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. 2021 Mar 15;16(3):e0248558. doi: 10.1371/journal.pone.0248558

Peer support workers in co-production and co-creation in public mental health and addiction services: Protocol for a scoping review

Kristina Bakke Aakerblom 1,*, Ottar Ness 2
Editor: Sherief Ghozy3
PMCID: PMC7959669  PMID: 33720989

Abstract

Worldwide, there is a growing interest to employ people with lived experiences in health and social services. Particularly in mental health and addiction services, individuals with lived experience of mental health problems enter the workplace as peer support workers (PSW´s). Their aim in the services is to bring in the perspective of service users in interactive processes at the micro and macro levels. The services´ ability to exploit the knowledge from PSW´s lived experiences will influence both the content and quality of the services, its effectiveness and its capacity to innovate and change. The concepts of co-production and co-creation are used to describe these interactive processes in the services in the literature. While co-production is aimed at improving individual services, co-creation seeks to develop service systems. This scoping review aims to provide an overview of the research status of PSW´s different involvement, in co-production and co-creation, in public mental health and addiction services. Studies describing PSW´s involvement in co-production and co-creation will be contrasted and compared. Knowledge about PSW´s involvement in co-production and co-creation is vital for understanding and further developing these interactive processes with PSW´s. The studies reviewed will describe PSW´s different types of involvement in co-production and co-creation in public mental health and addiction services or across organizational and institutional boundaries. The research question is: How are peer support workers involved in co-production and co-creation in public mental health and addiction services, and what are the described outcomes? Literature searches are conducted in Medline, PsycINFO, Embase, Oria, WorldCat, Google Scholar, Scopus, Academic Search Elite, Cinahl, and Web of Science, from the inception of each database to January 4, 2021. Expected results are that PSW´s are often described as a frontline worker who spends most of their working hours in a joint effort to co-produce with service users. Fewer studies describe PSW´s involved in interactive processes to re-design or transform public services systems. It is anticipated that this scoping review will increase the knowledge of the services’ abilities to exploit PSW´s expertise and inform policy and research.

Introduction

In public mental health and addiction services, an increasing number of individuals with lived experience of mental health problems enter the workplace as peer support workers (PSW´s). There is a growing range of research on PSW´s [1]. Existing research seems to be primarily focused on the normative side and demonstrates why we should implement PSW´s. The research literature indicates that deployment of PSW´s leads to increased service user participation [2], active involvement and empowers service users. This makes the services more democratic and lead to realizing mental health as a human right [1].

The introduction of PSW´s in the public mental health and addiction services seems to fit like a hand in a glove with a service-dominant approach to public sector innovation [3]. At the service production level, the service users are understood as the nodal point of discretionary service production. The key is to unlock the “tacit knowledge” that service users possess to re-design the entire service system in the pursuit of producing public value. Understanding service users´ perspectives, and translating it into policies and practice, is perceived as a valuable source of increasing public mental health systems´ responsiveness to service users´ needs and goals. For this purpose, one particular strategy is integrating PSW´s in the mental health workforce [4].

In the research literature, co-production and co-creation are concepts used to describe such interactive processes. Sometimes these concepts are used interchangeably without distinguishing between their meanings [5]. This scoping review will make a conceptual distinction between them based on a service-dominant approach [3] to public sector innovation. Co-production then refers to the interactive process through which the service providers and service users apply their different resources and capabilities in service production and delivery. The purpose of the joint interactive process in co-production is to produce and deliver a pre-determined public service. While the service may be adjusted and improved to meet the users´ needs, it is not subject to innovation defined as the development and realization of new disruptive ideas [6]. A service-dominant approach to public sector innovation takes the process beyond individual services co-production and unlocks the potential for the co-design and co-creation of public services. Co-creation often involve more participants (volunteers, social entrepreneurs, citizens, private service actors) than the dyadic interplay of service producers and service users in co-production. Co-creation is considered a vital tool in enhancing innovation and improving the relevance of services. Co-production and co-creation are both gaining ground at the public service production level. However, most public services are still designed and produced by bureaucratic and professionalized public agencies with little contribution from service users, citizens, and volunteers [7].

