Search Results

Background:

Transformative Innovation Policy (TIP) encompasses a variety of policy frameworks that seek to use the potential of science, technology, and innovation to address societal challenges. To do so, it relies on inclusive co-creation processes for the design, implementation and evaluation programmes and policies that can drive systemic transformation towards sustainability.

Aims and objectives:

To date there are few empirical studies available on how this co-creation approach can be implemented at the level of programmes and projects working on transformative innovation, and what specific competences, processes and functions are required for the successful implementation of this framework. This paper seeks to provide empirical evidence on how to implement TIP at the project level.

Key conclusions:

This paper shows the importance of adaptability and modularity of processes that are used to translate the TIP framework to a specific context, allowing and encouraging processes of adaptation by project partners and other stakeholders. Secondly, we highlight how knowledge services can be used to translate and negotiate meaning for complex frameworks, resulting in the production of new knowledge that is not only contextually relevant, but that feeds into a larger pool of evidence of how theories apply to real-world cases. Thirdly, it highlights the importance of building teams with skills such as facilitation, brokering, communication, translation and embedding of science-based concepts and frameworks, and the ability to lead processes of co-design that ensure coherence across different interventions while being adaptable to varied project contexts.

Background:

The emergency response to the COVID-19 pandemic has required a rapid acceleration of policy decision making, and raised a wide range of ethical issues worldwide, ranging from vaccine prioritisation, welfare and public health ‘trade-offs’, inequalities in policy impacts, and the legitimacy of scientific expertise.

Aims and objectives:

This paper explores the legacy of the pandemic for future science-advice-policy relationships by investigating how the UK government’s engagement with ethical advice is organised institutionally. We provide an analysis of some key ethical moments in the UK Government response to the pandemic, and institutions and national frameworks which exist to provide ethical advice on policy strategies.

Methods:

We draw on literature review, documentary analysis of scientific advisory group reports, and a stakeholder workshop with government ethics advisors and researchers in England.

Findings:

We identify how particular types of ethical advice and expertise are sought to support decision making. Contrary to a prominent assumption in the extensive literature on ‘governing by expertise’, ethical decisions in times of crisis are highly contingent.

Discussion and conclusions:

The paper raises an important set of questions for how best to equip policymakers to navigate decisions about values in situations characterised by knowledge deficits, complexity and uncertainty. We conclude that a clearer pathway is needed between advisory institutions and decision makers to ensure ethically-informed debate.

Background:

Meetings are essential events for the production of a policy. Yet they are largely taken for granted in policy studies: they are perceived as tools for achieving predefined tasks and used as a means of studying other topics, such as public participation.

Aims and objectives:

I aim to study meetings themselves and to develop the concept of meeting in brackets, which helps understand how meetings produce the policy to which they relate. I focus on a Belgian mental health policy supporting a shift from hospital to community mental healthcare.

Methods:

Qualitative methods, including direct observation of 77 meetings and interviews, were combined over an eight-year period in order to comprehensively understand the relationship between meetings and policy production.

Findings:

The Belgian mental health policy gradually emerged from meetings that took place at international, national and local levels. As a result of references made by the participants to previous meetings or to the resulting documents, these meetings gradually formed a web, outside of which the Belgian mental health policy cannot be understood.

Discussion and conclusions:

The concept of meeting in brackets led to define meetings as communicative events framed by decisions about meeting structure, which I call bracketing decisions. These decisions facilitate a form of communication described as reflexive. Reflexive communication in turn leads to a collective creation: a unique vision of the policy under discussion. Such unique visions are gradually assembled as meetings succeed each other, thus forming a web of meetings which is inherent to policy production.

Background:

‘Co-production’ is one of the key concepts in evidence-informed policy and practice – in terms of both its theoretical importance and its practical applications − being consistently discussed as the most effective strategy for mobilising evidence in policy and practice contexts. The concept of co-production was developed (almost) independently across multiple disciplines and has been employed in various policy and practice fields including environment, sustainability, and health.

Aims and objectives:

This paper surveys the literature to identify different meanings of co-production across different disciplinary bodies of knowledge. Such exploration is aimed at identifying the key points of convergence and divergence across different disciplinary and theoretical traditions.

