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In this study, we introduce a new approach to addressing the complexities of health systems challenges, which we name the Ecology of Design Briefs. This approach offers a structured framework for delivering key leverage points within these challenges and creating a conceptual space for feasible design opportunities. Acknowledging the limited reach of individual design solutions in tackling the complexities of health systems challenges, our approach draws on the ecology concept of Transition Design. The utilisation of the Ecology of Design Briefs results in a collection of interconnected specification documents for design projects that guide the creative process, working together synergistically to tackle the complexities. This approach was applied to enhance hospital care experiences for individuals with acute exacerbations of chronic obstructive pulmonary disease (COPD). Hospitalisations for this group frequently lead to multidimensional negative experiences, and addressing these issues is closely linked to resolving underlying health systems problems. Our findings suggest that the developed briefs provide comprehensive, mutually reinforcing, and detailed insights necessary for understanding these challenges. This study contributes to health systems problem-solving by conceptualising the Ecology of Design Briefs as an approach and documenting its application in a hospital care setting.

Objectives: This scoping review aimed to summarise available evidence relating to co-creation experiences among adults in diverse contexts. Understanding how participation in co-creation processes shapes experiences is important as it can offer insights into the improved development and effective use of such processes. Co-creation has increasingly gained attention due to its many claimed advantages and benefits to participants. There is however a lack of aggregated literature on stakeholders’ experience of the co-creation process.

Study design: Scoping review.

Methods: Arksey and O'Malley's methodological framework for conducting scoping reviews was used. A systematic search was conducted in Scopus and the Health CASCADE Co-creation Database (an open access curated database of 13,501 articles, screened for inclusion based on criteria relating to co-creation participatory research). Themes were generated through thematic analysis.

Results: We included 80 publications. Positive co-creation experiences were linked to establishing interpersonal relationships and positive group dynamics, enhanced well-being, personal development, satisfaction and fulfilment. Negative experiences were associated with initial uncertainties, project-related challenges, interpersonal issues, dissatisfaction, and disengagement.

Conclusion: This review offers insights into how co-creation shaped experiences and demonstrates the scope and characteristics of co-creation experiences. It highlights the need for further research, particularly in understanding the mechanisms underpinning and explaining experiences and in strategies for promoting positive experiences and mitigating negative experiences.

Background: Co-creation engages diverse stakeholders, including marginalized populations, in collaborative problem-solving to enhance engagement and develop contextually appropriate solutions. It is increasingly recognized as a way to democratize research and improve the impact of interventions, services, and policies. However, the lack of synthesized evidence on co-creation methods limits methodological rigor and the establishment of best practices. This review aimed to identify co-creation methods in academic literature and analyze their characteristics, target groups, and associated benefits and challenges.

Methods: This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The search was conducted in the Health CASCADE database v1.5 (including CINAHL, PubMed, and 17 additional databases via ProQuest) from January 1970 to March 2022. Data was aggregated and summarized, with qualitative data analyzed using Braun and Clarke's six-phase thematic analysis approach.

Results: The review included 266 articles, identifying 248 distinct co-creation methods published between 1998 and 2022. Most methods were rooted in participatory paradigms (147 methods), with 49 methods derived from co-approaches like co-creation, co-design, and co-production, and 11 from community-based health promotion and action research. Methods were applied across 40 target populations, including children, adults, and marginalized groups. Many methods (62.3%) were delivered face-to-face, with 40 articles incorporating digital tools. Thematic analysis revealed nine benefits, such as enhanced creativity, empowerment, and improved communication, and six challenges, including resource constraints and systemic and structural barriers.

Conclusion: This review emphasizes the importance of robust documentation and analysis of co-creation methods to inform their application in public health. Findings support the development of collaborative co-creation processes that are responsive to the needs of diverse populations, thereby enhancing the overall effectiveness and cultural sensitivity of the outcomes. This review highlights the potential of co-creation methods to promote equity and inclusion while emphasizing the importance of evaluating and selecting methods tailored to specific objectives, offering a critical resource for planning, conducting, and evaluating co-creation projects.

This article reflects on how patient education tool design can benefit from a co-creation process with patients and key stakeholders involved, using a case study in chronic obstructive pulmonary disease (COPD) care. Unfavourable hospitalisation experiences for COPD patients are often linked to organisational issues and health literacy challenges. This study presents insights from a year-long co-creation practice involving COPD patients, a family member, healthcare practitioners, and hospital managers, aimed at developing patient education tools to enhance health literacy concerning the hospitalisation process. The primary outcome is a set of patient education infographics that can be integrated into digital platforms or printed formats. For such co-creation practice, we found that setting clear creativity expectations and using methods such as user journey maps empower participants. Balancing the power dynamics between patients and healthcare practitioners enables culturally relevant and patient-centred tools. In addition, family members play a crucial role in both co-creation process and care journey, while hospital managers ensure tools align with clinical practices. We also advocate for an ecological perspective towards intervention development, acknowledging diverse needs emerged from the co-creation process. Future research should implement strategies in further individualising infographics to improve their effectiveness.

Background: Adapting co-creation research processes and/or public health interventions improves the fit between the intervention and population of interest, potentially resulting in more relevant and effective interventions. Mode 2 research approaches (e.g., co-creation, co-production, co-design, community-based participatory research, and participatory action research) can ensure that adaptations fit the socio-cultural and economic contexts. However, an overview of existing practices and how to co-adapt is lacking. This study aimed to provide an overview of the use of co-adaptation in co-creation processes and/or public health interventions.

