Inclusive governance and sustainable value co-creation in circular business models: The case of ‘neighbourhood hubs against food waste’ in Milan

Our paper contributes to the broader coastal studies literature, proposing a methodology and methods that can enhance young people’s participation in research and policymaking. Framed by the emerging concept of child-friendly blue urbanism and founded on principles of attentiveness and context-responsiveness it sets out a novel approach that foregrounds young people’s contributions as co-researchers, and their lives as embodied and intimately connected to the social and physical fabric of the coast. Drawing on our original research with young people in a small, English coastal town, we explore how a unique focus on children’s emplaced lives offers creative opportunities that can enhance young people’s participation. Logistical and ethical challenges about how to safely navigate and safeguard children in a spatially remote, seasonally reliant seaside location were particularly salient. We discuss how the resulting walking tours, intergenerational postcard exchange, animation and booklet emerged through this process of co-creation and solution building with young people, enabling them to express their views and influence community dialogue. In setting out our distinctive attentive, context-responsive approach we critically explore the unique challenges and creative opportunities emerging from researching with young people in coastal contexts and their potential to realise the ambitions of child-friendly blue urbanism.

Contemporary recruitment practices remain dominated by Applicant Tracking Systems (ATS) that operate on elimination logic, sequentially filtering candidates through keyword gates and multiple-hurdle screenings. While efficient at reducing applicant volume, this paradigm systematically discards potentially suitable candidates and degrades the quality of information available to hiring decisions. This paper introduces Applicant Relationship Management (ARM), a relational paradigm for talent acquisition derived from Customer Relationship Management (CRM) theory. ARM reconceptualises applicants as stakeholders in a co-creative assessment process, replacing sequential elimination with compensatory multi-dimensional evaluation, dialogue-based interaction, and sustained relationship management including silver medallist re-engagement. Drawing on stakeholder theory, relationship marketing, and compensatory assessment science, we develop the ARM framework and its lifecycle model. We then examine its implications for emerging regulatory and sustainability reporting frameworks, including the EU Artificial Intelligence Act (which classifies recruitment AI as high-risk from August 2026), the UN Sustainable Development Goals 8 and 10, and the CSRD/ESRS S1 workforce disclosure standards. Preliminary evidence from a pilot platform implementation is reported alongside explicit boundary conditions and a future research agenda with testable propositions. The paper contributes to recruitment theory by proposing a paradigm shift from transactional processing to relational cultivation, and to management practice by offering a framework that aligns operational effectiveness with regulatory compliance and applicant dignity

Purpose This study investigates how healthcare professionals make complex adoption decisions that transform service encounters and value co-creation processes. While most research has focused on patient-side technology adoption, this study advances the understanding of the configurational conditions that drive provider-side adoption of digital service innovations. Design/methodology/approach Employing fuzzy-set qualitative comparative analysis (fsQCA), this study analyzes data from 315 self-employed otolaryngologists (ENTs) who interacted with a virtual-reality-based healthcare service. The configurational approach reveals how combinations of technological, professional, and contextual factors jointly shape professionals' intentions to adopt service innovations. Findings Four conditions are necessary for adoption: performance expectancy, hedonic motivation, price value, and social influence (consistency = 0.90). When combined with effort expectancy, facilitating conditions and low Anxiety, they form a sufficient configuration explaining 63% of high adoption cases (consistency = 0.97). This pattern shows professional service innovation adoption needs cognitive evaluation, intrinsic motivation, economic viability and social legitimacy, unlike consumer technology adoption where single factors may suffice. Originality/value Beyond methodological innovation through fsQCA application, this study advances professional service theory by revealing how adoption requires multiple psychological mechanisms: expectancy-value calculations, intrinsic motivation, social validation and emotional regulation. The necessity of these conditions distinguishes professional service innovation from consumer technology adoption and IT implementation. These insights extend professional service firm theory by showing how knowledge intensity, low capital intensity and workforce shape digital transformation patterns. The study provides guidance for designing provider-centered digital healthcare services in post-pandemic ecosystems.

