背景:体重管理服务并不总是使每个人都平等受益。生活在更贫困地区的人,种族化的社区,那些有复杂额外需求的人(例如,身体或精神残疾),男性参与体重管理服务的可能性较小。这可能会扩大健康不平等。解决这一问题的一种方法是与服务不足的团体共同设计服务,以更好地满足他们的需求。使用案例研究方法,我们探讨了共同设计的成人体重管理服务是如何开发的,共同设计的障碍和促进者,以及对未来调试的影响。
方法:我们选择了英格兰西南部成人体重管理服务的四个案例研究,代表了一系列的人口和环境。在每种情况下,我们招募了服务专员和提供者,在可能的情况下,参与共同设计活动的社区成员。面试是在网上进行的,录音,逐字转录,并使用专题分析法进行分析。
结果:我们采访了18位参与者(8位女性,10位男性):7位委员,八个供应商,和三名社区成员参与共同设计服务。案例研究使用了一系列共同设计活动(计划和实施),从轻触摸到更深入的方法。在两个案例研究中,计划了共同设计活动,但由于组织时间或资金限制,没有充分实施。参与者积极地认为共同设计是创造更合适的服务和更好的参与的一种方式,从而有可能导致不平等现象的减少。与社区建立关系,个别社区成员,与合作伙伴组织-是成功的共同设计的关键,需要时间和精力。短期和不可预测的资金往往会阻碍共同设计工作,并可能损害与社区的关系。一些委员对联合设计的证据有限表示担忧,而其他人则描述了在调试共同设计时必须接受“一种不同的思维方式”。
结论:联合设计是在服务中设计健康的一种日益流行的方法,但在传统的资助和委托实践中可能难以实现。根据我们的案例研究,我们为那些想要共同设计医疗服务的人提出了关键的考虑因素,注意到建立牢固关系的重要性,创造支持性的组织文化,发展证据基础。
BACKGROUND: Weight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case
study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning.
METHODS: We selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis.
RESULTS: We interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships- with communities, individual community members, and with partner organisations- was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace \"a different way of thinking\" when commissioning for co-design.
CONCLUSIONS: Co-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base.