The trials and triumphs of co-producing an evaluation plan: A principles-focused evaluation

Abstract

Background

Recovery Colleges are mental health-oriented education programs that are rooted in principles of peer support and co-production. Co-production, in this context, involves people with lived experience of mental health and addiction challenges and people with other forms of expertise (e.g., mental health professionals, administrators, and researchers) collaborating on the design and actualization of programs and initiatives. Despite co-production being a central feature of Recovery Colleges, very few Recovery College evaluations appear to be co-produced. In addition, there is a lack of research that evaluates the quality of the co-production processes in developing evaluations. The Recovery College at the Centre for Addiction and Mental Health, called the Collaborative Learning College, established an Evaluation Subcommittee with the goal of co-designing and implementing an evaluation plan for the program. In response to the dearth of literature on co-producing Recovery College evaluations and the quality of such collaborative processes, the Evaluation Subcommittee conducted a principles-focused evaluation to assess the quality of their process of co-producing an evaluation plan.

Methods

All members of the Evaluation Subcommittee collaboratively developed and agreed on three principles that they felt were most important in their co-production process. Using a self-narrative approach, each member then produced a reflection on the importance of the principles, the degree to which the committee adhered to them, and the impact. Finally, members engaged in collaborative thematic analysis and co-wrote this manuscript.

Results

The results of this study outline member’s purposes for joining the Evaluation Subcommittee, the strengths and challenges related to embodying the collaborative principles, and the associated impacts.

Conclusions

The findings demonstrate the value of co-producing health education evaluations with people with lived experience and highlight important lessons learned through the Evaluation Subcommittee’s collaborative process, specifically related to mitigating the impacts of power imbalances. These lessons can be valuable for others to consider in their co-production processes.

Plain English summary

Recovery Colleges are mental health-oriented education programs that are rooted in principles of peer support and co-production. This means that people with lived experience co-create programs alongside those with professional expertise. Each program must use feedback to determine the program’s quality through an evaluation process. While co-production is central to Recovery Colleges, few evaluations involve co-production and little research evaluates the quality of co-production processes in developing evaluations.

The Recovery College at the Centre for Addiction and Mental Health, called the Collaborative Learning College, established an Evaluation Subcommittee to co-produce an evaluation plan for the program. To assess the quality of their co-production process, the Evaluation Subcommittee used a principles-focused evaluation, which looks at specific principles to assess how well a program or project aligns with them. The Evaluation Subcommittee developed three principles that were most important in their co-production process. Then, members produced reflections on the principles’ importance, how well the committee followed them, and their impact. Members identified themes across the reflections and wrote this manuscript together.

The findings identified members’ purposes for joining the Evaluation Subcommittee, such as collaboration, teaching and learning from others, and creating an evaluation process consistent with the Recovery College’s values. When discussing challenges, several responses acknowledged the differences in power experienced within healthcare and educational spaces. The findings demonstrate the value of co-producing health education evaluations with people with lived experience and highlight important lessons that others can consider in their co-production processes.

Background

There is a growing body of research demonstrating the value of co-producing health education initiatives with people with lived experience/expertise (PWLE) of accessing healthcare [1]. Co-production in health education involves PWLE, those with expertise stemming from their profession and/or academia, and people who have both of these perspectives collaborating to design and deliver educational initiatives together. Co-production moves beyond a tokenistic approach to engagement by recognizing PWLE as experts and involving them from the very beginning of an educational initiative [2, 3]. Despite a growing interest in co-producing health education initiatives, there remains a lack of literature on assessing the quality of co-production processes [4], particularly in the context of developing evaluations.

The dearth of literature on evaluating co-production is curious given its importance in areas of research and programming such as peer support and recovery-oriented care. As an example, Recovery Colleges are low-barrier mental health-oriented programs that are rooted in principles of peer support and co-production [5]. Emerging in the United Kingdom in 2009, Recovery Colleges have expanded rapidly, with over 220 operating across 28 countries [6]. Although often affiliated with tertiary mental health care services or community mental health agencies, Recovery Colleges offer course-based educational programming rather than clinical interventions. Their focus is on fostering connection, hope, optimism, identity, meaning, and empowerment, regardless of participants’ clinical status [6, 7]. Co-production, in this context, involves PWLE related to navigating mental health and/or substance use challenges, those with learned expertise from profession and/or academia, and people with both perspectives collaborating to design and actualize every aspect of the program. Despite co-production being a central feature of Recovery Colleges and evaluation being a standard practice across these programs, only 14% of Recovery Colleges’ evaluations appear to be co-produced [8]. To our knowledge, there are no studies that evaluate the quality of co-production processes in developing evaluations, especially related to Recovery Colleges.

