Needs Assessment of Digital Technology in Co-Creation: A Health CASCADE Scoping Review

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Loisel, Qingfan An, Vinayak Anand-Kumar, George Balaskas, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6819176/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Oct, 2025 Read the published version in Research Involvement and Engagement → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Patient and public involvement (PPI) is increasingly recognised as essential for meaningful, equitable, and impactful health and social care research. Co-creation is a promising involvement approach, but it faces barriers to enable its optimal potential. Digital technologies have the potential to overcome these challenges and strengthen the participatory process, but the specific technology needs that underpin effective participation and engagement remain underexplored. Methods: We conducted a comprehensive scoping review of 60 peer-reviewed studies to systematically map the digital technology needs supporting co-creation processes. Needs were extracted and thematically analysed, resulting in a structured synthesis. Results: A total of 337 distinct digital technology needs were identified and organised into five thematic areas: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics, and Process Management. While most needs focused on functional attributes, non-functional characteristics, such as usability, scalability, and inclusivity, emerged as critical for meaningful patient and public engagement. The review highlights the fragmented articulation of technology needs across disciplines and settings. It proposes a structured framework to make latent needs visible, align stakeholder perspectives, and guide the development of digital tools. The emerging role of artificial intelligence in supporting hybrid models of involvement, along with the associated ethical challenges, is also discussed. Conclusion: This review provides the first thematic framework for understanding and addressing digital technology needs in co-creation. The findings offer a foundation for researchers, practitioners, and policy-makers within health and social care to develop and implement digital tools that enhance accessibility, engagement, and impact of participatory processes. Future research should validate and refine these insights in partnership with patients, service users, and diverse communities to ensure technological solutions foster truly inclusive and effective involvement. Patient and Public Involvement (PPI) Digital technology Co-creation Participatory Research Collective Intelligence Artificial intelligence Figures Figure 1 Figure 2 Figure 3 Plain English summary Involving patients, carers, and the public in health and social care research helps make research more relevant, helpful, and fair. Today, digital technologies, such as online meetings, apps, and artificial intelligence, can help more people become involved. But what do we really need from these technologies to make everyone’s involvement easier and better? In this study, we looked at 60 research articles to find out what kinds of digital tools are needed to support group work and co-creation in research. We discovered 337 different needs and grouped them into five main areas: making sure the process is fair and open, supporting the methods, helping people understand and take part, working well in groups, and keeping everything organised. We found that while many tools focus on what they do, it’s just as important that they are easy to use, work well for lots of people, and help everyone join in, especially people who may find it harder to get involved. We also discuss how new technologies like artificial intelligence can help, but why they need to be used responsibly. Our findings can help researchers, organisations, and the public choose or design better digital tools for involving patients and the public in research. This way, everyone’s voice can be heard, and health and care research can become more inclusive and effective. 1. Introduction Modern health and social care systems face complex and evolving challenges, ranging from global pandemics and widening health inequalities to the impacts of climate change, that have direct and profound consequences for patients, communities, and public well-being ( 1 – 4 ). Responding effectively requires not only sustainable innovation but also meaningful involvement of those most affected by health and care decisions. There is now strong recognition that patient and public involvement (PPI) is essential for research and service improvement, leading to higher-quality, more relevant, and more equitable outcomes ( 5 – 7 ) Within the PPI spectrum, co-creation has emerged as a promising paradigm for embedding the patient and public voice at every stage of research and innovation. It brings together patients, service users, carers, professionals, researchers, and policy-makers as equal partners. By leveraging collective intelligence and fostering shared decision-making, co-creation seeks to integrate diverse lived experiences and expertise to generate effective, widely accepted, and sustainable solutions in health and social care ( 8 ). The participatory nature of co-creation offers a mechanism for developing more inclusive, implementable, and resilient strategies to drive systemic change ( 9 , 10 ). However, realising the full potential of co-creation is challenging in practice, and participatory approaches face significant barriers. Its iterative and collaborative nature demands versatile, resource-intensive, and highly adaptive organisational processes, which can be challenging to initiate, implement, and manage at scale ( 11 , 12 ). Furthermore, the collective intelligence and shared governance principles that underlie co-creation require careful management of risks such as groupthink ( 13 ) and power imbalances among co-creators ( 14 ), which can inhibit the integration of critical or marginalised perspectives. As the number of co-creators increases, methodological obstacles arise, such as maintaining meaningful engagement across large and diverse groups, which can limit the effectiveness of collective processes ( 15 ). Such challenges can limit the meaningful integration of the patient and public perspective, despite policy and funding imperatives. Digital technologies offer potential solutions to address these barriers, supporting PPI and co-creation in research and practice. From cloud computing and social media platforms to recent innovations, such as generative artificial intelligence and blockchain, these technologies enable the creation of tools that can help overcome some of these barriers, supporting the coordination, inclusivity, and adaptability required for effective co-creation processes ( 16 , 17 ). The COVID-19 pandemic starkly demonstrated the enabling role of technology for remote and distributed engagement, making participation possible when in-person involvement was restricted ( 18 , 19 ). At the same time, rapid digital innovation is transforming the ways patients and the public can contribute, collaborate, and influence research. Digital tools promise not only to enhance existing practices but also to fundamentally reshape the ways we work together, making involvement more accessible, scalable, and inclusive ( 20 ). Yet, despite the growing emphasis on digital approaches in co-creation, a systematic understanding of the specific digital technology needs that support meaningful engagement processes remains lacking. This study aims to address this gap by systematically mapping and thematically analysing the digital technology needs that underpin effective co-creation processes. In a context where terminology and practices surrounding involvement, engagement, co-creation, and related concepts are often fragmented and overlapping across disciplines, this review adopts a deliberately broad perspective, recognising that valuable insights can be drawn from the broader field of co-creation to inform best practice in PPI and patient involvement. Our findings provide a foundation for researchers, practitioners, and policy-makers to develop and select digital tools that strengthen patient and public participation and foster more inclusive, impactful research and service improvement. 2. Methods There is a wide range of definitions of co-creation ( 21 ); for this study, we adopted an all-encompassing definition, which incorporates any collective creativity involving a diverse set of relevant and affected actors in creative problem-solving to achieve a desired outcome ( 22 ). For consistency, we refer to these methodologies collectively as "co-creation," the participants as "co-creators," and digital technologies as "technology." Our research question was: “What are the needs for digital technology in co-creation?”. To answer this, a systematic scoping review of the literature was conducted. This study design is well-suited to answering research questions that request an overview of the literature to identify knowledge gaps and orient future research questions ( 23 ). We followed the PRISMA guidelines for scoping reviews ( 24 ) and used artificial intelligence technologies to assist the search and selection stages. The PRISMA Checklist can be found in Additional file 1. While no public or patient was involved, this work is part of the Health CASCADE programme ( 25 ) and serves as the foundation for developing future co-creation projects that will actively engage patients and the public. The GRIPP2-SF checklist ( 26 ) is provided in Additional file 2. 2.1. Stage 1: Search We examined peer-reviewed articles on co-creation processes that identified specific needs and suggested technology as a potential solution. We conducted a search using the standard Boolean format combination of keywords from the lexical field ”technology” AND “needs” AND “co-creation”: Technology : (technolog*; AI; artificial intelligence; big data; robot*; communication technolog*; ICT; information communication technolog*; deep learning; machine learning; ML; DL; IoT; internet; VR; virtual; 3D; software; computer; digital*; high tech*; cloud; voice recognition; T2S; text to speech; speech to text; NLP; natural language process*; avatar; social media; blockchain; collaboration tool; program*; API) Needs : (need; trouble; problem; issue; challenge; stake; necessity*; drive; opportunit*; limitation; solution; requirement) Co-creation : (“co-creat*” OR “co-production” OR “public participation” OR “participatory” OR “co-design” OR “user-involvement”). We searched the following databases: Co-Creation Database (CCDB) version 1.5 (a specialised pre-existing database that comprises all peer-reviewed literature about co-creation in PubMed, ProQuest, and CINAHL from 1970 to December 2021 ( 22 ), PubMed, ProQuest, Scopus, Web of Science and CINAHL. The search within databases retrieved many records that could not be narrowed down without risking the exclusion of relevant material ( 22 ), which would have been inconsistent with the strength of the scoping review methods. Therefore, we developed a deep-learning classification model to filter relevant material and identify relevant papers within the large pool of retrieved articles. To train this classifier, we used the human-annotated data developed during the creation of the Co-creation Database (CCDB) version 1.5 ( 27 ) as training material. Based on the BERT architecture ( 28 ), we trained an encoder-transformer model on a downstream classification task to identify documents relevant to co-creation based on their title and abstract. We employed a heuristic approach to the downstream results of the deep-learning model. The model was evaluated on unseen data, achieving an accuracy of 15% with 35% false positives and 15% false negatives. When our classifier was ready, we conducted comprehensive Boolean searches in CCDB version 1.5, Scopus, and Web of Science from 1970 to June 2024 and in PubMed, ProQuest, and CINAHL from December 2021 to June 2024. We presented the paper’s titles and abstracts to our trained model, which classified the records. The records classified as positive were included after two rounds of deduplication: one aimed at deduplicating documents found in multiple databases and one against the papers used to produce the CCDB. We further refined the search by using a Python script keyword-matching process. It identified records containing sentences combining at least one keyword of the set “technologies” and one of the “needs” set, which is similar to a Boolean search (e.g., [(“technolog*” OR “AI” OR “etc.”) AND (“need” OR “trouble” OR “etc.”)]), in their title or abstract. We added the condition that these terms had to appear in sentences (syntactic space terminated by a dot “.”, a question mark “?” or an exclamation mark “!”). 2.2. Stage 2: Study Selection We used an artificial intelligence tool, ASReview, to assist with the title and abstract screening of the references obtained. Based on simulations, we could expect 95% of relevant references by screening 10% of the dataset ( 29 ). We used the same validated process as the one used to curate the CCDB ( 22 ). QL, SB and GB proceeded with the title and abstract AI-assisted screening. The references obtained were full-text screened by QL, GB, SC, GRL, QA, VAK, and MGG. At least two independent researchers screened each study. Any second source referring to a need within a paper was checked and added to the full-text screening process. Both screenings were double-blinded, and any conflicts were resolved through discussion. The selection criteria are presented in Table 1 . Table 1 Selection Criteria Inclusion Criteria Exclusion Criteria - Written in English. - Include at least one keyword of each lexical field: “technology”, “needs”, and “co-creation”. - Mention a process that adheres to our definition of co-creation. - Mention at least one need relative to this process. - Mention that technology could solve the mentioned need. - Focus exclusively on challenges or needs without specifying that technology could solve them. - Discuss technology in the context, but not concerning addressing any specific need in the co-creation process. 2.3. Stage 3: Charting and analysing the data The data from the included papers was gathered through a standardised extraction table made in Excel. The extraction was organised around three sections: ( 1 ) basic bibliographic information, ( 2 ) information about the study, ( 3 ) needs and their characteristics. QL and SB piloted the table with five papers before performing the extraction. QL, GB, SC, GRL, QA, VAK, and MGG proceeded with the charting. A second researcher double-checked each extraction. We employed thematic analysis ( 30 ) as a methodological framework to systematically categorise the diverse needs for digital technologies in co-creation. This approach was instrumental in identifying, analysing, and reporting patterns across the collected literature. Each document was read thoroughly to achieve deep familiarity, enabling the initial identification of relevant data points related to digital technology needs in co-creation contexts. Subsequent coding was performed iteratively; initial codes were generated to label text segments that signified distinct aspects related to digital technologies in co-creation. These codes were then examined for patterns and grouped into potential themes of digital technology needs. Each theme was rigorously reviewed and refined to ensure it captured the essence of the coded data and the overarching insights from the literature. The final themes and subthemes were named and defined to represent the synthesised findings accurately. Then, a narrative description of each subtheme and its overarching themes was produced. 3. Results 3.1. Search Results Figure 1 shows the PRISMA flow chart. The search retrieved 5,431 records from the CCDB and 57,448 from the Web of Science, Scopus, CINHAL, ProQuest, and PubMed. Deduplication and identification reduced the number of records to 5,321. After the title, abstract, and full-text screening, 60 studies were included in this review. 3.2. Study descriptions The dataset included a total of 60 studies. Case studies were the most common, with 19 instances (31.7%). Theoretical studies accounted for 10 entries (16.7%). Empirical studies made up six entries (10%). Five studies focused on tool or system development and evaluation (8.3%). Literature reviews were represented in 4 instances (6.7%). Framework-related studies, including theoretical frameworks, framework proposals, and framework analyses, comprised eight entries (13.3%). Finally, there were eight unique study types (13.3%) that do not fall into the previous categories, including "Randomised Trial," "Prototype Development," "Opinion Paper & Case Review," and "Perspective Article." Regarding the field covered, Urban Planning and related topics were the most prevalent, appearing in 19 entries (31.7%). Studies in Human-Computer Interaction (HCI) appeared in seven entries (11.7%), including combinations with Participatory Design, Child-Computer Interaction, Citizen Science, and Autism Research. Environmental Sciences accounted for six entries (10%). Studies involving Public Policy and E-Government total five entries (8.3%). Participatory Design was featured in five entries (8.3%), often with HCI or Urban Planning fields. Citizen Science fields appeared in three entries (5%). Public Administration was represented by three entries (5%). At the same time, Communication Design, Creative AI, Digital Democracy, Technology-Enhanced Learning, Water Management and Participatory Planning each appeared once or twice, collectively accounting for 6.7% of the dataset. Other unique areas, such as Virtual Reality & Design, Software Engineering, and Collaboration Support Systems, appeared once each, collectively making up the remaining 5% of the studies. The goals of the studies vary widely, covering several domains of participatory design and digital co-creation. Among them, 13 studies (21.7%) aimed to explore or analyse digital tools and platforms to enhance public participation and engagement, including specific technologies such as VR, social media, WebGIS, and mobile interactions in urban design and planning. Additionally, 13 studies (21.7%) focused on developing or evaluating digital platforms or tools to support participatory processes, such as frameworks for urban co-creation, youth-centred spatial data tools, and cognitive mapping systems. A smaller subset, nine studies (15%), sought to establish frameworks and methodologies for participatory processes across various contexts, including health, environmental planning, and urban resilience. Six studies (10%) focused on integrating advanced technologies like AI, blockchain, and fog computing to address trust, security, and inclusivity in participatory design. Furthermore, seven studies (11.7%) explored the challenges and opportunities of participatory design in unique settings, including remote and culturally diverse contexts, emphasising inclusivity and collaboration. Lastly, 12 studies (20%) examined specific applications or case studies in which digital tools were applied in real-world settings, providing insights into the practical implementations of participatory technology in citizen science, climate policy, and e-governance. The details of each study are provided in Additional file 3. 3.3. Needs Classification The data extraction revealed 337 digital technology needs for co-creation. To highlight their singularities, they have been classified according to two dimensions: ( 1 ) their attribute and ( 2 ) their expression mode. The classification is illustrated in Fig. 2 , and its details can be found in Additional file 4. The attribute dimension concerns whether the need pertains to a technological or non-technological functional attribute. Functional attributes describe what the technology does: its core features, operations, and tasks. They are tied to the direct capabilities or behaviours that a system must exhibit to meet user requirements or business needs (e.g., “The system can authenticate users with a password” or “The application provides data export functionality”). Non-functional attributes, however, describe how well the technology performs or operates under certain conditions. They capture performance, reliability, usability, scalability, security, and maintainability. These attributes do not specify what the system should do (i.e., the functionality) but rather define the criteria or constraints for how it should do it (e.g., “The system must handle up to 10,000 simultaneous users” or “The page load time should not exceed 2 seconds”). 274 needs concern functional attributes, and 63 concern non-functional attributes. These findings reflect a common trend in requirements-gathering processes: users and stakeholders initially focus on the specific tasks and features they want a system to perform. Functional attributes are more straightforward to visualise and articulate, making them more likely to emerge. Non-functional attributes are often perceived as more abstract or technical and can be more challenging for participants to recognise or define until they encounter problems. The second dimension identifies how the needs were expressed. General Needs are broad, high-level statements that identify areas for improvement without specifying particular solutions, such as "enhancing collaboration" or addressing "limited accessibility." These needs highlight overarching goals and serve as a foundation for identifying where technological interventions might be helpful. In contrast, Specific Needs are detailed and actionable, specifying exact functionalities or technologies, like the requirement for a "data aggregation tool" or "GPS-based tracking." These needs provide precise guidance for development, enabling the creation of targeted solutions. Explicit Needs are directly and unambiguously stated, using assertive language to indicate a straightforward requirement, such as "the system must support multilingual interfaces." These needs leave no room for interpretation, offering clear mandates for action. On the other hand, Implicit Needs are indirectly suggested through context, highlighting potential areas for improvement without explicitly stating them, such as when users report that "current tools make collaboration difficult." These needs require interpretation and contextual understanding to identify underlying requirements. Combining these characteristics allowed us to define four types of needs expression. In the case of a general and implicit need, we refer to “latent”, conveying that the need is broad and underlying or not directly stated . For a general and explicit need, “articulated” emphasises that the need is broad in scope but clearly spelt out . For a specific and implicit need, “inferred” suggests the need is detailed but must be deduced or gleaned from context . Finally, in case of a particular and explicit need, the “prescriptive” indicates the need is detailed and unambiguously stated, which, in essence, is a clear directive . There are 58 articulated, 22 inferred, 160 latent and 97 prescriptive needs. These results highlight that, in co-creation contexts, many expressed needs initially emerge as broad, high-level intentions that are not fully articulated (“latent” needs). This is common when stakeholders describe overarching challenges without pinpointing a specific solution. Conversely, many “prescriptive” needs reflect when stakeholders are specific about the required functionalities or features. The smaller numbers for “articulated” and “inferred” needs suggest that while some participants can voice broad requirements, fewer needs emerge as implicit yet detailed enough to be “inferred.” This distribution shows that authors often gravitate toward general, sometimes implied, needs, with more precise directives from potentially more informed or experienced authors. 3.4. Technological Needs The attribute and expression dimensions were considered during the thematic analysis to nuance the structuration of the five needs themes: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics and Process Management. The themes and their 25 sub-themes are described below and illustrated in Fig. 3 . 3.4.1. Ensuring Integrity 90 needs and five subthemes fall into the “Ensuring Integrity” theme, reflecting technology's need to ensure governance and co-creation values. 3.4.1.1. Accessibility With 25 needs, the “Accessibility ” subtheme focuses on designing digital tools that remove barriers to participation, ensuring that diverse and underrepresented groups can easily engage in activities through inclusive and co-creator-friendly technologies. Key priorities encompass promoting broad participation and flexible engagement by leveraging digital solutions that facilitate diverse contributions and simplify data collection ( 31 , 32 ). Ensuring inclusivity involves tailoring tools specifically for children and individuals with special needs, such as developing child-friendly platforms and neurodiversity-oriented design utilities ( 33 , 34 ). Additionally, fostering inclusion for diverse co-creator groups requires accommodating various cultural backgrounds and abilities, ensuring that interfaces are co-creator-friendly and equitable across different socioeconomic contexts ( 35 , 36 ). Addressing affordability, usability, and context sensitivity is also critical, with solutions focusing on creating cost-effective, adaptable technologies that function seamlessly in varied environments and meet specific co-creator contexts ( 37 , 38 ). 3.4.1.2. Engagement With 21 needs, the “Engagement ” subtheme emphasises the development of interactive and motivating digital platforms that sustain active participation from various co-creators, mainly targeting hard-to-reach populations to maintain dynamic and ongoing collaboration. Key priorities include implementing structured approaches to attract diverse communities and ensure meaningful participation through tailored digital platforms and practical data management tools ( 32 , 39 – 42 ). Flexible frameworks are also essential, advocating for adaptable and centralised systems that support sustained co-creator involvement and accommodate local or domain-specific nuances ( 35 , 37 , 43 – 47 ). Additionally, high-level directives emphasise the need for continuous engagement through long-running platforms to maintain involvement beyond the initial phases ( 35 , 40 , 48 ). Furthermore, enhancing performance and co-creator experience is crucial, focusing on interactive design elements and refining collaboration practices to sustain co-creator interest and ensure high-quality interactions ( 49 , 50 ). 