Co-creation is crucial for fostering active patient engagement in health management. However, the efficacy of co-creation in chronic disease management varies, and there is a lack of detailed description regarding co-creation practice. This study aimed to explore the effectiveness of co-creation on health outcomes and cost-effectiveness, detailing its implementation.
Data Source
PubMed, Embase, Scopus, Cochrane Library and Web of Science.
Study Inclusion and Exclusion Criteria
We included peer-reviewed randomized controlled trials, published in English, that analyzed the effects of co-creation on physical health, participation outcomes, psychological health, self-efficacy and cost-effectiveness.
Data Extraction
Two researchers independently screened the articles and assessed the quality of the 16 included studies using a pre-prepared checklist.
Data Synthesis
Meta-analyses were conducted to summarize the characteristics, outcomes, and risk of bias of the included studies.
Results
The results showed that co-creation significantly enhanced patients’ physical health (P = 0.006) and participation outcomes (P = 0.009). Subgroup analysis revealed that co-creation combined with theory was better than co-creation without theory in improving physical health (P = 0.007). However, no significant difference was observed between the two groups regarding psychological health, self-efficacy and cost-effectiveness (P = 0.29) (P = 0.11) (P = 0.50).
Conclusion
Co-creation effectively improved patients’ physical health and participation outcomes, without affecting psychological health, self-efficacy, and cost-effectiveness. Social determinants were found to play a more crucial role in influencing physical health of patients. Additionally, age disparities might impact the cost-effectiveness of co-creation. Future research should explore the influence of intergenerational co-creation on health promotion.
BennettJEStevensGAMathersCD. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet. 2018;392(10152):1072-1088. doi:10.1016/S0140-6736(18)31992-5
2.
AbegundeDOMathersCDAdamTOrtegonMStrongK. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370(9603):1929-1938. doi:10.1016/S0140-6736(07)61696-1
3.
MaddisonRCartledgeSRogersonM, et al.Usefulness of wearable cameras as a tool to enhance chronic disease self-management: scoping review. JMIR Mhealth Uhealth. 2019;7(1):e10371. doi:10.2196/10371
4.
TaylorMLThomasEEVitangcolK, et al.Digital health experiences reported in chronic disease management: an umbrella review of qualitative studies. J Telemed Telecare. 2022;28(10):705-717. doi:10.1177/1357633X221119620
5.
AllegranteJPWellsMTPetersonJC. Interventions to support behavioral self-management of chronic diseases. Annu Rev Publ Health. 2019;40(1):127-146. doi:10.1146/annurev-publhealth-040218-044008
6.
GreenhalghTJacksonCShawSJanamianT. Achieving research impact through co-creation in community-based health services: literature review and case study. Milbank Q. 2016;94(2):392-429. doi:10.1111/1468-0009.12197
7.
RobertGCornwellJLocockLPurushothamASturmeyGGagerM. Patients and staff as codesigners of healthcare services. BMJ. 2015;350:g7714. doi:10.1136/bmj.g7714. Published online February 10.
8.
AgnelloDMLoiselQEAAnQ, et al.Establishing a health CASCADE–curated open-access database to consolidate knowledge about co-creation: novel artificial intelligence–assisted methodology based on systematic reviews. J Med Internet Res. 2023;25:e45059. doi:10.2196/45059
9.
LeaskCFSandlundMSkeltonDAChastinSF. Co-creating a tailored public health intervention to reduce older adults’ sedentary behaviour. Health Educ J. 2017;76(5):595-608. doi:10.1177/0017896917707785
10.
AnQSandlundMAgnelloD, et al.A scoping review of co-creation practice in the development of non-pharmacological interventions for people with chronic obstructive pulmonary disease: a health CASCADE study. Respir Med. 2023;211:107193. doi:10.1016/j.rmed.2023.107193
11.
HalvorsrudKKucharskaJAdlingtonK, et al.Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature. J Public Health. 2021;43(1):197-208. doi:10.1093/pubmed/fdz126
12.
