Abstract
Background: YiPEE (Youth co-Production for sustainable Engagement and Empowerment in health) is a collaborative research initiative focusing on improving young people’s mental health through a co-designed multi-level school-based intervention, with inner, social, and environmental components, in urban settings in India (Chennai), Kenya (Nairobi), South Africa (Cape Town), and Sweden (Stockholm). Successful co-creation is known to generate highly contextualized, locally relevant and feasible solutions. However, little is known on how and why co-creation works, under which conditions and for whom. We aim to unravel these aspects by evaluating the co-design workshops organised across all four urban settings, in which the multi-component school-based intervention is collaboratively developed by adolescents, teachers, and stakeholders from the broader school environment.
Approach: We adopt a realist approach to test an initial programme theory (IPT) based on the Normalization Process Theory (NPT) and Self-Determination Theory (SDT). The IPT will be tested and refined, for each site, using data from multiple workshop participants, including observers, facilitators, and participants in the workshops. Information from the different sources is triangulated and synthesized into the Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurational framework.
Results: In the realist approach, the program theory consolidates causal explanations in the form of ICAMO configurations, which explain how interventions (I) within/and contexts (C) allow (or not) the emergence of mechanisms (M) in actors (A) that produce outcomes (O). The overarching goals of the workshop sessions were linked to the four constructs of the NPT: coherence (youth as interpreters), cognitive participation (youth as co-designers), collective action (youth as participants and implementers) and reflective monitoring (youth as researchers). We anticipate identifying multiple contextual factors (C) that facilitate engagement (O) of participants (A) by triggering NPT- and SDT-related mechanisms such as coherence (M), cognitive participation (M), collective action (M) and reflective monitoring (M), as well as perceived autonomy/agency (M), social connection/relatedness (M) and competence (M). Co-creation will be phased across the different study sites, allowing for iterative learning, theorizing on theory consolidation, and eventual scale-up.
Implications: We expect this study to provide new understanding of how and why co-creation works, for whom, and under which real-world conditions. The study aims to offer fresh insights into the study of co-creation by integrating implementation science theory and realist evaluation.