3.4.1.3. Representativity With 18 needs, the “Representativity” subtheme ensures that the co-creator pool accurately reflects the diversity of the broader community by implementing tools and strategies that minimise bias, redistribute power, and promote equitable representation. Key priorities focus on fostering inclusive representation and balancing power dynamics to ensure diverse perspectives are heard, and equitable decision-making is achieved ( 36 , 44 , 48 , 51 , 52 ). AI-enhanced solutions are proposed to improve stakeholder inclusion by simulating varied viewpoints and aligning system designs with diverse interests, thereby bridging gaps that conventional methods may miss ( 53 – 55 ). Mitigating bias in design and participation is also critical, with strategies aimed at reducing power concentration, preventing co-creator selection bias, and ensuring equitable representation ( 39 , 55 – 57 ). Additionally, robust data handling practices and protective measures are proposed to maintain trust and prevent manipulation or privacy breaches ( 36 , 58 ). 3.4.1.4. Accountability and Transparency With 16 needs, the “Accountability and Transparency” subtheme involves establishing clear, open mechanisms for tracking contributions and decision-making, fostering trust among co-creators by making processes and data handling visible and understandable. Key priorities for focus on embedding openness into digital processes through tools that enable transparent communication, maintain comprehensive activity logs and ensure fair decision-making ( 44 , 52 , 55 – 57 ). Clear directives emphasise implementing advanced mechanisms such as blockchain-based frameworks and secure data handling practices to ensure responsibility and traceability within co-creation systems ( 58 , 59 ). Additionally, broader views position transparency and accountability as fundamental principles for building trust and legitimacy ( 36 , 38 , 55 , 57 , 58 , 60 ). 3.4.1.5. Security and Privacy With 10 needs, the subtheme “Security and Privacy” prioritises protecting co-creator data and the integrity of collaborative environments through robust encryption, secure communication channels, and measures that safeguard against data breaches and misuse. Key priorities involve safeguarding co-creator information while maintaining transparent and trustworthy interactions. Ensuring privacy in digital collaboration requires embedding robust privacy protections and mechanisms that balance data transparency with personal anonymity, such as tracking co-creator activity without compromising identities ( 36 , 37 , 44 ). Integrating robust security measures is essential, necessitating fortified digital environments, encryption, and secure network protocols to protect collaborative workspaces from vulnerabilities and unauthorised access ( 37 , 61 ). Additionally, advanced protective measures must be coupled with co-creator-friendly designs to ensure that security protocols do not hinder seamless participation ( 48 , 59 , 62 ). 3.4.2. Enabling Methodology 67 needs and six subthemes fall into the “Enabling Methodology” theme, representing the need for technology to enable existing and new co-creation methodologies. 3.4.2.1. New Methods With 10 needs, the “New Methods ” subtheme groups the needs to enable current co-creation methodologies or call for developing new ones. Key priorities involve developing participatory and geospatial tools to accomplish the optimal capacity of participatory mapping ( 41 , 62 ). Evolving digital participation frameworks are essential, focusing on integrating next-generation technology into participatory design platforms and creating adaptive, wide-ranging engagement systems supported by coherent guidelines to ensure consistency and bridge academic insights with practical applications ( 37 , 43 , 59 ). Developing new online workshops and co-creation activities is crucial to enable more co-creators to contribute effectively, maintain creativity, and sustain momentum in remote settings ( 52 , 63 ). 3.4.2.2. Distributed Process With 10 needs, the “Distributed Process ” subtheme focuses on digital solutions that support collaboration among geographically dispersed co-creators, ensuring seamless communication and coordination in co-creation processes. Key priorities focus on facilitating remote collaboration through tools that streamline virtual participation and eliminate common friction points, supported by robust frameworks ( 33 , 49 ). Flexible and adaptive participation approaches are essential, promoting models that accommodate co-creators across various locations and time zones by integrating streamlined methods into everyday routines and simplifying interfaces ( 60 , 64 – 66 ). Additionally, comprehensive blueprints for organising distributed endeavours are advocated to help teams navigate complex tasks efficiently ( 45 ). Furthermore, developing hybrid tools and inclusive virtual environments is prioritised to seamlessly blend digital and face-to-face interactions ( 44 , 67 ). 3.4.2.3. Large Scale Process With 10 needs, the “Large Scale ” subtheme addresses the need for scalable digital tools and methodologies to accommodate extensive public engagement and participation without compromising functionality or inclusivity. Key priorities include building capacity for broad public engagement by developing digital platforms that enhance creativity and facilitate diverse contributions while organising asynchronous input from widely dispersed co-creators to maintain momentum and coordination ( 45 , 52 ). Concrete strategies emphasise the need for integrated tools to manage large volumes of responses, moderate discussions effectively, and utilise pervasive technologies for data collection and processing to derive reliable insights from extensive co-creator pools ( 48 , 52 , 56 ). Additionally, ensuring scalability and inclusion is crucial, with solutions to create flexible digital methods that can accommodate expanding stakeholder groups without compromising accessibility or coherence ( 55 , 56 , 68 ). 3.4.2.4. Decision-Making With 14 needs, the “Decision-Making ” subtheme centres on technologies that enhance and streamline the decision-making processes within co-creation, enabling more informed, transparent, and participatory outcomes. Key priorities focus on strengthening collective decision-making processes by leveraging technology that enhances informed and effective participation, such as data-driven systems for evaluating options and robust platforms that guide groups through complex choices ( 54 , 60 , 69 ). Inclusive models and tools are essential to ensure adaptability to different voting contexts, simplify public input, and broaden access so that all co-creators, regardless of their familiarity with specialised software ( 36 , 56 , 57 , 68 , 70 , 71 ). Additionally, guidance and reliable systems are necessary to maintain dynamic yet well-regulated engagement, facilitate focused and transparent discussions, support deeper deliberation in complex planning scenarios, and foster diversity in collective decisions ( 43 , 44 , 68 , 72 ). 3.4.2.5. Evidence-Based Process With 8 needs, the “Evidence-Based Process ” emphasises the integration of reliable data and evidence-based tools to support informed discussions, counter misinformation, and facilitate evidence-driven decision-making in co-creation. Key priorities emphasise leveraging digital technologies to enhance public discourse by filtering out inaccuracies and fostering constructive conversations grounded in reliable data ( 36 , 71 , 73 ). Data-driven avenues utilise advanced functionalities such as machine learning and natural language processing to assemble, interpret, and present rigorous evidence, enabling engagement with complex findings ( 36 , 46 , 54 ). Additionally, ensuring straightforward access to valuable information is needed to allow diverse audiences to form well-rounded opinions while maintaining discretion ( 40 , 43 ). 3.4.2.6. Specific Tools With 15 needs, the “Specific Tools ” subtheme pertains to developing and implementing specialised digital systems tailored to support participatory design, urban planning, and other co-creation activities, ensuring functionality and adaptability to co-creator needs. Key priorities include the creation of dedicated digital platforms tailored to participatory design and urban development, which integrate decision-making with collaborative communication to engage diverse co-creators effectively ( 74 – 76 ). Additionally, there is a strong emphasis on developing open-ended, adaptive, and integrated systems that can evolve alongside emerging design needs and co-creator preferences, supporting a wide variety of planning contexts such as sustainability and large-scale stakeholder management while bridging domains like citizen science with participatory practices ( 48 , 56 , 77 , 78 ). Furthermore, customisation and empirical validation are critical, advocating for tailor-made solutions that meet specific co-creator or community demands and ensuring that digital co-creation tools are continuously refined through hands-on case studies and real-world experimentation to balance broad applicability with local adaptability ( 40 , 73 ). 3.4.3. Cognitive Needs 40 needs and three subthemes fall into the “Cognitive Needs” theme, encompassing the need for technologies to consider individual co-creators' necessary mental processes, motivations, and capacities. 3.4.3.1. Mental Capacity With 13 needs, the “Mental Capacity ” subtheme highlights the co-creators' need to absorb, interpret, and apply knowledge through features designed to support learning, creativity, and cognitive ease. Key priorities include fostering creative and educational engagement by developing digital platforms that promote imaginative thinking, support open-ended innovation, and provide learning opportunities through transparent information-sharing and structured guidance ( 35 , 66 , 79 ). Ensuring intuitive knowledge contribution is essential, achieved by designing simpler interfaces that allow co-creators to add spatial data and outline ideas effortlessly ( 48 , 80 , 81 ). Harnessing advanced AI and structured support involves embedding intelligent functionalities that mimic human thought processes, utilising automation and machine learning to reduce manual tasks, and providing dynamic step-by-step guidance ( 38 , 46 , 63 , 82 , 83 ). Additionally, improving clarity and reducing effort is crucial, focusing on streamlining tasks, enhancing clarity, and maintaining co-creator-friendly standards to minimise technical barriers and prevent co-creator fatigue ( 32 , 84 ). 3.4.3.2. Motivation With 16 needs, the “Motivation ” subtheme focuses on the factors, incentives, and platform elements that inspire co-creators to stay committed and actively contribute throughout the co-creation process. Key priorities involve integrating playful dynamics to actively engage co-creators by incorporating game-inspired mechanisms that attract and sustain co-creator involvement, ensuring enjoyable and compelling interactions ( 55 , 70 , 72 , 85 ). Rewarding participation through various adaptive incentives is proposed, from token-based rewards to role-specific recognitions ( 36 , 44 , 58 , 83 ). Additionally, tailoring experiences through contextual and intelligent tools is promising, leveraging natural language processing and machine learning to personalise content, recommend relevant topics, and adjust roles based on co-creator needs and evolving contexts ( 37 , 39 , 44 , 75 , 85 ). Creating an engaging digital atmosphere would further enhance motivation by designing intuitive and stimulating environments that captivate co-creators and support the interactive spirit of co-creation, ensuring that technology serves as an inviting and meaningful backdrop ( 51 , 67 ). 3.4.3.3. Visualisation With 11 needs, the “Visualisation” subtheme emphasises the importance of presenting data and ideas in accessible, context-driven ways that aid comprehension, inform decision-making, and maintain co-creator engagement. Key priorities involve facilitating contextual understanding and clarity by developing tools supporting data-driven discussions and presenting information in straightforward, easily interpreted visual formats, enhancing co-creator comprehension and dialogue ( 64 , 76 ). Empowering targeted applications is essential, focusing on tailored visualisation capabilities that address specific areas such as gender-responsive planning and provide robust graphical feedback to support distributed participatory design activities ( 31 , 49 , 60 ). Managing and scaling complex data sets is critical, necessitating platforms that can efficiently handle extensive data volumes while offering offline visualisation capabilities to ensure continuous access to essential insights even in limited connectivity scenarios ( 38 , 40 ). Additionally, enhancing educational and cost-efficient visual engagement is needed to ensure accessibility and usability across diverse co-creator needs ( 35 , 38 , 83 ). 3.4.4. Group Dynamics 83 needs and six subthemes fall into the “Group Dynamics” theme, illustrating the need for technology to support collective dynamics. 3.4.4.1. Bridging Diversity With 15 needs, the “Bridging Diversity ” subtheme explores strategies and tools for uniting co-creators across varying cultural, generational, or disciplinary backgrounds to ensure a more representative and equitable design process. Key priorities involve fostering collaboration across generations by developing digital platforms that enable different age groups to participate inclusively, ensuring that previously overlooked voices are integrated into co-creation processes ( 79 , 86 ). Building bridges among co-creator groups is essential, emphasising improved knowledge-sharing across professional, local, and community divides, designing channels that reconcile scientific perspectives with on-the-ground realities ( 44 , 55 , 70 , 75 , 77 ). Embracing cultural and linguistic diversity requires accommodating global co-creator bases and multicultural settings by embedding cross-linguistic capabilities, adhering to culture-specific engagement standards, and integrating translation components ( 37 , 65 , 86 ). Additionally, accommodating mixed abilities and contexts is crucial, necessitating the design of flexible participation mechanisms that adapt to varying physical and cognitive skills, ensuring that co-creation spaces remain accessible and effective for all individuals ( 37 ). 3.4.4.2. Social Dynamic With 16 needs, the “Social Dynamic ” subtheme focuses on how individuals and groups interact and connect during co-creation, emphasising inclusivity, empathy, and constructive engagement. Key priorities focus on encouraging empathy and counteracting hostilities by integrating features that build mutual understanding, detect and mitigate harmful language, and promote emotional sensitivity through interactive and visual means ( 36 , 73 , 87 ). Strengthening collaborative ties and social connectedness is essential, potentially achieved by designing digital spaces that foster team building, support nonverbal communication, and adapt to co-creators’ emotional needs to create a strong sense of community and meaningful interactions ( 37 , 51 , 67 , 72 , 88 ). Additionally, streamlining coordination and shared decision-making involves implementing integrated processes that seamlessly connect discussion spaces with decision-making platforms, utilising recommendation engines to highlight relevant content and facilitate consensus-building ( 39 , 64 ). Maintaining research-driven underscores the importance of grounding social dynamic platforms in empirical studies ( 64 , 83 ). 3.4.4.3. Mitigating Conflict With seven needs, the “Mitigating Conflict ” subtheme addresses mechanisms and approaches for recognising potential disagreements, preventing escalation, and transforming conflicts into productive dialogue within collaborative settings. Key priorities focus on cultivating productive dialogue by providing mechanisms that guide large, diverse groups through structured discussions and foster respectful exchanges, even on contentious issues, establishing common ground ( 52 , 53 ). Tools for conflict resolution and knowledge sharing are essential, emphasising flexible solutions that resolve clashes and integrate diverse forms of expertise into cohesive frameworks to ensure smooth and systematic group progress ( 35 , 44 , 71 ). Additionally, structuring complexity requires adaptable systems capable of managing evolving problems and inherent uncertainties, along with integrated moderation and translation capabilities to overcome language, disciplinary, and contextual barriers, ensuring effective decision-making and collaboration ( 52 , 71 ). 3.4.4.4. Understanding Sentiments With seven needs, the “Understanding Sentiments ” subtheme highlights the importance of capturing and interpreting emotional cues so that co-creation platforms can respond adaptively to co-creators’ feelings, enhancing empathy and reducing miscommunication. Key priorities involve capturing emotional nuances in digital spaces by developing mechanisms that sense and interpret co-creators' emotional dynamics, such as monitoring mood fluctuations and detecting nonverbal cues ( 37 , 67 ). Overcoming barriers to engagement is essential, achieved by designing welcoming digital environments that accommodate diverse emotional and communicative styles, reducing hurdles and fostering empathy-driven interactions ( 79 , 85 ). Additionally, integrating and summarising emotional data is crucial, with solutions that incorporate sentiment analysis into the co-creation process by merging affective data with other relevant information and presenting collective sentiment in meaningful ways to provide real-time feedback on group morale and engagement ( 52 , 63 ). 3.4.4.5. Collaboration With 26 needs, the “Collaboration ” subtheme concentrates on creating and sustaining shared spaces, feedback mechanisms, and collective decision-making processes that enable co-creators to work effectively toward common goals. Key priorities encompass foundational solutions for multi-party collaboration by developing digital platforms that enable seamless coordination among globally distributed teams, support cross-organisational networks, and provide integrated spaces for collective planning and project development, all while ensuring robustness and efficiency at larger scales ( 35 , 37 , 52 , 56 , 73 , 78 , 79 ). Streamlined approaches to feedback and annotation are essential, emphasising enhanced feedback loops and straightforward annotation tools that facilitate real-time responses and maintain organised, trustworthy input ( 37 , 49 , 61 , 64 , 81 ). Additionally, fostering co-creative spaces and AI-supported collaboration highlights the need for environments that harness group inventiveness and problem-solving through specialised engagement spaces and AI modules that clarify system outputs and support collective brainstorming ( 52 , 73 , 82 ). Facilitating consensus and structured decision-making is also crucial, with collaborative tools designed to guide teams toward agreement in complex contexts, co-creator-friendly scenario-testing modules that visualise outcomes, and structured processes that refine proposals collaboratively, promoting convergence ( 39 , 46 , 56 , 66 , 76 ). 3.4.4.6. Communication With 12 needs, the “Communication ” subtheme examines the channels, modes, and strategies that support rich and accessible information exchanges, ensuring that all co-creators can meaningfully engage in the design conversation. Key priorities involve supporting multiple modes and contexts of interaction by developing platforms that accommodate diverse communication types, including text-based exchanges and visually enriched and audio-driven interactions, while integrating advanced mechanisms to capture non-verbal signals and ensure fluid, responsive dialogues in both real-time and asynchronous settings ( 37 , 40 , 44 , 51 , 56 , 79 , 82 , 83 ). Tailoring communication for distributed teams is essential, necessitating tools that bridge time zones, support remote coordination, and integrate context-aware collaborative features to enhance creativity and informed decision-making throughout the project lifecycle ( 51 , 79 , 83 ). 3.4.5. Process Management 57 needs and four subthemes fall into the “Process Management” theme, encompassing the digital support mechanisms required to coordinate co-creation. 3.4.5.1. Data Management With 23 needs, the “Data Management” subtheme focuses on capturing, integrating, and analysing diverse inputs, ensuring accurate, reliable, and context-rich information underpins participatory efforts. Key priorities involve geospatial data collection and integration by developing digital solutions that capture co-creator-centric geospatial insights and combine mapping with urban-planning functionalities to support comprehensive city-scale decision-making ( 35 , 40 , 43 , 76 , 80 ). Effective data management and analytical tools are essential, emphasising the systematic organisation, filtering, and precise handling of co-creator-contributed data through advanced language-processing techniques and real-time data parsing toolkits that structure co-creator engagement ( 44 , 46 – 48 , 69 , 73 , 83 ). Additionally, facilitating collective creativity and idea generation requires automated routines categorising co-creator suggestions, organising insights, analysing, and synthesising feedback ( 44 , 46 , 73 , 81 ). 3.4.5.2. Information and Knowledge With eight needs, the “Information and Knowledge” subtheme addresses how project updates, feedback, and other contributions are gathered, distilled, and made accessible, enabling co-creators to turn collective insights into tangible outcomes. Key priorities involve ensuring accessible project updates and discussion summaries by establishing transparent, ongoing communication channels such as dedicated developer blogs and tools that distil lengthy discussions into clear, structured overviews, enabling all co-creators to stay informed and contribute meaningfully ( 64 ). Evaluating and filtering diverse contributions is essential, achieved through technologies that extract the most pertinent ideas from open-ended discussions and employ sophisticated natural language processing functionalities to apply relevance scoring, enhancing clarity and facilitating efficient decision-making ( 63 ). Additionally, advancing knowledge management requires robust information management systems that provide co-creators with seamless access to necessary materials, incorporating specialised features like semantization tools to shape knowledge bases and guide teams through co-creation best practices to ensure a consistent flow of know-how across different project phases ( 35 , 56 , 70 , 77 ). 3.4.5.3. Process Optimisation With 15 needs, the “Process Optimisation” subtheme targets streamlining participatory workflows through efficient facilitation, accelerated decision-making, and reduced resource demands. Key priorities focus on streamlining participation and fostering continuous improvement by developing digital platforms that lower barriers to engagement, support straightforward input, and implement mechanisms for evaluating and refining project outcomes ( 40 , 56 , 74 , 85 , 89 ). Automation and AI-enhanced support are crucial, emphasising the integration of natural language processing systems and AI-powered feedback engines to suggest and assess ideas, automate summarisation tasks, and generate communication aids, thereby enabling faster iterations, greater transparency, and the generation of fresh insights from co-creator inputs ( 63 ). Additionally, holistic solutions that consolidate resources eliminate geographic and financial obstacles, minimise repetitive tasks, and create cost-efficient collaborative environments ( 40 , 57 , 65 , 79 , 81 ). 3.4.5.4. Organisation With 11 needs, the “Organisation” subtheme covers the structures, platforms, and tools that align multiple co-creators, tasks, and collaborative elements within co-creation initiatives. Key priorities involve fostering engagement and recruitment by developing digital platforms that facilitate the collection of co-creator input during face-to-face sessions and strategically attract and retain co-creators through accessible, co-creator-friendly recruitment and communication channels ( 44 , 48 ). Coordinating multi-level collaboration is essential, achieved by creating platforms that align efforts across diverse teams and organisations, manage tasks seamlessly, and provide comprehensive environments for managing online engagement, including visual representations of processes to streamline the input-review cycle ( 40 , 46 , 56 , 59 ). Additionally, integrating real-time AI and advanced facilitation tools is crucial, with solutions that enable live interactive elements, automate facilitation tasks, and utilise machine learning algorithms to filter and categorise inputs, thereby enhancing co-creator engagement, managing complex processes, and guiding collaborative teams toward coherent outcomes ( 37 , 46 , 56 , 82 ). 4. Discussion This review highlights 337 needs for digital technologies in co-creation. The analysis allowed us to understand and structure these needs into five categories: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics, and Process Management. This discussion first considers the general implications of our findings for advancing co-creation practices, then contextualises each theme with existing literature, and finally explores the transformative role of artificial intelligence as a catalyst for hybrid collective intelligence in co-creation aimed at patient and public involvement (PPI) and engagement in health and social care research. 