Innovation studies, in general, and health innovation literature, in particular, point out different types of innovations, such as new products, services, processes, methods, markets, and sources of supply [4,20,21]. New procedures, health policy innovations, and strategy innovation are also defined as special types of innovation in relation to health [4]. In each of the subprojects, a new digital health innovation is developed. However, the focus of the synergy project is not on the innovation as such (end result), but on the process of coproduction in which health innovations are designed, developed, and disseminated.

There are many different models of innovation, developed for diverse purposes and aiming at various levels of aggregation. A linear—technology-push—model of innovation conceptualizes innovation as a process triggered by accomplishments in research and development that through production and marketing lead to a commercialized product on the market [22]. According to a chain-linked—market-pull—model of innovation, innovation emerges when the potential in the market has been identified and developed through constant feedback between design, test, and market units, which are embedded in research and knowledge environment [23]. More recent models of innovation put even higher emphasis on the interactive nature of the innovation process, not least arguing for the users as important partners for collaboration in innovation [24,25]. The system of innovation approach views innovation as a cumulative process emerging through systemic interactions of the actors (firms, research organizations, governmental authorities, and customers) embedded in a certain institutional setting, delineated by regional, national, or sectorial boundaries [26-28]. In this literature, users can be viewed as sophisticated buyers, active codevelopers, and value setters, contributing to structural change processes [29]. In our project, we view innovation as a circular process with 4 related stages—solution, output, outcome, and impact (Figure 1). The impact stage describes the process of defining a problem together with users and other stakeholders in relation to a challenge that can be addressed through the introduction of a new innovation.

The solution stage describes the design of strategies for how a solution to the defined problem can ground challenges in logical frameworks or theories of change that could be used in the design of solutions together with users and other stakeholders. The output stage describes the process of knowledge, service, and technology development in coproduction with various stakeholders and the implementation of the developed artifact, guided by models and methods for intervention and change management and for evaluation. The outcome stage describes the evaluation of effects of implementation in relation to the defined problem and thereafter dissemination of the results. This includes a critical analysis of the direct and indirect consequences of dissemination and how it contributes toward impact in relation to the initially identified problem. This model, with its 4 stages, has been developed as a part of strategic work to define health innovation efforts at Halmstad University [30]. It goes beyond technology-push or market-pull dichotomy, highlights the iterative nature of innovation, and suggests that innovation can be triggered at any stage of the process. It is inspired by an interactive approach to innovation, emphasizing collaboration with different stakeholders at each stage. In this synergy project, we want to advance our understanding about one type of stakeholders—users; more concretely, we are interested in finding under which circumstances and what roles different groups of users play under different stages of a health innovation process as well as to analyze challenges and mechanisms related to their inclusion. Thus, we are interested in user-centered innovations which we define as triggered by unique user needs and developed in collaboration with product or service providers, public sector, and researchers. Including users and other stakeholders of health products and services in the design and development process leads to increased efficiency and quality of health care processes [31,32].

Various concepts, such as cocreation, codesign, and coproduction, are used to describe innovation processes with several stakeholders involved. Sometimes they are used as synonyms, and sometimes differences are pointed out [33]. Cocreation is the broadest term, including different forms of interaction with users (or other stakeholders) from consultation to participation and generation [34]. Codesign refers to the “creativity of designers and people not trained in design working together in the development process” and focuses on the early stages of the innovation process from idea generation to product development and less so on implementation, dissemination, and evaluation [33]. In this project, we follow Dunston et al’s (2009) understanding of coproduction in health, which implies that health innovation evolves in a collaboration process between users, health care professionals, and other stakeholders, such as private companies bringing products and services to the market and researchers at the University [32]. This concept is chosen because it is best aligned with the understanding of the innovation process that is used in this project. It also delineates interaction with users as an active collaboration rather than opening up for any type of activities where users influence innovation processes.

According to health care and innovation scholars, one of the biggest potentials for renewal of the health sector is via digitalization, which also has considerable potential to result in cost savings [2,35]. In the Swedish context, it is estimated that digitalization of health care could save 180 billion SEK a year [36]. Furthermore, the use of digital technologies could also lead to better disease prevention, greater personal engagement in one’s health, and an improved work environment for health care professionals [36]. Thus, because of its high innovation and value-added potential, we focus on digital, user-centered health innovations. In this project, we understand digitalization as the use of a variety of converging digital tools (wireless sensors, information systems, social networking, and mobile connectivity) in health-related products and services (see also [2]).

The synergy project consists of 3 subprojects, allowing us to study user participation and coproduction in different organizational contexts and in relation to different user groups and, thus, to address coproduction-related challenges from different perspectives. Although the projects have a similar emphasis on user participation in coproduction, they also target distinctive phases or segments in the spectrum from problem elicitation to the implementation of health innovation (Figure 1). Implementing these projects in parallel will help gain an in-depth understanding of the challenges and barriers associated with user-centered coproduction and how these barriers can be overcome or managed during the innovation process. The projects are similar in that they are addressing complex health challenges and are designed so that users and other stakeholders have significant influence over the content of the projects. Collectively, our proposed projects are likely to yield new knowledge of these challenges and how to tackle them from a holistic perspective, rather than from a segmented process of innovation.

