Measuring co-design in global health research: methodological challenges and decolonial innovations

Although co-design is increasingly recognised as a cornerstone of implementation science in global health research, methods for its evaluation are often heterogeneous or of poor quality, and can reinforce the power inequalities they seek to address. In the worst cases, the term co-design can be used to cover up research practices that reproduce power differentials between partners from high-income countries and low-income and middle-income countries. Methodological innovation is urgently needed to move beyond measuring the number of attendees and participant satisfaction within global health interventions, and towards evaluating whether the dynamics and process of co-design are achieving equity, power sharing, and knowledge democratisation. This Viewpoint critically examines the current state of tools and measures used in implementation science and highlights trends and examples of innovations that move towards decolonising global health. We identify five key methodological innovations in measuring co-design processes and practices: theory-informed evaluation, co-developed tools, data triangulation, expanded impact metrics, and feedback loops and adaptive measurement. Our aim in presenting these measurement techniques is to inspire further innovation and move the field forward in thinking critically about what equity, power sharing, and knowledge democratisation means in practice, responding to questions of whether decolonising global health is achievable through redefining what we measure and, in turn, what we value.