Sense of psychological ownership in co‐design processes: A case study
Anette Juel Lene L. Berring Annette Erlangsen Erik R. Larsen Niels Buus
Service users are increasingly participating in health research. Although collaborative research is assumed to give users a sense of psychological ownership, little is known about the specific psychosocial processes through which ownership develops and ...
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PubMed Central (PMC)
2.3. Workshops

In applying a participatory approach to the website design, we followed general guidelines for service user participation. 2 , 15 , 16 , 17 , 18 , 19 , 20 Eight workshops were organised by the first author over the course of a 2‐year period, starting in May 2019 and ending in March 2021 (see Table ). The first five workshops were held in person in a public meeting venue in Copenhagen and, due to Covid‐19 restrictions, the subsequent three workshops were held as online sessions. Each workshop had a planned duration of 3 h.

Table 2

Workshop number#, month and yearPhysical/onlineWorkshop participantsDuration#1, May 2019In personService user no. 1–82 h, 59 minResearcher no. 1–4Website designer#2, June 2019In personService user no. 2, 3, 5, 6, 82 h, 44 minResearcher no. 4Website designer#3, August 2019In personService user no. 1–3, 6, 82 h, 46 minResearcher no. 1, 4Website designer#4, December 2019In personService user no. 2, 3, 5, 6, 82 h, 47 minResearcher no. 4Website designer#5, August 2020In personService user no. 1–3, 5, 6, 83 h, 1 minResearcher no. 4Website designer#6, January 2021OnlineService user no. 2, 3, 5, 62 h, 8 minResearcher no. 1, 2, 4Website designer#7, February 2021OnlineService user no. 2, 3, 5, 6, 82 h, 50 minResearcher no. 4Website designer#8, March 2021OnlineService user no. 2, 3, 5, 6, 82 h, 3 minResearcher no. 4Website designer

The first author and the website designer prepared the workshop agendas. The first workshop was less structured; after a brief introduction to all participants, a general discussion of wishes and expectations to the website evolved. All subsequent workshops had a more structured agenda and listed various topics related to the website design. The agenda was sent to all participants by email ahead of each workshop. The first item on the agenda at the beginning of each workshop was reflections and experiences since the last meeting and the closing item was reflections on the discussions that had evolved during the workshop. The first author and the website designer, who led the meeting, introduced the points on the agenda and explained how they would like service users to contribute with suggestions to the outline of topics and design for the website. After each workshop, a resume was sent to all participants. The resume briefly stated key points raised and decisions made during the meeting. In a few instances, service users were invited via email to comment on specific issues in the intervals between workshops. Service users received travel reimbursement and an honorarium payment after each attended workshop. The audio recordings of the workshops were transcribed verbatim by a research assistant. Subsequently, the first author checked the accuracy of these transcriptions against the recordings. Observational data were mainly focused on the psychosocial atmosphere during the workshops, for example, if the first author observed interactional patterns in the participants' formal and informal discussions. Therefore, the workshop transcripts constituted the main data in the analysis.

Different formats of psychoeducation were suggested for the website, including (1) video clips that recaptured parents' experiences of providing care for children with suicidal behaviour, (2) questions and answers (Q&A), addressing specific topics of relevance, (3) a chat robot, in the form of an avatar, that is, a computer animated adult female, who, in segmented video clips combined through programming, asked parents questions and provided advice on issues of concern and (4) virtual peer support groups.

3.1. Sense of ownership during the early design phase

In the period leading up to the first workshop, the researchers and the website designer had compiled a proposal with their ideas for the website. These ideas comprised a chat robot and video clips capturing experiences of parents providing care for children with suicidal behaviour. Moreover, the researchers had obtained funding to develop a website with these elements. This contextual condition positioned them in control of the process and afforded them the power to define the preliminary procedures for service user participation. They decided on the number of workshop participants and invited service users. They arranged the workshops, defined the structure and agenda of each workshop and decided how they would like service users to contribute to the group work. They developed templates of their ideas for the website, which they presented to the service users during the first workshop. Hence, they had invested a considerable amount of time and effort in sketching a path for the workshops and in creating an outline for the chat robot and video clips. Owing to these early design activities, the researchers and the website designer perceived psychological ownership of the website process before initiating the workshops.

Their sense of ownership was displayed in their voiced enthusiasm about their design ideas. For instance, when introducing the chat robot, researcher no. 2 stated: ‘We thought it might be a helpful tool, well it is our idea, so now you are welcome to tell us if it is totally off’. The researcher used the expression ‘our idea’ and emphasised its potential value, thereby suggesting that the researchers and the website designer would be reluctant to abandon this idea. As such, the website design context positioned the service users with limited control over this part of the process. They were, at the beginning of the workshops, unable to make decisions because they lacked insight into research processes and had limited knowledge of software programming, research methods and potential tools for psychoeducation.

