Living Labs in digital health: a collaborative ecosystem approach for continuum of care.

Introduction: Living Labs (LLs) are increasingly recognized in healthcare as collaborative environments that drive digital health innovation through stakeholder co-creation in real-world settings. However, existing research has predominantly conceptualized LLs as experimental testbeds for technology validation, neglecting their broader systemic potential in integrated health services. Objectives: This study seeks to advance the understanding of LLs in digital health by identifying their foundational elements, analyzing their methodologies, and proposing an expanded framework for their application within healthcare ecosystems. Methods: The study combines a systematic scoping review, guided by PRISMA and based on ENOLL's (2021) six LL principles, with expert focus group discussions. This multi-method design integrates conceptual insights with practical perspectives from digital health contexts. Findings: The study delineates the defining features of LLs in digital health, including their typologies, methodological specificities, stakeholder configurations, intended outcomes, and systemic challenges. These insights inform the Collaborative Living Ecosystem Approach (CLEA), a conceptual framework that reconceptualizes LLs as multidimensional platforms for sustainable healthcare innovation. Discussion: CLEA encompasses three core dimensions: a reconceptualization of LLs beyond innovation hubs, a stakeholder-driven model that fosters co-creation, and an emphasis on integrating healthcare services to enhance connectivity across health and care levels. By providing a structured and integrated perspective on LLs, this study contributes to the discourse on digital health ecosystems, shifting the focus from technology validation to holistic, sustainable healthcare solutions that address complex health and societal needs.