Methods:

We performed a systematic search of Web of Science via a query designed to capture literature likely focusing on co-production, and then manually examined each document for relevance. Citation network analysis was then used to ‘map’ this literature by grouping papers into clusters based on the density of citation links between papers. The top-cited papers within each cluster were thematically analysed.

Findings:

This research identified five meanings of co-production, understood as a science-politics relationship, as knowledge democracy, as transdisciplinarity, as boundary management, and as an evidence-use intervention.

Discussion and conclusions:

Even though different clusters of scholarship exploring co-production are closely connected, this concept is mobilised to capture phenomena at different levels of abstraction – from post-structuralist theories of knowledge and power to specific strategies to be employed by researchers and policymakers.

Background:

Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces.

Aims and objectives:

This study investigated key factors affecting municipal officials’ policymaking for obesity and related health disparities.

Methods:

Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021.

Findings:

Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviours, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take; limitations based on the scope of government; challenges with intergovernmental collaboration or across government levels; ability of policymakers and government employees to understand the problem; and the challenge of framing health disparities given the social-political context.

Discussion and conclusion:

Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.

Background:

This article comes in response to two gaps within the research use literature: a lack of work on quality of use as distinct from quality of evidence, and a lack of research use models based on practitioner, as opposed to researcher, perspectives.

Aims and objectives:

The study probes into the views of education practitioners about ‘using research well’, and explores: (1) the extent to which those views align with or differ from a conceptual framework of quality research use; and (2) whether and how practitioner views can provide deeper insights into quality use of research in practice.

Methods:

The article draws on open-text survey (n=492) and interview (n=27) responses from Australian teachers and school leaders, which were analysed in relation to components of the Quality Use of Research Evidence (QURE) Framework.

Findings:

There was considerable alignment between the practitioners’ views and the QURE Framework, but greater recognition for certain enablers such as ‘skillsets’ and ‘leadership’, as compared with others, such as ‘relationships’ and ‘infrastructure’. The practitioners’ accounts provided nuanced descriptions and elaborations of different aspects of using research well.

Discussion and conclusions:

The findings suggest that: the QURE Framework has empirical validity as a way of conceptualising quality research use; practitioners’ views on using research well can inform future capacity building efforts; and research use as a field needs far more work that is focused on the quality of use and the perspectives of users.

Background:

There has been little applied learning from organisations engaged in making evidence useful for decision makers. More focus has been given either to the work of individuals as knowledge brokers or to theoretical frameworks on embedding evidence. More intelligence is needed on the practice of knowledge intermediation.

Aims and objectives:

This paper describes the evolution of approaches by one UK Centre to promote and embed evidence in health and care services. This is not a formal evaluation, given the lack of critical distance by authors who led work at the Centre, but a reflective analysis which may be helpful for other evidence intermediary bodies.

Conclusions:

We analyse the founding conditions and theoretical context at the start of our activity and describe four activities we developed over time. These were filter (screening research for relevance and quality); forge (engaging stakeholders in interpreting evidence); fuse (knowledge brokering with hybrid teams); and fulfil (sustained interaction with implementation partners). We reflect on the tensions between rigour and relevance in the evidence we shared and the way in which our approaches evolved from a programme of evidence outputs to greater focus on sustained engagement and deliberative activities to make sense of evidence and reach wider audiences. Over the lifetime of the Centre, we moved from linear and relational modes towards systems type approaches to embed and mobilise evidence.

Background:

Despite the known need for empirical research-to-policy studies, little is known about the factors and conditions needed to support meaningful evidence use or how to intervene to promote quality evidence use.

Aims and objectives:

To study research-policy processes empirically and descriptively, we conducted an ethnography that focused on the impact of the Research-to-Policy Collaboration (RPC) on legislator and researcher evidence use or policy engagement, including whether and how researchers and policymakers created and sustained meaningful relationships.

Methods:

The ethnography included participant observation as well as pre- and post- semi-structured interviews from policymakers (n=17), researchers (n=23), and RPC staff (n=5). The team attended relevant events as well as observed the formal and informal ways research is used in policymaking.