Although the researchers and the website designer had initiated the design process ahead of the workshops, they rhetorically tried to downgrade the significance of this, possibly to support a sense of a genuine collaborative partnership. This occurred at workshop no. 1 when they informed the service users that they had the power to make decisions regarding all website content and refrained from mentioning that the chat robot and video clips were mandatory elements because they had been specified in the funding proposal. When the researchers and the website designer presented their arguments about the value of the chat robot and video clips, service users rejected these by suggesting that Q&A and virtual peer support groups would be more helpful. This rejection suggested that service users did not feel ownership over these website elements. The researchers and the website designer did not challenge the service users' stance but promptly accepted their suggestion to develop a Q&A section, possibly to mediate their reluctance towards the chat robot and video clips.

The following data extract illustrates how service users challenged the researchers' arguments for producing the video clips and instead argued in favour of creating virtual peer support groups. The extracted dialogue occurred during workshop no. 1, where one researcher had asked the service users about their wishes and expectations to the website:

Service user no. 4: ‘The thing that provides the most support is to be in direct dialogue with someone who has been through the same experience’.

Researcher no. 1: ‘I think parents need to know that their behaviour is normal given the context of this disaster’.

Service user no. 8: ‘But that would require that they meet someone who can tell them that’.

Researcher no. 1: ‘That's what I'm hoping the video clips can instigate [addresses service user #7 who is shaking her head]… you stress me out when you shake your head at me like that’.

Service user no. 8: ‘I think it's about meeting others face to face in groups, to enable that reflection in others, and I just can't see that happening right now [on the website], but I think it would be great if you made a virtual peer support group where parents can meet on the internet, I'm sure it's technically possible’.

Service user no. 1: ‘It is a good message to have on a website, that there is a special room that can strengthen the capacity to endure’.

Researcher no. 2: ‘Well, I am open to all suggestions, but I think that to make a virtual peer group where parents can meet on this website and talk would require monitoring by a professional who can intervene, and that would be very expensive’.

The data extract illustrates how a service user suggested developing a virtual peer support group on the website, which was endorsed by other service users. One of the researchers immediately challenged this suggestion, arguing that video clips would provide a similar type of support to parents as peer groups. Although service users voiced considerable scepticism and continued to stress the relevance of virtual peer support groups, the suggestion was eventually dismissed by a researcher. The data extract exemplifies how researchers were reluctant to dismiss the video clip idea and how, due to their context‐generated position of power, they allowed themselves to reject the suggestion proposed by service users.

Similarly, the researchers and the website designer would occasionally disregard knowledge shared by service users if it conflicted with their own knowledge about website design and research methods. This occurred, among others, in workshop no. 3. Here, a researcher introduced a list of questions to be used in the interviews with parents for the video clips. Service users suggested omitting the final question: ‘Why do you think this happened to you and your family?’ because they were concerned that it might leave the interviewees with feelings of distress and guilt. However, the researchers ignored their concern and replied that this specific issue was addressed several times during the interview and therefore needed to be explored also at the end of the interview. To address their concerns, it was decided that a debriefing session would be conducted at the end of the interviews.

Although these examples illustrate that some of the service user input was ignored, the researchers and the website designer continued to emphasise that the lived experiences and opinions of the service users were essential for constructing a useful website. Unlike the researchers and the website designer, service users continually needed to legitimise their participation in the workshops by sharing their experiences, values and opinions, while realising that their potential contributions could be dismissed. This led to an initial distrust in the researchers and the website designer, which seemed to prevent the service users from feeling psychological ownership.

3.2. Sense of ownership during the collaborative design phase

Through the collaborative design activities, which were applied to create the website, gradual feelings of ownership started emerging among service users. Thus, in this second phase, all participants perceived psychological ownership of the design process. The activities gave service users increasing control of the process and allowed them to invest themselves in the process and to gain intimate knowledge of the process. We observed their growing sense of ownership in the ways in which they gradually changed their statements about the website and its elements and in their displays of agency in the workshops.

In the second phase, service users seemed to become more confident as to their role in the design process while accepting the decisions that were beyond their control. At this stage, the design process was more equally shared and controlled among all workshop participants. Service users exerted a greater influence on website design; for instance, they decided the wordings for the questions in the Q&A. Moreover, although they had been unable to overturn the decision regarding the video clips, they decided (1) which topics should be addressed in the video clips, (2) how the video clips should be recorded and (3) how the video clips would be organised on the website. In a similar vein, they decided which topics should be addressed by the chat robot, how it should appear on the website, how its voice should be and its name. In this way, the content of the website gradually began to represent items that were rooted in the service users' wishes and priorities. Moreover, a collaborative partnership developed as service users increasingly challenged and changed the group's activities to fit with their preferences. This observed behaviour demonstrates their increasing control of the process, which gave rise to their sense of ownership.

Service users also invested themselves in the design process. This investment was, among others, witnessed through the amount of time spent on the project, but also through their sharing of private thoughts, emotions and values. Service users openly shared the most difficult challenges that they had faced as parents to underpin their suggestions for video clip topics. Similarly, they revealed their emotional reactions to researcher‐produced questions included in the chat robot as arguments for why they thought questions should be formulated differently. They also shared both positive and negative experiences of accessing other websites to underpin their website layout preferences. This process implied that the website gradually started to reflect their experiences and values. This investment was increasingly reciprocated by the researchers and the website designer, who shared personal anecdotes about their own lives. As such, the various personal investments gradually formed a collectively shared practice.

