Illustrating Key Components to Co-Creation Through Preventive Care mHealth Messaging with Underserved Communities and Expert Partners

Meaningful community engagement is an essential component of impactful public health and implementation research. Multiple community engagement methods have been defined, including co-creation. Co-creation involves an iterative process that advances from identifying opportunities for value creation and solutions, to defining partner priorities, to evaluating co-created outcomes. This study reports our methods to co-create culturally and linguistically meaningful mHealth messages to promote preventive healthcare engagement for Arabic, Spanish, and Vietnamese - speaking communities. This multi-method study is part of a larger program of research, "Working towards Empowered community-driven Approaches to increase Vaccination and preventive care Engagement" (WEAVE), that aims to co-create and test a preventive healthcare program that includes mHealth and care coordination with medically underserved patients at multiple federally qualified health center (FQHC) locations near the US/Mexico border and surrounding region. A multi-level partner process was used to engage in co-creation across six partner groups (n = 27): (1) Community Advisory Boards (CAB), (2) Community Weavers (individuals with lived experience as members of an underserved community who act as cultural brokers between communities, public health systems, and researchers), (3) FQHC Care Coordinators, (4) FQHC Administrators, (5) a FQHC Clinical Expert, and (6) Research Experts in health communication, vaccine behavior research, and/or mHealth. Each of these partner groups was distinctly engaged through structured CAB meetings, weekly research and operations team meetings, topic-specific meetings, and e-review of content. The Research Engagement Survey Tool (REST) was used as a global assessment of partner engagement in the co-creation process. Results are organized by a co-creation framework anchored to identify, analyze, define, and design steps. Across four CAB meetings and engagement activities with the other co-creation partners, 262 mHealth messages (89 Arabic, 85 Spanish, 88 Vietnamese) were refined and approved. A message cadence and delivery mode were finalized. On the REST, the average ratings were over 4.50 (out of 5), indicating strong perceptions of engagement with the co-creation process and members. We successfully engaged six co-creation partner groups to develop and approve the content, cadence, and delivery mode of mHealth preventive care messages. These messages will be embedded in the multicomponent health program that will be tested in a randomized adaptive trial. NCT05841810, registration date: 03/28/2023.