Pragmatic co-design methodology: a tale of university and retirement village friendship

ABSTRACT

Co-authored by academic staff and older adult community members, this paper reports on an incidental and pragmatic co-design model grounded in a round table friendship-informed approach. Interdisciplinary academics met with residents of a proximate retirement community, sharing open discussions with no agenda, including improving engagement between the two communities. The ensuing co-designed programme of outreach activities was of myriad mutual benefits: the retirement community benefited through opportunities for meaningful engagement via inter-generational knowledge-sharing, social connection, and access to expertise and equipment, whilst the University benefited across Learning and Teaching, Research, Engagement, and Commercialisation sectors. This pragmatic co-design approach described resulted in equitable contributions to knowledge generation, exchange, and translation in an interdirectional way. We argue that future research can adopt such an approach, exhibiting potential across all forms of community engaged research.

KEYWORDS:

• Codesign
• ageing
• retirement
• community
• work integrated learning
• creative industries

1. Introduction

The Australian retirement village model, established in the 1970s, has grown to accommodate over 8% of Australians over the age of 75 (Travers et al. 2022). The retirement village sector continues to grow at a rate of 4.6% per annum nationally generating an estimated $5 billion year on year in revenue (IBISWorld 2023). To date, the retirement village model has long been touted as a major stress reliever on the aged care and health sectors, largely through prolonging healthy living, deferring the need for high-care, and in some cases removing the need entirely (McCrindle 2023). Originally established as a lifestyle and resort proposition for residents, the sector finds itself with a suite of ageing infrastructure and a business model not designed for the new generation of older Australians. Residents of the retirement village model have undergone a shift in their expectations and needs from one of the lifestyle within their forever home and community to a desire to age in place, resulting in a need to manage the complex and nuanced clinical care of tens of thousands of older Australians. With these new pressures on retirement village operators becoming more critical, there has never been a deeper need for research into the retirement village sector.

In this paper, we explore and critique a research project that engaged village residents in creative practice for wellbeing with a view to creating new best-practice models of wellbeing integrations through cultural engagement. Specifically, rather than taking a health and wellbeing focus in this case, we highlight the ways in which our project methodology addressed the complexities of integration into retirement village communities through pragmatic co-design. In doing so, we discuss how the research team became participants in the retirement village community and built trust to work towards a co-design methodology with a unique pragmatic framework specifically designed to speak to the challenges of integrating into a regional Australian retirement community.

1.1. Co-design thinking

At a policy level, the retirement village sector is challenged by where it sits within Australian Federal Government. Instead of being included in the Governmental Health portfolios, the retirement village policymaking sits with the Australian Competition and Consumer Commission (ACCC 2023) as a purely economic proposition. As a result, health and wellbeing, and social research has not been seen as valuable to the sector (Travers et al. 2022). From a social research perspective, the challenges are altogether different. The age demographic of retirement residents often that a socio-cultural position that does not pathologize itself as needing help (Breheny, Pond, and Lilburn 2020), mistrusts expertise and involvement of universities in their day-to-day life (Tavener, Byles, and Loxton 2014), and often limits the involvement of new individuals or organisations outside their specific communities (Goll et al. 2015). In most papers of this kind, we would begin with a discussion on project design through an underpinning methodology. In our case, we cannot take this approach as we did not start our work with traditional research methodologies in mind. Indeed, we came to a position of positing a new pragmatic friendship-informed codesign methodology by unintentional community work in the creative and cultural engagement space. With this in mind, rather than positioning our work as a comprehensive rethinking and retooling of existing co-design thinking, we instead highlight how our project emerged from community need, and how we pragmatically responded to that need. However, to contextualise this discussion we first explore some of the key discussion on co-design that inform this paper.

Within the context of retirement and retirement communities, co-design is yet to be widely utilised as there is a lack of significant research undertaken in Australian retirement villages (McCrindle 2023). Co-design/participatory research with older adults is a diverse and engaging field with multiple innovations emerging in recent publications (Constantin et al. 2022; Ianniello et al. 2019; Sakaguchi-Tang et al. 2021). However, recent reviews have highlighted variability in both co-design quality and approach (Constantin et al. 2022; Ianniello et al. 2019; Tong et al. 2022), with many co-design approaches only involving older adults at certain phases (Tong et al. 2022). Indeed, a lack of literature presenting co-creation frameworks has been identified as a specific barrier to the success of this approach (Constantin et al. 2022). Arnstein’s Ladder of Citizen Participation (Arnstein 2019) is sometimes suggested as a framework/lens to evaluate older adult involvement in such projects (Fischer et al. 2021). While the ladder is a neat method for positioning action within a hierarchy of power and citizen control, we have found undertaking a pragmatic approach to co-designing research with retirement village communities is a far more messy and diverse process that often contains elements across the various rungs of Arnstien’s model. Indeed, researchers have questioned if it is realistically ‘possible to combine efficiency and enrichment in decision-making?’ (Ianniello et al. 2019), calling for further empirical evidence (Constantin et al. 2022; Ianniello et al. 2019). Considering the intrinsic multi-disciplinary nature of citizen participation (Ianniello et al. 2019), our methodology, based on the case study outlined later in this paper, describes an effective and robust framework for co-design with older adults positioned as leaders in identifying their own community needs, truly engaging in citizen-led co-design.

