Experiences with a co-creation process to adapt a healthy sleep intervention with adolescents: A Health CASCADE process evaluation

Objectives: Co-adaptation is a collaborative process to adapt existing interventions to new contexts and offers a promising way to scale (co-created) public health interventions. However, there is limited understanding of how co-adaptation processes are experienced. This study examined whether a robust co-creation process can be maintained when adapting a previously co-created intervention to promote adolescents' healthy sleep. Adolescents' experiences during this co-adaptation process were explored, using five key dimensions of co-creation (1) multistakeholder collaborative action, 2) co-learning towards innovation, 3) contextual knowledge production, 4) generating meaning, 5) open, trustful, and inclusive dialogue) as the guiding framework. Study design: Qualitative observational study. Methods: Qualitative data were collected from a co-adaptation process with an action group of adolescents (n = 8) and researchers (n = 2). Over eleven sessions (50 min) following Intervention Mapping, a needs assessment was conducted, and the original intervention's goals and materials were adapted. Data sources included session transcripts, facilitator reflections, adolescent evaluations (n = 5), and focus group transcripts (n = 3), elaborating on adolescents' experiences during sessions, and were analysed using Qualitative Content Analysis (QCA). Results: All five dimensions of co-creation were reflected in adolescents' experiences of co-adapting the healthy sleep intervention. They enjoyed collaborating, committed to the project, reported ongoing possibilities for learning, and produced contextual knowledge from their lived experiences. The process felt meaningful, with a respectful atmosphere. However, challenges like the exclusion of students outside the group and time constraints were also encountered. Conclusions: The presence of the five dimensions of co-creation in this study demonstrates that robust co-creation research can be maintained also when co-adapting a previously co-created intervention to a new context with a new group of stakeholders.