Healthy Living and Co-Production: Evaluation of Processes and Outcomes of a Health Promotion Initiative Co-Produced with Adolescents

Abstract

Co-production is an approach to designing, delivering, and evaluating public services through strict collaboration among professionals and the people using services with an equal and reciprocal relationship. Health promotion initiatives that include education services rarely use the co-production approach. Nevertheless, the value of co-production is widely recognized, although it is considered a normative good, and scarce and mixed evidence is available in literature. The purpose of this paper is to provide evidence supporting the hypothesis that a co-production approach, applied to an intervention for preventing obesity, can be effective and efficient. To this end, an evaluation of the processes, outputs meant as intermediate results, and behavioral and economic outcomes of a public health-promotion initiative co-produced and co-delivered with adolescents (beFood) was conducted. Mixed methods were used, including field-observations, two self-reported questionnaires, and an opportunity–cost analysis that compared beFood to traditional approaches of public health promotion. The co-production model was successfully implemented and appears to be effective—more than 5000 adolescents were reached by only 49 co-producer adolescents, who reported behavioral changes (e.g., eating better and practicing more physical activity). The cost analysis showed that the co-production approach was also efficient, producing relevant savings and potentially making available more than 3000 h of professionals’ time. This research can support a re-thinking of public institutions’ organization, public initiatives’ design, and public servants’ role.

Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics

“…Quantitative data analysis methods include statistical analyses, such as structural equation modelling (e.g., [ 42 , 43 , 44 ]), factor analyses (e.g., [ 44 , 45 ]), correlation and regression analyses (e.g., [ 6 , 16 , 46 ]), analysis of variance (ANOVA or MANOVA) (e.g., [ 47 ]), nonparametric test (e.g., [ 48 , 49 , 50 ]), multiple imputation techniques (e.g., [ 51 ]), and cost analysis, such as cost minimisation analysis (e.g., [ 16 ]) and cost opportunity analysis (e.g., [ 17 ]). Qualitative data analyses mainly embrace content analysis (e.g., [ 52 ]) and deductive or inductive thematic analysis (e.g., [ 53 , 54 , 55 ]), including specific inductive methodology, such as Grounded Theory (e.g., [ 56 , 57 , 58 ]), Gioia methodology (e.g., [ 59 , 60 ]) and interpretative phenomenological analysis (e.g., [ 61 ]).…”

“…Length of admission x average costs per night [62]; [16,17,62]; The asterisk * indicates publications in the public domain.…”

“…In this regard, it must be emphasized that there is increasing interest in understanding the benefits of co-production for the healthcare ecosystem [15]. Extant knowledge shows that co-production positively impacts on specific single dimensions, e.g., provider costefficiency (e.g., [16,17]); health outcomes (e.g., [18]); perceived service quality (e.g., [19]); service accessibility (e.g., [20]); customer satisfaction and quality of life (e.g., [21,22]); and compliance (e.g., [23]). Nevertheless, a systematic evaluation of the impacts of coproduction on the different stakeholders involved and its sustainability over time still is lacking [24,25].…”

The COVID-19 emergency as an opportunity to co-produce an innovative approach to health services provision: the women's antenatal classes move on the web

“…To this end, the healthcare organizations should work in making the healthcare workers aware and empowered in their role of creating value in respect to the interaction with the healthcare services’ users (Sorrentino et al, 2015 ; De Rosis et al, 2020 ). Healthcare professionals oversee care delivery in healthcare sector, which is traditionally dominated by the «reverse hierarchy» organizational structure (Mosley, 2014 ).…”

Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways

“…27 Coproduction is becoming more common, and new models of coproduction and methods of assessment are constantly being developed 28–30 . Recent coproductive health research reports on the capacity of coproduction to increase impact, facilitate knowledge translation, identify underused or unrecognized resources (people, services, networks), improve information and education processes by tailoring to individual need and support overall health improvement initiatives 31–34 . Increases in the breadth of examples of coproductive health services research have also highlighted challenges to coproduction.…”