Plain English summary Background Continual improvements to health systems, products, and services are necessary for improvements in health. However, many of these improvements are not incorporated into everyday practice. When designing new health systems, products, and services, involving members of the healthcare community and the public with personal healthcare experience can help to make sure that improvements will be useful and relevant to others like them. Methods Together with healthcare workers and family members with healthcare experience, we developed and applied a step-by-step guide to involving those with personal experience in the design of health system improvements. Results Our guide has three phases— ‘Pre-Design’, ‘Co-Design’, and ‘Post-Design’. This paper describes each of these phases and illustrates how we applied them to our own project, which is to use virtual healthcare methods to improve care for children with chronic healthcare conditions and their families. In our own work, we found that healthcare workers and family members with personal healthcare experiences were able to use their knowledge and creativity to help us imagine how to improve care for children with chronic healthcare conditions and their families. We have created action items from these family member- and healthcare worker-identified needs, which we will use to shape our virtual healthcare system. Conclusions This paper may be useful for those seeking to involve members of the healthcare community and the public in the creation of better healthcare systems, products, and services. Abstract Background Challenges with the adoption, scale, and spread of health innovations represent significant gaps in the evidence-to-practice cycle. In the health innovation design process, a lack of attention paid to the needs of end-users, and subsequent tailoring of innovations to meet these needs, is a possible reason for this deficit. In the creative field of health innovation, which includes the design of healthcare products, systems (governance and organization mechanisms), and services (delivery mechanisms), a framework for both soliciting the needs of end-users and translating these needs into the design of health innovations is needed. Methods To address this gap, our team developed and applied a seven-step methodological framework, called A Generative Co-Design Framework for Healthcare Innovation. This framework was developed by an interdisciplinary team that included patient partners. Results This manuscript contributes a framework and applied exemplar for those seeking to engage end-users in the creative process of healthcare innovation. Through the stages of ‘Pre-Design’, ‘Co-Design’, and ‘Post-Design’, we were able to harness the creative insights of end-users, drawing on their experiences to shape a future state of care. Using an expository example of our own work, the DigiComp Kids project, we illustrate the application of each stage of the Framework. Conclusions A Generative Co-Design Framework for Healthcare Innovation provides healthcare innovators, applied health science researchers, clinicians, and quality improvement specialists with a guide to eliciting and incorporating the viewpoints of end-users while distilling practical considerations for healthcare innovation and design.

Initial evidence suggests that the WHO Disability Assessment Schedule (WHODAS 2.0) is valid and reliable in general youth populations; however, its psychometric properties in specific subgroups are less established. The primary objective was to test for measurement invariance of the 12-item WHODAS 2.0 in an epidemiological sample of youth aged 15 to 19 years with and without physical or mental conditions. Using data from 1,851 youth in the Canadian Community Health Survey–Mental Health, invariance was tested using multiple-group confirmatory factor analysis. Within-domain item correlations were significant and ordinal coefficient alphas were .91, .94, .93, and .92 for the healthy control, physical, mental, and comorbid groups, respectively. Partial measurement invariance was demonstrated for the WHODAS 2.0, with evidence of noninvariance for item residuals and factor variances related to cognition and participation. While these domain-specific comparisons may be biased, valid comparisons of overall disability across subgroups of youth can be made with confidence.

Background: Evidence suggests that physical and mental illnesses are strongly correlated in children. This study examined patterns of the chronicity of multimorbidity (co-occurring physical and mental illness); estimated homotypic continuity; and modelled factors associated with chronicity in children newly diagnosed with a chronic physical illness.Methods: Children aged 6-16 years diagnosed with one of asthma, diabetes, epilepsy, food allergy, or juvenile arthritis were recruited from two children's hospitals and followed for 6 months. Child mental illness was measured using the parentreported Mini International Neuropsychiatric Interview and Ontario Child Health Study Emotional Behavioural Scales at baseline and 6 months later. Children were stratified into three groups: no multimorbidity, acute (multimorbidity at only one assessment), and persistent (multimorbidity at both assessments).Results: Forty-nine children were available for analysis: no multimorbidity (n = 18), acute (n = 13), and persistent (n = 18). Homotypic continuity was highest for conduct disorder (67.5%) and lowest for major depression (16.7%). Unadjusted analyses showed positive associations between child and parent behavioural symptoms, as well as family functioning with persistent multimorbidity. These associations remained after adjustment, ranging from odds ratio (OR) = 1.29 [1.01, 1.64] for depression to OR = 1.61 [1.11, 2.33] and OR = 1.61 [1.10, 2.35] for attentiondeficit hyperactivity and oppositional defiant, respectively, in child models. In parent models, associations remained for parental anxiety (OR = 1.18 [1.04, 1.34]) and stress (OR = 1.15 [1.02, 1.31]).Conclusions: Multimorbidity is persistent in children newly diagnosed with physical illnesses, regardless of the mental comorbidity experienced. Integrating familycentred mental health services soon after the diagnosis of a physical illness should be prioritized in pediatric settings.

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