Patient and public involvement, engagement, and participation in practice: co-production of a creative health approach and theory of change through the ReCITE consortium-building project in Liverpool

This paper describes a process of working together to design a research programme that explores how creative activities such as storytelling could help reduce health inequalities. This work was part of a project called ReCITE, which brought together people from community organisations, health services, the arts, and universities in Liverpool. Fifty-six different people took part in six workshops over nine months. Together, they discussed how creative projects could support people’s well-being and make health outcomes fairer. From these discussions, the group developed a shared plan (known as a theory of change) showing how creative activities might lead to better health for everyone. This plan also helped design a research programme, which later received funding to continue the work. The process involved several rounds of gathering feedback, revising ideas, and returning to participants to check that their views were represented. Working together over time helped build trust and shared ownership of the research. However, it was sometimes difficult for community partners to stay involved throughout the process because there was limited funding to support their time and participation. Co-production with public stakeholders is increasingly recognised as an important approach to ensuring health research is relevant to communities and interventions and likely to generate sustainable change. Ideally, co-production needs to be sustained throughout different stages of research and allow stakeholders ownership of the research agenda. We explore a case study of iterative co-production conducted over a nine-month period with a wide range of disparate stakeholders that transformed into a research-ready consortium able to design and obtain funding for a creative health research programme. The ReCITE consortium is comprised of academics, creatives, and specialists in capacity development and community engagement in Liverpool, UK. Its main focus is health equity and coming up with new ways of working to tackle entrenched, avoidable and unfair differences in health. ReCITE led a series of six workshops in 2023 to co-produce a research programme to investigate creative approaches for improving health equity. Fifty-six stakeholders from the academic, creative and arts, health, community and voluntary sectors participated across six workshops that sought broad engagement and consolidated stakeholder input to develop a research agenda and expand the consortium. Common emerging themes were: (1) understanding complexities in funding creative health; (2) investigating storytelling as a catalyst for change; (3) achieving change through collective action; (4) the role of creative advocacy to change societal and funding structures; (5) evidencing the impact of community-led creative health interventions on health equity. These formed multiple co-produced outputs, including five pillars of a theory of change for the research that underpinned the research questions and determined five interventions to take forward by the research-ready consortium to securing funding for future work. The iterative process of gaining stakeholder input, consolidating it, and seeking further input, helped to incorporate the perspectives of different stakeholder groups into different project outputs. Equitable power-sharing guided decision-making over what to prioritise was important in building ownership of the research agenda and trust among stakeholders. However, this was a lengthy iterative process and sustaining time commitment was difficult for those stakeholders who were not fully funded to participate.