From co-creation to community engagement and system change in Generation Healthy Kids

Background

Many community programs use co‑creation to engage communities in child health initiatives, aiming to build capacity and drive action for system change. However, few studies have examined how engagement evolves over time and to what extent actions are leveraged to generate community‑level system change. This study investigates if the co‑created community intervention in the Generation Healthy Kids project contributed to community engagement, community actions, and early system changes over time.

Methods

Data were collected quarterly over a period of 18 months through registration of stakeholder engagement levels and community actions (number and characteristics) in an electronic database (REDCap). Engagement was assessed using a modified version of Rosenblatt’s Engagement Pyramid, while potential system changes by actions were determined using the Action Scale Model. Descriptive statistics and mixed‑effects models were applied to examine engagement patterns and action characteristics within and across communities over time.

Results

Stakeholder engagement varied across communities and over time, with a significant overall decline observed after 9 months (all p < 0.01). Communities initiated 55 actions, most targeting children (n = 37), aiming to increase physical activity (n = 34), and driven by school representatives (n = 18). Most actions were categorized as events (54.5%) or structural (38.2%) and emerged early (0–3 months), whereas actions targeted at the system‑levels of goals or beliefs appeared later (9–15 months).

Conclusions

Community programs using co‑creation can foster early engagement and support actions for child health but sustaining engagement and achieving actions that target deeper system change remain challenging. Phase‑specific implementation support that facilitates the transition from idea generation to concrete action may help sustain engagement and strengthen long‑term impact on children’s health.

Key messages

• This study shows that co‑creation can spark early community engagement and actions in child‑health efforts, yet sustaining involvement and achieving deeper system‑level changes remain challenges.

• This study moves beyond static assessment by showing how repeated tracking captures the dynamic evolution of engagement and impact in community child‑health efforts.