Designing futures together: co-designing health and social services with structurally vulnerable populations

Samantha K. Micsinszki, Alexis Buettgen, Gillian Mulvale, Sandra Moll, Michelle Wyndham-West, Emma Bruce, Karlie Rogerson, Louise Murray-Leung, Robert Fleisig, Sean Park and Michelle Phoenix

This blog post is based on the Evidence & Policy article, ‘Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations‘, part of the Special Issue on Creativity and Co-production.

What creative tools can we use to disrupt the status quo and create truly inclusive health and social services? Co-designing evidence and policy change in collaboration with health and social service users and their families is part of an exciting and growing international movement. In our Evidence & Policy article, ‘Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations’, we highlight how our interdisciplinary team of researchers, trainees and lived experience experts engaged in a three-year collaborative process to promote engagement, education, and innovation in equity-based co-design. This article is part of a special issue on creativity and co-production that highlights how collaborative practices, such as co-design and co-production, can be elevated using creative devices and tools (e.g., imagination, storytelling, art etc.) to create a shared language, build relationships, and make meaning.

Co-design approaches take a person-centered perspective, utilizing a design lens to develop solutions to problems in collaboration with lived experience experts. This approach can redistribute power when we meaningfully and effectively engage individuals and communities who experience structural vulnerabilities that affect their health and well-being (e.g., racism, sexism, ableism, colonialism). In other words, how do we ensure that diverse experiences are included and that co-design processes lead to lasting system change?

In 2019, we founded the Co-Design Hub with Vulnerable Populations, a three-year initiative located at McMaster University in Hamilton, Ontario, Canada. Through the development of the Hub, which includes interdisciplinary researchers, trainees, and people with lived experience expertise, we promote engagement, education, and innovation to advance co-design in health and social services and research. Overall, we envision the Hub as a mechanism to address the inequities faced by structurally vulnerable populations in health and social service research.

Co-design is a complex process and within it, there is a need for innovative methods to elicit diverse experiences. By envisioning a Hub for engagement, education, and innovation, we wanted to know what we could do to advance our understanding of co-design with structurally vulnerable populations. A community engagement strategy was used to develop a theory of change – a description of how and why an initiative is intended to create a desired change in a particular context. In this process, we involved community members to co-design the Hub’s vision, goals, outcomes, and plans for impact and sustainability.

To develop the theory of change, we hosted two conversation cafes with stakeholders who had experience working on co-design projects from the perspective of service users, service providers and other researchers. The first cafe illuminated three key touchpoints in the co-design process: 1) authentic engagement; 2) inclusiveness; and 3) institutional challenges. To set the stage in café 1, participants were asked to bring an image or object with them that represented their experience with co-design. Using imagination as a creative device helped to elicit diverse experiences and create a shared understanding of what the term ‘co-design’ meant in practice. Everyday objects and images were thus transformed into communication tools and a conduit for meaning making. In the second café, participants were put into groups to brainstorm possible solutions to address each touchpoint. We used Google Jamboards™, an interactive virtual whiteboard, to co-create prototype solutions in real-time. This allowed us to creatively work together, mirroring an in-person environment which was not possible due to the covid-19 pandemic. Jamboard’s virtual workspace allowed participants to brainstorm apart and in real time using tools like ‘sticky notes’, drawing, and images. Co-production through creatively working together helped us to tell a nuanced story of co-design with vulnerable populations, beyond words and text. Visual metaphors, such as an image of a ‘toolbox’, used with guided discussion from a facilitator helped participants to reflect deeper on the problem at hand, visualizing what resources and tools were required to support the co-design process with structurally vulnerable populations.

Lived experience experts were provided an honoraria and accessibility options, if needed, were provided. These strategies helped to enable diverse groups to participate. We then held follow up Hub team meetings to discuss what we heard at the conversation cafés and worked with a graphic design team to develop the Hub’s theory of change conceptually and visually (see image below).

The visualization of our theory of change represents people at the centre of all our work, and the importance of relationships in the process. The intersecting ovals represent our core strategies designed to work towards our vision of system change: a) to engage a range of key stakeholder partners from service users to policy makers; b) to educate and build capacity for people to engage in inclusive co-design; c) to promote innovation that moves beyond the status quo; and d) to evaluate the implementation and impact of inclusive co-design. The arrows represent the dynamic evolving nature of this work and the intersections between the strategies. The three overlapping images depict our proposed growth over time in terms of our sphere of influence, expanding our reach from local to global across a range of diverse stakeholder communities.

The theory of change highlighted the areas in which there is need for changes in how services are currently designed, delivered, and evaluated for these services to be inclusive of structurally vulnerable populations in the future. For example, participants described the need for resources for accessibility to diverse stakeholders to ensure that they can participate intentionally and meaningfully in co-design. This included time, access to transportation, and financial compensation. Moreover, to address system-level changes, there is a need for continuous power sharing and equitable distribution of resources within institutional infrastructures (e.g., providing research ethics boards with the support to understand co-design such as training modules and people with lived experience expertise with accessible access to REBs). These measures aim to address the pre-conditions for structural vulnerability and address the need for meaningful participation of all stakeholders throughout the co-design process – from planning, to implementation, iteration, and evaluation.

Moving into the future, we will continue to learn and work in solidarity with the broader movement that is co-producing evidence and policy change inclusive of people with lived experience expertise. Our future-making work will evolve in response to the needs and interests of stakeholders, and the social, cultural, political, and economic contexts in which we are working. Transformative change in health and social services is not easy, but we will continue to strive to engage, educate, innovate, and evaluate creative approaches to shift power and increase inclusion of structurally vulnerable populations.

Co-Design Hub Biography

The Co-Design Hub is a three-year co-design initiative located at McMaster University in Hamilton, Ontario, Canada that brings together inter-disciplinary researchers, trainees, service providers, and lived experience experts with the goal of facilitating partnerships, advancing methods of co-design, and enabling knowledge sharing to address complex inequities faced by structurally vulnerable populations. Connect with us via email at codesign@mcmaster.ca or on Twitter @CodesignHub


You can read the original research in Evidence & Policy:

Micsinszki S.K. Buettgen, A. Mulvale, G. Moll, S. Wyndham-West, M. Bruce, E. Rogerson, K. Murray-Leung, L. Fleisig, R. Park, S. and Phoenix, M. (2022). Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations. Evidence & Policy, DOI: 10.1332/174426421X16366319768599. OPEN ACCESS


Image credit: Photo by RhondaK Native Florida Folk Artist on Unsplash


If you enjoyed this blog post, you may also be interested to read:

He Ture Kia Tika/Let the Law Be Right: informing evidence-based policy through kaupapa Māori and co-production of lived experience OPEN ACCESS

Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations OPEN ACCESS

Creative and collaborative reflective thinking to support policy deliberation and decision making OPEN ACCESS


Disclaimer: The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

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