Methods Used in Co-Creation Within the Health CASCADE Co-Creation Database and Gray Literature: Systematic Methods Overview

Abstract

Background: Co-creation is increasingly recognized for its potential to generate innovative solutions, particularly in addressing complex and wicked problems in public health. Despite this growing recognition, there are no standards or recommendations for method use in co-creation, leading to confusion and inconsistency. While some studies have examined specific methods, a comprehensive overview is lacking, limiting the collective understanding and ability to make informed decisions about the most appropriate methods for different contexts and research objectives.

Objective: This study aimed to systematically compile and analyze methods used in co-creation to enhance transparency and deepen understanding of how co-creation is practiced.

Methods: To enhance transparency and deepen understanding of how co-creation is practiced, this study systematically inventoried and analyzed methods used in co-creation. We conducted a systematic methods overview, applying 2 parallel processes: one within the peer-reviewed Health CASCADE Co-Creation Database and another within gray literature. An artificial intelligence-assisted recursive search strategy, coupled with a 2-step screening process, ensured that we captured relevant methods. We then extracted method names and conducted textual, comparative, and bibliometric analyses to assess the content, relationship between methods, fields of research, and the methodological underpinnings of the included sources.

Results: We examined a total of 2627 academic papers and gray literature sources, with the literature primarily drawn from health sciences, medical research, and health services research. The dominant methodologies identified were co-creation, co-design, coproduction, participatory research methodologies, and public and patient involvement. From these sources, we extracted and analyzed 956 co-creation methods, noting that only 10% (n=97) of the methods overlap between academic and gray literature. Notably, 91.3% (230/252) of the methods in academic literature co-occurred, often involving combinations of multiple qualitative methods. The most frequently used methods in academic literature included surveys, focus groups, photo voice, and group discussion, whereas gray literature highlighted methods such as world café, focus groups, role-playing, and persona.

Conclusions: This study presents the first systematic overview of co-creation methods, providing a clear understanding of the diverse methods currently in use. Our findings reveal a significant methodological gap between researchers and practitioners, offering insights into the relative prevalence and combinations of methods. By shedding light on these methods, this study helps bridge the gap and supports researchers in making informed decisions about which methods to apply in their work. Additionally, it offers a foundation for further investigation into method use in co-creation. This systematic investigation is a valuable resource for anyone engaging in co-creation or similar participatory methodologies, helping to navigate the diverse landscape of methods.

Keywords: CASCADE; co-creation; co-design; coproduction; inventory; methodology; methods; participatory; research methods; text mining.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the screening processes for the systematic methods overview with two sources as follows: (A) academic literature and (B) gray literature.

Figure 2

Sankey diagram illustrating the co-occurrence of qualitative methods with other research methods in academic literature. Source methods are displayed on the left side (n=22) and target methods are on the right (n=149). The thickness of the line indicates the frequency of co-occurrences across the literature, with thicker lines representing more frequent co-occurrences between methods.

Figure 3

Sankey diagram illustrating the co-occurrence of participatory methods with other research methods in academic literature. Source methods are displayed on the left side (n=42) and target methods are on the right (n=132). The thickness of the line indicates the frequency of co-occurrences across the literature, with thicker lines representing more frequent co-occurrences between methods.

Figure 4

Sankey diagram illustrating the co-occurrence of quantitative, mixed, and ethnographic methods with other research methods in academic literature. Source methods are displayed on the left side (n=24) and target methods are on the right (n=156). The thickness of the line indicates the frequency of co-occurrences across the literature, with thicker lines representing more frequent co-occurrences between methods.

Figure 5

VOSviewer generated an image representing the co-occurrence of keywords representing methodologies across the title and abstracts of the academic literature. The size of the keyword bubble represents its importance in the number of co-occurrences. Each line represents a co-occurrence of the terms. cbpr: community-based participatory research; par: participatory action research; ppi: public and patient involvement.

Figure 6

VOSviewer generated an image representing the co-occurrence of keywords representing fields across the titles and abstracts of the academic literature. The size of the keyword bubble represents its importance in the number of co-occurrences. Each line represents a co-occurrence of the terms.

Figure 7

Venn diagram of methods sourced from academic, gray literature, or both. Percentages represent the portion of the total methods (n=956).