The setting

In 2019, based on the Recovery College model, The Centre for Addiction and Mental Health (CAMH) established the Collaborative Learning College (CLC) [9]. The goals of the CLC are to be a dynamic, inclusive community that supports people in pursuing their self-identified goals and to catalyze system transformation by challenging power dynamics that privilege professional and academic ways of knowing while relegating lived expertise to the margins. These goals are achieved through person-centered, non-clinical, and low-barrier education that is “co-created and co-led by people with experience of mental health, substance use and/or addiction challenges and/or social services use” [9, p. 1]. Given that co-production is central to Recovery Colleges, this program established an Evaluation Subcommittee in 2022 with the goal of co-designing and implementing an evaluation plan for the CLC.

Recruitment processes for the committee consisted of two distinct calls for expressions of interest, one for PWLE of mental health, substance use and/or addiction challenges and another for people with experience related to program evaluation and/or quality improvement. Selection processes prioritized ensuring that the committee membership was representative of diverse perspectives, experiences, and expertise. The committee, once selected, included nine individuals from a variety of backgrounds including evaluators (n = 2), researchers (n = 1), people who work in the CLC (n = 2), students who access the CLC (n = 3), PWLE of mental health and/or substance use challenges (n = 6), and those who embody multiple of the aforementioned perspectives. Some members participate as part of their paid duties (n = 7) while also having a personal interest and commitment to this work.

The Evaluation Subcommittee is responsible for determining the evaluation measures and approaches for the CLC. The evaluation plan must simultaneously take into account measures that are meaningful to the individuals accessing the CLC, while meeting the reporting obligations of the organization.

Aims and purpose

To address the dearth of literature on the quality of co-production in producing evaluations, we, the Evaluation Subcommittee, examined our own co-production process in situ using principles-focused evaluation (P-FE) methods [10]. The aim of this paper is to share what we have learned with others who are engaging in co-producing mental health education and research and who may be interested in both how to co-produce and how to measure the quality of co-produced initiatives. This process has also served as a reflexive exercise whereby we have identified areas of opportunity where we can further embody the principles of co-production in our processes.

Methods

The impetus for this evaluation came about organically when we began to reflect on the quality of our co-production process while creating an evaluation plan. In reflecting, we recognized that assessing our co-production process required a method that could capture the complexity of valuing the diverse experiences and perspectives of the committee members within the larger socio-political landscape of an academic hospital setting. Although our work was inspired and informed by several excellent engagement evaluation frameworks [11, 12], collectively, we decided to use a PF-E approach as it better aligned with the specific goals and context of our project. This type of evaluation determines the degree to which a program is adhering to core principles and assesses whether doing so is yielding desired results. In our case, it involved determining the principles of co-production that were most important to us, the degree to which we embodied these principles, and the impact of this.

In addition to the committee’s regularly scheduled meetings, members met for an additional one-hour biweekly meeting for a year and a half to complete this P-FE. As the first step, we collaboratively developed and agreed on three principles as the most important in our co-production process. In doing so, we drew on the work of Patton [10] whose GUIDE Framework outlines a process for developing principles that provide meaningful guidance (G) and are useful (U), inspiring (I), developmentally adaptable (D), and evaluable (E). Using a collaborative digital whiteboard to aid in collaborative brainstorming in conjunction with the GUIDE Framework, we decided on the following principles:

• 1. Nurture equitable collaboration through reciprocal engagement.

• 2. Include and leverage the diverse perspectives and experiences in our group.

• 3. Engage in shared decision-making.

Data collection

To understand the importance of our principles, the degree to which we adhered to them, and the impact, using a self-narrative approach, each of us independently produced reflections that described the story of our participation in the Evaluation Subcommittee as related to each of the three principles [13,14,15]. To facilitate the writing of our self-narratives, our committee collectively developed a set of questions to guide members’ reflections (Table 1). There were no guidelines on the length of responses, and members were given the option to provide their reflections through a traditional interview (n = 2) if preferred.

Table 1 Reflection guide

Reflections were then thematically analyzed following Braun and Clarke’s guidelines, which involve data familiarization, generating initial codes, identifying themes, and refining them iteratively [16]. We collectively decided that a single committee member (HH) should be responsible for coding individual reflections to mitigate any possible concerns about anonymity. HH was selected because she had protected time allocated to the project and experience related to qualitative data analysis. Committee members then had the opportunity to review how their data was coded and provide feedback. Coded responses were then iteratively analyzed by our entire committee and grouped into emerging themes, which we discussed refined, and interpreted through the lens of their relationships to our principles, informing both our results section and subsequent discussion.

