in-DEPtH framework: evidence-informed, co-creation framework for the Design, Evaluation and Procurement of Health services

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With a multitude of variables, the combinations of care, health program activities and outcomes are infinite, and this renders improvement efforts to complex health service interventions particularly intricate. Here, we describe a framework that seeks to incorporate research evidence and the multi-faceted considerations of stakeholders, context and resources to co-create sustainable health solutions that improve the health outcomes of patients and communities. This evidence-informed, co-creation framework for the Design, Evaluation and Procurement of Health services (in-DEPtH) is a systematic approach to support health agencies to commission services that are evidence-informed, contextually relevant and stakeholder engaged. The framework consists of several steps from defining the research question, health outcomes and search inclusion criteria, to the synthesis of evidence, and to co-creation and Delphi consultations with stakeholders. In this paper, we describe the various steps of the framework and explain the theoretical methods underpinning the framework. The approach of the framework is context neutral and can be applied to healthcare systems of different countries.

Original languageEnglish
Article numbere026482
Number of pages11
JournalBMJ Open
Issue number5
Publication statusPublished - 2019

Bibliographical note

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:


  • health service interventions
  • stakeholders
  • variables
  • framework
  • health services research
  • public health systems research
  • health services administration
  • translational research
  • healthcare systems


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