Lessons learned about co-creation: developing a complex intervention in rural Peru
Lessons learned about co-creation: developing a complex intervention in rural Peru
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DOI：
10.1080/16549716.2020.1754016
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发表时间：
2020-12-31
影响因子：
2.6
通讯作者：
Beran, David
中科院分区：
文献类型：
--
作者：
Lazo-Porras, Maria;Perez-Leon, Silvana;Beran, David
背景：共同创造是让利益攸关方参与制定干预措施的过程。虽然共同创造越来越普遍，但关于这一进程和经验教训的报告却很少。目的：描述使用COHESION手册的过程和经验教训，COHESION手册是一种共同创建的方法，旨在秘鲁资源匮乏的环境中，在初级卫生保健水平上改进慢性病的诊断和/或管理。研究方法：观察性研究，介绍为中低收入国家的一个多国项目开发的COHESION手册“从研究转向干预：COHESION模式”的使用情况，以促进共同创造，并根据北方秘鲁农村社区的当地情况进行调整。结果如下：在秘鲁，共同创造的实际过程包括在形成性研究中与共同创造有关的问题;与微观、中观和宏观层面的利益攸关方进行初步磋商（如社区成员、卫生工作者和决策者）;分析收集的数据;与每个利益攸关方群体进行第二次磋商;确定干预方案的优先次序;最后，为复杂干预中的所有活动设计一个变革理论。复杂的干预措施包括：1）为卫生工作者提供特定疾病和软技能的培训，2）创建广播节目，促进慢性病预防和管理，并使患者能够在访问初级卫生保健设施时提出问题，以及3）为初级卫生保健提供小额赠款，用于改善基础设施。对COHESION手册的小修改对于这一共同创造过程是必要的。结论：这项研究提供了一个实际的例子，共同创造复杂的干预措施，以增加在低资源环境中的医疗保健的可及性和质量的过程。所确定的过程、组成部分、挑战和机遇可能对其他希望与类似环境中的受益者共同创造干预措施的研究人员有用。
Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce. Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru. Methods: Observational study to describe the use of the COHESION manual 'Moving from Research to Interventions: The COHESION Model' developed for a multi-country project in low- and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru. Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process. Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.