Patient and public involvement

We used a participatory approach for this P-FE, which, in our case, meant that everything was co-produced. All members of our committee co-produced the data collection process, jointly analyzed the data, co-wrote this manuscript, collectively determined the order of authorship, and collaboratively developed a knowledge translation plan.

Virtual meetings were held bi-weekly with the flexibility for people to “pop in and out” and contribute how and when they saw fit. All members of the committee were invited to attend every meeting and one-on-one catch-up meetings were available for those unable to attend certain meetings. Meetings began with an “icebreaker” question, allowing each of us to continue building personal relationships with one another. This facilitated a sense of comfort which allowed us to actively engage in the group’s work. There were also flexible timelines, giving space for everyone to learn and explore as needed.

Meeting collaboration took the following forms:

• Shared documents.

• Jamboards for brainstorming.

• Didactic educational PowerPoint presentations on different aspects of P-FE.

• Activities and discussions.

We also collectively determined how we wanted to share our learnings from this P-FE. We discussed the value of using the information and learnings to inform our co-production process within the committee going forward but also thought that there would be value in sharing our learnings more broadly. As such, we collectively explored avenues to share learnings with others who may be interested in co-designing evaluations. We determined two paths: (1) academic outputs and (2) non-traditional knowledge translation products. For academic outputs, journal options were reviewed by committee members. The group collectively decided on a target journal for this submission. For non-traditional knowledge translation products, given that academic outputs are often not relevant or accessible to those outside of academia, we decided to produce accessible research outputs such as plain language summaries and arts-based products.

Results

Through our reflections, we each independently shared our perspectives about why we joined the group, the strengths and challenges of our co-production process, and the impact of our principles. In discussing the aggregated reflections together, we have crafted this results section. The results presented are organized by the overarching topics that our group developed to guide our reflections: (1) purpose for joining the group (2) strengths (3) challenges, and (4) the impact of adherence to principles. Each topic is accompanied by quotes from our reflections, which we felt were emblematic of the theme.

Purpose for joining the group

While exploring our collaborative process and associated principles, we took time to reflect on what motivated us to join the Evaluation Subcommittee. Specifically, we joined the Evaluation Subcommittee for three main reasons: to pursue opportunities for (1) collaboration and community building, (2) multi-directional learning, and (3) contributing in a values-based way.

Collaboration and community building

Through our reflections, many of us expressed that the opportunity to collaborate with individuals from the CLC and, on a broader scale, CAMH, to contribute to the CLC community was a key motivating factor for our committee participation:

I was looking to work with a diverse group, especially with the broader CLC community to co-produce and co-develop an evaluation plan to evaluate and measure the CLC.

I was excited to work with other people with lived experience of mental health and/or substance use challenges on a collaborative project.

Multidirectional learning

Some of us also joined the committee for opportunities for multi-directional learning. Multi-directional learning refers to the practice of people with different perspectives teaching and learning from each other and co-creating new knowledge at the intersections of their perspectives [17]. Specifically, some of us wanted to learn new things and build new skills, such as those related to co-production:

I had read a lot of literature and been involved in many discussions on the subject of co-production before joining this group, but I didn’t really have any first-hand experience with co-production and was excited to gain some.

Others wanted to gain evaluation experience:

I wanted to learn from others with previous experience in the evaluation process as I’d never helped with the creation of an evaluation plan.

In addition to a desire to learn, we also wanted to share our knowledge, skills, and perspectives in a meaningful way:

[The Evaluation Subcommittee was] an amazing opportunity to be heard. Since my breakdown, I have wanted to be heard about what it is like to have mental health concerns and to address stigma. Not only stigma from those outside of me (e.g., co-workers, friends, community) but also my own stigma against myself (e.g., [feeling that] I can’t contribute anymore, my thoughts are no longer important or valid).

Contributing in a values-based way

Many of us shared that we joined the committee to ensure the CLC lives up to its commitment to co-production and purported values of self-determination, lived experience leadership, meaningful engagement, and collaboration [9]. Specifically, we wanted to ensure that these values were upheld throughout the evaluation of the CLC:

My purpose for working with this group is to co-create evaluation approaches and measures that reflect the priorities of the CLC’s student body.

