Purpose: Over the past years, there has been increased attention for using co-creation when developing health promotion and behaviour change interventions. By generating collaborative knowledge and establishing an equitable partnership with stakeholders in the real world, the co-created intervention is tailored to the specific context and potentially more effective and sustainable. However, despite this tendency for optimism, it is important to recognize and investigate the pitfalls associated with co-creation. This “dark side” of co-creation can be seen as a continuum, ranging from limitations (i.e., flaws that affect the co-creation process or outcome) to misconduct (i.e., failing to adhere to specific principles or standards within co-creation) to misuse (i.e., purposively applying co-creation for the wrong reason or misusing the co-creators). The aim of this study is to examine the dark side of co-creation and identify its risk factors and strategies to overcome those risk factors.
Methods: This study is conducted within the Health CASCADE-project, a EU-funded project with the aim to develop the methodological foundation of evidence-based co-creation for health promotion research. From January 2024, we will start with a scoping exercise to collect evidence-based examples of limitations, misconduct and misuse in co-creation, from the perspectives of facilitators/researchers, co-creators and users of the intervention (presented in a 3x3 grid). Based on the scoping exercise, a series of workshops will be organized with experts in the field of co-creation to identify risk factors and to generate strategies that seem most feasible and effective in addressing these risks.
Results/findings: The scoping exercise will result in 3x3 grid data, which will be presented at the ISBNPA 2024 conference. We acknowledge that these data will not contain all possible pitfalls, but it provides a starting point for the risk and strategy analysis. This will lead to specific recommendations for facilitators/researchers and co-creators on how to recognize, avoid or deal with the dark side of co-creation.
Conclusions: This study will contribute to make co-creation a trustworthy methodology for health promotion and behaviour change interventions.

Purpose: In remote Yup’ik communities in Alaska, 51% of three-year-olds have obesity. This qualitative study describes our use of Our Voice with Yup’ik parents of children enrolled in an early education program, Head Start, to understand their experiences feeding their families. We report on adaptations made to address parental barriers and to facilitate their participation in data collection in remote, sub-Arctic Indigenous communities, and themes / factors that influence ‘eating in a good way’ among Yup’ik families.
Methods: With input from tribal partners, we collaborated with Head Start program leaders and staff in twelve Yup’ik communities to recruit parents to use the Our Voice Discovery Tool app to take photos and record narratives about what makes it easy or challenging to feed their families ‘in a good way.’ Next, parents met with facilitators to discuss their data and generate ideas. We used the Community Based Participatory Research Conceptual Model to thematically analyze transcripts and documented adaptations of methods used to improve the fit and feasibility of the Our Voice method.
Results/Findings: Twenty parents participated. Participant age range was 27-55 (M=38.6). Barriers to data collection included remote geography, weather, connectivity, and scheduling activities to avoid conflicts with seasonal harvests and school and parent work schedules. Adaptations to Our Voice methods included crafting the Discovery Tool question to avoid stigma (e.g., ‘eating in a good way’ versus ‘healthy eating’); providing flexible options to access the data collection app; and framing discussions around storytelling, traditions, and strategies for ‘eating in a good way.’ Themes from parents included Cultural Factors (e.g., teaching kids to share foods with elders); Policies (e.g., National restrictions on hunting and fishing); Core Values (e.g., eating traditional foods); Individual Beliefs (e.g., assuring no child goes to bed hungry); and Health Outcomes (e.g. eating foods that help kids grow up healthy).
Conclusions: Beginning with context is critical to the development of an acceptable and relevant data collection protocol, especially among remote and Indigenous populations. Findings from this study provide critical community insight on factors that influence family nutrition practices that can inform the co-design of a contextually relevant, family-based nutrition intervention.

Purpose
To demonstrate effective community-based participatory research through equitable partnership with Indigenous community members and local food security resource organizations who participate in a paid, project-long CAB to ensure our randomized controlled trial (RCT) is culturally informed, strengths-based, sustainable, and community-driven. This presentation outlines the CAB development and lessons learned.

Methods
The purpose of the CAB is to advise researchers conducting a 3-arm RCT to evaluate an intervention comparing the effects of a diabetes nutrition education curriculum, entitled “What Can I Eat?” (WCIE) with an added food security resource, WCIE alone, and food security resource alone for Indigenous adults with type 2 diabetes (T2D) at an urban Indian clinic in Oklahoma, OK, USA. WCIE is a culturally tailored curriculum developed for Indigenous people by Indigenous people, focusing on traditional foods and ways of knowing, balanced diabetes nutrition principles, mindful eating, and physical activity. The Indigenous CAB leader and lead researcher attended a day-long, Indigenous-led training to learn how to effectively engage a CAB. The CAB leader then worked with clinic staff to recruit CAB members through an application process. CAB members were selected using inclusion criteria – Indigenous, >18 years old, and willing to meet quarterly for 3 years.