A scoping review is chosen because it is suited to get an overview of PSW´s different involvement in public mental health and addiction services. Scoping reviews can be useful when bringing together literature in disciplines with emerging evidence. Furthermore, it is suited to address questions beyond effectiveness and efficiency [8]. PSW´s involvement in interactive processes is often described using other terms than co-production or co-creation. Therefore, it is necessary to have a broad search in the research literature. The research will be mapped with a particular objective to obtain an overview of the types of co-production and co-creation PSW´s are involved in, the conditioning factors (antecedents and barriers), and described aims and actual outcomes.

Aims of the scoping review

In the research literature, PSW´s often appear to engage directly in co-production in service delivery with service-users. To be able to add value to the production process in the pursuit of public value outcomes, service-users need to be involved in the early stages of public service development, i.e., in the initiation, decision-making and design phases [9]. Following this, we assume that the different types of interactive processes PSW´s are involved in can influence their ability to contribute to innovative changes and at the other side; the services´ ability to utilize PSW´s knowledge in developing and realizing new disruptive ideas. Co-creation processes have recently been found to have an innovative dimension not found in co-production [10]. A systematic review of citizens involvement in co-production and co-creation distinguishes between three different types, “an initiator, a co-implementor or a co-designer” which differ in their degree of involvement. We assume that PSW´s different involvement in co-production and co-creation will influence the content and quality of services for the service users, as well as the effectiveness and bottom line of organizations and services’ ability to innovate and change. The relevance of this scoping review will be twofold. First, we will explore what types of involvement PSW´s take on, typically described with different “co”; co-initiated, co-design, co-deliver, co-implement or co-evaluate. Secondly, we will compare and contrast their different involvement with its influential factors (antecedents and barriers), described aim and reported outcomes. This will be critical knowledge to be able to make use of PSW´s competence and develop the interactive processes with PSW´s in the services.

Methods

The data in this review will be collected based on Arkzey and O’Malley´s framework [11], with four phases: 1) identify the research questions, 2) search for relevant studies, 3) select studies, 4) chart the data, and 5) collate, summarize and report studies. This scoping review´s research question is: How are peer support workers involved in co-production and co-creation in public mental health and addiction services and, what are the described outcomes? Last literature search will be 2021.01.04. The protocol was registered in Protokols.io: 2021.02.11. The study protocol and, all available data, will be made public when the study is conducted and published.

Eligibility criteria

Types of studies

Articles should describe interactive processes with PSW´s in either the design, development, delivery, implementation or evaluation of services in public mental health and addiction services. Articles that do not describe interactive processes, but describe its outcomes, will be included if it is clear that PSW´s were involved.

The public sector will be defined broadly as those parts of the economy that are either in-state ownership or services under contracts to the state, because countries differ in what degree mental health services are part of the state or operate with contracts to the state. We will include different designs and aims of services such as acute services, outreach services, community services, social welfare services, hospital services, activity-based services, public management services, etc.

Focus of studies

All studies describing types of interactive processes and/or PSW´s different positions, roles, tasks, or activities in the services and across organizational or institutional boundaries, will be included. Articles describing mutual peer support, self-help groups, consumer-driven services, peer counselling, peer-led education or peer counselling programs related to medical or physical conditions, will not be included.

Participants

Participants engaged in interactive processes with PSW´s, like co-production or co-creation, in public mental health and addiction services. In a service setting a) members of the public who might be using a service or intervention; service-users, careers, patients, relatives, b) people working in the services; PSW´s, professional staff and managers, c) citizens or their representatives, social entrepreneurs, volunteers, d) organizations (voluntary, private and public) and/or organizations representing service users. When participants are people, we will include only adults from the general population (age 18–65).

Study design

Studies will not be restricted to a particular study type.

Language

Only articles written in English will be included.

Publication status

Only international peer-reviewed journal articles and books will be included.

Study selection

When reporting, the following tool will be used: the "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist" [8]. A flow diagram will be used to detail the study selection process (Fig 1).

