This chapter explores the transformation of Swedish health and welfare services towards co-production, emphasizing the shift from doing things for citizens and patients to doing things with them. It discusses the perplexity and potential for innovation, research and education to foster new ways of understanding and acting in line with co-production principles. The authors examine various terms and traditions associated with this transition, highlighting the need to adapt to co-production in Swedish health and welfare services. The chapter also delves into the application of co-production values in research, education and innovation, stressing the importance of defining key principles and creating a conducive environment for co-production to thrive.

Introduction Sparse education on sexual health promotion for health and welfare professionals can lead to unequal sexual health care provision, with related needs and rights being insufficiently met. To improve knowledge for health and welfare professionals, co-production and shared learning are essential, as students' learning, and professional development are facilitated by effective partnerships between universities and workplaces.Methods Using a theoretical framework based on the concepts co-production, work-integrated learning, digital teaching and digital didactics, an initial programme theory was created. Thereafter, a realist evaluation was made of outcomes from five different digital master-level courses, all covering various aspects of sexual health promotion. Four data sources were used: 1) midway course evaluation from 32 students analysed with reflective thematic analysis, 2) focus group interviews with four teachers, analysed with reflective thematic analysis, 3) Students' Attitudes to Sexual Health Extended survey pre- and post-test with 17 students, analysed with comparative statistics, and 4) learning analytics based on data from the digital tool FeedbackFruits, where interactions were analysed using a digital whiteboard).Results The analysis resulted in a refined programme theory indicating that students found courses relevant for practice, became more comfortable talking about sexual health in practice and applied their learning in practice.Discussion The study supports the value of co-production in developing and delivering digital master-level courses in sexual health promotion for professionals, and the added value of work-integrated learning in this setting and highlights the need for digital literacy among both students and teachers. Confirmation or contradiction of the findings should be tested in this and other settings, and preferably with a larger sample.

Co-production has the capacity to encourage meaningful engagement and create public value. Co-production can occur at various stages or throughout the entire participatory process and there is increasing application of this approach in digital settings. The use of digital tools further complicates an already complex co-production process. Applying the Engagement, Alignment, and Agreement (EAA) framework (Masterson et al., 2024) this case study explores the experiences and shared learnings gained from participating in a co-production process in physical and digital environments as well as synchronous and asynchonrous interaction (blended co-production). The case study called “Heart of the Matter” involved citizens coming together to use the EAA-framework to explore co-production. We problematized how to create a conducive environment for co-production in a digital context maintaining its values and principles, whether in real-time, synchronized dialogues, or in delayed, asynchronous dialogues throughout the blended process.

The aim is to examine the challenges and opportunities participants encountered when using digital tools for social interaction and collaborative learning in a blended co-production setting.  The analysis is ongoing, and we will present preliminary findings from this case study exploring experiences and shared learnings from undertaking co-production in a blended setting. 

This presentation seeks to advance the conversation on digital co-production by adding the perspectives of participants and provide actionable insights for those who are planning to engage in co-production involving digital tools. 

Masterson, D., Lindenfalk, B., Kjellström, S., Robert, G., & Ockander, M. (2024). Mechanisms for co-designing and co-producing health and social care: a realist synthesis. Research Involvement and Engagement, 10(1). https://doi.org/10.1186/s40900-024-00638-3 

Co-production, as an approach to research and participatory processes, has gained significant attention due to its potential to foster meaningful engagement. However, despite the growing adoption of co-production and co-creation methods, there is sometimes an overreliance on the concepts to encapsulate complex engagement processes. Co-production can occur at various stages or throughout the entire engagement/participatory process. In a realist synthesis, central elements for co-production were identified and presented in an Engagement, Alignment and Agreement (EAA) framework (Masterson et al., 2024). That EAA framework is an initial programme theory posited to guide the co-production process in a range of contexts. When co-production requires interaction in a digital setting, an additional layer of complexity is introduced. This presentation explores these complexities by reflecting on two case studies that examine co-production in both fully digital and blended environments. The research question was; How can the complexities of engagement in fully digital and blended settings be managed to achieve meaningful co-production that generates public value?

The first case study examines a fully digital online course where students co-produce tools with patients to inform healthcare practice. The second is a blended co-production process that involves citizens in a research setting exploring the EAA-framework and solutions for implementing co-production. Each case provides valuable insights into the challenges and opportunities of using digital tools to foster social interaction and collaborative learning.

In this presentation, we present a Blended Social Interaction and Learning Framework based on the lessons learned from these two case studies. This framework is intended to serve as a guide for integrating digital tools into co-production processes, offering a structured approach for making informed decisions about how to engage participants in both fully digital and blended contexts. Questions are raised about how a conducive environment for co-production can be achieved when co-production requires interaction in a digital setting and also how to make sure that the values and principles —such as inclusivity, equity, and shared decision-making— can be established and operationalised in a fully digital or blended setting, in parts or throughout an entire collaborative process. We also reflect on the application of these frameworks in the context of value co-creation in digital settings.

The findings from these case studies suggest that careful consideration must be given to the design and facilitation of the process to preserve the integrity and authenticity of the engagement. The Blended Social Interaction and Learning Framework provides a practical tool for addressing these considerations.

