Evidence-informed, experience-based co-design: a novel framework integrating research evidence and lived experience in priority-setting and co-design of health services.

OBJECTIVE: To describe a new co-design framework termed Evidence-informed, Experience-based Co-design (E2CD). BACKGROUND: Involving consumers and clinicians in planning, designing and implementing services results in the end-product being more likely to meet the needs of end-users and increases the likelihood of their uptake and sustainability. Different forms and definitions of co-design have been described in the literature and have had varying levels of success in health service redesign. However, many fall short of including people with lived experience in all aspects of the process, particularly in setting priorities for service (re)design. In addition, health services need to deliver evidence-based care as well as care that meets the needs of users, yet few ways of integrating research evidence into co-design processes are described. This paper describes a new framework to approach co-design which addresses these issues. We believe that it offers a roadmap to address some of healthcare's most wicked problems and potentially improve outcomes for some of the most vulnerable people in our society. We use improving services for people with high healthcare service utilisation as a working example of the Framework's application. CONCLUSION: Evidence-informed experience-based co-design has the potential to be used as a framework for co-design that integrates research evidence with lived experience and provides people with lived experience a central role in decision-making about prioritising and designing services to meet their needs.

HealthLit4Kids: Supporting schools to be health literacy responsive organisations.

ISSUE ADDRESSED: To reduce inequity, services and community organisations must respond to the health literacy needs and strengths of each individual accessing their services. As a social determinant, health literacy is compounded by interactions between the service provider, the individual, and their wider community. Schools provide a critical nexus between the teacher (as service provider), the student (as learner) and their family (carers and wider community) to support the development of children's health literacy. METHODS: Five Tasmanian primary schools (84 teachers) completed an assessment of their school in relation to the domains of a health literate organisation using the HeLLOTas! (HEalth Literacy Learning Organisations Tasmania) Self-Assessment Checklist, before and after taking part in the HealthLit4Kids program. RESULTS: While the differences between pre- and post-intervention ratings were not large, they moved in a positive direction for all six domains. There was a significant main effect of time, F (1, 4) = 83.9, P < .001, ƞ2  = 0.99, showing that overall ratings increased from before to after the intervention. Teacher-recommended actions across all schools were grouped for insight into their interpretation and application of the tool in the school context. CONCLUSION: Using the HeLLOTas! Self-Assessment Checklist served a dual purpose. Teachers developed a shared understanding of the characteristics of a health-literate organisation to produce a schoolwide action plan. Simultaneously, we gained valuable insights into the processes required to support the development of organisational health literacy in schools, and we share ten propositions applicable to other schools locally, nationally and internationally. SO WHAT?: To the best of our knowledge, this is the first time that a school's health literacy responsiveness has been measured. Our key propositions will support future efforts by policy makers, researchers and school principals.