Abstract
This chapter summarizes the co-design, co-production, and co-evaluation processes of a mobile health check-up research project in Jaipur, India, from March 2016 to June 2020. It is the continuation of our previous paper which was published in November 2018 at Sustainability. The main focus of this chapter is to describe the processes of co-production, co-implementation, and co-evaluation research activities after November 2018. To accomplish this, all documents and materials related to the research processes of co-design, co-production, and co-evaluation were thoroughly reviewed, including minutes from meetings, consultations, workshops, trainings, presentation slides, pictures, and reports. After reviewing the past 4 year’s research process, the road map of a sustainable mobile health check-up project in India was proposed.
You have full access to this open access chapter, Download chapter PDF
Similar content being viewed by others
Keywords
- Healthcare services
- Disease prevention
- Transdisciplinary research
- Co-design
- Co-implementation
- Co-evaluation
- India
1 Introduction
Future Earth research incorporates both natural and social sciences to solve global environmental issues (Lovbrand et al. 2015) and has “pioneered approaches to co-design and co-production of solutions-oriented transdisciplinary research for global sustainable development” (Future Earth 2014). However, transdisciplinary research is still hampered by a number of issues. First, the most recent reviews of transdisciplinary case studies concluded that in the co-design and co-production, processes of transdisciplinary research, methods, and concepts are still not clearly framed (Moser 2016; Brandt et al. 2013; Leemans 2016; Zscheischler et al. 2017). Second, most previous literature pertaining to transdisciplinary research only describe an early stage of “co-design” rather than actual implementation, application, and evaluation stages (Brandt et al. 2013; Page et al. 2016). Previous research includes the key components of early co-design phases such as “framing of problems” (Leemans 2016; Zscheischler et al. 2017; Adler et al. 2018), “social capital,” “partnership with mutual trust” (Mckee et al. 2015; Emmons et al. 2008; Ruddy and Rhee 2005), “scaling” (Fraser et al. 2006), “accountability” (Van Del Hel 2016; Lang et al. 2012), “ownership” (Lang et al. 2012), and “priorities and needs” (Rhodes et al. 2012). However, a few previous transdisciplinary research have reported on participatory case studies including “co-design,” “co-production,” and “co-evaluation” together in a comprehensive, bottom-up manner (Leemans 2016). Finally, fewer transdisciplinary case studies, particularly on health issues, have been conducted in low- and middle-income countries in Asia, compared to Europe and North America (Leemans 2016). Therefore, the whole processes of co-design, co-production, and co-evaluation in health-related transdisciplinary research in Asia are still vague and largely unknown.
To fill these knowledge gaps, a community-based mobile health check-up research project called “Portable Health Clinic (PHC)” was introduced in Jaipur, India, in March 2016 as part of a collaborative Future Earth research project among Kyushu University (KU), Biyani Group of Colleges (BGC), and Grameen Communications (GC) (Yokota et al. 2018) (Fig. 3.1). This paper is the continuation of our previous paper which was published in November 2018 at Sustainability and aims to update and describe the processes of this health-focused transdisciplinary research that are still taking place as of June 2020. Based on the reviews of the past 4 year’s research process, the road map of a sustainable business model in the mobile health check-up project was proposed. As an initial step, we hope to contribute to developing a methodological and conceptual framework for health-focused transdisciplinary research, as well as a new model for collaborative processes in the Asian context.
2 Portable Health Clinic (PHC) Research Project
A remote healthcare system called PHC was originally developed and implemented in Bangladesh in 2010 under a research collaboration agreement between GC and KU in 2007. GC is one of the Grameen family organizations established by Dr. Muhammad Yunus, the Nobel Peace Prize-winning founder of Grameen Bank. It is a non-profit information technology company in Bangladesh that provides software products and services, Internet services, hardware and networking services, and IT education (Wikipedia 2018). PHC is an e-health service system that includes a set of medical sensor devices in a briefcase allowing mobile health check-ups and telemedicine services in remote rural areas using Skype (Nohara et al. 2015; Ahmed et al. 2014; Nakashima et al. 2013) (Fig. 3.1). After Kyushu University Hospital joined the PHC project in 2012, PHC focused on the prevention and management of noncommunicable diseases (NCDs) such as diabetes, hypertension, and obesity. At the beginning of 2019, PHC services had been used by more than 42,000 people at 32 locations in Bangladesh (Grameen Communications 2020).
2.1 Data Sources
Data sources for this paper were all the research reports, activity logbooks, presentation slides, and the research plan/protocol including research timelines, activity schedules, and budgets. These documents produced during the period between March 2016 and June 2020 were thoroughly reviewed.
