ReviewHealth research policy and systems2026
Realist synthesis of co-production of services in a local authority context: what works, for whom, how and in what circumstances?
Review in Health research policy and systems, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
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Corrections and comments
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Authors and funding
7 authors.
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Abstract
backgroundCo-production is increasingly promoted as a means of improving the design and delivery of local authority services, yet evidence on how and why it works remains limited. This realist synthesis explored how co-production operates within complex local authority systems, identifying the circumstances and mechanisms that enable or constrain meaningful involvement of stakeholders in co-production processes and sustained change to ensure that services are co-produced with professionals and those with lived experience.
methodsScoping searches identified key literature on co-production related to a local authority context to develop initial programme theories. Context-mechanism-outcome (CMO) configurations were constructed as "if-then-because" statements under four themes: equity and inclusion; collaboration and systems change; ethical and sustainable engagement and measurement and evaluation. These were refined through an analysis of 25 sources from searches across Scopus, CINAHL, Academic Search Ultimate, Web of Science and SocINDEX. Further refinement took place in two workshops with six participants with lived experience and four local authority officers. Analysis was thematic, retroductive and iterative to promote critical engagement between the research team, the literature and workshop participants.
resultsNine CMOs and an overarching programme theory illustrate how relational, structural, ethical and evaluative mechanisms interact to support authentic co-production. First, trust emerged as a central mechanism for engagement, built through culturally competent, inclusive and power-sharing practices. Second, sustainable co-production depended on visible leadership commitment, long-term investment and opportunities for skill development and emotional support. Third, ethical integrity and trauma-informed facilitation were essential for creating safe spaces where people felt respected and brave enough to share their vulnerability. Fourth, cross-sector collaboration and systems thinking enabled shared purpose and accountability across organizational boundaries. Finally, participatory and creative approaches to evaluation strengthened trust, demonstrated impact and promoted continuous learning. Concepts such as trust, power-sharing and leadership commitment operated recursively across different contexts and at varying system levels.
conclusionsAuthentic co-production in local authority systems depends on aligning relational trust, ethical practice and structural support within learning cultures that value lived experience. This synthesis advances theoretical understanding and offers practical guidance for embedding equitable, sustainable collaboration into the everyday culture and governance of local authorities.
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