Introduction

Europe has an ageing population. Over the last ten years, there has been an increase in citizens aged 65 years and over from 16 to 21% and the share of citizens aged 80 years and over has doubled1. This demographic transition increases the demand for healthcare and other housing alternatives for the elderly population that prefer to live on their own. Other approaches for promoting healthy ageing must be considered in order to fulfil the needs of this generation. Within our study we understand healthy ageing2 defined as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’3.

One way to support healthy ageing is through the creation of age-friendly communities4 in which municipal/government policies, services and structures related to the physical and social environment are designed to support and enable older citizens to “age actively”, that is, to live in security, enjoy good health and continue to participate fully in society5.

Several countries and cities around the world are engaged in the Global Network for Age-Friendly Cities and Communities (AFCC) which builds on the idea that both the physical and social environment affect physical and mental health and well-being and thus quality of life6,7.

In recent years there has been rising demand for in-between solutions to meet the needs of citizens entering older adulthood. Senior co-housing communities8,9,10,11, which are a mixture of individual housing units with shared facilities, striking a balance between privacy and shared spaces12, multigenerational housing forms where different generations live together within a larger-scale intergenerational co-housing13,14,15,16, and accommodation with technology and opportunities for daily assistance and care17,18,19,20 are being implemented. Common to all housing forms are the support and comfort offered through social contacts with partners, family, friends and neighbours or professional careers.

Social contacts seem to enrich life and become more important as citizens get older21,22, and the availability of social contacts and one’s ability to participate in social interactions are regarded as important to maintain healthy ageing and mitigate loneliness23,24. It is well-known that the health status among older citizens is strengthened by networks and social relations because of increased terms of belonging, independence and safety25. Social participation, according to the World Health Organization (WHO), involves empowering people, communities, and civil society by including them in decision-making processes that impact health at all levels of the system and through the policy cycle26. According to Arnstein´s Ladder of Citizen Participation, participation exists in various forms, categorized into eight levels that represent different degrees of citizen power. These levels fall under three overarching categories: nonparticipation, tokenism and citizen power27 and can be used to determine the level of participation of older citizens28.

Professional social networks in the communities, especially senior housing and nursing homes, are in Denmark often driven by the municipality with some support from voluntary and community organizations2. However, policy initiatives are increasingly focused on involving older citizens in the delivery of public services, aiming to reduce healthcare costs, provide high-quality service, and increase citizen satisfaction with the services delivered29,30. There has been a rising interest on advancement of collaborative and co-productive approaches in local health policies31,32,33 and the concepts of co-creation and co-production have gained attention as potential solutions to welfare challenges34,35. Co-creation emerged from private sector commercial business36, while co-production stems from the public sector, in which Elinor Ostrom observed and documented the positive effect of active involvement of users on the quality and effect of public services in the 1970s37,38. Brandsen and Honingh argue that co-creation and co-production are two different concepts, in which co-creation deals with involving citizens in the design and planning phase and co-production involves citizens in the implementation of services36. In literature the two terms are often used as synonyms30 but in relation to involvement of users in the public sector it is suggested to phase out the term, co-creation, to be able to create coherence between the how, when and why users are involved in co-production39. The fundamental element of co-production is the equitable distribution of power so that recipients of public services have real control over their desires, needs, and expectations35. Users will become members of the public organization and are expected to take an active part in it, changing the roles that users and the public play. This shift in the balance of power places demands on the organization as well as the users, since it must guarantee that users, front-line staff, management, and politicians work together to build and produce welfare39. As we concentrate on co-production about public services and outcomes and an equal distribution of power between citizens and the public, we lean on the definition by Loeffler and Bovaird, 2013: “Professionals and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improved efficiency”35.

The involvement of older citizens has primarily been in the healthcare sector where there is an increased recognition of the benefits of involving patients and their relatives to optimize service delivery and patient outcomes40,41. In addition, the involvement of older citizens as co-researchers has grown in the past 20 years42.