Findings:

In the paper, we describe how 1) legislative priorities were identified; 2) networks were established and maintained; 3) trainings evolved over time; 4) relationships between RPC staff, congressional staff, and researchers were facilitated; and 5) RPC followed up with policymakers and researchers.

Discussion and conclusions:

We 1) describe the experiences of participants and whether involvement in the intervention changed attitudes or behaviours about evidence use in policy; 2) describe the RPC process in practice, and how it was implemented and evolved over time; and 3) better understand the conditions supporting evidence use in policymaking. We conclude with the value of the RPC as a resource to fill a niche within the evidence and policy space, as well as suggestions for future research-to-policy programmes and practices.

Background:

Government-funded knowledge brokering organisations (KBOs) are an increasingly prevalent yet under-researched area. Working in the space between knowledge and policy, yet framing themselves as different from think tanks and academic research centres, these organisations broker evidence into policy.

Aims and objectives:

This article examines how three organisations on different continents develop similar narratives and strategies to attempt to inform policymaking and build legitimacy.

Methods:

Using documentary analysis and semi-structured interviews, it shows how the organisations construct their credibility and legitimacy, and make sense of their emergence, activities and relationships with policymakers.

Findings:

The study responds to the lack of political focus on many existing studies, examining how KBOs make sense of their origins and roles, articulating notions of evidence, and mobilising different types of legitimacies to do so. The research also addresses an empirical gap surrounding the emergence and activities of KBOs (not individuals), analysing organisations on three different continents.

Discussion and conclusions:

KBOs developed similar narratives of origins and functions, despite emerging in different contexts. Furthermore, they build their legitimacy/ies in similar ways. Our research improves our understanding of how a new ‘tool’ in the evidence-informed policymaking (EIPM) arsenal – KBOs – is being mobilised by different governments in similar ways.

Background:

Local government (LG) is ideally placed to influence the determinants of public health (PH) and reduce inequalities, but opportunities are routinely missed.

Aims and objectives:

The aim of the Local Authority Champions of Research (LACoR) study was to explore ways to embed a culture of evidence use in LG.

Methods:

Five linked work packages were undertaken using mixed methods. In this paper, we report data from semi-structured interviews with UK local authority (LA) staff (n=14).

Findings:

Findings show a changing culture of LG: embedded researchers can enhance connectivity and interaction, build linkages, use levers of influence, and learn alongside LG navigators. Understanding the diverse microcultures of evidence use in LG is critical. Research champions can help to navigate the social, financial, political and regulatory context of LG and academia, influencing change dynamically as opportunities emerge.

Discussion:

Changing organisational subcultures is ambitious and unpredictable given the complexities of, and variability in, local contexts. Cumulative changes appear possible by recognising existing assets, using relational approaches to respond to LG priorities. In-house capacity remains underestimated and underutilised in efforts to embed evidence use in LG decision making. Co-located embedded researchers can use contextually specific knowledge and relationships to enhance evidence use in LG in collaboration with system navigators.

Conclusions:

There is a need for academics to adapt their approach, to take account of the context of LG to achieve meaningful health and social impacts with LG and test the contribution of embedded approaches to wider system change.

Background:

Although lawmakers play an essential role in policymaking, there is no systematic review on the use of research evidence in legislatures.

Aims and objectives:

To examine types of research use and factors facilitating and hindering use in legislatures.

Methods:

We conducted a systematic review of studies in legislatures, regardless of geographical region or year of publication. We included empirical studies irrespective of the methodology employed. Thematic synthesis was used to synthesise the type of use and the facilitating and hindering factors to using research evidence in parliaments. We included 21 studies.

Findings:

The most frequently observed type of utilisation was the use for symbolic or tactical purposes. Forms of use specific to legislatures were also identified, such as to prepare questions and debates and to help build consensus. Four categories of factors seen as facilitators or barriers were found: institution and organisation, research characteristics, policy and political context, and individual characteristics. Some factors had already been identified in previous reviews, while others seem to apply exclusively to legislatures.

Discussion and conclusions:

The review identified types of use of research evidence observed in legislatures and developed a new categorisation of factors that may promote or hinder evidence use in this institutional setting. It highlighted a need for more research beyond the US, in unicameral legislatures and in countries with a parliamentary form of government. Content analysis of parliamentary debates in legislative assembly or committee to examine the use of research evidence seems to be underused.

