Co‐Creating a Digital Learning Platform for Cross‐Sectoral Virtual Consultations: An Action Research Study

ABSTRACT

Aim

To co‐create a digital education and training programme that actively engages healthcare professionals, patients and their families, preparing them for effective participation in cross‐sectoral virtual consultations.

Design

This action research study was conducted through three iterative workshops involving hospital and primary care professionals, general practitioners, municipal nurses, patients, relatives and researchers. Data were collected from group discussions, field notes and visual materials and analysed thematically.

Results

The co‐creation process identified essential competencies in communication, technical proficiency, meeting leadership and patient engagement. These were translated into eight targeted learning modules and an explainer video, forming an accessible digital training platform. The Calgary‐Cambridge guide informed the communication framework used within the learning modules to support patient‐centred virtual care. Stakeholder feedback confirmed the programme's relevance, usability and potential for broader implementation.

Conclusion

The study demonstrates that collaborative, practice‐based co‐creation supports the development of digital and communicative competencies across sectors. The resulting platform offers a transferable model for integrating virtual consultations in future healthcare education and practice.

Patient or Public Contribution

Patients and relatives actively participated in workshops, significantly contributing to content identification, platform development and the emphasis on patient‐centred communication.

1. Introduction

Economic and demographic shifts, coupled with advancements in medical knowledge and technology, have substantially increased pressure on healthcare systems globally [1]. The growing population of older patients with multimorbidity (e.g., chronic heart failure, chronic obstructive pulmonary disease [COPD], diabetes and cancer) has notably exacerbated these challenges, necessitating innovative healthcare delivery solutions [2, 3, 4]. Telemedicine and virtual technologies have become essential strategies to address these demands [2, 3, 4]. Virtual consultations, as a specific form of telemedicine, are anticipated to significantly increase, with policy targets aiming to convert approximately 30% of traditional physical consultations into virtual interactions [1, 3]. Virtual consultations, defined as consultations facilitated through digital screen‐mediated communication [3], have proven effective in healthcare fields such as nursing [5], multidisciplinary cancer treatment planning [6, 7, 8, 9] and palliative care [10, 11]. Patients living with multimorbidity heavily depend on integrated and coordinated care incorporating the patient's experiences and wishes across various healthcare sectors [12, 13]. However, they often face fragmented care, limited patient engagement, ineffective communication among providers, and inadequate continuity and holistic care management. This fragmentation can lead to inappropriate medication use and increased mortality risks [14, 15, 16]. When virtual consultations are used to coordinate care between hospital‐based services, general practice and municipal healthcare providers, they take on a cross‐sectoral character, introducing additional demands on communication, role clarity and coordination across organisational boundaries. In this study, cross‐sectoral virtual consultations are understood as a specific, digitally mediated form, involving screen‐based consultations with the patient and/or relatives to coordinate care across sectors. Cross‐sectoral collaboration through virtual consultations has been highlighted as essential to improving patient‐centred care, particularly for patients managing complex multimorbid conditions [12, 17]. Collaboration refers to coordinated interaction in transitional care between hospital‐based services, general practitioners and municipal healthcare providers to support patients with multimorbidity [18]. Nevertheless, successful adoption and implementation require healthcare professionals, patients and their relatives to possess specific digital competencies. Several national and international initiatives have already highlighted the necessity of enhancing digital competencies within healthcare professions [2, 3, 4]. Digital competence encompasses a combination of skills, attitudes and knowledge necessary to effectively perform tasks, solve problems, communicate, manage information and create and share content via technology. In this study, digital competence is understood as the specific set of technical, communicative and organisational competencies required for effective participation in cross‐sectoral virtual consultations [3]. Despite the recognised importance of digital competencies, there remains a significant gap in the literature regarding effective methods for acquiring these competencies [19, 20, 21, 22]. The absence of structured teaching and training programmes tailored to virtual consultations prompted this study to develop a targeted educational intervention.

To address this research gap, this study aimed to co‐create a digital education and training programme that actively engages healthcare professionals, patients and their families, preparing them for effective participation in cross‐sectoral virtual consultations. In this study, healthcare professionals are defined as licensed clinicians, for example physicians, nurses and general practitioners, involved in patient care across hospital and primary care sectors.

The study addressed the following research questions:

1. Which specific digital competencies in communication, technical skills, meeting leadership and patient engagement do healthcare professionals, patients and their relatives identify as critical for effective participation in cross‐sectoral virtual consultations?

