Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations.

Background: Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems.

Objective: To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action.

Design: Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study.

Setting And Participants: Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations.

Interventions: Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care.

Main Outcome Measures: Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA.

Results: The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples.

Discussion And Conclusions: The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.