HIM006/APT6: CODESIGN
SUSTAINABLE
HEALTHCARE
All Learning Team Meetings, Trainings & Lectures
,LTM1 – Societal preferences and stakeholder
perspectives in reimbursement decisions
14-02-2025
Understand what co-design is and the ways in which stakeholders can be meaningfully
involved in the policy making process/coverage decisions
Source: Syllabus
Co-design in HTA is a collaborative approach that involves various stakeholders—such as
patients, healthcare professionals, policymakers, researchers, and sometimes even technology
developers—in the assessment process of health technologies. This approach aims to make
HTA more inclusive, transparent, and responsive to the real needs and priorities of all groups
impacted by new or existing health technologies. Co-design could lead to increased relevance
and accuracy, higher stakeholder engagement, improved transparency and trust, better
alignment with patient-centered goals, promotion of health equity and inclusivity, and many
others.
When stakeholders participate in the HTA process, the resulting recommendations are more
likely to reflect patient preferences and clinical effectiveness, enhancing the legitimacy of these
decisions. This collaborative approach fosters a sense of solidarity among stakeholders, as
diverse voices contribute to shaping the healthcare system. As stakeholders feel their
perspectives are heard and considered, trust is built within the system. Ultimately, the
integration of co-design in HTA contributes to improved healthcare governance and better
health outcomes, ensuring that coverage decisions are responsive to the needs of patients and
the community while promoting a shared commitment to equitable care. Hence, proper
stakeholder elicitation is key in co-designing sustainable healthcare coverage
Source: Slattery, P., Saeri, A. K., & Bragge, P. (2020). Research co-design in health: a rapid
overview of reviews. Health research policy and systems, 18, 1-13.
Billions of dollars are lost annually in health research that fails to create meaningful benefits for
patients, because of non-publication, incomplete reporting and poor design. Engaging in
research co-design – the meaningful involvement of end-users in research – may help address
this research waste.
- Key contributor: health research frequently addresses questions and outcomes of
limited relevance to clinicians, patients and other end-users.
- Co-design: meaningful end-user engagement in research design and includes instances
of engagement that occur across all stages of the research process and range in
intensity from relatively passive to highly active and involved.
- Research co-design: meaningful involvement of research users during the study
planning phase of research project, where ‘meaningful involvement’ is taken to refer to
participation in an explicitly described, defined and auditable role or task necessary to
the planning and/or conduct of health research.
- Research users: consumers, clinicians or other people or groups (other than
researchers) that have an interest in the results of health research.
- Study planning phase: all activities occurring prior to the finalization of the research
question in a research study.
Approaches to research co-design in health settings
- All focused on some type of research-related engagement with one or many groups of
research end-users, such as the public, patient, consumer, stakeholder and
communities.
, - Most used ‘involvement’ or ‘engagement; to describe cases where research end-users
contributed to the research process.
- Patient and public involvement
- Stakeholder engagement
- Participatory research
- Patient and stakeholder engagement
- Consumer engagement
- Participatory methods
- Inclusive health research
- Community-academic partnerships
- Community-based participatory research
- Stakeholder involvement
- Patient engagement
- Consumer involvement in research
Activities involved in research co-design approaches
- Interviews and participation in advisory councils
- Co-design activities were typically used to facilitate (1) prioritization and research
agenda-setting; (2) review of research proposals, and (3) contribution to design study,
outcomes and materials.
- Structured input from end-users on research protocols, especially in selecting outcome
measures that mattered to patients, providing feedback on technical or culturally
appropriate language in study materials and operational processes such as recruitment
and obtaining consent.
- Foundational co-design activities were typically taken by the researchers prior to any
contribution activities, and included identifying end-user groups, defining specific roles
and responsibilities for end-users, and recruiting and managing end-users to the
research project or programmes.
o Focus groups
o Interviews
o Surveys
o Deliberative methods
- Many different roles for co-design participants, e.g. advisors and committee members
who provide advice, reviewers who examined plans and materials, co-production roles
where the co-designers initiated, and/or shared control of the research.
