for business growth through new products and services and through creating wider potential markets.\ud Consumer packaging is a field in which many people, including young able bodied people, often struggle in relation to openability. Until now, the main thrust of inclusive design in the consumer packaging field has been driven by art and design disciplines, focusing on the shape and ergonomics of the packaging or cognitive solutions in order to make them easier to open. This approach does not always work first time and a time consuming, materially expensive trial and error process often ensues.\ud This paper outlines all the arguments for inclusive design, stressing the importance for both consumers and business. This paper also outlines an engineering design approach for\ud inclusive design that uses real human factors as design limits, resulting in packaging that will be easily opened by all it’s end users without the expensive trial and error approach that has been used up to this point in time. The example of the Roll-On-Pilfer-Proof (ROPP) closure system is used in this paper.

There is a requirement (within the food packaging industry) for a greater analytical knowledge and more scientific understanding of the ROPP capping process and of the interaction of caps (closures) with the threaded part of the glass container (finish). Threads used within the industry have largely developed empirically from metal thread profiles. An improved understanding is needed so that problems associated with that process can be better understood and solved. Such problems can be manifest in damaged closures, ‘spinners’ and closures that are just too difficult to open. The term ‘spinners’ is used for closures that do not break the pilfer band (a tamper evident safety feature) when twisted. The same term is also used to describe closures that have been turned the wrong way (i.e. clockwise) on opening, stripping the thread whilst not breaking the pilfer band. To combat this problem it is desirable to produce a closure system that has a high torque when twisted in the wrong direction (known as the over torque) whilst maintaining good seal integrity and a low torque for correct opening procedure.\ud A successful feasibility study was carried out to investigate the appropriateness of using finite element techniques to investigate closure systems and gain the required understanding to improve these systems.\ud The follow on project utilised these finite element techniques and experimental testing using a single-head capping machine. The Project focuses on the industry standard glass thread finish called the GF305 that utilises an extra deep, aluminium ROPP closure. The results of this work so far are presented here.

Social equality demands a shift in attitude, away from treating older people and people with disabilities as special cases requiring special design solutions, and towards enabling them to have equal access to any product or service through a more inclusive approach to the design of buildings, public spaces and, more recently, products and services. This is not just important for social equality but also for business growth through new products and services and through creating wider potential markets.\ud It is a sad fact of life that as people get older there is a massive decline in their strength and dexterity. Due to the fact that we handle and manipulate so many things\ud throughout our life time, from the tiniest and most dexterous of tasks to heavy manual labour, this decline is very noticeable in our hands. In nearly all the actions that we use our hands for there is some form of grip used in order to hold onto an object before manipulating it. The natural decrease in strength combined with debilitating illness such as arthritis, means that hand grip strength or finger grip strength are very seriously affected.\ud This has a knock on affect of making it much harder to twist things or pinch and pull things. Therefore there is often a measured decrease in torque strength with age caused not so much by a decrease in wrist strength but more often than not by a decrease in grip strength.\ud Consumer packaging is a field in which many people, including young able bodied people, often struggle in relation to openability. Yet it is present in even the most mundane and neccessary of every day tasks such as eating, cleaning teeth, even drinking. Human interation with consumer packaging requires a wide range of hand dexterity and strength and a variety of differing hand actions. This paper looks at just one such set of actions; that used to open bottles and jars. It outlines all the arguments for inclusive design, stressing the importance for both consumers and business. This paper also outlines an engineering design approach for inclusive design that uses real human factors as design limits, resulting in packaging that will be easily opened by all it’s end users without the expensive trial and error approach that has been used up to this point in time. This paper examines the affect of\ud grip strength on the required trorque to open closures and concludes that there is an optimum diameter for ease of opening that will decrease the required strength to open such closures.

Work by Yoxall (2010) and Light (2010) showed that the relationship between artefacts and their use is complex; often beyond mere functional and physical use to a wider psychosocial context. Lack of understanding of this psychosocial aspect of product or service use immediately compromises the product or services design and future success. Further, in attempting to alleviate one issue through improved design we may create others. There is then an inherent complexity in the provision of design\ud solutions that could be specific for each design. That the design process is complex and is involved in attempting to provide answers to 'wicked' problems (Rittel and\ud Weber, 1973) is well understood. However, little work has been undertaken investigating the relationship between design solutions (either artefacts or services) and their effect on wellbeing. To that end the authors have undertaken a number of case studies outlining the complexity of design solutions, the unintended\ud consequences and the effects on wellbeing of the individuals studied. Further the authors attempt to develop enhanced design processes to understand the complexity of the design solutions proposed and improve their effectiveness.\ud The development of this understanding has required an interdisciplinary approach and has been a significant factor in arriving at the recognition of the importance of\ud these psychosocial attachments. Hence this work examines these case studies in detail and examines the benefits and issues of interdisciplinary research activity.

