The persistent pressure on general practice requires interventions that not only support professionals but also (potential) patients before they seek care. In 2012, the Dutch College of General Practitioners (NHG) launched a public website, Thuisarts (‘home doctor’), with trustworthy information on health, symptoms, and diseases based on guidelines developed by professional societies in collaboration with patient organisations.To describe the development and maintenance of Thuisarts as a national media platform supporting self-management in the context of competing digital sources.GP and specialist guidelines on a broad range of topics were produced in co-creation with partners across primary and secondary care as part of programs supported by the government. This included the development of public and patient information to implement the guidelines in practice. Thuisarts was designed to enhance access to context-specific content and to promote self-care and a healthy lifestyle. Generative AI was used for personalised information (e.g., post-GP vs. post-specialist visit). Its use was measured with website parameters and digital surveys.Annual use of Thuisarts.nl has increased from less than 1 million visits in the first year to approximately 72 million visits in 2024 (200,000 per day). The website covers more than 600 topics. Popular topics include children with fever, urinary tract infections, sore throats, and sexually transmitted diseases. During the COVID-19 pandemic, information about COVID-19 was accessed most frequently. Almost all GPs (98%) used Thuisarts.nl, and 85% advised patients to consult the website. All stakeholders supported its maintenance with public funds and the introduction of artificial intelligence to promote self-management.Influencing patient behavior requires media, data expertise, and strict quality assurance. Thuisarts can be considered as an antidote to misinformation, supporting patient autonomy, equal access to reliable knowledge, and interprofessional collaboration to improve the quality of care. Broad support from all stakeholders involved in healthcare is a crucial determinant of success.Thuisarts demonstrates that a combined approach of excellent content, technology, and care integration supports GPs and patients in decision-making before seeking care, relieving pressure on general practice. Further scale-up and rigorous scientific evaluation are essential to increase impact and facilitate implementation.

Rural and remote populations continue to experience inequities in access to healthcare services. Although these challenges are well documented, translating evidence into locally adapted and actionable solutions remains difficult. Living labs offer a user-centred, real-world approach to innovation through co-design, yet their application in rural healthcare remains limited.To synthesize and characterize published applications of living lab approaches in the design, development, or implementation of rural healthcare services and innovations.This scoping review followed PRISMA-ScR guidelines. A systematic search of MEDLINE, EMBASE, and CINAHL was conducted on May 10, 2025, to identify peer-reviewed studies describing living lab or participatory approaches applied to rural healthcare services or innovations. Two reviewers independently screened studies, extracted data using a standardized form, and synthesized findings using descriptive statistics and narrative analysis.The search identified 1,080 articles, of which 11 met inclusion criteria. Studies were published between 2016 and 2025 and conducted in Canada (n=3), the United States (n=3), Australia (n=2), Guatemala (n=1), Uganda (n=1), and France/Portugal (n=1). Settings included rural hospitals, regional health networks, Indigenous communities, farming and fishing communities, and underserved regions. Targeted health domains included cardiovascular disease, diabetes, musculoskeletal conditions, perinatal care, palliative care, and infectious disease management. Methodologies included theory-driven frameworks (n=4), community-based participatory research (n=4), user- or human-centred design (n=3), and co-design workshops or interviews (n=3). Only one study explicitly used the term “living lab.”This scoping review highlights that, despite participatory and user-centred innovation, living lab approaches have been infrequently and inconsistently applied in rural healthcare. Existing studies show considerable methodological heterogeneity, with many relying on participatory or co-design principles without explicitly framing their work as a “living lab.” Applications have focused on specific clinical domains and limited geographic regions, suggesting missed opportunities to address broader rural health system challenges. The lack of evaluation frameworks limits comparability across studies and constrains the accumulation of transferable knowledge, underscoring the need for clearer conceptualization and stronger methodological reporting.Living lab approaches remain underutilized in rural healthcare. Clearer conceptualization, broader application, and more robust evaluation are needed to fully assess their potential to support innovation and equity in rural health systems.

People experiencing socioeconomic hardship face barriers in accessing healthcare despite having greater health needs. The literature highlights the need for multidisciplinary interventions integrating somatic, mental and social care, to improve access to care of vulnerable populations. In France, a program supported the implementation of a participatory approach within multi-professional primary care centres, combining health mediation, professional interpreting, outreach, and patient’s participation in the centre organization.To explore the effects of this participatory approach on both patients and healthcare professionals working within a multi-professional primary care centre (XXX) implementing a participatory approach.A qualitative study using a grounded theory approach was conducted among patients engaged in participatory activities and among professionals working at or partnering with the Centre XXX. Semi-structured individual interviews and focus groups were carried out. All interviews were analysed inductively, with triangulation by three researchers.Forty-eight participants were included (25 patients and 23 professionals). Patients described a shift towards more horizontal, trusting and supportive relationships with healthcare professionals, in contrast with previous care experiences. Engagement in, and benefits from, the participatory approach appeared greater among socially isolated individuals. Patients reported benefits related to social empowerment , that supported better patient’s skills for accessing health care, sometimes associated with a perceived improvement in health. Professionals reported an evolving organisational culture marked by the coexistence of institutional and private-practice logics and the progressive appropriation of participatory methods. Although the concept of “participatory approach” remained unclear for many, it was perceived as beneficial for improving access to care and adapting practices to the needs of people in precarious situations. The required investment was significant and sometimes created tensions between clinical demands and participation in non-clinical activities.This study provides an initial exploration of a participatory-based model implemented within a coordinated primary care centre in France. Further studies in different primary care settings are needed to obtain an holistic comprehension of the effects of this approach.The participatory primary care approach appears to enhance patient empowerment, foster more horizontal care relationships and support more active healthcare use among people facing precarity, while also transforming professional practices and organisational dynamics.

