Co-production experiences were found in 23 papers reporting on 18 studies. Stakeholders represented were intervention developers (students, school staff, external partners like parents and facilitators) and those studying intervention development (researchers). Note co-production facilitators and researchers were sometimes the same individual. Views are separated by stakeholder where this was done in data sources. The analytical themes found were acceptability (how stakeholders received co-production); feasibility (stakeholders’ thoughts on how co-production interacted with context); and decision-making (stakeholders’ thoughts on developing and delivering co-produced health activities).
Individual-Level Capacity-Building Co-production
Students’, facilitators’ (teachers’ and youth workers’) and researchers’ experiences were reported in 11 papers of nine interventions (Jensen et al.
2005; Simovska
2007; Simovska and Jensen
2008; Epstein
2007; Soleimanpour et al.
2008; Ozer et al.
2008,
2010,
2013; Miller
2010; Goodnough
2014; Shriberg et al.
2017). Papers tended to privilege teacher, youth worker and researcher perspectives over students.
Students’ experienced this type as
acceptable because they felt empowered, had project ownership and were afforded an opportunity to take part in decision-making during learning (Simovska
2007), research projects (Goodnough
2014; Shriberg et al.
2017; Ozer et al.
2013) and school change (Goodnough
2014; Epstein
2007; Ozer et al.
2013). They perceived more control over goal-setting (Ozer et al.
2013) than teachers, who were advisors (Ozer et al.
2013; Jensen et al.
2005) and trusted learning partners (Goodnough
2014). Taking photos (Miller
2010), selecting topics, developing questions and conducting quality interviews and surveys (Jensen et al.
2005; Soleimanpour et al.
2008; Shriberg et al.
2017; Ozer et al.
2008) were considered demanding tasks. Nevertheless, they felt they benefitted from increased health (Shriberg et al.
2017; Miller
2010; Simovska
2007; Jensen et al.
2005; Goodnough
2014) and research knowledge (Goodnough
2014), confidence (Jensen et al.
2005) and skills in leadership (Shriberg et al.
2017; Goodnough
2014), communication (Ozer et al.
2013), teamwork (Epstein
2007; Jensen et al.
2005) and problem-solving (Jensen et al.
2005).
Students raised
feasibility concerns about discussing sensitive issues and having limited time. Discussing sensitive issues, i.e. gang affiliation, was problematic due to confidentiality and because students thought facilitators would judge them (Ozer et al.
2013). Time was important to develop the trusting student-facilitator relationships needed (Shriberg et al.
2017; Goodnough
2014), conduct research outside lesson time (Soleimanpour et al.
2008) and complete projects within a year which was not always achieved. Students accepted actions were long term though (Goodnough
2014) and were happy to forego
decision-making by implementing previous cohort projects, if needed (Ozer et al.
2013).
Facilitators thought the democratic, transformative pedagogy underlying co-production was more
acceptable than traditional, didactic health risk-based curricula (Simovska and Jensen
2008; Jensen et al.
2005; Epstein
2007). They recounted that student engagement varied by confidence (Jensen et al.
2005), motivation (Jensen et al.
2005; Epstein
2007) and skill acquisition (Simovska and Jensen
2008). This was affected by whether students had elected or understood project requirements before electing classes (Ozer et al.
2010; Jensen et al.
2005). Therefore, sustaining engagement in lengthy projects was necessary through encouragement (Simovska and Jensen
2008) and incentives (Soleimanpour et al.
2008). Teachers also reinforced student concerns about mastering skills (Jensen et al.
2005; Goodnough
2014), particularly due to short skill development times (Goodnough
2014); but acknowledged engagement leads to student personal growth (Epstein
2007; Simovska
2007), development of leadership (Shriberg et al.
2017; Goodnough
2014) and action competence (Simovska and Jensen
2008) and a wider awareness of health (Simovska and Jensen
2008).
Teachers expressed
feasibility concerns as the new pedagogy involved high levels of commitment (Jensen et al.
2005), and they worried they were occasionally leading rather than scaffolding learning (Simovska
2007; Ozer et al.
2013). Some students needed additional support which was difficult in classrooms (Jensen et al.
2005). Initial training was important (Jensen et al.
2005); although ongoing external, scheduled and responsive support for research naïve facilitators was imperative to translate training into teaching (Ozer et al.
2008; Jensen et al.
2005) demonstrated when researchers observing classes were drawn in as co-teachers (Ozer et al.
2008). Ongoing support was especially necessary when only one teacher was involved as no peer support was available (Jensen et al.
2005). Overall, facilitators thought delivering curricula was more feasible in schools where the national curriculum aligned to problem-solving (Jensen et al.
2005); previous relationships existed between youth organisations and schools (Ozer et al.
2010); an established youth training workforce existed (Ozer et al.
