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BACKGROUND: Co-design is increasingly used to involve older adults in the development of digital tools, yet less attention has been given to how to engage them effectively in these processes. Older adults represent a highly diverse population, but co-design practices often overlook this heterogeneity and rely on limited representation. Similarly, co-design approaches vary widely in structure and degree of user involvement. While evaluations often focus on outcomes such as usability and technical performance, fewer studies explore the value of participation itself.

AIM: This study evaluates the process of a 5-day online design sprint where participants, including older adults, healthcare and technology professionals, researchers, facilitators and business representatives, collaborated to develop housing-related digital support tools.

METHODS: A hybrid thematic analysis process links process documentation and participant reflections with value-based frameworks to examine how different elements of the process created or inhibited value for participants.

RESULTS: The findings highlight how the structure of the design sprint, together with specific facilitation practices, fostered respectful dialogue, trust, autonomy and a sense of ownership among participants. The evaluation describes how the process satisfied participants' collectively prioritised values, and their individual needs.

CONCLUSIONS: The study highlights that co-design is not a neutral method, but a practice with social, ethical and emotional consequences. Effective facilitation is essential to support agency, ensure psychological safety and promote authentic collaboration. Recognising the heterogeneity of older adults and aligning facilitation strategies with participants' values and needs can enhance both the relevance of digital innovations and the meaningfulness of the co-design experience itself.

PATIENT AND PUBLIC CONTRIBUTION: The project was supported by a reference group that was actively involved throughout. The group included, for instance, representatives from the municipality, regional authorities and a pensioners' organisation.

Introduction: Enhancing Quality of Life for Individuals with Stroke (EQL-stroke) is an international, collaborative multiphase project aiming to strengthen supported self-management for older adults recovering from stroke at home in Sweden, Latvia and the Netherlands. Existing poststroke pathways may provide insufficient support for self-management during the transition from hospital to home, and there is limited evidence on interventions that integrate social networks and everyday environmental context.

Methods and analysis: EQL-stroke uses a participatory, multimethod design across three phases. Phase I generates knowledge through policy review, qualitative interviews and people-place mapping (~25 participants per country) and includes cross-cultural adaptation of the Collective Efficacy of Networks Scale. Phase II co-designs and specifies a tailored social network-informed supported self-management intervention (the Network-Based Intervention), including core components and principles for local adaptation (~15 participants per country). Phase III will recruit approximately 20-40 stroke survivors for a single-arm pilot feasibility study with an 8-week follow-up and embedded process evaluation to assess feasibility, acceptability and fidelity in routine practice.

Ethics and dissemination: Ethical approval has been obtained from the Swedish Ethical Review Authority (reg. no. 2025-00083-01), the Rīgas Stradiņa Universitāte Research Ethical Committee (reg. no. Rīgas Stradiņa Universitāte Research Ethical Committee) and the Research Ethics Committee of the Faculty of Spatial Sciences, University of Groningen (reg. no. 2025-07). Findings will be disseminated through peer-reviewed publications, stakeholder engagement activities and patient/public channels.

Aims and objectives: This study aimed to explore stroke rehabilitation staff's experiences, challenges and adaptations in their work during the first two waves of the COVID-19 pandemic in Sweden.

Methods: A web survey was conducted from September to December 2020 with staff involved in stroke rehabilitation. It covered participant characteristics, experiences, COVID-19 management, patient safety, organisation, information allocation and information and communication technologies (ICT). Quantitative data was presented with descriptive statistics. Free-text responses were used to illuminate the findings.

Results: Three hundred and forty stroke rehabilitation staff answered the survey. No stroke rehabilitation organisation was closed entirely, but services had been paused or altered in several regions. Adaptations included prioritising patients with COVID-19 and thereby reducing the capacity to supply rehabilitation for stroke survivors. The participants experienced a shortage of personal protective equipment (PPE) and patient safety had been compromised. The pandemic restricted opportunities to provide ordinary rehabilitation, often resulting in ethical dilemmas and stress. The rapid transition to using ICT was primarily experienced positively.

Conclusions: Staff reported working under complex, constantly changing and stressful conditions during the first two waves of the COVID-19 pandemic. Disruptions in ordinary practice led to compromised patient safety and increased stress among staff, intensified by limited access to PPE. Ethical guidelines, as well as regular debriefing protocols, should be put in place to prevent adverse health outcomes among staff and to prepare healthcare systems for future crises and disruptions. ICT offers a potential pathway for more flexible and accessible care in the future.

Despite growing emphasis on home-based rehabilitation following stroke, there remains limited understanding of how to effectively tailor services to individual needs. This study employed concept mapping to explore diverse stakeholder perspectives on adapting home-based rehabilitation to better support the recovery process after stroke. Through this mixed-methods participatory approach, we engaged 89 stakeholders, including stroke survivors, significant others, healthcare professionals, managers, and architects. Participants generated, sorted, and rated statements about what matters most in home-based stroke rehabilitation. A hierarchical cluster analysis was conducted to organize the data into concepts. Five clusters were identified: 1) social support at home and beyond; 2) professional competence; 3) supportive home environment; 4) teamwork and resources; and 5) patient involvement. Patient involvement was rated highest for importance and feasibility, followed by professional competence. Specifically, stakeholders emphasized that rehabilitation should feel meaningful and be tailored to the patient's needs. No generated ideas from the cluster “supportive home environment” were found in the go-zone, and adapting rehabilitation to diverse home environments was recognized as crucial but hard to implement. The findings underscore the need for individualized, context-sensitive approaches and suggest that strengthening professional competence, particularly in navigating diverse environments and engaging support networks, will be essential to translating person-centered principles into everyday rehabilitation practice.

