Coproducing healthcare with immigrants

Christina Mathilde Radl-Karimi

Research output: ThesisPh.D. thesis


The concept of coproduction holds great promise for meaningful and genuine partnerships between patients and health
professionals. According to coproduction, services are, unlike goods, always coproduced by a user and a public service provider. Coproduction is especially important for immigrants, who experience limited access and involvement in their healthcare and are at risk of receiving lower quality of care. However, research on how immigrants can use their own experience and expertise to participate in the coproduction of health is scarce. This thesis provides practical insights into how health professionals and immigrant patients can coproduce to create better health from healthcare services.

The systematic scoping review on facilitators for coproduction (Study I) showed that immigrant patients can be a valuable source of information and powerful coproducers of their own health if the healthcare organization and frontline health professionals prepare for it. In the two qualitative studies, we explored health professionals’ (Study II) and immigrant patients’ (Study III) experiences with coproduction at an interdisciplinary outpatient clinic for immigrants and refugees. Study II, from participant observations, interviews, and focus groups, showed that leadership-supported flexibility and interdisciplinary support enabled health professionals to find sensible solutions for each patient. Communication tools designed around patient needs guided health professionals in listening and creating a safe space built on trust and empathy. This safe space was essential for shared decisions about care. Relational continuity strengthened coproduction but also bore risks of emotional dependency. Study III, based on qualitative interviews with immigrant patients, showed that mutual trust and feeling safe encouraged immigrant patients to open up and take a more active role in the coproduction of their health. A strong therapeutic relationship enabled them to become agents of their own health.

Using a coproduction lens, we recognized that creation of a service requires time and that the patient and the health professional to work together. They contribute their resources of lived experience and professional expertise in coproducing healthcare services and thus value for the patient. Our findings
highlight the need for flexibility in daily practice, for compassion and kindness for diverse patient populations, and for accepting vulnerability arising from the complexity and ambiguity of clinical
practice and of life.

To move coproduction forward, future research should investigate the validity of our findings in different settings with different groups of patients and professionals. Further, long-term effects of healthcare coproduction on immigrant patients’ health and well-being should be studied. Finally, immigrant patients can contribute with their lived experiences to improvement and codesign initiatives to further improve the experiences of care for patients and professionals.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
  • von Plessen, Christian, Principal supervisor
  • Batalden, Paul, Co-supervisor, External person
  • Sodemann, Morten, Co-supervisor
  • Nielsen, Dorthe Susanne, Co-supervisor
  • Nicolaisen, Anne, Supervisor
Date of defence18. Nov 2021
Publication statusPublished - 18. Nov 2021

Note re. dissertation

Print copy of the full thesis is restricted to reference use in the Library.


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  • PhD competition

    Radl-Karimi, Christina Mathilde (Recipient), 27. Sept 2021

    Prize: Prizes, scholarships, distinctions

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