This paper highlights activities in the planning stage of our project, facilitated by co-design. The initial situational assessment provided an in-depth understanding that resulted in a source of data including challenge areas as they relate to community overdose response plans (strengths, gaps, needs, etc.) in Ontario. The second stage of adaptation and planning (co-design workshop) helped prioritize the challenges, which were organized into five major categories; potential supports to address each of the challenges were discussed in this process. The preliminary four categories of support from the situational assessment were refined through this process to develop the model in Fig 6 and Fig. 7. Through this process, detailed delivery methods and ideas for specific supports and tools were captured. These prioritizations and delivery methods will be instrumental in guiding the project in the next stage: identification and design of project tool(s) as this framework and information is used to develop capacity building support.

Our findings suggest that the community overdose response plans have several needs that require capacity building to support the development and implementation of plan objectives and goals. Capacity building is defined as the development of knowledge, skills, commitment, structures, and leadership to address challenges and improve health in three ways: the advancement of knowledge and skills, expansion of support, and development of engagement, partnership, and collaboration in communities [25]. Capacity building support can be delivered in various forms, including technical assistance, virtual and in-person training sessions, online learning options, and guidance materials (e.g., knowledge products). However, organizations should carefully consider the desired outcomes and select forms effective to those outcomes [25].

The identified and prioritized delivery methods in the workshop for building capacity included the use of online/in-person resources, social media platforms, a variety of training materials and adaptable guidelines. Addressing stigma and equity is another challenge that needs to be addressed when developing various educational programs and guidelines for providers and should therefore receive additional consideration. For example, understanding and addressing the experiences of PWLE [26] and emphasizing appropriate and non-stigmatizing language [27] can address opioid-related stigma among providers through educational programs and guidelines.

Insights on Co-design process

A co-design methodology was used to guide the development of this project to support the participation of individuals with varied expertise in a manner that is engaging and easy to understand. The design process endeavored to share, mobilize, generate, and activate knowledge, specifically in complex systems such as community-based health care innovations [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].

As co-design methodology has been increasingly utilized in healthcare system approaches, more knowledge is needed on the factors that impact the effectiveness of these methods. The main influential factors in implementation of a co-design approach include: collaboration, practical and organizational factors, process and methods, and skills in facilitating and utilization of outcomes. The co-design approach plays an essential role in sharing and co-creation of knowledge, addressing power dynamics and positionality, negotiation of controversies, and generation of new ideas and solutions, which is a necessary mechanism for uncovering community-based knowledge and factors that might impact successful implementation of change [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29].

The workshop enablers and challenges

The evaluation of the COM-CAP co-design workshop showed some considerations around the enablers and challenges of the workshop. Enabling factors included: high levels of expertise, a great mix of participants to share vulnerable perspectives, the role of facilitators, productive group discussion, having frontline people and people with lived/living expertise of drug use at the table, and workshop materials (pre-made cards and matrix) that supported activity focused productive discussion.

We also identified two barriers to effective co-design, including:

  • Participant fatigue as a challenge for solving problems at such a high level; components of the breakout sessions were found to be complex, difficult to understand and process; workshop activities were heavily layered and tasks were noted to be too intensive, specifically for PWLE;

  • Facilitator observations that breakout groups had similar populations, geographic area and size; different group sizes; lack of equal representation of PWLE in all groups (due to COVID-19 many invitees were not able to attend the workshop); and time constraints for networking. They found that allocating more time for networking and informing participants in advance of the specific discussion topics and workshop activity details would have been beneficial.

The evaluation results of the COM-CAP workshop can help identify key barriers in co-design research processes to inform future practices. Insights gathered from this study could enhance the foundation and application of participatory design in the healthcare domain.

Previous research on strategic research partnerships with PWLE and peer organizations, highlights the importance of having meaningful participation of PWLE in research and policy through an environment that enables and values both leadership and contribution [30]. This includes providing visibility and recognition of these partnerships with peer organizations and groups in the broader research, government and health service sector [30]. The continued use and refinement of the co-design techniques used in this study could enhance the engagement of PWLE in the project’s upcoming phases and in similar projects and initiatives. Blomkamp (2018) [31], notes that co-design within the public sector can often be used as a more effective, democratic and innovative alternative to community engagement, public participation and policy development. While barriers were observed in this project, co-design approaches can provide meaningful and visible participation of relevant and diverse stakeholders which can enhance cross-sectoral collaboration, the integration of local knowledge and experience, power-sharing at the individual and community-level and further support community engagement. Its important to note that co-design in public health related projects with marginalised groups has received critique and is an area of rapid development of new perspectives and practices [32]

The next stage of this work is two-fold, 1) the development of supports and capacity building tools aligned with the results of this workshop that are applicable across the sector and can be distributed widely, 2) the development of tools and supports with three community partner projects where participatory processes will guide the development of practical supports to meet localized needs with learnings that can be shared and adopted across the sector.


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