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Research – health and wellbeing

Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England. (Samskapa research programme 2019-2024)

Co-creation, co-production and co-design are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of co-production in individual projects, there remain significant gaps in the evidence base.

Our aim is to explore, enhance and measure the value of co-production for improving the health and wellbeing of citizens. We will focus on three fundamental issues: a) measures of co-production processes and their outcomes, b) mechanisms that enable inclusivity and reciprocity, and c) management systems and styles.

Nine co-production projects will form the core of an interactive research programme (Samskapa). Six of these will take place in Sweden and three in England to enable knowledge exchange and cross-cultural comparison.

The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sense-making process will generate relevant lessons both for participants and researchers. Based on the findings we will develop explanatory models and other outputs to increase the sustained value (and values) of future co-production initiatives in these sectors.

Project overview:

Keywords: co-production, co-design, healthcare, social care, case study

Contributed by: Glenn Robert, King’s College London



Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement
Research involvement and engagement, January 2019
Louise Locock, Susan Kirkpatrick, Lucy Brading, Gordon Sturmey, Jocelyn Cornwell, Neil Churchill, Glenn Robert

Patient or user involvement in health research is a well-established principle. However, involvement is often limited to advising on research questions and design, leaving researchers to complete data collection and analysis. Involvement in data analysis is one of the most challenging, least well-explored aspects of involvement. The research aimed to discover what user involvement in this analysis would bring, and how best to achieve it.

Contributed by: Glenn Robert, King’s College London



Codesigning health and other public services with vulnerable and disadvantaged populations: insights from an international collaboration
Health Expectations, January 2019
Gillian Mulvale, Sandra Moll, Ashleigh Miatello, Glenn Robert, Michael Larkin, Victoria Palmer, Alicia Powell, Chelsea Gable, Melissa Girling

Co-design has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective co-design. The research sought to explore citizens’ involvement in co-designing public services for vulnerable groups, identify challenges and suggest improvements.

Contributed by: Glenn Robert, King’s College London



The Participatory Zeitgeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement
Medical Humanities, June 2018
Victoria Palmer, Wayne Weavell, Rosemary Callander, Donella Piper, Lauralie Richard, Lynne Maher, Hilary Boyd, Helen Herrman, John Furler, Jane Gunn, Roderick Iedema, Glenn Brian Robert

This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services.

The model advances theoretical thinking in co-production beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome.

Contributed by: Glenn Robert, King’s College London



‘It’s sometimes hard to tell what patients are playing at’: How healthcare professionals make sense of why patients and families complain about care
Health 22:6, August 2017
Mary Adams, Jill Maben, Glenn Robert

This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

Contributed by: Glenn Robert, King’s College London



What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis
BMJ Open, 7:7, July 2017
David Clarke, Fiona Jones, Ruth Harris, Glenn Robert

Our intention was to identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings. We found a lack of rigorous evaluation in acute healthcare settings and recommend that future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Broader impacts on the values and behaviours of participants should also be considered.

Contributed by: Glenn Robert, King’s College London



Using co-production to improve patient carer and staff experiences in health care organisations: a multi-centre, mixed methods evaluation in inpatient stroke units (CREATE) (Samskapa research programme 2019-2025)

Stroke is the largest cause of adult disability in the United Kingdom (UK), and accounts for 5% of total NHS costs. Early rehabilitation relevant to patients’ needs can improve independence and the intensity of activity impacts on the degree of recovery, yet national targets to increase therapy intensity and frequency are not being met.

Our research focuses on the feasibility and impact of patients, carers and clinicians co-producing and implementing interventions to increase supervised and independent therapeutic patient activity in acute stroke units.

The research will be undertaken in three phases. In phase 1 we will complete a rapid evidence synthesis to update the evidence on the efficacy and effectiveness of co-production approaches in acute healthcare settings. In phase 2 we will use Experienced Based Co-Design (EBCD) as our co-production approach to design interventions and evaluate the impact in two stroke units. Phase 3 will implement and evaluate the co-produced interventions developed in a further two stroke units.

Anticipated benefits of the study include establishing whether EBCD can be effectively employed in acute healthcare. We also aim to identify interventions to increase therapeutic inpatient activity which can be deployed in all stroke units nationally and potentially in other settings including elderly care and trauma and orthopaedic wards.

Project overview:

Keywords: co-production, rehabilitation, acute healthcare, experience-based co-design, stroke

Contributed by: Fiona Jones, St George’s University of London, Kingston University



Co-production & Public Health: public & clinicians’ perceptions of the barriers & facilitators (2018-2019)

Co-production is an approach increasingly recognized across public services internationally. However, awareness of the term and the barriers and facilitators to its implementation in the NHS are not widely understood. This all-Wales study examined clinician and public perceptions of co-production within the context of the Prudent Healthcare initiative.
Qualitative research methods (interviews & focus groups) were used to provide insights into how co-production is viewed by clinicians and the public and to identify perceived barriers and facilitators to its implementation.
Key barriers relating to capability include lack of awareness of the term co-production and inadequate communication between clinicians and citizens. Opportunity‐centred barriers include service and time constraints. Conversely, facilitators included utilizing partnerships with community organizations. Motivation‐related barriers included preconceptions about patients’ limitations to coproduce.
We concluded that there were broadly positive perceptions among participants regarding co-production, despite initial unfamiliarity with the term. Despite study limitations including underrepresentation of employed public participants and junior doctors, our analysis may assist researchers and policymakers who are designing, implementing and evaluating interventions to promote co-production.

Keywords: co-production, NHS, Prudent Healthcare Initiative, Wales, qualitative research

Contributed by: Daniella M. Holland-Hart, Cardiff University, University of South Wales



Trans Ageing and Care (TrAC): Dignified and inclusive health and social care for older trans people in Wales

A research project seeking to develop dignified and inclusive health and social care services for older trans people in Wales. Based at Swansea University in the Centre for Innovative Ageing, this project is dedicated to improving health and social care services for trans individuals over 50 years of age. We also want to learn more about the wellbeing, needs and interests of trans and gender diverse adults in later life.

Keywords: transgender; health-care; social care; co-production; older people; identity; health and social care delivery

Contributed by: Paul Willis, Bristol University, Christine Dobbs, Swansea University, Michele Raithby, Swansea University




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