{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:30:33Z","timestamp":1791808233090,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2025,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n The terms coproduction, co\u2010creation and codesign (called the \u2018Three\u2010Cs\u2019 in this article) are applied to activities that include stakeholders in the design and implementation of health services. This scoping review sought to understand how Three\u2010Cs approaches have been designed and implemented sustainably in the primary health care context.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Three databases (Medline, Embase and CINAHL) were searched for articles published between 2013 and 2024 using key words related to the Three\u2010Cs and primary health care (Appendix\u00a0A) and limited to articles available in English. Dual blind review against specific inclusion and exclusion criteria was carried out at both title\/abstract and full text screening stages. The SPICE Framework was used to consider design, implementation, impact and sustainability. An assessment of quality and risk of bias was completed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist [1]. The Framework to Assess the Impact of Translational (FAIT) health research [2] was used to review and assess the impact of the design and implementation of Three\u2010Cs approaches in each study.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirty articles were included in this review with 33% (\n n<\/jats:italic>\n \u2009=\u200910) providing a clear definition of their Three\u2010Cs approach: 10% (\n n\u2009<\/jats:italic>\n =\u20093) identified their approach as Coproduction, 20% (\n n<\/jats:italic>\n \u2009=\u20096) as co\u2010creation, and 70% (\n n<\/jats:italic>\n \u2009=\u200921) as Codesign. Implementation contexts included clinical settings (10%,\n n<\/jats:italic>\n \u2009=\u20093), for example prediabetes programs; community settings (50%,\n n<\/jats:italic>\n \u2009=\u200915) such as care navigation support; and health systems settings (40%,\n n<\/jats:italic>\n \u2009=\u200912) including health service development. Approaches were implemented across metropolitan (37%,\n n<\/jats:italic>\n \u2009=\u200911), regional (43%,\n n<\/jats:italic>\n \u2009=\u200913), and rural (17%,\n n<\/jats:italic>\n \u2009=\u20095) settings.\n <\/jats:p>\n \n Three\u2010Cs approaches in primary health care settings were most typically used for health promotion, and to support improved health equity and health access. Key outcomes included novel solutions to problems, improvements to health and health systems, and solutions that met consumer needs. While nine of the 30 studies undertook some form of evaluation, limited evidence on impact and sustainability was found (7%,\n n<\/jats:italic>\n \u2009=\u20092), where only two studies assessed whether the change that was implemented using a Three\u2010Cs approach was maintained in the longer term.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Three\u2010Cs approaches have been adopted across a variety of primary health care settings, yet evidence for impact and sustainability is currently limited. More research is needed to evaluate how the Three\u2010Cs may best be implemented to support the long\u2010term sustainability of programs designed by such approaches. Future work should focus on developing a primary health care specific framework or guidance for implementing and evaluating Three\u2010Cs models, particularly in low\u2010resource settings and in typically underrepresented populations. This study will extend to consider how the FAIT assessment process can help to support the development of much needed implementation guidance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/hex.70447","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T10:59:58Z","timestamp":1759575598000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Co\u2010Production, Co\u2010Creation and Co\u2010Design in Primary Health Care: A Scoping Review of Design, Implementation, Impact and Sustainability"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3918-9756","authenticated-orcid":false,"given":"Cate","family":"Dingelstad","sequence":"first","affiliation":[{"name":"University of Newcastle, Hunter New England Central Coast Primary Health Network, Hunter Medical Research Institute Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2025-5310","authenticated-orcid":false,"given":"Nicolette","family":"Hodyl","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute, Hunter New England Local Health District Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4872-2112","authenticated-orcid":false,"given":"Rebecca","family":"Wyse","sequence":"additional","affiliation":[{"name":"University of Newcastle Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5250-7415","authenticated-orcid":false,"given":"Suzanne","family":"Lewis","sequence":"additional","affiliation":[{"name":"University of Newcastle Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6304-5884","authenticated-orcid":false,"given":"Alison","family":"Koschel","sequence":"additional","affiliation":[{"name":"Hunter New England Central Coast Primary Health Network Tamworth New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4900-3352","authenticated-orcid":false,"given":"Nicholas","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Centre for Research in Health System Performance, Yong Loo Lin School of Medicine, National University of Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"World Health Organization UNICEF. Primary Health Care accessed November 2024."},{"key":"e_1_2_14_3_1","unstructured":"WHO Director\u2010General UNICEF Opening Remarks at the 72nd Session of the Regional Committee for Africa published2024."},{"key":"e_1_2_14_4_1","unstructured":"World Health Organization UNICEF.Declaration of Astana. World Health Organization and the United Nations Children's Fund published2024."},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-001551"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-015088"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51844"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.7628"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.13.04043"},{"key":"e_1_2_14_10_1","unstructured":"L.Ferrer Engaging Patients Carers and Communities for the Provision of Coordinated\/Integrated Health Services: Strategies and Tools: Working Document. World Health Organization. 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