Multi-stakeholder perspectives on co-production: Five key recommendations following the Liverpool Co-PARS project

Discerning the perspectives and working practices of those who deliver and receive a health service makes for a sensible step towards improving it. The Liverpool Co-PARS project was a four-year iterative process in which a physical activity referral scheme for inactive patients with health conditions was developed, refined, and evaluated. The aim of the present study was to explore multidisciplinary stakeholder perspectives of those involved in the co-production of Co-PARS and inform recommendations for future co-production research. We invited 5 stakeholders (service user, exercise referral practitioner, fitness centre manager, general practitioner/ public health commissioner, and an academic) to co-author the present paper and provide their reflections of co-production. Four non-academic stakeholders completed a similar to 30-minute phone discussion of their personal reflections of the co-production process, transcribed in real-time by the first author and edited and checked for accuracy by the stakeholder. The fifth, academic author completed their reflections in writing. The multi-stakeholder reflections presented in this paper highlight identified strengths (multidisciplinary perspectives that were listened to and acted upon, co-production that permeated throughout the research project, real-time intervention adaptation) and challenges (homogeneous sample of service users, power imbalances, and a modestly adapted intervention) of co-production. We propose that co-production could be seen as a proactive tool for the development of health service interventions, by mitigating potential issues encountered during latter implementation phases. We conclude with five key recommendations to facilitate future co-production research.