Weight management services give people living with obesity support with diet and physical activity. The services aim to help people be healthier and manage their weight. The services are often run by public health teams in councils or by the NHS.
Weight management services haven’t always benefitted all groups of people equally. People who are less likely to take part in a weight management service include:
As a result, such services can increase health inequalities rather than reduce them.
One possible solution is to design services with under-represented groups, so that services might better meet their needs. Designing services together in this way is called ‘co-design’.
There are several co-designed weight management services in the West of England. We wanted to explore how these services were co-designed with community members.
This research project was led by NIHR ARC West in collaboration with local NHS and local authority partners.
We wanted to know:
We selected four adult weight management services in the West of England that incorporate co-design. These case studies represented a range of populations and settings.
We gave our case study services the following pseudonyms:
We spoke to seven commissioners, eight providers and three community members involved in co-designing the services.
The case studies used a range of co-design activities from light-touch to more in-depth approaches.
Participants across all four services saw the potential benefits of co-designing weight management services with community members.
They felt co-design could:
However, they also saw co-design as challenging and needing significant time and effort.
Building strong relationships was seen as critical to co-design.
It took time and effort to build the trust and credibility needed for successful co-design. This was done in different ways:
You can’t just go in and “do” co-production… It takes groundwork. You have to build all these relationships to do it well.
Funding for co-design was often short-term and unpredictable. Two services were unable to implement all their co-design plans because the timeframe was too short or government funding was pulled at the last minute.
Participants noted this unpredictability could damage relationships with communities.
Communities have been hit by the “hit-and-run”, people saying we’re going to do this… then a month later they’re gone.
Some commissioners were concerned with the lack of an evidence base for co-design. In the context of tight budgets, they wondered if public money would be better spent on well-evidenced national programmes. Other commissioners felt their current approach was not working and they needed to try something new.
Are we better spending a huge amount on one [co-designed] group and we don’t know how effective it is, compared to less on a wider group where we know the results are reasonable?
Evaluating co-designed services and building the evidence base was challenging. Short-term funding made it hard to build in rigorous evaluation.
But a wider issue related to what outcomes should be assessed. For example, the Men’s Project was funded as a weight management project but, being fully “co-created”, the men chose its focus.
Their priorities were more about loneliness, mental health and building community, than weight loss. The commissioner of this project felt it created “the context that enables people to make choices around their weight at a later date” but recognised it posed challenges for evaluation.
Would I say it was a success? Yes, but that’s taking new perspective on what success is. If I presented this to a board of clinicians or NHS England, would they say it was successful? I don’t know!
Some participants felt current commissioning practices – which focused on “Key Performance Indicators, bums on seats, people through the door” – did not fit easily with the flexibility needed for co-design.
Some participants felt commissioning for co-design required “a change in mindset and culture”, as well as “courage” and a willingness to embrace uncertainty. Finding the right partners to work with – those who shared your ethos and values around co-design – was seen as critical.
As a commissioner you think you know what you want to come out of it, and it might not be that. If you’re truly going to do co-creation… it demands flexibility and openness… which is not a traditional commissioner role, allowing for that uncertainty and emergence.
Drawing on our analysis, we identified key considerations (PDF) for those wanting to co-design health services:
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