Principles Of Co-production Research Articles

A qualitative study of minority ethnic women’s experiences of access to and engagement with perinatal mental health care

BackgroundApproximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessing appropriate perinatal mental health care.AimsTo explore minority ethnic women’s experiences of access to and engagement with perinatal mental health care.MethodsSemi-structured interviews were conducted with 18 women who had been diagnosed with perinatal mental health difficulties and who were supported in the community by a specialist perinatal mental health service in South London, United Kingdom. Women who self-identified as being from a minority ethnic group were purposefully selected. Data were transcribed verbatim, uploaded into NVivo for management and analysis, which was conducted using reflective thematic analysis.ResultsThree distinct overarching themes were identified, each with two or three subthemes: ‘Expectations and Experiences of Womanhood as an Ethnic Minority’ (Shame and Guilt in Motherhood; Women as Caregivers; Perceived to Be Strong and Often Dismissed), ‘Family and Community Influences’ (Blind Faith in the Medical Profession; Family and Community Beliefs about Mental Health and Care; Intergenerational Trauma and Family Dynamics) and ‘Cultural Understanding, Empowerment, and Validation’ (The Importance of Understanding Cultural Differences; The Power of Validation, Reassurance, and Support).ConclusionWomen of ethnic minority background identified barriers to accessing and engaging with perinatal mental health support on an individual, familial, community and societal level. Perinatal mental health services should be aware ethnic minority women might present with mental health difficulties in different ways and embrace principles of cultural humility and co-production to fully meet these women’s perinatal mental health needs.

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key

ObjectiveTo develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics.MethodsMixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia.ResultsInterview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February–April 2020) involving 21 stakeholders culminating in the co-production of the “DIVA Key”. The DIVA Key was evaluated between May–December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63–0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2–27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8–10]; 8 [8–10 respectively).ConclusionThe DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.

Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways.

ContextToo many people living with chronic kidney disease are opting for and starting on hospital‐based dialysis compared to a home‐based kidney replacement therapy. Dialysis services are becoming financially unsustainable.ObjectiveThis study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability.DesignA 2‐year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public.Setting and ParticipantsA national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study.FindingsCoproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies.Discussion and ConclusionsPatient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services.Patient or Public ContributionInvolved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.

The Need for Children’s Advocacy Centres: Hearing the Voices of Children

ABSTRACT Children and young people (CYP) can be empowered to take on roles as agents of change in their own communities. CYP want to be heard and should be actively involved in the co-production, design and development of services aimed at them to ensure that the resulting services are acceptable and accessible. Little analysis of the framing and discourse of co-production in different contexts has been undertaken. Building on Children’s Advocacy Center models from the United States of America (which are held in high esteem by local communities), there is perceived value of such a center in the UK. A service development initiative was designed to work with children from Greater Manchester (UK) to determine the potential for the establishment of a children’s advocacy center in the North of England. This report presents the design and outcome of the initiative and contributes to the literature on the co-production of such service development projects with CYP, notably the means of achieving that outcome. Recommendations are made for the piloting of an Advocacy House model in the UK with collaborative efforts between CYP as well as health, education, law enforcement, social care providers, charities and voluntary groups. A community-inclusive partnership, underpinned by the principles of co-production and co-design, is integral to the further development of this pilot.

Development of a self-management intervention for stroke survivors with aphasia using co-production and behaviour change theory: An outline of methods and processes.

