Co-producing sexual health services with minoritized communities: Learning from a longitudinal qualitative evaluation

Introduction:
Co-production is an important practice for addressing health disparities and developing equitable services with underserved communities. Co-production aims to ensure underserved communities are central to the design of services that reflect community need. African and Caribbean heritage communities (ACHC) face heightened risks of HIV due to stigma, discrimination, social, economic, and structural factors, leading to significant health inequities. Despite a national target to end new HIV transmissions by 2030, HIV remains prevalent. Common Ambition Bristol (CAB) is a co-production project aiming to increase HIV knowledge and testing. CAB’s Project Delivery Group (PDG) involves ACHC community members and sexual health staff working in equal partnership to improve sexual health services for ACHC.
Methods: A longitudinal qualitative evaluation explored the process of CAB’s co-production over time. Interviews were conducted with members of CAB’s PDG at three time points. Interviews examined PDG views and experiences of the co-production process. Data were analyzed thematically.

Results:
Five themes are reported which relate to equitable power-sharing and inclusive decision-making: (1) Acknowledging power imbalances and negotiating roles (2) Appreciating commonalities and the importance of language (3) Benefits of sharing lived and sexual health experiences (4) Negotiating different opinions safely (5). Co-production: the messy middle.

Conclusions:
Findings underscore the potential of co-production to drive meaningful progress in health equity. Key elements of co-production which promote equitable power-sharing and effective decision-making are; (1) acknowledging and addressing unequal power structures which may affect group dynamics; (2) fostering reciprocal learning from lived experience and sexual health expertise; (3) recognizing and appreciating personal and sexual health commonalities; (4) negotiating and developing ways to ensure equitable decision making and (5) agreeing a shared language which reflects 1-4.