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Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal and Peru
  1. David Beran1,
  2. Maria Lazo-Porras2,3,
  3. Maria Kathia Cardenas2,
  4. François Chappuis1,
  5. Albertino Damasceno4,
  6. Nilambar Jha5,
  7. Tavares Madede4,
  8. Sarah Lachat1,
  9. Silvana Perez Leon2,
  10. Nathaly Aya Pastrana6,
  11. Maria Amalia Pesantes2,
  12. Suman Bahadur Singh5,
  13. Sanjib Sharma5,
  14. Claire Somerville7,
  15. L Suzanne Suggs6,8,
  16. J Jaime Miranda2,9
  17. on behalf of the COHESION Team
    1. 1 Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
    2. 2 CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
    3. 3 Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
    4. 4 Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
    5. 5 B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    6. 6 BeCHANGE Research Group, Institute of Public Communication, Università della Svizzera italiana, Lugano, Switzerland
    7. 7 Gender Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
    8. 8 Swiss School of Public Health, Zürich, Switzerland
    9. 9 School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
    1. Correspondence to Dr David Beran; david.beran{at}unige.ch

    Abstract

    Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach.

    • study design
    • health services research

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0

    https://doi.org/10.1136/bmjgh-2018-001183

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      Footnotes

      • DB and ML-P are joint first authors.

      • Handling editor Seye Abimbola

      • Collaborators Jorge Correia, Valerio Govo, Khatia Munguambe, Savaiva Munguambe and Mauricio Toyama.

      • Contributors DB and JJM drafted the initial draft. ML-P wrote the section ‘Application of this approach in three countries’ with contributions from TM and SBS. All authors helped develop the initial methodological approach as well as contributed critically to this article.

      • Funding The COHESION Project is funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development.

      • Competing interests None declared.

      • Patient consent Not required.

      • Ethics approval (1) Commission Cantonale d'éthique de la recherche, Genève, Switzerland; (2) Comité Institucional de Bioética em Saúde da Faculdade de Medicina/Hospital Central de Maputo, Maputo, Mozambique; (3) Nepal Health Research Council, Kathmandu, Nepal; (4) Institutional Review Board of the Universidad Peruana Cayetano Heredia, Lima, Peru.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement All data relevant to this publication can be obtained by request to the authors. In addition, some material is available on the project website: http://www.cohesionproject.info.