4.1. The central role of technology in co-creation Our results reveal a fragmented landscape of needs in the scientific literature, where functional requirements are far more prevalent than non-functional ones. Additionally, the expression of these needs varies widely, ranging from broad and implicit statements to specific and explicit directives. However, a majority of functional needs are expressed implicitly. This is not surprising since our study reviews literature from only a minority of departments specialised in technology. While this broad representation captures a realistic and heterogeneous view of co-creation practices, it also underscores the inherent complexity of systematically capturing and addressing digital needs in multi-actor ecosystems within health and social care. To address this gap, our study proposes a first structured organisation of these needs based on their specificity and level of articulation. By making implicit needs more visible, aligning diverse stakeholder perspectives, and translating broad technological aspirations into actionable insights, we provide a foundational framework for enhancing co-creation processes toward greater patient, public, and service user participation. Furthermore, we observed a strong synergy between the identified themes and the principles of co-creation from Chastin and colleagues (under review), as illustrated in Table 2 . These principles establish key conditions for authentic co-creation, and their correspondences with our themes reinforce the validity of our structure. Importantly, they illustrate that technological needs are deeply intertwined with the value-creation processes essential for co-creation to drive systemic and sustainable change involving patients and the public. By aligning with established theories in participatory design, PPI, and engagement in health and social care, our results represent a first step toward bridging the gap between high-level conceptual discussions and the practical considerations necessary for designing and implementing effective digital solutions that support co-creation for patient and public involvement and engagement. Table 2 Correspondence between the themes and the Co-creation Principles. Themes Subtheme Corresponding Co-creation Principles Ensuring Integrity Accessibility #1 (Open access to knowledge), #3 (Transparency) Engagement #4 (Recognized contributions), #10 (Active participation) Representativity #9 (Diversity) Accountability & Transparency #2 (Legal & ethics), #3 (Transparency) Security & Privacy #2 (Legal & ethics) Enabling Methodology Specific Tools #7 (Evaluate), #8 (Reflect), #11 (Systematic, flexible process) Decision-Making #5 (Focus on clear problem), #6 (Best evidence) New Methods #8 (Reflect), #11 (Systematic, flexible process) Distributed #9 (Diversity), #10 (Active participation), #11 Large Scale #11 (Scaling and replicability) Evidence-Based Process #6 (Best evidence) Cognitive Needs Motivation #10 (Active participation) Visualisation #6 (Best evidence), #7 (Evaluate), #8 (Reflect) Mental Capacity #10 (Active participation), #11 (Support structured, inclusive process) Group Dynamics Collaboration #10 (Active participation), #11 (Systematic collaboration) Social Dynamic #9 (Diversity), #10 (Active participation) Bridging Diversity #9 (Diversity) Communication #10 (Active participation) Mitigating Conflicts #9 (Diversity), #10 (Active participation) Sentiments #9 (Respect for diverse views), #10 (Support constructive engagement) Process Management Data Management #2 (Legal & ethics), #3 (Transparency), #6 (Best evidence) Process Optimisation #7 (Evaluate), #8 (Reflect), #11 (Enhance systematic approach) Organisation #11 (Structured, replicable process) Information & Knowledge #1 (Open access to knowledge), #6 (Best evidence), #9 (Diversity) 4.2. Themes and Implications Ensuring Integrity emerged as the core theme, highlighting the critical role of technology in fostering accessibility, engagement, and balanced representation in co-creation processes. Tools must ensure diverse participation while integrating accountability mechanisms to maintain transparency in decision-making, all while addressing the inherent tension with privacy and security. For instance, accessibility-focused tools like public ICT solutions and adaptive interfaces could bridge the digital divide, enabling underrepresented groups to contribute meaningfully. These findings align with existing research emphasising accessibility and inclusivity as prerequisites for effective collaboration ( 90 ). However, this study advances the discourse by positioning accountability as a central integrity component and addressing the challenge of balancing transparency and privacy. Technologies like blockchain offer promising solutions for transparent yet secure participation frameworks. By ensuring equity and trust, these needs form the foundation for higher-order processes, such as effective group dynamics and complex decision-making, establishing the governance structures essential for building trust and supporting advanced co-creation needs. Enabling Methodology underscores the necessity for new technological tools and innovative methods to fully leverage technology's potential in co-creation processes. This includes developing hybrid participation models that combine in-person and digital engagement to enhance flexibility and inclusivity. These models, alongside tools that enable large-scale, distributed, and asynchronous collaboration, break down barriers of location and time, creating opportunities for broader and more diverse co-creation. Additionally, technology must provide evidence to co-creators and support optimal decision-making approaches, ensuring that processes are both informed and effective. The findings align with prior research highlighting scalability and adaptability as essential for large-scale participatory engagements ( 91 ). Asynchronous participation methods could enable inclusivity by allowing individuals to contribute conveniently. This study also highlights the dual focus on standardisation and customisation. Standard frameworks are proposed as a foundation tailored to balance adaptability and scalability for advancing digital co-creation processes, particularly in distributed and resource-constrained environments relevant to health and social care settings Cognitive Needs addresses the individual capacities of co-creators, emphasising the importance of reducing cognitive overload while sustaining engagement through intuitive, user-friendly tools. This theme focuses on overcoming the complexity of co-creation processes by motivating participants and ensuring clarity. Practical visualisation tools, gamification features, and AI-driven systems that adapt to user preferences are essential for maintaining participant focus and interest. These findings align with cognitive load theory and its application in participatory design, highlighting the importance of simplifying complex data and processes to enhance user engagement ( 92 ). Moreover, the study emphasises the need for technologies that bridge the gap between technical experts and lay participants. Simplified interfaces, knowledge translation mechanisms, and educational resources democratise access to knowledge, enabling participants with varying expertise levels to contribute effectively. This democratisation would sustain engagement and enhance the inclusivity and quality of co-creation outcomes. Group Dynamics fosters collaboration and resolves conflicts within diverse and distributed co-creation teams. This theme emphasises the importance of tools that bridge cultural, linguistic, and generational divides, thereby ensuring equitable participation and fostering mutual understanding in multi-stakeholder health and care settings. Culturally adaptable platforms, empathy-driven technologies, and sentiment analysis tools enable effective stakeholder communication that accommodates diverse perspectives and goals. These findings align with existing research emphasising the challenges of managing diversity in participatory processes, particularly in global initiatives where multilingual tools and culturally sensitive designs are critical for inclusivity ( 93 ). The study also underscores the role of empathy-driven technologies, such as visualisations or augmented reality simulations, which enable participants to understand others’ perspectives, reduce misunderstandings, and foster a sense of connectedness, even in asynchronous settings. Conflict resolution tools would further enhance group dynamics by supporting structured decision-making, moderation, and bias mitigation, ensuring the equitable integration of diverse viewpoints from all stakeholder groups, including patients and the public. Process Management is the logistical and organisational layer of needs, emphasising advanced tools to manage data, disseminate knowledge, and optimise processes. Simplifying and streamlining the process is essential to reduce its complexity and resource demands, providing much-needed support to co-creators in organising intricate workflows. The findings build on existing research highlighting the complexity of management and the complex processes of co-creation ( 11 , 12 ). Centralised digital platforms that foster collaboration and transparency by enabling resource sharing and retrieval further reduce inefficiencies. Scalability and adaptability are crucial, with modular systems designed to accommodate varying levels of complexity, from localised initiatives to global, multi-stakeholder initiatives in health and social care, aiming for systemic, sustainable change. 4.3. The Rise of Hybrid AI-Co-Creation Processes The rapid evolution of artificial intelligence (AI) promises future flexible tools with applications spanning all identified themes. AI extends beyond operational enhancements to actively shape participation, collaboration, and decision-making across health and social care research and practice. In ensuring integrity, AI could mitigate biases to promote equitable representation, ensuring fair participation while enhancing transparency ( 94 ). Personalised experiences like adaptive workflows and interfaces could help sustain engagement and inclusivity among patients, service users, and public contributors ( 95 ). For enabling methodology, AI could streamline scalability and adaptability through dynamic workflows and evidence-based decision-making, transforming unstructured participant feedback into actionable insights via natural language processing (NLP) ( 96 ). AI’s role in addressing cognitive needs could involve simplifying complex data to fit the capacity of the co-creator and sustaining motivation among participants with diverse backgrounds and levels of expertise ( 97 ). For group dynamics, AI could mediate interactions, fostering collaboration and mitigating conflict through sentiment analysis tools that enable real-time intervention ( 98 ). In process management, AI could automate logistical tasks, optimise resource allocation, and enhance knowledge dissemination, improving transparency and efficiency in participatory health and care research settings ( 99 ). However, alongside these opportunities, significant challenges arise. Algorithmic bias, privacy risks, and a lack of transparency in AI systems can undermine trust, particularly in health and social care initiatives where legitimacy and inclusivity are critical ( 100 ). Careful attention must be paid to ensure that AI-enabled solutions do not inadvertently introduce new barriers to equitable participation or reinforce existing inequalities. The stakes are proportional to the integration and responsibility of these technologies within participatory ecosystems. Overall, AI marks a fundamental shift toward hybrid co-creation systems, where human and machine intelligence are integrated to address complex health and social challenges more inclusively, scalably, and innovatively. By leveraging AI responsibly, co-creation processes can be redefined to support better the systemic transformations required for a more inclusive and impactful future in health and social care research. 4.4. Limitations and Future Research Despite providing a comprehensive analysis for understanding digital technology needs in co-creation, this study has several fundamental limitations. Focusing on English-language literature may exclude valuable insights from other regions and cultures, and the analysis reflects researchers' interpretations, which may not capture all perspectives. Future research should broaden its scope to incorporate non-English literature and diverse cultural perspectives. In addition, the evolving role of AI in supporting hybrid collective intelligence systems warrants particular attention, particularly concerning adaptive workflows and ethical considerations. Engaging with co-creation experts beyond academia will strengthen the practical relevance of research and provide valuable insights into real-world technology needs. Furthermore, developing a comprehensive taxonomy of digital technologies in co-creation will provide a structured framework for future development. 5. Conclusion This scoping review aimed to clarify and categorise the multifaceted digital technology needs that support co-creation processes, advancing patient and public involvement (PPI) and engagement in health and social care research and practice. By examining a broad body of literature and consolidating 337 identified needs, this study uncovers five areas to enhance co-creation: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics, and Process Management. While functionality remains a recurring priority across these needs, the findings emphasise that non-functional requirements such as usability, scalability, inclusivity, and reliability warrant explicit and strategic attention to fully realise the transformative potential of co-creation and involvement in health and social care. Collectively, the results underline that effective co-creation hinges on the dynamic interplay between human and technological factors. To build trust, foster broad participation, and sustain long-term engagement, technologies must first secure accessibility, accountability, and privacy. From this foundation, they can evolve to support large-scale collaboration, evidence-based decision-making, and personalised, inclusive user experiences for patients, caregivers, and the public. Moreover, emerging AI solutions present opportunities to automate logistical processes, enhance data interpretation, and facilitate richer group interactions, thereby expanding the reach and impact of PPI and co-creation initiatives. However, ethical considerations must remain central to AI integration to safeguard the trust and inclusivity essential for equitable and impactful health and social care innovation. Future research should refine and empirically validate these findings across diverse cultural, organisational, and geographic contexts, primarily through close partnership with patients, service users, and communities. In doing so, researchers and practitioners can contribute to building technological ecosystems that enable co-creation and involvement to their full capacity, supporting meaningful, person-centred research and improvement in health and social care. Declarations Ethics Approval and Consent to participate This study is a scoping review of the published literature and did not involve the collection of primary data from human participants. Therefore, ethical approval and consent to participate were not required. Consent for publication Not applicable. Availability of data and materials The datasets supporting the conclusions are included within the article and its additional files. Competing interests The authors declared no conflict of interest. Funding This study was funded by the European Union’s Horizon 2020 Research and Innovation Program under the Marie Skłodowska-Curie grant agreement 956501. The views expressed in this manuscript are the author's and do not necessarily reflect those of the funders. Authors contributions QL and SC conceptualised the study and developed the methodology with input from GB. Data curation was performed by QL, GB, SC, GRL, QA, VAK, and MGG. QL conducted the formal analysis and wrote the original draft. All authors contributed to the review and editing. SC supervised the project. All authors validated the final manuscript. Acknowledgements Not applicable. Additional Files Three additional PDF files are included with this research. First, Additional file 1, titled “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist”, contains the PRISMA-ScR checklist guiding the scoping review process. Additional file 2, titled “GRIPP2-SF checklist”, includes the GRIPP2-SF reporting on the patient and public involvement (PPI) dimension of this work. Then, Additional file 3, titled “List of Included Studies”, features a table displaying the studies included along with their type, aim, field, implied co-creation process, and associated needs. Finally, Additional file 4, titled “List of the Needs”, presents a table detailing each identified need along with its name, type of expression, attribute, theme, and associated subtheme. References United Nations. World Social Report 2020: Inequality in a Rapidly Changing World [Internet]. UN; 2020 [cited 2024 Apr 17]. Available from: https://www.un-ilibrary.org/economic-and-social-development/world-social-report-2020_7f5d0efc-en Chakraborty I, Maity P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Sci Total Environ. 2020 Aug 1;728:138882. Dodds W. Disease Now and Potential Future Pandemics. In: Dodds W, editor. The World’s Worst Problems [Internet]. Cham: Springer International Publishing; 2019 [cited 2024 Apr 17]. p. 31–44. Available from: https://doi.org/10.1007/978-3-030-30410-2_4 Calvin K, Dasgupta D, Krinner G, Mukherji A, Thorne PW, Trisos C, et al. IPCC, 2023: Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland. [Internet]. First. Intergovernmental Panel on Climate Change (IPCC); 2023 Jul [cited 2024 Apr 17]. Available from: https://www.ipcc.ch/report/ar6/syr/ Shelton JD. Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale. Glob Health Sci Pract. 2014 Aug;2(3):253–8. Brett J, Staniszewska S, Mockford C, Herron‐Marx S, Hughes J, Tysall C, et al. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expect Int J Public Particip Health Care Health Policy. 2014 Oct;17(5):637–50. Staniszewska S, Denegri S, Matthews R, Minogue V. Reviewing progress in public involvement in NIHR research: developing and implementing a new vision for the future. BMJ Open. 2018 Jul 30;8(7):e017124. Leask CF, Sandlund M, Skelton DA, Altenburg TM, Cardon G, Chinapaw MJM, et al. Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions. Res Involv Engagem. 2019 Dec;5(1):2. De Boer J, Delfmann LR, An Q, Loisel QEA, McCaffrey L, Koobasi M, et al. School staff experiences on involvement in a co-creation process: a Health CASCADE scoping review and thematic synthesis. BMC Public Health. 2025 Mar 7;25(1):916. An Q, Sandlund M, Lundell S, Kuenen C, Chastin S, Helleday R, et al. Transition design: Co-creating system solutions for chronic obstructive pulmonary disease (COPD) care. Des Stud. 2025 May 1;98:101297. Leask CF, Sandlund M, Skelton DA, Chastin SF. Co-creating a tailored public health intervention to reduce older adults’ sedentary behaviour. Health Educ J. 2017 Aug;76(5):595–608. Vogelsang M, McCaffrey L, Ryde GC, Verloigne M, Dall P. Preparing for Co-Creation: A roadmap for planning a co-creation initiative from a case study on sedentary behaviour in Scottish SMEs – A health CASCADE study. Public Health. 2025 May 1;242:157–64. Viscusi G. Collective intelligence, crowd dynamics, and co-creation: preliminary insights from a case study in Robotics Innovation Facilities (RIFs). 2020 Dec 28 [cited 2025 Apr 29]; Available from: http://hdl.handle.net/10044/1/86083 Moons I, Daems K, Velde LVDV de. Co-Creation as the Solution to Sustainability Challenges in the Greenhouse Horticultural Industry: The Importance of a Structured Innovation Management Process. Sustainability [Internet]. 2021 [cited 2025 Apr 29]; Available from: https://consensus.app/papers/cocreation-as-the-solution-to-sustainability-challenges-moons-daems/50c895cdb066508f8734de2e691d76d0/ Mulder I, Stappers P. Co-creating in practice: Results and challenges. 2009 IEEE Int Technol Manag Conf ICE. 2009;1–8. Bridge C, Demirbilek O, Mintzes A. Transforming Inclusion: Designing in the Experience of Greater Technological Possibility. Stud Health Technol Inform. 2016 Jan 1;229:143–52. Brinkley J, Huff EW, Boateng K. Tough but Effective: Exploring the use of Remote Participatory Design in an Inclusive Design Course Through Student Reflections. In: Proceedings of the 52nd ACM Technical Symposium on Computer Science Education [Internet]. Virtual Event USA: ACM; 2021 [cited 2023 Jan 26]. p. 170–6. Available from: https://dl.acm.org/doi/10.1145/3408877.3432527 Albrecht J, Stark AL, Dongas E, Wrona KJ, Dockweiler C. Hosting an Online World Café to Develop an Understanding of Digital Health Promoting Settings from a Citizen’s Perspective-Methodological Potentials and Challenges. Int J Environ Res Public Health. 2022 Aug 12;19(16). Godinho MA, Borda A, Kariotis T, Molnar A, Kostkova P, Liaw ST. Knowledge co-creation in participatory policy and practice: Building community through data-driven direct democracy. Big Data Soc. 2021 Jan 1;8(1):20539517211019430. Jaworski BK, Webb Hooper M, Aklin WM, Jean-Francois B, Elwood WN, Belis D, et al. Advancing digital health equity: Directions for behavioral and social science research. Transl Behav Med. 2023 Apr 3;13(3):132–9. Masterson D, Areskoug Josefsson K, Robert G, Nylander E, Kjellström S. Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future. Health Expect. 2022;25(3):902–13. Agnello DM, Loisel QEA, An Q, Balaskas G, Chrifou R, Dall P, et al. Establishing a Health CASCADE–Curated Open-Access Database to Consolidate Knowledge About Co-Creation: Novel Artificial Intelligence–Assisted Methodology Based on Systematic Reviews. J Med Internet Res. 2023 Jul 18;25(1):e45059. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005 Feb;8(1):19–32. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467–73. Verloigne M, Altenburg T, Cardon G, Chinapaw M, Dall P, Deforche B, et al. Making co-creation a trustworthy methodology for closing the implementation gap between knowledge and action in health promotion: the Health CASCADE project. Perspect Public Health. 2022 Oct 7; Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. Res Involv Engagem. 2017 Aug 2;3(1):13. Loisel Q, Agnello D, Chastin SFM. zenodo.org. 2022. Co-Creation Database. Available from: doi:10.5281/zenodo.6773028 Devlin J, Chang MW, Lee K, Toutanova K. BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding. 2018 [cited 2023 Apr 29]; Available from: https://arxiv.org/abs/1810.04805 van de Schoot R, de Bruin J, Schram R, Zahedi P, de Boer J, Weijdema F, et al. An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell. 2021 Feb;3(2):125–33. Braun V, Clarke V. Thematic analysis: a practical guide. London ; Thousand Oaks, California: SAGE; 2022. 338 p. Fessler F, Reinwald F, Weichselbaumer R, Wentz J, Gebetsroither-Geringer E. Digitally Supported Participation Processes and Tools to Promote Gender-Responsive Public Spaces: Int J E-Plan Res. 2024 Mar 20;13(1):1–25. Fredericks J, Foth M. Augmenting public participation: enhancing planning outcomes through the use of social media and web 2.0. Aust Plan. 2013 Sep 1;50(3):244–56. Winschiers-Theophilus H, Goagoses N, Rötkönen E, Zaman T. Pushing political, cultural, and geographical boundaries: Distributed co-design with children from Namibia, Malaysia and Finland. Int J Child-Comput Interact. 2022 Mar 1;31:100439. Constantin A, Hourcade JP. Toward a Technology-based Tool to Support Idea Generation during Participatory Design with Children with Autism Spectrum Disorders. In: Proceedings of the 20th International ACM SIGACCESS Conference on Computers and Accessibility [Internet]. Galway Ireland: ACM; 2018 [cited 2024 Oct 2]. p. 385–7. Available from: https://dl.acm.org/doi/10.1145/3234695.3240995 Šuklje Erjavec I, Ruchinskaya T. A Spotlight of Co-creation and Inclusiveness of Public Open Spaces. In: Smaniotto Costa C, Šuklje Erjavec I, Kenna T, De Lange M, Ioannidis K, Maksymiuk G, et al., editors. CyberParks – The Interface Between People, Places and Technology [Internet]. Cham: Springer International Publishing; 2019 [cited 2023 May 23]. p. 209–23. (Lecture Notes in Computer Science; vol. 11380). Available from: http://link.springer.com/10.1007/978-3-030-13417-4_17 Helbing D, Mahajan S, Fricker RH, Musso A, Hausladen CI, Carissimo C, et al. Democracy by Design: Perspectives for Digitally Assisted, Participatory Upgrades of Society. J Comput Sci. 2023 Jul;71:102061. Constantin A, Alexandru C, Korte J, Wilson C, Fails JA, Sim G, et al. Distributing participation in design: Addressing challenges of a global pandemic. Int J Child-Comput Interact. 2021 Jun;28:100255. Pejovic V, Skarlatidou A. Understanding Interaction Design Challenges in Mobile Extreme Citizen Science. Int J Human–Computer Interact. 2020 Feb 7;36(3):251–70. Aboucaya W, Angarita R, Issarny V. Detecting obstacles to collaboration in an online participatory democracy platform: a use-case driven analysis. In: Proceedings of the 2nd International Workshop on Equitable Data and Technology [Internet]. Pittsburgh Pennsylvania: ACM; 2022 [cited 2023 Jan 26]. p. 25–33. Available from: https://dl.acm.org/doi/10.1145/3524491.3527307 Panagiotopoulou M, Stratigea A. Spatial Data Management and Visualization Tools and Technologies for Enhancing Participatory e-Planning in Smart Cities. In: Stratigea A, Kyriakides E, Nicolaides C, editors. Smart Cities in the Mediterranean [Internet]. Cham: Springer International Publishing; 2017 [cited 2023 May 17]. p. 31–57. (Progress in IS). Available from: http://link.springer.com/10.1007/978-3-319-54558-5_2 Eilola S, Käyhkö N, Fagerholm N. Lessons learned from participatory land use planning with high-resolution remote sensing images in Tanzania: Practitioners’ and participants’ perspectives. Land Use Policy. 2021 Oct;109:105649. Wong TYT, Peko G, Sundaram D, Piramuthu S. Mobile environments and innovation co-creation processes & ecosystems. Inf Manage. 