Self-management is a promising approach to improve quality of life after stroke. However, evidence for the appropriateness and effectiveness of self-management for stroke survivors with aphasia is limited. This article reports on the process used to develop a supported self-management intervention for stroke survivors with aphasia (SSWA) using co-production and behaviour change theory. Preparatory research included systematic reviews, and qualitative interviews and focus groups with SSWA, family members and speech and language therapists (SLTs). We conducted six, 2 hour long intervention development workshops with key stakeholders. The workshops were informed by principles of co-production and the intervention development process outlined by the Behaviour Change Wheel (BCW). We also incorporated the findings of our preparatory research within workshops. Each workshop included an introduction, 1-2 co-production tasks and time for feedback at the end of the session. Data were analysed on an ongoing basis so that findings could be used to feed in to subsequent workshops and intervention development. Workshop participants (n = 12) included; SSWA (n = 5), family members (n = 3) and SLTs (n = 4). Together, participants engaged with accessible and participatory co-production tasks which aligned with the BCW framework. Participants engaged in discussion to define self-management in behavioural terms (behavioural diagnosis) and to identify what needed to change to support self-management. Participant's co-produced solutions for supporting self-management and discussed options to implement these in practice. Prototype materials were generated by the research team and evaluated by participants. Intervention functions and behaviour change techniques (BCTs) were mapped to the solutions generated by participants by the research team, after the final workshop. A supported self-management intervention for SSWA was developed which will be delivered by SLTs through community stroke services. This paper reports the process we used to integrate co-production work with behaviour change theory to develop a complex self-management intervention. This is of relevance for researchers looking to harness the strengths of co-production methods and theory in intervention design. Future research will feasibility test the supported self-management intervention developed. This paper provides transparency to our intervention development process which will help others to better interpret the findings of our feasibility work.

Research as usual in humanitarian settings? Equalising power in academic-NGO research partnerships through co-production

BackgroundResearch partnerships in conflict-affected and humanitarian settings can reveal complex power hierarchies between academics and NGOs. During the process of research, decision-making may skew in favour of more powerful actors, who often direct the scope of the research, hold the budget and lead the analysis. Co-production is increasingly emerging as a helpful approach that attempts to equalise power dynamics during research. The aim of this paper is to draw attention to the main challenges associated with a “research as usual” approach to research partnerships in humanitarian settings, as power hierarchies may be particularly magnified in these settings.MethodsThis paper is based on a comprehensive literature review and 32 semi-structured interviews with academics and practitioners from non-government organisations. Participants were selected purposively based on their experience in co-producing research or working within research partnerships. Some participants had worked in humanitarian settings while others had experience co-producing research in non-humanitarian contexts. We used Nvivo to thematically code data.ResultsThis paper documents the problems with “research as usual” partnerships in humanitarian settings, specifically: the burden on communities as merely sources of data, certain forms of knowledge being valued over others, lack of reflection on the power hierarchies structuring research partnerships, top-down decision-making and lack of transparency, one-way “capacity-building”, lack of mutual benefit, and rigid research processes and timeframes.ConclusionThis paper highlights key challenges with standard research practices in humanitarian settings and identifies seven key principles of co-production that can be helpful in attempting to equalise power dynamics within research partnerships, specifically in conflict-affected and humanitarian settings.

Learning from knowledge co-production research and practice in the twenty-first century: global lessons and what they mean for collaborative research in Nunatsiavut

An increasing need for novel approaches to knowledge co-production that effectively and equitably address sustainability challenges has arisen in the twenty-first century. Calls for more representative and contextual co-production strategies have come from Indigenous communities, scientific research forums, and global environmental governance networks. Despite calls to action, there are no systematic reviews that derive lessons from knowledge co-production scholarship to interpret their significance through the lens of a specific sociopolitical and cultural context. We conducted a systematic review of peer-reviewed and grey literature on knowledge co-production published from 2000 to 2020. Using a hybrid inductive and deductive thematic analysis, we identified two conceptual themes—guiding principles and approaches—to structure the synthesis and interpretation of 102 studies. We found that knowledge co-production studies often converged on four interrelated principles: recognition of contextual diversity bounding knowledge co-production, preemptive and intentional engagement with Indigenous knowledge holders, formation of shared understanding of the purpose of knowledge co-production, and empowerment of knowledge holders throughout the co-production cycle. These principles manifested in multiple approaches for interpreting, bridging, applying, and distributing power amongst diverse knowledge systems rooted in different epistemologies. We filter these findings through the social–ecological context that frames an ongoing knowledge co-production project with Inuit communities in Nunatsiavut, Canada: the Sustainable Nunatsiavut Futures Project. Our review suggests that emerging forms of knowledge co-production principles and approaches yield immense potential in diverse contexts. Yet in many regions, including Nunatsiavut, principles alone may not be enough to account for systemic and contextualized issues (e.g., colonisation and data sovereignty) that can present roadblocks to equitable sustainability science in the twenty-first century if left unaddressed.

