Article Text

Download PDFPDF

Integrated care and co-production during a pandemic: responding to the needs of local populations using infographics
  1. Chris Gilmartin,
  2. Arpana Soni,
  3. Phoebe Rutherford,
  4. Mando Watson
  1. Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Arpana Soni, Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK; asoni{at}


Connecting Care for Children, an integrated care collaborative in northwest London, responded to local child health needs during the start of the COVID-19 pandemic through the co-production of infographics. Here we describe the development and evaluation of co-produced infographics using quality improvement methodology, to highlight their effectiveness in swiftly responding to local community health concerns.

  • adolescent health
  • child health
  • COVID-19
  • primary health care
  • paediatrics

Data availability statement

Data are available upon reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The problem

Children and young people (CYP) and their families faced significant challenges during the pandemic and associated lockdowns. Our team’s approach to address local child health concerns with patient and public involvement (PPI) required adaptation in response to reduced face-to-face contact between local families and health and care professionals.


To use quality improvement (QI) methodology to co-produce infographics that deliver targeted health information, to meet the health needs of children, young people and local families, within the confines of the COVID-19 pandemic.

Making a case for change

Co-production is a collaborative development process whereby stakeholders work in equal partnership with communities to improve the effectiveness and sustainability of an intervention.1 Bringing together health professionals (primary and secondary care) and local families enables the development of mutual understanding and trust. This collaboration empowers professionals to address child health concerns together and support families to make informed health choices.

Infographics are an effective medium for communication,2 allowing for accurate, timely and reliable information to be presented in an accessible format and shared across community and professional networks. The development of infographics using co-production lends itself easily to working in a virtual environment within societal lockdowns.

The use of infographics is becoming common practice within public health and academic bodies. The Royal College of Paediatrics and Child Health released guidance for families on the COVID-19 pandemic in the form of infographics.3

Your improvements

Connecting Care for Children (CC4C) asked stakeholders to share their concerns regarding CYP health and well-being. Infographics were then co-produced with stakeholders (see figure 1) to address those concerns.

Figure 1

Stakeholders for the co-production of infographics with CC4C in North West London. CC4C, Connecting Care for Children; CCG, clinical commissioning group; CYP, children and young people; GP, general practitioners; MDT, multidisciplinary team; NHS, National Health Service; NWL, North West London; WSIC, whole systems integrated care.

Plan/do/study/act (PDSA) cycles were used to produce each infographic: see the example of the childhood influenza vaccine infographics (figures 2 and 3) and stages of development (figure 4).

Figure 2

Overview of PDSA cycles for children’s influenza vaccine infographic. PDSA, plan/do/study/act.

Figure 3

PDSA cycle for engaging stakeholders for children’s influenza vaccine infographic. GP, general practitioner; PDSA, plan/do/study/act.

Figure 4

Phases of development of children’s influenza vaccine infographic. The title changed to encourage peer to peer infuence, the text in the boxes changed in response to feedback from lay readers, the colours changed to align with the (trusted) NHS brand. GP, general practitioner; NHS, National Health Service.

The impact of the infographics to deliver targeted health information was measured using qualitative feedback from families and professionals during each study phase of PDSA cycle. For example, Community Champions (trained community volunteers) were asked for their feedback on the childhood influenza vaccine infographic. They identified areas requiring clarification, such as differences between the spray and injectable vaccinations, and phrases open to potential misinterpretation by local families.

Qualitative feedback on the final co-produced influenza vaccine infographic was highly positive. Evaluation unanimously supported the reutilisation of infographics and the co-production approach for future influenza seasons. One Community Champion commented: ‘thank you so much … This is very useful, especially as there is difficulty giving face to face advice. I have sent it out to all my network contacts.’ A local general practitioner (GP) commented on another vaccine hesitancy infographic: ‘This looks great—you have made me smile at 1830 on a Tuesday! I am very excited about these going out to parents.’

Our suite of infographics can be accessed via our Twitter feed4 and website.5

Learning and next steps

The use of QI methodology enables infographics to be rapidly tested and modified to address the specific needs of communities and professionals.

Spending time developing relationships across community and professional networks enables co-production to occur at pace, if required, with established rapid feedback mechanisms. The infographic PDSA cycles happened in a matter of days.

Distribution across social media networks broadens the target audience. To combat digital exclusion, the team looked at where volunteers could hand out hard copies of the infographics, for example, at food banks.

The child health infographics produced by CC4C were initially shared across local professional and community networks. Regional adoption through child health networks has enabled wider sharing of accessible information.

CC4C has demonstrated that co-produced infographics are a useful tool to address local health concerns and can be used by professionals, CYP and families to support individual health choices and practices.

PPI needs to be embedded in all health programmes, to enable care systems to listen and provide timely, meaningful and adaptable responses to local health needs.

Data availability statement

Data are available upon reasonable request.

Ethics statements

Patient consent for publication

Ethics approval

This study does not involve human participants.



  • CG and AS are joint first authors.

  • Twitter @ChrisGSG, @CC4CLondon, @mandowatson

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.