Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration

Mulvale, Gillian, Moll, Sandra, Miatello, Ashleigh, Robert, Glenn, Larkin, Michael, Palmer, Victoria J., Powell, Alicia, Gable, Chelsea and Girling, Melissa (2019) Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration. Health Expectations, 22 (3). pp. 284-297. ISSN 1369-6513

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Official URL: https://doi.org/10.1111/hex.12864

Abstract

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.

Item Type: Article
Additional Information: The Canadian Social Sciences and Humanities Research Council (SSHRC) provided funding for this project through a Connections Grant (#611‐2017‐0221); Aston University's Visiting Scholar Fund also provided funding towards this project. The case study of justice services for young people who offend in England was supported by the National Institute for Health Research. The Australian CORE Study case study was based on a research study funded by the Victorian State Government Mental Illness Research Fund & The Psychiatric and Disabilities Donations Trust Fund (2013–2017). Finally, the youth with mental disorders’ Canadian case study presented in this paper was funded by the Ontario Ministry of Research, Innovation and Science (ER13‐09‐203). The views expressed here are those of the authors.
Uncontrolled Keywords: codesign, public services, vulnerable populations
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Rachel Branson
Date Deposited: 16 Mar 2021 14:34
Last Modified: 31 May 2021 14:41
URI: http://nrl.northumbria.ac.uk/id/eprint/45709

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