2.1.1 Co-design and Co-production Processes Among KU, GC, and BGC in Phase 1 (Photo 3.1)
In India, the PHC research project started in March 2016 as a community-based health check-up service as a collaboration between KU, GC, and BGC as part of the Future Earth Research Project funded for the Institute of Decision Science for Sustainable Society, KU (Fig. 3.2). For more detailed information on the processes in phase 1, please refer to Yokota et al. (2018).
2.1.2 Co-design Process with Local Government Agencies in Phase 2 (Photo 3.2)
After going through the pilot phase 1, KU and BGC realized that permission and agreement from local government agencies were necessary for officially implementing the PHC research project in Rajasthan (Map 3.1). In May 2017, the research team visited the following agencies: Rajasthan state and Jaipur district department of medical, health, and family welfare; Kalwar village office; and Kalwar health center (Fig. 3.2). For more detailed information on the processes in phase 2, please refer to Yokota et al. (2018).
2.1.3 Co-design, Co-production, and Co-evaluation Processes with a Civil Society Organization in Phase 3 (Photo 3.3)
In phase 3, starting from October 2017, KU and BGC had signed the official academic collaboration agreement. Based on the revised research plan and protocol, we decided to investigate the health needs, priorities, and longitudinal effects of our PHC health check-up services among different population cohort groups in various Jaipur districts. To achieve these objectives, we needed to follow up with the same individuals over time to monitor changes in their health status, behaviors, needs, and priorities. In this aspect, members of civil society organizations were much easier to follow up with than general community residents over the years. Thus, BGC first contacted the Brahma Kumaris World Spiritual University (BK) to be a stakeholder and target research population group (Fig. 3.2). For more detailed information on the processes in phase 3, please refer to Yokota et al. (2018).
2.1.4 Co-design, Co-production, and Co-evaluation Processes with Local Government Industry in Phase 4 (Photo 3.4)
In phase 4, starting January 2018, the core research objective was the same as in phase 3, to understand the health status, behaviors, and needs of local people as well as determining the effectiveness and acceptability of our project in a Jaipur district. However, in phase 4, the research target population was industry employees rather than general community residents or civil society members. Our aim was to identify the high-risk population groups which are most in need of health check-up services for NCD prevention. Thus, the study in phase 4 enables the comparison of health needs, health status, and health behaviors among civil society organization members, industry employees, and the general community members in Rajasthan. For more detailed information on the processes in phase 4, please refer to Yokota et al. (2018).
2.1.5 Co-design, Co-production, and Co-evaluation Processes with Local Private Industry in Phase 5 (Photo 3.5)
In phase 4, PHC services could not continue as a sustainable business model nor health insurance scheme in a sustainable manner. From the previous phrases, we learned that there are needs for eye check-up and traditional Indian doctors (Ayurveda) among factory employees in Jaipur district, India. In addition, factory employees need more detailed blood tests including HbA1c for diabetes and HDL/LDL cholesterol. Therefore, the Indian PHC services were customized according to specific population’s needs. We also learned that it was very difficult to implement long-term sustainable health check-up services for government factory employees due to the following reasons: (1) government system is very slow and difficult such that it has many approval steps and paper works to proceed a new health check-up scheme, (2) government factory managers (leaders) do not want to have additional tasks or extra works to start new sustainable health check-up system, and (3) government leaders request many things but not take initiatives to start a new sustainable health check-up system. In phase 5, therefore, we changed our collaborative partners from government companies to private companies because private companies do not have such obstacles (1)–(3) that government companies have. From September to October 2018, we have searched for any potential private companies who are interested in implementing health check-up services for their employees in a long term as a health insurance scheme or social business. From BGC’s principle’s network, we found that Lotus Dairy (LD) Milk Company is interested in the PHC health check-up services for their employees and they were willing to provide their own factory’s facility room as a PHC clinic and also willing to pay for a cost for medicines. KU, GC, BGC, and LD had several meetings to discuss “how can we continue to implement PHC health check-up services for LD’s employees even after research funds finish?”. Based on the discussions, all four (KU, GC, BGC, and LD) could have an official agreement on implementing sustainable PHC health check-up services for LD’s factory employees in Jaipur district, India (Fig. 3.2). However, due to the closure of KU, Institute of Decision Science for Sustainable Society, this agreement had to be ended by the end of March 2020. Although the official joint research agreement was ended in March 2020, KU, BGC, GC, and LD tried to continue the project by developing the cost-sharing scheme as below:
-
LD is to provide a cost for their factory clinic, electricity, water, and other clinic maintenance cost as well as the cost for medical drugs.
