JMIR Publications

ABSTRACT

Background:

Addressing the adverse impacts of climate change on human health requires global effort across multiple sectors. Impacts on food production, extreme heat, air pollution, and a lack of safe drinking water sources due to drought or increasing water salinity are only a few examples of climate change effects that can pose direct or indirect risks to human health. People living in low-and middle-income countries are particularly vulnerable to the health crises induced by climate change. Context-specific solutions to tackle such challenges are therefore essential to ensure preventative measures are in place for mitigating such risks.

Objective:

This study protocol outlines an integrated, participatory approach to co-create multi-sectoral interventions tailored to specific environmental and health challenges in Bangladesh, India and Indonesia. This work is done as part of the Global Health Research Centre for Non-Communicable Diseases and Environmental Change funded by the National Institute of Health Research. The overall aim is to collaboratively design and assess interventions that deliver dual benefits for planetary and human health.

Methods:

To address the multisectoral nature of the challenges, the study will adopt a co-creation methodology that blends co-design and co-production approaches. While the problem areas are specific to each context – tackling air pollution due to plastic burning in Indonesia, improving dietary diversity of public food procurement systems and managing extreme heat in India, and mitigating drinking water salinity in Bangladesh, the underlying co-creation framework is consistent and can be adapted to the needs of each study setting. The workflow consists of four key stages guided by an existing co-creation framework: Planning, Developing, Evaluation, and Reporting, with the six core elements of the Medical Research Council’s Complex Intervention Development Framework embedded throughout the process. Drawing on the Double Diamond design process, the co-creation stage involves the following phases: co-development of a theory of change to explore potential context-specific interventions; shortlisting of intervention components through gap analysis and prioritisation; co-designing and co-producing selected intervention components; and assessing appropriateness and feasibility of intervention implementation. The co-creation process will be evaluated using the Research Quality Plus for Co‑Production framework to ensure methodological rigour and quality.

Results:

Co-creation will take place over six months. Sampling and recruitment of co-creators (key stakeholders across sectors) have been completed in all three countries. We have developed the tools for co-creation phase, informed by the findings from formative research and received necessary ethical approval to conduct these activities.

Conclusions:

The co-creation of multisectoral interventions to tackle both environmental change and health is a comparatively new domain of implementation research. This protocol addresses the complex, multidimensional and unique nature of such interventions by developing a structured and scientifically sound approach to be implemented in real-life settings.