The screening process of included studies is reported below in the PRISMA Flow below (Fig. 1). Twenty-two studies were included.

We summarised the selected studies’ details in Table 2, including information about authors, year of publication, public health issues and challenges addressed, as well as details about the co-creators participating in the intervention and the study’s aim.

Most interventions were designed directly in the LMIC setting [32, 34, 36,37,38, 40,41,42,43, 45,46,47, 50, 53, 54], while two interventions were initially designed and implemented in another LMIC and then transferred and adapted to the study’s LMIC setting [35, 48], one transition occurring within the same continent, moving from Ghana and Nigeria to Uganda [35], while the other involving a transfer from Vietnam and Kyrgyzstan to Uganda [48]. Three interventions were initially designed in a HIC setting and transferred and adapted to an LMIC setting [33, 44, 51].

The majority of interventions were conceived and designed within LMIC settings, with two being transferred between different LMIC contexts, and an additional three originating in a high-income country (HIC) before being adapted to LMIC settings. The studies in which the original intervention was designed in the HIC all highlighted the relevance of conducting a contextual adaptation phase. One study undertook the identification of local needs and a co-design intervention phase [44] while the other two studies conducted focus groups and interviews with local stakeholders for the adaptation of the intervention’s materials [33, 51].

We applied no time limitation on the search strategies, but all included papers were published between 2019 and 2023 and one study was published in 2016 [53].

We represented the geographical distribution of studies in Fig. 2.

Geographical distribution of co-creation projects in LMIC countries, including references

Studies adopted one or a combination of the following approaches: co-creation, co-production, co-design, co-production and co-development. Studies, in some cases, complemented these approaches with CBPR, participatory action research, citizen science, and human-centred design. The majority of studies reported adopting solely a co-creation approach [33, 33,34,35, 39, 41, 45, 48, 50, 51], while others used co-creation in combination with CBPR [43, 47] or with co-design [38, 46, 53] or with co-production and participatory action research [42]. Co-creation was also combined with co-design and CBPR [40]. Some adopted a co-production approach [36] while others used the approach of co-design [48], co-development [37, 52]. Others utilized human-centred design [53] or citizen science as their approach when co-creating [38]. One of the studies adopted a co-design approach combined with CBPR [44].

Despite having involved end-users at different moments of the intervention, all the authors engaged with representatives from people living in socio-economically vulnerable circumstances when developing the intervention’s outputs.

Several authors have been engaging with representatives of the people living in socio-economically vulnerable circumstances to conduct needs and contextual assessment before the intervention’s design [34, 35, 38, 45, 47, 53, 55] while some have also involved representatives from the target population also when co-designing the intervention [34, 36, 38, 41,42,43, 49, 50, 52, 53].

To group and present implementation barriers and facilitators’ results, we used the CFIR components [30] as described in the Methods section and represented in Fig. 3.

Outer setting is described as the setting in which the Inner setting exists, including the local environments, such as the hospital system, school district, state, but also as the wider socioeconomic environment in which the intervention is taking place, including systemic-level implementation facilitators and enablers [18].

The lack of financial investment in flexible processes by local and global funders.

have been reported to cause difficulty in the implementation of co-creation projects [38].

Systemic conditions related to the participants’ context, such as the individual’s socioeconomic status, including factors related to household composition, parental education and difficulty to absent from work for participation in the sessions, are mentioned, by several authors, as an important influential condition which must be taken into account when developing and implementing co-creation [32, 37, 44, 50,51,52]. Several studies [34, 35, 38, 45, 47, 53, 55], in fact, recommend conducting a needs assessment and investigating contextual factors influencing the context and issue, as described in the ‘Needs assessment’ paragraph in the implementation facilitators section of this manuscript.

The impact of existing entrenched power dynamics and social hierarchies within the settings and between stakeholders has been said to influence the project dynamics [34, 46]. Some authors experienced difficulties gaining policymakers’ support [47, 50] or top administrators’ buy-in [45].

Several studies reported participants’ varying literacy levels and formal education impact on the process [34, 35, 52]. A lack of shared language and equivalents of technical terms in the local language was expressed as a challenge in conveying an understanding of the subject matter [20, 21, 40], together with difficulty in accounting for all the variety of languages spoken within the same local setting [34]. Some participants experienced technological challenges [33] and, more specifically, difficulties in accessing and charging mobile phones [35] or related to a weak network system [33].

The inner setting is the setting in which the innovation is implemented, e.g., a hospital, school, city.

Lack of data on subject matters related to the monitoring of facilities, specifically on disaster hazards [36] but also access to an extensive list of socioeconomic indicators [37], has been proven difficult. The need to better share monitoring information and data across agencies was highlighted [36].

Some reported the process as time and effort intensive [41, 50] stressing this might represent a more significant challenge when set in resource-limited settings because of the limited availability and capacity of targeted participants [