-
BGC is to provide a cost for human resources (coordinator, Ayurveda doctor, health workers, IT technicians).
-
GC is to provide technical assistance on data management and software for PHC system.
-
KU is to provide scientific knowledge and evidence on the effects and impacts of health check-up and tele-consultation services (data collection, data analysis, publish academic papers, etc.) and provide consumables for health check-up for the first 1 or 2 years.
In addition, KU and BGC developed a road map of the proposed business model for LD to be self-sustained in this PHC project (Fig. 3.3). In February 2020, KU, BGC, and LD had a face-to-face meeting at the LD headquarter office at Jaipur, India, to discuss the possibility of continuing the PHD project as the proposed business model. LD made two requests:
-
1.
More detailed evaluation results collected from company employees who received the PHC services including their satisfaction levels
-
2.
More robust supports and promotion from local government agencies such as the Ministry of Health, Medicine, and Family Welfare in India
KU and BGC agreed to have the evaluation interview survey for those who received PHC services and request LD for jointly implementing the second time PHC services and evaluation surveys targeting those who received PHC services once before. Unfortunately, due to the COVID-19 situations in India and Japan, our joint PHC project has been pending as of June 2020.
2.1.6 Summary of Co-design and Co-production Processes in All Five Phases
In all phases that we described in this section, we utilized the following co-design, co-production, and co-evaluation process steps (Fig. 3.4): (1) jointly develop and revise a research plan and protocol which includes research objectives, methods, timelines, activity schedules, and budgets; (2) reach collaborative agreement and consensus on the research plan and protocol with both academic and nonacademic stakeholders through meetings, consultations, and workshops; (3) conduct local research staff training workshops based on the protocol in order to improve the quality of services and quality of data jointly with stakeholders; (4) implement the pilot PHC health check-up research involving all stakeholders; (5) analyze, disseminate, and provide feedback on the results with all stakeholders through presentations, seminars, workshops, and conferences; (6) revise the research plan and protocol based on feedback such as local needs, priorities, and requests from stakeholders; and (7) develop and implement sustainable PHC social business model (business partners, staff, customers, business services and products, service delivery process and activities, business resources, cost structures, time frame, target locations, marketing plan). We should have engaged with all of our government, industry, and community stakeholders at an earlier stage of the co-design process, so that we did not need to go and back again between co-design and co-production. Van der Hel et al. (2016) indicated that engaging more stakeholders throughout the research process will increase legitimacy and reduce skepticism. Some key factors, such as effective local coordinators, personality types of stakeholder leaders, and continuous involvement and engagement with stakeholders, particularly both government and nongovernment stakeholders helped mitigate such difficult situations in our research in India.
References
Adler C, Hadorn GH, Breu T, Wiesmann U, Pohl C (2018) Conceptualizing the transfer of knowledge across case in transdisciplinary research. Sustain Sci 13:179–190
Ahmed A, Rebeiro-Hargrave A, Nohara Y, Kai E, Hossein Ripon Z, Nakashima N (2014) Targeting morbidity in unreached communities using portable health clinic system. IEICE Trans Commun 3:97
Brandt R, Ernst A, Gralla F, Luederitz C, Lang DJ, Newig J, Reinert F, Abson DJ, von Wehrden H (2013) A review of transdisciplinary research in sustainability science. Ecol Econ 92:1–15
Emmons KM, Viswanath K, Colitz GA (2008) The role of transdisciplinary collaboration in translating and disseminating health research. Am J Prev Med 35(2):S204–S210
Fraser EDG, Dougill AJ, Mabee WE, Reed M, McAlpine P (2006) Bottom up and top down: analysis of participatory processes for sustainability indicator identification as a pathway to community empowerment and sustainable environmental management. J Environ Manag 78(2):114–127
Future Earth (2014) Future earth 2025 vision. http://www.futureearth.org/sites/default/files/future-earth_10-year-vision_web.pdf. Accessed on 3 May 2018.
