Development of a Novel Coding Scheme to Explore Interactions in the Co-Production of Public Services with Priority Populations

This study focuses on the development of a reliable coding scheme (CP-CODER) for studying interaction dynamics during the co-production of a public service involving priority communities. CP-CODER addresses the need to involve priority populations in the development of public services, an approach that has been recognized as difficult because of the high possibility of their experiencing negative health, social, and economic outcomes. The coding scheme was designed to capture group dynamics and forms of public engagement by adopting and integrating existing theoretical frameworks in the public service management and qualitative method literature. Coding was conducted on the transcripts of four co-production workshops, which included 26 family caregivers, three local health and social care service provider representatives, and five researchers involved in the coproduction of new community-based services. One category was added to the two theoretical frameworks. The kappa ranged from 0.70–1.00 for the eight variables and the 26 individual items. The overall kappa was 0.91, while the overall percentage of agreement was 91.16%. The results of the pilot test showed the importance of integrating and managing three dimensions in coproducing with a priority population: the turn-taking, the content, and the level of abstraction of the discussion. The findings of this study have enhanced and supported both practitioners and researchers in co-producing services, ensuring the equal contribution of all participants, even those whose voices are rarely heard

Cremona Beside Caregivers: una ricerca per assistere chi assiste

Stato dell’arte In Europa la fascia di popolazione over 65 rappresenta il 19% della popolazione, mentre In Italia ha già superato il 22%. Tuttavia, la distribuzione di queste persone non è omogenea sul territorio, ma presenta una maggiore presenza nelle aree rurali dove tale fascia di popolazione ha un alto rischio di esclusione sociale e fragilità (Burholt & Dobbs, 2012). Sebbene siano stati posti per molto tempo in secondo piano, i bisogni delle persone anziane nelle aree rurali sono di primario interesse, soprattutto per la diversità di richieste e di necessità che ci si aspetta di trovare in queste aree rispetto a zone con buona presenza di servizi. In questi contesti, infatti, un ruolo cruciale nell’assistenza agli anziani viene svolto dai caregiver, che si trovano largamente caricati del supporto all’invecchiamento (Sixsmith et al., 2014). Nel 2009 è stato infatti rilevato che in Italia due terzi delle cure necessarie alle persone anziane venivano assicurate da loro parenti (Troisi & Knodratowitz, 2013), anche per garantire c alle persone anziane di poter continuare a vivere nei contesti a loro cari, attraverso pratiche di “aging in place” - cioè di invecchiamento attivo nel proprio contesto comunitario di vita (Rodríguez-Rodríguez & Sánchez-González, 2016). In questo scenario, la provincia di Cremona rappresenta per sue caratteristiche territoriali e sociali un osservatorio privilegiato per studiare le necessità della popolazione anziana e di chi li assiste, anche nell’ottica di promuovere una rappresentazione propositiva e partecipe di questa fase della popolazione alla co-definizione dei servizi e dei prodotti ad essi dedicati. Date queste premesse, l’obiettivo di questo progetto di ricerca è di condurre una mappatura degli stakeholders sul territorio Cremonese, delle risorse presenti e dei bisogni scoperti, al fine di orientare attività di supporto dedicate prioritariamente al target dei caregiver. Approccio metodologico A copertura dei suddetti obiettivi si è definito un disegno di ricerca multi-fase e multi-metodo così composto: Fase 1 - analisi sistematica dei database statistici Istat, volta a descrivere le caratteristiche socio-demografiche della popolazione anziana cremonese, sia attuale che in trend storico, comparandola con quella nazionale; Fase 2 - Desk analysis per identificare i servizi sanitari, socio-sanitari e sociale attivi sul territorio a favore dell’anziano fragile che vive a casa, in termini di ruoli e i professionisti coinvolti, le collaborazioni formali e informali tra professionisti e tra Enti; regimi dietetici proposti agli anziani (i.e. in famiglia nelle RSA, nelle cooperative, nell’ADI…); Fase 3 - Interviste qualitative biografiche a stakeholders locali (i.e. rappresentanti Fondazioni, Cooperative, Comuni, RSA, associazioni di volontariato…) riconosciuti per la loro centralità nel rapporto con anziani e caregiver, al fine di approfondire le loro esperienze, l’analisi delle priorità e delle necessità presenti sul territorio. Principali risultati I dati demografici confermano la tendenza alla senilizzazione della provincia di Cremona: è la seconda provincia con la percentuale di over 65 della Regione Lombardia, dopo Pavia (Elaborazione Ires L. Morosini su dati Istat, 2019). Negli ultimi venti anni, tale percentuale è cresciuta dal 23,7% nel 2002 al 26,8% di oggi (Istat, 2021). La durata di vita attesa degli anziani cremonesi oltre i 65 anni resta inferiore a quella media lombarda: 22,1 anni nelle donne e 18,4 negli uomini, di cui la maggior parte trascorsi “senza limitazioni funzionali” (Elaborazione Ires L. Morosini su dati Istat, 2019). Tuttavia, nel 2016 il 10,8% degli ultrasessantacinquenni residenti nella Provincia di Cremona beneficiava di un’indennità di accompagnamento, il 13,8% tra le donne e il 6,9% tra gli uomini di quella fascia di età. Dalla mappatura degli stakeholders sono stati identificati 36 enti del settore sanitario, 35 del terzo settore e 7 istituzioni chiave per lo studio del fenomeno degli anziani e dei loro caregiver. Dalle prime interviste biografiche condotte emerge la necessità di dotarsi di strumenti di mappatura sistematica della fragilità senile; inoltre gli stakeholder sottolineano l’importanza di creare spazi di lavoro multidisciplinari che possano operare nelle diverse aree di ci la fragilità senile si compone (sanitaria, sociale, alimentare, economica, …). Conclusioni I primi risultati confermano il bisogno del territorio cremonese nell’ambito dell’assistenza agli anziani fragili: le attività e le risorse finora messe in campo necessitano di essere orchestrate per operare in maniera efficace e sostenibile per il territorio stesso e per le persone che lo vivono