ManssonLWiklundMÖhbergFDanielssonKSandlundM. Co-creation with older adults to improve user-experience of a smartphone self-test application to assess balance function. IJERPH. 2020;17(11):3768. doi:10.3390/ijerph17113768
13.
LundellSTootsASönnerforsPHalvarssonAWadellK. Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease. BMC Med Inform Decis Mak. 2022;22(1):68. doi:10.1186/s12911-022-01806-9
14.
MessihaKChinapawMJMKetHCFF, et al.Systematic review of contemporary theories used for co-creation, co-design and co-production in public health. J Public Health. 2023;45(3):723-737. doi:10.1093/pubmed/fdad046
15.
PengYWuTChenZDengZ. Value cocreation in health care: systematic review. J Med Internet Res. 2022;24(3):e33061. doi:10.2196/33061
16.
TurnerKMRousseauNCrootL, et al.Understanding successful development of complex health and healthcare interventions and its drivers from the perspective of developers and wider stakeholders: an international qualitative interview study. BMJ Open. 2019;9(5):e028756. doi:10.1136/bmjopen-2018-028756
17.
MoherDLiberatiATetzlaffJAltmanDGThe PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097
18.
RamaswamyVOzcanK. The Co-creation Paradigm. Stanford University Press; 2014. doi:10.1515/9780804790758
19.
Int J Health Care Qual Assur. Bringing user experience to healthcare improvement: the concepts, methods and practices of experience-based design. 2008;21(1). doi:10.1108/ijhcqa.2008.06221aae.002
20.
ProcterRGreenhalghTWhertonJSugarhoodPRouncefieldMHinderS. The day-to-day co-production of ageing in place. Comput Support Coop Work. 2014;23(3):245-267. doi:10.1007/s10606-014-9202-5
21.
WhertonJSugarhoodPProcterRHinderSGreenhalghT. Co-production in practice: how people with assisted living needs can help design and evolve technologies and services. Implement Sci. 2015;10(1):75. doi:10.1186/s13012-015-0271-8
22.
Cacari-StoneLWallersteinNGarciaAPMinklerM. The promise of community-based participatory research for health equity: a conceptual model for bridging evidence with policy. Am J Publ Health. 2014;104(9):1615-1623. doi:10.2105/AJPH.2014.301961
23.
DostilioLD. Democratically engaged community– university partnerships: reciprocal determinants of democratically oriented roles and processes.
24.
McGillBCorbettLGrunseitACIrvingMO’HaraBJ. Co-produce, co-design, co-create, or co-construct—who does it and how is it done in chronic disease prevention? A scoping review. Healthcare. 2022;10(4):647. doi:10.3390/healthcare10040647
25.
GrindellCCoatesECrootLO’CathainA. 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. doi:10.1186/s12913-022-08079-y
26.
SterneJACSavovićJPageMJ, et al.RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898. Published online August 28.
27.
O’Mara-EvesABruntonGMcDaidD, et al.Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Res. 2013;1(4):1-526. doi:10.3310/phr01040
28.
HigginsJPTThomasJChandlerJ, et al.Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019.
29.
LuoDWanXLiuJTongT. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):1785-1805. doi:10.1177/0962280216669183
30.
BariliFParolariAKappeteinPAFreemantleN. Statistical primer: heterogeneity, random- or fixed-effects model analyses?Interact Cardiovasc Thorac Surg. 2018;27(3):317-321. doi:10.1093/icvts/ivy163
31.
LeaskCFSandlundMSkeltonDA, et al.Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions. Res Involv Engagem. 2019;5(1):2. doi:10.1186/s40900-018-0136-9
32.
Senabre HidalgoEFuster MorellM. Co-designed strategic planning and agile project management in academia: case study of an action research group. Palgrave Commun. 2019;5(1):151. doi:10.1057/s41599-019-0364-0
33.
