Lessons learned about co-creation: developing a complex intervention in rural Peru

Abstract

Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce. Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru. Methods: Observational study to describe the use of the COHESION manual 'Moving from Research to Interventions: The COHESION Model' developed for a multi-country project in low-and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru. Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process. Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.

Social trust and health seeking behaviours: A longitudinal study of a community-based active tuberculosis case finding program in the Philippines

“…For isolated individuals that may not have family members, in close proximity or at all, it would also be important for programs to prioritize trust-building between each ACF setting and community health workers so that they are able to serve as ‘extended family’ substitutes and provide an alternate structure for social support. Examples of interventions that may increase social trust may include trust-building exercises ( Rhodes et al, 2020 ; Sseguya et al, 2018 ), group cognitive behavioural therapy ( Papas et al, 2020 ), targeted training for community health workers on how to develop trusting relationships with the community ( Dawson-Rose et al, 2020 ; Lazo-Porras et al, 2020 ), and guidance on participant or family engagement with the intervention ( Mantovani et al, 2017 ; Walton et al, 2018 ).…”

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…In addition, the growing prevalence of diabetes mellitus across LatAm and the complexity of the disease suggest opportunities to create or strengthen collaborations towards its prevention and early detection [141][142][143][144]. For example, multinational and multidisciplinary researchpublic health-health care policy-clinical care partnerships which already exist in formal or informal platforms may be well-positioned to evaluate the impact of nutrition, health insurance, housing, and other public policies [79,141,143,[145][146][147][148][149][150][151][152][153][154] on health outcomes and assess their potential translation into preventive strategies at the public health and clinical care levels.…”

“…Integrating social determinants of health into diabetes care demonstrated objective improvements in patient knowledge and cardiometabolic parameters [233]. Enhancing medical continuing education [234], an intervention combining diabetes prevention and self-management [235], co-creating interventions with community stakeholders and other countries [141,144] are other examples of alternatives to improve diabetes care throughout the region. Another major regional example of efforts to implement better care for patients with diabetes has been led by the Latin American Diabetes Association (ALAD in Spanish) to engage 17 medical associations and wrote a consensus statement on the treatment of type 2 diabetes in LatAm [207].…”

International experiences with co-production and people centredness offer lessons for covid-19 responses

“…To develop the package, the different stakeholders also had to interact regularly, which occupied more of people's time and resources than other approaches. 20 Co-production requires transparency and accountability to achieve the mutual trust that is sometimes lacking within health systems. 22 Consultation with health service users requires methods that are more than just a token.…”

“…In Peru, researchers, health workers, and policy makers, working with communities, co-produced interventions to improve diagnosis and management of chronic diseases in rural areas as part of the COmmunity HEalth System InnovatiON (COHESION) project. 20 21 They developed a package that included radio programmes to help improve health literacy among patients, and interventions, such as training for health workers and infrastructure improvements. Because the local measures were embedded within a national framework, they worked at all levels of the health system, supported by a national advisory group.…”