Billie and Ruth value of copro in sexual health project Scotland

sorry. Yeah, sorry about that. So? So the project is about the value of coproduction. So could you share with me? Um, an experience of using the co-production approach, please

Yeah, absolutely. So, um, we wanted to share a little bit about, um, a project that we've been doing for the past few years called Conundrum. So this is a project working in sexual health

It started out as a research study. It was commissioned by the Scottish government and three different NHS health boards To try to understand why, um, those thing changes in young people's use of condoms and contraception up in Scotland and specifically trying to understand why fewer young people were using free condom services and some forms of, um, long acting reversible contraception. So we were part of the research team that was commissioned to do this project, and quite early on, we agreed with the the study commissioners that it would be best if we involved, um a broad range of different sexual health stakeholders in actually working to co develop

What? That study looked like. So right Early on, we did some workshops where we sort of worked with young people themselves. We did six workshops with young people from really diverse backgrounds and, um, with different identities

Um, to try and understand what they thought that the the study should focus on what they thought the kind of priorities were, Um, And to try and understand what people's view of what might be causing, um, these changes, uh, was at the beginning, and then what? They thought they needed more. We needed more evidence on. So we also did a workshop with, um, professional stakeholders as well

So, um, that included people working in, um, youth organisations. Um, that was sexual health leads within the NHS. Um, we had, uh, people with nurse community nursing backgrounds, people that were doing, um, sex education, work in schools and so on

So a really diverse group and we did a similar, uh, sort of priority setting activity, um, within the workshops with them. So that was just right at the start of the project to kind of figure out what the project should be should be about. And then we also worked, um, to copro produce how the study should happen

So what the methods should be, Um, so, for example, we would we we sort of agreed that one of the things that we wanted to do was create an online survey and code development of that survey was really, really key to, um ensuring its success. Basically. So we ended up, um, having a really good response to survey from young people across Scotland

And that was because young people had been involved in helping us develop it. So right from you know what? The question should be about how we should ask them what the survey should look like, What information young people needed to know to decide whether they wanted to take part in the survey. All of those those things young people were involved in and other sexual health stakeholders

And and I think that was really, really important, Um, in coming up with a a much more engaging survey than we might have done, um, as a research team on our own. Um And I guess I guess one of the challenges that we encountered was, um, that the project was happening at sort of in the early stages of, um, the covid pandemic. And so a lot of what we had been planning to do was gonna be in person and we had to shift to it, being completely virtual happening virtually and at the same time, a lot of the sexual health stakeholders that we were working with, um, they were being pulled into the kind of the covid response

So they, you know, they, um, had sort of serious time constraints. But I think because that happened halfway through the project, we already had a lot of momentum and a lot of commitment from people. And I think that sort of helped carry us, carry us through

And we ended up actually being able to adapt to the project so that we included some questions about, um, young people's experience of trying to access sexual health services during the pandemic. And that's like really resulted in some really important information. Um, about that early early stage of covid

Um So what then happened was once we had all the sort of the data from the from the study. We then worked with stakeholders again to sit down, look at you know what have we found and then work to copro produce some recommendations. So we did that via another

Another set of, um, workshops with young people, um, with sexual health, clinicians and people in the Scottish government that were making sexual health policy as well. And so and out of that, we codeveloped a set of nine recommendations for what we thought needed to happen next. And that's really how we've now gone into the next phase of conundrum

Um, because the absolute number one priority that everybody there was kind of complete consensus about is that we needed to have a system where young people are more meaningfully involved in sexual health poli policy making and also trying to improve sexual health services as well. Um, so we're now in this phase of conundrum where we're doing a kind of a bit of an experiment, I guess, Um, a new phase called conundrum Action where we're focusing just on this one, um, vision of trying to increase young people's meaningful involvement, Um, in policy making services. So we're we're doing that by, um, bringing together an action group of young people of, uh, policy makers from the Scottish government of people that lead on, um, planning sexual health services in the NHS

And then we've also got, um, representation from, um third sector and Sexual Health Organisation as well and then us as a team of researchers, too. So it's quite a big, big group of us, and we've all committed to spending six months working together in this action group. So we meet once every three weeks for two hour long meetings

