Co-what? A new perspective on participation and collaboration with vulnerable populations in design studies: Methodological inquiry

Although co-design is widely promoted in healthcare, it is seldom true co-design. In practice, power imbalances persist, and (former) service-users’ voices rarely shape design decisions. This study examines how design processes can nevertheless surface these much-needed perspectives. Using a multiple-case study design, nine peer-reviewed healthcare design projects were selected and reformulated into analytical scenarios, enabling systematic comparison of methodological strategies. Thematic cross-case analysis explored how user perspectives were elicited, how insights informed design decisions, and where representation broke down. A key finding is that lower levels of direct involvement require more methodological steps to capture and translate users' needs adequately. The results offer a modest compass for designers designing within healthcare contexts. They might prevent situations in which co-design or participatory approaches are merely performative because they align with current trends, while the service users’ perspective is not genuinely embraced in the process.