  Designing digital artifacts is not a linear, straightforward process. This is
particularly true when applying a user-centered design approach, or co-design,
with users who are unable to participate in the design process. Although the
reduced participation of a particular user group may harm the end result, the
literature on solving this issue is sparse. In this article, proxy design is
outlined as a method for involving a user group as proxy users to speak on
behalf of a group that is difficult to reach. We present a design ethnography
spanning three years at a cancer rehabilitation clinic, where digital artifacts
were designed to be used collaboratively by nurses and patients. The empirical
data were analyzed using content analysis and consisted of 20 observation days
at the clinic, six proxy design workshops, 21 telephone consultations between
patients and nurses, and log data from the digital artifact. We show that
simulated consultations, with nurses roleplaying as proxies for patients
ignited and initiated the design process and enabled an efficient in-depth
understanding of patients. Moreover, we reveal how proxy design as a method
further expanded the design. We illustrate: (1) proxy design as a method for
initiating design, (2) proxy design as an embedded element in co-design and (3)
six design guidelines that should be considered when engaging in proxy design.
The main contribution is the conceptualization of proxy design as a method that
can ignite and initiate the co-design process when important users are
unreachable, vulnerable or unable to represent themselves in the co-design
process. Based on the empirical findings from a design ethnography that
involved nurses as proxy users speaking on behalf of patients, the article
shows that roleplaying in proxy design is a fitting way of initiating the
design process, outlining proxy design as an embedded element of co-design.