PURPOSE: Self-management has increased in recognition in stroke research and rehabilitation along with growing trends of shorter hospital stays and more patient-centred care. Family members are key persons in the self-management process, but their views and experiences of self-management have not been studied in detail. This study aimed to explore family members' understanding of self-management, the strategies they use and the challenges they face when providing support.

METHODS: For this descriptive study, semi-structured interviews with family members (n = 27) were conducted. Data were analysed using inductive content analysis.

RESULTS: The analysis resulted in three main categories and eight subcategories. Most family members saw self-management as performing practical tasks, such as daily living activities and rehabilitation training. However, family members described a broad range of actions to support self-management, including emotional and motivational support. They found it challenging to give the right amount of support and expressed a need of more information after discharge.

CONCLUSIONS: Family members' conceptualisations of self-management differ from the strategies they use to provide support. A clearer understanding of self-management as a collective process can benefit the development and delivery of efficient self-management support.

Objectives: A growing number of frail older adults live at home, placing increasing demands on health and social care systems. Digital twins may improve homecare services and support person-centred and integrated care. This study investigated older adults' experiences of homecare and their perspectives on the potential use of digital twins in homecare.

Methods: An exploratory, two-stage qualitative study was conducted with 14 older adults from two Swedish municipalities. In the first stage, semi-structured interviews explored participants' experiences of homecare. In the second stage, the same participants took part in either a semi-structured interview or a focus group discussion regarding their views on digital twins, with participants choosing their preferred format. Reflexive thematic analysis was used to interpret the data.

Results: The analysis generated one main theme, Navigating uncertainty and possibility in digital twin-supported homecare, with four sub-themes, Challenges in understanding and accepting digital twins, Concerns about privacy and ethics, Opportunities for safety and prevention, and Potential effects on daily routines. Participants struggled to comprehend the nature of digital twins. Concerns about their potential use in homecare included ethical issues, impacts on privacy, and reduced social interaction with homecare staff. However, participants also identified potential benefits of digital twins, such as more responsive services, improved scheduling, and enhanced safety through monitoring and predictive functions.

Conclusion: This study highlights the potential of digital twins in homecare from the perspective of older adults. While digital twins offer opportunities, integrating them into homecare services is complex and requires addressing the concerns raised by participants.

UNLABELLED: Stroke patients are rarely asked about their responses to specific design attributes. Virtual reality (VR) offers a promising tool to explore how hospital environments are experienced after stroke.

PURPOSE: To gather perspectives and emotional responses regarding physical design attributes of hospital patient rooms after stroke.

MATERIAL AND METHODS: We developed a 'VR experience' for adult stroke patients in both single and multi-patient room designs, with four additional physical design attributes: spaciousness, greenery outlook, night-time noise, and design attributes for social connectivity e.g. furnishings. A qualitative study approach involved semi-structured interviewing, that followed immersion in the VR patient room designs. Qualitative descriptive and thematic analysis was done. (Australian New Zealand Clinical Trials Registry, Trial Id: ACTRN12620000375954).

RESULTS: Thirty-five stroke patients participated (April 2019-March 2020). Interviews yielded three themes and ten sub-themes. Themes were: (1) action and care supported by design and layout, such as ease of movement; (2) connection to people, nature, and place, emphasising social interaction and greenery; and (3) control of the environment, involving attributes like space.

CONCLUSIONS: Findings showed how physical design attributes enhance movement accessibility, promote social interaction, or provide sensory comfort. Using VR allowed rich, detailed feedback from patients, offering valuable insights for designing hospital environments.

INTRODUCTION: Many tools support housing decisions for older adults but often overlook mobility patterns and social health. We explored these factors in older Canadians living at home to inform housing decisions.

METHODS: We conducted a mixed-methods study with 20 older adults (65+) from Quebec and Alberta living independently or in senior residences with outdoor mobility. Data collection included sociodemographic information, GPS tracking, walking interviews, daily journals, and in-depth interviews. Data from interviews, which explored physical and social assets and barriers to social health and mobility, were analyzed using deductive content analysis in NVivo 12. GPS data were subjected to spatial analysis in QGIS (Quantum Geographic Information System) to map activity spaces and mobility patterns by the number and distance of activities, activity types, and modes of transportation. Daily journals were transcribed into an Excel spreadsheet and compared with GPS data. Overall analysis was guided hierarchically by qualitative data, utilizing verbatim narratives and visualization (activity space maps) to illustrate data convergence.

RESULTS: Among 20 participants, 14 completed all activities, including GPS trackers. GPS maps showed participants mostly left home to drive for shopping or walking. Over 14 days, participants made an average of 10.4 (±5.8) trips and traveled 186.9 km (±130.4), averaging 16.8 km (±29.8) per day. Transportation modes included car (n=9), walking (n=5), and bus (n=2). Daily journals revealed that participants typically traveled alone. Interviews identified physical assets as libraries and supermarkets (n=10), while social assets were family support when desired (n=13) neighborhood familiarity (n=14), both contributing to social health. Winter weather was the most cited mobility barrier (n=13).

CONCLUSIONS: These findings provide actionable insights to guide the development of user-informed decision support tools tailored to the housing decisions of Canadian older adults.