I really value the opportunity to play a part in helping to ensure that the CLC lives up to its values, and in continually and critically examining our work to highlight our successes or identify areas where we might be falling short. Most of my education in research and evaluation methodology has conformed to fairly mainstream, positivist traditions. I’ve often been critical of these traditions for devaluing the experiences and perspectives of the individuals who make up the populations being studied, and I like being able to better embody my own values in my work.

Implementation of principles

Consistent with the P-FE approach, we reflected on how well our committee adhered to our core principles. As such, we identified various strengths of our co-production process as well as challenges, specifically related to the impact of power dynamics.

Strengths of our co-production process

Through analyzing our reflections, we identified three overarching strengths of our co-production processes: (1) time and space to dialogue, (2) inclusion, and (3) learning through collaboration.

Time and space to dialogue

A strength of our collaborative process was having the time and space to engage in dialogue. This involved being able to go back and forth with ideas, navigate differences of opinions or challenges, and think about things in new ways to reach consensus:

A willingness to be somewhat flexible with timing, both in terms of the agendas of individual meetings and of broader timelines for the development of an evaluation plan, has been vital in ensuring decisions are made as a group by allowing for thorough discussions and space to resolve confusion or disagreements.

Most of the time, I feel that there is space for everyone to explain their perspective and ideas and to go back and forth in dialogue, offering new suggestions until we reach a consensus.

Inclusion

Through our collaborative process, some of us indicated feeling that our unique expertise, perspectives, and lived experiences were valued and contributed to a greater goal.

I feel the group has created a space of non-judgment, open-mindedness, mutual respect and safety. In this kind of a space, I feel more inclined to share my thoughts and engage in an honest and authentic way.

This sense of inclusion was supported by incorporating regular check-ins during every meeting. This approach cultivated a heightened sense of trust and safety and fostered an atmosphere of openness. We felt more comfortable sharing our ideas, seeking clarification when needed, and expressing dissenting opinions due to the structure of the meetings:

I felt comfortable enough to engage as fully as I have… because of not only the people involved, but also the manner in which meetings have been held, particularly with the check-ins where I have gotten to know people on a personal level.

From the check-ins forward, everyone is primed to give each other all the space required to think through concepts, present ideas, express concerns, and ask questions about concepts and approaches that they may not fully understand or are confused by.

Learning through collaboration

Many of us felt that we had achieved our goals of sharing our knowledge and learning from others with other areas of expertise through the collaborative process. Those of us who came in with little evaluation expertise described the learnings that we gained through the collaborative process:

I have learned quite a bit about evaluation, which was my original goal. I have learned to think differently about what can be measured, and what kind of questions we need to ask about how we measure things, and how we pose evaluation questions.

Those of us with expertise in evaluation noted that using a co-production approach revealed the assumptions underlying our previous work and demonstrated the value of collaborative methods in evaluation:

Attempting to include diverse voices in the design of an evaluation means integrating many different ideas about what is important to measure and how, and this has prompted a lot of deeper reflection in me around what constitutes rigorous evidence and about the compatibility of different epistemological viewpoints within a single evaluation project.

Challenges

When discussing ways in which we have fallen short of upholding our principles, we identified a common theme around the impact of power dynamics. We discussed (1) the impact of hierarchies, (2) missed opportunities, and (3) opportunities moving forward.

Impact of hierarchies

Mental health systems and associated academic structures are deeply hierarchical. That is, certain voices, ways of knowing, subjectivities, and roles are situated as privileged and dominant while others are silenced and marginalized. Our group was not immune to the impacts of this. Some of us described how the power dynamics in the group led to instances of feeling rushed and scattered due to messaging emanating through those who were ultimately accountable to the institution by virtue of their role for the completion of promised deliverables (i.e. an evaluation plan):

At times I felt we were rushed. There were occasions when it felt like there was a timeline that wasn’t being met.

I feel like sometimes, (not so much in the last few meetings) we’re scattered and rushed. We’ll do multiple things at a meeting, and then we won’t come back to it for a couple of meetings. I sometimes feel like I’m starting from scratch.

Some of us also noted that, at times, the voices of those in/with power took precedence, consequently limiting space for other voices and perspectives:

For the first number of months, the meetings seemed to be run in a top-down manner [with] those with evaluation expertise determining and delivering content with little check-in to see if people were understanding content.

There were a couple of occasions where I felt I was dismissed by comments that may not have resonated with others in/with power. I don’t think it was intentional, however, it can lead to a fractured sense of safety and trust. Differences of opinion are going to happen for sure, but glossing over [things] can feel dismissive.