Target audience:

What Works Centres; other intermediary brokerage agencies; their funders and users; and researchers of research use.

Background:

Knowledge brokerage and knowledge mobilisation (KM) are generic terms used to describe activities to enable the use of research evidence to inform policy, practice and individual decision making. Knowledge brokerage intermediary (KBI) initiatives facilitate such use of research evidence. This debate paper argues that although the work of KBIs is to enable evidence-informed decision making (EIDM), they may not always be overt and consistent in how they follow the principles of EIDM in their own practice.

Key points for discussion:

Drawing on examples from existing brokerage initiatives, four areas are suggested where KBIs could be more evidence-informed in their work: (1) needs analysis: evidence-informed in their analysis of where and how the KBI can best contribute to the existing evidence ecosystem; (2) methods and theories of change: evidence-informed in the methods that the KBI uses to achieve its goals; (3) evidence standards: credible standards for making evidence claims; and (4) evaluation and monitoring: evidence-informed evaluation of their own activities and contribution to the knowledge base on evidence use. For each of these areas, questions are suggested for considering the extent that the principles are being followed in practice.

Conclusions and implications:

KBIs work with evidence but they may not always be evidence-informed in their practice. KBIs could benefit from more overtly attending to the extent that they apply the logic of EIDM to how they work. In doing so, KBIs can advance both the study, and practice, of using research evidence to inform decision making.

Background:

Devolution and integration of health and social care have placed increasing pressure on local statutory services, with a corresponding shift of health and social care to community organisations. The voluntary and charitable sector (VCS) is expected to make the case for increased funding by providing evidence of value and impact.

Aims and objectives:

This paper explores the challenges of compiling evidence on health outcomes which do not reflect the holistic nature of VCS support. We document how knowledge brokering can be used to enable the VCS to generate evidence.

Key conclusions:

Knowledge brokering (KB) may be an effective approach for developing community-generated evidence. Brokering is also needed to change perspectives on what counts as good evidence

Background:

To improve the use of evidence in policy and practice, many organisations and individuals seek to promote research-policy engagement activities, but little is known about what works.

Aims and objectives:

We sought (a) to identify existing research-policy engagement activities, and (b) evidence on impacts of these activities on research and decision making.

Methods:

We conducted systematic desk-based searches for organisations active in this area (such as funders, practice organisations, and universities) and reviewed websites, strategy documents, published evaluations and relevant research. We used a stakeholder roundtable, and follow-up survey and interviews, with a subset of the sample to check the quality and robustness of our approach.

Findings:

We identified 1923 initiatives in 513 organisations world-wide. However, we found only 57 organisations had publicly-available evaluations, and only 6% (141/2321) of initiatives were evaluated. Most activities aim to improve research dissemination or create relationships. Existing evaluations offer an often rich and nuanced picture of evidence use in particular settings (such as local government), sectors (such as policing), or by particular providers (such as learned societies), but are extremely scarce.

Discussion and conclusions:

Funders, research- and decision-making organisations have contributed to a huge expansion in research-policy engagement initiatives. Unfortunately, these initiatives tend not to draw on existing evidence and theory, and are mostly unevaluated. The rudderless mass of activity therefore fails to provide useful lessons for those wishing to improve evidence use, leading to wasted time and resources. Future initiatives should draw on existing evidence about what works, seek to contribute to this evidence base, and respond to a more realistic picture of the decision-making context.

Background:

Continued growth of the evidence and policy field has prompted calls to consolidate findings in pursuit of a more holistic understanding of theory and practice.

Aims and objectives:

The aim of this paper is to develop and explore an analytical typology that offers a way to consider the heterogeneity of different actors in UK evidence and policy.

Methods:

We draw upon a discourse coalitions approach to analyse a series of semi-structured interviews with a cross-section of professionals in the evidence and policy field.

Findings:

We describe an analytical typology that is composed of three discourse coalitions, each with their own framings of the problems of evidence and policy relations, the practices needed to address these, the organisation of people, and their priorities for future development. These are: the analytical coalition, which typically theorises evidence and policy relations in a way that matches empirical observations; the advocacy coalition, which typically normatively refines and prescribes particular evidence and policy relations; and the application coalition, which typically evaluates contextual conditions and enacts techniques to bring evidence into policy and practice.