- Co-design activities were tailored to the end-user groups (typically patients) involved.
Effectiveness of existing research co-design approaches
- Rarely tested empirically or experimentally, but qualitative evaluations are positive
- The research topics, research questions and design of materials were perceived to be
more appliable and acceptable to research end-users because of co-design
- Several benefits for end-users who participated in research co-design were identified,
including positive emotional outcomes, increased knowledge about and increased skills
for contributing to the research process and managing their medical condition.
- Research co-design can benefit researchers
- Some negative aspects of co-design: increased time and the financial resources
required to incorporate co-design elements into a research process; tensions between
researchers and end-users in decision-making and sacrificing scientific rigor for end-
user preferences; and concerns regarding study design.
Discussion
, - The effective implementation of misalignment could have substantial positive impacts,
from improving the function of health systems and the societies that depend on them.
- Key barriers to overcome for better research co-design evaluation
o Many of the metrics involved are quite different to those traditionally measured
or valued in health
o Lack of consistency across co-design metrics
o Lack of clearly accepted causal framework or theory of change that (1) argues for
the value of measuring specific instrumental (e.g. research design improvement)
and (2) explains and justifies the probable relationships between these metrics
(e.g. better research design leads to better health for these reasons, which in
turn leads to improved social outcomes)
Rarely been tested empirically or experimentally, existing research suggests that it can benefit
researchers, practitioners, research processes and research outcomes. Realizing the potential
of research co-design may require the development of clearer and more consistent terminology,
better reporting of the activities involved and better evaluation.
Understand the promises and pitfalls of such participatory methods as codesign
Source: 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, 25(3),
902-913.
Findings:
- Increase in research exploring co-production and co-design in health and social care
contexts
- Increase in number of new definitions during last decade, despite just over a third of
included articles providing no definitions or explanation for their chosen concept
- Increase in the number of publications using the terms co-production or co-design while
not involving citizens/patients/service users
SUSTAINABLE
HEALTHCARE
All Learning Team Meetings, Trainings & Lectures
,LTM1 – Societal preferences and stakeholder
perspectives in reimbursement decisions
14-02-2025
Understand what co-design is and the ways in which stakeholders can be meaningfully
involved in the policy making process/coverage decisions
Source: Syllabus
Co-design in HTA is a collaborative approach that involves various stakeholders—such as
patients, healthcare professionals, policymakers, researchers, and sometimes even technology
developers—in the assessment process of health technologies. This approach aims to make
HTA more inclusive, transparent, and responsive to the real needs and priorities of all groups
impacted by new or existing health technologies. Co-design could lead to increased relevance
and accuracy, higher stakeholder engagement, improved transparency and trust, better
alignment with patient-centered goals, promotion of health equity and inclusivity, and many
others.
When stakeholders participate in the HTA process, the resulting recommendations are more
likely to reflect patient preferences and clinical effectiveness, enhancing the legitimacy of these
decisions. This collaborative approach fosters a sense of solidarity among stakeholders, as
diverse voices contribute to shaping the healthcare system. As stakeholders feel their
perspectives are heard and considered, trust is built within the system. Ultimately, the
integration of co-design in HTA contributes to improved healthcare governance and better
health outcomes, ensuring that coverage decisions are responsive to the needs of patients and
the community while promoting a shared commitment to equitable care. Hence, proper
stakeholder elicitation is key in co-designing sustainable healthcare coverage
Source: Slattery, P., Saeri, A. K., & Bragge, P. (2020). Research co-design in health: a rapid
overview of reviews. Health research policy and systems, 18, 1-13.
Billions of dollars are lost annually in health research that fails to create meaningful benefits for
patients, because of non-publication, incomplete reporting and poor design. Engaging in
research co-design – the meaningful involvement of end-users in research – may help address
this research waste.
- Key contributor: health research frequently addresses questions and outcomes of
limited relevance to clinicians, patients and other end-users.