Place4Carers: a mixed-method study protocol for engaging family caregivers in meaningful actions for successful ageing in place

IntroductionEngaging family caregivers could be a critical asset to make the \u2018ageing-in-place\u2019 imperative a reality. This is particularly evident in rural and remote areas, where caregivers can fill the gaps that exist due to the fragmentation of the welfare system. However, there is little knowledge about the expectations that family caregivers have from healthcare services in rural and remote areas.Place4Carers (P4C) project aims to co-produce an innovative organisational model of social and healthcare services for family caregivers of older citizens living in Vallecamonica (Italy). The project is expected to facilitate ageing-in-place for older citizens, thus helping caregivers in their daily care activities.Methods and analysisP4C is a community-basedparticipatory research project featuring five work packages (WPs). WP1 consists of a survey of unmet needs of caregivers and older people receiving services in Vallecamonica. WP2 consists of a scoping literature review to map services that provide interventions of support to caregivers living in remote areas and promote engagement. WP3 organises co-creation workshops with caregivers to co-design, co-manage, and co-assess ideas and proposalsfor shaping caregiver-oriented services and organisational models. WP3 enriches the results of WP1 (survey) and WP2 (scoping literature review), and aims to co-create new ideas for intervention support with and for caregivers in relation to the objectives, features and characteristics of a new service able to address the caregivers\u2019 needs and expectations. WP4 tests the service ideas co-created in WP3 through piloting an intervention based on ideas co-created with caregivers. Finally, WP5 assesses the transferability of the intervention to other similar contexts. Ethics and dissemination. The study has been approved by the Ethics Committees of the Department of Psychology of Universit\ue0 Cattolica del Sacro Cuore and Politecnico of Milan. Results will be disseminated through peer-reviewed journals, scientific meetings and meetings with the general populatio

How to prevent and avoid barriers in co-production with family carers living in rural and remote area: an Italian case study

Background Co-production has been widely recognised as a potential means to reduce the dissatisfaction of citizens, the inefficacy of service providers, and conflicts in relations between the former and the latter. However, the benefits of co-production has begun to be questioned: co-production has often been taken for granted, and its effects may not be effective. To understand and prevent unsuccessful citizen and provider collaboration, the recent literature has begun to focus on the causes of co-destruction. This paper investigates how the barriers that may arise during the co-production of a new social service with family carers can be identified and interpreted. Methods To investigate this topic, we undertook a single case study - a longitudinal project (Place4Carers (Graffigna et al., BMJ Open 10:e037570, 2020)) intended to co-produce a new social care service with and for the family carers of elderly patients living in rural and remote areas. We organised collaborative co-assessment workshops and semi-structured interviews to collect the views of family carers and service providers on the co-production process. A reflexive approach was used in the analysis for collecting the opinions of the research team that participated in the co-production process. Results The analysis revealed four main co-production barriers: lack of trust, lack of effectiveness of engagement, participants’ inability (or impossibility) to change and the lack of a cohesive partnership among partners. Despite these findings, the project increases carers’ satisfaction, competence and trust in service providers by demonstrating the positive effects of co-production. Conclusions Our article confirms that co-creation and co-destruction processes may coexist. The role of researchers and service providers is to prevent or remedy co-destruction effects. To this end, we suggest that in co-production projects, more time should be spent co-assessing the project before, during and after the co-production process. This approach would facilitate the adoption of adjustment actions such as creating mutual trust through conviviality among participants and fostering collaborative research between academia and organisations that are not used to working togethe