Fig 1. PRISMA flow diagram of the search strategy.

Fig 1

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Search strategies for the identification of studies

Database sources for the review are Medline, PsycINFO, Embase, Oria, WorldCat, Google Scholar, Scopus, Academic Search Elite, Cinahl, and Web of Science. The search is limited to title, abstract, and keywords. The titles or abstracts for all studies included in the database searches will be read. In addition to searching in electronic databases, we will search manually within reference lists and perform citation searches of the included studies and authors to identify further publications linked to the included articles. We will also consult experts in peer support work in mental health and addiction services. The search in databases will be from the inception of each database chosen until 04.01.2021.

The search will, in all the databases, consist of the following search terms

  1. peer group

  2. peer adj (provid* or support*)).ti,ab.

  3. (live* adj experience*).ti,ab.

  4. psw.ti,ab.

  5. (expert adj by adj experienc*).ti,ab.

  6. prosum*.ti,ab.

  7. enduce*.ti,ab.

  8. (boundary adj spanner*).ti,ab.

  9. (peer adj mentor*).ti,ab.

  10. (peer adj educator*).ti,ab.

  11. (peer adj advocate*).ti,ab.

  12. (peer adj listen*).ti,ab.

  13. (peer adj provid*).ti,ab.

  14. or/1-13

  15. exp Cooperative Behavior/

  16. collaborat*.ti,ab.

  17. participat*.ti,ab.

  18. integrat*.ti,ab.

  19. ((collaborat* or social) adj innovat*).ti,ab.

  20. cooperat*.ti,ab.

  21. cocreat*.ti,ab.

  22. (co adj creat*).ti,ab.

  23. coproduct*.ti,ab.

  24. (co adj produc*).ti,ab.

  25. or/15-24

  26. exp Public Sector/

  27. exp Health Care Sector/

  28. exp Mental Health Services/

  29. exp Mental Health/

  30. exp State Medicine/

  31. exp Primary Health Care/

  32. exp "Delivery of Health Care"/

  33. (public adj care adj service*).ti,ab.

  34. (public adj service*).ti,ab.

  35. (mental adj health*).ti,ab.

  36. (Addiction adj Service*).ti,ab.

  37. exp Health Services/

  38. (Peer adj Recovery adj Support adj Service*).ti,ab.

  39. (recover* adj service*).ti,ab.

  40. municipal*.ti,ab.

  41. (Social adj health adj care*).ti,ab.

  42. exp Social Work/

  43. (Social adj service*).ti,ab.

  44. (statutory adj mental adj health adj service*).ti,ab.

  45. exp Community Mental Health Services/

  46. (third adj sector adj organisation*).ti,ab.

  47. or/26-46

  48. 14 and 25 and 47

  49. limit 48 to English

Data synthesis

The mapping will follow a funnel approach, meaning that the studies will be categorized in stages. For each step, the number of studies in each category will be counted and described. The number of included studies will thus decline through the mapping process until only the relevant studies remain, which will be read and mapped in detail.

Data extraction

The articles will be handled using Endnote and the online software for conducting literature reviews, Rayyan [12]. First, all records from the databases will be downloaded to Endnote. From Endnote, the records will be exported to Rayyan. Rayyan will be further used as a working tool for the review. The first author (KBAA) will perform the first steps in the selection process, which includes (1) removing duplicates, (2) removing studies that are not written in English, (3) removing editorials, reports, opinion papers, and conference papers, (4) removing studies that are not conducted in or related to mental health services. All these steps will be decided based on reading the abstract. If it is not possible to determine based on this, the studies will be included. The remaining records will then be read by the first author (KBAA), and the second author (ON) will read 20% of all the records randomly. Rates of concordance between these researchers will be calculated, and any disagreements will be discussed and resolved together. The focus of discussion will be if the articles clearly describe interactive processes and whether PSW´s involvement in the process is clearly explained. If needed, disagreements will further be discussed and solved with the PhD candidates extended supervisory team, as this review article is part of a PhD project. The next step will be to read all included articles to identify if they meet the eligibility criteria. This step will be performed by the first author (KBAA). The second author (ON) will read 20% of all the studies randomly. Both review authors will then read all the included articles based on a full reading of articles and decide which to be included in the review. As this is a scoping review, our goal is to determine the available range of studies (quantitative and/or qualitative). We also intend to address the current state of knowledge, offer a new perspective and point out areas for future research, in line with a “state of the art”-review [13]. We will represent this visually as a mapping or a charting of the located data. However, if data is suitable for quantitative analysis at this stage, a meta-analysis will be considered.

