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Published on Authors of this article:. Background: User involvement in the development of health care services is important for the viability, usability, and effectiveness of services. This study reports on the second step of the co-design process. Objective: The aim was to explore the significant challenges in advancing the co-design process during the requirements specification phase of a mobile Internet service for the self-management of physical activity PA in rheumatoid arthritis RA.

Methods: A participatory action research design was used to involve lead users and stakeholders as co-designers. Data-collection methods included video recordings and naturalistic observations. Results: The inductive qualitative video-based analysis resulted in 1 overarching theme, merging perspectives, and 2 subthemes reflecting different aspects of merging: 1 finding a common starting point and 2 deciding on design solutions.

Conclusions: Co-designing the system requirements of a mobile Internet service including multiple stakeholders was a complex and extensive collaborative decision-making process. Further research is needed to replicate the results and to increase knowledge on key factors for a successful co-design of health care services. User involvement in the development of health care services is important for the viability, usability, and effectiveness of services [ 1 - 3 ].

However, even when the users are involved, the development process may be unsuccessful, and the service may not be accepted and used. Previous research has reported diverse results regarding both benefits and drawbacks of user involvement [ 1 , 2 ]. One explanation for the drawbacks may be that little is known about the various aspects of collaboration associated with the development of a successful service [ 4 , 5 ].