Background Patients are increasingly being asked to provide feedback about their experience of health-care services. Within the NHS, a significant level of resource is now allocated to the collection of this feedback. However, it is not well understood whether or not, or how, health-care staff are able to use these data to make improvements to future care delivery. Objective To understand and enhance how hospital staff learn from and act on patient experience (PE) feedback in order to co-design, test, refine and evaluate a Patient Experience Toolkit (PET). Design A predominantly qualitative study with four interlinking work packages. Setting Three NHS trusts in the north of England, focusing on six ward-based clinical teams (two at each trust). Methods A scoping review and qualitative exploratory study were conducted between November 2015 and August 2016. The findings of this work fed into a participatory co-design process with ward staff and patient representatives, which led to the production of the PET. This was primarily based on activities undertaken in three workshops (over the winter of 2016/17). Then, the facilitated use of the PET took place across the six wards over a 12-month period (February 2017 to February 2018). This involved testing and refinement through an action research (AR) methodology. A large, mixed-methods, independent process evaluation was conducted over the same 12-month period. Findings The testing and refinement of the PET during the AR phase, with the mixed-methods evaluation running alongside it, produced noteworthy findings. The idea that current PE data can be effectively triangulated for the purpose of improvement is largely a fallacy. Rather, additional but more relational feedback had to be collected by patient representatives, an unanticipated element of the study, to provide health-care staff with data that they could work with more easily. Multidisciplinary involvement in PE initiatives is difficult to establish unless teams already work in this way. Regardless, there is merit in involving different levels of the nursing hierarchy. Consideration of patient feedback by health-care staff can be an emotive process that may be difficult initially and that needs dedicated time and sensitive management. The six ward teams engaged variably with the AR process over a 12-month period. Some teams implemented far-reaching plans, whereas other teams focused on time-minimising ‘quick wins’. The evaluation found that facilitation of the toolkit was central to its implementation. The most important factors here were the development of relationships between people and the facilitator’s ability to navigate organisational complexity. Limitations The settings in which the PET was tested were extremely diverse, so the influence of variable context limits hard conclusions about its success. Conclusions The current manner in which PE feedback is collected and used is generally not fit for the purpose of enabling health-care staff to make meaningful local improvements. The PET was co-designed with health-care staff and patient representatives but it requires skilled facilitation to achieve successful outcomes. Funding The National Institute for Health Research Health Services and Delivery Research programme.

This paper reports on part of a research-through-design PhD study. This study sought to understand if participatory workshops to share design skills and approaches with adolescents with chronic pain could have an impact on their management abilities and behaviours. Academics have long sought to understand, define and articulate the skills that designers possess and how they ‘do’ designing. In recent literature there is increasing interest in how these skills might be shared and utilized outside of design professions in areas such as; education, business management, policy-making and as a means of empowering citizens. Supporters of this application of design typically associate the use of design practices and process to innovation, problem-solving, business strategy, behaviour change and resourcefulness. There is an emergent precedent in health sectors to use design this way. Literature suggests it is a young field with scope to develop knowledge within it. Knowledge gaps include; developing an understanding of the impact of sharing design practices and approaches, exploring different types of engagement with a variety of stakeholders to identify how they might benefit from this approach, and to further develop methods and exemplars of delivery. Furthermore, a better understanding of healthcare contexts, languages, modes of operation and philosophical frames is required. A mixed methods analysis was used to understand the impact of the workshops. Initial findings indicate positive changes in mind-sets associated with design approaches, greater understanding of design skills and subsequent application to management abilities and behaviours. This paper will present the methods used in, and findings from, the research. It will also reflect on the complexities of conducting this type of design-led project in a healthcare context, where there can be conflicting worldviews on evidence and knowledge, and strict ethical procedures to adhere to. Refereed/Peer-reviewed