Exploring co-design: a systematic review of concepts, processes, models, and frameworks used in public health research

Background: Co-design has emerged as a preferred collaborative approach among public health practitioners and researchers to increase the potential for effective design, implementation, and dissemination of innovations in practice. However, there is a lack of consistency in its application and reporting, which limits co-design theory building and best practice. This systematic review aimed to examine the peer-reviewed literature reporting on the use of co-design as a process in public health, synthesizing co-design definitions, processes, models or frameworks, and participant involvement. Methods: Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted. MEDLINE Complete, Global Health, and CINAHL databases were searched in April 2024. Results: Fifty-five articles on co-design in public health published between 2016 and 2024 were included, noting a publication surge in 2023. Most studies were from Oceania, especially Australia. While 44% lacked a co-design definition, 56% highlighted its collaborative, inclusive nature. Over half (64%) used specific frameworks with a 4–5 stage process. Participant roles varied from informants to co-designers, with many studies not developing prototypes for testing. Conclusions: A more transparent and systematic application of co-design principles, guided by clearer frameworks and reporting standards, could improve the consistency and effectiveness of co-design in public health.