1.2. Case study: accidental co-design through a pragmatic friendship

It was the 20^th of February 2021, when Geoff, a retirement village resident and co-author of this paper, chose to attend the opening of a creative industries facility at the Sippy Downs campus of the University of the Sunshine Coast. At this event, Geoff introduced himself to Dr Ward, then head of department and manager of the new facility. After exchanging emails, Geoff set about organising meetings, coffees, sessions, calls, and many other methods for consistent and considered contact with Dr Ward. It was in these sessions that a true friendship was born, not from a transactional need to a researcher to develop a project with a participant, but to discuss Geoff’s philosophy, his needs, his passion for his community, and his creative desires. A pragmatic friendship that accidentally sparked 3 years of ongoing co-designed work with retirement villages in the Sunshine Coast region.

It took 3 months of coffee and discussion for Dr Ward and Geoff to come up with our first plan: to stage a show long thought about by Geoff. Not as a wellbeing project, or a creative practice research output, or even really with research in mind, but as a community designed event to help Geoff share his wisdom, experience, music, and history. What emerged from this event was a show, a work in cultural production and oral history. It did not emerge from any predisposed concepts of how one party might serve the agenda of the other to their own ends. Nor did it manifest in a meaningful and clear quantitative study of health metrics and outcomes. What did emerge from this approach was a new, albeit unacknowledged at the time, pragmatic approach to codesigning projects with retirement village residents. A methodology of codesign that entirely surrendered the agenda of research to the needs of the participant. Deploying Geoff’s concept, and the involvement of three of his musical friends, a 90-minute show called Life Transitions: a philosophical elders journey was born. As researchers and creative practitioner, Dr Ward and Geoff utilised the stage show to invite over 70 guests from across the sector and the university attending. The work was filmed and distributed to the university executive, researchers in gerontology, and the operational staff of the retirement village to great success, ultimately being cited as an artefact that led to the further funding of projects in the village.

Here, we note the first clear community and participant benefit whereupon the university not only provided research staff to undertake a qualitative review of the experience, but also provided staffing, creative development and workshopping, stage and video production resources, and a venue all of which would cost beyond the financial capacity of the village residents if the production was to be undertaken privately. Fundamentally, this approach allowed for community to realise their desired outcomes through the utilisation of university resources that would otherwise not be open to the public. In our model of pragmatic co-design, we highlight here how important this element is. Specifically, universities, especially in regional Australia are oft underutilised and siloed from the community. Using our approach, we were able to free up the resources of the University to provide meaningful creative activation, audience building, and community development.

While in this case the approach of pragmatic friendship might seem imprecise, it is in fact a detailed, deliberate, and structured method that embraces the thinking and needs of both parties. Friendship as a method of inquiry and research is written about by many scholars in both health and ethnographic research (Owton and Allen-Collinson 2014; Tillmann-Healy 2003) and the role friendship plays in co-design with vulnerable groups (Calvo and Sclater 2021; Zhu, Hardy, and Myers 2022), yet discussion on the pragmatic role friendships might play in the process of co-design are still limited. In our case, the friendship that led to a non-transactional creative development process exemplifies an approach that can be highlighted in more detail.

The outcomes present in the seemingly simple creative production of Life Transitions represents a meaningful qualitative account of four older Australian’s lives with far reaching implications and outcomes including: innovative approaches to wellbeing research through cultural activation, and new models of oral history and heritage recording. The potential for using this cultural engagement approach to research development actively speaks to notions of co-design but attempts to remove the transactional notion of deliberately motivated research with predetermined outcomes. To clarify, when you commence a programme of research in haematology, it is assumed your outcome will be haematological. Instead, using our pragmatic approach, we commenced with no knowledge of the end result of our work but connected university and village staff and residents whereupon the participants’ self-identified desires were directly developed and realised. The resulting cultural production then existed as a site for investigation and data capture. Put more simply, the participant tells the researcher what they want to do, and the researcher explores its implications and impacts on any number of possible research fields (Health, Heritage, Creative Industries, etc).

