JMIR Publications

ABSTRACT

Background:

Co-production of health and care involving patients, families and professionals in care processes can create joint learning about how to meet patients’ needs. Although barriers and facilitators to co-production have been examined previously in various healthcare contexts, the preconditions for co-production in Swedish chronic cardiac care contexts are yet to be explored. This study is set in the health system of the Swedish region of XX County, and is part of system-wide efforts to promote better health for persons with heart failure.

Objective:

To test the usefulness of the Capability, Opportunity, Motivation, Behavior (COM-B) model when assessing heart failure (HF) patients’, family members’ and professionals’ perceived barriers to, and facilitators of, co-production of health and care in a Swedish chronic cardiac care context, as a guide for subsequent initiatives.

Methods:

Data collection involved one focus group interview with HF patients (n=5), one with family members (n=5), one with professionals in primary care (n=7) and one with professionals in cardiac care (n=4). In addition, HF patients wrote diaries about their thoughts regarding co-production. Using a deductive approach to content analysis, underpinned by the COM-B model, barriers and facilitators were categorized into capabilities, opportunities and motivation to co-produce health and care.

Results:

The participants showed limited understanding of co-production as a practice. They appeared to view co-production as a privilege to be offered to patients on top of traditional care, and rarely as an approach for improving healthcare processes. The interviews revealed the limited health literacy among patients, and the professionals’ struggle to convey health information to these patients. Co-production was considered to be more resource-intensive compared to traditional care. Different expectations of stakeholders’ roles were revealed: professionals expected older patients not to want to co-produce health and care. All participants expected professionals to be in charge of healthcare services. The family members’ position involved trying to balance support for their relatives with understanding when, how and with whom to co-produce. Presumed co-production benefits motivated stakeholders to co-produce: co-production was recognized to promote patients’ and family members’ sense of security in everyday life and to motivate patients to improve self-care. However, the participants recognized that motivation to co-produce health and care varies over time among stakeholders.

Conclusions:

Co-production can be facilitated by the stakeholders’ motivation to co-produce health and care. However, varying understandings of co-production, patients’ limited health literacy, unease with power sharing between patients and professionals and resource constraints are barriers to co-production that need to be managed to promote co-produced care and better health for persons living with heart failure. Further research is warranted to explore how to co-produce healthcare services with heart failure patients and how leaders can facilitate the inevitable cultural change it requires and represents.