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"Giné-Garriga, Maria"
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Establishing a Health CASCADE–Curated Open-Access Database to Consolidate Knowledge About Co-Creation: Novel Artificial Intelligence–Assisted Methodology Based on Systematic Reviews
by
Balaskas, George
,
Steiner, Artur
,
de Boer, Janneke
in
Access
,
Artificial Intelligence
,
Authorship
2023
Co-creation is an approach that aims to democratize research and bridge the gap between research and practice, but the potential fragmentation of knowledge about co-creation has hindered progress. A comprehensive database of published literature from multidisciplinary sources can address this fragmentation through the integration of diverse perspectives, identification and dissemination of best practices, and increase clarity about co-creation. However, two considerable challenges exist. First, there is uncertainty about co-creation terminology, making it difficult to identify relevant literature. Second, the exponential growth of scientific publications has led to an overwhelming amount of literature that surpasses the human capacity for a comprehensive review. These challenges hinder progress in co-creation research and underscore the need for a novel methodology to consolidate and investigate the literature.
This study aimed to synthesize knowledge about co-creation across various fields through the development and application of an artificial intelligence (AI)-assisted selection process. The ultimate goal of this database was to provide stakeholders interested in co-creation with relevant literature.
We created a novel methodology for establishing a curated database. To accommodate the variation in terminology, we used a broad definition of co-creation that encompassed the essence of existing definitions. To filter out irrelevant information, an AI-assisted selection process was used. In addition, we conducted bibliometric analyses and quality control procedures to assess content and accuracy. Overall, this approach allowed us to develop a robust and reliable database that serves as a valuable resource for stakeholders interested in co-creation.
The final version of the database included 13,501 papers, which are indexed in Zenodo and accessible in an open-access downloadable format. The quality assessment revealed that 20.3% (140/688) of the database likely contained irrelevant material, whereas the methodology captured 91% (58/64) of the relevant literature. Participatory and variations of the term co-creation were the most frequent terms in the title and abstracts of included literature. The predominant source journals included health sciences, sustainability, environmental sciences, medical research, and health services research.
This study produced a high-quality, open-access database about co-creation. The study demonstrates that it is possible to perform a systematic review selection process on a fragmented concept using human-AI collaboration. Our unified concept of co-creation includes the co-approaches (co-creation, co-design, and co-production), forms of participatory research, and user involvement. Our analysis of authorship, citations, and source landscape highlights the potential lack of collaboration among co-creation researchers and underscores the need for future investigation into the different research methodologies. The database provides a resource for relevant literature and can support rapid literature reviews about co-creation. It also offers clarity about the current co-creation landscape and helps to address barriers that researchers may face when seeking evidence about co-creation.
Journal Article
Grey literature scoping review: a synthesis of the application of participatory methodologies in underrepresented groups at an elevated risk of dementia
2025
Background
Diverse populations are more exposed to life course influences on adverse ageing, including brain ageing. Research into dementia in the United Kingdom inadvertently lacks diversity. Therefore, there is a need for more inclusive dementia research, developed in a way to ensure those who are currently missing from standard health data are represented. This may warrant the use of co-creation (emphasising collaborative creation and solution development), drawing on participatory methodologies in healthcare, research and service delivery.
Methods
This study presents a scoping review of grey literature using Arksey and O’Malley’s methodology. Literature was sourced from the Patient Experience Library and supplemented by a targeted Google Scholar search, employing snowball sampling to identify additional materials. The search strategy incorporated keywords such as “marginalised”, “vulnerable”, “disadvantaged” and participatory terms like “co-creation” and “co-design”. Two reviewers independently screened and extracted key higher-level attributes (e.g., type of report, purpose of the activity (design), participating stakeholders/target populations) as well as data related to “co-creation process dimensions” and “participation levels”.
Results
Our review identified 30 grey literature reports on participatory methodologies among underrepresented groups living with or at elevated risk of dementia, covering diverse locations within the United Kingdom. The reported activities aimed to enhance healthcare and social services through stakeholder participation. Our findings highlight a focus on multi-stakeholder collaborative action as the dominant co-creation dimension identified. However, there was also a notable absence of more inclusive methodologies, with consultation being the most commonly used approach.
Conclusions
Our scoping review highlights the value of grey literature in understanding participatory methodologies for underrepresented populations at risk of or living with dementia. It reveals there is still a potential need to shift from mere consultations to sustained partnerships, promoting meaningful inclusion and greater ownership of (health) outcomes among these populations.
Ethics and dissemination
Ethical approval was not required for this grey literature scoping review.
Clinical trial number
Not applicable.
