Living lab approaches in rural healthcare: a scoping review

OBJECTIVE: Living labs represent a user-centric approach to solving real-world challenges by encouraging active participation of external stakeholders in co-designing the research and innovation process. Highlighted by contextual research and user co-creation, living labs are ideal for addressing the challenges of providing optimal healthcare to patients living in rural and remote regions. Our objective was to synthesise the existing research on the living lab approach in co-designing, developing or implementing a rural healthcare service, clinical intervention or health-related technology. DESIGN: Scoping review. DATA SOURCES: A search was conducted on 10 May 2025, to identify articles from three electronic databases (MEDLINE, EMBASE and CINAHL). ELIGIBILITY CRITERIA: We included published literature that presented a living lab approach to improve the provision of healthcare services in a rural environment. We excluded articles examining social determinants of health (eg, physical activity and general health promotion) without a direct link to clinical service innovation or healthcare delivery. DATA EXTRACTION AND SYNTHESIS: We collected data on study methodologies, settings, stakeholders and innovation types. Data extraction was performed by two independent reviewers using a standardised form. We used frequencies and a narrative synthesis to map characteristics, methods and contexts of living lab applications in rural healthcare. RESULTS: The search identified a total of 1080 articles and ultimately included 11 articles. Studies were published between 2016 and 2025 and conducted in Canada (n=3), the USA (n=3), Australia (n=2), Guatemala (n=1), Uganda (n=1) and France/Portugal (n=1). Study settings included rural hospitals, regional health networks, Indigenous communities, farming and fishing communities and underserved rural regions. Health issues targeted included cardiovascular disease, diabetes, musculoskeletal conditions, perinatal care, palliative care and infectious disease management. Study methodologies included formalised, theory-driven frameworks (n=4), community-based participatory research (n=4), user- or human-centred design (n=3) and co-design workshops and interviews (n=3). Only one study explicitly used the term 'living lab' to describe their innovation. CONCLUSIONS: Relatively few living lab approaches have been meaningfully applied in rural health. There is a need for greater global diversification, expanded domains of focus and more robust evaluation to fully understand the potential and impact of living labs in rural healthcare.