Discussion and conclusions:

We discuss the potential of this analytical lens to inform recognised tensions in evidence and policy relations, and consider how greater awareness of the positioning of individuals within these coalitions may help to foster improved collaboration and consolidation in the field. Ultimately, we note that distinct priorities in the three coalitions signify different visions for progress within the field that need to be negotiated.

Background:

Education decision makers are increasingly expected to use evidence to inform their actions. However, the majority of educational interventions have not yet been studied and it is challenging to produce high quality research evidence quickly enough to influence policy questions.

Aims and objectives:

We set out to gather evidence on the efficacy of reading resources implemented at 23 struggling elementary schools in a large, urban district in the US. The schools were at risk of closure by the state.

Methods:

For each reading resource, we searched for existing effectiveness studies and collected professional judgements by surveying practitioners. We also used an expert survey to collect judgements from three reading experts. We compared the ratings among experts and between practitioners and experts. We also compared practitioner and expert judgements to evidence summaries from research repositories.

Findings:

We found evidence summaries in research repositories for only five of 23 reading resources used in the 23 schools. Experts showed poor to good agreement on ten questions about each resource. Agreement between practitioners and experts was low with practitioners generally rating resources more positively than reading experts.

Discussion and conclusions:

Practitioners may be overly optimistic about the efficacy of educational materials while experts have difficulty assessing how well the materials serve an unfamiliar population. In the absence of rigorous evaluations of locally-implemented programmes, district decision makers can review the consistency of evidence collected from practitioners and experts, along with external research evidence, to inform actions towards supporting and guiding struggling schools.

Background:

In participatory research approaches, co-researchers and university researchers aim to co-produce and disseminate knowledge across difference in order to contribute to social and practice change as well as research. The approaches often employ arts-based research methods to elicit experiential, embodied, affective, aesthetic ways of knowing. The use of arts-based research in co-production in participatory research is embedded in a contested discursive terrain. Here, it is embroiled in political struggles for legitimacy revolving around what counts as knowledge and whose knowledge counts.

Aims and objectives:

The aim is to present and illustrate the use of a theoretical framework for analysing the complexities of co-production in the nexus between arts and research – with a focus on the overarching tension between cultivating the collaborative, creative process and producing specific research results. The article maps out the contested discursive terrain of arts-based co-production, and illustrates the use of the theoretical framework in analysis of a participatory research project about dance for people with Parkinson’s disease and their spouses.

Methods:

The theoretical framework combines Bakhtin’s theory of dialogue, Foucault’s theory of power/knowledge and discourse, Wetherell’s theory of affect and emotion, and work in arts-based research on embodied, affective, aesthetic knowing.

Results:

The analysis shows how arts-based processes of co-production elicit embodied, emotional, aesthetic knowing and with what consequences for the research-based knowledge and other outputs generated.

Discussion and conclusions:

Trying to contribute to both research and practice entails navigating in a discursive terrain in which criteria for judging results, outputs and impact are often defined across conflicting discourses.

Background:

Not attending to local political climate negatively impacts the implementation and sustainability of evidence-informed models of health service. Policy codesign aims to align policy, systems, and community from the ‘ground up’, with structured information gathering, synthesis and creative design methods that incorporate relevant scientific evidence.

Aims and objectives:

This paper provides an example of policy codesign to develop a jail-based re-entry programme for adults with opioid use disorder in a rural county in the US.

Methods:

The design process adapted Theory U, a systems planning framework to include a rapid evidence review. The process included five sessions from July-September 2020. Mixed methods were used to collect data from the design team (n=5), community at large (n=10), and potential consumers (n=14). Qualitative and descriptive analyses assessed satisfaction with the design process, and the acceptability and perceived feasibility of programme implementation.

Findings:

Satisfaction with the design process was high among design team members. Acceptability and perceived feasibility of the designed programme were ‘very high’ across all respondents. The community implemented the designed programme, which aligned with the extant evidence base, although design team members did not explicitly acknowledge research as a source of design. This suggests that the process achieved creative control, and qualitative findings support the teams’ sense of shared ownership.

