Co-destruction in social care services: how to identify and evaluate barriers arising from a co- production exercise with family carers living in rural and remote areas

Abstract

Background: Co-production has been widely recognised as a plausible means to reduce the dissatisfaction of citizens, the inefficacy of service providers, and conflicts in relations between the former and the latter. However, the enhancement of co-production has begun to be questioned: co-production has often been taken for granted, and its effects may not always be fruitful. To understand and prevent unsuccessful citizen and provider collaboration, the recent literature has begun to focus on the causes of co-destruction. This paper investigates how the barriers that may arise during the co-production of a new social service with family carers can be identified and interpreted.Methods: To investigate this topic, we undertook a single case study by considering a longitudinal project (Place4Carers) intended to co-produce a new social care service with and for the family carers of elderly patients living in rural and remote areas. We organised collaborative co-assessment workshops and semi-structured interviews to collect the views of family carers and service providers on the co-production process. As part of the research team that participated in the co-production process, we contributed to the analysis with a reflexive approach.Results: The analysis revealed four main co-production barriers: lack of trust, lack of effectiveness of engagement, participants’ inability (or impossibility) to change and the lack of a cohesive partnership among partners. Despite these findings, the project increases carers’ satisfaction, competence and trust in service providers by demonstrating the positive effects of co-production.Conclusions: Our article confirms that co-creation and co-destruction processes may coexist. The role of researchers and service providers is to prevent or remedy co-destruction effects. To this end, we suggest that in co-production projects, more time should be spent co-assessing the project before, during and after the co-production process. This approach would facilitate the adoption of adjustment actions such as creating mutual trust through conviviality among actors and fostering collaborative research between academia and organisations that are not used to working together.

A longitudinal assessment of chronic care pathways in real-life: self-care and outcomes of chronic heart failure patients in Tuscany

“…Despite some scholars highlighted the resistance of professionals and patients towards the patient involvement in the provision of care, it remains a key public strategy for achieving individual health outcomes, and for contributing to the sustainability of the healthcare system as well [55]. Managing collaborative process is as important as it is delicate [56]. Such strategies should not be as granted, and nevertheless they should be recognized as essential part of patient-centered policies [57].…”