Results
10 CAB members were selected and attended a kickoff meeting at the clinic. This meeting focused on group-derived agreements for their CAB’s success, overview of the RCT to provide context for project advising, and team building. The CAB met twice more to determine the “food security resource” to use in the RCT and ensure it was culturally relevant, sustainable, and fit the needs of Indigenous people with T2D at the clinic. The CAB also informs recruitment and retention strategies, how to emphasize traditional foods, and will help interpret findings and guide dissemination efforts.

Conclusion
With increased emphasis on diversity, equity, inclusion, and justice in healthcare and research, engaging members of the priority community in equal partnership is critical to decrease health disparities and improve health outcomes for all. Engaging paid CABs can be successful but must be done with intention and provided with resources including time, funding, time, and leadership.

Purpose: Makoyoh’sokoi (the Wolf Trail Program) is a self-control, non-randomized, holistic
health intervention for Indigenous women. The 15-week program includes exposure to diverse physical activities, nutrition education modules, and celebrations of culture through ceremony and sharing circles. It was developed through cross-sectoral collaboration and has always been community based, participatory research. The program is currently offered in 8 communities across Alberta, British Columbia, and Saskatchewan. We acknowledge the traditional territories of the people of the Treaty 6, 7 regions and are grateful to conduct programming and research on these lands. We asked, “How does Makoyoh’sokoi impact the health journey of participants?”

Methods: At the end of the program and one year later, participants are asked to complete a
reflective photovoice project answering the question above. Perspectives of health that consider mental, physical, spiritual and emotional dimensions are encouraged. The project is led by a peer researcher. Participants present 1-4 photos to their group in a sharing circle format then reflect on recurring themes and write a caption for their photo. The photos and oral transcripts are analysed using NVivo software.

Results: Twenty-seven participants from two cohorts, as well as 3 program facilitators, and 2 researchers have completed the photovoice project to date, submitting a total of 80 photos for discussion. Preliminary results give rich insight into the experiences of participants and facilitators and give the research team and community leads strength to carry on despite numerous barriers. Frequently, participants used nature as a metaphor for health.

Conclusion: Community-based interventions that approach the multi-faceted nature of
Indigenous health are important for addressing the systemic issues that contribute to
prevalence of excess weight among Indigenous women. Participants enjoy the oral nature of
photovoice as it aligns closely with Indigenous oral traditions, and it gives the participants agency over their narratives.

Engaging Adults with Intellectual and Developmental Disabilities (IDD) in Patient-Facing Preventive Care: The “IDD-Transform” Project at Stanford Clinics

Zakaria Doueiri (corresponding author, presenting author), Alex Szawranskyj (corresponding author), Megan Cvitanovic (corresponding author), Justin Steinberg (corresponding author), Ann Banchoff, Abby C. King (corresponding author), Holly Tabor (corresponding author)

Introduction: For adults with intellectual and developmental disabilities (IDD), difficulties in accessing preventive healthcare around risk factors like physical inactivity have become significant determinants of inequities. This is revealed in significantly higher rates of comorbidities and an average lifespan ten years shorter for adults with IDD compared to the general population. This first-generation partnership between the Stanford IDD-Transform Project and the Our Voice Citizen Science Initiative investigates how adults with and without IDD experience barriers and facilitators to healthcare access through a patient-facing community data collection process.

Methods: Twelve adults (6 adults with IDD and 6 adults without IDD) partnered up to gather insights across three Stanford Hospital clinics: family medicine, internal medicine, and senior care. Data were collected using The Discovery Tool app, which enables participants to take photos+narratives of the assets and barriers in their surroundings. Our Voice-trained facilitators from the IDD-Transform team worked with participants to analyze the data and arrange them according to themes and priorities for future actionable steps. Clinic staff were invited to a separate meeting with participants, to hear their perspectives and ideas for change.

Results: Major initial findings indicate adults with IDD were able to, in partnership with adults without IDD, effectively capture aspects of the clinic environment that promoted or hindered their care. Participants captured a total of 170 photos and 154 narratives and categorized them into five themes: physical accessibility (e.g., narrow doorways, tripping hazards), accommodations (e.g., knowledge of what accommodations exist), signage (e.g., small lettering, broken directories), sensory considerations (e.g., lighting, noise) and informational handouts (e.g., lack of plain language).

Conclusion: Understanding the healthcare experiences of adults with IDD is a crucial step in improving the accessibility of healthcare and health outcomes for all. Engaging patients and caregivers in identifying and implementing recommendations is a key first step in achieving this aim. Following this project, the IDD-Transform team is working with the building facilities/signage committee to implement recommendations. Additional iterations of this project seek to expand participant recruitment and increase representation of clinic types, in addition to exploring the most compelling methods for instituting data-driven changes in healthcare settings.