Abstract

INTRODUCTION Applying digital health technologies (DHTs) for health promotion and disease prevention is recommended by official bodies such as the World Health Organization. User-centered co-design with patient and public involvement is considered best practice for developing such complex interventions. While well-established frameworks are available to broadly guide such procedures, there is a need to better focus and guide the co-design process with preceding contextual research. Moreover, more specific guidance on additional methodological steps for the validation of DHT components and to facilitate their implementation, scalability, and sustainability would benefit the research community.

OBJECTIVES This manuscript presents a consensus-based methodological guideline that delineates best practices for each step along the full lifecycle of DHT-enhanced training and rehabilitation concepts – from contextualization through co-development and evaluation to implementation.

METHODS The Co-Develop-IT guideline was co-created through an expert consensus process. It consisted of biweekly 90-minute meetings between August 2024 and February 2025 in combination with written elaboration, feedback, and revisions between meetings, to gradually develop a consensus on best practice recommendations.

RESULTS The Co-Develop-IT guideline consists of eight iterative phases directed toward multidisciplinary expert teams coordinating projects on DHT-enhanced training and rehabilitation concepts. It is applicable to any type(s) of end-user(s), exercise type(s), intended context(s) of use (e.g., primary healthcare, community health services, telemedicine) and overarching goal(s) (e.g., health promotion, primary through tertiary disease prevention). The guideline integrates and refines previous methodological frameworks and expands on existing best practices by introducing five distinct preparatory contextual research phases preceding generative co-design and development. These novel phases are dedicated to harmonizing all contributors’ interests and clarifying their level of involvement (particularly between research, industry, healthcare, and end-users), aligning co-design procedures with expectations and requirements of interest-holders, collaboratively delineating clear strategies to monitor project progression, and promoting implementation, scalability, and sustainability of the solutions to be co-developed.

CONCLUSION The Co-Develop-IT guideline proposes best practices for how participatory research and patient and public involvement may be efficiently implemented and structured to benefit the establishment of individually tailored DHT-enhanced training concepts. Its main novelty lies in guiding the structured establishment of a more robust conceptual foundation through extensive preparatory contextual research phases, aimed at better targeting tailored co-development efforts toward successful implementation. We advocate for the continued refinement and consolidation of this methodological guideline to help the field strike a better balance between maximizing the benefits and mitigating the increased resource demands of collaborative research practices – ultimately maximizing its real-world impact.

Competing Interest Statement

The research project involving MR and LH that provided the second application covering the development of Reality DTx is a collaborative initiative between the Vrije Universiteit research team and the manufacturer of Reality DTx, Strolll Limited, United Kingdom, formalized in a collaboration agreement as part of a shared research and development grant (EUreka Eurostars Grant E115506) attracted by MR and Strolll Limited. As part of the arrangement, Vrije Universiteit Amsterdam transferred intellectual property related to augmented reality cueing and data science to Strolll Limited in exchange for share options. MR is a scientific adviser with share options for Strolll Limited alongside his full-time academic positions at Vrije Universiteit Amsterdam and Maastricht University. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Funding Statement

PMs time dedicated to this project was funded by the Swedish Research Council (Dnr 2022-00636) as well as the Strategic Research Area Health Care Science (SFO-V) at Karolinska Institutet (Blue Sky Grant Dnr 2025-01126). The fees for open access publication were covered by Bibsam-agreement.

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8. AbbreviationsCo-Develop-ITCo-design, Development, and Evaluation of Individually Tailored Technology-Enhanced Training and Rehabilitation ConceptsDHTdigital health technologiesEQUATOREnhancing the QUAlity and Transparency Of health ResearchMIDEMultidisciplinary Iterative Design of ExergamesMRCMedical Research CouncilNASSSnonadoption, abandonment, scale-up, spread, and sustainabilityPDParkinson’s diseasePRACTISPRACTical planning for Implementation and Scale-upRCTrandomized controlled trialSWOTStrength, Weakness, Opportunities, and Threats