Missed opportunities

We also explored things that we would do differently to mitigate the negative effects of power dynamics. Specifically, some of us discussed that we would have liked to see a different composition of the group with more representation of CLC students:

Reflecting on the diversity of the group, I would like to have seen more students of the CLC within the group. While there is an excellent representation of people who identify as having living and lived experience, additional people who share that identity and who are students of the CLC would help us to meet the goal of achieving an evaluation plan that reflects the priorities of students of the college.

We also discussed that having a group agreement upfront could have helped mitigate some of the negative impacts of power imbalances:

I think that creating shared values, principles, and practices for the group should have happened first, and that group practices should indicate what somebody can do when the principles/values of the group are not being lived up to, especially when there is a power differential.

A terms of reference was developed without the input of the final members of the subcommittee (PWLE) and we have yet to revisit this task. While it is our intention to do so, I believe this should have been done in collaboration with the group from the outset.

Opportunities moving forward

Given that the work of our committee is not yet complete, we discussed how we will implement lessons learned to inform future group processes related to acknowledging and mitigating the negative effects of power dynamics. In particular, a few of us emphasized the importance of conducting formal reflexive practice discussions to assess whether each of us is engaged equitably and to make adjustments if equitable engagement is lacking:

Probably, we need to do more formal check-ins to ensure all members have a feeling of engagement.

To promote equitable engagement, some of us proposed implementing a process to catch members up following an absence with the aim of ensuring all voices and perspectives are considered in decision-making:

I’m also reflecting on the nature of consensus building in the context of so small a group, particularly as it relates to meeting attendance or absence. In instances when committee members have been unavailable, I think we’ve generally tried to move the work forward regardless, but perhaps we could be doing more to ensure people are fully brought up to speed after absences and are involved in decisions that may have been considered without their input.

Impact of adherence to principles

In alignment with a P-FE approach, we discussed the impact of our adherence to our co-production principles. Although there were ways in which we fell short of fully realizing adherence to our principles, our collaborative process yielded important and valuable results. Specifically, we discussed how our co-production process has resulted in (1) a rich and purposeful evaluation development process, (2) high quality of work, and (3) authentic and productive relationships.

Rich and purposeful evaluation development process

We discussed how our co-production process allowed us to explore and develop creative approaches to collaboratively developing an evaluation plan:

The subcommittee is diverse with members coming from different backgrounds and areas of expertise and therefore allows for a variety of knowledge to be contributed.

By creating spaces for everyone to contribute, we allow for a richer pool of ideas which ultimately leads to more innovative and meaningful outcomes… and the potential for creating [an innovative] and new evaluation plan.

Quality of work

We also found that achieving deliverables (i.e., logic model, evaluation plan) with the potential for far-reaching impact was made possible through mutual learning and collaboration:

I’m impressed with the quality of the work this group has been able to co-create so far. I had been accustomed to thinking of co-production in terms of addressing power imbalances and amplifying voices that might not otherwise be heard, but I think the slow, deliberate, consensus-driven approach this group has taken has been leading to a really refined final product and that’s something I hadn’t considered before… This evaluation might be the most ambitious I’ve ever been involved in with regards to the diversity of audiences to whom the results are meant to be relevant.

Authentic and productive relationships

Finally, we discussed how our collaborative process fostered strong, authentic, and productive relationships amongst one another:

[The Evaluation Subcommittee’s principles] encourage open communication and empathy, leading to stronger relationships and better group dynamics.

I was surprised at the honesty of people, not only in expressing their opinions but in developing relationships with the other subcommittee members.

Discussion

Evaluation can be a useful tool to identify the strengths of an initiative, inform quality improvement, and guide decision-making processes. However, evaluations are usually designed by evaluation experts with little or no engagement of those most impacted (i.e., those who offer and access the program). Our work offers key insights into the value of co-producing health education evaluations with PWLE as well as potential challenges that those undertaking this work should consider.

There are several lessons that we learned through our collaborative process. For one, although fitting community engagement into academic structures that privilege positivist researcher-led processes is challenging and uncomfortable, we contend that the benefits of co-production outweigh these challenges. We acknowledge this discomfort and muddle through it together, recognizing that change can only be realized at the edge of what we know – at the edge of our comfort zones. This is especially true when considering power.