Information on the following categories will be sought in the studies

  1. First author-name

  2. Year of publication

  3. Country

  4. Process of collaboration (co-production and/or co-creation)

  5. Participants (PSW´s, service-users, careers, professionals, leaders, volunteers, services, organizations)

  6. PSW´s various types of involvement (co-produce, co-deliver, co-implement, co-initiated, co-design, co-evaluate)

  7. PSW´s positions (administrative functions, caseworker, frontline worker)

  8. Aims of PSW´s involvement

  9. Influential factors (antecedents and barriers)

  10. Outcome (for; service-users, PSW´s, services, organizations)

  11. Context

  12. Study design (methodology and data analysis)

  13. Study findings/results

  14. Comments

Discussion

In this study protocol, we make a conceptual distinction between co-production and co-creation. While co-production is aimed at improving individual services, co-creation seeks to develop service systems. A reason to separate the concepts is to illuminate that co-creation processes have an innovative dimension not found in co-production [10]. A service-dominant approach to public sector innovation highlights the need to utilize PSW´s tacit knowledge to re-design service systems and pursue public value outcomes. In that case, we should pay attention to their involvement in co-creation versus co-production processes.

Research indicates that PSW´s most often are involved in the direct delivery of services. This co-producer role has proven to be essential because it contributes to greater involvement from service users [2] in addition to more satisfied service users. Less research seems to describe PSW´s involvement in co-creation processes, the re-design or development of service systems. Based on a service-dominant approach to public sector innovation [3], we argue that PSW´s different types of involvement will influence their ability to contribute to innovation and change in the services. A recent study demonstrates that contributions from staff with addiction experience in SUD treatment to collaborative and responsive service production had bounded efficacy and limited influence over organization-level changes [14]. To influence the services delivery systems, PSW´s need to be involved in the initiation, decision-making and design phases [9].

Participation in decision-making is still often felt beyond certain people’s capabilities [15]. The role of service-users and professional service providers shows very clear contrasts in different public administration regimes, especially in determining service quality [16]. How the interactive processes with PSW´s develop may depend on the interplay of forces at the micro and macro levels of society favoring the development of particular public administration regimes rather than another. Internationally, there is a great diversity in the implementation of PSW´s, and the tendency worldwide is nevertheless towards employed of PSW´s in a diverse and growing number of domains, such as education, politics, social sectors, healthcare and welfare, and research [17]. Many countries are in the process of engaging PSW´s in their mental health and addiction services. Therefore, it is increasingly relevant to study the actual involvement of PSW´s within the interactive processes. This has the potential for developing in quite different directions in different public administrative regimes. It is reasonable to expect that the interactive processes will develop both in an individual or collective fashion and that it will involve more or less citizens participation, depending on the public administration regime [16]. This implies that citizens and PSW´s involvement in co-production and co-creation processes will be both regime specific and service specific.

