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Introduction: Hospital care is critical when assessing the overall quality of chronic obstructive pulmonary disease (COPD) care, particularly for people living with severe COPD who are frequently hospitalised due to exacerbations. The hospitalisation experience for people with COPD is often complex, involving various interactions and has been reported to be suboptimal. A comprehensive understanding of these experiences is lacking. With the intention of informing a holistic approach in COPD hospital care, this study aimed to explore the experiences and expectations of individuals with severe COPD regarding hospital care due to exacerbations of COPD.

Methods: Acknowledging the complexity of interactions within the studied scenarios, this research employed a qualitative study design, utilising co-creation workshops for data collection. A total of 13 participants were involved in the data collection process. Five people with severe COPD were recruited using purposive sampling. In addition, one family member, four healthcare practitioners, one digital health program designer, and two hospital managers were recruited through convenience sampling. Data were collected during three co-creation workshops. During each workshop, participants were divided into subgroups focused on specific topics. Relevant transcripts from these subgroup discussions were chosen for analysis, which was conducted using qualitative content analysis.

Results: The analysis resulted in four categories that illustrate both the experiences and expectations of people with COPD regarding hospital care from admission to discharge: lack of trustworthy guidance, increased vulnerability during hospitalisation, discharge issues, and advocacy for COPD recognition. Our findings reveal some deficiencies, particularly in admission procedures, information exchange, healthcare interactions, and transitions from hospital to home. At the same time, patients also expressed appreciation for the continuous support provided by COPD nurses and home care teams.

Conclusion: This study highlights the need for person-centred care in managing COPD exacerbations. It identifies key interventions such as early help-seeking, better patient education, staff training, care continuity, improved discharge services, and public awareness. Emphasising individualised experiences, it calls for familiar care settings, collaborative discharge planning, and integration of home care to enhance hospital care quality.

Background: To reduce the risk of falls, tailored interventions including exercise that simultaneously challenges cognition (motor–cognitive) are recommended. However, considerable variation in motor–cognitive approaches exist, and its use in clinical practice is less widespread. This study aimed to explore older peoples’ and physiotherapists’ perspectives on motor–cognitive exercise and their suggestions for programme development during co-creation.

Method: Community-dwelling women (n = 8) and men (n = 9), aged (mean ± SD) 74 ± 5.6 years, and 4 physiotherapists working in geriatric rehabilitation were included. Data were collected through nine workshops. The discussions were audio-recorded and analysed employing a qualitative content analysis approach. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results: The analysis resulted in four themes and nine categories. The themes were: discovering the motor–cognitive concept through engagement in activity, balancing safety and challenge, navigating the complexity of individualisation, and managing motivation and compliance. The context was initially difficult to grasp. Performing practical activities led to understanding, and motor–cognitive exercises were experienced as enjoyable yet challenging to perform. Balancing safety while providing exercises that were challenging enough to make the programme effective was perceived as challenging by both older participants and physiotherapists. Regular individual follow-up during the exercise programme was considered important for promoting progression and compliance. Leader-led, group-based exercises later incorporated into daily life routines were suggested to support motivation and promote safety.

Conclusion: Incorporating motor–cognitive exercise in fall prevention exercises programmes for older people at risk of falls, may enhance enjoyment and motivation but requires consideration for safe and effective delivery. The co-creative design in this context is rare and the results may be useful for further research and for the development of fall prevention interventions.

This article reflects on how patient education tool design can benefit from a co-creation process with patients and key stakeholders involved, using a case study in chronic obstructive pulmonary disease (COPD) care. Unfavourable hospitalisation experiences for COPD patients are often linked to organisational issues and health literacy challenges. This study presents insights from a year-long co-creation practice involving COPD patients, a family member, healthcare practitioners, and hospital managers, aimed at developing patient education tools to enhance health literacy concerning the hospitalisation process. The primary outcome is a set of patient education infographics that can be integrated into digital platforms or printed formats. For such co-creation practice, we found that setting clear creativity expectations and using methods such as user journey maps empower participants. Balancing the power dynamics between patients and healthcare practitioners enables culturally relevant and patient-centred tools. In addition, family members play a crucial role in both co-creation process and care journey, while hospital managers ensure tools align with clinical practices. We also advocate for an ecological perspective towards intervention development, acknowledging diverse needs emerged from the co-creation process. Future research should implement strategies in further individualising infographics to improve their effectiveness.

Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

Background: Co-creation methods ensure that interventions are tailored to the target group by incorporating their unique insights and preferences, strengthen innovation, and facilitate implementation. Although co-creation research is becoming more common, most research exploring co-creation focuses on the researchers' perspectives rather than the experiences of the target population. By exploring these experiences, researchers can better understand the preferences for, and facilitators/barriers to, engagement and participation to inform future co-creation studies. This study aimed to explore older persons' experiences and insights into participating in co-creation of an intervention to prevent falls.

Methods: Qualitative interviews were conducted with 13 community-dwelling older persons (aged 66–83 years) after their participation in a co-creation study developing an intervention for fall prevention. Data were analyzed using qualitative content analysis.

