Co-Designing interventions

Working with others for better outcomes

About this page

Interventions that are designed by engaging with all the relevant stakeholders should be more amenable to those stakeholders and in time more effective in their outcomes. Practice-based health promotion and community work has been aware of this for many decades and more recently, research-driven intervention designers have also taken more interest in the methods of, and integration of, stakeholder engagement work.

This page includes a range of resources to help reflect on best practice in the Co-Design of Interventions. Some content is focussed on community interventions and some on the process of doing research.

Key Recommended Reading

  • Masterson, D., Areskoug Josefsson, K., Robert, G., Nylander, E., & Kjellström, S. (2022). Mapping definitions of co‐production and co‐design in health and social care: A systematic scoping review providing lessons for the future. Health Expectations. https://doi.org/10.1111/hex.13470

  • Smith, B., Williams, O., Bone, L., & the Moving Social Work Co-Production Collective (2022). Co-production: A resource to guide co-producing research in the sport, exercise, and health sciences. Qualitative Research in Sport, Exercise and Health, 1-29. https://doi.org/10.1080/2159676X.2022.2052946

  • Vargas, C., Whelan, J., Brimblecombe, J., & Allender, S. (2022). Co-creation, co-design, co-production for public health: a perspective on definition and distinctions. Public Health Research & Practice, 32(2). https://www.phrp.com.au/wp-content/uploads/2022/06/PHRP3222211.pdf

  • Knowles, S. E., Allen, D., Donnelly, A., Flynn, J., Gallacher, K., Lewis, A., ... & Drinkwater, J. (2021). More than a method: trusting relationships, productive tensions, and two-way learning as mechanisms of authentic co-production. Research involvement and engagement, 7(1), 1-14. https://doi.org/10.1186/s40900-021-00262-5

  • Slattery, P., Saeri, A. K., & Bragge, P. (2020). Research co-design in health: a rapid overview of reviews. Health research policy and systems, 18(1), 1-13. https://doi.org/10.1186/s12961-020-0528-9

  • Esmail, L., Moore, E., & Rein, A. (2015). Evaluating patient and stakeholder engagement in research: moving from theory to practice. Journal of comparative effectiveness research, 4 (2), 133-145. https://doi.org/10.2217/cer.14.79

  • Coldham, T., & INVOLVE Group (2018). Guidance on co-producing a research project. https://www.learningforinvolvement.org.uk/wp-content/uploads/2021/04/NIHR-Guidance-on-co-producing-a-research-project-April-2021.pdf

  • Robert, G., Locock, L., Williams, O., Cornwell, J., Donetto, S., & Goodrich, J. (2022). Co-Producing and Co-Designing (Elements of Improving Quality and Safety in Healthcare). Cambridge: Cambridge University Press. doi:10.1017/9781009237024

  • Voorberg, W. H., Bekkers, V. J., & Tummers, L. G. (2015). A systematic review of co-creation and co-production: Embarking on the social innovation journey. Public management review, 17(9), 1333-1357. https://doi.org/10.1080/14719037.2014.930505

A Rationale for Stakeholder Work

UK Guidance on Health Actions that involve Engagement

  • 2004 - Choosing Health: Making Healthier Choices Easier.....success based on partnerships & sharing info

  • 2006 - Our Health, Our Care, Our Say...Partnership between people and public services

  • 2010 - Equity and Excellence Liberating the NHS

  • 2010 - Healthy Lives, Healthy People...Strong partnerships between communities, business and the voluntary sector will help address a range of health challenges

Working with what's already there

Brooks, F., & Kendall, S. (2013). Making sense of assets: What can an assets-based approach offer public health?. Critical Public Health, 23(2), 127-130. https://doi.org/10.1080/09581596.2013.783687

Working with stakeholders: The "target" population

Scriven, A. (2017). Promoting Health: A Practical Guide-E-Book: Ewles & Simnett. Elsevier Health Sciences. [Ch13: working with groups]

Different way's of engaging

Contains an adapted Ladder of Community Participation for Public Health

Morgan, M. A., & Lifshay, J. (2006). Community engagement in public health. California Endowment under the sponsorship of Contra Costa Health Services (CCHS), 1-8. http://www.schoolhealthcenters.org/wp-content/uploads/2011/09/community_engagement.pdf

Boulton, E. R., Horne, M., & Todd, C. (2020). Involving Older Adults in Developing Physical Activity Interventions to Promote Engagement: A Literature Review. Journal of Population Ageing, 13(3), 325–345. https://doi.org/10.1007/s12062-019-09247-5

Community Capacity Building & Empowerment

Raeburn, J., Akerman, M., Chuengsatiansup, K., Mejia, F., & Oladepo, O. (2006). Community capacity building and health promotion in a globalized world. Health promotion international, 21(suppl_1), 84-90. https://doi.org/10.1093/heapro/dal055

Heritage, Z., & Dooris, M. (2009). Community participation and empowerment in Healthy Cities. Health Promotion International, 24(suppl_1), i45-i55. https://doi.org/10.1093/heapro/dap054

Wallerstein, N., Minkler, M., Carter-Edwards, L., Avila, M., & Sanchez, V. (2015). Improving health through community engagement, community organization, and community building. In Glanz et al. Health behavior: Theory, research and practice. John Wiley & Sons.