It's all happening virtually, Um, and we're ba. We've basically been figuring out what we want to collaborate on, how we want to collaborate and really trying to develop our learning about what meaningful involvement can look like in sexual health. Um, so maybe I'll just, um, pass over to Billy, who's been leading on on a lot of that engagement work

Um, and Billy maybe could share some insights from that So far? Yeah, sure, Yes. So I joined um, the project kind of the action group phase. Um and, yeah, it's been really, really interesting to see, um, how those groups of people have have interacted and been brought together in this online space and to really take time to have those conversations

I think it's to have those kind of slow conversations that need to be had, um, and the things that we're prioritising, which is what the group voted on in the beginning is, um, to look at digital priorities for sexual health. Um, and also to look at building, um, using kind of participatory systems, mapping tools to build a map of, um, sexual health stakeholders. And also, um, a map of a kind of causal loop diagram

Um, which is basically showing what the causes and effects of, um, low involvement of young people in sexual health policy making. Um, so they are the things that the group have have decided they wanted to prioritise, and we've kind of every week been doing a bit more on each of those objectives, and and the project has been kind of evolving as it goes. And as as we've sort of, um decided to focus more time on one or the other or to take one in one direction

And so, yeah, it's been been a kind of completely evolving process. It's been really interesting to see. Um, yeah, we hope that the the map will kind of produce some really useful tools to map out actually what the sexual health system looks like and where young people can be more involved

Um, and the digital priority is intended to, um, be kind of ashamed of policymakers to give an idea of what young people across Scotland want to see from digital sexual health services. So that's sort of the main things I've been working on in the, um, action group. If you got anything else to add to that roof, Um I mean, I can I guess, uh, we can share some learning about what's been

What we're finding is working or, um, some of the things that we that have been challenges because I guess we're learning as we go, And, um, trying to provide lots of opportunities, uh, to discuss, you know, how our actual process of meeting in these groups feels. Can I Can I just ask 11 question about, um, uh, it sounds it sounds really, um, amazing, actually. How? You've, uh, sort of built, um, for want of a better term, an iterative sort of process which sounds to tally with, um, co-production values

But, um, can you do? Do you do you pay the young people that are involved? Yeah. So young people are compensated, Um, uh, on a voucher basis at the moment. So they receive

Um a £25 voucher per hour of their time. And so we at the beginning of the project, we kind of budgeted for how much time we thought young people would spend in the meetings and then also on other activities outside of the meetings, Um, and then the other participants in the action group. So the NHS, um, stakeholders and people in the government, they're, um, offering their time

Um, just as part of their kind of professional practise. So they're not compensated in vouchers. Um, but what we have found is, as you know, as as it's co-produced, and it's evolving all the time

Some of the things that you think you're gonna do in a project at the beginning when you're putting together the budget aren't actually what you end up doing, and then other things become much more important. And so it's been really important. It's been really useful for us that we've had, um, you know, the people that are funding us have allowed us to have flexibility and what we spend our costs on

And so we had at one point thought, Oh, we'll be using bringing in external consultants to kind of um, provide expertise in in digital strategy. And we haven't ended up doing that because that's not a direction that the project went in. But we have decided to engage with more different groups of young people

So the young people in the action group are gonna be, um, peer researchers that are gonna be co-lead workshops to engage with young people beyond the action group. And so we needed to have costs to be able to spend on their on those other groups of young people's time as well. So it's been really useful to have that flexibility

I think that's one of the things that set us up for success that we actually can, um, properly act on the decisions that the action group has taken about the direction that they want things to go in. And we do have that flexibility to change our plan a little bit. Yeah, that's that sounds really great, because it it it indicates, um that, um, you know, you're having you're making positive changes there to the process

Um, by reflecting on what people are actually telling you in the here and now, um, you can you tell me a bit more about that, Billy, Has that happened? Um, while you've been involved with with the payment specifically or well, well, whatever you want. Whatever. I mean, we're interested in the impact on using a co-production approach

So what? What you've just been discussing would indicate that you've actually made some changes because you're you're using, uh, you know, an approach that that is respecting, you know, um, shared values, if you like. That's what That's what I'm hearing. Yeah, Yeah, definitely

