Initiating insulin therapy in older individuals with type 2 diabetes (T2DM) poses unique challenges and requires a nuanced understanding of the age-related factors that impact safety and efficacy. ...This study employed Experience-Based Co-Design (EBCD) to enhance the insulin initiation and management experience for this population, emphasising a collaborative approach involving patients, caregivers, and healthcare professionals. The primary aim of the research was to develop a tailored care pathway, utilising co-design and the Behaviour Change Wheel (BCW), which addressed issues specific to older adults on insulin therapy. The study sought to identify key challenges, propose practical interventions, and construct a logic model illustrating a pathway for enhanced insulin treatment experiences. An adapted EBCD process was used which integrated the Medical Research Council (MRC) Framework and BCW. The study involved thematic synthesis, video interviews, and feedback focus groups with patients, caregivers, and healthcare professionals. The 'Crazy Eights' brainstorming method, as part of the co-design workshop, generated practical solutions which informed subsequent logic model development. Focus group findings revealed distressing insulin initiation experiences, inconsistent dietary advice, and perceived disparities in care between type 1 and type 2 diabetes. The co-design workshop identified eight key challenges, leading to proposed interventions aligned with the BCW. The logic model illustrates a pathway for older individuals undergoing insulin treatment, emphasising behaviour change among patients, caregivers, and healthcare professionals. The collaborative efforts of participants contributed valuable insights in terms of the unique educational and emotional needs of patients, the importance of care continuity and of improving access to specialist services. Findings from this study can be used to inform and enhance tailored support strategies for older adults with T2DM during their insulin transition and ongoing management.
BackgroundCo-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention ...for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings.AimsTo identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings.DesignRapid evidence synthesis.Data sourcesMedline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues.Study selectionStudies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting.Findings712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made.ConclusionsDespite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered.
Objectives
This study aimed to explore how the concepts of co‐production and co‐design have been defined and applied in the context of health and social care and to identify the temporal adoption of ...the terms.
Methods
A systematic scoping review of CINAHL with Full Text, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, PubMed and Scopus was conducted to identify studies exploring co‐production or co‐design in health and social care. Data regarding date and conceptual definitions were extracted. From the 2933 studies retrieved, 979 articles were included in this review.
Results
A network map of the sixty most common definitions and—through exploration of citations—eight definition clusters and a visual representation of how they interconnect and have informed each other over time are presented. Additional findings were as follows: (i) an increase in research exploring co‐production and co‐design in health and social care contexts; (ii) an increase in the number of new definitions during the last decade, despite just over a third of included articles providing no definition or explanation for their chosen concept; and (iii) an increase in the number of publications using the terms co‐production or co‐design while not involving citizens/patients/service users.
Conclusions
Co‐production and co‐design are conceptualized in a wide range of ways. Rather than seeking universal definitions of these terms, future applied research should focus on articulating the underlying principles and values that need to be translated and explored in practice.
Patient and Public Contribution
The search strategy and pilot results were presented at a workshop in May 2019 with patient and public contributors and researchers. Discussion here informed our next steps. During the analysis phase of the review, informal discussions were held once a month with a patient who has experience in patient and public involvement. As this involvement was conducted towards the end of the review, we agreed together that inclusion as an author would risk being tokenistic. Instead, acknowledgements were preferred. The next phase involves working as equal contributors to explore the values and principles of co‐production reported within the most common definitions.
