Academic Journal
Προβολή σε EDS

Opening the black box of co-creation: exploring process delivery, stakeholder experiences and perceived outcomes in the development of a family-based healthy weight development intervention for infants.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Opening the black box of co-creation: exploring process delivery, stakeholder experiences and perceived outcomes in the development of a family-based healthy weight development intervention for infants.
Συγγραφείς: Kierkegaard L; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark. leki@sdu.dk., Bonnesen CT; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark., Carlsson RR; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark., Pedersen TP; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark., Rasmussen M; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark., Ahlmark NG; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark., Krølner RF; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
Πηγή: Health research policy and systems [Health Res Policy Syst] 2026 May 28; Vol. 24 (1). Date of Electronic Publication: 2026 May 28.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: BioMed Central Country of Publication: England NLM ID: 101170481 Publication Model: Electronic Cited Medium: Internet ISSN: 1478-4505 (Electronic) Linking ISSN: 14784505 NLM ISO Abbreviation: Health Res Policy Syst Subsets: MEDLINE
Imprint Name(s): Original Publication: [London] : BioMed Central, 2003-
Ιατρικοί όροι (MeSH): Stakeholder Participation* , Parents* , Health Promotion* , Body Weight* , Program Development* , Child Development*, Humans ; Infant ; Qualitative Research ; Denmark ; Community-Based Participatory Research ; Program Evaluation ; Community Health Nursing ; Nurses, Community Health
Περίληψη: Background: Co-creation has gained prominence in public health intervention research, as stakeholder involvement is expected to strengthen implementation and effectiveness. Its growing popularity highlights the need for a critical examination of how co-creation is conceptualized and operationalized. This study examines: (1) the delivery of the co-creation process; (2) stakeholders' experienced involvement; and (3) perceived outcomes, including how the process shaped the intervention design and stakeholders' perceived value of participation. The co-creation centred on developing The Bloom Study, an early intervention to promote healthy weight development amongst infants integrated in the Danish community health nurse system.
Methods: The co-creation activities comprised six workshops and eight group meetings with a Participatory Planning Group of community health nurses, researchers and facilitators, supplemented by four parent group interviews. The evaluation followed a qualitative research design, combining multiple data sources: transcripts from co-creation activities, a joint oral evaluation and individual interviews with the Participatory Planning Group participants. Analysis was guided by the PROcesS Evaluation framework for CO-creation (PROSECO) framework.
Results: (1) The co-creation process was delivered as intended, though parental involvement was challenging. (2) Participants perceived themselves as highly involved, but still viewed the intervention primarily as the researchers' project. The Participatory Planning Group demonstrated strong motivation and constructive group dynamics. Despite initial uncertainty about their roles, they felt they were able to meaningfully influence the intervention. (3) The Participatory Planning Group valued the co-creation process as a reflective space that enabled knowledge exchange. The intervention was shaped through iterative negotiation, integration of research and practice knowledge, and adaptation to contextual constraints. Although parental involvement was limited, their input helped refine materials and address parental needs.
Conclusions: This study provides empirical insight into how co-creation unfolds within a health system context. Meaningful stakeholder involvement was constrained by structural and temporal conditions tied to the research project, including fixed timelines. Despite these limitations, the process supported contextually grounded adaptations, strengthened stakeholder ownership and enhanced responsiveness to local needs. The critical application of the PROSECO framework helped "opening the black box" of co-creation and offers implications for health systems, particularly regarding how participatory approaches can inform implementation practices.
(© 2026. The Author(s).)
Competing Interests: Declarations. Ethics approval and consent to participate: The development part of the Bloom Study is registered and approved by the Research and Innovation Office at the University of Southern Denmark (reference number: 10.828), and the project is approved by the Research Ethics Committee at the University of Southern Denmark (approval ID: 21/30422). Parents received comprehensive verbal and written information about the purpose of the project and the terms of participation, including that participation is voluntary, that withdrawal from the study is possible at any time and that data are handled confidentially. CHNs and other study participants also received comprehensive verbal and written information about the project and the terms of participation. Consent for publication: Not applicable. Data availability: The datasets generated during the current study are not publicly available due to the confidential nature of the participant interviews and the data, which contain information that could compromise research participants’ privacy. Consent to share anonymized interview transcripts was not asked for at the time of the research. Competing interests: The authors declare no competing interests.