Limitation of the study

We have chosen to do a scoping review because we assume that it will not be possible to make a statistical comparison of PSW´s different involvement in the public mental health and addiction services. The reviews will not assess the studies´ quality, and the reliability of data extracted from selected studies will not be commented on. PSW´s as an employer group is relatively new in the services, and too renders true for the research field. Much of the existing research on PSW´s seem to focus on the normative side primarily and demonstrate why we should implement PSW´s. Seemingly, less attention is paid to PSW´s involvement or roles in the interactive processes and the outcomes of PSW´s different contributions. This is a limitation. In this review, we have chosen to use the term “peer support worker” due to this title being common across countries. People with lived experience of mental health and/or addiction experiences working in mental health and addiction services hold a wide range of different job titles. This implies that we may possibly fail to grasp all the literature describing this employer group, which is another limitation. In this review, we apply a framework from public sector innovation studies and elaborate on PSW´s involvement in interactive processes described in the research literature. The literature describing PSW´s contributions often depict the interactive processes with other terms than co-production and co-creation. Altogether, the authors are required to read all the research articles that describe PSW´s different involvement, and then decide, based on the various descriptions and concepts used, which interactive processes PSW´s are involved in. We make a conceptual distinction between the concepts of co-production and co-creation, while the existing research literature seems to use the concepts interchangeably. This may also be a limitation of the study.

Quality assessment /risk of bias and evidence quality

A scoping review is designed to provide an overview of the existing research literature. We will not perform a formal assessment of the methodological quality of the included studies. The exception is if meta-analysis is conducted at the final stage (see paragraph above); then the risk of bias and strength of evidence will be assessed for the studies included in the meta-analysis. The included papers´ quality will then be rated according to an adapted version of the Critical Appraisal Skills Programme (CASP) for qualitative research [18].

Acknowledgments

This protocol for a scoping review is related to the first authors´ PhD research project. The project addresses peer support workers’ integration in public mental health and addiction services as a co-creative social innovation.

Data Availability

All relevant data from this study will be made available upon study completion.

Funding Statement

KBAA has a doctoral scholarship from the Dam foundation. Dam Foundation have 38 members, all voluntary health and rehabilitation organizations based in Norway. The foundation receives part of the profit from the national lottery in Norway, Norsk Tipping. The funds from the lottery supports project work in voluntary humanitarian organizations in preventive health care, rehabilitation and research. All voluntary humanitarian/socially dedicated organizations and professional organizations for the functionally disabled in Norway may apply for funds regardless of membership in the foundation.

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Decision Letter 0

Marianne Storm

6 Jan 2021

PONE-D-20-37362

The influence of peer support worker integration on co-production and co-creation in public mental health and addiction services: Protocol for a scoping review

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Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review for minor grammar and spelling errors.

Reason for "major review" selection: Include a discussion at the end for the potential impact of the scoping review on the field. This is important to include.

Remove info on how data will be collected in the “aim of study” section. This more appropriately belongs in “methods.”

Include the visual you discussed about the study selection process, inclusion, and exclusion.

PSW or PSWs? In some sentences, plural seems to fit in better with certain sentences and grammar.

Spell out all acronyms the first time you use them (United Nations, line #65).

Need to describe where data will be made available when the study is complete.

Include clear dates of articles included in study. Currently says from inception to 8.31.2020, but that you will update again 1.4.2021. Does that mean that your search will include items that are published up until January 2021? Or will the search only go up until the end of August 2020? Also define what inception is. Is it the start of the journal, etc.?

Reviewer #2: Thank you for the opportunity to review this Registered Report Protocol that aims to examine the influence of peer support worker integration on co-production and co-creation in public health and addictions services. This is an interesting study with some important research questions. It is very important to understand how peer support workers are integrated into co-production and co-creation processes in health system. My comments are below regarding this manuscript:

1. Abstract is not traditional written, which is fine. I see authors report background and method. Final sentence in abstract is research question. I believe abstract will be improved if authors add a one or two sentence/s regarding any expected results and and how these results will inform field.

2. Although authors defined co-creation and co-production, It is still difficult to understand the difference between co-creation and co-production. The distinction between co-creation and co-production could be explained with an example.

3. Second paragraph in introduction has some parts that could be moved to purpose of study. For example, line 93 and rest is about purpose of study. Interestingly, in "Aim of the Study" section authors talk about background again. I suggest authors to move all background information into introduction section. I also suggest authors have a brief and concise purpose of study.

4. There are too many questions in introduction. It is very hard to overall understand introduction due to all questions and how introduction is organized. I suggest authors to be more concise with purpose section and improve background section.

