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Background Co-production is an umbrella term used to describe the process of generating knowledge by bringing together researchers and those who will use research to work in partnership. Multiple benefits of research co-production have been hypothesized, and in some cases documented, in the academic and practice record. However, there are significant gaps in understanding how to evaluate the quality of co-production designs, processes, and results. This gap in knowledge undermines the value of co-production and co-producers. Methods Our research tests the relevance and utility of a novel research co-production evaluation framework: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Following a co-production approach ourselves, members of our team collaborated to develop study objectives, questions, analysis and results sharing strategies. We used a dyadic field-test design to simulate RQ + 4 Co-Pro evaluations amongst 18 independently recruited subject matter experts. We used standardized reporting templates and qualitative interviews to collect data from field-test participants, and thematic analysis and deliberative dialogue to analysis and interpret results. Results The field test surfaced unanimous support for the relevance and utility of RQ + 4 Co-Pro. Research participants shared opportunities for fine-tuning language and criteria within the prototype version, but also, for alternative uses and users of RQ + 4 Co-Pro. This data facilitated our deliberative revision and publication herein of a field-tested RQ + 4 Co-Pro Framework and Assessment Instrument. Conclusion Evaluation is necessary for understanding and improving co-production, and, for ensuring co-production delivers on its promise of better health, health equity, and general public good. RQ + 4 Co-Pro provides an immediately practical evaluation tool, and we invite co-producers and stewards of co-production – including the funders, publishers, and universities who increasingly claim to encourage socially relevant research – to adapt and experiment with RQ + 4 Co-Pro in their contexts.

Background A learning health system framework provides an opportunity for health system restructuring to provide value-based health care. However, there is little evidence showing how to effectively implement a learning health system in practice. Objective A mixed methods review is proposed to identify and synthesize the existing evidence on effective implementation strategies and outcomes of LHS in an international context. Methods A mixed methods systematic review will be conducted following methodological guidance from JBI and PRISMA reporting guidelines. Six databases (CINAHL, Embase, Medline, PAIS, Scopus and Nursing at Allied Health Database) will be searched for terms related to learning health systems, implementation and evaluation measures. Three reviewers will independently screen the titles, abstracts and full texts of retrieved articles. Studies will be included if they are published in a peer reviewed journal and report on the implementation of a learning health system in any health care setting. Qualitative, quantitative or mixed methods study designs will be considered for inclusion. No restrictions will be placed on language or date of publication. Grey literature, reviews, conference proceedings and dissertations will be excluded. Data will be extracted from included studies using a standardized extraction form. One reviewer will extract all data and a second will verify. Critical appraisal of all included studies will be conducted by two reviewers. A convergent integration approach to data synthesis will be used, where qualitative and quantitative data will be synthesized separately and then integrated to present overarching findings. Data will be presented in tables and narratively. Conclusion This review will address a gap in the literature related to implementation of learning health systems. The findings from this review will provide researchers with a better understanding of how to design and implement learning health system interventions. This systematic review was registered in PROSPERO (CRD42022293348).

Background Interventions to improve discharge communication in emergency practice settings are inherently complex and incorporate multiple strategies aimed at patient, caregiver and healthcare provider behaviours. Behaviour change theories, including the capability-opportunity-motivation-behaviour (COM-B) model and Behaviour Change Technique Taxonomy version 1 (BCTTv1), provide consistent language for identifying and evaluating the active components of interventions. The objectives of this study were to: (1) identify common barriers and enablers to discharge communication interventions and (2) describe behaviour change techniques (BCTs) present in pediatric emergency discharge communication interventions aimed at patients, caregivers and health care providers. Methods We conducted a secondary analysis of 35 experimental and quasi-experimental studies included in a narrative synthesis of discharge communication interventions in pediatric emergency care. Included studies were reviewed to identify reported barriers and enablers to implementation and intervention effectiveness, which were then mapped to the COM-B model. Trained BCT coders independently coded intervention descriptions using the BCTTv1 as a coding framework. Consensus was used to resolve any discrepancies. BCTs were analyzed using descriptive statistics to determine the frequency of the 93 individual BCTs and 16 BCT categories for patient/caregiver and health care provider interventions. Results Barriers and enablers were identified at the patient/caregiver, health care provider, intervention and health system levels. Psychological capability was the most frequently coded COM-B component. Of the 33 studies that included BCTs, 29 interventions targeted patients or caregivers. A total of 20 different individual BCTs were identified across the interventions in the 33 studies. The number of BCTs identified in each study ranged from 1-9 BCTs, with most (n=14, 42%) interventions containing one BCT. Reporting deficiencies were noted related to adequate details of intervention components and implementation fidelity.Conclusions The COM-B model and BCTTv1 proved to be useful tools to provide a foundational understanding of the common mechanisms used in pediatric discharge communication interventions. With only a fraction of the available BCTs were used in the included studies, future research is needed to explore the utility of other BCTs to address common implementation barriers and improve the effectiveness of discharge communication interventions.