Enablers and Barriers to an Experience-Based Co-Design Process to Develop Service Improvements in Enhanced Community Care in Ireland: A Qualitative Study.

Background: Experience-Based Co-Design (EBCD) is a popular collaborative process where service users and healthcare providers share their experiences of using and delivering services to identify ways to adapt services to enhance those experiences.

Objective: This study aimed to identify enablers and barriers to the successful implementation of EBCD as part of Ireland's recently adopted Enhanced Community Care (ECC) programme.

Design: Service users and staff at two sites (N = 17) participated in an accelerated EBCD process designed to enhance service provision for older people and those living with chronic conditions. This included four co-design working group sessions per site.

Methods: Transcripts from the co-design working groups and from brief follow-up interviews with individual participants were analysed. Thematic analysis was used to identify enablers and barriers to the EBCD process.

Results: We generated six key themes reflecting barriers and enablers; enablers were the fundamental role of the facilitator (Theme 1), a flexible approach that met group members' needs (Theme 2) and active and interactive activities to support participant engagement (Theme 3). The fundamental role of the facilitator was also identified as a barrier (Theme 4); additional barriers included balancing experience-sharing and decompressing (Theme 5) and the scope of the group as an invisible barrier (Theme 6), which reflected challenges in facilitating dialogue about change when participants were aware of system-level constraints on the potential for change.

Conclusions: The facilitator is critical in ensuring the successful implementation of the EBCD process. Considering how best to draw on the facilitator strengths while also ensuring that the service user perspectives are equally weighted with staff perspectives is important for effective communication within EBCD projects.

Patient Or Public Contribution: Service users (also including carers) at two sites participated in EBCD projects alongside health and social care professionals, ultimately generating two service improvements for the ECC programme. The participation of these service users was celebrated at an academic conference, which was attended by a number of service users, and where the outcomes of the EBCD project were presented.