ABSTRACT Although social media use during times of high uncertainty (e.g. public health crises) can pose risks to user well-being, we suggest that co-creation among users can derive meaningful benefits for them under such circumstances. Drawing on the taxonomic framework of value co-creation and the DART model, our study investigated how social media environmental cues (i.e. user-to-system and user-to-user cues) could facilitate the user-to-user co-creation process and benefit users’ well-being. Through a two-phase online survey involving social media users in Australia, Canada, and the UK, we found that user-to-system and user-to-user cues promote access and transparency, which form the foundational elements of the co-creation process. In addition, we showed that dialogue and risk assessment—triggered by access and transparency—further contributed to psychological well-being and social connectedness. These results were relatively consistent across countries; slight variations emerged in the specific co-creation elements predicted psychological well-being. Our study advances the co-creation literature by elucidating how co-creation among users can be shaped by social media cues that support psychological well-being during times of heightened uncertainty and by unpacking the interdependence co-creation mechanisms within the DART model.

A new community centre in a district with a high amount of equity deserving populations in Halle (Saale), Germany provides a space to design and implement health-related services that reflect the needs and priorities of local residents. Health information often fails to meet existing quality standards. Therefore, strengthening critical health literacy is essential. Co-creation is a participatory approach that addresses needs by involving community members as equal partners in the joint development of ideas, concepts and interventions. The study aims to co-create interventions with residents of the community to promote critical health literacy. The study will be conducted as an iterative co-creation process and feasibility study using both qualitative and quantitative methods, based on the PRODUCES+ framework and guided by the UK Medical Research Council (MRC) framework for developing and evaluating complex interventions. In phase I, co-creators engage in a multi-step co-creation process involving participatory workshops and focus group interviews to explore community health needs, information behaviours and to co-develop tailored interventions. Interest-holders representing local institutions are continuously involved to ensure contextual relevance and sustainability. The co-creation process will be evaluated using the PROSECO framework. In phase II, the developed interventions will undergo feasibility testing and pilot implementation within the newly established community centre, using qualitative and quantitative methods such as think-aloud, observations, interviews and questionnaires. The study is expected to develop interventions that will strengthen critical health literacy and empower residents to make informed health decisions. It will also provide insights into mechanisms and success factors of co-creation.

Co-creation processes are part of a movement to create change in collaboration with people with lived and living experience (PWLLE); in this paper we focus on experience with health and social services. Research co-creation with PWLLE is increasing, however, processes tend to include people who are well connected in health and research environments, often excluding equity-deserving groups (EDGs) who experience barriers to engagement in research and society more broadly (e.g., people with mental health conditions, immigrants, refugees, people who are unhoused). We conducted an evaluation to understand how equity-based co-creation (EqCC) is enacted in health and social services and what outcomes are produced. Informed by realist evaluation methods, we used multiple case study methodology to explore and describe how co-creation was enacted in four sites that were actively conducting EqCC projects. The case study sites were engaging in projects on student mental health and well-being; youth mental health transitions; individuals in critical care; and women experiencing complex long-lasting homelessness. A variety of data sources were collected including interviews with 2-3 key members of each project, organisational documents (e.g., meeting minutes, ethics approvals, reports), and observations. Data analysis included identifying the contexts, mechanisms, and outcomes, and causal configurations to develop a deductive coding scheme and codebook. The causal configurations were found to be consistent with the data collected at the four sites: (1) Values (the culture and values that enable co-creation); (2) Driving Issue (a community-identified problem as the catalyst for the co-creation to occur); (3) Organisational Infrastructure (the organisation's tangible infrastructure to support long-term co-creation, including funding, time, and training among others); and (4) Experiential Knowledge Network (people involved in the co-creation, including the networks and partnerships created prior to, during, and as a result of the co-creation). The causal configurations explored in this evaluation identify the key contexts, mechanisms and outcomes that support co-creation with people from EDGs. These may inform inclusive co-creation project design and the development of a middle range theory of equity-based co-creation. This research was co-designed and co-produced by researchers and PWLLE who were members of the McMaster University Co-Design Hub at the time of the project. The research questions guiding this work were informed through ongoing conversations with members of different communities affiliated with the McMaster University Co-Design Hub. Co-author LML identifies as a PWLLE and was instrumental in developing the research question, writing and discussing the causal configurations, and contextualising findings. We shared project updates at numerous team meetings (which included researchers and PWLLE) over the course of the research. Insights and feedback were sought at these meetings which helped to contextualise the work and understand the topic from multiple lenses, including PWLLE.