The use of coproduction to inform an evidence-based service delivery model for mental health service users with complex needs

AimsCo-production recognises that people who use social care services (and their families) and third sector organisations within community settings have knowledge and experience that can be used to help make services better for services users and those who care for them. This study shares the coproduction that took place in the design of a mixed methods study that aims to understand: the profile and history of service users currently defined as having complex needs; the decision-making processes by clinicians that lead to these individuals entering this complex group; service users and carers experience of service use; and, the associated costs. This study involves a comprehensive evaluation that aims to inform an evidence-based service delivery model for mental health service users with complex needs.MethodA study stakeholder group, including clinicians, academics, service users, housing associations, health economists, and statisticians was formed from the outset to inform the mixed methods design, combining quantitative (in-depth analysis of patient records and economic evaluation) and qualitative (written medical notes and in-depth interviews with service users, carers, and clinicians) methods. The study included five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of direct medical costs, direct non-medical costs, and indirect costs for each patient; (3) semi-structured interviews about patients and carers experiences; (4) data from components 1-3 was used to co-produce vignettes jointly with the stakeholders group; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group by using the vignettes as example case studies.ResultCoproduction took place at each stage of the study, including the design, development of data collection tools, data analysis and formation of the vignettes required for stage five. The results demonstrated how co-production and multiagency working have been evident throughout the process of designing the study, the continuous engagement throughout the analysis, dissemination and implementation of the findings.ConclusionThe findings support the application of the core principles of co-production in the design, set-up and implementation of research within an NHS Trust as demonstrable by the acceptability and collaborative working within the study. The study's key outcomes were to: examine the resource use and cost impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how decisions are made in their treatment to inform how services are delivered in the future and made more person-centred and consistent.

Co-development, co-production and co-dissemination of scientific research: a case study to demonstrate mutual benefits.

Inadequate and inequitable distribution of research capacity and resources limits both the opportunity for leadership and participation in science. It also results in biases of effort, poor and misinterpretation of global patterns and the availability of limited usable knowledge for current challenges. Increased participation in ocean research and decision-making is needed to account for many stressors and challenges. The current intergovernmental attention on the ocean (e.g. UN Decade of Ocean Science for Sustainable Development) and the development of technologies that permit exploration and accelerate exploitation suggest that it is timely to focus on the ocean and its stewardship. Employing the principles of co-development, co-production and co-dissemination, this paper uses a case study of a deep reef project in Seychelles to illustrate some activities that can be employed to magnify research outcomes and legacy. We provide examples that range from ministerial briefings and planning meetings to joint fieldwork, grant allocation and co-authoring outputs. These activities helped us to align priorities, promote authentic interactions and focus on equitable science. Finally, reflecting on our experiences, we acknowledge the benefits brought by respectful and long-term partnerships, the variety of activities needed to develop these and challenges of maintaining them. In the future, we also want to include more opportunities for regional peer-to-peer learning and technology transfer.

Becoming a global citizen?

This article will propose a more authentic learning environment for students of the social sciences, one that is not only learner-centred but community-centred. Drawing on the principles of social pedagogy, cultural-based learning, place-based learning and co-production, this article advocates engaging community groups as co-producers in the generation of knowledge, enhancing learning within – and beyond – the university. By not using the community simply as a source of research data or placement opportunities, the curriculum is more likely to produce reflexive graduates better equipped to engage with complex global problems, enhancing their global citizenship and that of the wider community.

