Transforming integrated care through co-production
: a meta-ethnography & a multi-case study using participatory action research

  • Susan Conquer

Student thesis: Doctoral Thesis

Abstract

Background
Health and care systems and services are required to work with people who use and provide integrated care. In response, co-production has become a prevalent approach, and an increasingly researched concept, to understand how doing so impacts the design and transformation of services. An array of approaches have been implemented to co-produce with service users, family carers and the workforce, however, questions remain about how co-production should be applied within different contexts in integrated care systems. In addition, whilst these systems incorporate users as both recipients and co-producers of care, the conceptual literature of integrated care and co-production have not theoretically aligned. Researching developing frameworks and models is required to further explore the possibility of this alignment within practice.

Aim
To explore co-production with service users, family carers and the workforce within the design and transformation of integrated care services.

Methods
The research was designed with input from a Co-production Advisory Group of service users, family carers and the workforce. A systematic review was completed using meta-ethnography, which can generate potential theories by interpreting patterns between qualitative studies set in different contexts. Then, a multi-case study was set within one Integrated Care System (ICS) in England, underpinned by a critical constructivist and participatory methodology. It used Participatory Action Research (PAR) where participants became co-researchers (service users, family carers, volunteers, community representatives, and service transformation leads) alongside the researcher within each case.
The three case studies were:
1. Developing an adult Autism Spectrum Disorder and Attention- Deficit/Hyperactivity Disorder pathway.
2. Growing a community-based memory café for people living with dementia and carers.
3. Improving access and inclusion of end-of-life care for diverse communities.

Data from the PAR processes were thematically analysed and a deliberative workshop was hosted for cross-case analysis.

Findings
The systematic review found that co-production requires a well-defined focus. An additional step on the ‘ladder of co-production’ and a cyclic co-delivery framework were proposed. The multi-case study found that a sense of belonging and organisational structures were integral for co-production within integrated care, and an eight-stage process was identified to support ICSs to co-produce. This proposed that a smaller co-production group can work alongside a wider co-delivery group, creating opportunities in the community and enabling service design and transformation closer to the community.

Discussion
Sustainable models and processes for co-production are required to embed lived experience into integrated care design and transformation. A system-wide learning community is key to building co-production competence, and this thesis provides five working recommendations for ICSs to build the required supportive environment. This thesis contributes to the field of co-production within integrated care through existing theories, including peer-to-peer learning, community-powered practice, and integrated community care, and therefore supports the theoretical alignment between co-production practice and integrated care.
Date of AwardJan 2025
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorValerie Gladwell (Supervisor), Rachel Heathershaw (Supervisor) & Karen Windle (Supervisor)

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