2. How can a digital education and training platform be collaboratively developed with these groups to address these identified competencies?

To address these challenges, this study applies an action research approach to co‐create targeted education that supports participation across sectors.

2. Method

2.1. Design

An action research design was chosen for this study due to its inherent flexibility, allowing iterative cycles of reflection and action tailored to the unique context and participants involved [23, 24, 25, 26], as illustrated in Table 1. Action research actively engages stakeholders from the field of practice, ensuring their direct participation and fostering the collaborative development of practical solutions. In this study, stakeholders refer to all participating groups involved in the action research process. Stakeholders included healthcare professionals (nurses and doctors), patients and their relatives, researchers, nursing students and assistant professors. Here, the term ‘stakeholders’ is used as a methodological umbrella concept commonly applied in action research, encompassing healthcare professionals, patients and relatives as specified in the study aim. These diverse participants collaborated actively through a series of structured workshops, addressing mutually relevant topics to facilitate collective dialogue and reflection.

TABLE 1.

Iterative cycles of reflection and action tailored research process involving all stakeholder groups in co‐creating the digital education and training platform. Participants: action research team, network group and user group.

Each cycle included iterative reflection and dialogue among stakeholders, which informed both data collection and ongoing analysis to ensure that emerging insights directly shaped subsequent activities [27]. This alignment between data collection and analysis was central to maintaining the participatory and practice‐oriented focus of the action research process.

The research was organised around three distinct stakeholder groups:

• Action research team: Responsible for overall research design, planning, facilitating workshops, prototype preparation and ensuring regular meetings and coordination with the network group.

• Network group: Comprised healthcare professionals from primary and secondary care sectors, patient representatives, researchers, students and assistant professors. This group participated actively in planning workshops, analysing data collected during the workshops and developing drafts for the digital learning platform.

• User group: Included a broader representation of healthcare professionals, patients, researchers, students and assistant professors. This group actively engaged in each of the three workshops, directly contributing to the identification and refinement of competencies and content for the digital education and training programme.

2.2. Settings and Participants

The study was carried out in the period November 2022 to August 2023 in a collaboration between a Region Zealand hospital (MVH Hospital) in Denmark and five municipalities. Health professionals from the primary healthcare system and from hospitals, patients and relatives, general practitioners (GP), and nursing students from University College Absalon and assistant professors participated in the study. Across the three workshops, between 30 and 38 stakeholders participated in each session. Participants were: health professionals from the primary health care system (n = 8) and from hospitals (n = 8), patients and relatives (n = 4), general practitioners (GP) (n = 2), nursing students (n = 10) from University College Absalon and assistant professors (n = 6).

Participants were identified and invited through existing professional networks, municipal and hospital collaborations. This composition ensured representation from all key stakeholders involved in cross‐sectoral virtual consultations.

2.3. Ethical Considerations

The study adhered strictly to ethical standards outlined in the Declaration of Helsinki [28] Participation was voluntary and all participants were informed orally and in writing about the study objectives, and their right to withdraw at any time without repercussions. All participants provided informed consent prior to workshop participation. Data confidentiality was ensured through de‐identification of all personal identifiers and secure data storage in compliance with the General Data Protection Regulation (GDPR). The research process was aligned with the checklist for improving action research quality in healthcare context [29], Data S1. The regional Ethical Committee in Region Zealand waived ethical approval, as this type of project does not require it.

2.4. Data Collection

Data collection was conducted through three iterative phases integrated within the action research design, comprising preparatory desk research, co‐creation workshops and prototype testing and refinement. The present paper focuses on the co‐creation workshops and the identification of competency needs informing the development of the digital education and training platform; the remaining phases are reported to contextualise the overall action research process.

2.4.1. Phase 1: Desk Research

In the initial phase, comprehensive desk research was conducted to gather existing knowledge, research outcomes and information from ongoing projects related to digital education and training programmes for healthcare professionals, patients and families participating in cross‐sectoral virtual consultations [3, 30]. The patient‐centred fundamental in care (PCC) and the Calgary‐Cambridge guide (CCG) were used as theoretical frameworks to inform the competency focus and educational content of the study [12, 31, 32]. The platform concept included educational content based on the CCG, as it demonstrates a structured communicative approach to clinical consultation and serves as a frame for planning, facilitating and evaluating a cross‐sectoral virtual meeting [30]. PCC emphasises individualised, respectful and responsive care that incorporates patient preferences and values into decision‐making. The CCG demonstrates a structured communicative approach to the clinical consultation that enables a systematic evaluation of communication skills and their impact on patient outcomes. These theoretical frameworks guided the planning and facilitation of action research processes in the subsequent co‐creation workshops focusing on both patient care and the competencies needed in the virtual consultation. This phase informed the theoretical framing and workshop design but did not generate empirical results reported in this paper.