2016 Apr;53(3):336–44. Aikins S. Participatory E-Planning: Bridging Theory and Practice through Improvements in Technology. Polit Democr E-Gov Particip Serv Deliv. 2010 Jan 1;131–49. Reynante B, Dow SP, Mahyar N. A Framework for Open Civic Design: Integrating Public Participation, Crowdsourcing, and Design Thinking. Digit Gov Res Pract. 2021 Oct 31;2(4):1–22. Slingerland G, Murray M, Lukosch S, McCarthy J, Brazier F. Participatory Design Going Digital: Challenges and Opportunities for Distributed Place-Making. Comput Support Coop Work CSCW. 2022 Dec;31(4):669–700. Zellner ML. Participatory modeling for collaborative landscape and environmental planning: From potential to realization. Landsc Urban Plan. 2024 Jul;247:105063. Skarzauskiene A, Rondinella G, Du Ciommo F, Mačiulienė M, Rahman MA, Abati YB. Framing Citizen Science for Climate Assemblies. In: 2023 8th International Conference on Smart and Sustainable Technologies (SpliTech) [Internet]. Split/Bol, Croatia: IEEE; 2023 [cited 2024 Jul 31]. p. 1–5. Available from: https://ieeexplore.ieee.org/document/10193044/ Katapally TR. The SMART Framework: Integration of Citizen Science, Community-Based Participatory Research, and Systems Science for Population Health Science in the Digital Age. JMIR MHealth UHealth. 2019 Aug 30;7(8):e14056. Heintz M, Law ELC, Govaerts S, Holzer A, Gillet D. Pdot: participatory design online tool. In: CHI ’14 Extended Abstracts on Human Factors in Computing Systems [Internet]. Toronto Ontario Canada: ACM; 2014 [cited 2023 Feb 20]. p. 2581–6. Available from: https://dl.acm.org/doi/10.1145/2559206.2581266 Joubert M, Wishart J. Participatory practices: Lessons learnt from two initiatives using online digital technologies to build knowledge. Comput Educ. 2012 Aug;59(1):110–9. Reith A, Szilágyi-Nagy A, Balogh PI. Report of a Remote Participatory Design Process to Renew a Schoolyard during COVID-19 [Internet]. DE: Wichmann Verlag; 2021 [cited 2023 Jan 26]. Available from: https://doi.org/10.14627/537705037 Jannack A, Münster S, Noennig J. Enabling Massive Participation: Blueprint for a Collaborative Urban Design Environment. In 2015. p. 2363–80. Matsumoto T, Kibi Y, Kondo T. Purpose Model Simulation - Purpose Formation of Multi-stakeholder by Dialog with LLM-Based AI. In: Streitz NA, Konomi S, editors. Distributed, Ambient and Pervasive Interactions [Internet]. Cham: Springer Nature Switzerland; 2024 [cited 2024 Jul 31]. p. 110–29. (Lecture Notes in Computer Science; vol. 14718). Available from: https://link.springer.com/10.1007/978-3-031-59988-0_7 Du J, Ye X, Jankowski P, Sanchez TW, Mai G. Artificial intelligence enabled participatory planning: a review. Int J Urban Sci. 2024 Apr 2;28(2):183–210. Münster S, Georgi C, Heijne K, Klamert K, Rainer Noennig J, Pump M, et al. How to involve inhabitants in urban design planning by using digital tools? An overview on a state of the art, key challenges and promising approaches. Procedia Comput Sci. 2017 Jan 1;112:2391–405. Leonardi C, Not E, Gerosa M, Lotti R. A Case Study of Cross-Organizational Co-Design with Public Bodies: Opportunities for a Collaborative Platform. In: The 11th International Conference on Communities and Technologies (C&T) [Internet]. Lahti Finland: ACM; 2023 [cited 2024 Jul 31]. p. 6–11. Available from: https://dl.acm.org/doi/10.1145/3593743.3593747 Mariani I, Mortati M, Rizzo F. Strengthening e-Participation through Design Thinking. Relevance for Better Digital Public Services. In: Proceedings of the 24th Annual International Conference on Digital Government Research [Internet]. Gda?sk Poland: ACM; 2023 [cited 2024 Jul 31]. p. 224–32. Available from: https://dl.acm.org/doi/10.1145/3598469.3598494 Whelan B. Enhancing Participatory Design Through Blockchain. Preserv Digit Technol Cult. 2024 Jul 26;53(2):73–9. Shaikh AK, Baig S, Adhikari N, Shihi HA. E-participation System: Leveraging Blockchain Technology to Enhance Democratic Engagement. In: 2023 IEEE 8th International Conference on Engineering Technologies and Applied Sciences (ICETAS) [Internet]. 2023 [cited 2024 Jul 31]. p. 1–5. Available from: https://ieeexplore.ieee.org/document/10346551/?arnumber=10346551 Mahmoud H, Arima T. A Web-Based Public Participation System that Supports Decision Making. J Asian Archit Build Eng. 2011 May;10(1):77–84. Barenji AV, Guo H, Wang Y, Li Z, Rong Y. Toward blockchain and fog computing collaborative design and manufacturing platform: Support customer view. Robot Comput-Integr Manuf. 2021 Feb;67:102043. Mougiakou E, Parskevopoulos Y, Tsadari S. Spatial Tools and ppWebGIS Platforms for Sustainable Urban Development and Climate Change Adaptation: Participatory Planning in Urban Areas with Special Conditions. In: Gervasi O, Murgante B, Rocha AMAC, Garau C, Scorza F, Karaca Y, et al., editors. Computational Science and Its Applications – ICCSA 2023 Workshops [Internet]. Cham: Springer Nature Switzerland; 2023 [cited 2024 Jul 31]. p. 630–45. (Lecture Notes in Computer Science; vol. 14105). Available from: https://link.springer.com/10.1007/978-3-031-37108-0_40 Lieven C, Lüders B, Kulus D, Thoneick R. Enabling Digital Co-creation in Urban Planning and Development. In: Zimmermann A, Howlett RJ, Jain LC, editors. Human Centred Intelligent Systems. Singapore: Springer; 2021. p. 415–30. (Smart Innovation, Systems and Technologies). Hess J, Randall D, Pipek V, Wulf V. Involving users in the wild—Participatory product development in and with online communities. Int J Hum-Comput Stud. 2013 May;71(5):570–89. Luusua A, Ylipulli J, Kalarikalayil Raju D, Rönkkö E. Bridging Distances for Global Participation: Conducting and Theorizing Participatory Design and Research in Hybrid Contexts: Conducting and Theorizing Participatory Design and Research in Hybrid Contexts. In: Extended Abstracts of the 2023 CHI Conference on Human Factors in Computing Systems [Internet]. Hamburg Germany: ACM; 2023 [cited 2024 Jul 31]. p. 1–5. Available from: https://dl.acm.org/doi/10.1145/3544549.3573823 Jutraz A, Zupancic T. Criteria for Cooperative Urban Design through Digital System of Design Tools. In: 2012 16th International Conference on Information Visualisation. 2012. p. 416–21. Bucchetti V, Rossi M, Tolino U, Verrotti Di Pianella B, Visconti P. Communication Design for Welfare, the Challenge of Preserving Human Interactions in Remote Participation. Rethinking and Redefining Collaborative Activities for a Virtual Environment. In: Zanella F, Bosoni G, Di Stefano E, Iannilli GL, Matteucci G, Messori R, et al., editors. Multidisciplinary Aspects of Design [Internet]. Cham: Springer Nature Switzerland; 2024 [cited 2024 Jul 31]. p. 475–84. (Springer Series in Design and Innovation; vol. 37). Available from: https://link.springer.com/10.1007/978-3-031-49811-4_45 Stelzle B, Jannack A, Rainer Noennig J. Co-Design and Co-Decision: Decision Making on Collaborative Design Platforms. Procedia Comput Sci. 2017;112:2435–44. Arsenopoulos A, Mastromichalakis N, Psarras J. Developing a software-based platform for strengthening public participation in Greece. In: 2020 11th International Conference on Information, Intelligence, Systems and Applications (IISA. 2020. p. 1–6. Horlitz T. The Role of Model Interfaces for Participation in Water Management. Water Resour Manag. 2007 Jun 15;21(7):1091–102. van Kouwen F, Dieperink C, Schot PP, Wassen MJ. Computer-Supported Cognitive Mapping for Participatory Problem Structuring. Environ Plan Econ Space. 2009 Jan 1;41(1):63–81. Mačiulienė M, Skaržauskienė A. Evaluation of co-creation perspective in networked collaboration platforms. J Bus Res. 2016 Nov;69(11):4826–30. Roszczyńska-Kurasińska M, Wróblewska N. Technological Innovations for Citizen Environmental Participation: Case of Poland. Sustainability. 2023 Mar 12;15(6):5031. Jutraz A, Zupancic T. Digital system of tools for public participation and education in urban design: Exploring 3D ICC. In Prague, Czech Republic; 2012 [cited 2023 Jan 25]. p. 383–92. Available from: http://papers.cumincad.org/cgi-bin/works/paper/ecaade2012_113 Dalsgaard P. Challenges of participation in large-scale public projects. In: Proceedings of the 11th Biennial Participatory Design Conference [Internet]. Sydney Australia: ACM; 2010 [cited 2023 Jan 17]. p. 21–30. Available from: https://dl.acm.org/doi/10.1145/1900441.1900445 Pipan T. Interactive tangible planning support systems and politics of public participation. Urbani Izziv. 2018 Sep 28;29(supplement):63–78. Zhu L, Barricelli B, Iacob C. A Meta-Design Model for Creative Distributed Collaborative Design. IJDST. 2011 Oct 1;2:1–16. Giesen N, Süpke D. ProPlaNET: Collaborative Sustainable Project Planning: A Comparison with Existing Approaches. In: Golinska P, Fertsch M, Marx-Gómez J, editors. Information Technologies in Environmental Engineering [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2011 [cited 2023 May 17]. p. 397–406. (Environmental Science and Engineering; vol. 3). Available from: https://link.springer.com/10.1007/978-3-642-19536-5_31 Walsh G, Foss E. A case for intergenerational distributed co-design: the online kidsteam example. In: Proceedings of the 14th International Conference on Interaction Design and Children [Internet]. Boston Massachusetts: ACM; 2015 [cited 2023 Feb 20]. p. 99–108. Available from: https://dl.acm.org/doi/10.1145/2771839.2771850 Hennig SS, Vogler R, Schötz T, Strobl J, Imanalieva P. Towards more User-Centered Contributory Citizen Science Initiatives: Learning from the u3Green Approach. Int J Geoinformatics. 2023 Nov 29;19(11):26–37. Heintz M, Law ELC. Pdotcapturer and Pdotanalyser: participatory design online tools for asynchronous idea capturing and analysis. In: Proceedings of the 10th Nordic Conference on Human-Computer Interaction [Internet]. Oslo Norway: ACM; 2018 [cited 2023 Feb 8]. p. 622–33. Available from: https://dl.acm.org/doi/10.1145/3240167.3240214 McCormack J, Hutchings P, Gifford T, Yee-King M, Llano MT, D’inverno M. Design Considerations for Real-Time Collaboration with Creative Artificial Intelligence. Organised Sound. 2020 Apr;25(1):41–52. Skarlatidou A, Hamilton A, Vitos M, Haklay M. What do volunteers want from citizen science technologies? A systematic literature review and best practice guidelines. J Sci Commun. 2019 Jan 17;18(01):A02. Dufendach KR, Koch S, Unertl KM, Lehmann CU. A Randomized Trial Comparing Classical Participatory Design to VandAID, an Interactive CrowdSourcing Platform to Facilitate User-centered Design. Methods Inf Med. 2017 Oct;56(05):344–9. Kelley T, Johnston E. Discovering the appropriate role of serious games in the design of open governance platforms. Public Adm Q. 2012 Jan 1;36. García-Holgado A, García-Peñalvo FJ, Butler P. Technological Ecosystems in Citizen Science: A Framework to Involve Children and Young People. Sustainability. 2020 Mar 1;12(5):1863. Krishnamurthy R, Bhagwatwar A, Johnston EW, Desouza KC. A Glimpse into Policy Informatics: The Case of Participatory Platforms that Generate Synthetic Empathy. Commun Assoc Inf Syst [Internet]. 2013 [cited 2023 Jan 25];33. Available from: https://aisel.aisnet.org/cais/vol33/iss1/21 Siemon D, Becker F, Eckardt L, Robra-Bissantz S. One for all and all for one - towards a framework for collaboration support systems. Educ Inf Technol. 2019 Mar;24(2):1837–61. Chen MFY. Co-immersive-Creation: A Hybrid Approach for Using Virtual Reality and Telepresence Systems in Co-design Research. In: Stephanidis C, Antona M, Ntoa S, editors. HCI International 2021 - Posters [Internet]. Cham: Springer International Publishing; 2021 [cited 2023 May 24]. p. 217–24. (Communications in Computer and Information Science; vol. 1420). Available from: https://link.springer.com/10.1007/978-3-030-78642-7_29 De Moor K, Berte K, De Marez L, Joseph W, Deryckere T, Martens L. User-driven innovation? Challenges of user involvement in future technology analysis. Sci Public Policy. 2010 Feb 1;37(1):51–61. Reay P, Seddighi HR. An empirical evaluation of management and operational capabilities for innovation via co‐creation. Eur J Innov Manag. 2012 Apr 20;15(2):259–75. Feinberg S, Murphy M. Applying cognitive load theory to the design of web-based instruction. 2000 [cited 2025 Apr 29]; Available from: https://consensus.app/papers/applying-cognitive-load-theory-to-the-design-of-webbased/d7c46ef1f2375976b7aad1279984efb3/ Sushama P, Ghergu C, Meershoek A, de Witte LP, van Schayck OCP, Krumeich A. Dark clouds in co-creation, and their silver linings: Practical challenges we faced in a participatory project in a resource-constrained community in India, and how we overcame (some of) them. Glob Health Action. 2018 Jan;11(1):1421342. Pescetelli N. A Brief Taxonomy of Hybrid Intelligence. Forecasting. 2021 Sep;3(3):633–43. Mitre X, Zeneli M. Using AI to Improve Accessibility and Inclusivity in Higher Education for Students with Disabilities. In: 2024 21st International Conference on Information Technology Based Higher Education and Training (ITHET) [Internet]. 2024 [cited 2025 Mar 29]. p. 1–8. Available from: https://ieeexplore.ieee.org/document/10837607 Balaskas G, Papadopoulos H, Loisel Q, Pappa D, Efthymoglou G, Chastin S. An end-to-end system for transcription, translation, and summarization to support the co-creation process. A Health CASCADE Study. In: Proceedings of the 16th International Conference on PErvasive Technologies Related to Assistive Environments [Internet]. New York, NY, USA: Association for Computing Machinery; 2023 [cited 2024 Mar 5]. p. 625–31. (PETRA ’23). Available from: https://dl.acm.org/doi/10.1145/3594806.3596567 Khan MA, Asadi H, Zhang L, Qazani MRC, Oladazimi S, Loo CK, et al. Application of artificial intelligence in cognitive load analysis using functional near-infrared spectroscopy: A systematic review. Expert Syst Appl. 2024 Sep 1;249:123717. Gao J, Guo Y, Lim G, Zhang T, Zhang Z, Li TJJ, et al. CollabCoder: A Lower-barrier, Rigorous Workflow for Inductive Collaborative Qualitative Analysis with Large Language Models [Internet]. arXiv; 2024 [cited 2025 Mar 29]. Available from: http://arxiv.org/abs/2304.07366 Spillias S, Tuohy P, Andreotta M, Annand-Jones R, Boschetti F, Cvitanovic C, et al. Human-AI collaboration to identify literature for evidence synthesis. Cell Rep Sustain [Internet]. 2024 Jul 26 [cited 2025 Mar 29];1(7). Available from: https://www.cell.com/cell-reports-sustainability/abstract/S2949-7906(24)00207-6 Bahangulu JK, Owusu-Berko L. Algorithmic bias, data ethics, and governance: Ensuring fairness, transparency and compliance in AI-powered business analytics applications. World J Adv Res Rev. 2025;25(2):1746–63. 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Chastin","email":"","orcid":"","institution":"Glasgow Caledonian University","correspondingAuthor":false,"prefix":"","firstName":"Sebastien","middleName":"F.M.","lastName":"Chastin","suffix":""}],"badges":[],"createdAt":"2025-06-04 10:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6819176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6819176/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40900-025-00797-x","type":"published","date":"2025-10-21T16:17:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84919355,"identity":"0094918d-8443-4b9d-9bbf-add49c52b715","added_by":"auto","created_at":"2025-06-18 19:33:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":187181,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow Chart of the Selection Proces\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/b3a63c301b689a0f2e0566a3.png"},{"id":84919354,"identity":"1af678b0-8fb4-44db-aead-54a9f14c009f","added_by":"auto","created_at":"2025-06-18 19:33:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107996,"visible":true,"origin":"","legend":"\u003cp\u003eSankey Diagram for classifying the needs regarding their attribute, mode of expression and theme\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/44cf5e3be16b754062465f5b.png"},{"id":84920991,"identity":"105c62da-ccdd-40f2-9140-a5c1f6ab077f","added_by":"auto","created_at":"2025-06-18 19:41:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":78018,"visible":true,"origin":"","legend":"\u003cp\u003eThe themes and subthemes of digital technologies needed in co-creation and their corresponding quantities\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/ca613424a3fa101d75d4a705.png"},{"id":94490596,"identity":"d4f1b751-81da-4b13-93dd-603d3ad524c2","added_by":"auto","created_at":"2025-10-27 17:12:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1630171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/87869d94-c330-40fe-b92e-07c4a76d42fc.pdf"},{"id":84919356,"identity":"99a90c09-7375-4b0c-b910-993454b7f02b","added_by":"auto","created_at":"2025-06-18 19:33:30","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":134096,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/26b8d801f3b82e11a25d2102.pdf"},{"id":84919358,"identity":"e9649541-d161-4414-989b-7a536cd01dc5","added_by":"auto","created_at":"2025-06-18 19:33:31","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":120917,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/c1128576e246a2733a2289c3.pdf"},{"id":84920993,"identity":"3a526465-623d-4f78-a10d-c89e7edfae3d","added_by":"auto","created_at":"2025-06-18 19:41:31","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":209453,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/b84430bd937b13e1774b5160.pdf"},{"id":84919372,"identity":"c377e27c-440e-4080-bce5-aa0035421b7d","added_by":"auto","created_at":"2025-06-18 19:33:31","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":410903,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6819176/v1/ea7afc18aad7f0cb60c68755.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Needs Assessment of Digital Technology in Co-Creation: A Health CASCADE Scoping Review","fulltext":[{"header":"Plain English summary","content":"\u003cp\u003eInvolving patients, carers, and the public in health and social care research helps make research more relevant, helpful, and fair. Today, digital technologies, such as online meetings, apps, and artificial intelligence, can help more people become involved. But what do we really need from these technologies to make everyone’s involvement easier and better?\u003c/p\u003e\n\u003cp\u003eIn this study, we looked at 60 research articles to find out what kinds of digital tools are needed to support group work and co-creation in research. We discovered 337 different needs and grouped them into five main areas: making sure the process is fair and open, supporting the methods, helping people understand and take part, working well in groups, and keeping everything organised.\u003c/p\u003e\n\u003cp\u003eWe found that while many tools focus on what they do, it’s just as important that they are easy to use, work well for lots of people, and help everyone join in, especially people who may find it harder to get involved. We also discuss how new technologies like artificial intelligence can help, but why they need to be used responsibly.\u003c/p\u003e\n\u003cp\u003eOur findings can help researchers, organisations, and the public choose or design better digital tools for involving patients and the public in research. This way, everyone’s voice can be heard, and health and care research can become more inclusive and effective.\u003c/p\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eModern health and social care systems face complex and evolving challenges, ranging from global pandemics and widening health inequalities to the impacts of climate change, that have direct and profound consequences for patients, communities, and public well-being (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Responding effectively requires not only sustainable innovation but also meaningful involvement of those most affected by health and care decisions. There is now strong recognition that patient and public involvement (PPI) is essential for research and service improvement, leading to higher-quality, more relevant, and more equitable outcomes (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWithin the PPI spectrum, co-creation has emerged as a promising paradigm for embedding the patient and public voice at every stage of research and innovation. It brings together patients, service users, carers, professionals, researchers, and policy-makers as equal partners. By leveraging collective intelligence and fostering shared decision-making, co-creation seeks to integrate diverse lived experiences and expertise to generate effective, widely accepted, and sustainable solutions in health and social care (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The participatory nature of co-creation offers a mechanism for developing more inclusive, implementable, and resilient strategies to drive systemic change (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, realising the full potential of co-creation is challenging in practice, and participatory approaches face significant barriers. Its iterative and collaborative nature demands versatile, resource-intensive, and highly adaptive organisational processes, which can be challenging to initiate, implement, and manage at scale (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Furthermore, the collective intelligence and shared governance principles that underlie co-creation require careful management of risks such as groupthink (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and power imbalances among co-creators (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), which can inhibit the integration of critical or marginalised perspectives. As the number of co-creators increases, methodological obstacles arise, such as maintaining meaningful engagement across large and diverse groups, which can limit the effectiveness of collective processes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Such challenges can limit the meaningful integration of the patient and public perspective, despite policy and funding imperatives.\u003c/p\u003e \u003cp\u003eDigital technologies offer potential solutions to address these barriers, supporting PPI and co-creation in research and practice. From cloud computing and social media platforms to recent innovations, such as generative artificial intelligence and blockchain, these technologies enable the creation of tools that can help overcome some of these barriers, supporting the coordination, inclusivity, and adaptability required for effective co-creation processes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The COVID-19 pandemic starkly demonstrated the enabling role of technology for remote and distributed engagement, making participation possible when in-person involvement was restricted (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). At the same time, rapid digital innovation is transforming the ways patients and the public can contribute, collaborate, and influence research. Digital tools promise not only to enhance existing practices but also to fundamentally reshape the ways we work together, making involvement more accessible, scalable, and inclusive (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eYet, despite the growing emphasis on digital approaches in co-creation, a systematic understanding of the specific digital technology needs that support meaningful engagement processes remains lacking. This study aims to address this gap by systematically mapping and thematically analysing the digital technology needs that underpin effective co-creation processes. In a context where terminology and practices surrounding involvement, engagement, co-creation, and related concepts are often fragmented and overlapping across disciplines, this review adopts a deliberately broad perspective, recognising that valuable insights can be drawn from the broader field of co-creation to inform best practice in PPI and patient involvement. Our findings provide a foundation for researchers, practitioners, and policy-makers to develop and select digital tools that strengthen patient and public participation and foster more inclusive, impactful research and service improvement.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThere is a wide range of definitions of co-creation (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e); for this study, we adopted an all-encompassing definition, which incorporates any collective creativity involving a diverse set of relevant and affected actors in creative problem-solving to achieve a desired outcome (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). For consistency, we refer to these methodologies collectively as \"co-creation,\" the participants as \"co-creators,\" and digital technologies as \"technology.\"\u003c/p\u003e \u003cp\u003eOur research question was: \u0026ldquo;What are the needs for digital technology in co-creation?\u0026rdquo;. To answer this, a systematic scoping review of the literature was conducted. This study design is well-suited to answering research questions that request an overview of the literature to identify knowledge gaps and orient future research questions (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). We followed the PRISMA guidelines for scoping reviews (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and used artificial intelligence technologies to assist the search and selection stages. The PRISMA Checklist can be found in Additional file 1.\u003c/p\u003e \u003cp\u003eWhile no public or patient was involved, this work is part of the Health CASCADE programme (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and serves as the foundation for developing future co-creation projects that will actively engage patients and the public. The GRIPP2-SF checklist (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) is provided in Additional file 2.