Enablers and Barriers to an Experience-Based Co-Design Process to Develop Service Improvements in Enhanced Community Care in Ireland: A Qualitative Study

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Expectations Pub Date : 2025-03-12 DOI:10.1111/hex.70206

Fay O'Donoghue, Máire T O'Donnell, Tomás P. Griffin, Eileen Fahy, Elaine Newell, Ann-Marie Creaven

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Abstract

Background

Experience-Based Co-Design (EBCD) is a popular collaborative process where service users and healthcare providers share their experiences of using and delivering services to identify ways to adapt services to enhance those experiences.

Objective

This study aimed to identify enablers and barriers to the successful implementation of EBCD as part of Ireland's recently adopted Enhanced Community Care (ECC) programme.

Design

Service users and staff at two sites (N = 17) participated in an accelerated EBCD process designed to enhance service provision for older people and those living with chronic conditions. This included four co-design working group sessions per site.

Methods

Transcripts from the co-design working groups and from brief follow-up interviews with individual participants were analysed. Thematic analysis was used to identify enablers and barriers to the EBCD process.

Results

We generated six key themes reflecting barriers and enablers; enablers were the fundamental role of the facilitator (Theme 1), a flexible approach that met group members' needs (Theme 2) and active and interactive activities to support participant engagement (Theme 3). The fundamental role of the facilitator was also identified as a barrier (Theme 4); additional barriers included balancing experience-sharing and decompressing (Theme 5) and the scope of the group as an invisible barrier (Theme 6), which reflected challenges in facilitating dialogue about change when participants were aware of system-level constraints on the potential for change.

Conclusions

The facilitator is critical in ensuring the successful implementation of the EBCD process. Considering how best to draw on the facilitator strengths while also ensuring that the service user perspectives are equally weighted with staff perspectives is important for effective communication within EBCD projects.

Patient or Public Contribution

Service users (also including carers) at two sites participated in EBCD projects alongside health and social care professionals, ultimately generating two service improvements for the ECC programme. The participation of these service users was celebrated at an academic conference, which was attended by a number of service users, and where the outcomes of the EBCD project were presented.

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以经验为基础的共同设计过程在爱尔兰加强社区护理中发展服务改进的推动者和障碍：一项定性研究

背景基于体验的协同设计（EBCD）是一种流行的协作过程，服务用户和医疗保健提供者在其中分享他们使用和交付服务的经验，以确定调整服务以增强这些体验的方法。本研究旨在确定EBCD作为爱尔兰最近通过的增强社区护理（ECC）计划的一部分成功实施的推动因素和障碍。设计服务的用户和工作人员在两个站点（N = 17）参与了一个加速EBCD过程，旨在加强为老年人和慢性病患者提供的服务。这包括每个站点四个共同设计工作组会议。方法对共同设计工作组和个别参与者的简短随访访谈记录进行分析。专题分析用于确定EBCD进程的推动因素和障碍。我们产生了六个反映障碍和促进因素的关键主题；推动者是引导者的基本角色（主题1），满足小组成员需求的灵活方法（主题2）和支持参与者参与的积极互动活动（主题3）。引导者的基本角色也被确定为障碍（主题4）；其他障碍包括平衡经验分享和减压（主题5）以及作为无形障碍的小组范围（主题6），这反映了在参与者意识到变革潜力的系统级限制时促进变革对话的挑战。促进者对于确保EBCD过程的成功实施至关重要。考虑如何最好地利用促进者的优势，同时确保服务用户的观点与员工的观点同等重要，这对于在EBCD项目中进行有效沟通非常重要。两个地点的病人或公众捐款服务使用者（包括护理员）与卫生和社会护理专业人员一起参与了社区康复计划的项目，最终为社区康复计划带来了两项服务改善。在一次学术会议上庆祝了这些服务使用者的参与，有一些服务使用者出席了会议，并介绍了EBCD项目的成果。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.