Co-Design and Creation of a Documentation Support System for Care Workers with Large Language Models

Co-Design and Creation of a Documentation Support System for Care Workers with Large Language Models | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Co-Design and Creation of a Documentation Support System for Care Workers with Large Language Models Reinhard Kletter, Matthias Hirschmanner, Helena Anna Frijns, Evelyn Mayer-Haas, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8214439/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Developing meaningful and wanted technologies for the care context presents a significant challenge. This study illustrates the development of a documentation support prototype created with continuous involvement of care stakeholders. The process is examined in terms of its strengths and weaknesses, and key design requirements are identified. We employ a co-design approach involving 43 unique care stakeholders (24 care workers, 19 residents) across four study phases conducted in Vienna residential care homes. Each phase incorporates divergent and convergent methods to identify challenges and define solutions. Four mock speech interactions were recorded for feasibility testing, followed by 40 recordings of real care interactions (avg. ca. 11 min). Qualitative data from interviews with care workers is analyzed using thematic analysis, and system performance was evaluated using ROUGE-1, BERTScore, and care worker annotations. Based on the recordings and interview data, we identify topics in care worker–resident dialogues that are relevant or irrelevant to documentation. We found that the system consistently generates relevant information for documentation (55% on average). Of the labeled topics, 29.6% were identified as not relevant for documentation. We identify transcription errors and lack of speaker diarization for part of the reason for the remaining 15.4% of summaries consisting of wrong segments. We present the design outcomes of a multi-phase co-design study. Our findings demonstrate that the system can extract care-relevant information from care interactions, and we discuss insights related to the co-design process, as well as potential implications for work practices and privacy. Co-design Residential care home Documentation support Large Language Models Prototype Care work Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 15 Mar, 2026 Reviews received at journal 23 Feb, 2026 Reviews received at journal 23 Jan, 2026 Reviewers agreed at journal 17 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers invited by journal 15 Dec, 2025 Editor assigned by journal 10 Dec, 2025 Submission checks completed at journal 27 Nov, 2025 First submitted to journal 26 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8214439","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606309941,"identity":"a0c6e79b-d47f-4d38-88fc-2ed905564cfc","order_by":0,"name":"Reinhard Kletter","email":"data:image/png;base64,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","orcid":"","institution":"TU Wien","correspondingAuthor":true,"prefix":"","firstName":"Reinhard","middleName":"","lastName":"Kletter","suffix":""},{"id":606309942,"identity":"417fc4c9-0eba-438a-ab78-321fcc1dfcb4","order_by":1,"name":"Matthias Hirschmanner","email":"","orcid":"","institution":"TU Wien","correspondingAuthor":false,"prefix":"","firstName":"Matthias","middleName":"","lastName":"Hirschmanner","suffix":""},{"id":606309943,"identity":"b747d463-d9ec-4355-bbd9-b811cca678b7","order_by":2,"name":"Helena Anna Frijns","email":"","orcid":"","institution":"Interdisciplinary Transformation University Austria","correspondingAuthor":false,"prefix":"","firstName":"Helena","middleName":"Anna","lastName":"Frijns","suffix":""},{"id":606309944,"identity":"940d7822-7c71-4eaa-a890-9cfaf094d887","order_by":3,"name":"Evelyn Mayer-Haas","email":"","orcid":"","institution":"Caritas der Erzdiözese Wien","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"","lastName":"Mayer-Haas","suffix":""},{"id":606309945,"identity":"3363e412-320a-4060-a986-4ef9f4847b30","order_by":4,"name":"Sabine Theresia Koeszegi","email":"","orcid":"","institution":"TU Wien","correspondingAuthor":false,"prefix":"","firstName":"Sabine","middleName":"Theresia","lastName":"Koeszegi","suffix":""}],"badges":[],"createdAt":"2025-11-26 15:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8214439/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8214439/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105035327,"identity":"50cb6558-082e-4e14-808e-e76fb773f52d","added_by":"auto","created_at":"2026-03-20 07:25:52","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1521775,"visible":true,"origin":"","legend":"","description":"","filename":"DocumentationSupport.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8214439/v1_covered_6f2714ba-bc45-4be4-a055-e088b6c1a83d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Co-Design and Creation of a Documentation Support System for Care Workers with Large Language Models","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"computer-supported-cooperative-work-cscw","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cosu","sideBox":"Learn more about [Computer Supported Cooperative Work (CSCW)](http://link.springer.com/journal/10606)","snPcode":"10606","submissionUrl":"https://submission.nature.com/new-submission/10606/3","title":"Computer Supported Cooperative Work (CSCW)","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Co-design, Residential care home, Documentation support, Large Language Models, Prototype, Care work","lastPublishedDoi":"10.21203/rs.3.rs-8214439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8214439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Developing meaningful and wanted technologies for the care context presents a significant challenge. This study illustrates the development of a documentation support prototype created with continuous involvement of care stakeholders. The process is examined in terms of its strengths and weaknesses, and key design requirements are identified. We employ a co-design approach involving 43 unique care stakeholders (24 care workers, 19 residents) across four study phases conducted in Vienna residential care homes. Each phase incorporates divergent and convergent methods to identify challenges and define solutions. Four mock speech interactions were recorded for feasibility testing, followed by 40 recordings of real care interactions (avg. ca. 11 min). Qualitative data from interviews with care workers is analyzed using thematic analysis, and system performance was evaluated using ROUGE-1, BERTScore, and care worker annotations. Based on the recordings and interview data, we identify topics in care worker–resident dialogues that are relevant or irrelevant to documentation. We found that the system consistently generates relevant information for documentation (55% on average). Of the labeled topics, 29.6% were identified as not relevant for documentation. We identify transcription errors and lack of speaker diarization for part of the reason for the remaining 15.4% of summaries consisting of wrong segments. We present the design outcomes of a multi-phase co-design study. Our findings demonstrate that the system can extract care-relevant information from care interactions, and we discuss insights related to the co-design process, as well as potential implications for work practices and privacy.","manuscriptTitle":"Co-Design and Creation of a Documentation Support System for Care Workers with Large Language Models","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 06:28:51","doi":"10.21203/rs.3.rs-8214439/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-15T09:38:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T19:38:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-23T21:14:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260061248604761296868139789501490487824","date":"2026-01-17T14:46:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157288388936884319314638962149090290914","date":"2026-01-13T01:09:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-15T22:32:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-10T21:22:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-27T11:39:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Computer Supported Cooperative Work (CSCW)","date":"2025-11-26T15:14:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"computer-supported-cooperative-work-cscw","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cosu","sideBox":"Learn more about [Computer Supported Cooperative Work (CSCW)](http://link.springer.com/journal/10606)","snPcode":"10606","submissionUrl":"https://submission.nature.com/new-submission/10606/3","title":"Computer Supported Cooperative Work (CSCW)","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5500c3e6-a88b-4dc3-a0ea-7ac0baa06f1a","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T06:28:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 06:28:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8214439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8214439","identity":"rs-8214439","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}