School staff experiences on involvement in a co-creation process: a Health CASCADE scoping review and thematic synthesis.

Background: Implementing public health interventions in schools requires active involvement of multiple stakeholders and adaptation of interventions to fit local contexts, to account for successful design, implementation, and consequently effectiveness of these interventions. Active collaboration, preferably in a co-creation process, with school staff is needed to enhance the implementation of school-based public health interventions. However, involving them in research through a co-creation process is challenging due to competing demands on their time. Hence, there is a need for insights into the factors facilitating or impeding co-creation processes involving school staff.

Methods: To gain in-depth knowledge of school staff's experiences a scoping review and thematic synthesis have been conducted. Peer reviewed articles written in English and published between January 2012 and November 2023 were retrieved from ERIC, Education Database, Medline (PubMed interface), Embase, Web of Science, Scopus, and Health CASCADE Co-creation Database. Considering the high amount of search results the title and abstract screening was performed using ASReview. A thematic synthesis was conducted on the included articles.

Results: Ten scientific peer reviewed articles were included and thematically synthesised. Six descriptive themes described factors influencing the co-creation process, including competing work roles and responsibilities of school staff, multistakeholder collaboration, benefits of participation in the co-creation process, power imbalances between different stakeholders, and school staff's lived experiences. Additionally, four analytical themes emerged indicating that demands of the co-creation process outweigh its benefits. To tackle excessive demands school staff preferred a guided process in which high-level participation was less important. School staff joined the co-creation process to serve students and emphasised the importance of being heard and taken seriously.

Conclusions: School staff indicated that excessive demands outweigh the benefits experienced during the co-creation process. Therefore, school staff preferred less time-intensive processes. Improving students outcomes was school staff's motivation to be involved, which asks for processes with student-related goals and observable student benefits. Moreover, school staff needs to be acknowledged as an expert and valued for their involvement. These results should be considered to make co-creation processes involving school staff more feasible and satisfactory.