Studies on the involvement of older citizens in the planning and development of age-friendly communities are on the rise, in particular various ways to engage older citizens in the development of new housing initiatives28. However, concrete examples of the involvement of older citizens often evolve around the conceptual development and design phases of housing solutions of homes and buildings43 or transformations of existing housing units for older citizens44. To contribute to the field of age-friendly community building, we believe it is crucial to explore a co-production initiative within a recently established senior village. This exploration will enable us to provide recommendations on creating optimal environments for healthy ageing.

Aim of the study

To increase our understanding of the involvement of older citizens in the planning and development of an age-friendly community initiative and to identify barriers and potentials for refinement of co-production with older citizens, this qualitative study aims to investigate a co-production initiative between older citizens, a municipality, and a real estate company in a newly established senior village. The primary research questions are:

  1. 1.

    How does the organizational setting and physical environment influence the co-production process?

  2. 2.

    What other factors influence citizens´ engagement and perceptions of the co-production process?

Methods

Setting

The study was conducted in a senior village in a municipality on the west coast of Denmark developed in line with the aim the vision of the municipality ‘to create a framework for seniors to live a good and dignified senior life, where they have control over their existence and ample opportunities to live a physically and mentally healthy life with strong social relationships’45.

Shown in Fig. 1, the senior village consists of a public nursing home (centrally situated), two senior housing blocks with atrium courtyards (each side of the nursing home) administered by a private real-estate company, medical facilities (far right corner), and a variety of shared facilities to offer their seniors a safe environment with opportunities to stay social and active46. The municipality engaged in the project has been a part of the AFCC since 2018 and is thus obligated to have an age-friendly vision and strategies by offering facilities, services and activities that support healthy ageing47.

Fig. 1
figure 1

The senior village with nursing home, senior housing, and medical facilities. Obtained from https://danskboligbyg.dk/c/aktuelt/krebsehusene-rejsegilde-paa-fremtidens-seniorby. Picture taken by the turnkey contractor, Dansk Boligbyg (https://danskboligbyg.dk/) and owned by entrepreneur, Claus Sørensen Ejendomme A/S (https://www.csgruppen.dk/en/ejendomme/).

Full size image

Study design

We conducted an explorative qualitative study in the senior village from March to August 2023. To guide the evaluation of the co-production initiative in the senior village, we introduced the user-oriented Danish BIKVA model (“Brugerinddragelse i kvalitetsvurdering”) which in English is “service user involvement in quality development”48,49.

The BIKVA model consists of four steps (Fig. 2). The first step is a group interview with users in which they present their view of the service provided; positive as well as negative. Secondly, their subjective experiences and statements are then thematically systemized and presented to front-line staff (employees in direct contact with users). In a group interview with front-line staff, the statements from the users are discussed and their practice is reflected on. In step three, statements from users and front-line staff are presented to managers for them to discuss and reflect on. Ideally, politicians are involved as the fourth and last step of the evaluation, who, based on a summary of the statements from the users, front-line personnel and management, must assess the causes of problems and decide how to develop the practice48,50. The fourth step was, however not included in the evaluation of the co-production process in the senior village as politicians were not involved in the process.

Fig. 2
figure 2

Modified BIKVA flow chart39 illustrating the interview process. Generated by first author using draw.oi (version 1, https://www.drawio.com).

Full size image

Study population, sampling, and data collection

For the first step of the evaluation process, we recruited older citizens 60+ years of age to take part in an activity that had been co-produced via purposeful sampling, while an additional group were recruited via snowball sampling. The aim was to include a diverse sample of older citizens with regards to age (60 ± years of age), gender, educational level, and residence (nursing home, senior housing, and neighbouring area). Participants for the first step of the evaluation process were purposefully sampled via an employee from the municipality and via other older citizens in the senior village.

