Evidence map›Paper›PMID 42816878›Full record

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?

Andrew Harding, Reuben Tete Larbi, Aviel Lowndes, Paul Marshall, Adam Mars, Michaela Goodridge, Pauline Wigglesworth

Abstract readReview
In one paragraph

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.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Andrew HardingDivision of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom. a.harding5@lancaster.ac.uk.
Reuben Tete LarbiDivision of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
Aviel LowndesBlackpool Council, Blackpool, United Kingdom.
Paul MarshallInstitute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.
Adam MarsDivision of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
Michaela GoodridgeBlackpool Council, Blackpool, United Kingdom.
Pauline WigglesworthBlackpool Council, Blackpool, United Kingdom.

Funding

National Institute for Health and Care Research NIHR150965
6 · The paper itself

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.

Indexed as

Cooperative BehaviorDelivery of Health CareStakeholder ParticipationDiversity, Equity, InclusionHumansLeadershipTrust

Identifiers

PMID42816878
PMCPMC13625338

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.