- Co-design: meaningful end-user engagement in research design and includes instances
of engagement that occur across all stages of the research process and range in
intensity from relatively passive to highly active and involved.
- Research co-design: meaningful involvement of research users during the study
planning phase of research project, where ‘meaningful involvement’ is taken to refer to
participation in an explicitly described, defined and auditable role or task necessary to
the planning and/or conduct of health research.
- Research users: consumers, clinicians or other people or groups (other than
researchers) that have an interest in the results of health research.
- Study planning phase: all activities occurring prior to the finalization of the research
question in a research study.
Approaches to research co-design in health settings
- All focused on some type of research-related engagement with one or many groups of
research end-users, such as the public, patient, consumer, stakeholder and
communities.
, - Most used ‘involvement’ or ‘engagement; to describe cases where research end-users
contributed to the research process.
- Patient and public involvement
- Stakeholder engagement
- Participatory research
- Patient and stakeholder engagement
- Consumer engagement
- Participatory methods
- Inclusive health research
- Community-academic partnerships
- Community-based participatory research
- Stakeholder involvement
- Patient engagement
- Consumer involvement in research
Activities involved in research co-design approaches
- Interviews and participation in advisory councils
- Co-design activities were typically used to facilitate (1) prioritization and research
agenda-setting; (2) review of research proposals, and (3) contribution to design study,
outcomes and materials.
- Structured input from end-users on research protocols, especially in selecting outcome
measures that mattered to patients, providing feedback on technical or culturally
appropriate language in study materials and operational processes such as recruitment
and obtaining consent.
- Foundational co-design activities were typically taken by the researchers prior to any
contribution activities, and included identifying end-user groups, defining specific roles
and responsibilities for end-users, and recruiting and managing end-users to the
research project or programmes.
o Focus groups
o Interviews
o Surveys
o Deliberative methods
- Many different roles for co-design participants, e.g. advisors and committee members
who provide advice, reviewers who examined plans and materials, co-production roles
where the co-designers initiated, and/or shared control of the research.
- Co-design activities were tailored to the end-user groups (typically patients) involved.
Effectiveness of existing research co-design approaches
- Rarely tested empirically or experimentally, but qualitative evaluations are positive
- The research topics, research questions and design of materials were perceived to be
more appliable and acceptable to research end-users because of co-design
- Several benefits for end-users who participated in research co-design were identified,
including positive emotional outcomes, increased knowledge about and increased skills
for contributing to the research process and managing their medical condition.
- Research co-design can benefit researchers
- Some negative aspects of co-design: increased time and the financial resources
required to incorporate co-design elements into a research process; tensions between
researchers and end-users in decision-making and sacrificing scientific rigor for end-
user preferences; and concerns regarding study design.
Discussion
, - The effective implementation of misalignment could have substantial positive impacts,
from improving the function of health systems and the societies that depend on them.
- Key barriers to overcome for better research co-design evaluation
o Many of the metrics involved are quite different to those traditionally measured
or valued in health
o Lack of consistency across co-design metrics
o Lack of clearly accepted causal framework or theory of change that (1) argues for
the value of measuring specific instrumental (e.g. research design improvement)
and (2) explains and justifies the probable relationships between these metrics
(e.g. better research design leads to better health for these reasons, which in
turn leads to improved social outcomes)
Rarely been tested empirically or experimentally, existing research suggests that it can benefit
researchers, practitioners, research processes and research outcomes. Realizing the potential
of research co-design may require the development of clearer and more consistent terminology,
better reporting of the activities involved and better evaluation.
Understand the promises and pitfalls of such participatory methods as codesign
Source: 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, 25(3),
902-913.
Findings:
- Increase in research exploring co-production and co-design in health and social care
contexts
- Increase in number of new definitions during last decade, despite just over a third of
included articles providing no definitions or explanation for their chosen concept
- Increase in the number of publications using the terms co-production or co-design while
not involving citizens/patients/service users