For the second and third steps of the evaluation process frontline staff in the senior village and management respectively were recruited via purposeful sampling by email. We wanted to include frontline staff who were often in direct contact with the older people in the senior village and management responsible for the co-production. Frontline staff were one facilitator/coordinator of the co-production of activities in the shared facilities, two nurses from the nursing home, one nurse from the in-house nurse clinic, one physiotherapist from the fitness centre, one kitchen leader and one kitchen staff from the café. Managers from the municipality, responsible for the co-production initiative, were one manager of the health department, one leader responsible for activity centres in the municipality, and one coordinator of activities, while the interviewees from the real estate company were one manager and one person responsible for the real estate facilities in the senior village.

All interviews followed an interview guide consisting of questions related to the older citizens’ experience of moving to or using the shared facilities in a newly established senior village, their view of the physical facilities and surroundings in the senior village, their perception of being involved in co-production of arrangement and activities in the shared facilities, and questions related to their expectations to the senior village. As guided by the second step in the model, the subjective experiences and statements of the older citizens were transcribed, thematized and presented to seven front-line staff members. For the last step of the BIKVA-model evaluation, the summary of the statements from the older citizens and front-line staff formed the basis for the last interview guide for a focus group interview with the municipality and the real-estate company management. The participants in the final focus group discussed and evaluated the statements and came up with ideas as to how to solve potential problems.

For the focus group interviews at steps 2 and 3 with front-line staff and managers respectively, a student assistant from the university, observed the interviews looking for non-verbal cues such as body language and significant interactions or group dynamics, and provided feedback to the researcher after the interview.

Data analysis

All interviews were audio-recorded and automatically transcribed using the transcript software Good Tape51. To assure reliability, the automatic transcriptions were subsequently reviewed by the researcher and compared with the audio recordings.

Data transcripts were exported to NVivo version 12.052 and inductively analysed using reflexive thematic analysis by Braun and Clarke53.

To help guide the analysis a six-phase process was followed iteratively. As an initial step, the researcher got familiar with the data by listening to the audio recordings and taking notes. Secondly, data were systematically coded in NVivo, and initial themes were generated. The themes were then reviewed and further developed by re-exploring the data and the final themes were defined and named.

Results

Characteristics of study participants

The demographic characteristics of the participants of the BIKVA evaluation are summarized in Table 1.

Table 1 Characteristics of study participants at steps 1, 2 and 3 of the BIKVA evaluation.
Full size table

Just over half of the older citizens were women (56%). The median age of all participants was 75 years of age with a range of 60–90 years. Most participants lived in the senior housing (67%) or the neighbouring area (31%), while one participant was from the nursing home. Almost all participated in an activity (92%), while 19% had been involved in the co-production process.

In the focus group with front-line staff (step 2), most participants were female (86%) all employed by the municipality in various positions in the senior village. Half of the staff (43%) had been involved in the co-production process.

The third and last step of the evaluation process included five participants at the management level (4 men and 1 woman). Three participants represented the municipality while two participants came from the real-estate company.

Overall, six themes emerged from the thematic analysis as summarized in Fig. 3. All themes were divided into three broader categories organizational, environmental, and other challenges affecting co-production and unfolded below by statements from interviewees.

Fig. 3
figure 3

Categories and themes of the thematic analysis. Generated by first author using draw.oi (version 1, https://www.drawio.com).

Full size image

Impact of the organizational setting on co-production

The municipal organization shows up as one of the most important themes therefore, to understand how the co-production process was organized in the senior village, an organizational chart of stakeholders is presented in Fig. 4.

Fig. 4
figure 4

Stakeholders in the co-production process. Generated by first author using draw.oi (version 1, https://www.drawio.com).

Full size image

The municipal management initiated the co-production process and informed frontline staff and citizens about the initiative through a written invitation to a joined information meeting and workshop before establishing the senior village. The purpose of the meeting was to inform about the reasons for establishing the senior village, information about facilities and the citizens´ possibility to co-produce arrangements of rooms and activities. As part of the co-production initiative and aim to build communities, the municipality left the 2200 m2 ground floor of the nursing home open for citizens from the nursing home, the senior housing, and the neighbouring area to arrange rooms and create activities. Also, the two atrium courtyards at the senior housing blocks were kept open by the real estate company for citizens to enjoy. Three separate information meetings and workshops were carried out, each with 50 citizens from the senior housing, nursing home or neighbouring area respectively. Citizens interested in contributing ideas for arrangements and activities in the shared facilities continued the work in a joint workshop. All workshops were facilitated by staff from the municipality. According to both the management in the municipality and the real estate company, the ambition of the senior village was to create a framework for the municipality’s older citizens that enhances their quality of life through easy access to healthcare services and communities with co-produced activities.