Employed but not included: the case of consumer-workers in mental health care services

This article explores how employees with mental illness perceive HRM and its impact, drawing on consumer-centred perspectives. Using the case of consumer-workers employed for their lived experience of mental illness in mental health care services, we investigate the degree to which they feel included or marginalised by HR systems, processes and practices. Through a mixed method study designed along co-production principles, we found consumer-workers faced different but interrelated problems stemming from their status: a general lack of understanding of the role and its purpose; inequity in pay rates, workplace conditions, and training and development; as well as employment precarity and difficulties around disclosure, stigmatisation and discrimination. Overall, organisational support for these unique roles seemed to be lacking despite the clear business need for these positions. We make several contributions: firstly, we show how employees in a unique role that requires experience of mental illness are impacted by the interaction between HR systems, processes and practices; secondly, we illustrate why HR scholars need to engage with varied paradigms of knowledge about mental illness beyond the dominant medical/psychiatric one; and thirdly, we demonstrate a methodology that not only explores employee perspectives, but includes employees in the research design and process.

Knowledge co-production in academic-practitioner research collaboration: An expanded perspective on power

Knowledge co-production within academic-practitioner research collaborations is a promising means to address the pressing issue of research impact. Yet current theorising is hampered by a limited appreciation of power in the relationship between research partners. In this study, we explore various types of power and their effects on knowledge co-production in government-funded research collaborations. Drawing on interviews with academics and practitioners working on Australian Research Council Linkage Scheme projects, we initially document the prominence of structural and normative types of power, alongside resource power. We further show that both structural and normative power fail to conform to key principles of knowledge co-production. As a result, many of the projects studied fell short of the knowledge co-production ideal. Our investigation leads us to identify a boundary condition: knowledge co-production theory in its current form is bounded by resource power conditions. Our expanded perspective provides for an elaboration of knowledge co-production theory. We also explore the implications of our findings for business schools in search of impact.

Public development plan based on coproduction and slow principles: an analytical scheme by action research

Abstract This study aims to investigate and reflect on the evidence of a development plan based on the coproduction the population and the government of a small municipality, based on the principles of the Slow City Movement (SCM). A descriptive exploratory research was conducted with a qualitative approach. The main guiding strategy of the research, consisted of the action research method carried out in the municipality of Rio Doce, in Minas Gerais, Brazil. The results show that the space for dialogue between the population and the government was relevant and allowed the coproduction of a municipal planning with micro and macro elements and within the slow city principles. Also, traditional practices linked to culture with the use of local environmental resources were included, involving popular knowledge, technologies of social origin and the knowledge of the daily life of the community in a project of future desired by the population.

Giving voice to people with communication disabilities during mental capacity assessments.

Healthcare professionals without specialist training in communication disorders may not know how to identify and support patients with communication disabilities during mental capacity assessments. To meet this need, a novel communication screening tool was developed and tested as part of a mental capacity assessment support toolkit. To provide an initial evaluation of the communication screening tool's usability, interrater reliability and criterion validity. A prototype communication screening tool was developed iteratively using co-production and user-centred design principles. A mixed-methods case series design was used to explore how multidisciplinary healthcare professionals used the tool to test patients in acute hospital and intermediate care settings. Usability data were collected in an electronic survey and from a documentary analysis. Screening test outcomes obtained by pairs of professionals were compared to measure the tool's interrater reliability. Outcomes obtained by professionals were compared with the outcomes of a speech and language therapist's communication assessment to measure criterion validity. Quantitative data were analysed using frequency counts and inferential statistics. Qualitative data were analysed using framework analysis. A total of 21 professionals, including physicians, nurses, occupational therapists, physiotherapists, and speech and language therapists, and 17 patients with diagnoses of stroke or cognitive impairment took part. Professionals reported they found the tool easy to use, useful and that its use increased their understanding of communication support methods and the speech and language therapist role in relation to mental capacity assessment. However, not all used it consistently or accurately. Professionals reported they chose not to use the tool when they perceived patients' communication to be intact. Four of eight patients with a diagnosis of dementia or memory impairment, who professionals elected not to screen, were found to have significant communication needs. Screening outcome data for nine patients suggest the tool's interrater reliability is currently moderate, whilst its criterion validity is poor. This study highlights that non-speech and language therapist health professionals have difficulty identifying and screening for communication difficulties. This confirms existing evidence that people with communication disabilities may not receive the decision-making support they require during mental capacity assessments when speech and language therapists are not involved. Greater understanding of health professionals' thought processes regarding communication is required to further develop this unique communication screening tool so that it can effectively enable healthcare professionals to identify and use communicative adaptations to support decision-making. What this paper adds What is already known on this subject Limited previous research suggests that assessing the mental capacity of people with communication disabilities is complex. Practice needs to be improved to ensure this group is adequately supported to make decisions, in line with legal requirements. What this paper adds to existing knowledge This paper describes the development and testing of a novel communication screening tool for use by healthcare professionals preparing to undertake mental capacity assessments. It increases our understanding of how healthcare professionals without specialist training understand communication disability and the role of the speech and language therapist in relation to mental capacity assessment. What are the potential or actual clinical implications of this work? Healthcare professionals without specialist training require support to understand and respond to the needs of people with communication disabilities during mental capacity assessments. With further development and testing, in response to initial evaluation, this novel communication screening tool may be able to provide this support.