2010); and lesson time was allocated (Simovska and Jensen
2008; Goodnough
2014; Soleimanpour et al.
2008; Jensen et al.
2005).
Facilitators noted challenges with implementing student ideas after
decision-making (Simovska and Jensen
2008), especially in larger schools with fragmented teacher networks (Ozer et al.
2010) or where headteacher support was absent (Jensen et al.
2005). They thought lack of implementation led to future student disengagement so constrained issue selection and actions to realistic, short-term change (Ozer et al.
2010), attenuating this through ensuring students made micro-decisions i.e. data collection methods (Ozer et al.
2013).
Researchers thought the projects were
feasible because students developed as cohesive groups (Epstein
2007), and built solid relationships with outside facilitators (Goodnough
2014). They only noted varying student interest as a function of social maturity, causing classroom disruption and sometimes the need to adapt co-production by recruiting smaller groups to continue class work (Ozer et al.
2010; Epstein
2007; Ozer et al.
2013). They also thought curricula were well delivered, but more difficult within schools without a tradition of empowerment (Shriberg et al.
2017), or those focused on improving educational standards (Ozer et al.
2008,
2010). They acknowledged school management involvement was needed due to lengthy delivery times (Ozer et al.
2010). To ensure project traction and school embeddedness, there was a demand for regular communication with administration (Shriberg et al.
2017; Ozer et al.
2008), linking to established school structures (Shriberg et al.
2017), and planning for students to take over unfinished projects (Ozer et al.
2008). Continuity was an issue due to teacher and student turnover (Shriberg et al.
2017), and youth organisation withdrawal after funding ceased (Ozer et al.
2008).
Researchers noted a number of issues with
decision-making. Students choose activities that contested school-level policies (Ozer et al.
2008) or political and administrative functioning (Ozer et al.
2013); were too resource-intense (Ozer et al.
2008); or required change outside the school (Jensen et al.
2005). Therefore, ideas were not always adopted (Ozer et al.
2008; Ozer et al.
2013) and/or facilitators supported students to think of realistic, student-led actions deliverable within project time frames (Ozer et al.
2013; Soleimanpour et al.
2008), or ‘quick wins’ to maintain engagement and ensure implementation (Ozer et al.
2008; Goodnough
2014). Even when ideas were adopted, researchers questioned whether this was due to student recommendations, or a coincidental fit with educational system change (Ozer et al.
2010). A lack of idea implementation was considered a learning opportunity about democracy (Jensen et al.
2005), or curricula were adapted to incorporate lessons learnt (Ozer et al.
2008). Researchers concluded some projects emphasised developing responsible citizens, in lieu of actual school change (Epstein
2007). Students were not always aware of this, as they were not supported to critically evaluate project impact (Ozer et al.
2013).
System-Level Capacity-Building Co-production
Students’, school staff, facilitators’ and researchers’ experiences were reported in nine papers reporting on six studies (Bonell et al.
2015; Bonell et al.
2010a,
b; Fletcher et al.
2015; Bond et al.
2001; Bell
2014; Bell et al.
2017; Davison et al.
2011; Mino
2003). Papers tended to be very comprehensive process evaluations, so provided extensive data from all stakeholders.
Students thought co-production was
acceptable as it was a new and enjoyable experience (Mino
2003; Bonell et al.
2015), and because using a range of recruitment techniques meant RAGs were diverse (Bonell et al.
2015). RAGs and need assessments were perceived as key to hear all student voices (Fletcher et al.
2015), sometimes for the first time (Mino
2003). The lack of prior decision-making opportunities drove student participation (Fletcher et al.
2015; Bonell et al.
2015). One study highlighted RAGs were more acceptable than student councils as they were more representative and diverse, allowed younger students responsible roles, focused on true collaboration, real student issues, and resulted in an actual change (Fletcher et al.
2015; Bonell et al.
2015). Students felt a sense of being listened to, having improved self-regard and confidence, empowerment and school ownership, resulting in greater engagement in learning (Bonell et al.
2010a,
b; Fletcher et al.
2015).
Students thought adult style meetings were
feasible, as even those initially reluctant to speak felt able to contribute over time (Bonell et al.
2010a). Students were split on holding meetings at lunch or after school though (Bonell et al.
2015). Taking part in
decision-making allowed students to understand the complexities of school change, and teacher difficulties to implement change, leading to better student-teacher relationships (Bonell et al.
2010b).
Adult RAG members agreed about
acceptability, giving examples of students who benefitted from i.e. improved self-regard (Bonell et al.
2010a,
b). Students and staff also emphasised participation in resulting health activities had an additive beneficial effect (Bonell et al.
2010a,
b; Bonell et al.
2015; Fletcher et al.
2015). They said everyone was listened to and could have their say; their inputs were valued and respected which demonstrated empowerment (Bell
2014; Bonell et al.