Municipal organization—bridging the gap with frontline staff

Creating a senior village with communities across nursing homes and senior housing proved more difficult than expected as mentioned by the municipal management. In their effort to include citizens as much as possible in the co-production of arrangements of rooms and activities frontline staff were not included in the decisions around the organization of rooms at the ground floor or included in the co-production of activities together with citizens. Frontline staff were primarily informed about the concept of co-production as being a process with citizens initiating activities and organizing rooms, leaving frontline staff no influence on matters as expressed by nursing home staff:

But we were informed, but it was more of an information. This is the vision, and this is how it will be. And sometimes you can still feel a bit like we don’t have a say, even though we can see something that could be done differently, but it gets shut down. (Frontline staff, nursing home)

Not involving frontline staff in the entire co-production process has resulted in a lack of relations with senior housing residents and a greater division of units, which may hinder future collaboration and communication between municipal frontline staff and senior housing residents. The nursing home staff said:

The relationship we currently have with the seniors (senior housing residents) ... Of course, we have some couples where one spouse lives over there (in the senior housing) ... that’s where we build these relationships, but otherwise, we don’t have any relationship with them because we’re not involved in that. So, we almost become guests in our own house, and then it becomes ‘us and them.’ Because we’re not part of each other, and I think that’s a shame. (Frontline staff, nursing home)

To solve this issue, frontline staff believed that greater involvement of frontline staff in decisions together with citizens and management would optimize the co-production process and increase their interest and ownership as expressed by staff from the kitchen:

And that’s what I understand by co-production, that we want to be involved. We just need to be listened to and involved, because otherwise, you don’t have ownership over it. (Frontline staff, kitchen)

Frontline staff and municipal management did however not agree on the level of involvement. The municipal management believed that frontline staff had been involved in steering group meetings before the co-production process with citizens and did not want further involvement from the frontline after the establishment of the senior village. When presented with statements from frontline staff regarding the matter, municipal management believed that frontline staff were stuck in old roles and that a cultural change was needed in the organization to address the resistance to the type of co-production that the municipality’s management had envisioned.

To create the best conditions for future collaboration on co-production within the organization, bridging the gap between frontline staff and municipal management perspectives on the degree of involvement in the co-production process is essential.

Impact of the physical environment on co-production

Organization of facilities

The organization of the physical facilities in the senior village was regarded positively when it came to access to healthcare and the availability of activities on the ground floor of the nursing home. Residents considered having the doctor and nurse nearby gave them a sense of security not having to travel long distances to see a doctor.

In the shared facilities on the ground floor of the nursing home, the area around the kitchen created a lot of debate among citizens, frontline staff, and municipal leaders. Citizens expected a cafeteria in the shared facilities which would act as a place to gather around meals and events in a cozy environment. However, the kitchen is run by municipal staff, primarily catering to the nursing home with the option for senior housing residents and neighbouring citizens to pre-order meals. According to residents, having to pre-order meals limited the number of residents and neighbouring citizens visiting the kitchen. The area around the kitchen thus became more of a passage for entering activity groups instead of a shared environment with a nice atmosphere. Frontline staff believed that the missing atmosphere was due to citizens not coming to the area even though frontline staff at the kitchen made several attempts to attract customers. Besides they experienced the area becoming more of an information centre for visitors to the nursing home and drop off for postal service, which did not leave frontline staff much time to create a nice atmosphere and attract customers. Municipal leaders, however, believed that bringing life to the area and initiating common meals and events was still to come from citizens being true to the concept of co-production with citizens as initiators of ideas and activities. The different opinions of who would initiate activities and create an atmosphere in the area created tension among citizens, frontline staff and municipal leaders.