2.4.2. Phase 2: Co‐Creation Workshops

Three iterative workshops were conducted, each with a clear focus as illustrated in Table 2. The workshops served as the primary empirical setting for identifying competency needs through facilitated group discussions, reflective exercises and visual methods. Participants collaboratively articulated challenges, dilemmas and required competencies related to participation in cross‐sectoral virtual consultations. All workshop discussions and materials (including fieldnotes, post‐its and drawings) were documented immediately after each session. Written summaries were transcribed into digital format and stored securely. No audio recordings were made.

TABLE 2.

Overview of the co‐creation workshops (Phase 2), including focus, data sources and participants.

	Content	Data sources	Focus
Workshop I Identification of competencies essential for effective virtual consultations. n = 38	Expert‐led presentations Participants engaged in structured group discussions to define needed competencies	Notes, group discussions, post its, clustering, drawings and voting exercises	Identification of key competencies
Workshop II Idea generation and design development. n = 30	Expert‐led presentations Participants engaged in interactive group activities to capture the patient's perspective and ensure its integration into the digital platform.	Drawings and notes from visual brainstorming central themes emerging from this workshop included the importance of communication between health professionals, continuity of care and addressing technological challenges.	Co‐created draft modules
Workshop III Digital competencies needed for virtual consultations and finalising the platform content. n = 30	Presentations on professional readiness for virtual consultations, presentation of mock‐up.	Notes from collaborative review and refinement of platform content co‐creation of an explainer video to demonstrate best practices in patient‐centred virtual consultations.	Platform and content

Note: Summarises Phase 2 and 3.

2.4.3. Phase 3: Prototype Test and Completion

The final phase involved testing the digital platform prototype for technical functionality, usability and feasibility carried out by an IT expert and a researcher. This was followed by a one‐month pilot implementation to gather feedback and refine platform functionality, ensuring readiness for broader deployment. Feedback during the one‐month pilot confirmed usability and content relevance. Minor adjustments were implemented (wording, navigation) prior to the final release of the platform. This phase is included to illustrate completion of the co‐creation process and platform refinement and does not constitute a separate empirical focus of the present paper.

2.5. Data Analysis

All data from the three workshops‐notes from discussions, post‐its, drawings and observations‐were collected, digitised and categorised thematically within the framework of action research [24, 33] using thematic analysis [34]. The material was organised into a manual thematic matrix, and initial codes were generated collaboratively by the action research team. Through iterative cycles of discussion in the action research team, these codes were grouped into provisional categories (e.g., communication competence, technical skills, patient involvement). To ensure accuracy and inclusion, the provisional categories were refined by participants in the following workshop, where they merged, split or ranked the provisional categories into themes. For example, post its referring to ‘time pressure’ and ‘an overly full agenda’ informed a theme planning ‘the organization of the meeting’. Drawings highlighting ‘the patient in centre’ informed a theme of patient involvement. The iterative, dialogic process ensured that emerging interpretations were continuously discussed and validated within the group [25]. The thematic categories were communication skills, technical skills, meeting organisation and patient involvement. To strengthen credibility, the network group validated the theme development. The process is illustrated in Table 3. Illustrative quotes from participants have been added in the Section 3 to demonstrate transparency in theme interpretation. This iterative process across workshops ensured that themes reflected participants' language and priorities. To support trustworthiness, we emphasised credibility (stakeholder triangulation), dependability (documentation of coding decisions) and confirmability (team‐based reflexive discussions).

TABLE 3.

Analysis process leading to the co‐creative development of themes for digital competencies.