Corporate food museums are increasingly recognised as strategic heritage infrastructures capable of mediating between industrial memory, territorial identity, and contemporary societal challenges. This paper proposes a conceptual shift that repositions corporate food museums from static repositories of brand heritage to Living Labs for sustainable, inclusive, and participatory food innovation. Drawing on the EU-funded GNAM project, the study adopts a qualitative methodology combining the mapping of Italian corporate food museums with an analysis of European Living Labs in the food and agri-food domain. The comparative framework informs the development of a heritage-driven Living Lab model articulated around three interconnected dimensions: cultural heritage valorisation, community engagement, and sustainable food system innovation. The model is empirically grounded through a series of design-driven workshops, technology-transfer activities, and digital engagement initiatives conducted within corporate museums and academic laboratories in Southern Italy. These include co-creation processes involving students, citizens, companies, and researchers; experimentation with food waste valorisation, biodegradable and hybrid materials, and 3D food printing; and the deployment of digital platforms and immersive virtual environments. The paper contributes to heritage studies by advancing a replicable framework in which corporate food museums act as active agents of sustainable transformation, linking cultural heritage, technological experimentation, and community participation.

Contemporary socio-environmental transformations intensify the urgency of strategies that integrate sustainable technologies and social innovation to address complex development challenges. Recent literature highlights that digital and social innovation ecosystems constitute central arrangements for articulating science, policy, business, and society around solutions that reconcile economic growth, social inclusion, and environmental sustainability. For this reason, the article aims to analyze the integration of sustainable technologies and social innovation in the construction of regional ecosystems, investigating how these dimensions complement each other and what implications they bring to territorial policies and practices of inclusive development. The findings show that digital technologies such as IoT, blockchain, and artificial intelligence, combined with co-creation processes and participatory governance, drive circular ecosystems and strengthen the generation of public value. Results also indicate that cross-cutting policies, socio-environmental education and enlarged helix models are determinants for regional sustainability. It is concluded that collaborative, digital and green ecosystems are indispensable for social innovation, but gaps in measurement, mobilization in peripheral territories and institutionalization of fair practices persist. These limits reinforce the need for adaptive public policies and robust metrics to consolidate legitimate, inclusive, and sustainable regional ecosystems.

Leveraging mobile augmented reality (AR) and virtual reality (VR), applications (apps) has garnered unparalleled attention in the retail market. Grounded in S-D logic and value co-creation theories within the context of consumer decision-making, this study examines how reality technological attributes influence consumer continuous use intention as well as purchase intention. This research adopts a mixed-methods approach, text analytics and survey, to identify key themes and user concerns regarding immersive technology experiences. An experiment was conducted in a laboratory environment whereby participants were randomly selected to try either the AR IKEA Place or VR Roller Coaster mobile app. Subsequently, a full-scale web-based survey was administered, followed by partial least squares structural equation modeling (PLS-SEM) and bootstrap-based PLS multigroup analysis to examine the research model. The results show that these attributes influence consumers’ continuous use intention and purchase intention primarily through value co-creation, which serves as a central mechanism linking technology features to behavioral outcomes. Moreover, the findings reveal distinct value co-creation processes across AR and VR contexts: informativeness and interactivity are more influential in AR, whereas virtual quality plays a stronger role in VR. Finally, this study provides practical insights for retailers and reality app developers to enhance consumer wellbeing through emotional satisfaction, improved decision confidence, and personalized experiences tailored to various consumer needs.