According to a senior housing resident, they regarded the atrium courtyards private as they pay a monthly rent whereas the shared facilities on the municipality’s premises were public:

It’s once again the misunderstanding that was created when they made this project. Because you’re creating a private development with locked doors, and of course, we consider that ours because it’s part of our rent that we pay to have those facilities. And that’s the whole difference, it’s private, whereas the other is public. So, you can’t compare them in the same way. (Senior housing resident)

Frontline staff the other hand were convinced that there was a mutual sharing of facilities as access to atrium courtyards would be beneficial for nursing home residents:

That’s also what was implied... that we all gave a little, and then everyone gave a little, and then the atrium courtyards are completely closed off to us (the nursing home). In the beginning, they were open, so our residents could go in there, and it gave them some peace. We don’t want a constant stream of citizens coming over here. That’s not what we want, but just a walk around, that’s something we would like. (Frontline staff, nursing home)

Building inclusive communities

One of the goals of building a nursing home and senior housing close together was to create synergy between the two units and offer residents inclusive communities in the common areas on the ground floor and in the atriums connected to the senior housing.

Participating in the co-produced activities provided senior housing-, nursing home residents and neighbouring citizens an opportunity to build communities. They expressed great satisfaction in being a part of an inclusive community. A close neighbouring citizen was welcomed by a senior housing resident in the billiard community and enjoyed spending time together with other men in a community including everyone despite personal limitations:

So, I’ve come this far since I met X (senior housing resident) and then we’ve started this up more or less together, and we simply find it so cosy. It’s something we all can do. I mean, our rules and our laws, everything is such that everyone can participate. You can see, even someone like Y (nursing home resident) can participate (Neighbouring citizen)

Despite good intentions, creating a senior village as one entity where residents collectively build activities and more resourceful citizens assist weaker citizens has not been successful according to the municipal management:

There isn’t the connection we thought we could achieve, and that’s probably because the residents over there (senior housing) are too frail to engage in activities. So, they can’t muster the energy to support those who are even weaker. We haven’t achieved that synergy effect (Municipal management)

The communities that have emerged around the co-produced activities in the shared facilities on the municipality’s premises were characterized by the fact that it was primarily residents from the senior housing who initiated and participated in activities. Nursing home residents did not participate in the co-produced activities but attended events organized by the nursing home itself. According to frontline staff, these siloed communities could be attributed to several factors. First and foremost, they believed that the lack of participation was due to residents being both physically and mentally limited and that there was also not enough staff to accompany residents to activities. Frontline staff also believed that residents of the senior housing did not have the resources or sufficient knowledge to take care of nursing home residents during activities. They missed volunteers who could bring nursing home and senior housing residents together in activities. However, the physical planning of the senior village, with a nursing home on five floors and secured to prevent residents with dementia from leaving the building unattended, did not invite spontaneous access and visits by volunteers.

Other challenges affecting co-production

Information gaps

Despite the municipality informing citizens about facilities and their intention to co-production arrangements of rooms and activities at information meetings and workshops, several citizens were not aware of the possibility of engaging in the co-production process. Only residents already assigned to the senior housing and nursing home as well as a limited number of neighbouring citizens received an invitation and were able to join the information meeting and workshops. For that reason, newcomers to the nursing home and senior housing did not know of the facilities and the municipality’s intentions of co-producing arrangements of rooms and activities. A relative from the nursing home got the impression that the co-production process was solely for residents in senior housing. She said:

It just seemed like it was mostly for those who lived in the senior housing. And we don’t live there. The municipality clearly stated that 3 million kroner were allocated for arrangement here. And it was the users who were supposed to arrange it. It is not my impression that anyone from the nursing home has been involved in the arrangement. That, I think, is a deficiency. (Relative, nursing home)

Information on the availability of activities in the senior village was lacking according to citizens from the neighbouring area. Some were surprised by the number of activities offered and the possibility of making use of the activities together with senior housing and nursing home residents:

