Fit for purpose. Co-production of complex behavioural interventions: A practical guide and exemplar of co-producing a telehealth-delivered exercise intervention for people with stroke

Ramage, E.R., Burke, M., Galloway, M., Graham, I.D., Janssen, H., Marsden, D.L., Patterson, A.J., Pollack, M., Said, C.M., Lynch, E.A., English, C. (2022). Fit for purpose. Co-production of complex behavioural interventions. A practical guide and exemplar of co-producing a telehealth-delivered exercise intervention for people with stroke. Health Research Policy and Systems, 20(2). https://doi.org/10.1186/s12961-021-00790-2

Ramage and colleagues set out to develop an intervention protocol for people living with stroke that was to be delivered via telehealth. To increase the real-world application of the intervention, the authors used an approach in which the intervention protocol was co-produced by people living with stroke, caregivers of people living with stroke, and clinicians who would implement the intervention (these individuals referred to collectively as knowledge users).

Ramage, et al. used a 4-stage process including stages of:

• Start-up and planning – the research team met to determine the scope of the project and the essential components to be included in the intervention, such as timeline and the groups of knowledge users to be involved,
• Content development – recruitment of the knowledge users, facilitating workshops to discuss the intervention, outcomes, barriers, and enablers,
• Protocol development – refining the intervention protocol based on input from the knowledge users and identifying areas requiring further input, and
• Adaptation – demonstrating aspects of the intervention protocol, providing examples of materials and equipment for the intervention, and identifying further revisions to intervention.

Challenges with this process included competing time pressures, frequency and duration of meetings, power imbalance, and clear communication. Practical tips for supporting this process included involving more than one individual in each knowledge user group so that the weight of the role is shared by multiple individuals and allows for multiple opinions/experiences, ensuring clear and consistent expectations, providing materials and information about the workshops to knowledge users ahead of time so they can prepare, and being flexible with meeting frequency and duration.

The authors provide reflections on the sharing of power in co-production projects and the process of collaborative decision making, expressing the importance of all team members having a chance to voice their opinions and experiences. At the point of publication, the telehealth-delivered intervention protocol for individuals living with stroke was in a phase of testing prior to implementation.

Blogger: Rachel Benninger is a combined MClSc/PhD candidate working under the supervision of Dr. Lisa Archibald