Background: Communication and coordination across health, social and educational systems present significant challenges for parents of children with severe physical disabilities. Due to systemic barriers and the lack of integration between electronic records in hospitals and municipalities, parents are required to pass on information between professionals without the necessary knowledge or support. Implementing a simple, messenger-like tool for shared digital communication between parents and professionals could help alleviate this burden and facilitate cross-sector collaboration. However, barriers exist related to sector-specific legislation on data exchange and the General Data Protection Regulation (GDPR). Maintaining core principles such as purpose limitation, data minimization, and transparency may become increasingly challenging if unrestricted communication is allowed within a messenger-like thread. Therefore, as a part of a larger project with the overall aim of reducing the communicative caregiver burden for the parents (SHARE IT project), we aimed to explore how fundamental legal requirements can be met while using a messenger-like tool for shared digital communication. Approach: Through an iterative co-creation process involving legal advisors (n=6), parents (n=2), and researchers (n=3), brainstorming techniques and a case study of a child with cerebral palsy were employed to explore how fundamental legal requirements could be met if a messenger-like tool was to be used for shared digital communication (LetDialog by VISMA, Denmark). The co-creation process was conducted between January and November 2024 in 15 consecutive meetings and two additional advisory board meetings with other stakeholders involved in the project. Initially, the parents outlined their child's points of contact from birth onwards, establishing a foundation for identifying the professionals involved in their child’s care. Next, shared digital communication was discussed in relation to the simple messenger-like solution while addressing legal barriers and potential risks. Several models were introduced and reviewed collaboratively with the parents. Ultimately, a consensus was reached on a model that balanced the need for shared communication with legal compliance. Results: We have defined a person-centered model for using a messenger-like tool for shared digital communication across sectors, ensuring compliance with fundamental legal requirements, including the GDPR. The model consists of three main steps: 1) In collaboration with parents, a project coordinator maps the individual team of professionals involved with the child, and based on the parents' preferences, professionals are invited to join, 2) A coordination thread is created, and both parents and professionals across sectors are included, 3) If cross-sector communication is needed, participants in the coordination thread can request the coordinator to create task-specific threads where targeted digital dialogues can take place. In this simple model, principles such as purpose limitation, data minimization, data retention and transparency as well as authorization are upheld. Implications: The model will be tested in combination with the messenger-like tool to evaluate feasibility and effectiveness. This model may be applicable to similar contexts where legal barriers restrict the use of flexible digital communication across sectors. A thorough identification of legal requirements is crucial for researchers to assess data breach risks and should be considered from the outset of digital solution development.

Background: The +AGIL Barcelona program is an evidence-based, real-world, multidomain, and multidisciplinary initiative aimed at promoting healthy aging by enhancing older adults’ intrinsic capacity through a coordinated approach involving primary care, geriatrics and community resources. It aligns with the WHO’s ICOPE guidelines, emphasizing functional independence and an active lifestyle. Co-designed with healthcare professionals and end-users, the program bridges the gap between research findings and real-world practice. Initially implemented at one Primary Care Center (PCC), it showed significant improvements in physical function at three months, sustained at 6 months - even among individuals with cognitive decline. Building on its success, +AGIL is scaled to three PCCs with varied socio-demographic profiles, optimizing local resources to create a sustainable, person-centered care model. Approach: The implementation follows a stepped-wedge, cluster-randomized design, integrating a complex intervention into routine care. Each PCC begins with a baseline control period during which the +AGIL model is co-designed to fit local contexts. Participatory co-creation methodologies, including focus groups and technical sessions, are guided by Participatory Action Research (PAR) principles and actively engaged stakeholders – healthcare professionals, community agents and older adults. To ensure governance and share learning, a motor group oversees the global coordination and strategic decisions, while local implementation groups adapt and manage the program's day-to-day operations. Continuous evaluation identifies barriers and tailors solutions to diverse socio-economic contexts, ensuring seamless integration into routine clinical practice. Results: Preliminary findings indicate high acceptance of the +AGIL Barcelona across PCCs, with improved coordination between healthcare and community resources. The co-creation process yields practical tools, including a desk prism for healthcare professionals, a foldable physical activity guide, and informational brochures for participants and community agents. These tools have strengthened community engagement and empowered stakeholders to support program delivery actively. Implications: The +AGIL Barcelona program exemplifies key pillars of integrated care: a) Person centered-care, co-design approach prioritizes individual autonomy, aligning interventions with participants’ needs and preferences; b) coordinated care, the program fosters collaboration between healthcare providers and community agents to deliver accessible, continuous care that supports aging in place; c) system-based approach, levering existing healthcare and community assets, the program demonstrates system integration and resources optimization. The program’s sustainability and adaptability showcase a model of collaborative leadership and continuous improvement. Its flexible design translates scientific evidence into real-world clinical applications, bridging the gap between research and practice. A unique strength of +AGIL Barcelona lies in its bottom-up development: healthcare teams at each PCC lead the design and solutions, ensuring contextual relevance and alignment with existing workflows. This approach enhances sustainability, supports integration into daily clinical operations, and fosters long-term engagement. Through its replicable and scalable model, +AGIL Barcelona addresses the complex challenges of an aging society, paving the way for inclusive, person-centered, and sustainable healthcare solutions for older populations.

