Abstract
Introduction: Co-design can help realise patient-centredness in healthcare by partnering with patients and other stakeholders to redesign services or care pathways with their needs in mind. However, what remains unknown is whether co-designed interventions for multimorbidity offer superior benefits to usual care.
Methods: We conducted a systematic review to (a) identify examples of co-designed health interventions for multi-morbid patients and investigate their effectiveness in terms of health outcomes; (b) identify and describe the co-design approaches used and in which contexts they emerge, and (c) described the barriers and facilitators of the co-design process with multi-morbid patients. We searched MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO in 2022.
Results: We screened 14,376 articles resulting in 16 studies that met the eligibility criteria and were included. Of the co-design initiatives, few conducted impact evaluations. While co-design aided the design of novel services and interventions, improving their relevance, usability, and acceptability, the clinical benefits of these interventions remain unclear. Furthermore, limited studies targeted specific combinations of conditions, which may indicate an oversimplification of the clinical needs of multi-morbid patients. The most commonly reported challenges to co-design related to participant interactions. Poor buy-in or engagement with the process or power dynamics within the group inhibited stakeholder relationships. Another frequent issue was the inability to engage a breadth of stakeholders, which raised questions about the representativeness of the design group and corresponding output. Enablers largely centred around being flexible in the approach. Flexibility helped to accommodate different stakeholder needs, handle different schedules, and maximise engagement and output.
Conclusion: Co-design is a participatory approach that is becoming more prevalent in healthcare. However, the benefits of co-design in multi-morbid care remain unclear. Future efforts should continue to involve stakeholders in healthcare redesign but should also commit to evaluating the impact of co-design interventions. There is also a need for standardisation in co-design reporting, to improve consistency and enable quality assessment. The COcreation REsearch Standards (CORES) may help to resolve this issue in the future.