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Public health research impact goes beyond data: it warrants engaging diverse stakeholders. My doctoral work explores how co-creation can empower communities to shape research that affects them. Across Europe, I have seen participatory approaches bridge theory and practice, producing more inclusive solutions. This piece shares reflections on public health co-creation, along with practical guidance for putting it into practice.
Co-creation refers to a collaborative process in which all relevant stakeholders – such as community members, service users, professionals and researchers – actively define the problem, design solutions, implement interventions and evaluate outcomes together, with mutual learning and innovation at its core (Messiha et al., 2023).
Traditional research often positions the researcher as an expert, with limited engagement from the individuals or communities most affected by the work. This top-down approach risks producing insights with limited real-world application. Co- creation challenges this model by engaging stakeholders more actively throughout the research process.
This participatory approach not only improves the relevance of findings but also enhances the quality and ethical rigour of research. By engaging stakeholders in the design, implementation and evaluation phases, co- creation can be argued to facilitate more responsive and equitable public health interventions.
A personal journey
Research, when conducted with genuine intent, transcends academic exercise – it becomes a vehicle for insight, relevance and change. Through my academic journey and doctoral research at Amsterdam UMC, I have come to view co-creation as an important approach to public health research. Co-creation seeks to bridge theory and practice, promoting inclusive and participatory research that centres on the lived experiences of those it seeks to serve (Messiha et al., 2024; Messiha et al., 2025a,b; Delfmann et al., 2025).
From social sciences to public health
My academic foundation in Population and Geography (BSc, University of Southampton, 2018) and Social Policy and Social Research (MSc, UCL, 2020) sparked a research interest in addressing social inequalities through evidence-informed policy. These experiences shaped a commitment to understanding how health research can better engage with communities - especially those often marginalised in conventional research paradigms. Tips for initiating co-creation
Katrina Messiha
Bionote
Katrina Messiha is a Marie Skłodowska- Curie Actions PhD Fellow in the European Commission’s Health CASCADE project. Her doctoral research is focused on developing core theory-based principles that can address health inequalities and complex, wicked public health challenges through interdisciplinary research and policy development. Katrina has recently served as a visiting academic and policy researcher at EuroHealthNet as well as a visiting researcher at the University of Cambridge.
Tips for initiating co-creation in public health
Drawing on both academic study and practical experience, I suggest the following entry points for researchers and practitioners interested in applying co-creation:
• Engage stakeholders from the research- design stage: not just as subjects, but as co-designers.
• Invest time in relationship-building. Transparency and shared expectations are crucial.
• Use reflexive and critical frameworks to understand and address imbalances in power dynamics among stakeholders.
• Ground your co-creation process in theoretical frameworks such as critical realism and empowerment theory to guide analysis, inform methods and ethical considerations.
• Co-creation is iterative; adapt your approach based on stakeholder input and contextual shifts.
Doctoral research: Advancing co-creation
My doctoral work endeavours to contribute to the systematic application of co-creation within public health research. Key goals include:
• Exploring theoretical and methodological underpinnings of co-creation in public health.
• Applying critical realism to understand the structural and causal mechanisms influencing health inequalities.
• Investigating how the critical social theory of empowerment can support youth participation in research.
• Conducting multisource analyses of stakeholder roles in youth-engaged public health interventions, including the development of a comprehensive co- creation roles framework and systematic review.
• Establishing the theory-based principles for co-creation in public health via consensus exercises.
This work is part of the Health CASCADE project, which aims to build capacity for co- creation by developing a robust framework, evidence base and training materials for Katrina Messiha in Action at a European Conference researchers across Europe.
Katrina Messiha in Action at a European Conference about Co-creation in Brussels.
Practical insights from secondments
Through academic secondments, I have examined co-creation across varied settings:
• EuroHealthNet (Brussels): Co-developed a policy précis on citizen participation, focusing on inclusive engagement in health policy. University of Cambridge (England): Supported the development of a co-designed digital platform addressing dementia care in underserved communities (Messiha et al., 2025b).
• Stichting Alexander (Amsterdam): Explored empowerment within youth participatory research, analysing how co-creation can elicit youth’s agency and voice.
• Glasgow Caledonian University (Scotland): Shadowed Obesity Action Scotland’s national co-creation campaign, including its role in enhancing public health outcomes.
Each experience reinforced the importance of adaptability, contextual awareness and critical reflection when operationalising co-creation.
Looking ahead
As public health challenges grow in complexity, co-creation can offer a responsive approach to research: one that values diverse forms of knowledge and shared ownership of outcomes. By exploring a more systematic and well-considered theoretical, ethical and methodological foundation for co-creation, I aim to support researchers and practitioners in embedding related principles more widely. My ongoing work as part of Health CASCADE is a small part of a broader movement seeking to make public health research not only more effective but also more equitable.
Katrina Messiha
Orcid
Amsterdam UMC
k.m.messiha@amsterdamumc.nl
References
Delfmann, L.R., de Boer, J., Schreier, M., Messiha, K., Deforche, B., Hunter, S.C., Cardon, G., Vandendriessche, A. and Verloigne, M., 2025. Experiences with a co-creation process to adapt a healthy sleep intervention with adolescents: A Health CASCADE process evaluation. Public Health, 241, 69-74.
Messiha, K., Altenburg, T.M., Schreier, M., Longworth, G.R., Thomas, N., Chastin, S. and Chinapaw, M.J., 2024. Enriching the evidence base of co-creation research in public health with methodological principles of critical realism. Critical Public Health, 34(1), 1-19.
Messiha, K., Altenburg, T.M., Giné-Garriga, M., Chastin, S. and Chinapaw, M.J., 2025a. Enriching the existing knowledge about co-creation: identifying dimensions of co-creation using explicit theory in various research fields. Minerva, 24.
Messiha, K., Chinapaw, M.J., Ket, H.C., An, Q., Anand-Kumar, V., Longworth, G.R., Chastin, S. and Altenburg, T.M., 2023. Systematic review of contemporary theories used for co-creation, co-design and co-production in public health. Journal of Public Health, 45(3), 723-737.
Messiha, K., Thomas, N., Brayne, C., Agnello, D.M., Delfmann, L., Giné-Garriga, M., Lippke,
S. and Downey, J., 2025b. Grey literature scoping review: a synthesis of the application of
participatory methodologies in underrepresented groups at an elevated risk of dementia. BMC
Medical Research Methodology, 25(1), 122.