Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration.
codesign
public services
vulnerable populations
Journal
Health expectations : an international journal of public participation in health care and health policy
ISSN: 1369-7625
Titre abrégé: Health Expect
Pays: England
ID NLM: 9815926
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
06
08
2018
revised:
29
11
2018
accepted:
11
12
2018
pubmed:
4
1
2019
medline:
9
9
2020
entrez:
4
1
2019
Statut:
ppublish
Résumé
Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign. To explore citizens' involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements. A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions. A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations. Eight case studies working with vulnerable and disadvantaged populations in three countries. We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre-specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations. Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User-centred evaluations of codesigned public services are needed.
Sections du résumé
BACKGROUND
Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.
OBJECTIVE
To explore citizens' involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.
DESIGN
A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.
SETTING AND PARTICIPANTS
A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.
INTERVENTION STUDIED
Eight case studies working with vulnerable and disadvantaged populations in three countries.
RESULTS
We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre-specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.
DISCUSSION AND CONCLUSIONS
Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User-centred evaluations of codesigned public services are needed.
Identifiants
pubmed: 30604580
doi: 10.1111/hex.12864
pmc: PMC6543156
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
284-297Subventions
Organisme : Social Sciences and Humanities Research Council of Canada
ID : 611-2017-0221
Pays : International
Organisme : Victorian State Government Mental Illness Research Fund & The Psychiatric and Disabilities Donations Trust Fund
Pays : International
Organisme : Ontario Ministry of Research, Innovation and Science
ID : ER13-09-203
Pays : International
Organisme : Aston University Visiting Scholar Fund
Pays : International
Organisme : Department of Health
ID : DRF-2015-08-055
Pays : United Kingdom
Informations de copyright
© 2019 The Authors. Health Expectations published by John Wiley & Sons Ltd.
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