The project is generic in its ambition to create a meta-framework for solutions to problems that currently exist in the health sector, which transcend the boundaries of each subproject. By studying similarities and differences in our chosen areas of innovation—such as different social and organizational contexts and the needs, abilities, and conditions of different user groups—we will generate knowledge and solutions to creating health innovations that can be applied across a variety of contexts. The research question is multidisciplinary and needs an integrated effort from competencies belonging to different research fields to be answered. Moreover, the project aims at mobilizing researchers and representatives from industry, the public sector, and users in project teams, conducting health innovation in an integrated participatory design process where all actors are involved in the process at all stages.

Our rationale for this synergy is that the integration of users in the coproduction of health innovations contributes to relevance and quality of innovations as well as to efficiency in the innovation process. However, achieving such user participation can be challenging both in itself and because of circumstances and practices associated with various contextual factors. We have specifically identified 3 areas of challenges, namely, coproduction, positioning, and realization. These challenges are influenced by factors associated with different contexts and user groups, and therefore need to be studied from a variety of perspectives to create a broad understanding of the meaning of the challenges and how they can be managed at a general level. We intend to accomplish this by integrating 3 subprojects that focus on different user groups, apply different strategies to promote human health, and relate to distinct parts of the health sector.

The synergy subprojects are designed in such a way that each of them can be carried out independently of the others. The subprojects use a variety of methods to generate empirical data adapted to circumstances and conditions for the individual project, and to the different phases of the innovation process (Figure 1). In identifying challenges and problems for the involved user groups, individual and focus group interviews will be conducted, as well as observation of users in the context of their everyday life. In the phase of creation of health innovations, the workshop format plays a significant part, and using a mixture of methods—storyboards, scenarios, analogies, etc—user groups, researchers, and company representatives work together iteratively to find solutions to identified problems. To evaluate outcomes of implementation and interventions, both quantitative and qualitative methods are used, in the format of validated questionnaires as well as individual and focus group interviews.

The work on the work packages will use a case methodology for data collection and analysis based on the subprojects as data sources. Each subproject will be treated as a study object where documentation and results from the project will be used as data for qualitative analysis and design of frameworks and models that answer the goals described in the respective work packages [17,37]. A case study approach is beneficial in several ways for this project because it allows for a combination of data collection tools, gives attention to contextual factors regarding the phenomena under investigation, and can be used to develop theory [38]. Furthermore, in our ambition to develop a generic, as well as context-sensitive, understanding, the use of a multiple case study logic is vital. Our chosen cases (the subprojects) are similar in its attention to user participation in coproduction, but unalike regarding, eg, context and target groups. This allows for an examination of similarities and dissimilarities, patterns, and particulars in relation to each of the challenges (coproduction, positioning, and realization elaborated on in WP 1-3) and as such develops a generalized as well as context-sensitive understanding of user participation. The analysis of the research question at the synergy level will use strategies developed using the framework methodology to handle and analyze the vast amount of information generated within the subprojects [39]. This method uses matrices to summarize, compare, and synthesize diverse units for analysis.

Coproduction in the health sector is complex, and the prerequisites and opportunities for coproduction are dependent on the target group, the type of innovation being developed, and the target health sector. Therefore, lessons learned from the respective subprojects will be shared to maximize the success of each project as well as to the overall synergy project. The results presented in the work packages will strengthen the ability for coproduction within the involved research groups, companies, public sector, and user associations, and this acquired expertise will, through established networks and collaborations, be disseminated to other researchers within and outside the University as well as to partners and the involved stakeholders. The work packages have 2 types of deliverables. Reports are small publications or presentations aimed at (1) spreading experiences, methods, and new knowledge between the 3 subprojects and the participating partners from industry and the public sector early in the course of the project and (2) making sure that the knowledge generated in the project remains with the project partners beyond individuals. For some work packages, preliminary reports will be released early internally and then completed as final reports for dissemination outside the synergy project group, such as to interested recipients within industry, public sector, and nongovernmental organizations. Such dissemination can be in the forms of presentations, popular science articles, information booklets, news articles to be spread via conferences, industry breakfast meetings, industry magazines, specialized websites, social media, and other relevant mediums. In addition to researchers, representatives from companies, public sector, and user organizations will be involved in these dissemination tasks. Papers are in the format of in-depth research publications based on the various reports and are developed to meet criteria for scientific evidence.

The synergy project team will be responsible for coordinating and addressing the main research question with its work packages, but collaboration with companies and users will be paramount at this level, and not only in the subprojects. This collaboration at the synergy level will be organized in the format of workshops involving researchers, companies, and users. At these workshops, preliminary results and findings will be discussed and elaborated and function as a springboard to achieve deliverables in the form of reports and papers. An essential objective of these workshops is to identify novel knowledge that constitutes intellectual assets, such as scientific results, methods, and inventions, and how to use them for various purposes. To manage questions of ownership and availability, the Intellectual Asset Inventory will be used (Chalmers Innovation office [40]).