Working with Communities (papers from Green et al)

[from Ch 9, https://study.sagepub.com/greentones4e/student-resources/sage-journal-articles

  • Focused on the outbreak of the Ebola virus in West Africa, this paper outlines how bottom-up approaches were not widely implemented during the response. The paper shows the value of bottom-up approaches for current and future disease emergency responses.

Laverack, G., & Manoncourt, E. (2016). Key experiences of community engagement and social mobilization in the Ebola response. Global Health Promotion, 23(1), 79–82.

  • This paper is a useful case study showing how community development principles and outcomes can be achieved. The paper is focused on a Sardinian village (Ulassai), but has wider transferability to other contexts.

Sardu, C., Mereu, A., Sotgiu, A., & Contu, P. (2012). A bottom-up art event gave birth to a process of community empowerment in an Italian village. Global Health Promotion, 19, 5–13

  • This paper shows the value of utilising lay people in developing public health outcomes. The paper focuses on community health champions in Northern England and demonstrates the impact of the intervention both for the champions and the community recipients.

Woodall, J., White, J., & South, J. (2012). Improving health and well-being through community health champions: a thematic evaluation of a programme in Yorkshire and Humber. Perspectives in Public Health, 133(2), 96–103

Collective Change Lab (2022) Storytelling as Meaning-Making. https://collectivechangelab.medium.com/storytelling-as-meaning-making-689d27af23d7


Working with (small) groups to change behaviour

Much of my current research is around the creation and facilitation of small groups for supporting positive behaviour change. What constitutes a group? What techniques and methods can be used to ensure that individuals come together and benefit from a developing a stronger sense of social identity? These articles contain much insight into this topic.

Borek, A. J., & Abraham, C. (2018). How do Small Groups Promote Behaviour Change ? An Integrative Conceptual Review of Explanatory Mechanisms, Applied Psychology: Health and Well‐Being, 10(1), 30–61. https://doi.org/10.1111/aphw.12120

Hoddinott, P., Allan, K., Avenell, A., & Britten, J. (2010). Group interventions to improve health outcomes: a framework for their design and delivery. BMC Public Health, 10(1), 800. https://doi.org/10.1186/1471-2458-10-800

Tarrant, M., Haslam, C., Carter, M., Calitri, R., & Haslam, S. A. (2020). Social Identity Interventions. In M. Hagger, L. Cameron, K. Hamilton, N. Hankonen, & T. Lintunen (Eds.), The Handbook of Behavior Change (pp. 649–660). Cambridge. https://doi.org/10.1017/9781108677318.044

Working with Stakeholders: "Others"

This content is focused on engagement with the broader set of stakeholders, beyond the intended recipients of the intervention. These might include the delivery partners, commissioners, funding partners, allied professionals, community stakeholders and more.

Brandstetter, R. (2006) Successful Partnerships https://www.oecd.org/cfe/leed/36279186.pdf

Littlecott, H. J., Fox, K. R., Stathi, A., & Thompson, J. L. (2017). Perceptions of success of a local UK public health collaborative. Health promotion international, 32(1), 102-112. https://doi.org/10.1093/heapro/dav088

Working with Stakeholders: Further Reading

Recommended Textbooks

Brandsen, T., Steen, T., & Verschuere, B. (2018). Co-production and co-creation: Engaging citizens in public services. Taylor & Francis. https://doi.org/10.4324/9781315204956 [Open Access Textbook]

Newbury-Birch, D., & Allan, K. (Eds.). (2019). Co-creating and co-producing research evidence: A guide for practitioners and academics in health, social care and education settings. Routledge. [Routledge]

Robert, G., Locock, L., Williams, O., Cornwell, J., Donetto, S., & Goodrich, J. (2022). Co-producing and co-designing. Cambridge University Press. https://doi.org/10.1017/9781009237024 [Open Access Textbook]

Green, J., Tones, K., Cross, R. and Woodall, J. (2015) Health Promotion Planning & Strategies. (3rd ed.) Thousand Oaks: California: Sage Publications Ltd.

