Learning what really matters to older adults living with and beyond cancer through co-design

In the UK 66% of all cancers are diagnosed in those aged 65 and over. Increased physical activity, healthy diet and reduced sedentary time can alleviate the impact of cancer and associated treatments. Behaviour change interventions are becoming increasingly common. First a systematic review was conducted to explore the effectiveness and acceptability of these interventions. Issues were identified in the current literature base, leading to the aim: To use co-design to develop intervention recommendations with and for older adults living with and beyond cancer to improve the behaviours diet, physical activity, and sedentary time. This thesis reports a 12-month co-design process, involving eleven older adults living with and beyond cancer (mean age=72), and nine professionals/volunteers. The process consisted of three parts: Part A - Preparing, Part B - Co-designing and Part C - Evaluating. Part B drew on Experienced Based Co-Design, a structured method of co-design. The key stages of EBCD were incorporated in the process, with the addition of some adaptations to achieve the planned aims and objectives. Data generated was analysed using a 2-step thematic analysis approach. Participants expressed a greater interest in social interactions than the target behaviours throughout the process. Three key recommendations were developed: (1) Social is key – any future intervention for this population should have a significant social element; (2) Considering the individual – different individuals have different needs and different expectations from interventions; and (3) Enabling access – considering practical barriers to participation in programmes and interventions. The tensions, challenges, and benefits of using co-design for intervention development are also explored. Co-design should continue to be used to ensure interventions and services are acceptable for older people living with and beyond cancer. However, efforts should be made to ensure these processes move beyond consultation and truly put the individuals at the centre.