Co-Creation of Global Public Health Interventions Within the Context of Limited Resources: A Conceptual Qualitative Framework for Modest Co-Creation

Co-creation is increasingly promoted in global public health as a participatory methodology that centres lived experiences, the preferences, and structural realities of those most affected by health interventions. Within human-centred design (HCD), co-creation is typically operationalised through intensive cycles of qualitative inquiry, in-person workshops, facilitation, and iterative prototyping. While these approaches are methodologically robust, they are often resource-intensive and difficult to implement in low- and middle-income countries (LMICs) and other low resource settings, precisely where context-sensitive and equitable intervention design is most needed. Despite this tension, existing literature offers limited guidance on how co-creation can be meaningfully adapted to such contexts without eroding its epistemological, ethical, and participatory foundations. This conceptual qualitative methodology paper addresses this gap by proposing a ‘Modest Co-Creation’ framework, that is a resource-sensitive adaptation of co-creation grounded in constructivist and interpretivist qualitative paradigms. Drawing on a synthesis of participatory design, HCD, and qualitative methodology literature, alongside practical experience, the paper argues that methodological rigour in co-creation is not contingent on scale or intensity, but on adherence to core qualitative principles. The proposed framework foregrounds contextual understanding, shared interpretation, relationship-centered ethics, reflexivity and realistic iteration as non-negotible elements. The paper advances conceptual clarity on participatory rigour in constrained environments by articulating how co-creation can be recalibrated rather than reduced. It offers practical guidance for researchers, practitioners, policymakers, and funders seeking to democratise health intervention design without reproducing resource-driven inequities, and contributes to broader debates on equity, feasibility, and methodological integrity in global public health innovation.