Evidence-based co-creation methodology for bridging the implementation gap between knowledge and action in health promotion.

Project Information

Health CASCADE

Grant agreement ID: 956501

DOI

10.3030/956501

Project closed

EC signature date 13 August 2020

Start date 1 January 2021

End date 31 December 2024

Funded under

• EXCELLENT SCIENCE - Marie Skłodowska-Curie Actions

Total cost

€ 4 058 108,64

EU contribution

€ 4 058 108,64

Coordinated by

UNIVERSITEIT GENT
Belgium

Periodic Reporting for period 2 - Health CASCADE (Evidence-based co-creation methodology for bridging the implementation gap between knowledge and action in health promotion.)

Reporting period: 2023-01-01 to 2024-12-31

Summary of the context and overall objectives of the project

THE PROBLEM
Co-creation emerges as a promising strategy to address complex problems (such as the obesity epidemic) which are particularly resistant to resolution. The use of co-creation in many fields has grown exponentially in recent years and it is now expected, and often demanded, by funders, governments and policymakers to democratise and accelerate the impact of research. However, currently, there is 1) a lack of capacity for co-creation within research and practice workforces; 2) a lack of robust methodology to underpin co-creation practice; and 3) a lack of digital technology to facilitate co-creation.

IMPORTANCE
Society and European citizens are increasingly confronted with more complex problems in public health, climate change, biodiversity loss, growing inequalities, urban planning and threats to democracy which seem to resist traditional deterministic approaches. These problems have a high societal impact and financial burden. Health Cascade provides a rigorous and trustworthy methodology for co-creation, a new generation of highly trained young scientists, and a cascading training programme to build capacity throughout Europe. The methodology, capacity, training and technology developed in the network will empower actors across Europe to tackle complex problems in different sectors and develop effective solutions. Health Cascade has decreased the likelihood of harm and resource wastage. There are already numerous reports of co-creation having detrimental effects and uncharted potential unintended consequences, from poorly evidenced and poorly conducted co-creation. There is a real danger that this will ultimately lead to growing distrust towards co-creation from the public, policymakers and other stakeholders and, more importantly, that poorly conducted co-creation might put the public at risk.

OBJECTIVES
The aim of Health CASCADE was to foster the next generation of highly-trained research leaders in all aspects of evidence-based co-creation methodology to tackle the complexity of modern global health problems. Through a programme of training-by-research projects and tailored training events, Health CASCADE achieved the following objectives:
1) Trained the next generation of research leaders.
2) Advanced co-creation into a rigorous scientific methodology with evidence-based methods, practices and supportive technologies.
3) Developed a shared European cascading training system for evidence-based co-creation

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

Health CASCADE is the first cooperative and structured effort to comprehensively address the training and methodological development of co-creation.
Fifteen Early Stage Researchers were recruited in 2021. The scientific work encompasses three components:
- WP1 developed the foundation of a trustworthy and evidence-based rigorous co-creation methodology, including: theory, ethics, methods and implementation and evaluation
- WP2 developed enabling digital technology to support co-creation
- WP3,4,5 and 6 applied and tested the methodology in four key sectors for public health (schools, workplace, health care system outdoor urban setting)

WP1 developed an open-access knowledge base about co-creation by systematically searching the literature. Systematic reviews and expert interviews were conducted to: identify an epistemological lens and theories to underpin co-creation, establish a framework for continual ethical reflection to govern co-creation, establish a taxonomy of methods for conducting co-creation and establish an evaluation framework for co-creation. These were compiled into initial guidelines for evidence-based co-creation called PRODUCES+ for planning, conducting, evaluating and reporting co-creation.

WP2 conducted need assessments for technology in co-creation and from this devleoped an architecture for an eco-system of enabling technologies and priorities and two prototype technologies to address the top two needs: 1) An Artificial Intelligence question and answer service that co-creator can interrogate to gain knowledge about a specific topic and co-creation, 2) An artificial assistant capable of transcribing the content of workshop discussions in multiple languages and extract salient themes to help co-creators in decision making throughout the process.

WP3-6 tested the co-creation process across a range of sectors. WP3 co-created interventions targeting healthy sleep in adolescents in the school setting. WP4 co-created interventions to replace sitting at work with physical activity and explored the scalability of co-created interventions. WP 5 co-created interventions in healthcare settings in two projects; one to support pregnant women and another to support those living with COPD. WP6 co-created interventions to design outdoor urban environments in local communities.

WP 8 developed a Cascade Training programme based on the synthesis of the science of co-creation achieved in WP1-6. Extensive feedback allowed us to refine the business and cascading model. The next steps are to set up a social enterprise that will act as an agency for the ESRs and trained practitioners of the future to impart knowledge and support co-creation practice. The social enterprise will also partner with a community of practice around co-creation. We have secured external funding from the Converge Challenge Award 2024 to set up the social enterprise and ensure sustainability. The cascading model required that the training be provided in two formats: 1) an on-demand introductory format which will be delivered through bitesize videos and an AI Q&A agent 2) a three-day course that can be delivered online or face-to-face.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

Policy, funders and citizens now demand more participation from the public in research and decision-making. Currently, there are no accepted theories or consolidated methodologies to underpin co-creation and ensure it is robust and trustworthy.

Health Cascade developed:
- evidence-based guidelines for planning, conducting, evaluating and reporting co-creation to make it a robust and trustworthy methodology;
- an architecture and taxonomy for an ecosystem of digital technology specifically designed to support and enhance co-creation;
- a cascade training course for evidence-based co-creation to allow for greater reach and rapid scaling.


The impact of Health Cascade is in four areas:
- developing evidence-based co-creation and building capacity through a cascade training model.
- practical tools and digital technologies developed by Health Cascade
- real-world co-created interventions during the Health Cascade project in the health care, education, workplace and urban planning sectors.
- the main impact will be building capacity for robust and trustworthy co-creation, ensuring that European research and civil institutions have a more powerful methodology to tackle complex problems. In this respect, this will help build public trust in science, democracy and societal structures. Widely practised evidence-based cocreation within public health will, in turn, reduce the societal burden of disease.

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