Revolutionizing African healthcare: harnessing co-creation, patient empowerment, and future thinking for patient outcomes

Abstract

Introduction: African healthcare systems continue to face poor patient outcomes, yet the role of co-creation in improving outcomes within low-resource settings remains poorly understood. Existing literature treats co-creation, patient empowerment, and future thinking as separate constructs and rarely examines the motivational and cognitive pathways linking them. Drawing on Self-Determination Theory (SDT) and Future-Oriented Theory (FOT), this study tests a dual-pathway model of co-creation in Ghanaian healthcare. Methods: A cross-sectional survey was conducted among 385 patients in Ghanaian hospitals in 2025. Structural equation modeling was used to assess relationships among co-creation, patient empowerment, future thinking, and patient outcomes, with empowerment and future thinking tested as parallel mediators. Results: Co-creation was positively associated with patient empowerment, future thinking, and patient outcomes. Both patient empowerment and future thinking partially mediated the relationship between co-creation and patient outcomes. The findings show co-creation improves outcomes primarily by building autonomy and competence, which then activate forward planning that guides health behavior. Discussion: This study extends SDT and FOT to African healthcare and reveals a previously untested dual-pathway mechanism in Ghana. Co-creation functions as an implementation-focused process rather than a decision-focused process in low-resource contexts, emphasizing patient adherence within resource constraints rather than treatment choice. For policy and management, co-creation initiatives should combine autonomy support with tools that help patients mentally simulate future health actions to improve outcomes.