In this method, we allow the cultural and social engagement between the researcher and participant to guide the development of a project. In doing so the participant proposes the actions of the project according to their best suited needs and desired outcomes. The researcher then examines how this action can be utilised as a site of investigation. In one example, a participant may wish to take dance lessons, the researcher co-designs a musical playlist and uses dance as a site of exercise engagement research. In another example, the participant might want to better understand personal computers, the researcher will co-design resourcing to provide that service, and then deliver a PC workshop as a site of neurological health investigation. In making this approach more general in the context of retirement we would describe the process as:

1. The retirement resident (participant) and researcher socialise and explore the needs and desires of the resident based on their cultural history and lived experience

2. The resident then describes a desired action-based outcome speaking to that need while the researcher explores how to facilitate using university and retirement village resources

3. A plan to develop and deliver the action-based outcome is co-designed by both parties

4. The researcher devises a set of methods leveraging the outcome as site of investigation

In formalising our pragmatic co-design approach in a broad method flexible enough for any research approach, we describe each process as:

1. Social and cultural engagement (Co-designed)

2. Outcome development (participant-led)

3. Outcome planning and delivery (co-designed)

4. Leveraged research (researcher-led)

This approach is not dependent on a particular field or research focus, instead it provides outcomes that speak to the needs of community, responding to regional priorities, and demands the researcher innovate and devise experiments that can make those outcomes a valuable site of investigation. In this model, we found an effective way of navigating and reducing the barriers and complexities outlined earlier. Specifically:

1. In communities like retirement villages who are less likely to engage outside help, we allowed the social connection between academic and community to emerge pragmatically through a friendship connection. This allowed us to hold conversation about the nature of need in the community without is being seen as transactional or motivated by and ulterior agenda.

2. Building a project based on friendship that set the needs of the community at its centre allowed us to navigate trust issues. Specifically, once we were accepted as friends, we became part of the community and were not seen as problematic experts or researchers with our own motivations.

1.3. Resulting community testing: creative friendships

Beyond the social and cultural engagement stage of this project, Geoff and other members of his community outlined a need for more activity in the village community centre. The ultimate goal according to the village community was to engage more residents with the broader community and draw in residents that may be suffering loneliness, or simply need more creative activity in their day-to-day life. Broader consultation was then undertaken to ensure the community was engaged with the process and our first community centre meeting was held with more than 50 attendees from the village (Stage 1). From this session, Dr Ward and Dr Wadsworth utilised the university’s Work Integrated Learning (WIL) programme to place undergraduate creative industries students in the community centre every week for 12 weeks to talk, share ideas, and socialise with the community residents. Over the weeks, students and residents developed friendships in a non-clinical social and cultural environment with no precise research focus or need being outlined to either party. Instead, the cohort was allowed to produce their own creative work collaboratively (Stage 2) and chose to host an event showcasing the work resulting from their emerging friendships. The resulting event (Stage 3), funded by the retirement village operator, exhibited visual art, hosted performances of original poetry and music, and provided a social platform for the wider retirement community to engage with the project. Both residents and student brough family to the event resulting in a new familial history recording for multiple participants (Stage 4).

In one case, the students and residents took part in a songwriting workshop where they were asked to choose their own them to pen a song about. The cohort chose to speak from two different points of view representative of the transgenerational interactions between the two ages groups. The song was then transcribed into text, taken into the universities recording studio and produced into a sound recording by Dr Ward. The students then set about gathering the film work from the programme and set the song to video. What emerged was a demonstrable resource highlighting the strength of the programme, the genuine intergenerational connection, and qualifying the experience of the cohort in their own words. The video was then presented to the village residents as a promotional tool for more ongoing research in the community.

Creative Friendships, a new intergenerational friendship programme based on creative and cultural activity, is now an ongoing programme that brings together students, staff and retirement village residents and is in its third year of operation. In each iteration of the project more data is gathered with more methods and disciplines being added. Previous iterations have included interviews on wellbeing and participant experience.

