Co-production within integrated care: a multi-case study using Participatory Action Research within an Integrated Care System in England

Background: Globally, integrated health and care services are encouraged to work in collaboration with people who draw on their lived experience of health and care; co-producing change. Integrated Care Systems in England are structures, mandated in 2022, required to involve their service users, carers and citizens in strategic planning, service development, implementation and improvement. This multi-case study used Participatory Action Research to explore the impact of co-production on the design and transformation of services within integrated care. Methods: Case studies of varying examples of ongoing co-production within one Integrated Care System have been conducted simultaneously over a period of six months. The study, designed with an advisory group (Patient and Public Involvement), used Participatory Action Research which allowed the researcher to partner with the participants as co-researchers throughout. Co-researcher groups within each case study consisted of service users, unpaid family carers, volunteers, community members, service leads, clinical staff, co-production project leads, and the researcher. Group meeting transcripts, co-researcher reflections, process documentation and other case study data collected were continuously analysed and compared, developing a multi-case analysis. The three selected case studies are examples of co-production within the Integrated Care System: 1.Development of an ADHD and Autism pathway, 2.Inclusivity within hospice care for diverse communities, 3.Community-based service for people living with Dementia and their carers. Discussion: The knowledge built in each case allows for rich interpretations of the data, shaped with the co-researchers. The co-researchers were enabled to use the knowledge built during the case study as learning for their practice of co-production, in real-time. The findings will contribute to the development of co-produced guidance for integrated care systems.