Co-production of healthcare involving patients, families and professionals in care processes has been proposed to create joint learning about how to meet the patients’ needs, thus promoting best possible health and care. There is, however, a lack of knowledge in how healthcare organizations can be organized to be able to deliver co-produced care, also specifically in cardiac care settings. The global aim for the thesis presented here, is to explore whether, how and why co-production of healthcare services can contribute to best possible care, particularly for individuals with cardiac care needs in a Swedish chronic cardiac care setting. Here, the thesis’ first two studies are presented followed by reflections regarding next steps of the project.

Study I: Learning Café - a small scale model for co-production

Study I was an organizational case study using both quantitative and qualitative data to reveal atrial fibrillation (AF) patients' and professionals' experiences of pilot‐testing a Learning Café group education programme. Two nurses invited AF patients and partners to four 2.5‐hour Learning Café sessions. In the first session, they solicited participants' questions about life with AF. A physician, a nurse and a physiotherapist were then invited to address these questions in the remaining sessions. After each session patients rated their sense of security in everyday life on a scale of 0‐10, 10 representing “completely secure”. Study results indicate that AF patients gained a greater sense of security in everyday life, the professionals gained professional development and the organization gained knowledge about how to involve patients and family members in healthcare.

Study II: Understanding barriers and facilitators to co-production

Study II was a focus group study to assess heart failure patients’, family members’ and professionals’ perceived barriers and facilitators to co-production of healthcare. Barriers and facilitators to co-produce health and were categorized into capabilities, opportunities andmotivation care underpinned by the Capability, Opportunity, Motivation, Behavior (COM-B) model. Participants understood co-production as a service to be offered to patients on the microsystem level on top of traditional care. Limited health literacy among many patients was aggravated by professionals’ struggle to convey health information to these patients. Furthermore, co-production was considered to more resource intensive compared to traditional care. A barrier to co-production was that all participants expected the professionals to be in charge of healthcare services. However, presumed co-production benefits motivated stakeholders to co-produce. Co-production was recognized to promote patients’ and family members’ sense of security in everyday life and motivating patients to better selfcare. Participants recognized, however, that not all patients want to actively participate in healthcare decisions.

Next steps

The Learning Café pilot test exemplifies movement towards co-production, involving patients in co-design, co-delivery and co-evaluation of the Learning Café. Understanding the contextual barriers and facilitators to co-production is a key to future co-production. To manage these barriers and facilitators, healthcare leaders need to support co-production initiatives. The next step is to explore leaders’ preconditions for supporting such initiatives (study III). Finally, in study IV with details yet to be decided, lessons learnt from study I-III will be used to perform a co-production initiative in the cardiac care setting.