Journal Article
Exploring co-adaptation for public health interventions: insights from a rapid review and interviews
by
Deforche, Benedicte
,
de Boer, Janneke
,
Erikowa-Orighoye, Oritseweyinmi
in
Adaptation
,
Analysis
,
Biostatistics
2025
Background
Adapting co-creation research processes and/or public health interventions improves the fit between the intervention and population of interest, potentially resulting in more relevant and effective interventions. Mode 2 research approaches (e.g., co-creation, co-production, co-design, community-based participatory research, and participatory action research) can ensure that adaptations fit the socio-cultural and economic contexts. However, an overview of existing practices and how to co-adapt is lacking. This study aimed to provide an overview of the use of co-adaptation in co-creation processes and/or public health interventions.
Methods
We conducted a rapid review search on the Health CASCADE co-creation database. Relevant peer-reviewed studies reporting on co-adaptation of public health interventions were identified. A call for case studies via social media and co-authors’ snowballing was issued to perform interviews with co-creation researchers gaining insights into how co-adaptation was applied from unpublished studies and practice. Interviews were analysed using template analysis.
Results
Fourteen studies addressed various public health issues by co-adapting co-creation processes, intervention activities, communication platforms, monitoring strategies, training components, and materials’ language and tone. Most studies lacked detailed reporting on the co-adaptation process, though some provided information on group composition and number, duration, and methods applied. Two out of 14 studies used a framework (i.e., Intervention Mapping Adapt), seven described their adaptation procedure without naming a specific framework, and five did not report any procedures or frameworks. Five of seven case studies used adaptation frameworks (e.g., ADAPT guidance). Interviews provided insights into the co-adaptation process emphasising the importance of contextual fit, integrating prior knowledge, and logging adaptations.
Conclusions
This study is the first introducing the concept of and exploring co-adaptation of co-creation processes and/or public health interventions. It provides details regarding adaptations made, whether and which frameworks were used, and procedures applied to adapt. The findings highlight the need for tailored frameworks for co-adaptation and better reporting of co-adaptation processes.
Journal Article
Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
by
Roqué, Marta
,
Wert, David M.
,
Soto-Bagaria, Luis
in
Aged
,
Aging - physiology
,
Aging - psychology
2019
Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.
Journal Article
The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis
2020
Background
Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential.
Methods
A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies.
Results
A total of 77 adult studies (
n
=62, RCTs) and 84 studies (
n
=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I
2
83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I
2
65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I
2
86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I
2
98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I
2
98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes.
Conclusions
Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB.
Journal Article
Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study
2024
Background
Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents.
Objectives
To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI.
Design and setting
Cross-sectional study in 5 NHs conducted from January to March 2020.
Methods
We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed.
Results
We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a
p
-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44,
p
=.003), anticholinergic activity (OR = 3.50,
p
=.004) and risk of sarcopenia using SARC-F (OR = 2.75,
p
=.041) were associated with UI.
Conclusions
The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.
Journal Article
Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components
by
Zapata Restrepo, Jorge Raul
,
Davis, Aaron
,
de Boer, Janneke
in
Collaboration
,
Evaluation
,
Formative evaluation
2024
BackgroundCo-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation.MethodsWe searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components.Results54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation.ConclusionThe broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.
Journal Article
Investigating the impact of physical activity on mitochondrial function in Parkinson’s disease (PARKEX): Study protocol for A randomized controlled clinical trial
by
Avellanet, Merce
,
Deus, Cláudia Maria
,
Martínez-Vicente, Marta
in
Analysis
,
Care and treatment
,
Clinical trials
2023
Parkinson’s disease (PD) is characterized by the progressive dopaminergic neuron degeneration, resulting in striatal dopamine deficiency. Mitochondrial dysfunction and oxidative stress are associated with PD pathogenesis. Physical activity (PA) has been shown to ameliorate neurological impairments and to impede age-related neuronal loss. In addition, skin fibroblasts have been identified as surrogate indicators of pathogenic processes correlating with clinical measures. The PARKEX study aims to compare the effects of two different PA programs, analyzing the impact on mitochondrial function in patients’ skin fibroblasts as biomarkers for disease status and metabolic improvement. Early-stage PD patients (n = 24, H&Y stage I to III) will be randomized into three age- and sex-matched groups. Group 1 (n = 8) will undergo basic physical training (BPT) emphasizing strength and resistance. Group 2 (n = 8) will undergo BPT combined with functional exercises (BPTFE), targeting the sensorimotor pathways that are most affected in PD (proprioception-balance-coordination) together with cognitive and motor training (Dual task training). Group 3 (n = 8) will serve as control (sedentary group; Sed). Participants will perform three sessions per week for 12 weeks. Assessment of motor function, quality of life, sleep quality, cognitive aspects and humor will be conducted pre- and post-intervention. Patient skin fibroblasts will be collected before and after the intervention and characterized in terms of metabolic remodeling and mitochondrial bioenergetics. Ethical approval has been given to commence this study. This trial is registered at clinicaltrials.gov (NCT05963425). Trial registration. https://classic.clinicaltrials.gov/ct2/history/NCT05963425 .