This study investigates the drivers of value co-creation (VC) in metaverse environments for e-commerce ecosystems. VC represents collaborative engagement between businesses and tech-savvy customers who shape virtual worlds through their interactions. The metaverse powered by augmented reality, virtual reality, artificial intelligence, internet of things, and blockchain technologies enables e-commerce entities to develop interactive marketing campaigns, immersive brand experiences, and streamlined product prototyping while fostering emotional customer connections. Quantitative analysis of data from 310 e-commerce customers yielded two significant findings: (1) customer knowledge in the metaverse encompasses individual needs, behaviours, motivations, preferences, immersive shopping practices, and brand attitudes, and (2) VC capabilities in the metaverse are defined by customers' communication, collaboration, and analytical skills. This research contributes to understanding how customer-centric factors drive value co-creation processes within emerging virtual commercial environments.

This article engages with the complex relationship between vulnerability, relationality and hierarchy through the creation of Tatyana: Reflected in Your Gaze , a portrait of my friend, Tatyana, painted during our time in Oxford. By expanding the conventional understanding of vulnerability, drawing on Judith Butler and bell hooks, the author reframes it as a relational space and an empowering, co-creative process rather than a mere point of precariousness. Through the act of painting, I subvert traditional artist–subject hierarchies and instead foster a collaborative, mutual dialogue that allows for shared agency in the portrayal of the subject. In reflecting on the painting’s creation, I navigate the tension between personal identity, social context and academic constraints at Oxford, a space often resistant to vulnerability. The painting Tatyana becomes a dynamic site of negotiation, where multiple identities, histories and truths coexist, reminding us that meaning and power are never fixed but always shifting. This work, while exploring the limits of representation, invites ongoing dialogue and engagement with the vulnerabilities it seeks to represent, positioning the painting as a site for continuous transformation and collective understanding.

