Strategies for enacting health policy codesign: a scoping review and direction for research

Abstract

Background Strategies for supporting evidence-informed health policy are a recognized but understudied area of policy dissemination and implementation science. Codesign describes a set of strategies potentially well suited to address the complexity presented by policy formation and implementation. We examine the health policy literature describing the use of codesign in initiatives intended to combine diverse sources of knowledge and evidence in policymaking. Methods The search included PubMed, MEDLINE, PsychInfo, CINAHL, Web of Science, and Google Scholar in November 2022 and included papers published between 1996 and 2022. Terms included codesign, health, policy, and system terminology. Title and abstracts were reviewed in duplicate and included if efforts informed policy or system-level decision-making. Extracted data followed scoping review guidelines for location, evaluation method, health focus, codesign definition, description, level of health system user input, sectors involved, and reported benefits and challenges. Results From 550 titles, 23 citations describing 32 policy codesign studies were included from multiple continents (Australia/New Zealand, 32%; UK/Europe, 32%; South America, 14%; Africa, 9%; USA/Canada 23%). Document type was primarily case study (77%). The area of health focus was widely distributed. Policy type was more commonly little p policy (47%), followed by big p policy (25%), and service innovations that included policy-enabled funding (25%). Models and frameworks originated from formal design (e.g., human-centered or participatory design (44%), political science (38%), or health service research (16%). Reported outcomes included community mobilization (50%), policy feasibility (41%), improved multisector alignment (31%), and introduction of novel ideas and critical thinking (47%). Studies engaging policy users in full decision-making roles self-reported higher levels of community mobilization and community needs than other types of engagement. Discussion Policy codesign is theoretically promising and is gaining interest among diverse health sectors for addressing the complexity of policy formation and implementation. The maturity of the science is just emerging. We observed trends in the association of codesign strategies and outcomes that suggests a research agenda in this area could provide practical insights for tailoring policy codesign to respond to local contextual factors including values, needs, and resources.

Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol

“…The interest is due, in part, to the potential of Policy Codesign to reconcile the demands on the government to model democratic and participatory governance processes while also stewarding the responsible use of public funds. The rapid proliferation of codesign strategies in nonprofit and government sectors is evidence of the need to systematically study efforts to codesign public policies in behavioral health [ 31 ]. This study will engage in a systematic study of some of the claims made by codesign practitioners, including ourselves, to inform the wider field about participatory approaches to policymaking in behavioral health [ 31 , 42 ].…”

“…The rapid proliferation of codesign strategies in nonprofit and government sectors is evidence of the need to systematically study efforts to codesign public policies in behavioral health [ 31 ]. This study will engage in a systematic study of some of the claims made by codesign practitioners, including ourselves, to inform the wider field about participatory approaches to policymaking in behavioral health [ 31 , 42 ].…”

“…The integration of codesign within coproduction is an emerging method in implementation science [ 31 ], with qualitative and case study research suggesting that it improves policy implementation across varying areas of health [ 32 – 34 ]. However, the field lacks quantitative analysis of the impacts of codesign and coproduction efforts on behavioral health policy design.…”

“…A second study demonstrated the acceptability and feasibility of community policy ranking sessions as a strategy for engaging democratic participation in selecting evidence-informed policy strategies [ 41 ]. A recent scoping review of policy codesign, published in Implementation Science , identifies this as a growing area of interest in health services research, political science, and design research fields [ 31 ]. However, research in this area is dominated by case studies, making the assessment of different approaches difficult.…”

Bridging the gap between pregnancy loss research and policy and practice: insights from a qualitative survey with knowledge users

“…While published evidence to support best practices is limited [ 94 , 95 ], meaningfully involving knowledge users, particularly people with lived experience, in both the production and translation of knowledge—through integrated knowledge translation and related approaches (e.g. co-production)—is essential [ 94 , 96 , 97 ].…”