The Accordion Process: An Emancipatory Methodology for ‘How to’ Co-design Options for Health Policy to ‘Accord’ With Lay Priorities

Evidence supports the value of co-designing health policy through meaningful engagement with communities, ensuring their priorities are central to the process. However, there has been limited guidance for ‘how to’ authentically engage community members to create ideas for health policy guided by equity. This paper outlines a clear, actionable process for co-designing health policy that ‘accords’ with lay priorities - the Accordion Process. Using an emancipatory methodology based on human- centred, experience-based design thinking, our dialogic process involves researchers acting as conduits between community members and stakeholder groups, making sure both are engaged with, and recursively attending to community members’ voices to ensure policy options reflect lay priorities. The Accordion Process facilitated the identification of policy options using lay priorities (women across different social classes) and enabled stakeholders in media, service delivery and advocacy to develop recommendations that can be feasibly implemented in the context of real-world policy ecosystems for alcohol- related breast cancer prevention. The process moved beyond refutation of existing policies targeting individual-level behaviour change to identify entirely new options that venerated women’s ‘asks’ for changes at the ‘systems’ level to mediate social, political and commercial determinants of health. Our dialogic process bridges the gap between theorising the importance of co-design and developing recommendations for real-world policy. This paper offers a unique, instructive guide for co-designing inclusive health policy with the goal of increasing acceptability and effectiveness.