This article is a response to Oliver et al.'s Commentary 'The dark side of coproduction: do the costs outweigh the benefits for health research?' recently published in Health Research Policy and ...Systems (2019, 17:33). The original commentary raises some important questions about how and when to co-produce health research, including highlighting various professional costs to those involved. However, we identify four related limitations in their inquiry, as follows: (1) the adoption of a problematically expansive definition of co-production that fails to acknowledge key features that distinguish co-production from broader collaboration; (2) a strong focus on technocratic rationales for co-producing research and a relative neglect of democratic rationales; (3) the transposition of legitimate concerns relating to collaboration between researchers and practitioners onto work with patients, service users and marginalised citizens; and (4) the presentation of bad practice as an inherent flaw, or indeed 'dark side', of co-production without attending to the corrupting influence of contextual factors within academic research that facilitate and even promote such malpractice. The Commentary's limitations can be seen to reflect the contemporary use of the term 'co-production' more broadly. We describe this phenomenon as 'cobiquity' - an apparent appetite for participatory research practice and increased emphasis on partnership working, in combination with the related emergence of a plethora of 'co' words, promoting a conflation of meanings and practices from different collaborative traditions. This phenomenon commonly leads to a misappropriation of the term 'co-production'. Our main motivation is to address this imprecision and the detrimental impact it has on efforts to enable co-production with marginalised and disadvantaged groups. We conclude that Oliver et al. stray too close to 'the problem' of 'co-production' seeing only the dark side rather than what is casting the shadows. We warn against such a restricted view and argue for greater scrutiny of the structural factors that largely explain academia's failure to accommodate and promote the egalitarian and utilitarian potential of co-produced research.
Over the last decade, growing attention has been paid to the potential value of design theory and practice in improving public services. Experience-based Co-design (EBCD) is a participatory research ...approach that draws upon design tools and ways of thinking in order to bring healthcare staff and patients together to improve the quality of care. The co-design process that is integral to EBCD is powerful but also challenging, as it requires both staff and patients to renegotiate their roles and expectations as part of a reconfiguration of the relationships of power between citizens and public services. In this paper, we reflect upon the implementation and adaptation of EBCD in a variety of projects and on the challenges of co-design work within healthcare settings. Our discussion aims to contribute to the growing field of service design and to encourage further research into how co-design processes shape-and are shaped by-the power relations that characterize contemporary public services.
Green marketing has become increasingly prevalent, however, generating profits through green marketing has not. Although firms continue to adopt environmental strategies, they struggle to gain a ...competitive advantage. This study sheds light onto this discrepancy by introducing the concept of an eco-capability, as well as two antecedents instrumental to its formation (i.e., environmental orientation and organizational innovation). Applying the resource-based view of the firm and dynamic capabilities literature, we investigate this eco-capability which fully leverages a firm's human, business, and technology resources. Using survey data from marketing managers across fourteen industries, we estimate a Latent Moderated Structural model that provides support for these three resource components. Environmental orientation and organizational innovativeness are found to be predictors of this eco-capability. Their interaction is also significant, which suggests that a firm that it is both environmentally oriented and innovative is most likely to develop an eco-capability. Finally, we demonstrate that an eco-capability is positively related to two strategic outcomes — market and financial performance, as well as the perceived quality of the firm's offering.
•We develop an empirically test a new environmental construct called an eco-capability.•We define the human, business, & technology resources that comprise an eco-capability.•Environmental orientation and organizational innovativeness predict this eco-capability.•An eco-capability increases the perceived quality of a firm's product or service offering.•An eco-capability is positively related to a firm's market and financial performance.
Research into gratitude as a significant sociological and psychological phenomenon has proliferated in the past two decades. However, there is little consensus on how it should be conceptualized or ...investigated empirically. We present a meta-narrative review that focuses on gratitude in health care, with an emphasis on research exploring interpersonal experiences in the context of care provision. Six meta-narratives from literatures across the humanities, sciences, and medicine are identified, contextualized, and discussed: gratitude as social capital; gifts; care ethics; benefits of gratitude; gratitude and staff well-being; and gratitude as an indicator of quality of care. Meta-narrative review was a valuable framework for making sense of theoretical antecedents and findings in this developing area of research. We conclude that greater attention needs to be given to what constitutes “evidence” in gratitude research and call for qualitative studies to better understand and shape the role and implications of gratitude in health care.
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