# TAO/Co-Creation with Older Persons

Organizations and programs increasingly aim to create sustainability on all three levels, the individual, organizational, and societal level. One way to do so is by involving the end users of a particular product or service in the innovation process, also called co-creation. This study reports on four co-creation sessions with elderly that include an abundance of challenges and issues.
The investigation is based on observations in practice and analyses of the behavior of SeniorWebNL members and employees during the co-creation sessions. The purpose of this study is to critically reflect on different participatory methods that were used during the co-creation sessions, including Stakeholder Consultation (session A), Co-design (session B), Online Co-Creation (session C), and Theme Tables (session D). The analyses of the sessions provide insights into the challenges involved when co-creating with older persons.
This investigation hence complies with the issues and challenges involved, leading to more effective ways - guidelines - to co-create with older persons.

## Co-creation with older persons

In this article, four different co-creation methods will be analyzed. All methods were conducted with older persons and hence from these experiences new and improved ways to successfully co-create with elderly can be identified.
* Session A – Stakeholder Consultation, two focus group conversations of which the first included SeniorWebNL members and the second SeniorWebNL ambassadors.
* Session B – Co-design, two groups both including members, ambassadors, and employees of SeniorWebNL. The aim of this session was the co-design of a new service.
* Session C – Online Co-Creation, online collaboration through the use of Adobe Connect.
* Session D – Theme Tables, using the ‘World café’ method. The aim of this session was to discuss older persons’ requirements and needs with regard to existing web contact services.

### Stimulating creative thinking

During the sessions it almost immediately became clear that participants need to be triggered to think creatively. For example, in session D we have learned that sketching a service was not an effective approach for older persons to generate input. Participants found it quite difficult to translate the main points of all categories into definite online applications. Overall, the output of the Theme Tables session was quite satisfactory, as all participants made relevant contributions, leading to the reach of consensus on most categories. Nevertheless, co-designing the web contact services was regarded as extremely difficult by most members, since they were asked to draw the homepage of the web contact services on a flipchart. Expecting that online services can be created by performing offline actions appears thus as a rather ambitious approach. Providing them with offline tools such as sticky notes and categorized flipcharts proved to be more successful as became clear in the Co-design session. A different but related observation points to the ‘look-beyond-the-present’ approach which appeared to be difficult to accomplish as well. During several sessions many participants indicated that they find it challenging to look in the future, partly because they have little to no knowledge of computer hardware or online applications and thus often they do not know why and how they will use their computer in the future. It was apparent that only just asking questions without giving them comprehensible examples was not sufficient. Hence the question arises whether the methods considered the digital literacy of older persons?

### An issue of blind faith?

While observing both the organization and its members we have learned that it is important to encourage communication between both parties. During the evaluation of the Stakeholder Consultation, quite a few participants indicated that they appreciated being included in the innovation process because they felt more involved in the developments of the organization. For instance, during workshop A and D, participants pointed out that they did not know who were the ambassadors of SWNL. According to the organization, communication should be established by means of online participation and collaboration. During session C, however, we analyzed the online behavior of older persons where it became evident that communication via a webcam and microphone is not without problems. On the one hand, the older persons were impatient and did not want to depend on the technique, on the other hand, the online communication tools failed to meet the expectations and needs of these older persons. For example, the participants were only able to see each other on a small screen. Moreover, communication via the microphone was not successful either, since only one person could speak at a time. In addition to these unsuitable means of communication, the older persons also emphasized on the fact that offline – face-to-face – communication is preferred for the reason that they favor communication in a physical environment. Some methods used during the sessions show a blind trust in the technique and do not take into account typical technical conditions that would suit older persons.

### Using online applications

Another important observation points to the reasons why and how online applications are used by elderly. Whereas the organization also aims at increasing the use of online applications to build relationships and stimulate online collaboration between their members, participants repeatedly indicated that they use SWNL’s online applications mainly for practical reasons. According to SWNL, members of the organization can benefit from their online applications, as they offer a great variety of services available. Nevertheless, older persons appear to mainly use the organization’s services to solve problems, raise questions, and obtain information about developments within the organization, among other motives. During the sessions all participants mentioned not being open to having contact with other members for social reasons. However, in their private lives they frequently contact relatives through various online applications. Yet, this is often also because of a practical point of view. The fact that the idea of increasing engagement in online activities is based on a somewhat incorrect assumption is self-evident. Another important observation includes the use of online applications. The Online Co-Creation sessions allowed us to observe and analyze how older persons deal with non-daily used computer applications such as Adobe Connect. The differences between the first and second session were noteworthy, since - during the second session - the participants were unable to install their microphones, leading to an early end of the session. The preconceived image which was included in the research method appeared as rather true. Nevertheless, one can question whether the participants’ knowledge of installing hardware is applicable to all older persons. The problems could also be generated by a lack of knowledge on how to assist elderly online. Evidently, it appears that this method is more appropriate for the comparison of research methods than for obtaining relevant output, as the concrete output regarding the improvement of web contact services was less satisfactory.