A third factor that helped facilitate a growing sense of psychological ownership was the intimate insights that service users gradually gained into the web design process. Over the course of the 2‐year period, service users became familiar with the other workshop participants and the design activities. They learned that their personal investments were typically welcomed by the other participants, who responded with supportive and encouraging remarks. Thus, the workshops became a safe place where they could share their knowledge and rapport was established between the workshop participants. This growing familiarity enhanced service users' commitment, which was also underscored by their continued attendance at the workshops. Moreover, service users felt responsible for the website. An example of this was clear from workshop no. 5. Here, one of the researchers invited the service users to describe their thoughts regarding their participation. One service user who had participated in all workshops but refrained from responding to emails in between workshops said: ‘I am not sure that I am the right person to be here, you know, do I contribute enough… I have not always felt that I give enough, considering that I said yes to be here’ (Service user no. 6). In this data extract, the service user voiced uncertainty concerning whether her contributions were fulfilling, seemingly taking on responsibility for creating a useful website.

This state of psychological ownership was displayed in the way that service users gradually changed their thoughts about the chat robot and the video clips. For instance, they initially voiced their preferences for a Q&A section and virtual peer support groups rather than video clips. However, at workshop no. 5, when the researcher showed a pilot video clip, two service users immediately provided their positive feedback:

Service user no. 3: ‘I showed my husband the video clip that you sent, and he was deeply moved by it, he felt really bad for that mother [in the clip], I think it worked really well that you asked a question [at the beginning of the clip]’.

Service user no. 2: ‘I agree, it [the interview question] provides context so you know where you are’.

The service users found that the video clip was authentic and it produced an emotional reaction in viewers. As they were in charge of setting up for the video clips, they decided to include interview questions as part of the video clips and in this way, they voiced their opinion about the questions, saying that they set the context for the parents' unfolding narrative.

Similarly, service users gradually changed their view of the chat robot. At first, their response was negative. They thought it would possibly generate feelings of loneliness because it was unable to listen and to respond in a suitable manner and that it would possibly feel like a provocation. After investing time in designing the chat robot and gaining more influence on its appearance, they gradually changed their opinions:

Service user no. 2: ‘I think that she can actually calm you down when you're stressed out’.

Service user no. 8: ‘I agree’.

Service user no. 1: ‘Yes, it provides something else than reading, it conveys a human feeling even if it's just a robot’.

Service user no. 2: ‘There is something therapeutic about her, she provides some sort of comfort’.

Service user no. 1: ‘We can talk about this, we can verbalise this, it's amazing what it can do’.

From initially being opposed to the idea of the chat robot, service users started thinking that it would potentially serve to relieve distress and help verbalise difficult topics, seemingly comparing the robot to a therapist. The positive statements about the video clips and chat robot demonstrate how service users gradually assumed ownership of these website features. These statements were observed in workshop no. 5, which suggests that an amount of time was necessary for ownership to emerge. Similar to the researchers and the website designer, service users now spoke of the website as theirs.

4.1. Strengths and limitations

As noted by Tritter and McCallum, 7 participatory research should involve a multiplicity of different stakeholders. Despite elaborate recruitment efforts, stakeholders in the present study only comprised of mothers of children with suicidal behaviour and a counsellor. It would have been preferable to also involve fathers. However, fathers may be more reluctant to participate, by being less willing to share personal experiences than mothers 29 and to seek psychological support in general. 30 Consequently, it was not possible to draw any conclusions as to whether feelings of ownership may vary by gender. They differed with respect to years of lived experience, suggesting that service users had different insights regarding the care pathway and, thus, brought different perspectives and preferences to the design process. After the first workshop, two service users withdrew their participation. We did not document their reasons for dropout, but the workshops may not have been perceived as a safe setting by those who opted out of the study after their suggestion to develop virtual peer support groups was dismissed.

The analysis included data from workshops conducted over an extended period of time, which allowed us to map the negotiation of ideas and design activities over time. Thus, as a data collection method, audio recordings and observations of workshops proved to be a powerful tool with which to study collaborative processes. 22 The approach was, however, less suitable for gaining an understanding of psychological states, such as sense of ownership. For this reason, our findings regarding ownership were limited to recorded statements about the website and its elements and did not apply to ownership per se. Moreover, it was not possible to elaborate on all elements of the concept from the data; for instance, we were unable to explore how the design context and activities affected the three underlying motivations. Follow‐up interviews would be an efficient way to further deepen and strengthen the interpretation of data. It is also important to note that the first author held a ‘participant as observer’ position 31 as she participated in the workshops and subsequently led the analysis and interpretation of data. While participation may lead to a problematic ‘closeness’ to the situation, the opportunity to collaboratively study the audio recordings at a later time facilitated a ‘distance’ to the situation, which assisted in developing a balanced and nuanced interpretation. Our interpretations were strongly influenced by the selection of the theoretical framework, and to ensure that the interpretations were fruitful and firmly grounded in the data, we closely reread the workshop transcripts during data analysis. Finally, we used peer debriefing and kept an audit trail via memos, 32 which contributed to enhance the trustworthiness of the interpretations.