Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration

Gillian Mulvale, Sandra Moll, Ashleigh Miatello, Glenn Robert, Michael Larkin, Victoria J. Palmer, Alicia Powell, Chelsea Gable, Melissa Girling

Research output: Contribution to journalReview articlepeer-review


Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.

To explore citizens’ involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.

A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.

Setting and participants
A two‐day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.

Intervention studied
Eight case studies working with vulnerable and disadvantaged populations in three countries.

We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre‐specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.

Discussion and conclusions
Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User‐centred evaluations of codesigned public services are needed.
Original languageEnglish
Pages (from-to)284-297
Number of pages14
JournalHealth Expectations
Issue number3
Early online date1 Feb 2019
Publication statusPublished - 1 Jun 2019

Bibliographical note

© 2019 The Authors. Health Expectations published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Funding: The Canadian Social Sciences and Humanities Research Council (SSHRC) provided funding for this project through a Connections Grant (#611‐2017‐0221); Aston University's Visiting Scholar Fund also provided funding towards this project. The case study of justice services for young people who offend in England was supported by the National Institute for Health Research. The Australian CORE Study case study was based on a research study funded by the Victorian State Government Mental Illness Research Fund & The Psychiatric and Disabilities Donations Trust Fund (2013–2017). Finally, the youth with mental disorders’ Canadian case study presented in this paper was funded by the Ontario Ministry of Research, Innovation and Science (ER13‐09‐203).


  • codesign
  • public services
  • vulnerable populations


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