Cocreation and codesign in maternal health: processes, outcomes and implementation challenges

Objective To describe the application of cocreation/codesign in maternal health, characterise reported processes (including barriers/facilitators) and summarise clinical and experiential outcomes without inferring causal effects. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search of PubMed, MEDLINE, Embase, Cochrane Library and ScienceDirect (2014–2025) identified 1487 records. After deduplication and screening, 60 studies were included in this review. The eligibility criteria encompassed qualitative and quantitative studies employing cocreation or codesign in maternal or obstetric care, with open-access English full texts. Two blinded reviewers screened the studies using Rayyan and resolved conflicts by consensus agreement. Data extraction followed the Cochrane guidelines, and a narrative synthesis was performed because of study heterogeneity. The risk of bias was assessed using the Newcastle-Ottawa Scale, risk-of-bias 2 and the Risk Of Bias In Non-Randomised Studies - of Exposure (ROBINS-E) tools. Results Across 60 heterogeneous studies, cocreation and codesign were used to develop and adapt psychosocial support, communication and feedback interventions and digital tools such as decision-support and telemonitoring systems. Studies most often reported process and experiential outcomes, including acceptability, satisfaction, engagement and perceived relevance, to users and communities. The designs, contexts and outcome measures varied, and comparative evidence was limited. Common challenges included power imbalances, time and resource constraints, and difficulties in spreading and sustaining interventions. The reported enablers included early and ongoing stakeholder involvement, iterative cycles and attention to access barriers, including digital inclusion. Conclusion When cocreation and codesign are clearly described and suited to the context, they can support culturally relevant and equitable maternal care by incorporating stakeholder voices into service and intervention development. The current evidence does not support firm conclusions regarding effectiveness. Future work should transparently report codesign methods, specify the intended mechanism and context, and evaluate codesigned interventions with stronger comparative designs and longer follow-ups. PROSPERO registration number CRD42024622020.