Results: Three themes emerged from the analysis: Diversity of co-creators enriches understanding and creativity, Interactive activities promote learning, and Supportive environments enhance collaboration. These themes describe how participating in workshops with others deepened and broadened participants' knowledge and understanding of the subject and enabled them to contribute their experiences and perspectives. Discussing and testing exercises gave participants new insights into their physical abilities and the importance of exercise and a better understanding of the concept of motor-cognitive exercises and their role in everyday life. A respectful atmosphere where everyone shared responsibility for creating a supportive environment so all participants could express their thoughts was perceived as important by the participants.

Conclusions: The results underscore the potential for co-creation to enhance participants' knowledge and understanding of the topic, as well as their own capacity. For researchers, it is important to consider how to foster an inclusive and supportive environment, thereby boosting participation, engagement and collaboration.

Background: Falls among community-dwelling older adults can be significantly reduced through exercises for balance and strength. Digital solutions show promise in increasing the reach and promote adherence to fall prevention exercises among older adults. However, research on long-term engagement in self-managed fall prevention programs is lacking. The Safe Step application is designed, in collaboration with older adults, to motivate and support them in independently engaging in balance and strength exercises. The aim of this study was to explore longitudinal patterns of older adults’ engagement in self-managed fall prevention exercise supported by the Safe Step digital application.

Methods: A qualitative longitudinal study was nested within a randomized controlled trial that evaluated the effectiveness of the Safe Step application in reducing falls among community-living older adults. A selection of participants who maintained an exercise dose of ≥ 60 min each week was invited to the study. Fifteen participants were included. Each participant was interviewed twice, first at the end of a twelve-month trial period and then after an additional six months. The analysis followed the Pattern-Oriented Longitudinal Analysis approach, analyzing patterns of change over time.

Results: Four engagement patterns were identified that began to emerge during the first year and were consolidated over time: (i) Coherent and sustained pattern, (ii) Coherent and episodic pattern, (iii) Integrated and sustained pattern, and (iv) Integrated and episodic pattern. The long-term engagement in self-managed digital fall prevention was characterized by the degree of cohesion and regularity in training. Initially, all participants followed the exercise recommendations provided by the application. With time they developed different strategies to maintain the exercises that resonated with their own preferences and daily activities. Conclusions: The digital program played a meaningful role in initiating and establishing exercise routines, while other determinants also influenced long-term engagement strategies. Support for self-management of fall preventive exercise needs to evolve over time to meet the changing needs of individuals and their different patterns of exercise engagement. Further research is needed to inform digital interventions aimed at supporting long-term engagement in fall prevention programs.

Objectives: Co-creation is recognised as a promising methodology for addressing complex public health issues by leveraging the collective intelligence of multiple stakeholders to develop tailored solutions. However, there is a lack of clarity and significant fragmentation in the concept. This study aims to define the fundamental attributes and guiding principles of co-creation to establish it as a rigorous, evidence-based, and trustworthy methodology.

Study design: A participatory concept mapping process based on the Differentiae Principle was employed.

Methods: The study consisted of four stages: 1) systematic extraction of attributes and their definition from traditional scientific and participatory research methodological literature, 2) screening, 3) semantic analysis and clustering into principles using Natural Language Processing and Large Language Models and 4) selection of a final set of attributes and development of principles. The study involved 50 participants with diverse backgrounds within and outside the Health CASCADE Network over 18 months.

Results: The study identified 105 candidate attributes. A set of 38 was selected from which 10 key principles were derived (open access, recognised contribution, ethics and legal, transparency, rigorous evaluation, clear problem, plural evidence, critical reflection, diversity, and structured and flexible processes) across three domains: Governance, Scientific and Methodological Rigour, and Collective Intelligence Processes.

Conclusions: The attributes and guiding principles provide a comprehensive foundations for evidence-based co-creation, enhancing its trustworthiness, transparency, reliability, and impact in public health and other fields. Future research and practice should use these principles and attributes to refine and implement co-creation effectively.

Choosing the appropriate design process is critical for the effective implementation and long-term sustainment of interventions aimed at addressing public health challenges. To address this need, we proposed a Transition Design model to identify and deliver sustainable solutions for complex healthcare problems. This model generates system-level health-intervention initiatives that can synergistically function, particularly during the development and implementation phases, to enhance healthcare delivery. Drawing from a case study on addressing the challenges of hospitalisations and early discharge for people with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), we reflected on the process and analysed the outcomes. Although further testing for the initiatives is warranted, this study contributes to the evolving discourse in design research on systems solutioning for public-health challenges.

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 +. A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

Background: Incorporating co-creation process in the development of interventions may improve the outcome. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for Chronic Obstructive Pulmonary Disease (COPD).

Objective: This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD.

Methods: The methodology proposed by Arksey and O’Malley for scoping reviews was followed, and it was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included.

Results: 13 articles complied with the inclusion criteria. The composition of co-creators was diverse and reported in most of the included studies. Facilitating factors described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Few creative methods were mentioned or explained in the studies. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report implementation considerations as a discussion point in their co-creation workshops.

Conclusion: This review provides suggestions for evidence-based co-creation in COPD care which may improve the quality of care delivered by NPIs.