Periodic Reporting for period 1 - Health CASCADE (Evidence-based co-creation methodology for bridging the implementation gap between knowledge and action in health promotion.) Reporting period: 2021-01-01 to 2022-12-31 Summary of the context and overall objectives of the project THE PROBLEM Co-creation emerges as a promising strategy to address complex problems (such as the obesity epidemic) which are particularly resistant to resolution. The use of co-creation in many fields has grown exponentially in recent years and it is now expected, and often demanded, by funders, governments and policymakers to democratise and accelerate the impact of research. However, currently, there is 1) a lack of capacity for co-creation within research and practice workforces; 2) a lack of robust methodology to underpin co-creation practice; and 3) a lack of digital technology to facilitate co-creation. IMPORTANCESociety and European citizens are increasingly confronted with more complex problems in public health, climate change, biodiversity loss, growing inequalities, urban planning and threats to democracy which seem to resist traditional deterministic approaches. These problems have a high societal impact and financial burden. Health Cascade is providing a rigorous and trustworthy methodology for co-creation, a new generation of highly trained young scientists, and a cascading training programme to build capacity throughout Europe. The methodology, capacity, training and technology developed in the network will empower actors across Europe to tackle complex problems in different sectors and develop effective solutions. The impact of Health Cascade will also be to decrease the likelihood of harm and resource wastage. There are already numerous reports of co-creation having detrimental effects and uncharted potential unintended consequences, from poorly evidenced and poorly conducted co-creation. There is a real danger that this will ultimately lead to growing distrust towards co-creation from the public, policymakers and other stakeholders and, more importantly, that poorly conducted co-creation might put the public at risk. OBJECTIVESThe aim of Health CASCADE is to foster the next generation of highly-trained research leaders in all aspects of evidence-based co-creation methodology to tackle the complexity of modern global health problems. Through a programme of training-by-research projects and tailored training events, Health CASCADE will achieve the following objectives: 1) Train the next generation of research leaders. 2) Advance co-creation into a rigorous scientific methodology with evidence-based methods, practices and supportive technologies. 3) Develop a shared European cascading training system for evidence-based co-creation Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far Health CASCADE is the first cooperative and structured effort to comprehensively address the training and methodological development of co-creation.The recruitment of 15 Early Stage Researchers (ESRs) was completed in July 2021 and they were all in post by October 2021. The scientific work has three components:- WP1 is developing the foundation of a trustworthy and evidence-based rigorous co-creation methodology, including: theory, ethics, methods and implementation and evaluation - WP2 is developing, enabling digital technology to support co-creation - WP3,4,5 and 6 are applying and testing the methodology in four key sectors for public health ( Schools, the workplace, the health care system and the urban setting) WP1 developed an open-access knowledge base about co-creation by systematically searching the literature. Systematic reviews and expert interviews were conducted to: identify an epistemological lens and theories to underpin co-creation, establish a framework for continual ethical reflection to govern co-creation, establish a taxonomy of methods for conducting co-creation and establish an evaluation framework for co-creation. These were compiled into initial guidelines for evidence-based co-creation called PRODUCES+ for planning, conducting, evaluating and reporting co-creation (launched Nov 2022). WP2 conducted need assessments for technology in co-creation. These are: governance, knowledge management and process facilitation. WP2 developed an architecture for an eco-system of enabling technologies and priorities and two prototype technologies to address the top two needs: 1) An Artificial Intelligence question and answer service that co-creator can interrogate to gain knowledge about a specific topic and co-creation, 2) An artificial assistant capable of transcribing the content of workshop discussions in multiple languages and extract salient themes to help co-creators in decision making throughout the process. WP3-6 test the co-creation process across a range of sectors. WP3 is co-creating interventions targeting healthy sleep in adolescents in the school setting. WP4 is co-creating interventions to replace sitting at work with physical activity in the work setting and exploring the scalability of co-created interventions. WP 5 is co-creating interventions in healthcare settings.WP 8 develops a Cascade Training programme. We have written a curriculum development plan and assessed different business and exploitation plans. Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far) Policy, funders and citizens now demand more participation from the public in research and decision-making. Currently, there are no accepted theories or consolidated methodologies to underpin co-creation and ensure it is robust and trustworthy. Health Cascade is developing evidence-based guidelines for planning, conducting, evaluating and reporting co-creation to make it a robust and trustworthy methodology. Health Cascade developed an architecture and taxonomy for an ecosystem of digital technology specifically designed to support and enhance co-creation. In the first period, Health Cascade has developed pilot solutions for the top two priorities in the needs assessment, namely: 1) the need for co-creator to access rapidly and on-demand the state-of-the-art on a specific subject and 2) the need for co-creators to have a synthesis of the collective intelligence work done to facilitate decision making through the co-creation process. Health Cascade is developing a cascade training course for evidence-based co-creation. The guidelines, tools and technology form the foundation of a training cascading training course Health Cascade is co-creating with key stakeholders in different sectors (health, workplace, education and urban planning) across Europe. The course will be delivered through cascade training for greater reach and rapid scaling. The impact of Health Cascade is in four areas: - developing evidence-based co-creation and building capacity through a cascade training model. - practical tools and digital technologies developed by Health Cascade - real-world co-created interventions during the Health Cascade project in the health care, education, workplace and urban planning sectors.- The main impact will be building capacity for robust and trustworthy co-creation, ensuring that European research and civil institutions have a more powerful methodology to tackle complex problems. In this respect, this will help build public trust in science, democracy and societal structures. Widely practised evidence-based cocreation within public health will, in turn, reduce the societal burden of disease. The digital technologies developed will enable better access to knowledge for all citizens. Finally, the interventions will enable progress in these sectors, transforming health care, education, the workplace and urban planning. 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