Co-creating interventions

Background: Physical activity (PA) counselling by primary care providers (PCP) is recommended, but its implementation remains challenging, with PCPs citing lack of time and training as primary barriers. Moreover, such interventions may exacerbate health inequities, with rural, racialized, and economically disadvantaged populations experiencing reduced access to preventative care. Co-construction with stakeholder engagement is foundational to achieving acceptability and broader implementation. Program Delivery: We adopted a co-construction approach of an evidence-based PA promotion intervention to be implemented by PCPs, targeting patients with cardiometabolic conditions. A 2-day facilitator-led workshop brought together 32 stakeholders, including patient-partners, clinicians (kinesiologists, physicians, nurses, psychologists), and researchers. The workshop followed deliberative consultation methods and used small group discussions (both expertise- and context-specific, and transdisciplinary). Evaluation: Participants identified patients with higher SES, recently diagnosed with a cardiometabolic condition, and previously engaged in PA, as those most likely to be receptive to PA counselling. Patients with lower SES, who were allophones (i.e., first language other than English or French), and those experiencing social isolation, were identified as those most in need of PA counselling, but hardest to reach and least likely to seek PA counselling. Engaging social workers and caregivers, increasing intervention visibility with health and social service providers, and building more extensive communication channels with community partners, were identified as strategies to better address the needs of under-resourced and marginalized groups, enhance reach and adherence, and deliver impactful PA counselling efforts. Conclusions: Our approach was deemed feasible, allowed for a greater understanding of the barriers faced by patients and clinicians, and generated solutions to facilitate the adoption of this intervention. Practical Implications: Co-construction with multiple stakeholders is an insightful intervention development strategy. As in our case, resulting interventions should be piloted for feasibility and acceptability, and subsequently, for real-world effectiveness. Funding: CIHR, FRQS, and the CMDO network.

Background: A Physical Activity (PA) message is information that is educational or persuasive that aims to increase PA levels. There is little research on communicating PA messages with adolescents in schools. Purpose: This paper presents a co-creation study with school stakeholders from the Active School Flag (ASF) whole-of-school PA programme (WSP) in Ireland. It outlines the COMMUNICATE toolkit, its’ development and role in supporting the communication of PA in the school. Methods: Seven ASF secondary schools in Ireland, were invited to participate in the co-creation process. Guided by a research steering group (researchers (n=2), practitioners (n=2), policymakers (n=1) and adolescents (n=2)) an iterative process of consulting and refining was followed. Three rounds of workshops were conducted to generate ideas and provide feedback on the toolkit. The first two workshops lasted one hour and the final was a full day event. Results: Five schools participated in this study, one joined the research steering group and four participated in the co-creation workshops. The development of the toolkit through each consultation and refining stage is presented. The final toolkit incorporates resources for increasing emphasis of the ongoing WSP, planning to promote PA in the school and developing key communication skills, and is underpinned by inclusivity and diversity when communicating PA in the school. Conclusions: This study used multi-stakeholder voices and was informed by an intra-disciplinary research steering group. The COMMUNICATE toolkit is suitable for use by secondary schools engaged in a WSP for PA. Further research is needed to test the feasibility and effectiveness of implementing this toolkit. Practical implications: This study provides practical resources, for use by programme implementers in the school when communicating PA messages, that were developed considering student and staff voice from the outset. Funding: The Irish Research Council Government of Ireland Postgraduate Scholarship.