Discussion and conclusions:

Policy codesign is a promising strategy for integrating the evidence base with community creativity in policy and systems-level planning. Further research is needed to understand which elements optimised design members’ absorption of the evidence base, shared sense making, and creative control.

Background:

Interest in using arts-informed approaches within research to increase stakeholder engagement is growing; however, there is little work describing how these approaches are operationalised across contexts. This article addresses that gap by exploring the use of arts-informed approaches across three projects.

Aims and objectives:

We explore how conceptualising research and evaluation as creative endeavours, particularly in arts-informed approaches to co-production, create opportunities to move knowledge into action (knowledge mobilisation). We propose an actionable configuration of context + mechanism = outcome (CMO) to understand the influence of arts-informed approaches to co-production.

Methods:

Multi-case design and cross-case synthesis was conducted of three studies that used arts-informed approaches. A common focus across our cases was evidence use in the K-12 education sector; however, each engaged with this focus by involving different types of evidence and sets of education stakeholders.

Findings:

Arts-informed approaches and co-production were influenced by a variety of contextual factors such as relationships between researchers and stakeholders, ethical issues of collaborative research activities, approaches to meaningful stakeholder engagement, co-production of knowledge, capacity-building support and resources, and communication between multi-stakeholder partners. Outcomes included new ways of thinking about research topics based on arts-informed approaches, more positive attitudes about co-production, more relevant and useful research and evaluation findings, and increased openness to future co-productive work.

Discussion and conclusions:

Four propositions arising from this article include: (1) arts-informed approaches address context specificity and sensitivity; (2) arts-informed approaches promote engagement; (3) arts-informed approaches enhance and intertwine skills; (4) arts-informed approaches broaden thinking about impact.

Background:

Co-creation in policymaking is of increasing interest to national governments, and designers play a significant role in its introduction.

Aims and objectives:

We discuss instances from our fieldwork that demonstrated how UK Policy Lab used design methods to gain insight into the design-oriented methods introduced to policymakers’ practices, and how these may influence conventional policy design processes.

Methods:

This paper reports on the learnings from a two-month participant observation at UK Policy Lab conducted in early 2019.

Findings:

We found that, beyond human-centred and future-oriented practices, the designers working at this unit appropriate design as a reflective practice for the context of policymaking. We discuss how the use of visual and creative methods of design are utilised by policy designers to facilitate co-creative reflective practices, and how these make a valuable contribution to policymaking practices in UK Government.

Discussion and conclusions:

As deliberation and decision making is influenced both by what is thought about as well as who is doing the thinking, reflective practices allow notions and assumptions to be unpicked. Moreover, when done as a group activity, reflection leads to a co-production of a deepened understanding of policy challenges.

Consequently, we argue, the reflective practices introduced by Policy Lab are an essential contribution to developing a co-creation tradition in evidence-informed policymaking processes.

Background:

Evidence-based guidelines provide clinicians with best practice recommendations but not the means to implement them. Although co-design is increasingly promoted as a way to improve implementation there is frequently insufficient detail provided to understand its contribution. The presented case study addresses this by providing a detailed account of how a specific co-design approach contributed to an improving back pain education project in line with national guidance.

Aim:

The aim was to use creative co-design to produce prototype evidence-based back pain educational resources that were sensitive to context.

Objectives:

• Assemble a group of relevant stakeholders for a series of workshops.

• Use creative activities that encourage divergent and convergent thinking to iteratively understand the problem and develop prototype solutions.

• Thematically analyse outputs of each workshop to determine content of subsequent workshops.

• Present a final prototype ready for implementation.

Key conclusions:

• This approach produced an innovative system of thematically linked back pain educational resources that were contextually sensitive, evidence-based and ready for implementation.

• Research knowledge was successfully blended with stakeholder experiential knowledge.

• The creative methods helped diverse stakeholders develop trusting relationships and ensured everyone’s experiences and ideas were included.

• The process of co-creation and the objects created had vital roles in surfacing and understanding stakeholder knowledge, promoting innovation and facilitating implementation.

• The design process facilitated an evolving understanding of a complex problem alongside prototype development.