5. I wonder whether this following sentence should move to Method: "The data will be collected based on Arkzey and O'Malley's framework (10): 1) identify the research questions, 2) search for relevant studies, 3) select studies, 4) chart the data, and 5) collate, summarize and report studies."

6. What year period authors aim to conduct this study? Any time restriction such as from 2010 to 2020.

7. In any disagreement, what is the plan? I see authors reported that they will have discussion on disagreement to resolve it. What will be the focus of discussion? What is further step if there is no resolution? For example, do authors plan to bring a third reviewer to help resolution.

8. I see that editorials, reports, and opinion papers will be removed. Later, in "Information on the Following Categories....", item 4 has opinion papers and others.

Thank you for letting me review this Registered Report Protocol. This study seems to be an interesting and informing study.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2021 Mar 15;16(3):e0248558. doi: 10.1371/journal.pone.0248558.r002

Author response to Decision Letter 0

17 Feb 2021

Rebuttal Letter: Response to Reviewers PLOS ONE

Manuscript title:

Peer support workers in co-production and co-creation in public mental health and addiction services: Protocol for a scoping review

Dear PLOS ONE Academic Editor and Reviewers,

Thank you for your very useful comments which provide very valuable insights to improve our current manuscript quality and coherency. Each of the statements given is well analyzed and provided with necessary explanation, correction and response to support the manuscript's points. Hence, below we addressed your comments and responses. First, we will address the reviewer´s response to Questions 1 and 4, then we will address each reviewer´s specific comments:

Responses to question 1 and 4:

1. Does the manuscript provide a rationale for the proposed study, with a clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of the knowledge in the field.

Reviewer 2# Partly.

We have revised the research question to: How are peer support workers involved in co-production and co-creation in public mental health and addiction services and, what are the described outcomes?

This has also led to a refinement of the title to “Peer support workers in co-production and co-creation in public mental health and addiction services: Protocol for a scoping review”

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

Reviewer 1: No.

Author comments: This information has been updated and answered in the comments no 6, below. The protocol was registered in Protokols.io: 2021.02.11. The study protocol and, all available data, will be made public when the study are conducted and published.

The study protocol and, all available data, will be made public when the study finishes.

Comments and responses to each reviewer’s feedback:

Reviewer 1:

Thank you for your thorough feedback. Your comments made us able to deliver an enhanced and better manuscript. To respond clearly to all comments, they are numbered so that it is easier to follow:

1) Reason for "major review" selection: Include a discussion at the end for the potential impact of the scoping review on the field.

Authors response: A discussion at the end of the research protocol is included. The discussion part is characterized by the fact that it is a research protocol. This implies that we have pointed to the reasons for doing this study and what we expect to find based on our research question and why this knowledge will be of importance for policy, practice and research.

2) Remove info on how data will be collected in "the aim of study" section. This more appropriately belongs in "methods".

Authors response: Information on how the data will be collected are removed from "Aims of scoping review" to "Method".

3) Include the visual you discussed about the study selection process, inclusion and exclusion.

Response: A visualization of the study selection process based on PRISMA-Scr is added.

4) PSW or PSWs? In some sentences, plural seems to fit better with certain sentences and grammar.

Authors response: We have revised and consequently use PSW's. This fits better with grammar, as you suggest. However, the plural form works best because we address PSW's as employees in the services and not the individual employee.

5) All acronyms are spelled out the first time when they are used. For instance, (United Nations, line #).

Authors response: Thank you for making us aware of this mistake. Due to the refinement of this section, this sentence is no longer part of the introduction.

6) Need to describe where data will be made available when study is complete.

Authors response: The method section is updated with this information: The protocol was registered in Protokols.io: 2021.02.11. The study protocol and, all available data, will be made public when the study are conducted and published.

The study protocol and, all available data, will be made public when the study finishes.

7) Include clear dates of articles included in study. Also define what inception is. Is it the start of journal, etc.?

Authors response: This information is updated in the Method section, under the subheading, “study selection”: The search in databases will be from the inception of each database chosen until 04.01.2021.