Background: Physical activity referral schemes (PARS) have the potential to promote physical activity (PA) among the mostly inactive primary care population with non-communicable diseases (NCD). No PARS has yet been structurally implemented in the German primary care system. Purpose: The research project BewegtVersorgt aims to develop, implement and evaluate a PARS to promote PA for persons with NCD within the German healthcare system. Methods: The PARS was developed using a co-production approach which integrated twelve organizations from different sectors (health insurances, physicians, exercise professionals, patients’ representatives). Three co-production meetings were applied where individual ideas and current evidence were combined, and different PARS models were elaborated. Finally, all stakeholders agreed on one PARS for implementation as a regional model project and seven stakeholders were purposefully selected for interviews to evaluate the co-production process. Results: The co-produced PARS starts with the primary care physician who offers PA advice and afterward refers patients to an exercise professional. The exercise professional delivers the remaining components of the intervention: initial assessment, six 1-hour individual PA counselling sessions, final assessment. From stakeholder perspective, the following factors were highlighted as facilitators of the development process: co-production approach, process of co-production, multi-sector stakeholder group, possibility of active participation, coordinating role of researchers, communication, atmosphere and interaction. In contrast, differences in roles and hierarchy, merging of different perspectives, clarification of intervention costs, and competition and conflicting interests were pointed out as challenges. Conclusions: By using the co-production approach, it was possible to develop a new PARS and implement it as regional model project in routine practice. Practical implications: Co-production is a beneficial approach for the development of PARS intended for integration into healthcare systems. Support/Funding Source: The study is funded by the Federal Ministry of Health based on a resolution of the German ‘Bundestag’ by the federal government.

Background: One in four UK 5-year-olds live with overweight/obesity, with those from low-income families being disproportionately affected. Effective targeted health promotion efforts, engaging key stakeholders in areas of highest need, are required. We describe a 3-phase project, designed to translate research evidence into practice, to optimise health promotion in under-5s. Methods: In phase 1 (2023), an evidence synthesis of published systematic reviews was undertaken, extracting determinants of obesogenic behaviours in 0-6-year-olds (physical activity (PA), sedentary behaviour, fruit/vegetable consumption, sugar-sweetened beverages, dietary behaviours, portion size). We extracted and mapped common determinants across behaviours, using the socio-ecological model. In phase 2 (early 2024) findings were shared with key stakeholders (policy/practice partners, health visitors, early-years educators). Via online webinars or questionnaires, stakeholders were asked to outline their key health promotion priorities; who they felt promotion efforts should target; and desired material formats (e.g. videos, information sheets). In phase 3 (mid 2024) we will co-develop these health promotion materials, targeting common determinants across multiple health behaviours, evaluating reach and impact. Results: Phase 1 identified 16 determinants as common to at least two health behaviours, at the individual (e.g. child preference); interpersonal (e.g. modelling); community (e.g. provider training) and societal (e.g. safety) levels. In phase 2, 49 stakeholders contributed to the co-development webinars (n=24) or completed questionnaires (n=25). Their priorities included obesity prevention, sleep health and PA promotion; they stated families with under-5s and childcare providers would benefit most from targeted videos, infographics and social media resources. Iterative co-production of health promotion materials is ongoing, to be launched in summer 2024, with an impact evaluation planned. Implications: Targeting determinants common to several health behaviours, aligned with stakeholder priorities, has potential to optimise weight and wellbeing in young children. Co-producing evidence-based resources with stakeholders is a feasible and valuable way to promote healthy habits in under-5s.

Background: Physical activity (PA) is shown to have benefits for physical and mental health in children with chronic health conditions (CHCs). However, it can be very difficult for children living with CHCs to engage in PA. Purpose: Move to Improve is an ongoing hospital-based research project that aims to provide evidence on how to best incorporate PA into routine clinical care for children with CHCs. Methods: Semi-structured interviews were conducted with 34 participants (parents and children) across four CHCs (Type 1 Diabetes, Cancer, Burns, Cerebral Palsy) to understand their experiences with PA and explore barriers and facilitators to PA participation for children with CHCs. Interviews were audio recorded, transcribed verbatim, and thematically analysed to identify key themes. Results: Four key themes were identified – ‘fostering psychological safety’, ‘empowering families towards physical activity’, ‘supporting goal achievement’, and ‘providing tailored physical activity support’. These themes highlighted that, when engaging in PA, it is important for families to feel a sense of community and agency within a specific PA context. Incorporating appropriate goal setting strategies may be helpful in navigating challenges to partaking in PA. Families also highlighted a need for a tailored approach within clinical settings, focused on providing specific advice to cater to each child’s/family’s unique physical activity goals, needs, and concerns. Conclusions: Findings suggest that while incorporating PA into clinical care for children with CHCs, there is a need for tailored interventions that can cater to the child’s unique needs and circumstances. Practical implications: The findings contribute to an understanding of how PA can be incorporated into routine clinical care for children with CHCs in a manner that can foster physical and mental health benefits and is acceptable, feasible, and sustainable in the long run. Funding: This research is funded by Perth Children’s Hospital Foundation and Stan Perron Charitable Foundation.

