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Background <p>Co-creation has gained prominence in public health intervention research, as stakeholder involvement is expected to strengthen implementation and effectiveness. Its growing popularity highlights the need for a critical examination of how co-creation is conceptualized and operationalized. This study examines: (1) the delivery of the co-creation process; (2) stakeholders’ experienced involvement; and (3) perceived outcomes, including how the process shaped the intervention design and stakeholders’ perceived value of participation. The co-creation centred on developing The Bloom Study, an early intervention to promote healthy weight development amongst infants integrated in the Danish community health nurse system.</p> Methods <p>The co-creation activities comprised six workshops and eight group meetings with a Participatory Planning Group of community health nurses, researchers and facilitators, supplemented by four parent group interviews. The evaluation followed a qualitative research design, combining multiple data sources: transcripts from co-creation activities, a joint oral evaluation and individual interviews with the Participatory Planning Group participants. Analysis was guided by the PROcesS Evaluation framework for CO-creation (PROSECO) framework.</p> Results <p>(1) The co-creation process was delivered as intended, though parental involvement was challenging. (2) Participants perceived themselves as highly involved, but still viewed the intervention primarily as the researchers’ project. The Participatory Planning Group demonstrated strong motivation and constructive group dynamics. Despite initial uncertainty about their roles, they felt they were able to meaningfully influence the intervention. (3) The Participatory Planning Group valued the co-creation process as a reflective space that enabled knowledge exchange. The intervention was shaped through iterative negotiation, integration of research and practice knowledge, and adaptation to contextual constraints. Although parental involvement was limited, their input helped refine materials and address parental needs.</p> Conclusions <p>This study provides empirical insight into how co-creation unfolds within a health system context. Meaningful stakeholder involvement was constrained by structural and temporal conditions tied to the research project, including fixed timelines. Despite these limitations, the process supported contextually grounded adaptations, strengthened stakeholder ownership and enhanced responsiveness to local needs. The critical application of the PROSECO framework helped “opening the black box” of co-creation and offers implications for health systems, particularly regarding how participatory approaches can inform implementation practices.</p>

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Opening the black box of co-creation: exploring process delivery, stakeholder experiences and perceived outcomes in the development of a family-based healthy weight development intervention for infants

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Lene Kierkegaard,
  • Camilla Thørring Bonnesen,
  • Rikke Rothkegel Carlsson,
  • Trine Pagh Pedersen,
  • Mette Rasmussen,
  • Nanna Gram Ahlmark,
  • Rikke Fredenslund Krølner

摘要

Background

Co-creation has gained prominence in public health intervention research, as stakeholder involvement is expected to strengthen implementation and effectiveness. Its growing popularity highlights the need for a critical examination of how co-creation is conceptualized and operationalized. This study examines: (1) the delivery of the co-creation process; (2) stakeholders’ experienced involvement; and (3) perceived outcomes, including how the process shaped the intervention design and stakeholders’ perceived value of participation. The co-creation centred on developing The Bloom Study, an early intervention to promote healthy weight development amongst infants integrated in the Danish community health nurse system.

Methods

The co-creation activities comprised six workshops and eight group meetings with a Participatory Planning Group of community health nurses, researchers and facilitators, supplemented by four parent group interviews. The evaluation followed a qualitative research design, combining multiple data sources: transcripts from co-creation activities, a joint oral evaluation and individual interviews with the Participatory Planning Group participants. Analysis was guided by the PROcesS Evaluation framework for CO-creation (PROSECO) framework.

Results

(1) The co-creation process was delivered as intended, though parental involvement was challenging. (2) Participants perceived themselves as highly involved, but still viewed the intervention primarily as the researchers’ project. The Participatory Planning Group demonstrated strong motivation and constructive group dynamics. Despite initial uncertainty about their roles, they felt they were able to meaningfully influence the intervention. (3) The Participatory Planning Group valued the co-creation process as a reflective space that enabled knowledge exchange. The intervention was shaped through iterative negotiation, integration of research and practice knowledge, and adaptation to contextual constraints. Although parental involvement was limited, their input helped refine materials and address parental needs.

Conclusions

This study provides empirical insight into how co-creation unfolds within a health system context. Meaningful stakeholder involvement was constrained by structural and temporal conditions tied to the research project, including fixed timelines. Despite these limitations, the process supported contextually grounded adaptations, strengthened stakeholder ownership and enhanced responsiveness to local needs. The critical application of the PROSECO framework helped “opening the black box” of co-creation and offers implications for health systems, particularly regarding how participatory approaches can inform implementation practices.