Comments & Response for Reviewer 2:

Thank you for your thorough and useful feedback. Your comments made us able to revise and enhance the quality and arguments in our manuscript. Here, we will address your feedback:

Comment 1: Abstract is not traditional written, which is fine. I see authors report background and method. Final sentence in abstract is research question. I believe abstract will be improved if authors add a one or two sentences regarding any expected results and how these results will inform field.

Authors response: We have tried to improve the abstract, regarding sentences on expected results and how these results will inform field are included at the end. The text has been refined, and the abstract is more traditionally written.

Comment 2: Although authors defined co-creation and co-production. It is still difficult to understand the difference between co-creation and co-production. The distinction between co-creation and co-production could be explained with an example.

Authors response: The difference between the two concepts is now more precise defined in the text. First, in the abstract and then, this has been explained more thoroughly in the introduction, with examples.

We will address comment 3 and 4 together:

Comment 3: Second paragraph in introduction has some parts that could be moved to purpose of study. For example, line 93 and rest is about purpose of study. Interestingly, in "Aim of the Study" section authors talk about background again. I suggest authors to move all background information into introduction section. I also suggest authors have a brief and concise purpose of study.

Comment 4: There are too many questions in introduction. It is very hard to overall understand introduction due to all questions and how introduction is organized. I suggest authors to be more concise with purpose section and improve background section.

Authors responses to comments 3 and 4: The introduction section has been substantially modified. There are no questions in the introduction. The introduction starts with a background section where the research status and theoretical and practical assumptions for this study are accounted for. The reason to split between the concept, co-production and co-creation is explained, as the rationale for doing this study and in choosing this approach. The last section in the introduction describes the aim of this scoping review. We argue that PSW's different involvement in the interactive processes can influence their ability to contribute to innovative changes and that we need to pay attention to their involvement in co-creation processes because they have an innovative dimension not found in co-production.

Comment 5: I wonder whether this following sentence should move to Method: "The data will be collected based on Arkzey and O'Malley's framework (10): 1) identify the research questions, 2) search for relevant studies, 3) select studies, 4) chart the data, and 5) collate, summarize and report studies."

Authors response: This sentence has been moved to the Method section.

Comment 6: What year period authors aim to conduct this study? Any time restriction such as from 2010 to 2020.

Authors response: This is corrected in the Method section to be: From the inception of each included database until January 04.01.2021.

Comment 7: In any disagreement, what is the plan? I see the authors reported that they would have a discussion on disagreement to resolve it. What will be the focus of discussion? What is further step if there is no resolution? For example, do authors plan to bring a third reviewer to help resolution.

Authors response: This is corrected to be: The focus of discussion will be if articles clearly describe interactive processes, and if PSW's involvement in the process is clearly explained. If needed, disagreements will further be discussed and solved with the PhD candidates extended supervisory team, as this review article is part of a PhD project.

Comment 8: I see that editorials, reports, and opinion papers will be removed. Later, in "Information on the Following Categories....", item 4 has opinion papers and others.

Authors response: Thank you for making us aware of this mistake. We will not keep information about opinion papers. This has been deleted from the sentence.

Attachment

Submitted filename: Response to reviewers.docx

Click here for additional data file. (28.2KB, docx)

Decision Letter 1

Sherief Ghozy

2 Mar 2021

Peer support workers in co-production and co-creation in public mental health and addiction services: Protocol for a scoping review

PONE-D-20-37362R1

Dear Dr. Aakerblom,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Sherief Ghozy, M.D., Ph.D. candidate

Academic Editor

PLOS ONE

Additional Editor Comments:

There are many errors of English grammar and use in this manuscript, I would highly recommend cop-editing of this manuscript prior to final disposition.

Acceptance letter

Sherief Ghozy

5 Mar 2021

PONE-D-20-37362R1

Peer support workers in co-production and co-creation in public mental health and addiction services: Protocol for a scoping review

Dear Dr. Aakerblom:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Sherief Ghozy

Academic Editor

PLOS ONE

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    Submitted filename: Response to reviewers.docx

    Click here for additional data file. (28.2KB, docx)

    Data Availability Statement

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