By Sara Hodgkinson, Melanie Rimmer and Sarah Salway
In the context of healthcare, new concepts and buzzwords periodically appear, each carrying with them the promise of innovation and progress. The emergence of ‘co-production’ might initially have appeared to be just another trending catchphrase, yet the term appears to have established some credibility within the public health realm. Co-production refers to a collaborative process where healthcare providers work with healthcare users to shape health services with the intention of better tailoring them to need. This approach contrasts with the more typical ways of designing and delivering services where important decisions are made solely by those in positions of power.
The idea behind co-production is that by engaging service users in the design and creation of services, this will achieve better outcomes. But co-production isn’t just for service provision – it can also be used to make research more relevant by incorporating the views and ideas of local people in designing and carrying out projects (Durose et al., 2011). Because co-production can potentially include and involve groups of people that are easily excluded from research, it has been of particular interest to health equity researchers.
Several of our recent projects have used co-production. For example, one study aimed to develop health education materials on the topic of genetic risk associated with close relative marriage. We worked closely with members of the community to understand how they saw the issue, and used these insights to develop a print leaflet and an informational video that were then tested. The team trained and employed local people as co-researchers to engage and involve local people who might otherwise have been missed. Community researchers generated useful insights that helped to shape materials that were relevant and sensitive to local needs. However, the project also had challenges. In particular, not everyone in the community agreed with each other, and the community researchers sometimes found it difficult to navigate the range of perspectives held by different people, demonstrating one of several possible pitfalls of co-production. Co-production ‘blurs the lines’ between the professional and lay divide (Owens and Cribb, 2012: 268), but it is important not to place responsibility for the production of new knowledge in the hands of lay people alone. The value of collaboration should not be discounted, but it can be a challenge for co-production to separate the helpful information from that which is simply available. In other words, whilst all lay knowledge is valuable in its own right, not all will be usable.
It has been argued that co-production has the potential to reduce inequalities by giving a voice to service users whose views and needs are frequently overlooked. As an example, one of our recent projects – ‘WiLD: Weight Loss for people with Learning Disabilities’ – used co-production to explore how the Slimming World weight loss programme might be adjusted for people with learning disabilities. Insights and ideas from people with learning disabilities and Slimming World group leaders were used to make reasonable adjustments which were then tested in a small feasibility study. The team then made recommendations to Slimming World for further adjustments. Co-production was central to the design of the study and fundamental to its overall success. However, involving people with learning disabilities in the research required additional resource and time, and also necessitated various modifications to standard research methods, such as consent procedures. Researchers embarking on co-production projects without adequate awareness and preparation will at the least find the process frustrating and worse still may stray into unethical practice and inefficient use of resources (Salway et al., 2015).
Despite testimonies to the value of co-production, there is still some scepticism and a lack of consensus about what constitutes co-production and how it might best be achieved. The Social Care Institute for Excellence (SCIE) states that “there is no single formula for co-production” (2013), and this is echoed by others who highlight the “elasticity” of co-production as a term, and the broad scope of what the term might be used to mean (Needham et al, 2014: 3). The term “co-production” can be used to describe such varied methods as: professional and peer support networks for knowledge sharing; reciprocal relationships between service providers and users; and the personal development of individuals through positive use of lay knowledge and capabilities. Without clear definitions and descriptions it can be difficult to ensure that co-production methods are utilised most appropriately and effectively in research or policy making.
So what does the future hold for co-production? Will we see an upsurge in the use of co-production as researchers and policy makers recognise its worth and seek to improve the relevance of their work? Or will the ambiguity and challenges put people off from using these methods? It is clear that – when employed thoughtfully – co-production has the potential to revolutionise particular forms of research and service design. However, to ensure co-production delivers benefits to those who have previously been catered to least, there is clearly a need for significant new skills, resources and commitment to a different way of working.
Croot, L., Rimmer, M., Dowse, E., Harris, J., Hatton, C., Hillier, S., Lavin, J., O’Cathain, A. and Salway, S. (2016) ‘Modifying mainstream weight management interventions for use with people with intellectual disabilities: a user centred approach’, Obesity Facts 2016; 9 (suppl 1): 1-368 available at http://wild.group.shef.ac.uk/poster.html
Durose, C., Beebeejaun, Y., Rees, J., Richardson, J. and Richardson, L. (2011) Towards Co-production in research with communities, Swindon: AHRC
Needham, C., Durose, C., Mangan, C. and Rees, J. (2014) Evaluating co-production: pragmatic approaches to building the evidence base. For Co-production Panel, Political Studies Association Conference, 14-16 April 2014, Manchester, UK. Birmingham: University of Birmingham
Owens, J. and Cribb, A. (2012) ‘Conflict in Medical Co-Production: Can a Stratified Conception of Health Help?’ Health Care Analysis, 20 (3): 268-280
Salway S., Chowbey, P., Such, E, and Ferguson, B. (2015) ‘Researching health inequalities with community researchers: practical, methodological and ethical challenges of an ‘inclusive’ research approach’, Research Involvement and Engagement, 1 (9) available at http://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-015-0009-4
SCIE (2013) What is co-production – Defining co-production. [online] Available at: http://www.scie.org.uk/publications/guides/guide51/what-is-coproduction/defining-coproduction.asp [Accessed 16 Aug 2016]