Background: To address health disparities in truck drivers, a health promotion programme called the ‘Structured Health Intervention For Truckers’ (SHIFT) was developed to promote positive lifestyle changes in this at-risk occupational group. While UK truck drivers are mandated to undergo Driver Certificate of Professional Competence (CPC) training to maintain their licences, no current course covers lifestyle health-related behaviours. Purpose: To translate the SHIFT programme into a scalable health-focused CPC module, in collaboration with drivers and stakeholders, for industry adoption. Methods: Three co-creation workshops were conducted with drivers/driver trainers/stakeholders to showcase findings from our established SHIFT programme. The workshops were audio recorded and field notes collected. To co-create a SHIFT prototype CPC module, feedback and insights from the co-creators were gathered and analysed using content analysis. Results: Seventeen participants including two HGV drivers, twelve HGV driver trainers, two driver training and development managers and a compliance manager participated in online and in-person co-creation workshops. The SHIFT programme was translated into a 1-hour (Short-SHIFT, designed to raise awareness) and 7-hour-full health CPC module, covering chronic disease risk, mental wellbeing, benefits of physical activity, reducing sitting, and a heathy diet. The module was accredited by the Driver and Vehicle Standards Agency and is being implemented within a major UK logistics operator (~7000 truck drivers) providing proof of concept evidence. Conclusions: The successful translation and accreditation of the SHIFT programme into a driver CPC module, and module component, marks an impactful trajectory in health promotion for truck drivers within the UK’s Road freight industry. Practical implications: The SHIFT-CPC module provides drivers with a novel health education training opportunity tailored to their needs, allowing meaningful participant engagement to promote healthier lifestyles. The module could reach ~250,000 HGV drivers nationally, addressing a critical gap in their health education and literacy. Funding: The Colt Foundation.

Background: To solve complex public health challenges, such as inequalities in physical activity among youth, innovative solutions are needed. Co-creation of public open space (POS) in local communities is suggested as an innovative way to promote physical activity among residents. However, to understand the benefits and challenges of co-creation processes, more knowledge about stakeholders’ experiences of being involved in such processes is essential. Purpose: To gain in-depth knowledge of stakeholders’ experiences of a co-creation process of POS in municipalities. Method: Semi-structured group interviews, with a total of 54 informants (youth, NGO for self-organized physical activity, landscape architects and municipal planers) participating in co-creation of POS in six municipalities in Norway (2020-2022) were carried out. The data was analyzed by systematic text condensation. Results: Three themes were developed during the analysis, illustrating trade-offs that emerged during the co-creation processes in the municipalities: 1) iteration versus solution; 2) innovation versus convention; and 3) flexibility versus planning. All three themes reflect both advantages and disadvantages of co-creating POS. Different opinions about these trade-off points could be attributed to how some stakeholders were more familiar with conventional planning processes, while others pushed for more iteration, innovation, and flexibility. It could also be attributed to personal preferences, previous experiences, knowledge of planning processes, as well as how involved the stakeholders were in the process. Conclusion: All stakeholders who participated in the co-creation of the POS experienced clear trade-offs that they did not always share similar opinions about. Being aware of trade-offs present in co-creation processes is important both for the outcome and output of the project. Practical implications: To raise awareness about potential trade-offs in co-creation processes, clear communication and clarification of project goals, boundaries, needs, as well as expectations of the involved stakeholders, are essential. Funding: Norwegian Research Council.