Planning, implementing and governing systems-based co-creation: the DISCOVER framework

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Abstract

Background

Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral responses. This calls for systems-based approaches that facilitate the kind of collective and collaborative thinking and working required to address complexity. While the literature on systems thinking, system dynamics and the associated methodologies is extensive, there remains little clear guidance on how to plan, govern and implement participatory systems approaches within a co-creation process.

Methods

We used a three-step process to develop DISCOVER, a framework for implementing, and governing systems-based co-creation:

Stage 1: We conducted a literature analysis of key texts to identify well-documented methods and phases for co-creation using a systems approach, as well as areas where gaps existed.
Stage 2: We looked for the most appropriate methods and approaches to fill the gaps in the knowledge production chain.
Stage 3: We developed the framework, identifying how the different tools and approaches fit together end-to-end, from sampling and recruiting participants all the way through to responding with an action plan.

Results

We devised DISCOVER to help guide researchers and stakeholders to collectively respond to complex social, health and wider problems. DISCOVER is a strategic research planning and governance framework that provides an actionable, systematic way to conceptualise complex problems and move from evidence to action, using systems approaches and co-creation. In this article, we introduce the eight-step framework and provide an illustrative case study showcasing its potential. The framework integrates complementary approaches and methods from social network analysis, systems thinking and co-creation literature. The eight steps are followed sequentially but can overlap.

Conclusions

DISCOVER increases rigour and transparency in system approaches to tackling complex issues going from planning to action. It is being piloted in environmental health research but may be suitable to address other complex challenges and could be incorporated into research proposals and protocols for future projects.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-023-01076-5.

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Most cited references 34

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Achieving Research Impact Through Co‐creation in Community‐Based Health Services: Literature Review and Case Study

TRISHA GREENHALGH, Claire Jackson, Sara Shaw … (2016)

Policy Points: Co‐creation—collaborative knowledge generation by academics working alongside other stakeholders—is an increasingly popular approach to aligning research and service development. It has potential for “moving beyond the ivory towers” to deliver significant societal impact via dynamic, locally adaptive community‐academic partnerships. Principles of successful co‐creation include a systems perspective, a creative approach to research focused on improving human experience, and careful attention to governance and process. If these principles are not followed, co‐creation efforts may fail. Context Co‐creation—collaborative knowledge generation by academics working alongside other stakeholders—reflects a “Mode 2” relationship (knowledge production rather than knowledge translation) between universities and society. Co‐creation is widely believed to increase research impact. Methods We undertook a narrative review of different models of co‐creation relevant to community‐based health services. We contrasted their diverse disciplinary roots and highlighted their common philosophical assumptions, principles of success, and explanations for failures. We applied these to an empirical case study of a community‐based research‐service partnership led by the Centre of Research Excellence in Quality and Safety in Integrated Primary‐Secondary Care at the University of Queensland, Australia. Findings Co‐creation emerged independently in several fields, including business studies (“value co‐creation”), design science (“experience‐based co‐design”), computer science (“technology co‐design”), and community development (“participatory research”). These diverse models share some common features, which were also evident in the case study. Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed). In both the literature review and the case study, co‐creation “failures” could often be tracked back to abandoning (or never adopting) these principles. All co‐creation models made strong claims for significant and sustainable societal impacts as a result of the adaptive and developmental research process; these were illustrated in the case study. Conclusions Co‐creation models have high potential for societal impact but depend critically on key success principles. To capture the nonlinear chains of causation in the co‐creation pathway, impact metrics must reflect the dynamic nature and complex interdependencies of health research systems and address processes as well as outcomes.

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The application of systems thinking in health: why use systems thinking?

David H. Peters (2014)

This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. They each address problems of complexity, which is a frequent challenge in global health. The different methods and tools are suited to different types of inquiry and involve both qualitative and quantitative techniques. The paper concludes by emphasizing that explicit models used in systems thinking provide new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people’s health.