BackgroundFirst responders (FRs) and frontline workers are frequently exposed to traumatic events within their professional roles. This exposure places them at risk of experiencing acute stress, posttraumatic stress disorder, burnout, and other adverse mental health outcomes. Despite growing awareness of these risks, there remains a lack of evidence-based digital interventions (DIs) tailored to meet their unique mental health needs.ObjectiveThis study aims to address this gap by developing and testing Sentinel, an evidence-based, co-created DI to promote mental well-being, build resilience, and help manage and prevent trauma among FRs and frontline workers. The objectives include exploring their experiences of occupational trauma, identifying their preferences for digital mental health tools, and evaluating the feasibility of the Sentinel intervention.MethodsThe development of Sentinel followed a rigorous, 4-phase approach. In phase 1, we conducted market analysis and in-depth qualitative interviews with 54 FRs from fire services, police, and emergency health sectors. The aim was to explore their mental health needs, barriers to accessing support, and views on the potential role of DIs in addressing these needs. In phase 2, we developed the content for Sentinel by integrating findings from phase 1 with existing evidence, policies, and theoretical frameworks, ensuring the intervention reflected the lived experiences of FRs. In phase 3, a high-fidelity clickable prototype of Sentinel will be tested through co-design workshops, iterative development sprints, and usability evaluations. Feedback from FRs and frontline workers during this phase will refine the app’s design and functionality. Phase 4 involves a mixed methods, nonrandomized feasibility study to evaluate Sentinel’s acceptability, usability, safety, and implementation potential. Quantitative data will be collected from up to 100 FRs, complemented by qualitative interviews with 30 FR participants and 20 health and social care professionals who refer FRs to the intervention.ResultsThe co-creation process has proven essential in ensuring Sentinel meets the specific needs of FRs and frontline workers. Preliminary feedback highlights the app’s relevance and usability. Our pilot testing began in August 2025 and is planned for completion by August 2026. As of January 16, 2026, a total of 119 participants have completed the initial survey, and 59 have downloaded the Sentinel app, with 24 having used the app for 6 weeks and completed the follow-up survey. Of this group, 13 participants have consented to an interview. We are on track to meet our target recruitment sample, and these data will provide detailed insights to inform refinements and determine readiness for a larger efficacy trial.ConclusionsSentinel represents a novel, personalized digital solution designed to address the unmet needs of FRs and frontline workers exposed to occupational trauma. Future work will evaluate its capacity to improve mental well-being, support trauma recovery, and build resilience.

This paper investigates the use of participatory mapping as a tool to help communities navigate resource rushes by creating space for dialogue to identify alternative development trajectories and multiple land-use activities which could supplement, replace, or co-exist in post-industrial extractive spaces. The study focuses on renewed interest in mining development and alternative economies surrounding the historic Ivittuut cryolite mine nestled in the Arsuk fjord of Southwest Greenland. With increased international relevance placed on Greenland’s mineral resources, inclusive and co-creative participatory processes will become essential in uncovering, documenting, and resolving extractive and land-use conflict. By combining critical perspectives of social and political geology with participatory mapping, this paper spatializes diverse futures co-produced by residents and stakeholders invested in the future development pathways at Ivittuut. Our findings show that participatory mapping helps communities identify and consider complex scientific challenges, explore potential land-use conflicts in advance, and encourage co-development strategies in the Arctic.

Purpose This paper aims to explore how digital corporate social responsibility (CSR) communication, in the form of information, response and involvement strategies, shapes consumer engagement across cognitive, emotional and behavioral dimensions. Design/methodology/approach The study adopts a netnographic approach and analyses more than 3,237 rich Facebook comments to six coffee chains’ posts related to no plastic waste initiatives. Findings Findings illustrate how consumers use CSR messages on social media as spaces for sharing knowledge, expressing emotions and participating in CSR initiatives. Specifically, the results show that different digital CSR communication strategies shape how conversations with and among consumers evolve by triggering distinct types and valences of engagement. Moreover, the study identifies the objects of engagement (CSR activity, brand and community) and traces how engagement flows dynamically among these focal points. Research limitations/implications The data were collected from a specific social media platform (Facebook) and focus on a specific CSR activity, which is plastic waste. Practical implications The study offers guidance for brands seeking to navigate the interactive and often unpredictable nature of CSR communication online. It highlights that engagement is multidimensional and may not always signal endorsement, but, nonetheless, can contribute to the ongoing negotiation of corporate responsibility. Originality/value By integrating cognitive and emotional dimensions into the analysis of digital CSR engagement, this study extends prior research that has largely focused on behavioral metrics. It interprets digital CSR communications as the space for consumer engagement and reveals the role of such communications as both enablers of co-creation processes between companies and consumers – and among consumers – and inputs for criticism with companies’ concern for society.