Data preparation	Initial coding	Collaborative refinement	Theme development	Validation
Action research team	Action research team	Network group	All stakeholders in workshops	Network group
Raw workshop materials (post‐its, drawings, notes, voting outputs and transcripts of discussions) were collected and digitised by action research group.	The Action research team organised items into preliminary categories (e.g., ‘time pressure’, ‘agenda too full’ → organising the meeting).	These clusters were reviewed with the network group in plenary sessions, where participants validated, merged or ranked categories into themes. This served as member checking.	Categories were consolidated into broader themes that recurred across workshops. For example: ‘Patient voice’, ‘centred drawings’, → patient involvement ‘Time pressure’, ‘agenda full’, → meeting organisation ‘Technical gaps’, ‘platform use’, → technical skills	Representative participant quotes and visual artefacts were retained along with codes to maintain transparency between raw data and themes.

In the following Table 4 an example of the analysis process is presented how provisional categories and themes were identified.

TABLE 4.

Example of the thematic analysis process illustrating development of one theme (‘Being a leader of the meeting’).

Transcribed text and notes	Provisional category	Theme
Our own professionalism/understanding can ruin a plan (post‐it)	Mutual professional respect	Being a leader of the meeting
[…] actively regulate the interaction… (nurse)	Ability to actively facilitate participation	Being a leader of the meeting
[…] importance of having a clear structure or agenda (nurse)	Structural competence in meeting leadership	Being a leader of the meeting

3. Results

The study was conducted from November 2022 to August 2023 using a collaborative action research design. The iterative co‐creation involved three workshops with active participation from healthcare professionals across hospitals and primary care settings, general practitioners, nursing students, researchers, patients and their relatives. Across workshops I‐III, participants identified challenges concerning technical skills, patient involvement, meeting organisation, roles and communication skills, which informed subsequent development of the platform's modules.

The competencies identified across workshops I–III formed the analytical basis for the structure and content of the digital training programme, with each module developed to address one or more of the identified competency areas.

3.1. Identified Competency Areas

Analysis of workshop discussions, post‐it notes, drawings and observations revealed four overarching competency areas considered critical for effective participation in cross‐sectoral virtual consultations: technical competence, patient involvement, meeting leadership and cross‐sectoral role clarity and communication.

3.1.1. Technical Competence

During the workshop, several participants expressed concerns that technical challenges could dominate virtual meetings, potentially marginalising the patient's participation. Healthcare professionals described situations where substantial meeting time was spent troubleshooting technical issues, resulting in reduced attention to the patient's concerns:

All the time was spent on techniques that did not work (nurse).

Handling technology was highlighted as a top priority during dot voting exercises in the workshops. Participants emphasised the need for basic technical competence related to video set‐up, sound, camera positioning and platform navigation to ensure that technical issues do not disrupt communication or patient involvement. These findings directly informed the development of a dedicated module focusing on technical set‐up and video solutions.

3.1.2. Patient Involvement

Another central competency concerned the ability to safeguard and actively support the patient's perspective during cross‐sectoral virtual consultations. Participants highlighted that virtual settings require particular attention to inclusion, as the patient's voice can easily be overshadowed by professional dialogue across sectors. Stakeholders discussed challenged related to planning and structuring meetings as well as managing complex multidisiplinary dynamics. Effective meeting leadership was described as essential for ensuring that the patient's experiences and wishes were integrated into the consultation:

You need someone to act as the patient's voice (post‐it note).

Participants emphasised the importance of actively regulating interaction, ensuring inclusive participation and acknowledging input from both patients and relatives. Time management was also identified as a prerequisite for maintaining focus and ensuring that the patient's concerns were addressed. These insights informed the development of modules addressing meeting leadership and patient and relative participation.

3.1.3. Meeting Leadership and Organisation

Meeting leadership emerged as a distinct competency area, closely linked to both patient involvement and cross‐sectoral collaboration. Participants across professional groups highlighted the importance of clear structure, agenda setting and facilitation in virtual consultations. Observation notes and group discussions demonstrated that virtual meetings require explicit leadership to maintain focus, manage turn‐taking and align expectations across sectors.

Participants articulated a need for guidance on how to prepare for, lead and conclude cross‐sectoral virtual meetings. This included clarifying the purpose of the meeting, defining roles and ensuring shared goals for the patient's care trajectory. These findings informed the development of a specific module on leading virtual consultations.

3.1.4. Cross‐Sectoral Roles and Communication

Across all workshops, participants emphasised the importance of understanding roles, responsibilities and communication practices across sectors. Healthcare professionals discussed how differences in organisational cultures, documentation practices and clinical perspectives can complicate virtual collaboration.

