{"doi":"10.1111/jgs.70141","title":"Application of Participatory Design to Co‐Design a Thoracic Surgery Prehabilitation Program","abstract":"There is strong evidence that prehabilitation (prehab) before surgery in frail, older adult patients improves perioperative outcomes, yet only 10%–30% of eligible patients adhere to prehab programs [1-3]. We hypothesize that the lack of “end” user (e.g., patient, caregiver) engagement in the design of prehab programs contributes to poor adherence and describe the first application of user-centered, participatory, co-design [4, 5] principles to a prehab program for frail, older adult Thoracic Surgery patients. Patients/caregivers in the thoracic surgery clinic waiting room were invited to participate in a brief (5–10 min) interview to gather feedback on individual components of low-fidelity, early prototypes (e.g., hand-drawn pictures) of a prehab program. Three phases of interviews, with new participants at each phase, were conducted with continuous data analysis to inform the next iteration of the prototype (Table 1). For Phase 1, participants were shown an initial prototype of an Apple Watch (with daily exercise reminders and recording physical activity) and multiple formats (e.g., handout, cards, video) of physical activities (e.g., tai chi, walking, Zumba) for patients to perform. For Phase 2, the prototype consisted of the Apple Watch, a prescription for prehab, and a 13-page, single-sided, flipbook that was branded with the hospital name and included evidence of the benefits of the exercises from professional societies; a page for each exercise with step-by-step directions; a daily tracking log; and a brief guide on the use of the Apple Watch. For Phase 3, a near final prototype (Apple Watch, prescription, and flipbook with additional refinements to the exercise directions and a “Safety Tips” page) was reviewed by participants and the University of Chicago Health Literacy and Office of Diversity, Equity and Inclusion team. Participants were also asked about their receptivity to wearing the Apple Watch and receiving a daily exercise reminder. Finally, content and layout refinements were made by the study team in alignment with design criteria prioritized by patients and caregivers. The study was approved by the University of Chicago IRB22-1679. Exercise content (e.g., chair exercises, tai chi, walking Zumba) sourced from existing resources: Prototype formats included Apple Watch plus a handout, booklet, deck of cards and/or YouTube video channel. Physical flipbook for a “Daily prescription” of 3 exercises (marching in place, wall push-ups, chair squats), and 2 stretches (upper back and calf stretches) for a specific number of weeks, plus Apple Watch Included evidence-based information from ACS and ASA. Addition of “safety tips” page and refinement of exercises (names, directions, photography) and tracking logs for each exercise. For step-by-step exercise directions, offered participants choice between photography of real people or AI-generated (ChatGPT) image. A 15-page flipbook on stiff heavy-weight paper and plastic spiral binding to support tenting on a table. Flipbook includes: A total of 19 patients and 4 caregivers (n = 23) participated in the interviews (participation rate 96%, 23/24). Feedback from Phase 1 participants (n = 9) indicated a desire for (1) a “booklet” that is institutionally “branded” to convey quality and includes a limited number of exercises with evidence of patient benefit and is ordered by difficulty and (2) a “prescription” for prehab. Phase 2 participants (n = 3) endorsed the flipbook (booklet), found the exercise directions simple enough to complete at home, and requested more information about needed equipment. Phase 3 participants (n = 11) offered nuanced feedback about the content, order, and directions of the exercises (e.g., how to address poor balance or low strength; how to increase intensity), suggested adding walking as a physical activity, recommended modifying the log with a column for each exercise, expressed a preference for the photographs of directions to be of actual people ra","journal":"Journal of the American Geriatrics Society","year":2025,"id":547319,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9554,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":567234,"name":"Sara Y. Kim","orcid":"0000-0003-0105-3772","position":1,"is_corresponding":false},{"id":1440175,"name":"Donna Tong","orcid":null,"position":2,"is_corresponding":false},{"id":371011,"name":"Jane L. Holl","orcid":"0000-0002-2934-1672","position":3,"is_corresponding":false},{"id":553712,"name":"Maria Lucia L. Madariaga","orcid":"0000-0002-2950-7230","position":4,"is_corresponding":false},{"id":1359298,"name":"Amanda Geppert","orcid":null,"position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-19T02:53:41.314800Z","pmid":"41028941","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}