Fateme Tavallaei, Fattah Sharifzade, Reza Vaezi, Seyed Jalalodin Faraji,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: Non-communicable diseases (NCDs) account for 76% of mortality in Iran, where effective management hinges on community empowerment and integrated service delivery. Co-production, an innovative strategy involving shared power between service users and providers, is a promising approach for addressing the multifaceted needs of patients with chronic conditions. This study aimed to develop a context-sensitive framework for implementing and evaluating co-produced NCD management programs. We achieved this by integrating the core principles of co-production with a realist evaluation lens, drawing on the perspectives of senior healthcare managers.
Methods: Employing a qualitative methodology, this study conducted a thematic analysis of data derived from a comprehensive literature review and semi-structured interviews. A cohort of 17 senior healthcare managers, selected via purposive sampling in 2025, participated as key informants.
Results: The analysis yielded a hierarchical thematic structure comprising 71 basic themes, 20 organizing themes, and 6 overarching global themes. These global themes, which form the core of the proposed framework, are: (1) Developing Participatory Clinical Processes, (2) Establishing Equity-Oriented Support Services, (3) Recognizing Diverse User Groups, (4) Enhancing Provider Capabilities, (5) Understanding User Responses, and (6) Fostering Mutual Benefits among Stakeholders. The dynamic interplay of these themes is crucial for operationalizing effective NCD co-production.
Conclusion: By innovatively integrating co-production principles with a realist evaluation framework, this study offers a context-sensitive model that clarifies theoretical concepts for practical application in NCD management. A key implication is the necessity for monitoring systems that track both clinical and well-being outcomes, supported by multi-level incentive structures. This research provides a foundational model for policymakers to develop, implement, and evaluate more effective and equitable co-produced healthcare programs. Further longitudinal research is recommended to assess long-term outcomes and incorporate patient perspectives.