Background: As preventive medicine gains importance, healthcare professionals must be equipped with competencies in community health promotion and engagement. To strengthen these skills, a student co-creation model was introduced in the “Introduction to Community Medicine” course at Phramongkutklao College of Medicine, Thailand. Third-year medical students were divided into ten groups and tasked with designing and delivering peer-teaching sessions on public health topics, positioning them as both learners and educators. Despite its growing recognition, co-creation in community medicine remains underexplored, particularly in settings where students assume dual roles as teachers and learners. Objectives: This study evaluated students’ perceptions of the co-creation model and its performance in examinations compared with traditional lecture-based learning in community-oriented medical education. Methods: This descriptive study compared examination outcomes between the 2022 lecture-based cohort and the 2023 co-creation cohort. Examination data were analyzed using descriptive statistics and measures of variability. Student perceptions were collected through an anonymous survey comprising five-point Likert-scale items, open-ended questions, and a multiple-choice recommendation item, yielding an 80% response rate (N = 95). Results: Students reported positive perceptions of the co-creation experience, describing it as engaging and meaningful for learning through teaching. Reported learning related experiences included communication skills, teamwork, creativity, and confidence in explaining public health concepts. Challenges like time constraints and uneven workload distribution among group members are also reported. A majority of respondents indicated that they would recommend continuing the co-creation approach. Examination scores differed between the 2022 and 2023 cohorts, with mean scores of 41.0% and 56.2%, respectively. Score variability, expressed as the coefficient of variation, was 21.6% in 2022 and 17.5% in 2023. These results are presented descriptively, and no causal inferences can be drawn from this comparison. Conclusion: Student co-creation was associated with positive learning experiences and high levels of student engagement in community medicine education. Examination results provide contextual information on knowledge acquisition but may not fully reflect collaborative and creative competencies emphasized in the co-creation process. These findings suggest that student co-creation is a feasible pedagogical approach in community-oriented medical education, while highlighting the need for future research that uses aligned assessment strategies and more robust study designs.

In conflict-affected regions of Cameroon, access to malaria care is severely hindered by displacement, insecurity, and disrupted health systems. In response, we conducted an operational research aimed at breaking barriers to malaria services in conflict-affected communities of Cameroon. In 2021, a participatory co-creation workshop was held on the 21st and 22nd of October 2021, bringing together stakeholders from government health services, community leaders, internally displaced persons (IDPs), and community health workers (CHWs)to collaboratively design interventions aimed at addressing barriers to accessing malaria treatment. The workshop built on prior formative research conducted in 80 conflict-affected communities across the South West and Littoral regions of Cameroon, which identified context-specific challenges to malaria care. The design process included plenary sessions, group discussions, and facilitated brainstorming, and employed participatory methods to ensure that community voices shaped the development of the interventions. Three community-based innovations were co-created through this process. Community Health Participatory Approach (CoHPA) was designed to replace the traditional top-down community dialogue structure with a participatory, inclusive model. The Health Voucher System was designed to address financial and geographical barriers, a voucher-based system was introduced to enable access to subsidized malaria services. Vouchers covered malaria testing, treatment, and transport to health facilities. The Supportive Supervision Model was developed to enhance the capacity and motivation of CHWs, who play a crucial role in delivering malaria services in hard-to-reach areas. The co-creation process was key to developing contextually relevant and community-owned malaria interventions. It led to three innovations: the CoHPA model, which introduced internal community-led accountability mechanisms; a Health Voucher System that addressed both financial and transport barriers to care; and a supportive supervision model that aimed to improve CHW performance through bi-directional feedback and recognition. While each intervention introduced novel, context-sensitive elements, concerns remain about their scalability, sustainability, and integration into existing health systems without continued support and investment. The co-creation process produced three community-driven interventions with potential to break key barriers in access to malaria case management in conflict-affected communities of Cameroon. Pilot implementation and community buy-in for integration into national health systems are essential next steps.

Purpose Co-creation is increasingly used in the public sector for the development of public policies and services. The purpose of this paper is to empirically establish a framework for ethical co-creation in the public sector. Design/methodology/approach A mixed-method approach was used to collect data and cross-analyse four pilots from a three-year EU-funded project. Findings The results from this study highlight the need for an ethics co-creation framework to be provided at the start of a project that can support the co-creation strategy, process and implementation of the outcome. Such an ethics framework must be flexible in order to address issues that vary according to public service, policy being developed and local context. Originality/value Current legal and ethical frameworks for the public sector do not cover all the activities in public sector co-creation. This work is original and important as the use of co-creation in the public sector becomes increasingly important.