References: Eldredge LKB, Markham CM, Ruiter RA, Fernández ME, Kok G, Parcel GS. Planning health promotion programs: an intervention mapping approach. John Wiley & Sons; 2016.
Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. https://doi.org/10.1136/bmj.n2061. (PMID: 10.1136/bmj.n2061345935088482308)
Agnello DM, Anand-Kumar V, An Q, de Boer J, Delfmann LR, Longworth GR, et al. Co-creation methods for public health research — Characteristics, benefits, and challenges: a Health CASCADE scoping review. BMC Med Res Methodol. 2025;25(1):60. (PMID: 10.1186/s12874-025-02514-44005072911884017)
Agnello DM, Longworth GR. PRODUCES+: An Evidence-based Co-Creation Guidelines. 2025 . https://doi.org/10.5281/zenodo.7343028.
Oliver K, Kothari A, Mays N. The dark side of coproduction: do the costs outweigh the benefits for health research? Health Res Policy Syst. 2019;17(1):33. https://doi.org/10.1186/s12961-019-0432-3. (PMID: 10.1186/s12961-019-0432-3309223396437844)
World Medical Association. WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Participants 2024.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ (Clinical research ed). 2008;337(7676):979–83.
Leask CF, Sandlund M, Skelton DA, Altenburg TM, Cardon G, Chinapaw MJM, De Bourdeaudhuij I,Verloigne M, Chastin SFM. Grandstand, safe step and teenage girls on the move research groups. framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions. Res Involv Engagem. 2019;5:2. https://doi.org/10.1186/s40900-018-0136-9 . (PMID: 10.1186/s40900-018-0136-9306520276327557)
Movsisyan A, Arnold L, Evans R, Hallingberg B, Moore G, O'Cathain A, Pfadenhauer LM, Segrott J, Rehfuess E. Adapting evidence-informed complex population health interventions for new contexts: a systematic review of guidance. Implement Sci. 2019;14(1):105. https://doi.org/10.1186/s13012-019-0956-5. (PMID: 10.1186/s13012-019-0956-5318479206918624)
Bammer G. Key issues in co-creation with stakeholders when research problems are complex. Evid Policy. 2019;15(3):423–35. (PMID: 10.1332/174426419X15532579188099)
Heimburg DV, Cluley V. Advancing complexity-informed health promotion: a scoping review to link health promotion and co-creation. Health Promot Int. 2021;36(2):581–600. (PMID: 10.1093/heapro/daaa06332810227)
Reed H, Couturiaux D, Davis M, Edwards A, Janes E, Kim HS, et al. Co-production as an emerging methodology for developing school-based health interventions with students aged 11–16: systematic review of intervention types, theories and processes and thematic synthesis of stakeholders’ experiences. Prev Sci. 2020;22(4):475–91. (PMID: 10.1007/s11121-020-01182-8332375528060205)
Greenhalgh T, Jackson C, Shaw S, Janamian T. Achieving research impact through co‐creation in community‐based health services: literature review and case study. Milbank Q. 2016;94(2):392–429. (PMID: 10.1111/1468-0009.12197272655624911728)
Jagosh J, MacAulay AC, Pluye P, et al. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012;90:311–46.
Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, et al. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol. 2014. https://doi.org/10.1186/1471-2288-14-42 . (PMID: 10.1186/1471-2288-14-42246697513974746)
Jurkowski JM, Lawson HA, Green Mills LL, Wilner PG, Davison KK. The empowerment of low-income parents engaged in a childhood obesity intervention. Fam Community Health. 2014;37(2):104–18. (PMID: 10.1097/FCH.0000000000000024245691575491212)
Roura M, Dias S, Lemaster JW, Macfarlane A. Participatory health research with migrants: opportunities, challenges, and way forwards. Health Expect. 2021;24(2):188–97. (PMID: 10.1111/hex.13201335280828077110)
Seidler ALJB, Golley RK, Hunter KE. The complex quest of preventing obesity in early childhood: describing challenges and solutions through collaboration and innovation. Front Endocrinol. 2022. https://doi.org/10.3389/fendo.2021.803545 . (PMID: 10.3389/fendo.2021.803545)
Hawkins J, Madden K, Fletcher A, Midgley L, Grant A, Cox G, et al. Development of a framework for the co-production and prototyping of public health interventions. BMC Public Health. 2017;17(1):689. (PMID: 10.1186/s12889-017-4695-8288701925583990)
Vogelsang M, McCaffrey L, Ryde GC, Verloigne M, Dall P. Preparing for co-creation: a roadmap for planning a co-creation initiative from a case study on sedentary behaviour in Scottish SMEs – A Health CASCADE study. Public Health. 2025;242:157–64. (PMID: 10.1016/j.puhe.2025.02.03640080987)
Locock L, Boaz A. Drawing straight lines along blurred boundaries: qualitative research, patient and public involvement in medical research, co-production and co-design. Evid Policy. 2019;15(3):409–21. (PMID: 10.1332/174426419X15552999451313)
Voorberg WH, Bekkers VJJM, Tummers LG. A systematic review of co-creation and co-production: embarking on the social innovation journey. Public Manag Rev. 2015;17(9):1333–57. (PMID: 10.1080/14719037.2014.930505)
Vargas C, Whelan J, Brimblecombe J, Allender S. Co-creation, co-design, co-production for public health-a perspective on definition and distinctions. Public Health Res Pract. 2022;32(2):3222211. https://doi.org/10.17061/phrp3222211. (PMID: 10.17061/phrp322221135702744)
Agnello DM, Balaskas G, Steiner A, Chastin S. Methods used in co-creation within the Health CASCADE co-creation database and gray literature: systematic methods overview. Interact J Med Res. 2024;13:e59772. (PMID: 10.2196/597723952779311589503)
Steen T, Brandsen T, Verschuere B. The dark side of co-creation and co-production—Seven evils. Co-Production and Co-Creation. 1 ed: Routledge; 2018.
Jurkowski JM, Green Mills LL, Lawson HA, Bovenzi MC, Quartimon R, Davison KK. Engaging low-income parents in childhood obesity prevention from start to finish: a case study. J Community Health. 2013;38(1):1–11. (PMID: 10.1007/s10900-012-9573-9227146703547242)
Lioret S, Harrar F, Boccia D, Hesketh KD, Kuswara K, Van Baaren C, et al. The effectiveness of interventions during the first 1,000 days to improve energy balance-related behaviors or prevent overweight/obesity in children from socio-economically disadvantaged families of high-income countries: a systematic review. Obes Rev. 2022. https://doi.org/10.1111/obr.13524 . (PMID: 10.1111/obr.135243639437510078443)
Love P, Laws R, Litterbach E, Campbell KJ. Factors influencing parental engagement in an early childhood obesity prevention program implemented at scale: the Infant Program. Nutrients. 2018. https://doi.org/10.3390/nu10040509 . (PMID: 10.3390/nu10040509297025785986425)
Verloigne M, Altenburg T, Cardon G, Chinapaw M, Dall P, Deforche B, et al. Making co-creation a trustworthy methodology for closing the implementation gap between knowledge and action in health promotion: the Health CASCADE project. Perspect Public Health. 2023;143(4):196–8. (PMID: 10.1177/1757913922113671837589328)
Rod MH, Aagaard-Hansen J, Bauman A, Jespersen LN, Tørslev MK, Vallis M, et al. What fuels the research truck? Participatory health promotion research for sustainable change. Health Promot Int. 2022;37(Supplement_2):ii1–6. (PMID: 10.1093/heapro/daac05235748286)
Hesketh KD, Zheng M, Campbell KJ. Early life factors that affect obesity and the need for complex solutions. Nat Rev Endocrinol. 2024. https://doi.org/10.1038/s41574-024-01035-2 . (PMID: 10.1038/s41574-024-01035-239313572)
Pommerencke LM, Jørgensen SE, Pant SW, Carlsson RR, Bonnesen CT, Kierkegaard L, et al. Trends in social inequality in overweight and obesity among Danish infants, 2002–2022. Int J Public Health. 2025; 70-2025.
Bonnesen CT, Rasmussen M, Kierkegaard L, Carlsson RR, Jensen MP, Ubbesen TR, et al. Study protocol for a cluster-randomized controlled trial of a universal home-based, multi-component intervention to promote healthy weight development in children during infancy and toddlerhood in Denmark: the Bloom Study. BMC Public Health. 2025;25(1):2952. (PMID: 10.1186/s12889-025-24352-14086684612382212)
Pant SW, Pedersen TP. Sundhedsprofil for børn født i 2017 fra Databasen Børns Sundhed. København: National Institute of Public Health, SDU; 2019.
Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522–6. (PMID: 10.1093/fampra/13.6.5229023528)
Arnstein SR. A ladder of citizen participation. J Am Inst Plann. 1969;35(4):216–24. (PMID: 10.1080/01944366908977225)
Cornish F, Gillespie A, Zittoun T. Collaborative analysis of qualitative data. In: Flick U, editor. The SAGE handbook of qualitative data analysis. London: Sage Publications; 2014. p. 79–93. (PMID: 10.4135/9781446282243.n6)
Longworth GR, Agnello DM, Chastin S, Davis A, Hidalgo ES, Baselga SV, et al. Evaluating the co-creation process in public health interventions: the PROSECO framework. Public Health. 2025;245:105783. (PMID: 10.1016/j.puhe.2025.10578340449476)
Tavory I, Timmermans S. Abductive analysis: theorizing qualitative research. University of Chicago Press; 2014. (PMID: 10.7208/chicago/9780226180458.001.0001)
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. (PMID: 10.1191/1478088706qp063oa)
Høyer K. Hvad er teori, og hvordan forholder teori sig til metode? [What is theory, and how does theory relate to method?]. In: Vallgårda S, Koch L, editors. Forskningsmetoder i folkesundhedsvidenskab. Copenhagen: Munksgaard; 2011.
Broholm-Holst M, Tjørnhøj-Thomsen T. Ethical reflexivity: A critical examination of ethics in public health intervention research. Evaluation. 2026; 32(1):82–95. https://doi.org/10.1177/13563890251367001. (PMID: 10.1177/13563890251367001)
Uddannelses- og Forskningsministeriet. Den danske kodeks for integritet i forskning [The Danish Code of Conduct for Research Integrity]. Copenhagen: Uddannelses- og Forskningsministeriet; 2014.
Olsen NJ, Østergaard JN, Bjerregaard LG, Høy TV, Kierkegaard L, Michaelsen KF, et al. A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: a report produced by a working group of the Danish Council on Health and Disease Prevention. Obes Rev. 2023. https://doi.org/10.1111/obr.13641 . (PMID: 10.1111/obr.136413787196610909538)
Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obes Rev. 2024;15(9):769–79. (PMID: 10.1111/obr.12197)
Maindal HT, Timm A, Dahl-Petersen IK, Davidsen E, Hillersdal L, Jensen NH, et al. Systematically developing a family-based health promotion intervention for women with prior gestational diabetes based on evidence, theory and co-production: the Face-It study. BMC Public Health. 2021. https://doi.org/10.1186/s12889-021-11655-2 . (PMID: 10.1186/s12889-021-11655-2344795268418002)
Nielsen KK, Dahl-Petersen IK, Jensen DM, Ovesen P, Damm P, Jensen NH, et al. Protocol for a randomised controlled trial of a co-produced, complex, health promotion intervention for women with prior gestational diabetes and their families: the Face-It study. Trials. 2020. https://doi.org/10.1186/s13063-020-4062-4 . (PMID: 10.1186/s13063-020-4062-4332723197711053)
Campbell K, Hesketh K, Crawford D, Salmon J, Ball K, McCallum Z. The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: cluster-randomised controlled trial. BMC Public Health. 2008;8:103. (PMID: 10.1186/1471-2458-8-103183738772346474)
Daniels LA, Magarey A, Battistutta D, Nicholson JM, Farrell A, Davidson G, et al. The NOURISH randomised control trial: positive feeding practices and food preferences in early childhood—A primary prevention program for childhood obesity. BMC Public Health. 2009;9:387. (PMID: 10.1186/1471-2458-9-387198251932770488)
Slattery P, Saeri AK, Bragge P. Research co-design in health: a rapid overview of reviews. Health Res Policy Syst. 2020;18(1):17. (PMID: 10.1186/s12961-020-0528-9320467287014755)
Smith H, Budworth L, Grindey C, Hague I, Hamer N, Kislov R, et al. Co-production practice and future research priorities in United Kingdom-funded applied health research: a scoping review. Health Res Policy Syst. 2022;20(1):36. (PMID: 10.1186/s12961-022-00838-x353668988976994)
Timm A, Maindal HT, Hillersdal L. Co-creating with families and healthcare professionals: Shaping a context-sensitive health promotion intervention “Face-It.” Health Promot Int. 2022;37(Supplement_2):ii60–72. (PMID: 10.1093/heapro/daac03135748289)