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Stage 1: Search\u003c/h2\u003e \u003cp\u003eWe examined peer-reviewed articles on co-creation processes that identified specific needs and suggested technology as a potential solution. We conducted a search using the standard Boolean format combination of keywords from the lexical field \u0026rdquo;technology\u0026rdquo; AND \u0026ldquo;needs\u0026rdquo; AND \u0026ldquo;co-creation\u0026rdquo;:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTechnology\u003c/span\u003e: (technolog*; AI; artificial intelligence; big data; robot*; communication technolog*; ICT; information communication technolog*; deep learning; machine learning; ML; DL; IoT; internet; VR; virtual; 3D; software; computer; digital*; high tech*; cloud; voice recognition; T2S; text to speech; speech to text; NLP; natural language process*; avatar; social media; blockchain; collaboration tool; program*; API)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNeeds\u003c/span\u003e: (need; trouble; problem; issue; challenge; stake; necessity*; drive; opportunit*; limitation; solution; requirement)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCo-creation\u003c/span\u003e: (\u0026ldquo;co-creat*\u0026rdquo; OR \u0026ldquo;co-production\u0026rdquo; OR \u0026ldquo;public participation\u0026rdquo; OR \u0026ldquo;participatory\u0026rdquo; OR \u0026ldquo;co-design\u0026rdquo; OR \u0026ldquo;user-involvement\u0026rdquo;).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eWe searched the following databases: Co-Creation Database (CCDB) version 1.5 (a specialised pre-existing database that comprises all peer-reviewed literature about co-creation in PubMed, ProQuest, and CINAHL from 1970 to December 2021 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), PubMed, ProQuest, Scopus, Web of Science and CINAHL. The search within databases retrieved many records that could not be narrowed down without risking the exclusion of relevant material (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), which would have been inconsistent with the strength of the scoping review methods.\u003c/p\u003e \u003cp\u003eTherefore, we developed a deep-learning classification model to filter relevant material and identify relevant papers within the large pool of retrieved articles. To train this classifier, we used the human-annotated data developed during the creation of the Co-creation Database (CCDB) version 1.5 (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) as training material. Based on the BERT architecture (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), we trained an encoder-transformer model on a downstream classification task to identify documents relevant to co-creation based on their title and abstract. We employed a heuristic approach to the downstream results of the deep-learning model. The model was evaluated on unseen data, achieving an accuracy of 15% with 35% false positives and 15% false negatives.\u003c/p\u003e \u003cp\u003eWhen our classifier was ready, we conducted comprehensive Boolean searches in CCDB version 1.5, Scopus, and Web of Science from 1970 to June 2024 and in PubMed, ProQuest, and CINAHL from December 2021 to June 2024. We presented the paper\u0026rsquo;s titles and abstracts to our trained model, which classified the records. The records classified as positive were included after two rounds of deduplication: one aimed at deduplicating documents found in multiple databases and one against the papers used to produce the CCDB.\u003c/p\u003e \u003cp\u003eWe further refined the search by using a Python script keyword-matching process. It identified records containing sentences combining at least one keyword of the set \u0026ldquo;technologies\u0026rdquo; and one of the \u0026ldquo;needs\u0026rdquo; set, which is similar to a Boolean search (e.g., [(\u0026ldquo;technolog*\u0026rdquo; OR \u0026ldquo;AI\u0026rdquo; OR \u0026ldquo;etc.\u0026rdquo;) AND (\u0026ldquo;need\u0026rdquo; OR \u0026ldquo;trouble\u0026rdquo; OR \u0026ldquo;etc.\u0026rdquo;)]), in their title or abstract. We added the condition that these terms had to appear in sentences (syntactic space terminated by a dot \u0026ldquo;.\u0026rdquo;, a question mark \u0026ldquo;?\u0026rdquo; or an exclamation mark \u0026ldquo;!\u0026rdquo;).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Stage 2: Study Selection\u003c/h2\u003e \u003cp\u003eWe used an artificial intelligence tool, ASReview, to assist with the title and abstract screening of the references obtained. Based on simulations, we could expect 95% of relevant references by screening 10% of the dataset (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). We used the same validated process as the one used to curate the CCDB (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). QL, SB and GB proceeded with the title and abstract AI-assisted screening. The references obtained were full-text screened by QL, GB, SC, GRL, QA, VAK, and MGG. At least two independent researchers screened each study. Any second source referring to a need within a paper was checked and added to the full-text screening process. Both screenings were double-blinded, and any conflicts were resolved through discussion. The selection criteria are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSelection Criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Written in English.\u003c/p\u003e \u003cp\u003e- Include at least one keyword of each lexical field: \u0026ldquo;technology\u0026rdquo;, \u0026ldquo;needs\u0026rdquo;, and \u0026ldquo;co-creation\u0026rdquo;.\u003c/p\u003e \u003cp\u003e- Mention a process that adheres to our definition of co-creation.\u003c/p\u003e \u003cp\u003e- Mention at least one need relative to this process.\u003c/p\u003e \u003cp\u003e- Mention that technology could solve the mentioned need.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Focus exclusively on challenges or needs without specifying that technology could solve them.\u003c/p\u003e \u003cp\u003e- Discuss technology in the context, but not concerning addressing any specific need in the co-creation process.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Stage 3: Charting and analysing the data\u003c/h2\u003e \u003cp\u003eThe data from the included papers was gathered through a standardised extraction table made in Excel. The extraction was organised around three sections: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) basic bibliographic information, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) information about the study, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) needs and their characteristics. QL and SB piloted the table with five papers before performing the extraction. QL, GB, SC, GRL, QA, VAK, and MGG proceeded with the charting. A second researcher double-checked each extraction.\u003c/p\u003e \u003cp\u003eWe employed thematic analysis (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) as a methodological framework to systematically categorise the diverse needs for digital technologies in co-creation. This approach was instrumental in identifying, analysing, and reporting patterns across the collected literature. Each document was read thoroughly to achieve deep familiarity, enabling the initial identification of relevant data points related to digital technology needs in co-creation contexts. Subsequent coding was performed iteratively; initial codes were generated to label text segments that signified distinct aspects related to digital technologies in co-creation. These codes were then examined for patterns and grouped into potential themes of digital technology needs. Each theme was rigorously reviewed and refined to ensure it captured the essence of the coded data and the overarching insights from the literature. The final themes and subthemes were named and defined to represent the synthesised findings accurately. Then, a narrative description of each subtheme and its overarching themes was produced.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Search Results\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the PRISMA flow chart. The search retrieved 5,431 records from the CCDB and 57,448 from the Web of Science, Scopus, CINHAL, ProQuest, and PubMed. Deduplication and identification reduced the number of records to 5,321. After the title, abstract, and full-text screening, 60 studies were included in this review.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Study descriptions\u003c/h2\u003e \u003cp\u003eThe dataset included a total of 60 studies. Case studies were the most common, with 19 instances (31.7%). Theoretical studies accounted for 10 entries (16.7%). Empirical studies made up six entries (10%). Five studies focused on tool or system development and evaluation (8.3%). Literature reviews were represented in 4 instances (6.7%). Framework-related studies, including theoretical frameworks, framework proposals, and framework analyses, comprised eight entries (13.3%). Finally, there were eight unique study types (13.3%) that do not fall into the previous categories, including \"Randomised Trial,\" \"Prototype Development,\" \"Opinion Paper \u0026amp; Case Review,\" and \"Perspective Article.\"\u003c/p\u003e \u003cp\u003eRegarding the field covered, Urban Planning and related topics were the most prevalent, appearing in 19 entries (31.7%). Studies in Human-Computer Interaction (HCI) appeared in seven entries (11.7%), including combinations with Participatory Design, Child-Computer Interaction, Citizen Science, and Autism Research. Environmental Sciences accounted for six entries (10%). Studies involving Public Policy and E-Government total five entries (8.3%). Participatory Design was featured in five entries (8.3%), often with HCI or Urban Planning fields. Citizen Science fields appeared in three entries (5%). Public Administration was represented by three entries (5%). At the same time, Communication Design, Creative AI, Digital Democracy, Technology-Enhanced Learning, Water Management and Participatory Planning each appeared once or twice, collectively accounting for 6.7% of the dataset. Other unique areas, such as Virtual Reality \u0026amp; Design, Software Engineering, and Collaboration Support Systems, appeared once each, collectively making up the remaining 5% of the studies.\u003c/p\u003e \u003cp\u003eThe goals of the studies vary widely, covering several domains of participatory design and digital co-creation. Among them, 13 studies (21.7%) aimed to explore or analyse digital tools and platforms to enhance public participation and engagement, including specific technologies such as VR, social media, WebGIS, and mobile interactions in urban design and planning. Additionally, 13 studies (21.7%) focused on developing or evaluating digital platforms or tools to support participatory processes, such as frameworks for urban co-creation, youth-centred spatial data tools, and cognitive mapping systems. A smaller subset, nine studies (15%), sought to establish frameworks and methodologies for participatory processes across various contexts, including health, environmental planning, and urban resilience. Six studies (10%) focused on integrating advanced technologies like AI, blockchain, and fog computing to address trust, security, and inclusivity in participatory design. Furthermore, seven studies (11.7%) explored the challenges and opportunities of participatory design in unique settings, including remote and culturally diverse contexts, emphasising inclusivity and collaboration. Lastly, 12 studies (20%) examined specific applications or case studies in which digital tools were applied in real-world settings, providing insights into the practical implementations of participatory technology in citizen science, climate policy, and e-governance.\u003c/p\u003e \u003cp\u003eThe details of each study are provided in Additional file 3.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Needs Classification\u003c/h2\u003e \u003cp\u003eThe data extraction revealed 337 digital technology needs for co-creation. To highlight their singularities, they have been classified according to two dimensions: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) their attribute and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) their expression mode. The classification is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and its details can be found in Additional file 4.\u003c/p\u003e \u003cp\u003eThe attribute dimension concerns whether the need pertains to a technological or non-technological functional attribute. Functional attributes describe what the technology does: its core features, operations, and tasks. They are tied to the direct capabilities or behaviours that a system must exhibit to meet user requirements or business needs (e.g., \u0026ldquo;The system can authenticate users with a password\u0026rdquo; or \u0026ldquo;The application provides data export functionality\u0026rdquo;). Non-functional attributes, however, describe how well the technology performs or operates under certain conditions. They capture performance, reliability, usability, scalability, security, and maintainability. These attributes do not specify what the system should do (i.e., the functionality) but rather define the criteria or constraints for how it should do it (e.g., \u0026ldquo;The system must handle up to 10,000 simultaneous users\u0026rdquo; or \u0026ldquo;The page load time should not exceed 2 seconds\u0026rdquo;).\u003c/p\u003e \u003cp\u003e274 needs concern functional attributes, and 63 concern non-functional attributes. These findings reflect a common trend in requirements-gathering processes: users and stakeholders initially focus on the specific tasks and features they want a system to perform. Functional attributes are more straightforward to visualise and articulate, making them more likely to emerge. Non-functional attributes are often perceived as more abstract or technical and can be more challenging for participants to recognise or define until they encounter problems.\u003c/p\u003e \u003cp\u003eThe second dimension identifies how the needs were expressed. \u003cem\u003eGeneral Needs\u003c/em\u003e are broad, high-level statements that identify areas for improvement without specifying particular solutions, such as \"enhancing collaboration\" or addressing \"limited accessibility.\" These needs highlight overarching goals and serve as a foundation for identifying where technological interventions might be helpful. In contrast, \u003cem\u003eSpecific Needs\u003c/em\u003e are detailed and actionable, specifying exact functionalities or technologies, like the requirement for a \"data aggregation tool\" or \"GPS-based tracking.\" These needs provide precise guidance for development, enabling the creation of targeted solutions. \u003cem\u003eExplicit Needs\u003c/em\u003e are directly and unambiguously stated, using assertive language to indicate a straightforward requirement, such as \"the system must support multilingual interfaces.\" These needs leave no room for interpretation, offering clear mandates for action. On the other hand, \u003cem\u003eImplicit Needs\u003c/em\u003e are indirectly suggested through context, highlighting potential areas for improvement without explicitly stating them, such as when users report that \"current tools make collaboration difficult.\" These needs require interpretation and contextual understanding to identify underlying requirements. Combining these characteristics allowed us to define four types of needs expression. In the case of a general and implicit need, we refer to \u0026ldquo;latent\u0026rdquo;, conveying that the need is \u003cem\u003ebroad\u003c/em\u003e and \u003cem\u003eunderlying\u003c/em\u003e or \u003cem\u003enot directly stated\u003c/em\u003e. For a general and explicit need, \u0026ldquo;articulated\u0026rdquo; emphasises that the need is \u003cem\u003ebroad in scope\u003c/em\u003e but \u003cem\u003eclearly spelt out\u003c/em\u003e. For a specific and implicit need, \u0026ldquo;inferred\u0026rdquo; suggests the need is \u003cem\u003edetailed\u003c/em\u003e but must be \u003cem\u003ededuced\u003c/em\u003e or \u003cem\u003egleaned from context\u003c/em\u003e. Finally, in case of a particular and explicit need, the \u0026ldquo;prescriptive\u0026rdquo; indicates the need is detailed and unambiguously stated, which, in essence, is a \u003cem\u003eclear directive\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eThere are 58 articulated, 22 inferred, 160 latent and 97 prescriptive needs. These results highlight that, in co-creation contexts, many expressed needs initially emerge as broad, high-level intentions that are not fully articulated (\u0026ldquo;latent\u0026rdquo; needs). This is common when stakeholders describe overarching challenges without pinpointing a specific solution. Conversely, many \u0026ldquo;prescriptive\u0026rdquo; needs reflect when stakeholders are specific about the required functionalities or features. The smaller numbers for \u0026ldquo;articulated\u0026rdquo; and \u0026ldquo;inferred\u0026rdquo; needs suggest that while some participants can voice broad requirements, fewer needs emerge as implicit yet detailed enough to be \u0026ldquo;inferred.\u0026rdquo; This distribution shows that authors often gravitate toward general, sometimes implied, needs, with more precise directives from potentially more informed or experienced authors.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Technological Needs\u003c/h2\u003e \u003cp\u003eThe attribute and expression dimensions were considered during the thematic analysis to nuance the structuration of the five needs themes: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics and Process Management. The themes and their 25 sub-themes are described below and illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1. Ensuring Integrity\u003c/h2\u003e \u003cp\u003e90 needs and five subthemes fall into the \u0026ldquo;Ensuring Integrity\u0026rdquo; theme, reflecting technology's need to ensure governance and co-creation values.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section4\"\u003e \u003ch2\u003e3.4.1.1. Accessibility\u003c/h2\u003e \u003cp\u003eWith 25 needs, the \u0026ldquo;Accessibility\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme focuses on designing digital tools that remove barriers to participation, ensuring that diverse and underrepresented groups can easily engage in activities through inclusive and co-creator-friendly technologies. Key priorities encompass promoting broad participation and flexible engagement by leveraging digital solutions that facilitate diverse contributions and simplify data collection (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Ensuring inclusivity involves tailoring tools specifically for children and individuals with special needs, such as developing child-friendly platforms and neurodiversity-oriented design utilities (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Additionally, fostering inclusion for diverse co-creator groups requires accommodating various cultural backgrounds and abilities, ensuring that interfaces are co-creator-friendly and equitable across different socioeconomic contexts (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Addressing affordability, usability, and context sensitivity is also critical, with solutions focusing on creating cost-effective, adaptable technologies that function seamlessly in varied environments and meet specific co-creator contexts (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section4\"\u003e \u003ch2\u003e3.4.1.2. Engagement\u003c/h2\u003e \u003cp\u003eWith 21 needs, the \u0026ldquo;Engagement\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme emphasises the development of interactive and motivating digital platforms that sustain active participation from various co-creators, mainly targeting hard-to-reach populations to maintain dynamic and ongoing collaboration. Key priorities include implementing structured approaches to attract diverse communities and ensure meaningful participation through tailored digital platforms and practical data management tools (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40 CR41\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Flexible frameworks are also essential, advocating for adaptable and centralised systems that support sustained co-creator involvement and accommodate local or domain-specific nuances (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44 CR45 CR46\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Additionally, high-level directives emphasise the need for continuous engagement through long-running platforms to maintain involvement beyond the initial phases (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Furthermore, enhancing performance and co-creator experience is crucial, focusing on interactive design elements and refining collaboration practices to sustain co-creator interest and ensure high-quality interactions (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section4\"\u003e \u003ch2\u003e3.4.1.3. Representativity\u003c/h2\u003e \u003cp\u003eWith 18 needs, the \u0026ldquo;Representativity\u0026rdquo; subtheme ensures that the co-creator pool accurately reflects the diversity of the broader community by implementing tools and strategies that minimise bias, redistribute power, and promote equitable representation. Key priorities focus on fostering inclusive representation and balancing power dynamics to ensure diverse perspectives are heard, and equitable decision-making is achieved (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). AI-enhanced solutions are proposed to improve stakeholder inclusion by simulating varied viewpoints and aligning system designs with diverse interests, thereby bridging gaps that conventional methods may miss (\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Mitigating bias in design and participation is also critical, with strategies aimed at reducing power concentration, preventing co-creator selection bias, and ensuring equitable representation (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Additionally, robust data handling practices and protective measures are proposed to maintain trust and prevent manipulation or privacy breaches (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section4\"\u003e \u003ch2\u003e3.4.1.4. Accountability and Transparency\u003c/h2\u003e \u003cp\u003eWith 16 needs, the \u0026ldquo;Accountability and Transparency\u0026rdquo; subtheme involves establishing clear, open mechanisms for tracking contributions and decision-making, fostering trust among co-creators by making processes and data handling visible and understandable. Key priorities for focus on embedding openness into digital processes through tools that enable transparent communication, maintain comprehensive activity logs and ensure fair decision-making (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Clear directives emphasise implementing advanced mechanisms such as blockchain-based frameworks and secure data handling practices to ensure responsibility and traceability within co-creation systems (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Additionally, broader views position transparency and accountability as fundamental principles for building trust and legitimacy (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section4\"\u003e \u003ch2\u003e3.4.1.5. Security and Privacy\u003c/h2\u003e \u003cp\u003eWith 10 needs, the subtheme \u0026ldquo;Security and Privacy\u0026rdquo; prioritises protecting co-creator data and the integrity of collaborative environments through robust encryption, secure communication channels, and measures that safeguard against data breaches and misuse. Key priorities involve safeguarding co-creator information while maintaining transparent and trustworthy interactions. Ensuring privacy in digital collaboration requires embedding robust privacy protections and mechanisms that balance data transparency with personal anonymity, such as tracking co-creator activity without compromising identities (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Integrating robust security measures is essential, necessitating fortified digital environments, encryption, and secure network protocols to protect collaborative workspaces from vulnerabilities and unauthorised access (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). Additionally, advanced protective measures must be coupled with co-creator-friendly designs to ensure that security protocols do not hinder seamless participation (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2. Enabling Methodology\u003c/h2\u003e \u003cp\u003e67 needs and six subthemes fall into the \u0026ldquo;Enabling Methodology\u0026rdquo; theme, representing the need for technology to enable existing and new co-creation methodologies.