Grameen Communications (2020) Global Communication Center. Portable Health Clinic. http://ghealth.gramweb.net/. Accessed on 6 May 2020
Lang DJ, Wiek A, Bergmann M, Stauffacher M, Martens P, Moll P, Swilling M, Thomas CJ (2012) Transdisciplinary research in sustainability science: practice, principles, and challenges. Sustain Sci 7(Suppl. 1):25–43
Leemans R (2016) The lessons learned from shifting from global-change research programmes to transdisciplinary sustainability science. Curr Opin Environ Sustain 19:103–110
Lovbrand E, Beck S, Chilvers J, Forsyth E, Hedren J, Hulme M, Lidskog R, Vasileidou E (2015) Who speaks for the future of earth? How critical social science can extend the conversation on the Anthropocene. Glob Environ Chang 32:211–218
Mckee A, Guimaraes MH, Pinto-Correia T (2015) Social capital accumulation and the role of the searcher: an example of a transdisciplinary visioning process for the future of agriculture in Europe. Environ Sci Policy 2015:88–99
Moser SC (2016) Can science on transformation transform science? Lessons from co-design. Curr Opin Environ Sustain 20:106–115
Nakashim N, Hiramatsu T, Ghosh PP, Islam R, Kobayashi K, Inoguchi T (2013) Evaluation of “Portable Health Clinic” with BAN standard for 10K subjects in Bangladesh. In: Conference Proceedings of the IEEE Engineering in Medicine and Biology Society. pp 1672–1675
Nakashima N, Nohara Y, Ahmed A, Kuroda M, Inoue S, Ghosh PP, Islam R, Hiramatsu T, Kobayashi K, Inoguchi T, Kitsuregawa M (2013) An affordable, usable and sustainable preventive healthcare system for unreached people in Bangladesh. Stud Health Technol Inform 192:1051
Nohara Y, Kai E, Ghosh PP, Islam R, Ahmed A, Kuroda M, Inoue S, Hiramatsu T, Kimura M, Shimizu S, Kobayashi K, Baba Y, Kashima H, Tsuda K, Sugiyama M, Nakashima N (2015) Health checkup and telemedical intervention program for preventive medicine in developing countries: verification study. J Med Internet Res 17(1):e2
Page GG, Wise RM, Lindenfeld L, Moug P, Hodgson A, Wyborn C, Fazey L (2016) Co-designing transformation research: lessons learned from research on deliberate practices for transformation. Curr Opin Environ Sustain 20:86–92
Rhodes SD, Kelley C, Siman F, Cashman R, Alonzo J, McGuire J, Wellendorf T, Hinshaw K, Allen AB, Downs M, Brown M, Martinez M, Duck S, Reboussin B (2012) Using community-based participatory research (CBPR) to develop a community –level HIV prevention Intervention for Latinas: a local response to a global challenge. Women’s Health Issues 22(3):e293–e301
Ruddy G, Rhee K (2005) Transdisciplinary teams in primary care for the underserved: a literature review. J Health Care Poor Underserved 16(2):248–256
Van Del Hel S (2016) New science for global sustainability? The institutionalization of knowledge co-production in Future Earth. Environ Sci Pol 61:165–175
Wikipedia (2018) Grameen family of organizations. https://en.wikipedia.org/wiki/Grameen_family_of_organizations. Accessed on 29 May 2018
Yokota F, Biyani M, Islam R, Ahmed A, Nishikitani M, Kikuchi K, Nohara Y, Nakashima N (2018) Lessons learned from co-design and co-production in a portable health clinic research project in Jaipur District, India (2016-2018). Sustainability 10(11):4148
Zscheischler J, Rogga S, Bussse M (2017) The adoption and implementation of transdisciplinary research in the field of land-use science – a comparative case study. Sustainability 9:1926
Acknowledgments
I would like to thank the following stakeholders and the individuals who provided support for the project: Biyani Group of Colleges; Grameen Communications; Kalwar village office; Kalwar health center; Jaipur district and Rajasthan state department of medical, health, and family welfare; Brahma Kumaris Spiritual Centers; Saras Dairy; and Lotus Dairy. This work was supported by a grant JPMJRX16F1 from the Research Institute of Science and Technology for the Society (RISTEX) of Japan Science and Technology Agency (JST) as part of the Future Earth programs.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Copyright information
© 2021 The Author(s)
About this chapter
Cite this chapter
Yokota, F. et al. (2021). Co-design, Co-production, and Co-evaluation Processes for a Mobile Health Check-Up Research Project in Jaipur, India: A Case Study of the Portable Health Clinic, 2016–2020. In: Yahara, T. (eds) Decision Science for Future Earth. Springer, Singapore. https://doi.org/10.1007/978-981-15-8632-3_3
Download citation
DOI: https://doi.org/10.1007/978-981-15-8632-3_3
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-8631-6
Online ISBN: 978-981-15-8632-3
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)