ENRICHING THE EVIDENCE BASE OF CO-CREATION IN PUBLIC HEALTH WITH METHODOLOGICAL PRINCIPLES OF CRITICAL REALISM INTRODUCTION Meta-theory, such as Critical Realism (CR) provides a foundation for understanding and researching phenomena. CR, originating from Bhaskar's work, distinguishes between the real and observable world and encourages exploring complex social phenomena with a focus on causal mechanisms. Co-creation research lacks explicit meta-theoretical foundations, whereas CR is a convincing proponent for hypothesised mechanisms to have the strongest explanatory power, related to empirical evidence. This study aims to explore critical realism as a promising meta-theory providing clear methodological principles [1,2] to enrich the evidence base for co-creation in public health research. RESULTS + MAIN TAKE-HOME MESSAGES www.healthcascade.eu @health_cascade Health CASCADE is a Marie Skłodowska-Curie Innovative Training Network funded by the European Union’s Horizon 2020 research and innovation programme under Marie Skłodowska-Curie grant agreement n° 956501 AUTHORS: MESSIHA, K (1); ALTENBURG, TM (1); SCHREIER, M (2); LONGWORTH, GR (3); THOMAS, N (4); CHASTIN, S (5,6); CHINAPAW, MJM (1) Critical realism methodological principles seem well-suited as a meta-theoretical framework for evidence-based co-creation in public health empirical research METHODS Scan me to connect on LinkedIn Free hand Google Scholar Litmaps Full text screening Formative synthesis output Deliberative meetings Summative synthesis output Assessing applicability and usability (real-life case study “KiA”* [3] + WP3-6 feedback) Figure: Information flow chart of paper selection Define event as an outcome of research; Review literature for concepts, studies, and evidence; Provide chronological narrative; Analyse co-creators' perspectives; Compile key components: Actors, Actions, Objects, Outcome. Explication of Events Identification of + detailing the critical/ important events as a set of related actions or changes that occur over time and have a particular outcome or goal. Identify + analyse the components of the contextual environment that influence the event. Clarify their connections in order to understand how such event is influenced. Explication of structure + context Identification of social (norms) + physical structure, contextual environment + their relationships as linked to the event(s) which occurred. Propose superior mechanisms for event explanation; Identify contextual entities, including affordances influencing behaviours; Note retroduction's has 4 types: overcoded, undercoded, creative + meta-retroduction. Retroduction Identification + explanation of underlying mechanisms that caused the observed events. Formulate hypothesis based on prior knowledge; Test using empirical methods, longitudinally; Analyse data for variable relationships; Evaluate results for empirical adequacy; Further assess to corroborate/ refute refined theories. Empirical corroboration About the validation/ ‘confirmation’ of proposed causal mechanisms through empirical testing. Use diverse theories, methods, data sources + investigators for comprehensive perspectives; Assess event analysis significance (non-definitive). Triangulation and multi-methods About using (i.e., combining and integrating) a variety of data types and sources, relevant theories, analytical methods + observers in a research study to identify causal relationships. Principle 1 Principle 2 Principle 3 Principle 4 Principle 5 CR Principles with convincing empirical parallels to KiA... Event: Childhood overweight (outcome). Explored literature and local data (KiA neighbourhood). Participatory Assessment: 3-4 group meetings (children, n=20), interviews with parents (n=27), professionals (n=9). Results: Childhood overweight identified as main issue, with insufficient physical activity and unhealthy diet as main risk factors. Actions: Unhealthy behaviours. Objects: School, home, neighbourhood. Needs assessment w