Participants highlighted a need for profession‐specific preparation to support effective participation in cross‐sectoral virtual consultations. This led to the identification of distinct learning needs for hospital‐based clinicians, general practitioners, municipal nurses, patients and relatives. Emphasis was placed on fostering a shared understanding of roles while maintaining a patient‐centred approach that explicitly reflects patients' voices and needs.

3.2. Translation of Competencies Into Learning Modules

The identified competency areas directly informed the structure and content of the digital education and training platform. Figure 1 illustrates a typical cross‐sectoral virtual consultation scenario, reflecting the context in which the identified competencies are enacted.

FIGURE 1.

QR code to access the explainer movie about Else and Kurt illustrating best practices in patient‐centred virtual consultations. Link: https://regionsjaelland.23video.com/else‐final‐v2mp4.

Figure 2 presents an overview of the digital platform and its learning modules.

FIGURE 2.

QR code to access the featuring eight carefully developed educational modules.

See Figure 2.

The platform consist of eight modules:

• Module 1: Introduction to Cross‐sectoral Virtual Consultations

• Module 2: Technical Setup and Video Solution

• Module 3: Leading a Virtual Consultation

• Module 4: The General Practitioner's Role

• Module 5: The Hospital Team's Role

• Module 6: The Municipal Nurse's Role

• Module 7: Patient and Relative Participation

• Module 8: The Calgary‐Cambridge guide

Together, the modules operationalise the competency needs identified during the workshops by linking concrete learning content to the specific challenges articulated by participants. Technical competence is primarily addressed in Module 2, while competencies related to meeting leadership and organisation are central to Module 3. Cross‐sectoral role clarity is operationalised through profession‐specific modules (Modules 4–6), and competencies related to patient and relative involvement are addressed in Module 7. Structured communication principles are introduced in Module 8 through the CCG. Module 1 provides a shared conceptual introduction to cross‐sectoral virtual consultations and their purpose.

An explainer video was co‐created to illustrate best practices in patient‐centred cross‐sectoral virtual consultations, showcasing an exemplary scenario involving multiple stakeholders collaborating to meet patient needs. Stakeholders contributed actively to the development of the video to ensure that it reflected realistic consultation scenarios and highlighted essential communication and coordination strategies.

Overall, feedback from stakeholders during the co‐creation process confirmed that the platform addressed previously identified gaps, particularly regarding technical challenges, meeting leadership and patient involvement. The digital education and training platform was perceived as relevant and usable, with potential for broader implementation in cross‐sectoral virtual consultation practices.

4. Discussion

This study aimed to co‐create a digital education and training programme to support effective participation in cross‐sectoral virtual consultations. By involving healthcare professionals from primary and secondary care settings, patients and relatives in the co‐creation process, this study ensures that the digital platform reflected practical needs and expectations in everyday cross‐sectoral practice.

The findings demonstrate that competence development for virtual consultations is most effective when grounded in real‐world collaboration aligning with previous research emphasizing practice‐based and participatory approaches to digital competence development in healthcare [2, 3]. This alignment suggests that digital competencies are not optimally developed through generic or isolated training, but through learning activities embedded in professional practice and organisational contexts. This highlights the need for ongoing, practice‐based learning rather than one‐off training activities.

A crucial initial step in developing the educational content involved mapping the competencies deemed necessary by participants for effective virtual consultations. Through a structured action research approach [23, 24, 25], the study identified several critical competencies, notably communicative proficiency, technical mastery, patient involvement, relationship building and organisational skills for meeting facilitation. These findings resonate with earlier studies showing that digital competence in healthcare extends beyond technical skills to include communication, coordination and relational capabilities [21, 22]. Communication competencies were consistently highlighted as particularly crucial, encompassing both verbal and non‐verbal dimensions, active listening, inclusive dialogue and ensuring ample opportunity for all participants to contribute meaningfully to the consultation. Similar competency domains have been identified in previous studies of digital and virtual care, which underline the importance of combining technical, communicative and organisational skills.

To address these core competencies effectively, the digital learning platform integrates multiple targeted modules. The modules include technical instructions to overcome anticipated technological challenges, such as effective video conferencing set‐up, troubleshooting common technical issues and ensuring secure interactions. Participants explicitly identified potential technical difficulties as significant barriers to successful virtual consultations, which justified the inclusion of comprehensive, user‐friendly technical guidance. This finding aligns with earlier research demonstrating that insufficient technical preparedness may undermine patient involvement and shift professional attention away from the relational aspect of care [21, 35].