And, like you say, have been having flexibility and being able to go back to our original, um, proposal and kind of amend those as well has been, um, has enabled us to do that. So I think yeah, like retail is having flexibility in all of those, um, structures is is really how it's been able to to evolve as it goes. Billy, do you wanna maybe say something about, um, the evaluating that we're doing at the end of the meetings, and then how we're changing meetings based on that? Yeah

Yeah. So one of the other things that we've been doing is trying to get, um, you know, trying to get feedback constantly. So at the end of every a group meeting doing, um, live mental polls to sort of see what has and hasn't worked in that specific meeting

Um, and then we can see from those, Like what? What kind of like if we're using, um, jam board or if we're using breakout rooms, what's what's worked and what hasn't in terms of actually facilitating them. But then we've also been doing a, um uh, another piece of feedback using jambo um, which we've kind of used as like an action group journey so that the participants can all, um, reflect on their experience overall of being part of the action group and kind of, um, we've done, like a a timeline type of thing as well, so they can look, look back on the different meetings and, um, yeah, kind of reflect on their experience and how that's changed and what they're excited about, um, in the project and what they've learned so far, Um, and maybe what? What they want to see happen differently as well. So they've been really useful insights

Um, and we've got some feedback about doing that exercise, which has been really positive. Um, and so we're hoping to do it again as the project goes on, kind of towards more Towards the end, we did one in the midpoint and more towards the end of the project. Um, for them to go back to those boards and and, um, add their reflections as well

So, yeah, that's been a really nice exercise, and and obviously can Can you Can you think of an actually, Can you tell me a a sort of a real example of of maybe, um, of the impact of actually doing that reflective process or or even just from being in the meetings for people and having, um, perhaps an influence on on the way it goes, Can you Can you You know, from what people have actually said, What what feedback have you had? Yeah, I mean, a really simple a really simple example would just be that, um, young people have kind of expressed a real preference for when we have the smaller group discussions. So the whole group, like it's all happening virtually on Zoom and the whole group. It's sometimes like 20 people, and, um, although we've done quite a lot of, um, spent quite a lot of time trying to build relationships and get everyone familiar with each other

I think that can still be quite intimidating to speak in front of 20 people. So young people had said, um, in the polls that they found it easier to talk in the smaller group breakout rooms that we've been having. So we've made sure, as the meetings have gone on, to build that in much have much more time in the smaller groups and less sort of whole group discussion, Um, and just structuring the meeting, we're just trying to structure the meetings in response to what people are telling us does or doesn't work about them

And one of the things that we've seen as well, um, from from the action group, um, journeys that people have been filling out is that, um, they'd quite like another reflection session at the end of the project and maybe for it to be in person. So that's something that a few people have suggested that we're looking at, um, doing as well, based on kind of what they've said, that they, they think would be valuable. Great

Thank you. Um, I'm wondering about, um how, uh, using a, um might have had an effect. You thought about sort of individual people

Um, but also as the group as a whole. You talk about building that consensus there, and, um, about having a voice, perhaps having influence. I'm just because it sounds

It always sounds to me like it's better in Scotland, to be honest. But I'm wondering, um, you know about about that, either On the organisation, it's the NHS the service. But it's also policy

And you know what that impact actually is. You sort of You've talked about peer, you know, having peer support, changing, changing that, um, the way of doing things, that way of gathering information. But what I is is there an impact on the services themselves? I think it's potentially a bit too early for us to know yet what the impact on the services themselves might be

But I think what we're trying to do is build confidence in this way of working so that people that work in different health boards, um, it's almost like building capacity so that people feel more confident doing that and then diffusing that through their health boards. But I mean it. It's not that these aren't, um, you know, ways of working that people were already interested in or already doing

I don't think we're necessarily, um, you know, bringing something completely new. It's just, um I guess what is new about this particular project is that we've got those direct conversations that are happening between young people, people that plan services and people in the government. So I think everyone was People were already sort of committed to the ethos of, um, co-production, but maybe hadn't had that space to have those direct conversations, um, and experience of it in this particular way

So it's just Yeah, I think it's a little bit too early for us to know exactly what impact it might be having on specific services. But I guess we're just trying to, um, contribute to a sort of broader culture shift where this way of working just becomes typical. That's brilliant

That that and that's really fair as well. Very, very balanced. Um, so thank you

That that that's really great. It's it's really good to hear. Um, and I'm I'm just wondering if you wanted to say anything about that Billy