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Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions

Calum F. Leask, Marlene Sandlund, Dawn Skelton … (2019)

Plain English summary Background: Society has to cope with a large burden of health issues. There is need to find solutions to prevent diseases and help individuals live healthier lifestyles. Individual needs and circumstances vary greatly and one size fit all solutions do not tend to work well. More tailored solutions centred on individuals’ needs and circumstances can be developed in collaboration with these individuals. This process, known as co-creation, has shown promise but it requires guiding principles to improve its effectiveness. The aim of this study was to identify a key set of principles and recommendations for co-creating public health interventions. Methods: These principles were collaboratively developed through analysing a set of case studies targeting different health behaviours (such as reducing sitting and improving strength and balance) in different groups of people (such as adolescent schoolgirls and older adults living in the community). Results: The key principles of co-creation are presented in four stages: Planning (what is the purpose of the co-creation; and who should be involved?); Conducting (what activities can be used during co-creation; and how to ensure buy-in and commitment?); Evaluating (how do we know the process and the outcome are valid and effective?) and Reporting (how to report the findings?). Three models are proposed to show how co-created solutions can be scaled up to a population level. Conclusions: These recommendations aim to help the co-creation of public health interventions by providing a framework and governance to guide the process. Abstract Background: Due to the chronic disease burden on society, there is a need for preventive public health interventions to stimulate society towards a healthier lifestyle. To deal with the complex variability between individual lifestyles and settings, collaborating with end-users to develop interventions tailored to their unique circumstances has been suggested as a potential way to improve effectiveness and adherence. Co-creation of public health interventions using participatory methodologies has shown promise but lacks a framework to make this process systematic. The aim of this paper was to identify and set key principles and recommendations for systematically applying participatory methodologies to co-create and evaluate public health interventions. Methods: These principles and recommendations were derived using an iterative reflection process, combining key learning from published literature in addition to critical reflection on three case studies conducted by research groups in three European institutions, all of whom have expertise in co-creating public health interventions using different participatory methodologies. Results: Key principles and recommendations for using participatory methodologies in public health intervention co-creation are presented for the stages of: Planning (framing the aim of the study and identifying the appropriate sampling strategy); Conducting (defining the procedure, in addition to manifesting ownership); Evaluating (the process and the effectiveness) and Reporting (providing guidelines to report the findings). Three scaling models are proposed to demonstrate how to scale locally developed interventions to a population level. Conclusions: These recommendations aim to facilitate public health intervention co-creation and evaluation utilising participatory methodologies by ensuring the process is systematic and reproducible.

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Author and article information

Contributors

Niamh Smith:

ORCID: http://orcid.org/0000-0002-9255-2528

niamh.smith@gcu.ac.uk

Journal

Journal ID (nlm-ta): Health Res Policy Syst

Journal ID (iso-abbrev): Health Res Policy Syst

Title: Health Research Policy and Systems

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4505

Publication date (Electronic): 8 January 2024

Publication date PMC-release: 8 January 2024

Publication date Collection: 2024

Volume: 22

Electronic Location Identifier: 6

Affiliations

[1 ]School of Health and Life Sciences, Glasgow Caledonian University, ( https://ror.org/03dvm1235) Glasgow, G4 0BA UK

[2 ]School of Social and Political Sciences, University of Glasgow, ( https://ror.org/00vtgdb53) Glasgow, G12 8RZ UK

[3 ]GRID grid.38142.3c, ISNI 000000041936754X, MGH Institute for Technology Assessment, , Harvard Medical School, ; Boston, MA USA

[4 ]Department of Movement and Sports, Ghent University, ( https://ror.org/00cv9y106) Watersportlaan 2, 9000 Ghent, Belgium

Author information

Niamh Smith http://orcid.org/0000-0002-9255-2528

Article

Publisher ID: 1076

DOI: 10.1186/s12961-023-01076-5

PMC ID: 10773095

PubMed ID: 38167041

SO-VID: 9befd967-35b8-4cb8-afe1-d1e74af80bf6

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 5 May 2023

Date accepted : 20 November 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010010, Glasgow Caledonian University;

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ScienceOpen disciplines: Health & Social care

Keywords: systems mapping,systems thinking,methods,public health,group model building,health,policy formulation,co-creation

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ScienceOpen disciplines: Health & Social care

Keywords: systems mapping, systems thinking, methods, public health, group model building, health, policy formulation, co-creation

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Planning, implementing and governing systems-based co-creation: the DISCOVER framework

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Abstract

Background

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Conclusions

Supplementary Information

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Emerald: Healthier Lives

Most cited references 34

Achieving Research Impact Through Co‐creation in Community‐Based Health Services: Literature Review and Case Study

The application of systems thinking in health: why use systems thinking?

Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions

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