1.4. Terminological findings: what is in a name?

Throughout our work in the retirement community, we discovered that many of the common nomenclatures of research (eg. Participant, experiment, researcher) existed as a source of contention within the retirement community. A contention that often obfuscated the cohort’s ability to engage in traditional research/participant models (Robards 2013). In addressing this, we take an approach that situates researcher and participant as co-located in an intergenerational knowledge ecosystem (Järvi, Almpanopoulou, and Ritala 2018) where knowledge and experience is exchanged and transferred in an inter-directional manner. In this way, the traditional limits of the researcher/participant interaction become blurred as researchers ‘participate’, and participant’s ‘research’. Like many researchers working in co-design approaches in healthy ageing (Fischer et al. 2021; Sakaguchi-Tang et al. 2021; Tong et al. 2022) we extend Pike’s (Pike 1967) notions of ethnographic researcher participation and build on Participatory Action Research (Kemmis, McTaggart, and Nixon 2019; White and Verhoef 2005) models in clinical health to argue for model of co-design or design thinking (Palmer et al. 2015, 2019) that starts with participant-led identification of community need. This alternative pragmatic friendship approach to co-design methodology positions all agents inside the intergenerational knowledge ecosystem as equals in agency. Here we use the term pragmatic co-design, not to describe an expansion of approach but instead a way of thinking that pragmatically responds to the needs of the community through friendship-based community participation. In doing so, we seek to build on existing research in Experience-based Co-design approaches (Constantin et al. 2022; Donetto et al. 2015) to healthcare by expanding the model into healthy ageing programmes in retirement villages. In our case we took a focus on positive interventions (Beyer et al. 2019; Proyer et al. 2015) that use cultural engagement (Bradfield 2021; Fancourt and Steptoe 2019/1982) as sites of wellbeing development and socialisation through connecting university students and staff with retirement village residents in an intergenerational knowledge sharing process (Rossi et al. 2014).

To exemplify this approach, and to ensure the narratives of the retirement participants are front and centre in the case study, we note here that two authors of this paper are academic researchers in their middle age (42 and 40), and two are village residents, aged 73 and 76, who hold positions of leadership within the local retirement community. In this paper the term ‘the researchers’ includes all authors, two of whom are also participants in the traditional sense.

1.5. University findings and discussions

Approaching this project without a specific research agenda, the academics in the team did not know what benefits to the University would be forthcoming. We did not partner with the Community Co-Authors (or Retirement Village provider) as research partners in the traditional sense, more so adopting a goal of developing mutually beneficial activities and connections. However, the ensuing intergenerational connections and cultural exchanges have brought myriad benefits to the University, embedded across the Learning and Teaching, Research, Engagement, and Commercialisation spaces. While the outcomes of this research are focussed on the cultural production and wellbeing benefits to participants, there is considerable value in highlighting our pragmatic co-design approach and its peripheral and unforeseen benefits.

1.6. Learning and teaching

The immediate benefit to the University was access to WIL opportunities across non-traditional disciplines, namely Creative Industries and Information Technology (IT). The Creative Friendship WIL programme led by Dr Ward has seen an average of 10 percent of WIL students nominate into work in an ageing environment. There is continued significant interest and motivation on the part of Creative Industries students to work in this domain. In addition, two authentic WIL opportunities have been delivered to IT students through this programme, encompassing ‘Digital Literacy’ and ‘Website Development’ student projects. Students approached each of these IT projects as if they were engaging with a client in professional practice, not only developing their IT skills but also refining their interpersonal and communication skills through sustained interactions with different generational and cultural groups. Considering the ageing Australian population (United Nations 2020), and current aged-care workforce crisis in Australia (AU Gov, 2021; Australian Government. Treasury, 2022), we hypothesise that these benefits will extend beyond the learning and teaching environment, manifesting across individual professional practice and the Australian aged-care sector.

1.7. Research

Resulting from the trust and rapport built in cultural exchange programmes and WIL opportunities derived through this project, we have witnessed a significant uptake in older adult participants for unrelated research projects at the university. This unexpected benefit is best evidenced by the recruitment of 15 volunteer participants (including co-author Geoff) for an Exercise-Physiology based HDR project from the retirement village discussed – this represented a significant proportion of the target sample for this project, and was further supplemented by individual offers to attend pilot testing sessions to help students master assessment protocols and equipment. Recruitment of older adults for research is a common issue, with those aged 65+ years reportedly underrepresented in clinical research (Forsat et al. 2020) and less-willing to participate as they age (Petty et al 2001), making this an important observed effect from the current approach.

Research-related benefits extend to providing an authentic, person-centred, and regionally focussed lens through which to inform the future research directions of individual researchers, research groups, and the University as a whole.

1.8. Engagement

This project has also provided a range of invaluable engagement opportunities. Firstly, the strong relationship forged between university, retirement village provider, and residents, has presented engagement and public speaking opportunities for ECR staff and HDR students. From presenting at a formal opening of the village gym, to holding regular ‘health chats’ with small groups of residents, these opportunities have enabled less-experienced researchers and students to practice and refine presentation content and delivery to a diverse audience of older adults who are the ‘consumers’ of focus in their research, often requiring a change in tone/content from more academic presentations, all being delivered within a ‘safe space’ to an engaged group of people. Furthermore, the enjoyable, meaningful, and rewarding academic activities and interactions which have made up the entirety of this project can have an important impact on staff and student moral. Human behaviours and attitudes are influenced by those around us (Smith and Mackie 2016); consequently, the positive and enthusiastic approach of the older adults in this project can help to foster like feelings in university staff and students.

