Co-designing municipal multimorbidity rehabilitation: strengthening health literacy (CURIA study)

Background

People with multimorbidity face challenges navigating health information and services, alongside fragmented care and limited social support. Municipal rehabilitation for adults under 65 often lacks structures for sustained engagement and community integration. CURIA (Co-designing Municipal Rehabilitation) evaluated whether co-design can strengthen organizational and distributed health literacy and support ongoing community-based health engagement.

Methods

Co-design study using the three-phase OPHELIA model. Phase 1: assess health literacy needs, multimorbidity prevalence, and organizational conditions. Phase 2: identify priorities and develop interventions via co-design workshops with people with multimorbidity, municipal health professionals, civil society representatives. Phase 3: apply rapid-cycle prototyping (Plan–Do–Study–Act) to test initiatives guided by a logic model.

Results

Navigation of health services relied heavily on social networks, while both participants and professionals reported fragmented support and transitions. Co-design with 78 contributors generated 16 intervention ideas; six were piloted, including guided introductions to community activities and initiatives promoting social participation. Municipal professionals acted as matchmakers, facilitators, and link-workers, while civil society actors provided relational support enabling cross-sector coordination. Attendance varied, reflecting individual readiness and program integration.

Conclusions

CURIA shows that co-designed interventions can enhance organizational and distributed health literacy by embedding it within social networks, community resources, and municipal structures. Interventions supported structured transitions, peer continuity, and cross-sector collaboration, while extended professional roles and civil society involvement improved navigation of local health resources. Future research should examine scalability across municipalities with attention to context.

Key messages

• Integrating organizational and distributed health literacy in municipal rehabilitation strengthens coordination, navigation, and community participation, supporting long-term health management.

• Co-design with people with multimorbidity and stakeholders produced realistic, implementable solutions that enhanced health literacy, engagement, and continuity in rehabilitation.