I have a father who is on the fourth floor here at the nursing home. And it’s because of that, I look at the bulletin board. If it hadn’t been for that, I would never have received information that there was an offer here about various leisure activities. And I have also talked to some people around here over Easter, who live in the area. Well, they don’t know anything about it. (Neighbouring citizen and relative, nursing home)

In line with this, frontline staff missed information from the management as well and experienced uncertainty about the framework for participation in the senior village and to which extent neighbouring citizens could make use of the shared facilities:

But it (the information) is generally word of mouth. Suddenly, I can have someone call the fitness centre who wants this free offer because they heard it from someone else. And I’ve often been faced with, what is the neighbouring area? It’s quite complex to answer because I don’t have a framework for it. (Physiotherapist, shared facilities)

Not only frontline staff miss a framework. Citizens engaged in the co-production of arrangements of rooms and activities missed information about the financial ceiling for purchasing equipment for the shared facilities and how to organize rooms to meet everyone’s needs. A woman in the creative workshop said:

We have received everything we have come up with to use, and it’s fantastic, but then the problem, the way I see it, was that they could have made some frames so we knew something about, well, how much should it cost? How many should share a space? Or what’s the idea behind it? And we couldn’t get any information about it at all. (Senior housing resident)

Navigating expectations

Despite varying degrees of information about the new senior village and its activities, most informants believed that the senior village had met their expectations overall. Several respondents expressed great satisfaction, especially with the communities formed across activities and around the senior housing:

For my part, I would say that what reality is today, has far exceeded the expectations I had. Of course, there have been some things that haven´t been good enough. But my expectations have certainly been more than met. Especially with the social aspect, the companionship, and so on. I think it´s great. (Senior housing resident)

At some points, the information provided by the municipality and real-estate company was not clear as to which facilities were available and to whom. As mentioned earlier, citizens expected a cafeteria in the shared facilities which would act as a place to gather around meals and events in a cozy environment and a place for overnight guests. Citizens’ expectations were thus not met generating a negative mood among citizens and creating a distrust in the municipality and real-estate company. On behalf of the focus group informants, a senior housing resident expressed the following:

Well, the whole setup, also in the public space where they (the municipality and the real-estate company) describe this project with the senior village, it was kind of implied that it included both a cafeteria and the possibility of having guests overnight, which then turns out not to be the case because these things are only related to the nursing home. They (the municipality and the real-estate company) haven’t been good enough at distinguishing between the two (nursing home and senior housing). (Senior housing resident)

Harmonizing roles

As communicated at information meetings and workshops, the municipality expected citizens to initiate and run activities in line with the concept of co-production. In addition, the municipality aimed for residents at the senior housing to act as volunteers and include nursing home residents in activities. However, the expectations from the municipality exceeded citizens’ experienced resources leading to role strains with citizens having difficulties fulfilling the expectations. Some citizens believed that not being able to initiate and run activities or take care of nursing home residents was due to the old age of senior housing residents, being higher than expected, while others suggested that lack of personal resources was the main cause as expressed by one senior housing resident:

I feel that they (the municipality) have some expectations of us that I find unreasonable. We have people who are sick, we have people with spouses at the nursing home whom they must take care of, and we have people with all sorts of difficulties and problems. And if they (the municipality) think that we should include others who may have some problems... I don’t think we have the capacity for that. (Senior housing resident)

During interviews and observations in the senior village, it became clear that only a few residents from the senior housing were initiators of activities. Besides old age and lack of personal resources, some residents expressed that moving to the senior village was their time to enjoy their retirement and not be responsible for activities as described by a resident from the senior housing:

We’re all seniors, and we’ve been active our whole lives, both as chairpersons and in many other roles in associations. Now, it’s as if we should also start enjoying things. (Senior housing resident)

That citizens did not assume the roles that the municipality had hoped for means that there is a need for a new distribution of roles to create new activities for and with the citizens. On several occasions frontline staff had come up with ideas for new activities but experienced a need for additional support to help get the citizens started:

I experience that the motivation and drive for those who should be the driving force, it’s not there. I think that if someone else started it, maybe others would join in…. (Coordinator of activities, shared facilities)

His assumption was supported by the real estate company, which regularly holds meetings with the residents of the senior housing. They believed that residents were requesting assistance in initiating and running activities. To support the co-production of activities in the senior village it became clear during the interviews that the level of information from the municipality and real-estate company plays a crucial role in the collaboration with citizens. To support the co-production of activities timely communication and clarity of expectations and roles between stakeholders seems essential.