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.1. New Methods\u003c/h2\u003e \u003cp\u003eWith 10 needs, the \u0026ldquo;New Methods\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme groups the needs to enable current co-creation methodologies or call for developing new ones. Key priorities involve developing participatory and geospatial tools to accomplish the optimal capacity of participatory mapping (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e). Evolving digital participation frameworks are essential, focusing on integrating next-generation technology into participatory design platforms and creating adaptive, wide-ranging engagement systems supported by coherent guidelines to ensure consistency and bridge academic insights with practical applications (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Developing new online workshops and co-creation activities is crucial to enable more co-creators to contribute effectively, maintain creativity, and sustain momentum in remote settings (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.2. Distributed Process\u003c/h2\u003e \u003cp\u003eWith 10 needs, the \u0026ldquo;Distributed Process\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme focuses on digital solutions that support collaboration among geographically dispersed co-creators, ensuring seamless communication and coordination in co-creation processes. Key priorities focus on facilitating remote collaboration through tools that streamline virtual participation and eliminate common friction points, supported by robust frameworks (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Flexible and adaptive participation approaches are essential, promoting models that accommodate co-creators across various locations and time zones by integrating streamlined methods into everyday routines and simplifying interfaces (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). Additionally, comprehensive blueprints for organising distributed endeavours are advocated to help teams navigate complex tasks efficiently (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Furthermore, developing hybrid tools and inclusive virtual environments is prioritised to seamlessly blend digital and face-to-face interactions (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.3. Large Scale Process\u003c/h2\u003e \u003cp\u003eWith 10 needs, the \u0026ldquo;Large Scale\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme addresses the need for scalable digital tools and methodologies to accommodate extensive public engagement and participation without compromising functionality or inclusivity. Key priorities include building capacity for broad public engagement by developing digital platforms that enhance creativity and facilitate diverse contributions while organising asynchronous input from widely dispersed co-creators to maintain momentum and coordination (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Concrete strategies emphasise the need for integrated tools to manage large volumes of responses, moderate discussions effectively, and utilise pervasive technologies for data collection and processing to derive reliable insights from extensive co-creator pools (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Additionally, ensuring scalability and inclusion is crucial, with solutions to create flexible digital methods that can accommodate expanding stakeholder groups without compromising accessibility or coherence (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.4. Decision-Making\u003c/h2\u003e \u003cp\u003eWith 14 needs, the \u0026ldquo;Decision-Making\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme centres on technologies that enhance and streamline the decision-making processes within co-creation, enabling more informed, transparent, and participatory outcomes. Key priorities focus on strengthening collective decision-making processes by leveraging technology that enhances informed and effective participation, such as data-driven systems for evaluating options and robust platforms that guide groups through complex choices (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e). Inclusive models and tools are essential to ensure adaptability to different voting contexts, simplify public input, and broaden access so that all co-creators, regardless of their familiarity with specialised software (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Additionally, guidance and reliable systems are necessary to maintain dynamic yet well-regulated engagement, facilitate focused and transparent discussions, support deeper deliberation in complex planning scenarios, and foster diversity in collective decisions (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.5. Evidence-Based Process\u003c/h2\u003e \u003cp\u003eWith 8 needs, the \u0026ldquo;Evidence-Based Process\u003cb\u003e\u0026rdquo;\u003c/b\u003e emphasises the integration of reliable data and evidence-based tools to support informed discussions, counter misinformation, and facilitate evidence-driven decision-making in co-creation. Key priorities emphasise leveraging digital technologies to enhance public discourse by filtering out inaccuracies and fostering constructive conversations grounded in reliable data (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). Data-driven avenues utilise advanced functionalities such as machine learning and natural language processing to assemble, interpret, and present rigorous evidence, enabling engagement with complex findings (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Additionally, ensuring straightforward access to valuable information is needed to allow diverse audiences to form well-rounded opinions while maintaining discretion (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.6. Specific Tools\u003c/h2\u003e \u003cp\u003eWith 15 needs, the \u0026ldquo;Specific Tools\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme pertains to developing and implementing specialised digital systems tailored to support participatory design, urban planning, and other co-creation activities, ensuring functionality and adaptability to co-creator needs. Key priorities include the creation of dedicated digital platforms tailored to participatory design and urban development, which integrate decision-making with collaborative communication to engage diverse co-creators effectively (\u003cspan additionalcitationids=\"CR75\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). Additionally, there is a strong emphasis on developing open-ended, adaptive, and integrated systems that can evolve alongside emerging design needs and co-creator preferences, supporting a wide variety of planning contexts such as sustainability and large-scale stakeholder management while bridging domains like citizen science with participatory practices (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). Furthermore, customisation and empirical validation are critical, advocating for tailor-made solutions that meet specific co-creator or community demands and ensuring that digital co-creation tools are continuously refined through hands-on case studies and real-world experimentation to balance broad applicability with local adaptability (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003e3.4.3. Cognitive Needs\u003c/h2\u003e \u003cp\u003e40 needs and three subthemes fall into the \u0026ldquo;Cognitive Needs\u0026rdquo; theme, encompassing the need for technologies to consider individual co-creators' necessary mental processes, motivations, and capacities.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section4\"\u003e \u003ch2\u003e3.4.3.1. Mental Capacity\u003c/h2\u003e \u003cp\u003eWith 13 needs, the \u0026ldquo;Mental Capacity\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme highlights the co-creators' need to absorb, interpret, and apply knowledge through features designed to support learning, creativity, and cognitive ease. Key priorities include fostering creative and educational engagement by developing digital platforms that promote imaginative thinking, support open-ended innovation, and provide learning opportunities through transparent information-sharing and structured guidance (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e). Ensuring intuitive knowledge contribution is essential, achieved by designing simpler interfaces that allow co-creators to add spatial data and outline ideas effortlessly (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). Harnessing advanced AI and structured support involves embedding intelligent functionalities that mimic human thought processes, utilising automation and machine learning to reduce manual tasks, and providing dynamic step-by-step guidance (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). Additionally, improving clarity and reducing effort is crucial, focusing on streamlining tasks, enhancing clarity, and maintaining co-creator-friendly standards to minimise technical barriers and prevent co-creator fatigue (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section4\"\u003e \u003ch2\u003e3.4.3.2. Motivation\u003c/h2\u003e \u003cp\u003eWith 16 needs, the \u0026ldquo;Motivation\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme focuses on the factors, incentives, and platform elements that inspire co-creators to stay committed and actively contribute throughout the co-creation process. Key priorities involve integrating playful dynamics to actively engage co-creators by incorporating game-inspired mechanisms that attract and sustain co-creator involvement, ensuring enjoyable and compelling interactions (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). Rewarding participation through various adaptive incentives is proposed, from token-based rewards to role-specific recognitions (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). Additionally, tailoring experiences through contextual and intelligent tools is promising, leveraging natural language processing and machine learning to personalise content, recommend relevant topics, and adjust roles based on co-creator needs and evolving contexts (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). Creating an engaging digital atmosphere would further enhance motivation by designing intuitive and stimulating environments that captivate co-creators and support the interactive spirit of co-creation, ensuring that technology serves as an inviting and meaningful backdrop (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003e3.4.3.3. Visualisation\u003c/h2\u003e \u003cp\u003eWith 11 needs, the \u0026ldquo;Visualisation\u0026rdquo; subtheme emphasises the importance of presenting data and ideas in accessible, context-driven ways that aid comprehension, inform decision-making, and maintain co-creator engagement. Key priorities involve facilitating contextual understanding and clarity by developing tools supporting data-driven discussions and presenting information in straightforward, easily interpreted visual formats, enhancing co-creator comprehension and dialogue (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). Empowering targeted applications is essential, focusing on tailored visualisation capabilities that address specific areas such as gender-responsive planning and provide robust graphical feedback to support distributed participatory design activities (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Managing and scaling complex data sets is critical, necessitating platforms that can efficiently handle extensive data volumes while offering offline visualisation capabilities to ensure continuous access to essential insights even in limited connectivity scenarios (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Additionally, enhancing educational and cost-efficient visual engagement is needed to ensure accessibility and usability across diverse co-creator needs (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section3\"\u003e \u003ch2\u003e3.4.4. Group Dynamics\u003c/h2\u003e \u003cp\u003e83 needs and six subthemes fall into the \u0026ldquo;Group Dynamics\u0026rdquo; theme, illustrating the need for technology to support collective dynamics.\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section4\"\u003e \u003ch2\u003e3.4.4.1. Bridging Diversity\u003c/h2\u003e \u003cp\u003eWith 15 needs, the \u0026ldquo;Bridging Diversity\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme explores strategies and tools for uniting co-creators across varying cultural, generational, or disciplinary backgrounds to ensure a more representative and equitable design process. Key priorities involve fostering collaboration across generations by developing digital platforms that enable different age groups to participate inclusively, ensuring that previously overlooked voices are integrated into co-creation processes (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). Building bridges among co-creator groups is essential, emphasising improved knowledge-sharing across professional, local, and community divides, designing channels that reconcile scientific perspectives with on-the-ground realities (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). Embracing cultural and linguistic diversity requires accommodating global co-creator bases and multicultural settings by embedding cross-linguistic capabilities, adhering to culture-specific engagement standards, and integrating translation components (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). Additionally, accommodating mixed abilities and contexts is crucial, necessitating the design of flexible participation mechanisms that adapt to varying physical and cognitive skills, ensuring that co-creation spaces remain accessible and effective for all individuals (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section4\"\u003e \u003ch2\u003e3.4.4.2. Social Dynamic\u003c/h2\u003e \u003cp\u003eWith 16 needs, the \u0026ldquo;Social Dynamic\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme focuses on how individuals and groups interact and connect during co-creation, emphasising inclusivity, empathy, and constructive engagement. Key priorities focus on encouraging empathy and counteracting hostilities by integrating features that build mutual understanding, detect and mitigate harmful language, and promote emotional sensitivity through interactive and visual means (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e). Strengthening collaborative ties and social connectedness is essential, potentially achieved by designing digital spaces that foster team building, support nonverbal communication, and adapt to co-creators\u0026rsquo; emotional needs to create a strong sense of community and meaningful interactions (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e). Additionally, streamlining coordination and shared decision-making involves implementing integrated processes that seamlessly connect discussion spaces with decision-making platforms, utilising recommendation engines to highlight relevant content and facilitate consensus-building (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). Maintaining research-driven underscores the importance of grounding social dynamic platforms in empirical studies (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section4\"\u003e \u003ch2\u003e3.4.4.3. Mitigating Conflict\u003c/h2\u003e \u003cp\u003eWith seven needs, the \u0026ldquo;Mitigating Conflict\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme addresses mechanisms and approaches for recognising potential disagreements, preventing escalation, and transforming conflicts into productive dialogue within collaborative settings. Key priorities focus on cultivating productive dialogue by providing mechanisms that guide large, diverse groups through structured discussions and foster respectful exchanges, even on contentious issues, establishing common ground (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Tools for conflict resolution and knowledge sharing are essential, emphasising flexible solutions that resolve clashes and integrate diverse forms of expertise into cohesive frameworks to ensure smooth and systematic group progress (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Additionally, structuring complexity requires adaptable systems capable of managing evolving problems and inherent uncertainties, along with integrated moderation and translation capabilities to overcome language, disciplinary, and contextual barriers, ensuring effective decision-making and collaboration (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section4\"\u003e \u003ch2\u003e3.4.4.4. Understanding Sentiments\u003c/h2\u003e \u003cp\u003eWith seven needs, the \u0026ldquo;Understanding Sentiments\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme highlights the importance of capturing and interpreting emotional cues so that co-creation platforms can respond adaptively to co-creators\u0026rsquo; feelings, enhancing empathy and reducing miscommunication. Key priorities involve capturing emotional nuances in digital spaces by developing mechanisms that sense and interpret co-creators' emotional dynamics, such as monitoring mood fluctuations and detecting nonverbal cues (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). Overcoming barriers to engagement is essential, achieved by designing welcoming digital environments that accommodate diverse emotional and communicative styles, reducing hurdles and fostering empathy-driven interactions (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). Additionally, integrating and summarising emotional data is crucial, with solutions that incorporate sentiment analysis into the co-creation process by merging affective data with other relevant information and presenting collective sentiment in meaningful ways to provide real-time feedback on group morale and engagement (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec33\" class=\"Section4\"\u003e \u003ch2\u003e3.4.4.5. Collaboration\u003c/h2\u003e \u003cp\u003eWith 26 needs, the \u0026ldquo;Collaboration\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme concentrates on creating and sustaining shared spaces, feedback mechanisms, and collective decision-making processes that enable co-creators to work effectively toward common goals. Key priorities encompass foundational solutions for multi-party collaboration by developing digital platforms that enable seamless coordination among globally distributed teams, support cross-organisational networks, and provide integrated spaces for collective planning and project development, all while ensuring robustness and efficiency at larger scales (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e). Streamlined approaches to feedback and annotation are essential, emphasising enhanced feedback loops and straightforward annotation tools that facilitate real-time responses and maintain organised, trustworthy input (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). Additionally, fostering co-creative spaces and AI-supported collaboration highlights the need for environments that harness group inventiveness and problem-solving through specialised engagement spaces and AI modules that clarify system outputs and support collective brainstorming (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e). Facilitating consensus and structured decision-making is also crucial, with collaborative tools designed to guide teams toward agreement in complex contexts, co-creator-friendly scenario-testing modules that visualise outcomes, and structured processes that refine proposals collaboratively, promoting convergence (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section4\"\u003e \u003ch2\u003e3.4.4.6. Communication\u003c/h2\u003e \u003cp\u003eWith 12 needs, the \u0026ldquo;Communication\u003cb\u003e\u0026rdquo;\u003c/b\u003e subtheme examines the channels, modes, and strategies that support rich and accessible information exchanges, ensuring that all co-creators can meaningfully engage in the design conversation. Key priorities involve supporting multiple modes and contexts of interaction by developing platforms that accommodate diverse communication types, including text-based exchanges and visually enriched and audio-driven interactions, while integrating advanced mechanisms to capture non-verbal signals and ensure fluid, responsive dialogues in both real-time and asynchronous settings (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). Tailoring communication for distributed teams is essential, necessitating tools that bridge time zones, support remote coordination, and integrate context-aware collaborative features to enhance creativity and informed decision-making throughout the project lifecycle (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec35\" class=\"Section3\"\u003e \u003ch2\u003e3.4.5. Process Management\u003c/h2\u003e \u003cp\u003e57 needs and four subthemes fall into the \u0026ldquo;Process Management\u0026rdquo; theme, encompassing the digital support mechanisms required to coordinate co-creation.\u003c/p\u003e \u003cdiv id=\"Sec36\" class=\"Section4\"\u003e \u003ch2\u003e3.4.5.1. Data Management\u003c/h2\u003e \u003cp\u003eWith 23 needs, the \u0026ldquo;Data Management\u0026rdquo; subtheme focuses on capturing, integrating, and analysing diverse inputs, ensuring accurate, reliable, and context-rich information underpins participatory efforts. Key priorities involve geospatial data collection and integration by developing digital solutions that capture co-creator-centric geospatial insights and combine mapping with urban-planning functionalities to support comprehensive city-scale decision-making (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e). Effective data management and analytical tools are essential, emphasising the systematic organisation, filtering, and precise handling of co-creator-contributed data through advanced language-processing techniques and real-time data parsing toolkits that structure co-creator engagement (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). Additionally, facilitating collective creativity and idea generation requires automated routines categorising co-creator suggestions, organising insights, analysing, and synthesising feedback (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec37\" class=\"Section4\"\u003e \u003ch2\u003e3.4.5.2. Information and Knowledge\u003c/h2\u003e \u003cp\u003eWith eight needs, the \u0026ldquo;Information and Knowledge\u0026rdquo; subtheme addresses how project updates, feedback, and other contributions are gathered, distilled, and made accessible, enabling co-creators to turn collective insights into tangible outcomes. Key priorities involve ensuring accessible project updates and discussion summaries by establishing transparent, ongoing communication channels such as dedicated developer blogs and tools that distil lengthy discussions into clear, structured overviews, enabling all co-creators to stay informed and contribute meaningfully (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). Evaluating and filtering diverse contributions is essential, achieved through technologies that extract the most pertinent ideas from open-ended discussions and employ sophisticated natural language processing functionalities to apply relevance scoring, enhancing clarity and facilitating efficient decision-making (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). Additionally, advancing knowledge management requires robust information management systems that provide co-creators with seamless access to necessary materials, incorporating specialised features like semantization tools to shape knowledge bases and guide teams through co-creation best practices to ensure a consistent flow of know-how across different project phases (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec38\" class=\"Section4\"\u003e \u003ch2\u003e3.4.5.3. Process Optimisation\u003c/h2\u003e \u003cp\u003eWith 15 needs, the \u0026ldquo;Process Optimisation\u0026rdquo; subtheme targets streamlining participatory workflows through efficient facilitation, accelerated decision-making, and reduced resource demands. Key priorities focus on streamlining participation and fostering continuous improvement by developing digital platforms that lower barriers to engagement, support straightforward input, and implement mechanisms for evaluating and refining project outcomes (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e). Automation and AI-enhanced support are crucial, emphasising the integration of natural language processing systems and AI-powered feedback engines to suggest and assess ideas, automate summarisation tasks, and generate communication aids, thereby enabling faster iterations, greater transparency, and the generation of fresh insights from co-creator inputs (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). Additionally, holistic solutions that consolidate resources eliminate geographic and financial obstacles, minimise repetitive tasks, and create cost-efficient collaborative environments (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec39\" class=\"Section4\"\u003e \u003ch2\u003e3.4.5.4. Organisation\u003c/h2\u003e \u003cp\u003eWith 11 needs, the \u0026ldquo;Organisation\u0026rdquo; subtheme covers the structures, platforms, and tools that align multiple co-creators, tasks, and collaborative elements within co-creation initiatives. Key priorities involve fostering engagement and recruitment by developing digital platforms that facilitate the collection of co-creator input during face-to-face sessions and strategically attract and retain co-creators through accessible, co-creator-friendly recruitment and communication channels (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Coordinating multi-level collaboration is essential, achieved by creating platforms that align efforts across diverse teams and organisations, manage tasks seamlessly, and provide comprehensive environments for managing online engagement, including visual representations of processes to streamline the input-review cycle (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Additionally, integrating real-time AI and advanced facilitation tools is crucial, with solutions that enable live interactive elements, automate facilitation tasks, and utilise machine learning algorithms to filter and categorise inputs, thereby enhancing co-creator engagement, managing complex processes, and guiding collaborative teams toward coherent outcomes (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis review highlights 337 needs for digital technologies in co-creation. The analysis allowed us to understand and structure these needs into five categories: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics, and Process Management. This discussion first considers the general implications of our findings for advancing co-creation practices, then contextualises each theme with existing literature, and finally explores the transformative role of artificial intelligence as a catalyst for hybrid collective intelligence in co-creation aimed at patient and public involvement (PPI) and engagement in health and social care research.\u003c/p\u003e \u003cdiv id=\"Sec41\" class=\"Section2\"\u003e \u003ch2\u003e4.1. The central role of technology in co-creation\u003c/h2\u003e \u003cp\u003eOur results reveal a fragmented landscape of needs in the scientific literature, where functional requirements are far more prevalent than non-functional ones. Additionally, the expression of these needs varies widely, ranging from broad and implicit statements to specific and explicit directives. However, a majority of functional needs are expressed implicitly. This is not surprising since our study reviews literature from only a minority of departments specialised in technology. While this broad representation captures a realistic and heterogeneous view of co-creation practices, it also underscores the inherent complexity of systematically capturing and addressing digital needs in multi-actor ecosystems within health and social care.