Another essential component of the platform is the explainer film, collaboratively developed with participants to illustrate best practices for patient‐centred virtual consultations. The film exemplifies how virtual meetings can facilitate seamless interprofessional collaboration, enhance patient‐centred care and improve care continuity, particularly for multimorbid patients. Previous studies of multidisciplinary and virtual meetings similarly emphasise the importance of clear structure, shared purpose and facilitative leadership to support patient‐centred dialogue [6, 8]. Although these studies are not limited to virtual contexts, they highlight organisational and communicative challenges that are also present in cross‐sectoral virtual consultations.

Additionally, the platform features the Calgary‐Cambridge as a communication framework to support structure, patient‐centred interaction. Previous research has shown that structured communication models can enhance clinician–patient interaction and support the integration of patients' perspectives in complex care processes [12, 13]. In the context of this study, the guide functioned as a shared reference point across sectors, supporting both meeting leadership and inclusive dialogue.

The distinct modules were specifically designed to prepare participants comprehensively for their respective roles, whether as meeting leaders, hospital clinicians, primary care professionals, patients or relatives. The module dedicated to meeting leadership addresses a particularly critical function in virtual consultations, highlighting preparation, meeting organisation and the ability to ensure inclusive participation. Prior studies of cross‐sectoral and multidisciplinary collaboration similarly underline the importance of clear leadership and role definition to ensure effective coordination and patient involvement [8, 17, 36]. Other modules provide tailored guidance for healthcare professionals and patients to ensure that each stakeholder group can optimally prepare and contribute constructively to consultations.

In summary, this study leveraged an action research framework not merely for theoretical exploration but to produce tangible, practical resources immediately implementable in healthcare settings. The resulting educational platform directly addresses previously identified gaps in digital competencies and provides stakeholders with structured, targeted resources to facilitate successful cross‐sectoral virtual consultations. By situating competency development within collaborative, practice‐based learning processes, the platform offers a transferable model for supporting implementation of virtual consultations across healthcare sectors. Future studies should evaluate it's the platform's long‐term impact on interprofessional collaboration, patient involvement and care coordination in virtual healthcare contexts.

4.1. Strengths and Limitations

The strength of the study lies in its participatory, cross‐sectoral design, where multiple stakeholder perspectives shaped competency identification and platform development. The iterative workshops enabled direct articulation of competency needs grounded in clinical and lived experience, supporting practice‐relevant educational output.

Limitations were identified in the research process. First, competency identification was generated through stakeholder discussions, post‐it notes and visual materials, prioritising practical articulation over systematic participant‐level quantification. Second, the prototype testing phase focused on technical functionality, usability and feasibility, and was not designed as a formal evaluation of competency development or clinical outcomes. Consequently, conclusions cannot be drawn about measurable competency improvement or long‐term clinical impact at this stage. In addition, the study was conducted within a specific regional and organizational context, which may limit transferability to other healthcare settings with different structures, digital infrastructures or cross‐sectoral arrangements. Finally, participation was based on voluntary engagement, which may have introduced a degree of selection bias, as participants with an interest in digital solutions or cross‐sectoral collaboration may have been more inclined to participate.

5. Conclusion

The action research approach effectively facilitated the collaborative development of a comprehensive digital education and training programme tailored for cross‐sectoral virtual consultations. Engaging diverse stakeholders, including healthcare professionals, patients and relatives, ensured the programme's relevance and practicality. The iterative process identified and addressed essential competencies such as effective communication, technical proficiency, and patient‐centred care, successfully integrating these into an accessible digital platform. Future research should evaluate the long‐term effectiveness of this educational intervention in enhancing digital competencies, improving cross‐sectoral coordination, and ultimately fostering improved patient outcomes and experiences in virtual healthcare consultations.

Author Contributions

B.B. and M.B.H.P. were responsible for the overall design of the study and the development of the research idea, as well as leading the data collection and analysis. D.H. contributed to the study idea. M.V.N. and H.M.A. were involved in the writing and revision of the article. All authors approved the final manuscript.

Funding

The Region Zealand Health Science Research Foundation (REG‐145‐2022) funded the first and third authors, and the Novo Nordisk Foundation (0077572) funded this study.

Ethics Statement

This study adheres to the ethical principles outlined in the Declaration of Helsinki.

Consent

All participants provided informed consent prior to participation.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Checklist for Improving Action Research Quality in Healthcare Context [29], supporting methodological transparency of the study.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.