A qualitative study of service users’ experiences of mental health nurses’ knowledge and skills in relation to medication

The role of the mental health nurse in relation to medications remains complex. Despite an increasing focus on pharmacology within pre-registration nurse education, there is limited research exploring how mental health service users experience mental health nurses' knowledge and skills in relation to medication. To explore the experiences of service users working with mental health nurses, in relation to the nurses' knowledge and skills associated with medicines management. The research prioritized the principles of co-production and was undertaken collaboratively with a researcher with lived experience. Data were collected via semi-structured interviews with individuals who have accessed UK mental health services. Interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis. Three themes were generated from the data: inconsistencies in knowledge and practice, holistic therapeutic engagement and dialogical approach to medicines. Service users may have a sense of uncertainty around the role of the nurse, potentially resulting in frustration and anxiety. However, mental health nurses also possess unique skills in relation to medicines management. The findings emphasize that service users value not only pharmacological knowledge but also unique skills in facilitating dialogue, prioritising shared decision-making and practical support in medicines optimization.

Dying to talk? Co-producing resources with young people to get them talking about bereavement, death and dying

The Dying to Talk project in Bradford, UK aimed to build resilience in young people around the topic of death, dying and bereavement. Starting conversations early in life could buttress people’s future wellbeing when faced with bereavement and indeed their own mortality. Research indicates that a key feature in young people’s experience of bereavement is ‘powerlessness’ (Ribbens McCarthy, 2007). Drawing on the principles of co-production, young people led the development of the project aimed at encouraging young people to talk about death, using archaeology as a facilitator to those conversations. The partnership between the University of Bradford, the voluntary sector and the young people proved to be a positive and empowering one. It laid the foundations for future collaboration and developed a framework for engaging young people in talking about death, building their resilience for dealing with death and dying in the future – a step towards building a ‘compassionate city’ for young people (Kellehear, 2012).

Exploring patient and public involvement (PPI) and co-production approaches in mental health research: learning from the PARTNERS2 research programme

BackgroundPatient and Public Involvement (PPI) in research is a growing field of work, incorporating experiential knowledge within research processes. Co-production is a more recent PPI approach that emphasises the importance of power-sharing to promote inclusive research practices, valuing and respecting knowledge from different sources, and relationship building. Applying co-production principles in research trials can be difficult, and there are few detailed worked examples or toolkits. This paper explores the successes and challenges encountered by one research team.MethodsOur paper is written by a team of 21 people working on PARTNERS2, led by a smaller co-ordinating group. Using a co-operative style inquiry, the authors have reflected on and written about their experiences; analysis of the resulting 15 accounts provided examples of how PPI and co-production were delivered in practice.ResultsWe reveal varied and complicated experiences as we developed our collaborative approach across the entire research programme. Four main themes emerge from reflective accounts which describe aspects of this process: (1) recognising the importance of ‘emotional work’; (2) developing safe spaces to create and share knowledge; (3) some challenges of using our personal identities in research work; and (4) acknowledging power-sharing within the research hierarchy. We also found continual relationship building, how different forms of expertise were valued, and stigma were central to shaping what work was possible together. Other important practices were transparency, particularly over decision making, and clear communication.ConclusionsOur work provides one example of the ‘messy’ nature of collaborative research in practice. The learning we surface was contextual, generated within a large-scale research programme, but applicable to other studies. We found for success there needs to be an acknowledgement of the importance of emotional work, creating safe spaces to co-produce, transparency in decision making and reflection on the difficulties of using personal identities in research work including for service user researchers. These elements are more important than existing guidelines suggest. Implementation of actions to support emotional work, will require changes within individual teams as well as institutions. Introducing reflective practice in teams may be helpful in identifying further improvements to inclusive research practice.