2010b; Bell et al.
2017). Overall, they thought acceptability was the highest when projects were congruent with needs (Fletcher et al.
2015; Bonell et al.
2015; Mino
2003), prior commitments (Mino
2003) or a desire for bottom-up change (Bell
2014; Bell et al.
2017). A focus on health was welcomed (Bell
2014; Bond et al.
2001) but community issues needed tackling too (Mino
2003; Bell
2014).
Adult RAG members discussed how external facilitators made projects more
feasible. They guided processes (Bond et al.
2001), maintained project momentum (Bell
2014; Bond et al.
2001), acted as student advocates (Bonell et al.
2015) and provided an outside perspective (Bonell et al.
2010b; Bond et al.
2001) and link to support (Bond et al.
2001). Teachers thought they improved their capacity to truly collaborative with students (Fletcher et al.
2015; Bonell et al.
2015; Bell
2014; Bell et al.
2017), but a minority felt overwhelmed due to other work and personal pressures, or inexperience in processes like data analysis (Bell
2014). Additionally, needs assessments were considered imperative to
decision-making, as they gave a bottom-up understanding of student issues (Bell
2014). Data supported RAGs to ensure schools did not dismiss important issues (Fletcher et al.
2015), including understanding and legitimatising known problems (Bell
2014; Bell et al.
2017; Fletcher et al.
2015; Bond et al.
2001), or discovering new ones (Fletcher et al.
2015; Bond et al.
2001; Mino
2003).
Facilitators thought
acceptability would be attenuated as Inspectorates and parents may view data negatively (Bonell et al.
2015); however, senior staff opposed this, perceiving the data and the inclusion in interventions as evidence of school strengths (Bonell et al.
2010a; Fletcher et al.
2015). Senior staff thought projects appealed as they provided a contextually tailored intervention, resources such as finances and facilitator time, and fit with educational policies for student involvement (Fletcher et al.
2015) and health (Bonell et al.
2015; Bell
2014). They perceived intervention flexibility as advantageous as groups considered schools starting systems so they could build on prior work (Bond et al.
2001; Bonell et al.
2015) and the school ethos (Bonell et al.
2010a; Bonell et al.
2015), or try new activities (Bond et al.
2001; Bonell et al.
2015). One study noted management attributing benefits of increased attendance and positive Inspectorate feedback to the project (Bonell et al.
2015).
Adult RAG members and facilitators outlined conditions that did/could increase
feasibility. School recruitment was necessary in the prior year as co-production and implementation were lengthy (Bonell et al.
2015); manuals were unwieldy, so facilitators were selective in their use (Bonell et al.
2010b); teaching/facilitation experience was important for facilitators (Fletcher et al.
2015; Bonell et al.
2015); and senior staff involvement was necessary for RAGs to progress (Bonell et al.
2010a; Mino
2003; Fletcher et al.
2015; Bond et al.
2001). A lack of implementation of health activities after
decision-making was attributed to a disparity with schools’ ethos (Bonell et al.
2010a). It was thought implementation could be improved by integrating projects into School Improvement Cycles (Bonell et al.
2015).
Researchers agreed with the preceding experiences and summarised co-production themes. Projects were
acceptable in schools of varying deprivation, inspection ratings and baseline contexts (Bonell et al.
2015; Fletcher et al.
2015; Bond et al.
2001; Bonell et al.
2010a,
b).
Feasibility was increased when school leaders committed to progressing projects (Bell
2014; Bond et al.
2001; Fletcher et al.
2015; Bonell et al.
2015) and, when time was available to set up projects (Bonell et al.
2015), conduct more meetings (Bell
2014) and embed systemic changes (Bond et al.
2001). Developing broadly based RAGs was challenging though (Bond et al.
2001). Recruiting and retaining external stakeholders like parents and governors were difficult (Mino
2003; Bell
2014; Bonell et al.
2010a), resulting in stakeholder absences or recruiting already engaged parents (Mino
2003; Bonell et al.
2010a). Less engaged students were not always involved due to time limitations (Bonell et al.
2010a).
Researchers concluded successful capacity-building to support
decision-making about systemic change was attributed to the combination of RAG formation, external facilitators and school-specific data (Bond et al.
2001; Bonell et al.
2015). They thought facilitators’ presence supported stakeholders to form actions with clear intervention logic, considering iatrogenic effects too (Fletcher et al.
2015; Bonell et al.
2015), but they needed either school-based or youth work experience to do this effectively. Researchers agreed needs assessments were key to developing socially valid activities; however, other data sources such as audits (Bond et al.
2001; Bonell et al.
2015; Fletcher et al.
2015; Bonell et al.
2010a,
b) and PhotoVoice (Davison et al.
2011) were only briefly discussed.