A regional smart specialization initiative is investigated from aquadruple helix framework (industry, government, academia, andusers/civil society). Based on a qualitative case study, we examinethe interdependencies of actors, resources, and activities from amicro perspective. The aim is to understand the relationships andthe value created between the different actors. From the resultswe conclude that the fourth helix should be viewed as a whole –an arena where triple helix actors in different value addingrelationships take on different roles – where they create valueto civil society, for example, new jobs or products for improvedelderly care. In line with this, we state that the fourth helix is farmore complex than limiting it to simply become a fourth separatehelix of users or civil society. There is a complexity in thatthe fourth helix consists of both different users (including triplehelix actors) as well as civil society. Users in the quadruple helixframework can also be defined in several ways depending on thecontext of the arena (the fourth helix) and what value addingactivities they bring to civil society. Thus, users can be businesses,organizations, citizens, society, and many more things.