Optimising co-design methodologies for people with communication disorders following neurological impairment: establishing criteria, adapting practices, and enhancing inclusivity.

Abstract

Background: Co-design methodologies, which actively involve interest-holders in intervention development, are increasingly used in health care. In brain injury rehabilitation, they offer potential for tailored support for individuals with communication disabilities. However, the diversity of approaches and lack of communication-specific adaptations can limit their effectiveness and authenticity in equitably engaging interest-holders with communication disability.

Methods: This meta-synthesis reviewed 30 studies involving adolescents (aged ≥12 years) and adults with acquired brain injury affecting communication. Systematic searches of six databases identified studies using co-design in rehabilitation contexts. The review aimed to define minimum requirements for co-design and explore evidence-based adaptations that support inclusive participation.

Results: Studies used varied theoretical frameworks and qualitative methods, including interviews, focus groups and workshops. Adaptations to support communication included easy-read materials, bespoke design tools, and member-checking. Innovative techniques, such as the Someone Who Isn't Me technique for perspective-taking and modified consensus-building, were noted. Despite the value of lived experience, contributions were often underutilised due to inaccessible practices and inconsistent reporting.

Conclusion: Authentic co-design was demonstrated in studies that embedded inclusive principles and tangible adaptations. This review offers practical guidelines for optimising research inclusion by integrating accessible communication strategies, ensuring interventions are genuinely co-designed.