The Potential for Coproducing Food Security in Public Housing Communities

The coproduction literature has long acknowledged that citizens are active consumers and producers of public goods. Coproduction tends to be successful when citizens are already engaging in activities that can be enhanced through collaboration with activities of public managers, programs, and agencies. In this article, we investigate the strategies and activities public housing residents engage in to produce consistent access to sufficient nutritious food needed to support a healthy life. That is, we investigate residents’ food security. Focus group responses from adults and adolescents in six public housing communities in the Phoenix metropolitan area reveal barriers and opportunities for leveraging communities to attenuate place-based disadvantages associated with low food security. These responses also demonstrate a potential missed opportunity to engage in place-based solutions that use principles of coproduction to produce and maintain residents’ food security.

Implementing a Digital Tool to Support Shared Care Planning in Community-Based Mental Health Services: Qualitative Evaluation.

BackgroundMental health services aim to provide recovery-focused care and facilitate coproduced care planning. In practice, mental health providers can find supporting individualized coproduced care with service users difficult while balancing administrative and performance demands. To help meet this aim and using principles of coproduction, an innovative mobile digital care pathway tool (CPT) was developed to be used on a tablet computer and piloted in the West of England.ObjectiveThe aim of this study was to examine mental health care providers’ views of and experiences with the CPT during the pilot implementation phase and identify factors influencing its implementation.MethodsA total of 20 in-depth telephone interviews were conducted with providers participating in the pilot and managers in the host organization. Interviews were audio recorded, transcribed, anonymized, and thematically analyzed guided by the Consolidated Framework for Implementation Research.ResultsThe tool was thought to facilitate coproduced recovery-focused care planning, a policy and organizational as well as professional priority. Internet connectivity issues, system interoperability, and access to service users’ health records affected use of the tool during mobile working. The organization’s resources, such as information technology (IT) infrastructure and staff time and IT culture, influenced implementation. Participants’ levels of use of the tool were dependent on knowledge of the tool and self-efficacy; perceived service-user needs and characteristics; and perceptions of impact on the therapeutic relationship. Training and preparation time influenced participants’ confidence in using the tool.ConclusionsFindings highlight the importance of congruence between staff, organization, and external policy priorities and digital technologies in aiding intervention engagement, and the need for ongoing training and support of those intended to use the technology during and after the end of implementation interventions.

Co-production of knowledge for sustainability: an application of reflective practice in doctoral studies

ABSTRACTThis paper examines how doctoral students of sustainability science acquired reflective practice skills and engaged in critical reflection. Using the experience of a doctoral theory course on rural studies at the University of Guelph, students and faculty employed the principles of co-production and dialogue to explore the question: What does it mean to reflectively braid knowledge systems for sustainability? To do this, each doctoral scholar independently responded to the question, and then followed the response with an additional individual reflection. As a final discussion, we extended the reflection process and shifted the focus of conversation to ourselves and to the methodological aspects of the dialogical writing that we engaged in. Throughout this process, we used reflective practice and co-production to demonstrate how such processes must be integrated into the skills training and education of students who are taking inter- and trans-disciplinary programs. To finish, we reflect on the role of critical reflection, one that takes the normative dimensions of sustainability seriously, concluding that it is inseparable from reflective sustainability research and practice.