\u003c/p\u003e \u003cp\u003eTo address this gap, our study proposes a first structured organisation of these needs based on their specificity and level of articulation. By making implicit needs more visible, aligning diverse stakeholder perspectives, and translating broad technological aspirations into actionable insights, we provide a foundational framework for enhancing co-creation processes toward greater patient, public, and service user participation. Furthermore, we observed a strong synergy between the identified themes and the principles of co-creation from Chastin and colleagues (under review), as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. These principles establish key conditions for authentic co-creation, and their correspondences with our themes reinforce the validity of our structure. Importantly, they illustrate that technological needs are deeply intertwined with the value-creation processes essential for co-creation to drive systemic and sustainable change involving patients and the public.\u003c/p\u003e \u003cp\u003eBy aligning with established theories in participatory design, PPI, and engagement in health and social care, our results represent a first step toward bridging the gap between high-level conceptual discussions and the practical considerations necessary for designing and implementing effective digital solutions that support co-creation for patient and public involvement and engagement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrespondence between the themes and the Co-creation Principles.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorresponding Co-creation Principles\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEnsuring Integrity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#1 (Open access to knowledge), #3 (Transparency)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#4 (Recognized contributions), #10 (Active participation)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepresentativity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#9 (Diversity)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccountability \u0026amp; Transparency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#2 (Legal \u0026amp; ethics), #3 (Transparency)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecurity \u0026amp; Privacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#2 (Legal \u0026amp; ethics)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEnabling Methodology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecific Tools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#7 (Evaluate), #8 (Reflect), #11 (Systematic, flexible process)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecision-Making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#5 (Focus on clear problem), #6 (Best evidence)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew Methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#8 (Reflect), #11 (Systematic, flexible process)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistributed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#9 (Diversity), #10 (Active participation), #11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarge Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#11 (Scaling and replicability)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvidence-Based Process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#6 (Best evidence)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCognitive Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#10 (Active participation)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVisualisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#6 (Best evidence), #7 (Evaluate), #8 (Reflect)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMental Capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#10 (Active participation), #11 (Support structured, inclusive process)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eGroup Dynamics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#10 (Active participation), #11 (Systematic collaboration)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial Dynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#9 (Diversity), #10 (Active participation)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBridging Diversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#9 (Diversity)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#10 (Active participation)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMitigating Conflicts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#9 (Diversity), #10 (Active participation)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSentiments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#9 (Respect for diverse views), #10 (Support constructive engagement)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eProcess Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eData Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#2 (Legal \u0026amp; ethics), #3 (Transparency), #6 (Best evidence)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcess Optimisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#7 (Evaluate), #8 (Reflect), #11 (Enhance systematic approach)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrganisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#11 (Structured, replicable process)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformation \u0026amp; Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#1 (Open access to knowledge), #6 (Best evidence), #9 (Diversity)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec42\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Themes and Implications\u003c/h2\u003e \u003cp\u003eEnsuring Integrity emerged as the core theme, highlighting the critical role of technology in fostering accessibility, engagement, and balanced representation in co-creation processes. Tools must ensure diverse participation while integrating accountability mechanisms to maintain transparency in decision-making, all while addressing the inherent tension with privacy and security. For instance, accessibility-focused tools like public ICT solutions and adaptive interfaces could bridge the digital divide, enabling underrepresented groups to contribute meaningfully. These findings align with existing research emphasising accessibility and inclusivity as prerequisites for effective collaboration (\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e). However, this study advances the discourse by positioning accountability as a central integrity component and addressing the challenge of balancing transparency and privacy. Technologies like blockchain offer promising solutions for transparent yet secure participation frameworks. By ensuring equity and trust, these needs form the foundation for higher-order processes, such as effective group dynamics and complex decision-making, establishing the governance structures essential for building trust and supporting advanced co-creation needs.\u003c/p\u003e \u003cp\u003eEnabling Methodology underscores the necessity for new technological tools and innovative methods to fully leverage technology's potential in co-creation processes. This includes developing hybrid participation models that combine in-person and digital engagement to enhance flexibility and inclusivity. These models, alongside tools that enable large-scale, distributed, and asynchronous collaboration, break down barriers of location and time, creating opportunities for broader and more diverse co-creation. Additionally, technology must provide evidence to co-creators and support optimal decision-making approaches, ensuring that processes are both informed and effective. The findings align with prior research highlighting scalability and adaptability as essential for large-scale participatory engagements (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Asynchronous participation methods could enable inclusivity by allowing individuals to contribute conveniently. This study also highlights the dual focus on standardisation and customisation. Standard frameworks are proposed as a foundation tailored to balance adaptability and scalability for advancing digital co-creation processes, particularly in distributed and resource-constrained environments relevant to health and social care settings\u003c/p\u003e \u003cp\u003eCognitive Needs addresses the individual capacities of co-creators, emphasising the importance of reducing cognitive overload while sustaining engagement through intuitive, user-friendly tools. This theme focuses on overcoming the complexity of co-creation processes by motivating participants and ensuring clarity. Practical visualisation tools, gamification features, and AI-driven systems that adapt to user preferences are essential for maintaining participant focus and interest. These findings align with cognitive load theory and its application in participatory design, highlighting the importance of simplifying complex data and processes to enhance user engagement (\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). Moreover, the study emphasises the need for technologies that bridge the gap between technical experts and lay participants. Simplified interfaces, knowledge translation mechanisms, and educational resources democratise access to knowledge, enabling participants with varying expertise levels to contribute effectively. This democratisation would sustain engagement and enhance the inclusivity and quality of co-creation outcomes.\u003c/p\u003e \u003cp\u003eGroup Dynamics fosters collaboration and resolves conflicts within diverse and distributed co-creation teams. This theme emphasises the importance of tools that bridge cultural, linguistic, and generational divides, thereby ensuring equitable participation and fostering mutual understanding in multi-stakeholder health and care settings. Culturally adaptable platforms, empathy-driven technologies, and sentiment analysis tools enable effective stakeholder communication that accommodates diverse perspectives and goals. These findings align with existing research emphasising the challenges of managing diversity in participatory processes, particularly in global initiatives where multilingual tools and culturally sensitive designs are critical for inclusivity (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). The study also underscores the role of empathy-driven technologies, such as visualisations or augmented reality simulations, which enable participants to understand others\u0026rsquo; perspectives, reduce misunderstandings, and foster a sense of connectedness, even in asynchronous settings. Conflict resolution tools would further enhance group dynamics by supporting structured decision-making, moderation, and bias mitigation, ensuring the equitable integration of diverse viewpoints from all stakeholder groups, including patients and the public.\u003c/p\u003e \u003cp\u003eProcess Management is the logistical and organisational layer of needs, emphasising advanced tools to manage data, disseminate knowledge, and optimise processes. Simplifying and streamlining the process is essential to reduce its complexity and resource demands, providing much-needed support to co-creators in organising intricate workflows. The findings build on existing research highlighting the complexity of management and the complex processes of co-creation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Centralised digital platforms that foster collaboration and transparency by enabling resource sharing and retrieval further reduce inefficiencies. Scalability and adaptability are crucial, with modular systems designed to accommodate varying levels of complexity, from localised initiatives to global, multi-stakeholder initiatives in health and social care, aiming for systemic, sustainable change.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec43\" class=\"Section2\"\u003e \u003ch2\u003e4.3. The Rise of Hybrid AI-Co-Creation Processes\u003c/h2\u003e \u003cp\u003eThe rapid evolution of artificial intelligence (AI) promises future flexible tools with applications spanning all identified themes. AI extends beyond operational enhancements to actively shape participation, collaboration, and decision-making across health and social care research and practice.\u003c/p\u003e \u003cp\u003eIn ensuring integrity, AI could mitigate biases to promote equitable representation, ensuring fair participation while enhancing transparency (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). Personalised experiences like adaptive workflows and interfaces could help sustain engagement and inclusivity among patients, service users, and public contributors (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). For enabling methodology, AI could streamline scalability and adaptability through dynamic workflows and evidence-based decision-making, transforming unstructured participant feedback into actionable insights via natural language processing (NLP) (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e). AI\u0026rsquo;s role in addressing cognitive needs could involve simplifying complex data to fit the capacity of the co-creator and sustaining motivation among participants with diverse backgrounds and levels of expertise (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e). For group dynamics, AI could mediate interactions, fostering collaboration and mitigating conflict through sentiment analysis tools that enable real-time intervention (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e). In process management, AI could automate logistical tasks, optimise resource allocation, and enhance knowledge dissemination, improving transparency and efficiency in participatory health and care research settings (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, alongside these opportunities, significant challenges arise. Algorithmic bias, privacy risks, and a lack of transparency in AI systems can undermine trust, particularly in health and social care initiatives where legitimacy and inclusivity are critical (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e). Careful attention must be paid to ensure that AI-enabled solutions do not inadvertently introduce new barriers to equitable participation or reinforce existing inequalities. The stakes are proportional to the integration and responsibility of these technologies within participatory ecosystems.\u003c/p\u003e \u003cp\u003eOverall, AI marks a fundamental shift toward hybrid co-creation systems, where human and machine intelligence are integrated to address complex health and social challenges more inclusively, scalably, and innovatively. By leveraging AI responsibly, co-creation processes can be redefined to support better the systemic transformations required for a more inclusive and impactful future in health and social care research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec44\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Limitations and Future Research\u003c/h2\u003e \u003cp\u003eDespite providing a comprehensive analysis for understanding digital technology needs in co-creation, this study has several fundamental limitations. Focusing on English-language literature may exclude valuable insights from other regions and cultures, and the analysis reflects researchers' interpretations, which may not capture all perspectives. Future research should broaden its scope to incorporate non-English literature and diverse cultural perspectives. In addition, the evolving role of AI in supporting hybrid collective intelligence systems warrants particular attention, particularly concerning adaptive workflows and ethical considerations. Engaging with co-creation experts beyond academia will strengthen the practical relevance of research and provide valuable insights into real-world technology needs. Furthermore, developing a comprehensive taxonomy of digital technologies in co-creation will provide a structured framework for future development.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis scoping review aimed to clarify and categorise the multifaceted digital technology needs that support co-creation processes, advancing patient and public involvement (PPI) and engagement in health and social care research and practice. By examining a broad body of literature and consolidating 337 identified needs, this study uncovers five areas to enhance co-creation: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics, and Process Management. While functionality remains a recurring priority across these needs, the findings emphasise that non-functional requirements such as usability, scalability, inclusivity, and reliability warrant explicit and strategic attention to fully realise the transformative potential of co-creation and involvement in health and social care. Collectively, the results underline that effective co-creation hinges on the dynamic interplay between human and technological factors. To build trust, foster broad participation, and sustain long-term engagement, technologies must first secure accessibility, accountability, and privacy. From this foundation, they can evolve to support large-scale collaboration, evidence-based decision-making, and personalised, inclusive user experiences for patients, caregivers, and the public.\u003c/p\u003e \u003cp\u003eMoreover, emerging AI solutions present opportunities to automate logistical processes, enhance data interpretation, and facilitate richer group interactions, thereby expanding the reach and impact of PPI and co-creation initiatives. However, ethical considerations must remain central to AI integration to safeguard the trust and inclusivity essential for equitable and impactful health and social care innovation. Future research should refine and empirically validate these findings across diverse cultural, organisational, and geographic contexts, primarily through close partnership with patients, service users, and communities. In doing so, researchers and practitioners can contribute to building technological ecosystems that enable co-creation and involvement to their full capacity, supporting meaningful, person-centred research and improvement in health and social care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to participate\u003c/p\u003e\n\u003cp\u003eThis study is a scoping review of the published literature and did not involve the collection of primary data from human participants. Therefore, ethical approval and consent to participate were not required.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions are included within the article and its additional files.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was funded by the European Union\u0026rsquo;s Horizon 2020 Research and Innovation Program under the Marie Skłodowska-Curie grant agreement 956501. The views expressed in this manuscript are the author\u0026apos;s and do not necessarily reflect those of the funders.\u003c/p\u003e\n\u003cp\u003eAuthors contributions\u003c/p\u003e\n\u003cp\u003eQL and SC conceptualised the study and developed the methodology with input from GB. Data curation was performed by QL, GB, SC, GRL, QA, VAK, and MGG. QL conducted the formal analysis and wrote the original draft. All authors contributed to the review and editing. SC supervised the project. All authors validated the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAdditional Files\u003c/p\u003e\n\u003cp\u003eThree additional PDF files are included with this research. First, Additional file 1, titled \u0026ldquo;Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist\u0026rdquo;, contains the PRISMA-ScR checklist guiding the scoping review process. Additional file 2, titled \u0026ldquo;GRIPP2-SF checklist\u0026rdquo;, includes the GRIPP2-SF reporting on the patient and public involvement (PPI) dimension of this work. Then, Additional file 3, titled \u0026ldquo;List of Included Studies\u0026rdquo;, features a table displaying the studies included along with their type, aim, field, implied co-creation process, and associated needs. Finally, Additional file 4, titled \u0026ldquo;List of the Needs\u0026rdquo;, presents a table detailing each identified need along with its name, type of expression, attribute, theme, and associated subtheme.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eUnited Nations. World Social Report 2020: Inequality in a Rapidly Changing World [Internet]. UN; 2020 [cited 2024 Apr 17]. Available from: https://www.un-ilibrary.org/economic-and-social-development/world-social-report-2020_7f5d0efc-en\u003c/li\u003e\n \u003cli\u003eChakraborty I, Maity P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Sci Total Environ. 2020 Aug 1;728:138882.\u003c/li\u003e\n \u003cli\u003eDodds W. Disease Now and Potential Future Pandemics. In: Dodds W, editor. The World\u0026rsquo;s Worst Problems [Internet]. Cham: Springer International Publishing; 2019 [cited 2024 Apr 17]. p. 31\u0026ndash;44. Available from: https://doi.org/10.1007/978-3-030-30410-2_4\u003c/li\u003e\n \u003cli\u003eCalvin K, Dasgupta D, Krinner G, Mukherji A, Thorne PW, Trisos C, et al. IPCC, 2023: Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland. [Internet]. First. Intergovernmental Panel on Climate Change (IPCC); 2023 Jul [cited 2024 Apr 17]. Available from: https://www.ipcc.ch/report/ar6/syr/\u003c/li\u003e\n \u003cli\u003eShelton JD. Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale. Glob Health Sci Pract. 2014 Aug;2(3):253\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eBrett J, Staniszewska S, Mockford C, Herron‐Marx S, Hughes J, Tysall C, et al. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expect Int J Public Particip Health Care Health Policy. 2014 Oct;17(5):637\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eStaniszewska S, Denegri S, Matthews R, Minogue V. Reviewing progress in public involvement in NIHR research: developing and implementing a new vision for the future. BMJ Open. 2018 Jul 30;8(7):e017124.\u003c/li\u003e\n \u003cli\u003eLeask CF, Sandlund M, Skelton DA, Altenburg TM, Cardon G, Chinapaw MJM, et al. Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions. Res Involv Engagem. 2019 Dec;5(1):2.\u003c/li\u003e\n \u003cli\u003eDe Boer J, Delfmann LR, An Q, Loisel QEA, McCaffrey L, Koobasi M, et al. School staff experiences on involvement in a co-creation process: a Health CASCADE scoping review and thematic synthesis. BMC Public Health. 2025 Mar 7;25(1):916.\u003c/li\u003e\n \u003cli\u003eAn Q, Sandlund M, Lundell S, Kuenen C, Chastin S, Helleday R, et al. Transition design: Co-creating system solutions for chronic obstructive pulmonary disease (COPD) care. Des Stud. 2025 May 1;98:101297.\u003c/li\u003e\n \u003cli\u003eLeask CF, Sandlund M, Skelton DA, Chastin SF. Co-creating a tailored public health intervention to reduce older adults\u0026rsquo; sedentary behaviour. Health Educ J. 2017 Aug;76(5):595\u0026ndash;608.\u003c/li\u003e\n \u003cli\u003eVogelsang M, McCaffrey L, Ryde GC, Verloigne M, Dall P. Preparing for Co-Creation: A roadmap for planning a co-creation initiative from a case study on sedentary behaviour in Scottish SMEs \u0026ndash; A health CASCADE study. Public Health. 2025 May 1;242:157\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eViscusi G. Collective intelligence, crowd dynamics, and co-creation: preliminary insights from a case study in Robotics Innovation Facilities (RIFs). 2020 Dec 28 [cited 2025 Apr 29]; Available from: http://hdl.handle.net/10044/1/86083\u003c/li\u003e\n \u003cli\u003eMoons I, Daems K, Velde LVDV de. Co-Creation as the Solution to Sustainability Challenges in the Greenhouse Horticultural Industry: The Importance of a Structured Innovation Management Process. Sustainability [Internet]. 2021 [cited 2025 Apr 29]; Available from: https://consensus.app/papers/cocreation-as-the-solution-to-sustainability-challenges-moons-daems/50c895cdb066508f8734de2e691d76d0/\u003c/li\u003e\n \u003cli\u003eMulder I, Stappers P. Co-creating in practice: Results and challenges. 2009 IEEE Int Technol Manag Conf ICE. 2009;1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eBridge C, Demirbilek O, Mintzes A. Transforming Inclusion: Designing in the Experience of Greater Technological Possibility. Stud Health Technol Inform. 2016 Jan 1;229:143\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eBrinkley J, Huff EW, Boateng K. Tough but Effective: Exploring the use of Remote Participatory Design in an Inclusive Design Course Through Student Reflections. In: Proceedings of the 52nd ACM Technical Symposium on Computer Science Education [Internet]. Virtual Event USA: ACM; 2021 [cited 2023 Jan 26]. p. 170\u0026ndash;6. Available from: https://dl.acm.org/doi/10.1145/3408877.3432527\u003c/li\u003e\n \u003cli\u003eAlbrecht J, Stark AL, Dongas E, Wrona KJ, Dockweiler C. Hosting an Online World Caf\u0026eacute; to Develop an Understanding of Digital Health Promoting Settings from a Citizen\u0026rsquo;s Perspective-Methodological Potentials and Challenges. Int J Environ Res Public Health. 2022 Aug 12;19(16).\u003c/li\u003e\n \u003cli\u003eGodinho MA, Borda A, Kariotis T, Molnar A, Kostkova P, Liaw ST. Knowledge co-creation in participatory policy and practice: Building community through data-driven direct democracy. Big Data Soc. 2021 Jan 1;8(1):20539517211019430.\u003c/li\u003e\n \u003cli\u003eJaworski BK, Webb Hooper M, Aklin WM, Jean-Francois B, Elwood WN, Belis D, et al. Advancing digital health equity: Directions for behavioral and social science research. Transl Behav Med. 2023 Apr 3;13(3):132\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eMasterson D, Areskoug Josefsson K, Robert G, Nylander E, Kjellstr\u0026ouml;m S. Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future. Health Expect. 2022;25(3):902\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eAgnello DM, Loisel QEA, An Q, Balaskas G, Chrifou R, Dall P, et al. Establishing a Health CASCADE\u0026ndash;Curated Open-Access Database to Consolidate Knowledge About Co-Creation: Novel Artificial Intelligence\u0026ndash;Assisted Methodology Based on Systematic Reviews. J Med Internet Res. 2023 Jul 18;25(1):e45059.\u003c/li\u003e\n \u003cli\u003eArksey H, O\u0026rsquo;Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005 Feb;8(1):19\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eTricco AC, Lillie E, Zarin W, O\u0026rsquo;Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467\u0026ndash;73.\u003c/li\u003e\n \u003cli\u003eVerloigne M, Altenburg T, Cardon G, Chinapaw M, Dall P, Deforche B, et al. Making co-creation a trustworthy methodology for closing the implementation gap between knowledge and action in health promotion: the Health CASCADE project. Perspect Public Health. 