An in-depth understanding of stakeholders' experiences about their participation in the co-production of 'Maze Out': a serious game for the treatment of eating disorders

J Eat Disord. 2024 Nov 14;12(1):178. doi: 10.1186/s40337-024-01136-3.

Abstract

Background: Co-production is increasingly used in mental health research and clinical settings. Maze Out is a digital game co-produced by clinicians, patients with eating disorders (EDs), an art director with lived experience in EDs, and a game-developing company. Maze Out is based on everyday challenges when suffering from EDs and is currently being evaluated as a supplement tool in EDs treatment. Several studies on co-producing mental health interventions focus on design and effectiveness, but the experiences of those involved in the co-production process remain unexplored. An in-depth exploration of stakeholders' experiences offers valuable insights into the impact of co-production on different groups and generates crucial knowledge for successful implementation.

Objectives: This study evaluated and explored the co-production process and the meaning that EDs patients, clinicians, and game designers attributed to their participation in the co-production of Maze Out. The objectives were to determine (1) how stakeholders experienced their collaboration in the co-production of Maze Out.; and (2) to what extent the stakeholders involved in developing Maze Out followed Cahn's principles of equality, diversity, accessibility, and reciprocity.

Methods: Five stakeholders (two patients, two clinicians, and a game designer) who participated in the co-production completed semi-structured interviews. Two patients and one clinician's diaries supplemented the interviews. Reflexive thematic analysis was used to interpret the data.

Results: The results of this study highlight the importance of building a common language between clinicians, patients, and other professionals involved in developing new forms of treatment and interventions. A recommendation for researchers and clinicians to implement co-production in the future is that Cahn's principles: equality, reciprocity, accessibility, and diversity, serve as a strong foundation for successful co-production. In this study, three and partially one of the four Cahn's principles about co-production were identified: equality, reciprocity, and accessibility. When applied in an ED context, these principles provided stakeholders with valuable insights, enriching practice-based knowledge, using the knowledge applicable to clinical practice, and demonstrating their crucial role in fostering effective co-production processes.

Plain language summary

This study explored the co-production of Maze Out, a digital game developed as a supplementary tool for eating disorder treatment. Maze Out was co-created by eating disorder patients, clinicians, a game development company, and a designer with lived experience of eating disorders. This study explored how these stakeholders experienced the collaboration and whether they perceived the process to reflect principles like equality, diversity, accessibility, and reciprocity. We interviewed all stakeholders who participated in the co-production process. Two patients and one clinician’s diaries supplemented the interviews. In this study, three fundamental principles—equality, reciprocity, and accessibility—were central. These principles helped participants gain valuable insights and improve their practical and clinical knowledge about eating disorders. The findings highlight the importance of building a shared understanding among clinicians, patients, and other professionals involved in creating new treatments. Researchers and clinicians are recommended to implement Cahn’s principles to support successful collaboration in the future.