• It is recommended that these methods be considered by other project teams.

Background:

Co-design is an approach to engaging stakeholders in health and social system change that is rapidly gaining traction, yet there are also questions about the extent to which there is meaningful engagement of structurally vulnerable communities and whether co-design leads to lasting system change. The McMaster University Co-Design Hub with Vulnerable Populations Hub (‘the Hub’) is a three-year interdisciplinary project with the goal of facilitating partnerships, advancing methods of co-design with vulnerable populations, and mobilising knowledge.

Aims and objectives:

A developmental evaluation approach inspired by experience-based co-design was used to co-produce a theory of change to understand how the co-design process could be used to creatively co-design a co-design hub with structurally vulnerable populations.

Methods:

Twelve community stakeholders with experience participating in a co-design project were invited to participate in two online visioning events to co-develop the goals, priorities, and objectives of the Hub. Qualitative data were analysed using a thematic content analysis approach.

Findings:

A theory of change framework was co-developed that outlines a future vision for the Hub and strategies to achieve this, and a visual graphic is presented.

Discussion and conclusions:

Through critical reflection on the work of the Hub, we focus on the co-creative methods that were applied when co-designing the Hub’s theory of change. Moreover, we illustrate how co-creative processes can be applied to embrace the complexity and vulnerability of all stakeholders and plan for system change with structurally vulnerable populations.

Background:

Post-positivist critics of the linear-rational understanding of the role of knowledge in decision making have long argued the need for the construction of socially robust knowledge to illuminate policy problems from a variety of perspectives, including lived experiences.

Aims and objectives:

This article charts the attempts of researchers to employ a creative method, digital storytelling, alongside more traditional scientific data in stakeholder deliberations to inform local food governance in South Africa.

Methods:

Four storytellers from a marginalised group created and introduced their digital story about a ‘time when they had to make a difficult choice about what food to purchase or get’ to a public governance forum and the reactions of the audience self-reported.

Findings:

The digital stories were emotionally compelling and gave granular detail to the more top-down perspective of the scientific data. There were concerns, however, for the welfare of the storytellers when introducing their stories in the forum.

Discussion and conclusion:

Our findings highlight the multi-functionality of digital storytelling as a method of creativity within the process of co-production, not just as a technique to make visible knowledge from marginalised groups, but also as a mechanism (when used and viewed in a wider governance context) to promote knowledge mobilisation and alternative ways of knowing. The use of digital storytelling in these wider governance contexts, or social learning spaces, however, also surfaces ethical and other risks.

Background:

Humanitarian evidence is produced in settings of heightened power imbalances between research stakeholders. Yet evidence production processes often lack explicit reflection of who is shaping the questions asked and making meaning of the answers.

Aims and objectives:

Empowered Aid is participatory action research that seeks to mitigate sexual exploitation and abuse (SEA) perpetrated by aid actors. Refugee women and girls in Uganda and Lebanon, as experts on SEA risk, are engaged co-researchers in generating evidence on how to make aid distributions safer.

Methods:

Diverse creative processes are utilised to co-produce knowledge about SEA risks and strategies to reduce them. These same processes are used to reflect on power dynamics within the research process itself, local gender power dynamics, and structural power dynamics between aid actors and those receiving aid.

Findings:

Fifty-five Syrian and South Sudanese refugee women and girl co-researchers used ethnographic methods to document their and their peers’ lived experiences of SEA risks while accessing humanitarian aid. Creative methods including drawing, drama, storytelling, community mapping, and body mapping were applied during data collection and qualitative analysis, as well as in reflection and action analysis workshops. SEA was reported across all the types of aid studied, and these findings are being used to adapt aid distribution processes.

Discussion and conclusions:

Creative and participatory practices can address the barriers, such as illiteracy (including computer illiteracy) and lack of training, often cited as limiting researchers’ ability to share power with affected communities, and allow for greater co-production of knowledge and evidence.

Background:

Ninety-one per cent of Aotearoa New Zealand prisoners have been diagnosed with either a mental health or substance use disorder within their lifetime. Challenges exist in how to meet their needs. Diverse pūrākau (stories) of success in whānau ora (wellbeing) and stopping offending are missing from academic and public discourse that should direct law and policy changes.

