Improving Service Delivery and Care through Collaboration between Service Providers, Clients, and Student Interns in HIV Prevention Settings

Background and Purpose: Providers of social and public health services are increasingly encouraged to engage in co-production, defined in this study as service providers’ collaboration with clients and student interns to improve access to, quality of, and integration of social and health services. Co-production efforts have pragmatic benefits, such as providers offering more responsive services to clients and collaborating with partner organizations in order to improve services across agencies. The literature on factors that may influence co-production is minimal to date. This paper narrows this gap by (1) identifying factors associated with providers’ perceptions of collaboration within and across organizations and (2) clarifying the relationship between within-agency and across-agency co-production.

Methods: We used cross-sectional survey data from an NIMH-funded parent study, including 379 providers in 36 social and public health service organizations in New York City. Using 6-point scale questions (1=strongly disagree, 6=strongly agree), we developed two main dependent variables, providers’ views on degrees of within-agency (i.e., consumers and students in my agency participate in interagency collaboration on issues that concern them) and across-agency co-production efforts (i.e., colleagues from agencies in my network share information with consumers and students). We examined the association between within-agency and across-agency co-production and variables at the provider (e.g., demographic, employment, training backgrounds, interprofessional collaboration experience) and organization levels (e.g., size, ownership status, perceived level of competition). To examine the relationships between within- and across-agency co-production, we used within-agency co-production variable to explain the variation in across-agency co-production as an explanatory variable, and vice-versa. Random-effects ordered logistic regression was applied to reduce biases from unobserved organization-level confounders.

Results: Providers agree (4 on a 6-point scale) that their own and their partner organizations were engaged in both within- and across-agency co-production. Providers’ perception of within-agency and across-agency co-production was associated with their experience with collaboration efforts with other service providers. Greater flexibility, interdependence, creation of new activities from interprofessional collaboration were associated with greater degrees of within-agency and across-agency co-production. Within- and across-agency co-production variables were significantly and positively correlated with each other. The odds of within-agency co-production were lower by 42% (95% CI: 7%-64%) when a provider’s organization offered services in one additional language. Compared with case managers, program administrators and supervisors were more likely to expect providers in partner organizations to share information with clients and student interns.

Conclusions and Implications: Providers’ perceptions and experiences of co-production varied significantly based on how interprofessional collaboration was structured within and across agencies (i.e., degrees of interdependence, new activities, and flexibility), the number of language services provided, and providers’ positions within their organization. Positive relationships between within- and across-agency co-production variables reflect the growing practice of and pressure to adopt co-production among HIV-prevention service providers. This paper calls for more intentional and inclusive interprofessional collaboration initiatives, and also for institutional support/incentives for organizations and providers to co-produce social and public health services, which may improve responsiveness to clients and effectiveness.