Discussion

In this study we explored a co-production initiative between older citizens a municipality, and a real-estate company in a Danish senior village (1) to identify how the physical environment and the organizational setting influenced the co-production process and (2) to describe other factors influencing citizens’ engagement and perceptions of the co-production process.

We identified that the municipal management and real-estate company initially managed to involve citizens in the co-production process. However, there were difficulties in properly informing citizens and frontline staff about the framework of the project and their roles as co-producers. The lack of information and involvement of frontline staff in the decision-making process may have affected the internal collaboration in the municipality as well as the relationships between citizens from the different units. We also found that residents were in general satisfied with the unique physical environment and the activities co-produced, but tension arose due to different opinions regarding the use of shared facilities and the development of sub-communities. In addition, the physical planning of the senior village may have affected the formation of siloed communities. Information gaps and sparse communication may have contributed to citizens’ expectations for the senior village, their role as co-producers and their willingness to participate, which addressed the need for clarity and support from stakeholders to facilitate the co-production process. In the following, the main findings will be discussed.

What to be aware of when building communities

The senior village, a unique collaboration between a public and private organization, aims to create an environment promoting healthy ageing. Our study found that creating a framework for the municipality’s older citizens has largely succeeded in building communities. In other studies, we found that social participation in activities and communities increased citizens’ sense of belonging, reduced loneliness, and fostered feelings of safety25,54,55. In addition, social relationships are found to be favourable for both the mental and physical health of older citizens, reduce mortality rates and increase overall quality of life56,57. However, challenges arose in creating a senior village with inclusive communities across nursing homes and senior housing.

The communities that emerged were divided, with limited interaction among residents from different units. While some co-produced activities involved participants from both senior housing, nursing homes, and the neighbouring area, most communities formed within the senior housing remained exclusive to their residents. The absence of nursing home residents in these shared facilities caused concern among relatives and frontline staff, who believed that community-building should extend beyond the municipality’s premises to the property company’s domain.

As suggested by frontline staff the physical planning may have contributed to the fragmentation of units but may also be due to resource constraints at both the personal and organizational level. That is; residents at the nursing home were mentally unable to participate fully in the co-production of activities and needed assistance from either relatives, volunteers, or nursing home staff, who on the other hand were limited by staff resources. Residents from the senior housing unit were not able to or interested in acting as volunteers and taking care of nursing home residents but wanted to enjoy the communities as they were with other senior housing residents. This finding is supported by a systematic review that identified barriers to social participation in older adults stating that individual factors such as health and motivation affected older citizens´ inclination to act as volunteers58.

The degree of stakeholder involvement in the co-production process may also have affected the communities built and the collaboration between the nursing home -and senior housing units as stated by frontline staff. Not only do citizens and management possess skills, knowledge and expertise, but so do frontline staff as service professionals59. Involving all stakeholders in the co-production process, could enhance the number of resources available and enable the management to make use of a diverse set of resources to assist their capabilities60, ideally with equal involvement and influence61. As stated by Loeffler and Bovaird, in their definition of co-production: “Professionals and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improved efficiency”35, not involving frontline staff in the entire co-production process may have limited the overall collaboration between units.

The fragmented nature of the communities at the senior housing units and in the shared facilities on the municipality’s premises may impact the co-production of activities. Limited interaction between residents from senior housing and nursing homes, and differing perceptions of shared facilities pose challenges to collaboration. Additionally, the physical planning and factors such as physical and mental limitations among nursing home residents, and insufficient staffing may further hinder residents’ ability to participate in co-produced activities.

