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Use and reporting of experience-based codesign studies in the healthcare setting: a systematic review
  1. Theresa Green1,2,
  2. Ann Bonner1,2,
  3. Laisa Teleni1,
  4. Natalie Bradford1,
  5. Louise Purtell1,
  6. Clint Douglas1,
  7. Patsy Yates1,2,
  8. Margaret MacAndrew1,
  9. Hai Yen Dao1,
  10. Raymond Javan Chan1,3
  1. 1 School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  2. 2 Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
  3. 3 Division of Cancer Services Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
  1. Correspondence to Professor Raymond Javan Chan, School of Nursing, Queensland University of Technology–Kelvin Grove Campus, Kelvin Grove, QLD 4059, Australia; raymond.chan{at}


Background Experience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities.

Methods Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study.

Results We identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity.

Conclusion EBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner.

Trial registration number CRD42018105879.

  • healthcare quality improvement
  • health services research
  • implementation science
  • quality improvement methodologies

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  • Contributors RJC and TG conceptualised the review. RJC, TG, AB and LT developed the protocol which was reviewed by all authors. LT conducted the search and all articles were screened and LT, TG and RJC reviewed the full text to determine inclusion of studies. Data extraction was conducted by LT and checked by HYD. All authors completed quality appraisal and contributed to and approved the manuscript.

  • Funding This review is supported by the School of Nursing, Queensland University of Technology.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.