Nabatchi, T., Sancino, A., & Sicilia, M. (2017). Varieties of participation in public services: The who, when, and what of coproduction. Public Administration Review, 77(5), 766-776. https://doi.org/10.1111/puar.12765

Creative Practices in research co-production

An excellent editorial that gives an overview of the co-production landscape and signposts to specific papers in the same issue

Langley, J., Kayes, N., Gwilt, I., Snelgrove-Clarke, E., Smith, S., & Craig, C. (2022). Exploring the value and role of creative practices in research co-production. Evidence & Policy, 18(2), 193-205. https://doi.org/10.1332/174426421X16478821515272

Power and Empowerment

Laverack, G. (2005). Public health: power, empowerment and professional practice. Macmillan International Higher Education.

Theories of participation

Marent, B., Forster, R., & Nowak, P. (2012). Theorizing participation in health promotion: A literature review. Social Theory & Health, 10(2), 188-207. https://doi.org/10.1057/sth.2012.2

Community-Based Participatory Research

Brush, B. L., Mentz, G., Jensen, M., Jacobs, B., Saylor, K. M., Rowe, Z., ... & Lachance, L. (2020). Success in long-standing community-based participatory research (CBPR) partnerships: A scoping literature review. Health Education & Behavior, 47(4), 556-568. https://doi.org/10.1177/1090198119882989

Israel, B. A., Parker, E. A., Rowe, Z., Salvatore, A., Minkler, M., López, J., ... & Halstead, S. (2005). Community-based participatory research: lessons learned from the Centers for Children’s Environmental Health and Disease Prevention Research. Environmental health perspectives, 113(10), 1463-1471. https://doi.org/10.1289/ehp.7675

Engaging with stakeholders to help refine the intervention

An interesting paper that outlines a stage of the planning process that we have spoken about when using our workbook.

Morton, K. L., Atkin, A. J., Corder, K., Suhrcke, M., Turner, D., & Van Sluijs, E. M. (2017). Engaging stakeholders and target groups in prioritising a public health intervention: the Creating Active School Environments (CASE) online Delphi study. BMJ open, 7(1), e013340. http://dx.doi.org/10.1136/bmjopen-2016-013340

Reflections on the co-production process

Buckley, B. J., Newton, J., Knox, S., Noonan, B., Smith, M., & Watson, P. M. (2022). Multi-stakeholder perspectives on co-production: Five key recommendations following the Liverpool Co-PARS project. Qualitative Research in Sport, Exercise and Health, 1-15. https://doi.org/10.1080/2159676X.2022.2152085

Engaging with stakeholders to create positive change

Kok, G., Gurabardhi, Z., Gottlieb, N. H., & Zijlstra, F. R. (2015). Influencing organizations to promote health: Applying stakeholder theory. Health Education & Behavior, 42(1_suppl), 123S-132S. https://doi.org/10.1177/1090198115571363

Beyond the usual suspects

A research report containing a brief review of some of the evidence around inclusion but also a series of illustrative insights from interviews with service users who talk around themes that include tokenism, stigma, confidence and language.

Beresford, P (2013) Beyond the usual suspects. Shaping Our Lives https://www.shapingourlives.org.uk/documents/BTUSReport.pdf

The dark side of co-production

Williams, O., Sarre, S., Papoulias, S. C., Knowles, S., Robert, G., Beresford, P., ... & Palmer, V. J. (2020). Lost in the shadows: reflections on the dark side of co-production. Health Research Policy and Systems, 18(1), 1-10. https://doi.org/10.1186/s12961-020-00558-0

Practical Resources

HealthKnowledge.org.uk - Learning from Stakeholders - Workbook - Video Course

Dialogue by Design A Handbook of Public & Stakeholder Engagement - http://www.mspguide.org/sites/default/files/resource/dialogue_by_design_handbook_stakeholder_engagement_-_andrew_acland.pdf

Public Health Ontario - Planning Health Promotion Programs - Resource Page - https://www.publichealthontario.ca/en/health-topics/public-health-practice/program-planning-evaluation/planning-programs

Glandon, D., Paina, L., Alonge, O., Peters, D. H., & Bennett, S. (2017). 10 Best resources for community engagement in implementation research. Health policy and planning, 32(10), 1457-1465. https://doi.org/10.1093/heapol/czx123

Kaner, S. (2014). Facilitator's guide to participatory decision-making. John Wiley & Sons. [Google Books]

More Resources

ImproveWell.com (2020) Participatory change: 5 resources to guide staff involvement in healthcare quality improvement in 2020 and beyond https://www.improvewell.com/2020/11/20/resources-healthcare-quality-improvemen

Core Principles of Public Engagement - https://www.iap2.org/page/corevalues

Robert, G., Locock, L., Williams, O., Cornwell, J., Donetto, S., & Goodrich, J. (2022). Co-producing and co-designing. Cambridge University Press. https://doi.org/10.1017/9781009237024 [Open Access Textbook]

European Commission, Joint Research Centre, Williquet, F., Szkola, S., Catana, C., et al. (2021) The communities of practice playbook: a playbook to collectively run and develop communities of practice, Publications Office. https://data.europa.eu/doi/10.2760/443810