Aims and objectives:

We describe a kaupapa Māori co-production project called He Ture Kia Tika/Let the Law be Right. We highlight how kaumātua (Māori indigenous elders), academics, and practitioners merged their voices with people with lived experiences of mental health, addiction, and incarceration to create justice policy and solutions.

Methods:

We focus on the theory and application of our co-production, directed by kaupapa Māori methodology. We describe the work of a co-design group that actively guides the project, from inception towards completion, using rangahau kawa (research protocols) as culturally clear guidelines and ethically safe practices. We then detail our processes involved in the collection of co-created pūrākau (storytelling) with 40 whānau (family) participants, and describe our continued collaboration to ensure law and policy recommendations are centred on lived experiences.

Findings:

Kaupapa Māori informed co-production ensured rangahau kawa (research protocol and guidelines) were created that gave clear direction for an engagement at all levels of the project. We see this as bringing to life co-production, moving beyond theory to the practicalities of ‘being’ and ‘doing’ with each other in safe, ethical ways for all.

Discussions and conclusions:

A strong association exists between unmet mental health needs and reoffending. Tackling cultural, health, social and justice issues requires a multi-layered approach from a range of rangatira (leaders including kaumātua/elders) and tohunga, or experts, of their lived experiences to inform future policy and law reform.

Background:

Co-production, co-creation and co-design are increasingly used in healthcare research knowledge mobilisation. These methods have grown in popularity and the broad range of approaches are often used without any formal evaluation. The challenges to using these approaches are well reported yet there is little evidence on how to overcome them or how they work. This study evaluates ‘creative co-design’, a design-led, solutions-focused process developed specifically as a means to mobilise knowledge in healthcare.

Aims and objectives:

To investigate the impact of creative co-design on the knowledge mobilisation process. To understand how it impacts on the application of research knowledge in routine clinical practice.

Methods:

Semi-structured interviews were carried out with 20 participants from 14 projects. Data were analysed using the Framework approach. A workshop involving the first 10 participants was held prior to the final interviews and analysis.

Findings:

The findings indicate that creative co-design successfully facilitates knowledge mobilisation in healthcare. This is represented by three interconnected themes: creative and visual; design-led; and creating the right conditions.

Discussion and conclusions:

The themes highlight how the approach supports engagement and creates a safe space for knowledge sharing and synthesis in a non-hierarchical environment. This study contributes important insights into how creative co-design can mobilise knowledge in healthcare. Further evaluation is warranted to help it develop into a recognised and effective method for research implementation and service improvement.

Background:

Evidence regarding the impact of psychological problems on recovery from injury has limited influence on practice. Mindlines show effective practice requires diverse knowledge which is generally socially transmitted.

Aims and objectives:

Develop and test a method blending patient, practitioner, and research evidence and using Forum Theatre to enable key stakeholders to interact with it.

Assess this methods; impact on contributing individuals/groups; on behaviour, practice, and research; mechanisms enabling these changes to occur.

Methods:

Stage-1: captured patient (n=53), practitioner (n=62), and research/expert (n=3) evidence using interviews, focus groups, literature review; combined these strands using framework analysis and conveyed them in a play. Stage-2: patients (n=32), carers (n=3), practitioners (n=31), and researchers (n=16) attended Forum Theatre workshops where they shared experiences, watched the play, re-enacted elements, and co-produced service improvements. Stage-3: used the Social Impact Framework to analyse study outcome data and establish what changed, how and why.

Findings:

This approach enhanced individuals’/group knowledge of post-injury psychopathology, confidence in their knowledge, mutual understanding, creativity, attitudes towards knowledge mobilisation, and research. These cognitive, attitudinal, and relational impacts led to multilevel changes in behaviour, practice, and research. Four key mechanisms enabled this research to occur and create impact: diverse knowledge, drama/storytelling, social interaction, actively altering outcomes.

Discussion and conclusions:

Discourse about poor uptake of scientific evidence focuses on methods to aid translation and implementation; this study shows how mindlines can reframe this ‘problem’ and inform impactful research.

EPPIC demonstrated how productive interaction between diverse stakeholders using creative means bridges gaps between evidence, knowledge, and action.