"The paper illustrates an empirical research project concerning the co-creation process in Reggio Emilia's public services and their efforts to reduce childhood obesity. The research is based on a participative evaluation research methodology. The project has been implemented within the framework of the CoSIE project, funded by the Horizon 2020 Research Program — Innovation Action. It has been led by the Local Health Unit (LHU) of Reggio Emilia, a mid-size town in north-eastern Italy, and Cup2000/Lepida, a public/private corporation delivering ICT for health service in the Emilia-Romagna Region. The empirical research has been conducted by the University of Bologna, using a mixed method multi-dimensional strategy and combining the Action-Research tradition with the approach of the Theory of Change . The theoretical framework reflects on the co-creation process, distinguishing between its different phases. In particular, it defines the co-production and the co-design phase, operationalising them with the concepts of System Integration and Social Integration. This linkage allows the analysis of the involvement of institutional stakeholders and final users in the co-creation process. Many factors including the actors' identity, the participation modalities and the impact of each stakeholder on the service, contribute to the model of co-creation in “the shadow of institutions”, characterised by a low level of Social Integration and a high level of System Integration."

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