‘Playing’ with Evidence: combining creative co-design methods with realist evidence synthesis

Breaking the cycle of declining physical function and physical activity can improve health and independence for people with long-term conditions. Services within primary care are well placed to empower individuals and communities to achieve this. However, the best approach is uncertain, and must consider needs of people with long-term conditions and complexities of service delivery. This study aimed to understand how to reduce decline in physical function and physical activity in people with long-term conditions. We used realist methods integrated with co-design to provide an explanatory account of what works (or does not), for whom and in what circumstances, to generate ideas about service innovation, and provide recommendations for primary care. A key aspect was tracking evidence from different sources, presenting it creatively by converting it into physical games, enabling stakeholders to ‘play with’ and make-sense of it, to inform co-design work, enabling them to draw upon their own experiences and a wider understanding. In this article, we focus on the game activities, adding to the co-design games’ literature and suggest that this expands participants’ knowledge base beyond their experiences, empowering them to contribute more to the process and creating a strong link between the realist and co-design methods.