Information is key to matching expectations and distributing roles

Our study found that citizens generally had a positive attitude toward participating in co-production. Engaging in the process empowered them and increased their ownership of the activities co-produced as supported by other studies62,63. Active participation in the co-production process also enhanced greater satisfaction with the activities. This finding is in line with other research stating that citizen satisfaction is not only a motivation for engagement in co-production but also related to the concrete outcome co-produced64. Factors such as transparency and trustworthiness may however impact the degree of satisfaction and perceived quality of the public service co-produced65,66. As described in our findings, not all citizens’ expectations of the shared facilities were met. The degree of transparency from the municipality and real-estate company side may explain the dissatisfaction among citizens as enhanced transparency may elevate expectations, which in turn might mitigate the positive impacts of service quality and perceived citizen satisfaction67. We found that not meeting citizens´ expectations created distrust towards the municipality and the real-estate company. Trustworthiness is indeed a concept closely linked to the principles of co-production30,68 and is important as distrust may be a barrier to co-production69. The presence of clear incentives is another important factor for successful co-production30. Our findings suggest that the level of information from the municipality and real-estate company was not adequate, as citizens expressed concerns about inadequate details related to finances, organization of facilities and follow-up procedures. Additionally, expectations regarding citizens’ roles as co-producers remained unclear.” As stressed in other studies, informing participants about the incentive and aim of the co-production initiative and matching expectations for outcome and roles, appropriate information and follow-up is crucial to guide participants in the process and to gain a successful outcome of the co-production process70,71.

While the intentions behind establishing an age-friendly senior village are positive, addressing these issues is crucial for future collaboration and optimization.”

Methodological considerations

As recruitment for the study was based on purposeful sampling to include citizens informed and involved in the co-production process, the focus groups mainly consisted of senior housing residents from activity groups, potentially leading to selection bias as nursing home residents and neighbouring citizens were underrepresented. Attempts to include more diverse participants through flyers yielded minimal participation. The study used focus group interviews to explore perceptions of the co-production initiative among citizens, frontline staff, and management. However, power dynamics during management interviews may have influenced responses suggesting individual interviews with management could mitigate this issue. Reflexive thematic analysis53 was used for data analysis, leveraging the first author’s preexisting knowledge of the co-production process and participant views. However, there is a risk that these preconceptions may have impacted the analysis ‘objectivity. Going forward it is important to continue evaluating housing options for older citizens to create the best conditions for this generation in terms of health and well-being. In practice, exploring how public and private organizations may involve older citizens in the development of new housing forms is crucial, keeping in mind that older citizens are willing to engage under the right conditions. To investigate this, an exploration of their preferences for housing forms is necessary considering diversity and inequality within the target group, as one size does not fit all.

Conclusion

In conclusion, our study demonstrates that creating a healthy ageing environment through co-production is feasible. Citizens generally exhibit a positive attitude towards participating in co-production, which empowers them at different levels and enhances their ownership and satisfaction with the activities and the community in general. However, building healthy ageing environments through co-production is complex. Many interests are at stake, and it is challenging to meet everyone’s needs and expectations. The success of the co-production process is highly influenced by the organizational structure such as the level of involvement of stakeholders. The lack of frontline staff involvement in the decision-making affect internal municipal collaboration and the relationship between nursing home and senior housing units negatively affecting the overall result of co-production. Engaging all stakeholders, each possessing valuable knowledge and expertise, is vital for a fruitful process and outcome. In addition, the physical separation of nursing homes and senior housing units as well as different perceptions of shared facilities can lead to more isolated sub-communities hindering collaboration among all residents. Assuring adequate information during the entire co-production process to all stakeholders may improve communication to align expectations, increase the level of involvement at different levels and optimize outcomes. The findings of this paper contributes to the understanding of challenges associated with building healthy aging communities through co-production and highlights concerns that should be taken into consideration in future co-production relationships between the public and older citizens. To refine co-production practices and create healthier environments, future research on co-production with older citizens should explore how to properly engage multiple stakeholders in the process being aware of the impact of the physical planning on collaboration and community building as well as identifying optimal communication channels to assure adequate information throughout the process.