JMIR Publications

ABSTRACT

Background:

Mounting evidence suggests that reliance on BMI as a primary measure of childhood obesity, and health more broadly, is problematic. There are increasing calls for alternative approaches to understanding childhood health. Our previous research found that co-production of research and adopting a complex systems model of evidence can be transformative in helping to reconceptualise childhood health. However, less is known about how co-production helps prioritise elements for exploration or how we should assess the value of co-production in research development. This study addresses these gaps by co-producing a refined logic model (a graphical representation of a theory) of the influences on children’s health to support public health research and policy-making.

Objective:

This study aimed to: (1) identify critical contextual features for stakeholders when planning school-based interventions addressing physical activity, healthy eating, and mental wellbeing; (2) understand the difference that we, as co-producers, make when working together; and (3) identify learning about the process of producing and refining a logic model.

Methods:

Through collaborative workshops, we refined an existing theoretical framework identifying contextual influences on childhood health. We critically reviewed existing frameworks for evaluating co-production, creating a new evaluation approach for our collaborative practices, complemented by surveys and workshop feedback.

Results:

Six criteria were identified and applied to refine the original logic model, significantly reducing complexity. The revised model prioritised systemic and policy factors, emphasising environmental structuring rather than individual behaviours, and incorporated a stronger emphasis on life course factors. We used a tool and process developed specifically for this project, which may have broader utility for other research projects, to understand the value of working together. While many of us recognised that the impacts of the project and working together were unexpected and for some of us, transformational, we did nevertheless identify some factors that could support co-production in future. These included the need for clearer initial discussions on positionalities, role expectations, and autonomy.

Conclusions:

Our refined model aligns with broader calls to shift away from narratives centred on personal responsibility in childhood health. This research further demonstrates the practical value and feasibility of co-produced theoretical frameworks, effectively reshaping the focus of research from the outset and challenging established assumptions. Clinical Trial: The protocol (Version 4, April 2024) is available on the NIHR’s Funding and Awards database (see NIHR161485) and registered on the Research Registry (unique identifying number: 10035).