Fostering Equity & Accessibility Through Community Co-Design.

Background: Canada increasingly diverse populations face increased social and health inequities. VON embraces the opportunity to co-design community support services with equity-seeking populations.Community outreach and program co-design were exemplified in the culturally appropriate Meals on Wheels (MOW) pilot program in the highly diverse Mississauga community in Ontario. As per 2023 Ontario Health data, 57% of Mississauga population are visible minorities, 6% are older adults, of which 6% are low-income. Low-income racialized populations are often subject to higher rates of food insecurity, particularly among older adults with mobility challenges and declining functional ability. This subjects them to a greater risk of malnutrition, which subsequently increases the risks of falls in older adults () and increases mortality and length of stay in hospitals (2). As food is often tied to peoples identities, the MOW program was co-designed with community members, clients, families, and community partners to better serve equity-deserving populations.

Approach: Partnerships were established with community organizations, food banks, meal kitchen staff, other MOW providers, seniors apartment buildings, community centers, community health centers and faith-based organizations. Multi-pronged methods were utilized to gather community insights on needs, values, and preferences. Interviews, surveys and focus groups gathered insights from community residents, partners, volunteers, and program staff. From this, VON realized the need for Human-Centred Co-design. All partners worked together to address the design challenge - How might we meet diverse nutritional needs and choices (cultural, language, physical, mental, emotional, spiritual, financial) of the Mississauga community while simplifying interactions with the program staff. During co-design, partners tested culturally diverse meals to gain an understanding of the look, feel, taste, and portion size. Honorariums were provided to reduce barriers to engagement.

Results: The codesign focused on topics that fell in the intersectionality of what was desirable by the community, operationally feasible and financially sustainable. Community engagements identified barriers to prepared meals, including lack of program awareness, stigma, costs, language barriers, and the absence of cultural diversity in meals. The patient journey was mapped during the co-design, from learning about the program to intake, costs, communication, delivery, and meal consumption. Community experts were crucial in informing program staff how to de-colonizethe program awareness and referral strategies and offer multiple menus based on clients cultural preferences. Techniques were adopted to better assist clients with diverse abilities and continue community partnerships with ongoing outreach and awareness. These learnings were rolled out as a pilot in two phases and were evaluated for client and family satisfaction and experience.

Implications: Cultural sensitivity training for all program staff enhanced knowledge for working with equity-seeking populations. Co-design does not stop at implementation; it is integral for program implementation and evaluation to stay relevant to the community. Ongoing outreach and partnerships were critical in maintaining program awareness, real-time data collection for responsive programming, and co-designed surveys to capture the right indicators. With Ontario Health support, VON successfully completed the pilot. Practical lessons from this initiative will continue to inspire VON journey to co-design other programs and services to reduce social and health inequities.

References:. Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Malnutrition at admission predicts in-hospital falls in hospitalized older adults. Nutrients. 2020 Feb 20;2(2):54.2. Nigatu YD, Gebreyesus SH, Allard JP, Endris BS. The effect of malnutrition at admission on length of hospital stay among adult patients in developing country: A prospective cohort study. Clinical nutrition ESPEN. 202 Feb ;4:27-24.