Physical Activity Guidance Resources for Rural Families of Neurodiverse or Developmentally Diverse Children: Exploratory Co-Design Study.

Background: Being active benefits children and their parents, but there is a lack of co-designed resources that support families to engage in physical activity (PA) together. Objective: This exploratory co-design study aimed to identify ways to optimize guidance resources intended to assist in being active together, and to evaluate the co-design approach it used. Methods: Physiotherapist-researchers with experience and expertise in family PA drafted 2 evidence-informed prototypes. One prototype informed families about the holistic benefits of being active together, while the other helped families to plan their episode of PA. Twelve parents from 9 rural families and their neurodiverse or developmentally diverse children (n=13) were recruited as co-designers to ensure a wide range of considerations. Family co-designers took part in 2 to 3 workshops. They trialed the prototypes, telling researchers what worked well and how to improve them. Child and adult advisory groups oversaw the co-design approach. Each group met 3 times, with the child advisory group meeting prior to the adult advisory group. A child voice facilitator and advocate was used to support the child advisory groups and facilitate communication between child and adult advisory groups. Results: Sixty-two changes were made to the prototypes in response to feedback from families and researcher observations. Key changes to resources recommended by children, parents, and researchers to increase user acceptability and usability included changing the ordering of the planning resource to reflect the way that most families used it, adding a "hard words" section to improve readability, support to normalize that no-one wins all the time, additional examples to cover each section of the resources, and encourage negotiation among families to ensure that the planned PA was mutually desirable. All families used the resources to successfully complete, or adapt, their planned session of PA together. Overall, co-designers and advisory group members perceived the co-design approach to be appropriate and responsive. However, the researchers identified a possible gap in final communication with the children regarding dissemination of results of the project which were provided to families via parents' email. Conclusions: The co-design approach used in this study supported families, including neurodiverse and developmentally diverse children, to trial and provide feedback on PA resources. The large number of changes made to the resources from co-designer suggestions and researcher observations highlights the importance of gaining user feedback for consumer resources. Future research is needed to evaluate how these co-designed resources may impact family PA behavior and identity. The transparent co-design approach and evaluation highlighted limitations for research communication to children, which require careful consideration in future similar studies.