LongworthGRErikowa-OrighoyeOAnietoEM, 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. doi:10.1186/s12992-024-01014-2
34.
JollesMPFortMPGlasgowRE. Aligning the planning, development, and implementation of complex interventions to local contexts with an equity focus: application of the PRISM/RE-AIM Framework. Int J Equity Health. 2024;23(1):41. doi:10.1186/s12939-024-02130-6
35.
LiPWYuDS. A modeling-based narrative intervention to promote timely care-seeking in patients with acute myocardial infarction: a pilot randomized controlled trial and feasibility analysis. Eur J Cardiovasc Nurs. 2019;18(3):215-223. doi:10.1177/1474515118810126
36.
HumaldaJKKlaassenGDe VriesH, et al.A self-management approach for dietary sodium restriction in patients with CKD: a randomized controlled trial. Am J Kidney Dis. 2020;75(6):847-856. doi:10.1053/j.ajkd.2019.10.012
37.
PirhonenLBolinKOlofssonEH, et al.Person-centred care in patients with acute coronary syndrome: cost-effectiveness analysis alongside a randomised controlled trial. Pharmacoecon Open. 2019;3(4):495-504. doi:10.1007/s41669-019-0126-3
38.
JohnsonEKFraserRTLashleyS, et al.Program of active consumer engagement in self-management in epilepsy: replication and extension of a self-management randomized controlled trial. Epilepsia. 2020;61(6):1129-1141. doi:10.1111/epi.16530
39.
HoskinsGWilliamsBAbhyankarP, et al.Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma. Trials. 2016;17(1):584. doi:10.1186/s13063-016-1684-7
40.
WuZXuJYueCLiYLiangY. Collaborative care model based telerehabilitation exercise training program for acute stroke patients in China: a randomized controlled trial. J Stroke Cerebrovasc Dis. 2020;29(12):105328. doi:10.1016/j.jstrokecerebrovasdis.2020.105328
41.
SchwalmJDMcCreadyTLopez-JaramilloP, et al.A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial. Lancet. 2019;394(10205):1231-1242. doi:10.1016/S0140-6736(19)31949-X
42.
Lara-CabreraMLSalvesenØNessetMBDe Las CuevasCIversenVCGråweRW. The effect of a brief educational programme added to mental health treatment to improve patient activation: a randomized controlled trial in community mental health centres. Patient Educ Counsel. 2016;99(5):760-768. doi:10.1016/j.pec.2015.11.028
43.
RyuBKimNHeoE, et al.Impact of an electronic health record-integrated personal health record on patient participation in health care: development and randomized controlled trial of myhealthkeeper. J Med Internet Res. 2017;19(12):e401. doi:10.2196/jmir.8867
44.
CoxSRCzuber-DochanWWallCL, et al.Improving food-related quality of life in inflammatory bowel disease through a novel web resource: a feasibility randomised controlled trial. Nutrients. 2022;14(20):4292. doi:10.3390/nu14204292
45.
AliLWallströmSForsA, et al.Effects of person-centered care using a digital platform and structured telephone support for people with chronic obstructive pulmonary disease and chronic heart failure: randomized controlled trial. J Med Internet Res. 2021;23(12):e26794. doi:10.2196/26794
46.
OrregoCPerestelo-PérezLGonzález-GonzálezAI, et al.A virtual community of practice to improve primary health care professionals’ attitudes toward patient empowerment (e-MPODERA): a cluster randomized trial. Ann Fam Med. 2022;20(3):204-210. doi:10.1370/afm.2799
47.
RamliASSelvarajahSDaudMH, et al.Effectiveness of the EMPOWER-PAR intervention in improving clinical outcomes of type 2 diabetes mellitus in primary care: a pragmatic cluster randomised controlled trial. BMC Fam Pract. 2016;17(1):157. doi:10.1186/s12875-016-0557-1
48.