1.9. Commercialisation

In addition to the benefits outlined above, this approach has seen the development of a meaningful commercial relationship between the University and the retirement village operator including a regional study of all villages with significant industry funding. At a time where the retirement sector is facing a new demographic of incoming clients, the need for retirement village operator to update their knowledge and business models has led to a major developer funding additional research projects exploring the future of the retirement sector.

2. Critical reflection and discussion

Co-research projects ‘help ensure that the topic under investigation matters locally’ and ‘improve the relevance and cultural sensitivity … (of research)’ (Blair and Minkler 2009, 652), creating high-quality regionally responsive data (James and Buffel 2022). As such, the local communities around a university directly inform and benefit from the programmes of research being undertaken on their doorstep (noting that a common focus of University Strategic Goals is for ‘regionally responsive research’). In providing a platform for sustained involvement of older adults in this way, such projects can challenge negative stereotypes of ageing, ensuring voice and visibility for this often-neglected sector of society (James and Buffel 2022). Additionally, co-research conducted with older adults brings with it opportunities to gain new experiences, build relationships and networks, and develop research skill sets (James and Buffel 2022). Moreover, through access to university expertise and equipment, co-researchers are able to develop their expertise and skills, or even re-ignite a ‘lost’ skill, leading to a sense of empowerment and increased self-efficacy. Crucially, this regionally responsive, ‘ground up’ approach, can cumulatively foster a collective appetite for advocacy and change, whilst simultaneously laying the foundations of partnerships to stimulate such; elusive ingredients fundamental to successful large-scale funding and research collaboratives.

This is not to say our model is a panacea for the complexities of co-design with retirement village communities. Indeed, from the researcher’s perspective, these communities, like all communities are complex political and social ecosystems that require a light touch when engaging with new residents. We have experienced an initial trepidation when expanding our research and cultural activation into the broader village, whereupon we were required to build rapport and create new friendships in order to genuinely engage with community and commence a transparent discussion of broader community needs.

We assert the collaborative and pragmatic approach outlined in this project has delivered immediate benefits to both university and village resident alike, but there are considerable complexities that need to be explored before this model is truly translatable to other research projects and paradigms. One of the key critiques we offer to our approach is in examining its repeatability. That is to say, the pragmatics that led to a friendship connection between researcher and participant are not easily emulated. Indeed, the notion of using this pragmatic model as a methodology is to reduce the perceptions of transactionality between parties and build genuine rapport and trust. If we, as researchers, then set out to force a friendship or artificially engage in cultural practices, we undermine the fundamental benefit asserted by the approach.

To compound this issue, if we are to take this model and translate it into a different environment, demographic, or geography, there may be limitations to opportunity to engage with community in this type of friendship approach. Moreover, it becomes very difficult to distinguish where engagement with community stops and the research begins, leaving very little room to develop appropriate ethical protocols to ensure participant safety. As a result, and in our own project, the timeline on this kind of approach is significant. We have seen a three-and-a-half-year investment to get to this point of writing, and to realise some of the potential benefit in the partnership. This is in conflict with the need for research to be agile and responsive. Indeed, we recommend in undertaking this methodology the researchers must be ready for a long and time-consuming journey with no clear initial outcome. Something we think many researchers will find less than appealing. With this in mind, and in defence of our argument, we stand by our pragmatic friendship-based methodology in the context of our own research and have clearly outlined our own benefit and return on investment ideations.

3. Conclusion

Delivered through an interdisciplinary engagement lens, the success of our expanded co-design method is the result of a circular, mutually beneficial process where all sit as equal and draw upon the knowledge and skills of each other. The ensuing ongoing, organic relationships developed through this shared practice are grounded in common goals, perspectives, and principles, unifying the team, and resulting in multiple positive outcomes to all parties.

Beyond the application in healthy ageing research, expanded co-design has implication in all forms of community engaged research. Positioning researchers in the back seat allows for the community needs to emerge in an authentic and meaningful way based on no assumptions and with no clear research outcomes. While this seems like an untenable approach to many in the academy used to formulaic research approaches, we argue it is the primary role of the researcher to find meaningful research outcomes within the beneficial operations of any given community.

Disclosure statement

No potential conflict of interest was reported by the author(s).