Zhang Liyuan, Li Katherine T, Wang Tong, Luo Danyang, Tan Rayner K J, Marley Gifty, Tang Weiming, Ramaswamy Rohit, Tucker Joseph D, Wu Dan
University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Sex Health. 2024 Dec;21. doi: 10.1071/SH23149.
Background Top-down implementation strategies led by researchers often generate limited or tokenistic community engagement. Co-creation, a community engagement methodology, aims to create a shared leadership role of program beneficiaries in the development and implementation of programs, and encourages early and deep involvement of community members. We describe our experience using a four-stage co-creation approach to adapt and implement a sexually transmitted diseases (STD) testing intervention among men who have sex with men (MSM) in China. Methods We adapted a four-stage approach to co-creation. First, we conducted a needs assessment based on our prior work and discussions with community members. Second, we planned for co-creation by establishing co-creator roles and recruiting co-creators using both stratified convenience and opportunistic sampling. Third, we conducted co-creation via hybrid online/in-person focus groups (four multistakeholder groups and four MSM-only groups). Finally, we evaluated validity of the co-creation process through qualitative observations by research staff, analyzed using rapid qualitative analysis, and evaluated co-creator experience through post-discussion survey Likert scales and open-ended feedback. Results Needs assessment identified the needs to adapt our STD intervention to be independently run at community-based and public clinics, and to develop explanations and principles of co-creation for our potential co-creators. In total, there were 17 co-creation members: one co-creation lead (researcher), two co-chairs (one gay influencer and one research assistant), eight MSM community members, four health workers (two health professionals and two lay health workers) and two research implementers and observers. Co-created contents for the trial included strategies to decrease stigma and tailor interventions to MSM at public STD clinics, strategies to integrate STD testing services into existing community-led clinics, and intervention components to enhance acceptability and community engagement. Our evaluation of validity identified three main themes: challenges with representation, inclusivity versus power dynamics and importance of leadership. Surveys and free responses suggested that the majority of co-creators had a positive experience and desired more ownership. Conclusion We successfully adapted a structured co-creation approach to adapt and implement an STD testing intervention for a vulnerable population. This approach may be useful for implementation, and further research is needed in other contexts and populations.
背景 由研究人员主导的自上而下的实施策略往往只能带来有限的社区参与或象征性的参与。共同创造是一种社区参与方法，旨在让项目受益者在项目的开发和实施中发挥共同领导作用，并鼓励社区成员尽早并深入参与。我们描述了我们在中国男男性行为者（MSM）中采用四阶段共同创造方法来调整和实施性传播疾病（STD）检测干预措施的经验。方法 我们采用了四阶段共同创造方法。首先，我们根据之前的工作以及与社区成员的讨论进行了需求评估。其次，我们通过确定共同创造者角色并使用分层便利抽样和机会抽样招募共同创造者来规划共同创造。第三，我们通过线上/线下混合焦点小组（四个多利益相关方小组和四个仅由男男性行为者组成的小组）进行共同创造。最后，我们通过研究人员的定性观察评估共同创造过程的有效性，采用快速定性分析进行分析，并通过讨论后调查的李克特量表和开放式反馈评估共同创造者的体验。结果 需求评估确定了需要调整我们的性传播疾病干预措施，以便在社区诊所和公共诊所独立开展，并为潜在的共同创造者制定共同创造的解释和原则。共有17名共同创造者：一名共同创造负责人（研究人员）、两名联合主席（一名同性恋有影响力者和一名研究助理）八名男男性行为者社区成员、四名卫生工作者（两名卫生专业人员和两名非专业卫生工作者）以及两名研究实施者和观察员。该试验共同创造的内容包括在公共性传播疾病诊所减少耻辱感并针对男男性行为者调整干预措施的策略、将性传播疾病检测服务纳入现有社区主导诊所的策略以及提高可接受性和社区参与度的干预组成部分。我们对有效性的评估确定了三个主要主题：代表性方面的挑战、包容性与权力动态以及领导力的重要性。调查和自由回答表明，大多数共同创造者有积极的体验，并希望拥有更多自主权。结论 我们成功采用了结构化的共同创造方法来调整和实施针对弱势群体的性传播疾病检测干预措施。这种方法可能对实施有用，并且需要在其他背景和人群中进行进一步研究。