### Modifications of objectives

As stated above, the organization’s main goal is to increase engagement in their applications. In addition to the outcome as stated in ‘Unsuitable assumptions,’ participants also pointed out the importance of learning environments. In line with EU’s education policies, we have learned that SWNL could possibly enhance online engagement by creating environments where members not only learn from the organization but more importantly from and with other members. Consequently, members’ collaboration is expected to increase. Nevertheless, the organization must find appropriate ways to create these environments. As the outcomes of the co-creation sessions already have revealed, the output is more satisfactory when communicating offline. Online collaboration, first of all is not desired as indicated by most participants, but also does it entail numerous challenges. How could online collaboration be applied in a more effective and successful way? After analyzing the results of the co-creation sessions, we have learned that this way of communication still deserves a credible approach.

## Guidelines

After a proper analysis of the sessions’ outcomes, a number of guidelines to successfully co-create with elderly, can be identified.
“A guideline is a set of systematically developed standards or rules which assist in the decision about how to apply the policy or appropriate management of specific conditions” (Reeves, 2004, p.2).

### Important in advance

The following guidelines are important to consider before conducting co-creation with elderly.

#### General

* Before conducting co-creation with older persons one should first investigate their social and work background in order to understand who they are and to be able to correctly reflect on their input.
* A second step before the actual co-creation with elderly starts, entails the purpose of the co-creation sessions and the older persons’ role in the co-creation process. This way of communicating not only provides them clarity but they are also more prepared for the session.

#### Methodology

* Depending on the method, the elderly should be informed about the way they have to co-create with other older persons. For instance, when using an online collaboration tool, the older persons should be explained in detail on the possibilities the program offers, the limitations included in the technique, the way they should use the tool, and the possible problems that can occur during the co-creation session. A clear explanation of the method prior to the session reduces misunderstanding during the actual co-creation process.
* Based on an extensive study on the session’s participants, suitable methods should be chosen to obtain the most valuable input.
* When using peripheral devices, a clear overview of how to install these devices should be provided to the older persons.

### The co-creation process

The following guidelines are important to consider during the actual co-creation process with older persons.

#### General

* At the start of the co-creation session, the older persons should be informed about the schedule. A clear structure at the beginning of the session assures less problems during the co-creation process.
* Each session should include a few clear steps to structure the process, not forgetting to add a sufficient number of (short) breaks to keep the attention of the elderly.
* During the co-creation session it is important to be aware of any uncertainties, hence frequently asking questions, such as: are there any questions? Is it clear to everyone?, will increase the value of the older persons’ contribution.
* Stimulate group interaction and give each participant the feeling that their contribution is of great value for the research.
* When a moderator guides the group conversations, particular attention should be given to the relevance of what the elderly are telling. By timely intervention in broad discussions, consensus on most parts should be achieved.
* A moderator should also pay attention to group dynamics, as some persons might be more dominant than others which could lead to unilateral outcomes. In this case, the moderator should intervene more often by involving other participants more actively.
* During the co-creation process, examples should be used to clarify certain issues or challenges.

#### Methodology

* The choice of an appropriate method is of great importance for the successful completion of the co-creation process. A suitable method can be selected on the basis of the knowledge from previous co-creation studies with elderly and furthermore on the basis of the participants health condition and social and economic background.
* User requirements - the method should take into account the health condition of the older persons. Applicable keywords here, are: visibility, usability, and reliability.
* Assuming ‘things’ is not a good starting point to co-create with elderly. One should not assume that older persons can do all the things certain methods anticipate. Limitations are mainly found when older persons have to think creatively and collaborate online. Therefore, the methods should be adjusted to the older persons’ requirements.
* A moderator should lead group discussions, in particular when co-creating in online spaces.
* Offline tools such as sticky notes are an efficient way to generate valuable input.
* Discussion groups that consist of more than ten persons should be avoided in order to maintain the quality of the group conversations.
* Drawing is not the most efficient way to create input. Therefore, the use of images or pictures is recommended.
* When using an online communication tool, the older persons should be informed step by step (through audio or video coaching) about how they can access the program.
* As already indicated, these guidelines are based on previous experiences with older persons during different co-creation methods. In sum, these guidelines suggest that co-creation with older persons should acknowledge diversity among elderly, be aware of the differences in computer en Internet knowledge sometimes due to differences in age and should create learning environments where older persons will be taught on how to cope with certain co-creation methods.
* As abovementioned reveals, co-creation with older persons entails numerous challenges. However, based on the sessions analyses, we have learned how ways of co-creating with older persons can be innovated.
* The lessons learned during the four co-creation sessions appeared to be useful for improving the future guidelines.