2022 Oct 7;\u003c/li\u003e\n \u003cli\u003eStaniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. Res Involv Engagem. 2017 Aug 2;3(1):13.\u003c/li\u003e\n \u003cli\u003eLoisel Q, Agnello D, Chastin SFM. zenodo.org. 2022. Co-Creation Database. Available from: doi:10.5281/zenodo.6773028\u003c/li\u003e\n \u003cli\u003eDevlin J, Chang MW, Lee K, Toutanova K. BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding. 2018 [cited 2023 Apr 29]; Available from: https://arxiv.org/abs/1810.04805\u003c/li\u003e\n \u003cli\u003evan de Schoot R, de Bruin J, Schram R, Zahedi P, de Boer J, Weijdema F, et al. An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell. 2021 Feb;3(2):125\u0026ndash;33.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Thematic analysis: a practical guide. London ; Thousand Oaks, California: SAGE; 2022. 338 p.\u003c/li\u003e\n \u003cli\u003eFessler F, Reinwald F, Weichselbaumer R, Wentz J, Gebetsroither-Geringer E. Digitally Supported Participation Processes and Tools to Promote Gender-Responsive Public Spaces: Int J E-Plan Res. 2024 Mar 20;13(1):1\u0026ndash;25.\u003c/li\u003e\n \u003cli\u003eFredericks J, Foth M. Augmenting public participation: enhancing planning outcomes through the use of social media and web 2.0. Aust Plan. 2013 Sep 1;50(3):244\u0026ndash;56.\u003c/li\u003e\n \u003cli\u003eWinschiers-Theophilus H, Goagoses N, R\u0026ouml;tk\u0026ouml;nen E, Zaman T. Pushing political, cultural, and geographical boundaries: Distributed co-design with children from Namibia, Malaysia and Finland. Int J Child-Comput Interact. 2022 Mar 1;31:100439.\u003c/li\u003e\n \u003cli\u003eConstantin A, Hourcade JP. Toward a Technology-based Tool to Support Idea Generation during Participatory Design with Children with Autism Spectrum Disorders. In: Proceedings of the 20th International ACM SIGACCESS Conference on Computers and Accessibility [Internet]. Galway Ireland: ACM; 2018 [cited 2024 Oct 2]. p. 385\u0026ndash;7. Available from: https://dl.acm.org/doi/10.1145/3234695.3240995\u003c/li\u003e\n \u003cli\u003e\u0026Scaron;uklje Erjavec I, Ruchinskaya T. A Spotlight of Co-creation and Inclusiveness of Public Open Spaces. In: Smaniotto Costa C, \u0026Scaron;uklje Erjavec I, Kenna T, De Lange M, Ioannidis K, Maksymiuk G, et al., editors. CyberParks \u0026ndash; The Interface Between People, Places and Technology [Internet]. Cham: Springer International Publishing; 2019 [cited 2023 May 23]. p. 209\u0026ndash;23. (Lecture Notes in Computer Science; vol. 11380). Available from: http://link.springer.com/10.1007/978-3-030-13417-4_17\u003c/li\u003e\n \u003cli\u003eHelbing D, Mahajan S, Fricker RH, Musso A, Hausladen CI, Carissimo C, et al. Democracy by Design: Perspectives for Digitally Assisted, Participatory Upgrades of Society. J Comput Sci. 2023 Jul;71:102061.\u003c/li\u003e\n \u003cli\u003eConstantin A, Alexandru C, Korte J, Wilson C, Fails JA, Sim G, et al. Distributing participation in design: Addressing challenges of a global pandemic. Int J Child-Comput Interact. 2021 Jun;28:100255.\u003c/li\u003e\n \u003cli\u003ePejovic V, Skarlatidou A. Understanding Interaction Design Challenges in Mobile Extreme Citizen Science. Int J Human\u0026ndash;Computer Interact. 2020 Feb 7;36(3):251\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eAboucaya W, Angarita R, Issarny V. Detecting obstacles to collaboration in an online participatory democracy platform: a use-case driven analysis. In: Proceedings of the 2nd International Workshop on Equitable Data and Technology [Internet]. Pittsburgh Pennsylvania: ACM; 2022 [cited 2023 Jan 26]. p. 25\u0026ndash;33. Available from: https://dl.acm.org/doi/10.1145/3524491.3527307\u003c/li\u003e\n \u003cli\u003ePanagiotopoulou M, Stratigea A. Spatial Data Management and Visualization Tools and Technologies for Enhancing Participatory e-Planning in Smart Cities. In: Stratigea A, Kyriakides E, Nicolaides C, editors. Smart Cities in the Mediterranean [Internet]. Cham: Springer International Publishing; 2017 [cited 2023 May 17]. p. 31\u0026ndash;57. (Progress in IS). Available from: http://link.springer.com/10.1007/978-3-319-54558-5_2\u003c/li\u003e\n \u003cli\u003eEilola S, K\u0026auml;yhk\u0026ouml; N, Fagerholm N. Lessons learned from participatory land use planning with high-resolution remote sensing images in Tanzania: Practitioners\u0026rsquo; and participants\u0026rsquo; perspectives. Land Use Policy. 2021 Oct;109:105649.\u003c/li\u003e\n \u003cli\u003eWong TYT, Peko G, Sundaram D, Piramuthu S. Mobile environments and innovation co-creation processes \u0026amp; ecosystems. Inf Manage. 2016 Apr;53(3):336\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eAikins S. Participatory E-Planning: Bridging Theory and Practice through Improvements in Technology. Polit Democr E-Gov Particip Serv Deliv. 2010 Jan 1;131\u0026ndash;49.\u003c/li\u003e\n \u003cli\u003eReynante B, Dow SP, Mahyar N. A Framework for Open Civic Design: Integrating Public Participation, Crowdsourcing, and Design Thinking. Digit Gov Res Pract. 2021 Oct 31;2(4):1\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003eSlingerland G, Murray M, Lukosch S, McCarthy J, Brazier F. Participatory Design Going Digital: Challenges and Opportunities for Distributed Place-Making. Comput Support Coop Work CSCW. 2022 Dec;31(4):669\u0026ndash;700.\u003c/li\u003e\n \u003cli\u003eZellner ML. Participatory modeling for collaborative landscape and environmental planning: From potential to realization. Landsc Urban Plan. 2024 Jul;247:105063.\u003c/li\u003e\n \u003cli\u003eSkarzauskiene A, Rondinella G, Du Ciommo F, Mačiulienė M, Rahman MA, Abati YB. Framing Citizen Science for Climate Assemblies. In: 2023 8th International Conference on Smart and Sustainable Technologies (SpliTech) [Internet]. Split/Bol, Croatia: IEEE; 2023 [cited 2024 Jul 31]. p. 1\u0026ndash;5. Available from: https://ieeexplore.ieee.org/document/10193044/\u003c/li\u003e\n \u003cli\u003eKatapally TR. The SMART Framework: Integration of Citizen Science, Community-Based Participatory Research, and Systems Science for Population Health Science in the Digital Age. JMIR MHealth UHealth. 2019 Aug 30;7(8):e14056.\u003c/li\u003e\n \u003cli\u003eHeintz M, Law ELC, Govaerts S, Holzer A, Gillet D. Pdot: participatory design online tool. In: CHI \u0026rsquo;14 Extended Abstracts on Human Factors in Computing Systems [Internet]. Toronto Ontario Canada: ACM; 2014 [cited 2023 Feb 20]. p. 2581\u0026ndash;6. Available from: https://dl.acm.org/doi/10.1145/2559206.2581266\u003c/li\u003e\n \u003cli\u003eJoubert M, Wishart J. Participatory practices: Lessons learnt from two initiatives using online digital technologies to build knowledge. Comput Educ. 2012 Aug;59(1):110\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eReith A, Szil\u0026aacute;gyi-Nagy A, Balogh PI. Report of a Remote Participatory Design Process to Renew a Schoolyard during COVID-19 [Internet]. DE: Wichmann Verlag; 2021 [cited 2023 Jan 26]. Available from: https://doi.org/10.14627/537705037\u003c/li\u003e\n \u003cli\u003eJannack A, M\u0026uuml;nster S, Noennig J. Enabling Massive Participation: Blueprint for a Collaborative Urban Design Environment. In 2015. p. 2363\u0026ndash;80.\u003c/li\u003e\n \u003cli\u003eMatsumoto T, Kibi Y, Kondo T. Purpose Model Simulation - Purpose Formation of Multi-stakeholder by Dialog with LLM-Based AI. In: Streitz NA, Konomi S, editors. Distributed, Ambient and Pervasive Interactions [Internet]. Cham: Springer Nature Switzerland; 2024 [cited 2024 Jul 31]. p. 110\u0026ndash;29. (Lecture Notes in Computer Science; vol. 14718). Available from: https://link.springer.com/10.1007/978-3-031-59988-0_7\u003c/li\u003e\n \u003cli\u003eDu J, Ye X, Jankowski P, Sanchez TW, Mai G. Artificial intelligence enabled participatory planning: a review. Int J Urban Sci. 2024 Apr 2;28(2):183\u0026ndash;210.\u003c/li\u003e\n \u003cli\u003eM\u0026uuml;nster S, Georgi C, Heijne K, Klamert K, Rainer Noennig J, Pump M, et al. How to involve inhabitants in urban design planning by using digital tools? An overview on a state of the art, key challenges and promising approaches. Procedia Comput Sci. 2017 Jan 1;112:2391\u0026ndash;405.\u003c/li\u003e\n \u003cli\u003eLeonardi C, Not E, Gerosa M, Lotti R. A Case Study of Cross-Organizational Co-Design with Public Bodies: Opportunities for a Collaborative Platform. In: The 11th International Conference on Communities and Technologies (C\u0026amp;T) [Internet]. Lahti Finland: ACM; 2023 [cited 2024 Jul 31]. p. 6\u0026ndash;11. Available from: https://dl.acm.org/doi/10.1145/3593743.3593747\u003c/li\u003e\n \u003cli\u003eMariani I, Mortati M, Rizzo F. Strengthening e-Participation through Design Thinking. Relevance for Better Digital Public Services. In: Proceedings of the 24th Annual International Conference on Digital Government Research [Internet]. Gda?sk Poland: ACM; 2023 [cited 2024 Jul 31]. p. 224\u0026ndash;32. Available from: https://dl.acm.org/doi/10.1145/3598469.3598494\u003c/li\u003e\n \u003cli\u003eWhelan B. Enhancing Participatory Design Through Blockchain. Preserv Digit Technol Cult. 2024 Jul 26;53(2):73\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eShaikh AK, Baig S, Adhikari N, Shihi HA. E-participation System: Leveraging Blockchain Technology to Enhance Democratic Engagement. In: 2023 IEEE 8th International Conference on Engineering Technologies and Applied Sciences (ICETAS) [Internet]. 2023 [cited 2024 Jul 31]. p. 1\u0026ndash;5. Available from: https://ieeexplore.ieee.org/document/10346551/?arnumber=10346551\u003c/li\u003e\n \u003cli\u003eMahmoud H, Arima T. A Web-Based Public Participation System that Supports Decision Making. J Asian Archit Build Eng. 2011 May;10(1):77\u0026ndash;84.\u003c/li\u003e\n \u003cli\u003eBarenji AV, Guo H, Wang Y, Li Z, Rong Y. Toward blockchain and fog computing collaborative design and manufacturing platform: Support customer view. Robot Comput-Integr Manuf. 2021 Feb;67:102043.\u003c/li\u003e\n \u003cli\u003eMougiakou E, Parskevopoulos Y, Tsadari S. Spatial Tools and ppWebGIS Platforms for Sustainable Urban Development and Climate Change Adaptation: Participatory Planning in Urban Areas with Special Conditions. In: Gervasi O, Murgante B, Rocha AMAC, Garau C, Scorza F, Karaca Y, et al., editors. Computational Science and Its Applications \u0026ndash; ICCSA 2023 Workshops [Internet]. Cham: Springer Nature Switzerland; 2023 [cited 2024 Jul 31]. p. 630\u0026ndash;45. (Lecture Notes in Computer Science; vol. 14105). Available from: https://link.springer.com/10.1007/978-3-031-37108-0_40\u003c/li\u003e\n \u003cli\u003eLieven C, L\u0026uuml;ders B, Kulus D, Thoneick R. Enabling Digital Co-creation in Urban Planning and Development. In: Zimmermann A, Howlett RJ, Jain LC, editors. Human Centred Intelligent Systems. Singapore: Springer; 2021. p. 415\u0026ndash;30. (Smart Innovation, Systems and Technologies).\u003c/li\u003e\n \u003cli\u003eHess J, Randall D, Pipek V, Wulf V. Involving users in the wild\u0026mdash;Participatory product development in and with online communities. Int J Hum-Comput Stud. 2013 May;71(5):570\u0026ndash;89.\u003c/li\u003e\n \u003cli\u003eLuusua A, Ylipulli J, Kalarikalayil Raju D, R\u0026ouml;nkk\u0026ouml; E. Bridging Distances for Global Participation: Conducting and Theorizing Participatory Design and Research in Hybrid Contexts: Conducting and Theorizing Participatory Design and Research in Hybrid Contexts. In: Extended Abstracts of the 2023 CHI Conference on Human Factors in Computing Systems [Internet]. Hamburg Germany: ACM; 2023 [cited 2024 Jul 31]. p. 1\u0026ndash;5. Available from: https://dl.acm.org/doi/10.1145/3544549.3573823\u003c/li\u003e\n \u003cli\u003eJutraz A, Zupancic T. Criteria for Cooperative Urban Design through Digital System of Design Tools. In: 2012 16th International Conference on Information Visualisation. 2012. p. 416\u0026ndash;21.\u003c/li\u003e\n \u003cli\u003eBucchetti V, Rossi M, Tolino U, Verrotti Di Pianella B, Visconti P. Communication Design for Welfare, the Challenge of Preserving Human Interactions in Remote Participation. Rethinking and Redefining Collaborative Activities for a Virtual Environment. In: Zanella F, Bosoni G, Di Stefano E, Iannilli GL, Matteucci G, Messori R, et al., editors. Multidisciplinary Aspects of Design [Internet]. Cham: Springer Nature Switzerland; 2024 [cited 2024 Jul 31]. p. 475\u0026ndash;84. (Springer Series in Design and Innovation; vol. 37). Available from: https://link.springer.com/10.1007/978-3-031-49811-4_45\u003c/li\u003e\n \u003cli\u003eStelzle B, Jannack A, Rainer Noennig J. Co-Design and Co-Decision: Decision Making on Collaborative Design Platforms. Procedia Comput Sci. 2017;112:2435\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eArsenopoulos A, Mastromichalakis N, Psarras J. Developing a software-based platform for strengthening public participation in Greece. In: 2020 11th International Conference on Information, Intelligence, Systems and Applications (IISA. 2020. p. 1\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eHorlitz T. The Role of Model Interfaces for Participation in Water Management. Water Resour Manag. 2007 Jun 15;21(7):1091\u0026ndash;102.\u003c/li\u003e\n \u003cli\u003evan Kouwen F, Dieperink C, Schot PP, Wassen MJ. Computer-Supported Cognitive Mapping for Participatory Problem Structuring. Environ Plan Econ Space. 2009 Jan 1;41(1):63\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eMačiulienė M, Skaržauskienė A. Evaluation of co-creation perspective in networked collaboration platforms. J Bus Res. 2016 Nov;69(11):4826\u0026ndash;30.\u003c/li\u003e\n \u003cli\u003eRoszczyńska-Kurasińska M, Wr\u0026oacute;blewska N. Technological Innovations for Citizen Environmental Participation: Case of Poland. Sustainability. 2023 Mar 12;15(6):5031.\u003c/li\u003e\n \u003cli\u003eJutraz A, Zupancic T. Digital system of tools for public participation and education in urban design: Exploring 3D ICC. In Prague, Czech Republic; 2012 [cited 2023 Jan 25]. p. 383\u0026ndash;92. Available from: http://papers.cumincad.org/cgi-bin/works/paper/ecaade2012_113\u003c/li\u003e\n \u003cli\u003eDalsgaard P. Challenges of participation in large-scale public projects. In: Proceedings of the 11th Biennial Participatory Design Conference [Internet]. Sydney Australia: ACM; 2010 [cited 2023 Jan 17]. p. 21\u0026ndash;30. Available from: https://dl.acm.org/doi/10.1145/1900441.1900445\u003c/li\u003e\n \u003cli\u003ePipan T. Interactive tangible planning support systems and politics of public participation. Urbani Izziv. 2018 Sep 28;29(supplement):63\u0026ndash;78.\u003c/li\u003e\n \u003cli\u003eZhu L, Barricelli B, Iacob C. A Meta-Design Model for Creative Distributed Collaborative Design. IJDST. 2011 Oct 1;2:1\u0026ndash;16.\u003c/li\u003e\n \u003cli\u003eGiesen N, S\u0026uuml;pke D. ProPlaNET: Collaborative Sustainable Project Planning: A Comparison with Existing Approaches. In: Golinska P, Fertsch M, Marx-G\u0026oacute;mez J, editors. Information Technologies in Environmental Engineering [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2011 [cited 2023 May 17]. p. 397\u0026ndash;406. (Environmental Science and Engineering; vol. 3). Available from: https://link.springer.com/10.1007/978-3-642-19536-5_31\u003c/li\u003e\n \u003cli\u003eWalsh G, Foss E. A case for intergenerational distributed co-design: the online kidsteam example. In: Proceedings of the 14th International Conference on Interaction Design and Children [Internet]. Boston Massachusetts: ACM; 2015 [cited 2023 Feb 20]. p. 99\u0026ndash;108. Available from: https://dl.acm.org/doi/10.1145/2771839.2771850\u003c/li\u003e\n \u003cli\u003eHennig SS, Vogler R, Sch\u0026ouml;tz T, Strobl J, Imanalieva P. Towards more User-Centered Contributory Citizen Science Initiatives: Learning from the u3Green Approach. Int J Geoinformatics. 2023 Nov 29;19(11):26\u0026ndash;37.\u003c/li\u003e\n \u003cli\u003eHeintz M, Law ELC. Pdotcapturer and Pdotanalyser: participatory design online tools for asynchronous idea capturing and analysis. In: Proceedings of the 10th Nordic Conference on Human-Computer Interaction [Internet]. Oslo Norway: ACM; 2018 [cited 2023 Feb 8]. p. 622\u0026ndash;33. Available from: https://dl.acm.org/doi/10.1145/3240167.3240214\u003c/li\u003e\n \u003cli\u003eMcCormack J, Hutchings P, Gifford T, Yee-King M, Llano MT, D\u0026rsquo;inverno M. Design Considerations for Real-Time Collaboration with Creative Artificial Intelligence. Organised Sound. 2020 Apr;25(1):41\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eSkarlatidou A, Hamilton A, Vitos M, Haklay M. What do volunteers want from citizen science technologies? A systematic literature review and best practice guidelines. J Sci Commun. 2019 Jan 17;18(01):A02.\u003c/li\u003e\n \u003cli\u003eDufendach KR, Koch S, Unertl KM, Lehmann CU. A Randomized Trial Comparing Classical Participatory Design to VandAID, an Interactive CrowdSourcing Platform to Facilitate User-centered Design. Methods Inf Med. 2017 Oct;56(05):344\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eKelley T, Johnston E. Discovering the appropriate role of serious games in the design of open governance platforms. Public Adm Q. 2012 Jan 1;36.\u003c/li\u003e\n \u003cli\u003eGarc\u0026iacute;a-Holgado A, Garc\u0026iacute;a-Pe\u0026ntilde;alvo FJ, Butler P. Technological Ecosystems in Citizen Science: A Framework to Involve Children and Young People. Sustainability. 2020 Mar 1;12(5):1863.\u003c/li\u003e\n \u003cli\u003eKrishnamurthy R, Bhagwatwar A, Johnston EW, Desouza KC. A Glimpse into Policy Informatics: The Case of Participatory Platforms that Generate Synthetic Empathy. Commun Assoc Inf Syst [Internet]. 2013 [cited 2023 Jan 25];33. Available from: https://aisel.aisnet.org/cais/vol33/iss1/21\u003c/li\u003e\n \u003cli\u003eSiemon D, Becker F, Eckardt L, Robra-Bissantz S. One for all and all for one - towards a framework for collaboration support systems. Educ Inf Technol. 2019 Mar;24(2):1837\u0026ndash;61.\u003c/li\u003e\n \u003cli\u003eChen MFY. Co-immersive-Creation: A Hybrid Approach for Using Virtual Reality and Telepresence Systems in Co-design Research. In: Stephanidis C, Antona M, Ntoa S, editors. HCI International 2021 - Posters [Internet]. Cham: Springer International Publishing; 2021 [cited 2023 May 24]. p. 217\u0026ndash;24. (Communications in Computer and Information Science; vol. 1420). Available from: https://link.springer.com/10.1007/978-3-030-78642-7_29\u003c/li\u003e\n \u003cli\u003eDe Moor K, Berte K, De Marez L, Joseph W, Deryckere T, Martens L. User-driven innovation? Challenges of user involvement in future technology analysis. Sci Public Policy. 2010 Feb 1;37(1):51\u0026ndash;61.\u003c/li\u003e\n \u003cli\u003eReay P, Seddighi HR. An empirical evaluation of management and operational capabilities for innovation via co‐creation. Eur J Innov Manag. 2012 Apr 20;15(2):259\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eFeinberg S, Murphy M. Applying cognitive load theory to the design of web-based instruction. 2000 [cited 2025 Apr 29]; Available from: https://consensus.app/papers/applying-cognitive-load-theory-to-the-design-of-webbased/d7c46ef1f2375976b7aad1279984efb3/\u003c/li\u003e\n \u003cli\u003eSushama P, Ghergu C, Meershoek A, de Witte LP, van Schayck OCP, Krumeich A. Dark clouds in co-creation, and their silver linings: Practical challenges we faced in a participatory project in a resource-constrained community in India, and how we overcame (some of) them. Glob Health Action. 2018 Jan;11(1):1421342.\u003c/li\u003e\n \u003cli\u003ePescetelli N. A Brief Taxonomy of Hybrid Intelligence. Forecasting. 2021 Sep;3(3):633\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eMitre X, Zeneli M. Using AI to Improve Accessibility and Inclusivity in Higher Education for Students with Disabilities. In: 2024 21st International Conference on Information Technology Based Higher Education and Training (ITHET) [Internet]. 2024 [cited 2025 Mar 29]. p. 1\u0026ndash;8. Available from: https://ieeexplore.ieee.org/document/10837607\u003c/li\u003e\n \u003cli\u003eBalaskas G, Papadopoulos H, Loisel Q, Pappa D, Efthymoglou G, Chastin S. An end-to-end system for transcription, translation, and summarization to support the co-creation process. A Health CASCADE Study. In: Proceedings of the 16th International Conference on PErvasive Technologies Related to Assistive Environments [Internet]. New York, NY, USA: Association for Computing Machinery; 2023 [cited 2024 Mar 5]. p. 625\u0026ndash;31. (PETRA \u0026rsquo;23). Available from: https://dl.acm.org/doi/10.1145/3594806.3596567\u003c/li\u003e\n \u003cli\u003eKhan MA, Asadi H, Zhang L, Qazani MRC, Oladazimi S, Loo CK, et al. Application of artificial intelligence in cognitive load analysis using functional near-infrared spectroscopy: A systematic review. Expert Syst Appl. 2024 Sep 1;249:123717.\u003c/li\u003e\n \u003cli\u003eGao J, Guo Y, Lim G, Zhang T, Zhang Z, Li TJJ, et al. CollabCoder: A Lower-barrier, Rigorous Workflow for Inductive Collaborative Qualitative Analysis with Large Language Models [Internet]. arXiv; 2024 [cited 2025 Mar 29]. Available from: http://arxiv.org/abs/2304.07366\u003c/li\u003e\n \u003cli\u003eSpillias S, Tuohy P, Andreotta M, Annand-Jones R, Boschetti F, Cvitanovic C, et al. Human-AI collaboration to identify literature for evidence synthesis. Cell Rep Sustain [Internet]. 2024 Jul 26 [cited 2025 Mar 29];1(7). Available from: https://www.cell.com/cell-reports-sustainability/abstract/S2949-7906(24)00207-6\u003c/li\u003e\n \u003cli\u003eBahangulu JK, Owusu-Berko L. Algorithmic bias, data ethics, and governance: Ensuring fairness, transparency and compliance in AI-powered business analytics applications. World J Adv Res Rev. 2025;25(2):1746\u0026ndash;63.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient and Public Involvement (PPI), Digital technology, Co-creation, Participatory Research, Collective Intelligence, Artificial intelligence","lastPublishedDoi":"10.21203/rs.3.rs-6819176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6819176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nPatient and public involvement (PPI) is increasingly recognised as essential for meaningful, equitable, and impactful health and social care research. Co-creation is a promising involvement approach, but it faces barriers to enable its optimal potential. Digital technologies have the potential to overcome these challenges and strengthen the participatory process, but the specific technology needs that underpin effective participation and engagement remain underexplored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nWe conducted a comprehensive scoping review of 60 peer-reviewed studies to systematically map the digital technology needs supporting co-creation processes. Needs were extracted and thematically analysed, resulting in a structured synthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nA total of 337 distinct digital technology needs were identified and organised into five thematic areas: Ensuring Integrity, Enabling Methodology, Cognitive Needs, Group Dynamics, and Process Management. While most needs focused on functional attributes, non-functional characteristics, such as usability, scalability, and inclusivity, emerged as critical for meaningful patient and public engagement. The review highlights the fragmented articulation of technology needs across disciplines and settings. It proposes a structured framework to make latent needs visible, align stakeholder perspectives, and guide the development of digital tools. The emerging role of artificial intelligence in supporting hybrid models of involvement, along with the associated ethical challenges, is also discussed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nThis review provides the first thematic framework for understanding and addressing digital technology needs in co-creation. The findings offer a foundation for researchers, practitioners, and policy-makers within health and social care to develop and implement digital tools that enhance accessibility, engagement, and impact of participatory processes. Future research should validate and refine these insights in partnership with patients, service users, and diverse communities to ensure technological solutions foster truly inclusive and effective involvement.\u003c/p\u003e","manuscriptTitle":"Needs Assessment of Digital Technology in Co-Creation: A Health CASCADE Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 19:33:26","doi":"10.21203/rs.3.rs-6819176/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-02T20:41:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T11:20:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T18:59:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-10T09:44:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95580178347675532449135649966215754385","date":"2025-07-09T15:19:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318798337857330467785776495969277460310","date":"2025-07-09T12:05:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199203909174129671426953629780935014194","date":"2025-07-08T13:57:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76088901805133579820834045536685705371","date":"2025-07-07T00:40:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T09:05:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-11T23:46:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Research Involvement and Engagement","date":"2025-06-11T16:09:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b5a1666-09e9-4c90-a5ba-7b04f11996bd","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:35:41+00:00","versionOfRecord":{"articleIdentity":"rs-6819176","link":"https://doi.org/10.1186/s40900-025-00797-x","journal":{"identity":"research-involvement-and-engagement","isVorOnly":false,"title":"Research Involvement and Engagement"},"publishedOn":"2025-10-21 16:17:13","publishedOnDateReadable":"October 21st, 2025"},"versionCreatedAt":"2025-06-18 19:33:26","video":"","vorDoi":"10.1186/s40900-025-00797-x","vorDoiUrl":"https://doi.org/10.1186/s40900-025-00797-x","workflowStages":[]},"version":"v1","identity":"rs-6819176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6819176","identity":"rs-6819176","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}