NápolesAMOrtízCSantoyo-OlssonJ, et al.Nuevo Amanecer: results of a randomized controlled trial of a community-based, peer-delivered stress management intervention to improve quality of life in latinas with breast cancer. Am J Publ Health. 2015;105:e55-e63.
49.
PazokiRNabipourISeyednezamiNImamiSR. Effects of a community-based healthy heart program on increasing healthy women’s physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR). BMC Public Health. 2007;7(1):216. doi:10.1186/1471-2458-7-216
50.
WellsKBJonesLChungB, et al.Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities. J Gen Intern Med. 2013;28(10):1268-1278. doi:10.1007/s11606-013-2484-3
51.
SelingerCPCarberyIWarrenV, et al.The relationship between different information sources and disease‐related patient knowledge and anxiety in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2017;45(1):63-74. doi:10.1111/apt.13831
52.
TerkelsenASWesterCTGulisGJespersenJAndersenPT. Co-creation and co-production of health promoting activities addressing older people—a scoping review. IJERPH. 2022;19(20):13043. doi:10.3390/ijerph192013043
53.
WhiteheadMDahlgrenG. What can be done about inequalities in health?Lancet. 1991;338(8774):1059-1063. doi:10.1016/0140-6736(91)91911-D
54.
DahlgrenGWhiteheadM. The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health. 2021;199:20-24. doi:10.1016/j.puhe.2021.08.009
55.
MaenhoutLVerloigneMCairnsD, et al.Co-creating an intervention to promote physical activity in adolescents with intellectual disabilities: lessons learned within the Move it, Move ID!-project. Res Involv Engagem. 2023;9(1):10. doi:10.1186/s40900-023-00420-x
56.
LewinK. Frontiers in group dynamics: II. Channels of group life; social planning and action research. Hum Relat. 1947;1(2):143-153. doi:10.1177/001872674700100201
57.
IrwinBKurzDChalinPThompsonN. Testing the efficacy of ourspace, a brief, group dynamics-based physical activity intervention: a randomized controlled trial. J Med Internet Res. 2016;18(4):e87. doi:10.2196/jmir.5342
58.
HuangXMayerREUsherEL. Better together: effects of four self-efficacy-building strategies on online statistical learning. Contemp Educ Psychol. 2020;63:101924. doi:10.1016/j.cedpsych.2020.101924
59.
JalaliAZiapourAEzzatiEKazemiSKazeminiaM. The impact of training based on the pender health promotion model on self-efficacy: a systematic review and meta-analysis. Am J Health Promot. 2024;38:08901171231224101. doi:10.1177/08901171231224101. Published online December 23, 2023.
60.
SørensenSSJensenMBPedersenKMEhlersL. Examining the heterogeneity and cost effectiveness of a complex intervention by segmentation of patients with chronic obstructive pulmonary disease. Value Health. 2018;21(2):239-247. doi:10.1016/j.jval.2017.08.001
61.
LevinsonWKaoAKubyAThistedRA. Not all patients want to participate in decision making: a national study of public preferences. J Gen Intern Med. 2005;20(6):531-535. doi:10.1111/j.1525-1497.2005.04101.x
62.
RodriguezKLAppeltCJSwitzerGESonelAFArnoldRM. Veterans’ decision-making preferences and perceived involvement in care for chronic heart failure. Heart Lung. 2008;37(6):440-448. doi:10.1016/j.hrtlng.2008.02.003
63.
GualanoMRVoglinoGBertFThomasRCamussiESiliquiniR. The impact of intergenerational programs on children and older adults: a review. Int Psychogeriatr. 2018;30(4):451-468. doi:10.1017/S104161021700182X
64.
IlianoEBeeckmanMLatommeJCardonG. The GRANDPACT project: the development and evaluation of an intergenerational program for grandchildren and their grandparents to stimulate physical activity and cognitive function using co-creation. IJERPH. 2022;19(12):7150. doi:10.3390/ijerph19127150
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