Using Co-Production in Interventions to Reduce Health Inequalities: A Qualitative Study of Process and Impact

This thesis explores the use and impact of co-production in the development and implementation of interventions to reduce health inequalities. My empirical research focuses on the use of co-production in an intervention designed to reduce inequality in access to antenatal care (the Community REACH intervention).
Despite improvements in health, health inequalities remain prevalent worldwide. Co-production has been widely advocated in public health discourse because of its potential to address health inequalities. Co-production involves active participation of individuals and communities in designing, developing, and implementing interventions, services, or initiatives through equal and reciprocal relationships. Despite the promise of co-production, there is a lack of empirical evidence concerning process and impact, specifically in translating theory into practice and identifying factors that influence implementation.
This thesis used qualitative research and combined observations and interviews to identify factors that supported or hindered the use of co-production in the Community REACH intervention. The study developed fidelity indicators to assess adherence to co-production principles and practices.
Reciprocity, a foundational principle of co-production, was found to be key for successful implementation and facilitated other co-production elements. Collaborative practices were characterised by power imbalances connected to differences in disciplinary practices and insufficient attention dedicated to relationship‐building. This points to the need for a deliberate focus on relational practices to develop reciprocal relations and inclusive environments. Without these it was difficult for the various actors involved to establish shared understanding, negotiate roles, encourage social interactions among participants, and ensure a consistent high-fidelity co-production approach. The study also found that participating in a co-production process created a valuable community resource of volunteers who had strengthened their social networks and developed their capabilities and confidence to access new opportunities.
The study also found that those who participated in the co-production process strengthened their social networks, developed their capabilities and their confidence to access new opportunities, and together became a valuable community resource of volunteers.
Fidelity indicators developed in this study identify critical factors in the co-production process and potential solutions to avoid or address them, offering a systematic framework that leaves room for creativity in co-production. Future research should develop this set of fidelity indicators further.