Methods: We conducted a rapid review search on the Health CASCADE co-creation database. Relevant peer-reviewed studies reporting on co-adaptation of public health interventions were identified. A call for case studies via social media and co-authors’ snowballing was issued to perform interviews with co-creation researchers gaining insights into how co-adaptation was applied from unpublished studies and practice. Interviews were analysed using template analysis.

Results: Fourteen studies addressed various public health issues by co-adapting co-creation processes, intervention activities, communication platforms, monitoring strategies, training components, and materials’ language and tone. Most studies lacked detailed reporting on the co-adaptation process, though some provided information on group composition and number, duration, and methods applied. Two out of 14 studies used a framework (i.e., Intervention Mapping Adapt), seven described their adaptation procedure without naming a specific framework, and five did not report any procedures or frameworks. Five of seven case studies used adaptation frameworks (e.g., ADAPT guidance). Interviews provided insights into the co-adaptation process emphasising the importance of contextual fit, integrating prior knowledge, and logging adaptations.

Conclusions: This study is the first introducing the concept of and exploring co-adaptation of co-creation processes and/or public health interventions. It provides details regarding adaptations made, whether and which frameworks were used, and procedures applied to adapt. The findings highlight the need for tailored frameworks for co-adaptation and better reporting of co-adaptation processes.

Background: Implementing public health interventions in schools requires active involvement of multiple stakeholders and adaptation of interventions to fit local contexts, to account for successful design, implementation, and consequently effectiveness of these interventions. Active collaboration, preferably in a co-creation process, with school staff is needed to enhance the implementation of school-based public health interventions. However, involving them in research through a co-creation process is challenging due to competing demands on their time. Hence, there is a need for insights into the factors facilitating or impeding co-creation processes involving school staff.

Methods: To gain in-depth knowledge of school staff’s experiences a scoping review and thematic synthesis have been conducted. Peer reviewed articles written in English and published between January 2012 and November 2023 were retrieved from ERIC, Education Database, Medline (PubMed interface), Embase, Web of Science, Scopus, and Health CASCADE Co-creation Database. Considering the high amount of search results the title and abstract screening was performed using ASReview. A thematic synthesis was conducted on the included articles.'

Results: Ten scientific peer reviewed articles were included and thematically synthesised. Six descriptive themes described factors influencing the co-creation process, including competing work roles and responsibilities of school staff, multistakeholder collaboration, benefits of participation in the co-creation process, power imbalances between different stakeholders, and school staff’s lived experiences. Additionally, four analytical themes emerged indicating that demands of the co-creation process outweigh its benefits. To tackle excessive demands school staff preferred a guided process in which high-level participation was less important. School staff joined the co-creation process to serve students and emphasised the importance of being heard and taken seriously.

Conclusions: School staff indicated that excessive demands outweigh the benefits experienced during the co-creation process. Therefore, school staff preferred less time-intensive processes. Improving students outcomes was school staff’s motivation to be involved, which asks for processes with student-related goals and observable student benefits. Moreover, school staff needs to be acknowledged as an expert and valued for their involvement. These results should be considered to make co-creation processes involving school staff more feasible and satisfactory.

Choosing the appropriate design process is critical for the effective implementation and long-term sustainment of interventions aimed at addressing public health challenges. To address this need, we proposed a Transition Design model to identify and deliver sustainable solutions for complex healthcare problems. This model generates system-level health-intervention initiatives that can synergistically function, particularly during the development and implementation phases, to enhance healthcare delivery. Drawing from a case study on addressing the challenges of hospitalisations and early discharge for people with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), we reflected on the process and analysed the outcomes. Although further testing for the initiatives is warranted, this study contributes to the evolving discourse in design research on systems solutioning for public-health challenges.

Background: There is a growing investment in the use of co-creation, reflected by an increase in co-created products, services, and interventions. At the same time, a growing recognition of the significance of co-creators’ experience can be detected but there is a gap in the aggregation of the literature with regard to experience. Therefore, the purpose of this scoping review is to uncover the breadth of existing empirical research on co-creation experience, how it has been defined and assessed, and its key emotional and psychological characteristics in the context of co-created products, services, or interventions among adults.

Methods: The development of the search strategy was guided by the research question, Arksey, and O’Malley’s scoping review methodology guidelines, and through collaboration with members of the Health CASCADE consortium. The results of the search and the study inclusion process will be reported in full and presented both narratively and by use of the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram. Comprehensive searches of relevant electronic databases (e.g. Scopus) will be conducted to identify relevant papers. Snowball searches to identify additional papers through included full-text papers will be done using the artificial intelligence tool, namely, Connected Papers. All review steps will involve at least two reviewers. Studies in English, Dutch, Chinese, Spanish, and French, published from the year 1970 onwards, will be considered. Microsoft Excel software will be used to record and chart extracted data.

Discussion: The resulting scoping review could provide useful insights into adult co-creators’ experience of participating in the co-creation process. An increased understanding of the role of emotional and psychological experiences of participating in co-creation processes may help to inform the co-creation process and lead to potential benefits for the co-creators and co-created outcome.

Systematic review registration: 10.5281/zenodo.7665851.

Designers’ roles are at a turning point of transforming design from an expert-driven design process within an assumed social and economic order to design practices that advocate design-led societal transition toward more sustainable futures. Design education should be adapted accordingly. Introducing the transition design concept into established design education promotes the sustainable society transition by involving more systems thinking from designers in various sectors. This study reports on a pilot practice and reflection on introducing the transition design concept to design students.

Background: Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation.

Methods: We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components.

Results: 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).

38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).

13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation.

Conclusion: The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.