I mean, it is about visioning as well um people have, um, ideals that they're working towards, aren't they? Are you know, so you can you can you can talk about that as well, because you're you're talking about the hard facts that you know, the impact isn't there yet for sure. But you you're building capacity, and that that's really important. That's so It's great to hear

I'm wondering, I'm not. I hope I'm making sense, but, um yeah, sorry. I was there

Sorry. Was there a question in there for us? Ultimately, Um, what I'm getting at is about society as a whole. Um, there's because obviously and and whether this process you think maybe has an impact on on the whole of the way that society can work in the future

Um, you know, you're a young person, Billy. Um, you know, do you think that this this could change? Um, make a change for the better. For for society? Do you see what I mean? So I'm not asking you a hard and for as fact, but it it kind of it

Does it have that momentum? Is it? Is that what's happening here? Because part of me really hopes it is. I suppose so, Yeah, I think so. I think the one of the most interesting things about being, um, kind of witnessing these conversations between, um NHS commissioners and young people is just, like, really seeing people look at a problem from each other's perspective

Um, and really seeing kind of what? What the limitations and difficulties are of, um, trying to make sure changes in an organisation like the NHS, um kind of for young people being able to understand that from from the the people who are planning services, but then also from people planning services at the same time understanding what young people really need and actually having those direct conversations. I think that's been incredibly valuable and shows that those conversations need to happen. Yeah, and I think they've been really empathetic conversations as well

Like exactly what you're saying, Billy, about understanding different perspectives. And rather than, um, I think there's been something about the directness of, um people that are working in services, talking about the kind of constraints that they're often under in terms of. They recognise that they want to be delivering something different

But there's a whole load of institutional constraints and being able to say that directly to young people and young people understanding and respecting that constraint as well. So there has been a lot of, like, really empathetic dialogue. It's not that they don't want to be able to do lots of kind of, yeah, things better than Or they realise that things need to change that they or they working within these huge structures

So, yeah, kind of, Um but But have you been able to challenge that as well? Because, you know, quite a lot of bureaucratic processes are there to actually kind of prop up the system, the business. So yeah, and I I I think possibly the people that are involved in the action group find that frustrating themselves as well. So there's been space to talk about that

Yeah, Yeah. No, it's been good. There's been some really candid discussion

OK, right. Well, I think I think if that's ok, I'm gonna end that. Do you want to say anything else? Either of you? Before we end, I think just something I would say is, um just how time, like one of the things that we struggle with is I think it's brilliant what we're doing within the scope of this project

But, um, it's incredibly time consuming. So, like building these relationships and and, you know, creating these meetings where, um, you know, there's a lot of planning work that goes into creating these kind of meetings and developing the kind of trust between people in the Action group and like, Billy works full time in this in this role preparing for these meetings. And so I guess, um, one of the things that we're trying to think about is once this project is over, how we can kind of sustain momentum around this, and I think that's probably a perennial challenge in Co-production because it can take such a lot of time

Um, so that's something that we're giving quite a lot of thought to at the moment. It's just that that sort of a time commitment. And so So what are your initial thoughts around that? Because in a way, you are talking about how you're building capacity in a way

And so you have people. You you're talking about peer support work, work workers potentially to, um, carry on. Is it? I mean, yeah

So have you got Have you had ideas around that? Um, yeah. I mean, I think a lot one of the things that we're really trying to put a lot of emphasis into is sharing what we're learning. Um, and I think we're not trying to come up one size or way of doing this kind of involvement work in sexual health

But I think we're going to try. And we're trying to share learning that we're having from trying to involve young people and policy makers directly and then just put, I think we're going to be spending a lot of time trying to make sure that that's discussed with the wider sexual health communities in Scotland. Um, so that people can take that forward in ways that fit

You know what works best with within their local context and with their local populations that they're working with. Billy, Did you want to add any Any final thoughts, Billy? Um, yeah. No, I think that

And also yeah, the the next stage in terms of building, um, like, helping load and work with peer researchers. We're doing sort of capacity building, um, to develop skills as well, so they can be part of, um, the next stages of the research, so that will actually be something that they also gain from this. Um, yeah, OK, I'm gonna stop the recording

Thank you. Thank you. Best of luck

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