Studies indicate that the way structured participatory design activities are facilitated significantly effects participation, power relations, and generated output. Although facilitation is always adapted to the conditions of each design project, the way facilitation is enacted primarily depends on the individual facilitator. It is assumed that enactment on an individual level is influenced by how the facilitator conceptualizes both user involvement and their own role. To address these issues, semi-structured interviews were conducted with three facilitators in the same development unit of a large-scale health IT project. The primary focuses were the individual facilitator’s perspectives on the design process, their role, and their practice in the project. An in-depth qualitative content analysis of the transcribed interviews showed that the three facilitators held highly divergent perspectives on the facilitation of participatory design activities. Similarities were found between the facilitators’ perspectives and how user involvement is understood in different system development traditions. Based on the findings, a reflective approach towards facilitation is proposed along with examples of possible co-reflection activities among facilitators.