Building the OAChangeMap to improve the service delivery of the New South Wales Osteoarthritis Chronic Care Program: a worked example of using a co-design framework.

Objective: The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best-evidence OA care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritise the barriers, and generate strategies to address them.

Methods: This study provides a worked example of a seven-step theory-informed co-design framework. We invited OACCP coordinators to participate in semi-structured interviews (analysed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, researchers) to prioritise the barriers via a short survey (survey 2). We held five co-design workshops where we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them.

Results: Sixteen coordinators were interviewed and the main barriers identified were: 1. patients often have beliefs that are inconsistent with best-evidence care; 2. there are aspects of clinical care that are not delivered optimally; and 3. system level factors are a barrier to optimal patient care and sustainability of the OACCP. We co-designed a plan for action with patient educational materials, shared decision-making tools, and health professional education and training.

Conclusion: Our worked example of co-design used a theory-based, data driven approach with key stakeholders, identified and prioritised barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.