Journal Article
Development of a New Index of Balance in Adults with Intellectual and Developmental Disabilities
2014
The first objective was to propose a new model representing the balance level of adults with intellectual and developmental disabilities (IDD) using Principal Components Analysis (PCA); and the second objective was to use the results from the PCA recorded by regression method to construct and validate summative scales of the standardized values of the index, which may be useful to facilitate a balance assessment in adults with IDD.
A total of 801 individuals with IDD (509 males) mean 33.1 ± 8.5 years old, were recruited from Special Olympic Games in Spain 2009 to 2012. The participants performed the following tests: the timed-stand test, the single leg stance test with open and closed eyes, the Functional Reach Test, the Expanded Timed-Get-up-and-Go Test. Data was analyzed using principal components analysis (PCA) with Oblimin rotation and Kaiser normalization. We examined the construct validity of our proposed two-factor model underlying balance for adults with IDD. The scores from PCA were recorded by regression method and were standardized.
The Component Plot and Rotated Space indicated that a two-factor solution (Dynamic and Static Balance components) was optimal. The PCA with direct Oblimin rotation revealed a satisfactory percentage of total variance explained by the two factors: 51.6 and 21.4%, respectively. The median score standardized for component dynamic and static of the balance index for adults with IDD is shown how references values.
Our study may lead to improvements in the understanding and assessment of balance in adults with IDD. First, it confirms that a two-factor model may underlie the balance construct, and second, it provides an index that may be useful for identifying the balance level for adults with IDD.
Journal Article
Impact of a workplace ‘sit less, move more’ program on efficiency-related outcomes of office employees
by
González-Suárez, Angel M.
,
Martínez-Lemos, Iván
,
Bort-Roig, Judit
in
Absenteeism
,
Adult
,
Automation
2017
Background
Few studies have examined the impact of ‘sit less, move more’ interventions on workplace performance. This study assessed the short and mid-term impacts of and patterns of change within, a 19-week workplace web-based intervention (Walk@WorkSpain; W@WS; 2010–11) on employees´ presenteeism, mental well-being and lost work performance.
Methods
A site randomised control trial recruited employees at six Spanish university campuses (
n
= 264; 42 ± 10 years; 171 female), assigned by worksite and campus to an Intervention (IG; used W@WS;
n
= 129; 87 female) or an active Comparison group (A-CG; pedometer, paper diary and self-reported sitting time;
n
= 135; 84 female). A linear mixed model assessed changes between the baseline, ramping (8 weeks), maintenance (11 weeks) and follow-up (two months) phases for the IG versus A-CG on (i) % of lost work productivity (Work Limitations Questionnaire; WLQ); (ii) three scales for presenteeism (WLQ) assessing difficulty meeting scheduling demands (Time), performing cognitive and inter-personal tasks (Mental-Interpersonal) and decrements in meeting the quantity, quality and timeliness of completed work (Output); and (iii) mental well-being (Warwick-Edinburgh Mental Well-being Scale). T-tests assessed differences between groups for changes on the main outcomes. In the IG, a multivariate logistic regression model identified patterns of response according to baseline socio-demographic variables, physical activity and sitting time.
Results
There was a significant 2 (group) × 2 (program time points) interaction for the Time (F [3]=8.69,
p
= 0.005), Mental-Interpersonal (F [3]=10.01,
p
= 0.0185), Output scales for presenteeism (F [3]=8.56,
p
= 0.0357), and for % of lost work performance (F [3]=10.31,
p
= 0.0161). Presenteeism and lost performance rose significantly in both groups across all study time points; after baseline performance was consistently better in the IG than in the A-CG. Better performance was linked to employees being more active (Time,
p
= 0.041) and younger (Mental-interpersonal,
p
= 0.057; Output,
p
= 0.017). Higher total sitting time during nonworking days (Mental-interpersonal,
p
= 0.019) and lower sitting time during workdays (WLQ Index,
p
= 0.013) also improved performance.
Conclusion
Versus an active comparison condition, a ‘sit less, move more` workplace intervention effectively reduced an array of markers of lost workday productivity.
Trial registration
NCT02960750
; Date of registration: 07/11/2016.
Journal Article