Hoeeg D, Christensen U, Grabowski D. Co-designing an intervention to prevent overweight and obesity among young children and their families in a disadvantaged municipality: methodological barriers and potentials. Int J Environ Res Public Health. 2019;16(24):5110. (PMID: 10.3390/ijerph16245110318473426950007)
Emke H, Vandendriessche A, Chinapaw M, Deforche B, Verloigne M, Altenburg T, et al. Facilitating co-research: lessons learned from reflection forms within three participatory action research projects. Health Res Policy Syst. 2024;22(1):117. (PMID: 10.1186/s12961-024-01210-x3918011111342652)
Saavedra RQ, Covarrubias AC. From yard to healing garden: the role of participatory design in shaping therapeutic landscapes. HERD. 2026. https://doi.org/10.1177/19375867251406541 . (PMID: 10.1177/1937586725140654141544139)
Longworth GR, Goh K, Agnello DM, Messiha K, Beeckman M, Zapata-Restrepo JR, et al. A review of implementation and evaluation frameworks for public health interventions to inform co-creation: a Health CASCADE study. Health Res Policy Syst. 2024;22(1):39. (PMID: 10.1186/s12961-024-01126-63854916210976753)
Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018;13(1):98. (PMID: 10.1186/s13012-018-0784-z300457356060529)
Duenas DM, Weiss EM, Wilfond BS, Kraft SA. Ethical considerations for respectful research participant payment processes. J Clin Transl Sci. 2024;8(1):e204. (PMID: 10.1017/cts.2024.6503965502211626574)
Benz C, Scott-Jeffs W, McKercher KA, Welsh M, Norman R, Hendrie D, et al. Community-based participatory-research through co-design: supporting collaboration from all sides of disability. Res Involv Engagem. 2024;10(1):47. (PMID: 10.1186/s40900-024-00573-33873028311084036)
Longworth GR, Erikowa-Orighoye O, Anieto EM, Agnello DM, Zapata-Restrepo JR, Masquillier C, et al. Conducting co-creation for public health in low and middle-income countries: a systematic review and key informant perspectives on implementation barriers and facilitators. Glob Health. 2024;20(1):9. (PMID: 10.1186/s12992-024-01014-2)
Kragelund Nielsen K, Dahl-Petersen IK, Jensen DM, Damm P, Ovesen P, Mathiesen ER, et al. Effectiveness of a family-based health promotion intervention for women with prior GDM: the Face-It RCT. J Clin Endocrinol Metab. 2025;110(8):e2456–70. (PMID: 10.1210/clinem/dgae8563965796712261077)
Timm A, Kragelund Nielsen K, Alvesson HM, Jensen DM, Maindal HT. Motivation for behavior change among women with recent gestational diabetes and their partners—A qualitative investigation among participants in the Face-It intervention. Nutrients. 2023. https://doi.org/10.3390/nu15183906 . (PMID: 10.3390/nu151839063783642210574517)
Grindell C, Coates E, Croot L, O’Cathain A. The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res. 2022;22(1):877. (PMID: 10.1186/s12913-022-08079-y357992519264579)
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015. https://doi.org/10.1136/bmj.h1258 . (PMID: 10.1136/bmj.h1258257919834366184)
Longworth GR, de Boer J, Goh K, Agnello DM, McCaffrey L, Restrepo JZ, et al. Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components. BMJ Glob Health. 2024;9(7):e014483. (PMID: 10.1136/bmjgh-2023-0144833896487811227756)
Agnello DM, Smith N, Vogelsang M, Steiner A, An Q, de Boer J, et al. Developing and validating the co-creation rainbow framework for intrinsic evaluation of methods: a health CASCADE structured review of models representing co-creation principles. Health Res Policy Syst. 2025;23(1):127. (PMID: 10.1186/s12961-025-01381-14107407712512873)
Contributed Indexing: Keywords: Co-creation; Health systems; Implementers; Intervention development; Methodology; Process evaluation; Stakeholder engagement; Target group
Entry Date(s): Date Created: 20260529 Date Completed: 20260726 Latest Revision: 20260729
Update Code: 20260729
PubMed Central ID: PMC13404867
DOI: 10.1186/s12961-026-01486-1
PMID: 42210249
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1478-4505
DOI:10.1186/s12961-026-01486-1