Examining Indigenous child and family health experiences through a First Nation-based and institutional research partnership.The focus of the study was to examine Indigenous child and family health experiences. To explore and better understand: •How can Indigenous and non-Indigenous researchers collaborate in academic spaces that engage Indigenous Knowledge and Ways of Knowing, Being, and Doing, in the context of a First Nation’s Cultural Healing Centre’s programming for children and families? • What are the First Nation members’/residents’ individual and community health priorities? • What are the most appropriate ways to share the stories to inform the First Nation’s long-term child and family health and educational programming and services?Guided by an Indigenous Research Paradigm (IRP) informed by Indigenous traditional Knowledge and research practices, the study was led by Indigenous community members of the partnering First Nation. The study’s IRP engages the practice of Indigenous Storytelling methods (data collection) and the meaning-making process involved in Storytelling methods - the Storywork (analyses). The research activities were facilitated through collaboration with the community advisory circle and by conducting community-based Storytelling circles with families in the First Nation. The study focused on the early years program for children and families and two storytelling circles were hosted in partnership with the families in a culturally significant space – the local Cultural Healing Centre.The stories were analysed through Storywork processes and informed collective recommendations and additional health and educational research priorities for the community to mobilize.Overall, the IRP creates space for Indigenous Peoples to share their Knowledges from their own Worldviews and upholds the Indigenous right to self-determination by promoting traditional healing methods of Storytelling and Storywork.The IRP was tailored to represent traditional healing principles, and community-led research protocols. The Storytelling practice enabled the storytellers to share their own meanings of their lived experiences and depictions of unique historical contexts, that shape their contemporary health perspectives to inform the health and educational priorities in the First Nation.Overall, I describe my experience in leading an Indigenous Nation-based research study, within a Western-health science doctoral program, and report the First Nation communityrecommendations from the Storywork.

In Reggio Emilia (Northern Italy), a growing number of people with sickle cell disease, mostly of Sub-Saharan origin, has created an urgent need for antigen-compatible blood. To respond, a participatory action-research project, DREPANO-DONORS, was launched to co-develop strategies for engaging Sub-Saharan communities in blood donation. As the work evolved, it became clear that blood donation could not be addressed as an isolated behavioural issue, but was embedded in broader experiences of belonging, recognition, discrimination and institutional trust. This shifted the focus from a disease-specific project towards a wider process on migrant participation in health research and planning.DREPANO-DONORS combined qualitative, anthropologically informed research with participatory workshops. Interviews, focus groups, informal conversations and participant observation were carried out with current and potential donors, cultural mediators, diaspora associations, religious leaders, and healthcare professionals. Four participatory workshops were convened to discuss findings, validate interpretations and co-design strategies. This process led to the creation of a coordination group including stakeholders of Sub-Saharan origin, clinicians, transfusion specialists and primary care professionals. Building on this experience, the team launched RADICE, a broader action-research initiative in the Primary Health Care Department, aimed at developing structural spaces for migrant participation in local health research, planning and decision-making.Key lessons include the need to: (1) centre engagement on lived experience and social recognition, rather than on narrow behavioural targets; (2) move from short-term campaigns to sustained spaces for co-creation; (3) explicitly address institutional racism, rigid procedures and “cultural neutrality” as barriers to equity.The transition from DREPANO-DONORS to RADICE illustrates how participatory work around a specific clinical issue can open up broader debates on liberty, equity and fraternity in primary healthcare.This case shows how a project initially framed as “engaging a hard-to-reach group” for blood donation became a catalyst for rethinking migrant participation in health services.

In Italy, recent national reforms are redefining primary care delivery, emphasizing community-based structures (Case della Comunità, Community Health Centres, CHC) that integrate health and social care through multidisciplinary teamwork and community involvement. In this context, a peripheral primary care centre was redesigned following a hub-and-spoke model.The redesign included a structured reorganization of spaces, grouping services into functional macro-areas in alignment with national guidance; redefinition of care pathways between the centre and its reference hub; and implementation of a comprehensive wayfinding project. Interventions included redesigned internal and external signage, colour-coding of functional areas, and reorganized entry points to facilitate physical and cognitive accessibility. The centre also piloted extended medical and nursing presence for 12 hours a day, six days a week, ensuring access for all users regardless of GP affiliation. Community participation was promoted through a shared board involving citizens, local associations and third-sector organizations, jointly planning public events and health-promotion initiatives. Strengths included strong multidisciplinary collaboration; limitations include the absence of quantitative outcomes at this early stage.Key lessons include the value of co-design with professionals, early involvement of technical teams, and alignment of functional planning with architectural solutions. A participatory research project launched in November 2025 is engaging professionals and community members in co-designing a monitoring system with shared indicators; results are expected in the first half of 2026.This experience shows how organizational and spatial redesign, strengthened multidisciplinary care and community participation can jointly enhance accessibility, continuity and user experience in peripheral settings.The transformation demonstrates how the national CHC model can be effectively implemented through integrated organizational, spatial and participatory strategies. Further evaluation, including the forthcoming participatory project, is needed to assess outcomes and guide future adaptations.