Using formative evaluation to adapt a co-creation process within and between workplace contexts: A Health CASCADE study

OBJECTIVES: Co-creation offers a promising approach to developing tailored health promotion interventions, but it requires adaptable processes responsive to contextual needs. Formative evaluation supports this adaptability through continuous reflection and informed adaptations. This study examines adaptations through formative evaluation in co-creation processes within and between different workplace contexts to advance the evaluation, transferability, and public health impact of co-creation. STUDY DESIGN: A qualitative study examining adaptations to co-creation processes through thematic analysis. METHODS: A co-creation process to develop a context-specific solution to reduce workplace sedentary behaviour was implemented in three small-to-medium-sized enterprises (6-8 sessions per company). Data from a pilot session, project meetings, co-creator feedback, and facilitator reflections were systematically linked to the resulting adaptations they informed. Reasons for adaptations were derived through thematic analysis. RESULTS: Adaptations occurred at two stages: planned adaptations, made before implementing the co-creation process, based on pilot data and project meeting logs, and responsive adaptations, made during implementation, informed by co-creator evaluations and facilitator reflections. Three main reasons for adaptations emerged: tailoring to context, enhancing process effectiveness, and fostering engagement. CONCLUSION: Formative evaluation is crucial in evaluating co-creation processes. It ensures that these processes remain relevant, effective, and engaging, with skilled facilitators and end-user input being key. Replicating co-creation processes in new contexts requires the documentation of previous adaptations to identify core elements while allowing flexibility. These insights support the design of adaptable, evidence-based co-creation processes and help advance their evaluation and implementation in diverse contexts to develop effective and tailored solutions.