Our team bumped up against two hierarchical structures, healthcare and academia. Despite our commitment to power-sharing, the impacts of power differentials seeped into our process. With time and space for discussion, we were able to deeply engage with power rather than “sweeping it under the rug”. While power dynamics can never be fully eliminated, we found creative ways to mitigate the negative impacts of these dynamics and practice accountability when needed. Through our process of reflection, we have come to realize some of the ways that could have helped us further mitigate the impacts of power and work more equitably going forward. For example, this P-FE served as an impetus for us to co-create a terms of reference and a set of mutual expectations to guide our collaborative work. We will take our learnings forward with us in this project as well as into our other work. We offer our learnings to you, the reader, as well.

Another key learning that emerged through our collaborative process was the need to reconceptualise academic timelines to fully embody principles of co-production. Some aspects of our process, especially in the beginning, took much longer than anticipated. This was due to the differing perspectives and experiences of the group and the associated additional time needed to be inclusive of everyone’s perspectives. Although this made setting hard deadlines difficult, this flexibility created space for unexpected discussions that resulted in richer results that would not have been possible with shorter deadlines and fewer opportunities for everyone to participate. Although the additional time and space for dialogue may not be traditionally seen as productive, we found it to be precious, as it helped to forge relationships among the group by allowing us to come together as people first, with passions, struggles, and stories, thus increasing the skills and experience available to us and enriching our team dynamic. Timelines for co-production must consider the time needed for set-up (i.e., terms of reference, shared values, group agreement), relationship-building, and multi-directional learning. Often, co-production requires taking a step back or pausing to further consider a question or concept that a committee member has raised to make to be sure we all share an understanding of our current task. It may also involve getting a committee member up-to-speed if they have been absent or pivoting based on ideas and opportunities that emerge organically. Funding arrangements for co-production must account for the flexible timelines required for co-production to thrive. When external processes and structures are not compatible with the flexibility required, these external timelines should be communicated transparently to the group, who can then collectively determine how to navigate these pressures.

Working in a values-based way to move from tokenistic engagement to co-production can be challenging. It involves taking time and space to push back, slow down, pause, pivot, and explore creative tangents. It requires challenging traditional power structures in which the researcher or evaluator has final say or control over the process or final project. The process is iterative, unfolding based on everyone’s ideas, how people feel they will work best on a particular day, and with consideration of people’s strengths, interests, and stressors.

Limitations of our P-FE process

When we began our P-FE process, our group had already been working together for six months. While there were undoubtedly principles that shaped our work, these principles were not explicitly articulated until we engaged with this P-FE process. Because the development of the broader evaluation plan was already underway before we decided to conduct this P-FE, our principles may inadvertently reflect favourable descriptions of the ways we were already working rather than as guideposts to inform the conduct of our work.

It would be a mistake to conclude that, just because we have taken steps to redress or mitigate power imbalances in this group, that such imbalances have been eliminated. Although we have taken important steps to mitigate these within our group, it is important to consider how power structures within our group, as well as those embedded in expectations from academia about what knowledge is valuable and publishable, shaped this P-FE and the writing of this manuscript. The perspectives of those who are more familiar with navigating academic structures were centred to guide the group through the process of conforming to academic norms and expectations. Although our work deliberately challenges conventional notions of what counts as expertise and knowledge, we are still seeking recognition through the same exclusionary structures we are aiming to destabilize to reach audiences whom we want to invite to think differently [18]. We continue to grapple with these tensions.

Conclusions

Co-production is not a simple task. It is messy, time-consuming, and incredibly hard work. Sometimes it involves moving backward before moving forward. As our P-FE shows, it is a worthy endeavor. Co-production fosters meaningful inclusion and involvement from a variety of different viewpoints, backgrounds, experiences, and voices. These varying perspectives bring in fresh ideas that allow for richer and more nuanced results.

Our work emphasizes the value of co-producing health education evaluation with people with diverse perspectives while centering the voices of PWLE. The value was twofold: people and outputs. In terms of people, by establishing a group of diverse collaborators with a focus on centring lived experience, we developed strong collaborative relationships, challenged traditional power dynamics that privilege professional ways of knowing over lived expertise, and co-created new knowledge at the intersection of our diverse perspectives. Regarding outputs, even though our work is still ongoing, we have developed a logic model, vision statement, and robust evaluation plan for the CLC.

Finally, this P-FE exemplifies the rich information gained through reflecting on the quality of co-production processes and evaluating adherence to co-production principles. Through this reflexive practice exercise, we offered key insights into the strengths of our co-production processes, challenges, and lessons that we will use to further our embodiment of co-production principles going forward as well as insights that others can consider in their co-production processes.