Increasing the inclusivity of digital health co-production: an integrative review

Co-production is increasingly being used to develop sustainable improvements in health service delivery that are shaped by the experiences and needs of a diverse range of stakeholders including patients and healthcare providers. The process also offers a compelling means of fundamentally addressing the key issues of acceptability and applicability of digital health tools that contribute to ongoing inequity in the use of digital health technologies. However, creating and moderating hybrid digital health co-production teams is hindered by heightened obstacles to inclusivity and equitability of the cost and complexity of digital healthcare, and the diverse digital experience amongst the relevant stakeholders. With previous examples of co-production that involve direct interaction between developers and diverse groups of patients and staff rare, this integrative review has collated the latest evidence on engaging these diverse stakeholders in healthcare innovation, with best practice in co-production, and presents it within a framework representing the five core steps of co-production: <i>Set-up, Discovery, Definition, Development,</i> and <i>Delivery</i>. This guidance includes structured and tailored training in co-production and the concepts of digital health, surfacing and challenging existing assumptions around data security and confidentiality, defining funding models, introducing and refining protypes of increasing sophistication, and structured implementation and evaluation of both the co-production process and its outputs.