When theory meets users in co-design: four strategies towards synergy between bottom-up and top-down input

Abstract

In the co-design process, both evidence-based (top-down) and experience-based (bottom-up) input are important, especially in the healthcare context. While the risk of conflict is present, integration of both types of input can lead to synergetic design that encompasses the benefits of both worlds. By building on a case study in which we worked with cancer patients and oncology nurses to co-design an eHealth intervention focused on training self-compassion, this paper contributes to existing literature by exploring practical strategies to merge top-down and bottom-up input in the co-design process. The resulting strategies are: selecting (satisfy one need but not the other), combining (keeping multiple options in the design), integrating (designing a new and coherent functionality that serves both needs) and reframing (redefine perspectives in a way that dissolves the conflict). These bidirectional strategies can enable full co-creation, and further research could investigate their utility in other co-design spaces.