By examining these case studies and the accompanying framework, this presentation seeks to advance the conversation on digital co-production and provide actionable insights for researchers, educators, and practitioners seeking to design more effective participatory processes in a digital age.

Masterson, D., Lindenfalk, B., Kjellström, S., Robert, G., & Ockander, M. (2024). Mechanisms for co-designing and co-producing health and social care: a realist synthesis. Research Involvement and Engagement, 10(1). https://doi.org/10.1186/s40900-024-00638-3

Co-production in research is not only encouraged but rapidly becoming a required consideration in health research funding. The challenge in defining co-production continues and the misapplication of co-production has led to growing calls for an emphasis on operationalising the values and principles of co-production in research. This commentary considers Rycroft-Malone and colleagues' key messages about co-production being more than a set of activities, and reflects on the challenges within the academic sector when applying co-production. The Co- producing Meaningful Principles and Sharing Standards (Co-MPASS) tool offers a way to consider co-production values in the early stages of collaboration. Rather than a stand-alone tool for co-production, it is intended to be used with established methods and published toolboxes to emphasise co-production principles through reflection, conversation, documentation, and learning.

BACKGROUND: Recent years have seen a dramatic growth in interest in the nature and extent of co-production in the health and social care sectors. Due to the intense proliferation of work on co-production, there is intense variation in practice in how co-production is defined, understood and used in practice.

METHODS: We conducted a narrative review to explore, and provide an overview of, which models of health and social care co-production have been developed, applied and critiqued over the last few decades.

RESULTS: Seventy-three peer reviewed articles met our inclusion criteria. In this set of articles, we identified three broad types of models: conceptual/theoretical; practice-oriented; and presenting a typology. We found that practice-oriented models, predominantly from the Health Services Research and Quality Improvement literature, had largely not drawn on conceptual/theoretical models from the disciplinary fields of Public Administration & Management and Sociology. In particular, they have largely neglected theoretical perspectives on relationships and power and agency in co-production work, as well as the concepts of Service-Dominant Logic and Public Service-Dominant Logic as ways to think about the joint, collaborative process of producing new value, particularly in the context of the use of a service.

CONCLUSION: Our review has identified distinct literatures which have contributed a variety of models of health and social care co-production. Our findings highlight under-explored dimensions of co-production that merit greater attention in the health and social care contexts. The overview of models of co-production we provide aims to offer a useful platform for the integration of different perspectives on co-production in future research and practice in health and social care.

Background: Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

Aims: To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

Materials and methods: Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

Results: The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

Conclusion: Existential conversations in group may contribute to a more reflected doing in accordance with one’s own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual’s own preferences.

Significance: This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

Objectives: Analyse reported processes of co-design and co-production in the context of health and social care to explore the underlying mechanisms that enable inclusive and reciprocal engagement.

Search strategy: Peer review research was obtained from a prior scoping review searching eight databases consisting of all methodologies relevant to co-design or co-production in the context of health and social care services and involving service-users.

Methods of selection: Articles were included for synthesis if they reported a process of dialogue, with mutuality, insight and clarification in their engagement process. Ninety-three peer-review articles informed our programme theory development.

Analysis: Data relating to co-design and co-production processes were extracted and analysed through inductive, abductive, and deductive analysis leading to the development of an initial programme theory.

Main results: This realist synthesis finds that co-design and co-production can occur at different times, in part or all of the research and participatory process. There is an over reliance on the term ‘co-design’ or ‘co-production’ to convey complex engagement or participatory processes. We identified six mechanisms (intention, assets, dialogue, documentation, interpretation and understanding). Interaction between these six identified mechanisms in context, even if only brief, is important for supporting meaningful engagement, alignment and agreement within a co-design or co-production process.

Implications for practice: The initial programme theory presented in this article provides clarity by identifying essential mechanisms which can guide the design and implementation of a range of participatory approaches. Rather than relying on a single label to convey complex participatory methods or processes, the values and principles of co-design or co-production, in combination with this programme theory, could be applied to guide implementation and reporting of specific activities within a range of research or participatory methods.

Patient and public contribution: The initial programme theory was presented and piloted in a series of collaborative workshops between May 2023 and March 2024 with patient and public contributors, health professionals and researchers. This engagement process is currently underway to refine the programme theory and it is anticipated that this next phase will be completed in September 2024.

BackgroundAs coproduction in public services increases, understanding the role of leadership in this context is essential to the tasks of establishing relational partnerships and addressing power differentials among groups. The aims of this review are to explore models of coproduction leadership and the processes involved in leading coproduction as well as, based on that exploration, to develop a guiding framework for coproduction practices.MethodsA systematic review that synthesizes the evidence reported by 73 papers related to coproduction of health and welfare.ResultsDespite the fact that models of coleadership and collective leadership exhibit a better fit with the relational character of coproduction, the majority of the articles included in this review employed a leader-centric underlying theory. The practice of coproduction leadership is a complex activity pertaining to interactions among people, encompassing nine essential practices: initiating, power-sharing, training, supporting, establishing trust, communicating, networking, orchestration, and implementation.ConclusionsThis paper proposes a novel framework for coproduction leadership practices based on a systematic review of the literature and a set of reflective questions. This framework aims to help coproduction leaders and participants understand the complexity, diversity, and flexibility of coproduction leadership and to challenge and enhance their capacity to collaborate effectively.