Abstract Rationale Smoking remains the leading cause of preventable morbidity and mortality in the United States. Yet, stigma, mistrust, and uncertainty about quitting often hinder engagement in smoking cessation research among people who smoke. Co-design offers a participatory process that centers collaboration and lived experience to enhance relevance and equity in research. While the benefits of co-design are often evaluated in terms of the resulting research products, the process of co-design has value in engaging populations facing barriers to research participation. We employed co-design to develop an integrated community health worker (CHW) intervention to support smoking cessation. Here, we describe how the co-design process facilitated meaningful engagement of people who smoke in smoking cessation research. Methods Drawing from smoking cessation clinics, hospital-based support groups, community organization partners, and existing CHW programs, we convened a co-design team of CHWs and patients. Over five months, we held 10 iterative, virtual co-design sessions guided by design thinking principles: (1) foundation setting, (2) ideation, (3) prototyping, (4) iteration, and (5) finalization. Engagement was supported through regularly scheduled meetings, individualized 1:1 phone calls, and supplemental communication via email and mailed materials. Attendance and participation were tracked, and ethnographic observations were used to identify themes related to engagement. Results Eight co-designers participated, including two CHWs (one who smoked) and six patients (four with current, two with former smoking). Each session was attended by 4-8 co-designers, and each co-designer attended at least 8 sessions, with patient co-designers contributing most discussion time. Three themes characterized engagement (Figure): 1-Peer support: Co-designers valued sharing experiences and encouraging one another, fostering empathy and community; two co-designers quit smoking during the co-design process, and three reduced their cigarette use. CHWs reflected that hearing directly from patients enhanced their ability to serve as peer supports. 2-Ownership: Participants described feeling like equal partners and took pride in the products created, identifying themselves as “researchers.” 3-Personalization: Flexible, personalized communication and participation options supported continued engagement and informed a personalized approach to smoking cessation in the resulting intervention. Conclusions The co-design process fostered meaningful, sustained participation among people who smoke, people with a history of smoking, and CHWs. Beyond generating an intervention, co-design built peer relationships, enhanced CHW capacity, and promoted behavior change among co-designers. These findings underscore the value of co-design not only as a method for research and intervention development, but also as a mechanism for empowerment especially among groups that face barriers to engagement. This abstract is funded by: Charles A King Fellowship Grant
Kearney et al. (Fri,) studied this question.