Background Boundary objects can add value for innovative design and implementation research in health care through their organizational focus and the dynamic structure between ill-structured and tailored use. However, when innovation is approached as a boundary object, more attention will need to be paid to the preimplementation phase. Research and design thinking pay attention to the preimplementation stage but do not have a social or organizational focus per se. The integration of boundary objects in design methodologies can provide a more social and organizational focus in innovative design projects by mapping out the mechanisms that occur at boundaries during design. Four dialogical learning mechanisms that can be triggered at boundaries have been described in the literature: identification, coordination, reflection, and transformation. These mechanisms seem suitable for integration in innovative design research on health. Objective Focusing on innovation in health, this study aims to find out whether the different learning mechanisms can be linked to studies on health innovation that mention boundary objects as a concept and assess whether the related mechanisms provide insight into the stage of the design and implementation or change process. Methods The following 6 databases were searched for relevant abstracts: PubMed, Scopus, Education Resources Information Center, PsycINFO, Information Science and Technology Abstracts, and Embase. These databases cover a wide range of published studies in the field of health. Results Our initial search yielded 3102 records; after removing the duplicates, 2186 (70.47%) records were screened on the title and abstract, and 25 (0.81%) papers were included; of the 13 papers where we identified 1 mechanism, 5 (38%) described an innovation or innovative project, and of the 12 papers where we identified more mechanisms, 9 (75%) described the development or implementation of an innovation. The reflective mechanism was not identified solely but was present in papers describing a more successful development or implementation project of innovation. In these papers, the predetermined goals were achieved, and the process of integration was relatively smoother. Conclusions The concept of boundary objects has found its way into health care. Although the idea of a boundary object was introduced to describe how specific artifacts can fulfill a bridging function between different sociocultural sites and thus have a social focus, the focus in the included papers was often on the boundary object itself rather than the social effect. The reflection and transformation mechanisms were underrepresented in the included studies but based on the findings in this review, pursuing to trigger the reflective mechanism in design, development, and implementation projects can lead to a more fluid and smooth integration of innovation into practice.
Background Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. Objective In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. Methods The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. Results We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants’ continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. Conclusions This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner.
BACKGROUND Mental health care faces challenges where innovation is seen as necessary. Many of these challenges require the involvement of service users and people with lived experience in developing and evaluating mental health care services. Since the development of digital interventions is becoming more prevalent, design approaches are also increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and their lessons learned concerning the involvement of service users and people with lived experience. OBJECTIVE This systematic review aims to present an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to provide insight into the advantages of design approaches in mental health care innovation. METHODS The following six databases were searched for relevant abstracts: PsychInfo, PubMed, Web of Science, Scopus, and Embase. Additionally, two health design journal archives were searched. Both journals publish papers at the intersection of health and design. RESULTS Our initial database search yielded 2758 records. After removing the duplicates, 2013 records were screened. Next, of the 42 records, we screened the full text, leaving 28 papers for inclusion. We also identified 71 records via searching two specific health design journals. After removing the duplicates, we retrieved 54 records that were assessed for eligibility. Of those 54 records, 5 papers were included. This makes a total of 33 included papers. Most of the included studies focused on the design or evaluation of a digital intervention. The results show that design approaches are widespread in mental health services and that participants are involved in different roles, except in diagnostics. We identified a variety of reported added value, ranging from tailoring and testing (digital) interventions, improving engagement and collaboration, gathering the needs of stakeholders, emancipating participants, and using design as a paradigm for the therapeutic and personal recovery process itself. The challenges range from recruiting participants, flexibility and time management, providing a safe space and avoiding stigmatization, balancing insights from design and medical science, to managing design processes in medical environments. CONCLUSIONS This systematic review provides an overview of studies that used design to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages for involving service users and people with lived experience in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision-makers, and report on collaboration in a systematic and clear manner.
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