Facilitating co-production in public services: Empirical evidence from a co-design experience with family caregivers living in a remote and rural area

The involvement of vulnerable actors in co-production activities is a debated topic in the current public service literature. While vulnerable actors should have the same opportunities to be involved as other actors, they may not have the needed competences, skills and attitudes to contribute to this process. This paper is part of a broader project on family caregivers’ engagement in remote and rural areas. In particular, it investigates how to facilitate co-production by looking at four co-design workshops with family caregivers, representatives of a local home care agency and researchers. The transcripts of the workshops were coded using NVivo, and the data were analysed based on the existing theory about co-production. Two main findings were identified from the analysis. First, the adoption of co-production by vulnerable actors may occur in conjunction with other forms of engagement. Second, the interactions among facilitators and providers play a crucial role in encouraging the adoption of co-production. We identified at least two strategies that may help facilitators and providers achieve that goal. However, there is a need for an in-depth understanding of how facilitators and providers should interact to enhance implementation of co-production

Comparing the adoption of co-production in health and welfare contexts

The healthcare sector is facing new challenges related to changes in demographic, epidemiology and lifestyle of the worldwide population. To optimize current healthcare services, it is important to identify solutions that support providers in understanding patients’ needs and expectations (OECD Publishing, 2018). Co-production has been identified as a possible solution as it involves ‘service users in any of the design, management, delivery and/or evaluation of public services’ (Osborne, et al., 2016). Despite this approach has been adopted in several field, healthcare is one of the most used (Dhirathiti, 2018) and challenging one (Bovaird, et al., 2016). Healthcare professionals have highly professionalized skills and competences that distinguish them from patients or caregivers. This disequilibrium of knowledge makes the equal discussion between patients and professionals more complex to put in place (Parrado, et al., 2013). On the one hand, professionals with specific clinical knowledge feel at higher level than patients, on the other hand, patients feel unable to contribute due to their lack of competences and experience in the field (Crompton, 2019). This discrepancy in term of power is a barrier for the adoption of co-production, which requires an equal partnership between actors (Weaver, 2018). This article investigates this issue by comparing the power dynamics that arise from co-production (in particular, co-design) process in the healthcare and welfare sectors. The aim is to study how the power dynamics affect the co-production process in the healthcare sector compared to the welfare one. To achieve this objective, we adopt a multiple case study methodology, comparing two examples of co-design processes with service users in the healthcare and welfare sectors. In the first case, we analyze the co-design of the patient surgical journey in an orthopedic department of an Italian hospital. In the second care, we investigate the co-design of a new service for family caregiver of fragile and non-self-sufficient elders in a remote and rural area of Italy. Comparing the same process in different sectors allows us to deepen the influence of the context on the power dynamics (Farr, 2018). In the healthcare case, we carry out 4 co-design workshops, involving 1 researcher, 6 clinicians and 6 patients overall. In the welfare case, we organize 4 co-design workshops with 24 family caregiver, 4 researchers and 2 providers overall. Workshops last from 80 to 120 minutes and are verbatim transcribed to increase the effectiveness in the analysis of non-numeric data (Halcomb and Davidson, 2006). The transcripts are analyzed through a well-defined process with the support of NVivo software. The process uses an inductive approach that starts labelling the text with ‘in-vivo-codes’ and grouping codes in categories (Glaser, 1967). Once we have compared results with the existing literature, we organize categories in themes, identify patterns and generalize results (Saldaña, 2015). We expect to find few examples of equal relationships among stakeholders in the healthcare sector, proving the major role of power dynamics in this sector. By comparing the interactions among actors in these two sectors, we will try to assess the drivers that influence both in positive and negative way the equal collaboration. Disequilibrium in competences, knowledge (Crompton, 2019) and expectations, the presence of hierarchical structure (Weaver, 2018) with fixed practices and processes (Brown and Head, 2019), the inability to set the roles and duties during co-production processes are only some of the drivers recognized by the literature that influence power dynamics among actors (Agranoff, 2016). This raises the question of how (and if) co-production can be implemented in the healthcare sector. In line with this consideration, this paper suggests possible guidelines that may facilitate the adoption of co-production in this field in the next future