GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research

Feasibility study of a co-designed, evidence-informed and community-based incentive intervention to promote healthy weight and well-being in disadvantaged communities in Scotland

OBJECTIVES

To feasibility test a novel community-based financial incentive scheme to promote healthy weight and well-being.

DESIGN

Single-arm, prospective feasibility study using mixed methods.

SETTING

Two communities in Scotland experiencing high levels of disadvantage according to the Scottish Index for Multiple Deprivation (SIMD). Community C1 is in a large rural area with a small town centre (population~1.5K) and community C2 is a small and urban community (population~9K), enabling contextual comparison.

PARTICIPANTS

Eligible adult (18 years or over) community members recruited through community outreach.

INTERVENTION

The Enjoy Life LocallY (ELLY) intervention comprised free soup twice weekly (café/delivery/pickup); loyalty card stamped for engagement in community assets (such as local activities, groups and clubs) exchanged for a £25 shopping card when a participant attends a minimum of 9 assets over 12 weeks; goal setting; information resources; self-monitoring of weight and well-being.

OUTCOMES

Primary outcomes-feasibility of recruitment, retention and engagement. Acceptability of intervention components was assessed by self-reported questionnaires and interviews. Secondary outcomes-feasibility of collecting outcomes prioritised by communities for a future trial: health-related quality of life (EQ-5D-5L), mental well-being (WEMWBS), connectedness (Social Connectedness Scale) and weight-related measures (weight, body mass index (BMI)).

RESULTS

Over 3 months, 75 community citizens (35 citizens in C1, 40 citizens in C2) were recruited (125% of target recruitment of 60 participants (117% of 30 participants C1 target, 133% of 30 participants C2 target), 84% female, baseline weight mean (SD)=84.8 kg (20) and BMI mean (SD)=31.9 kg/m2 (7.3), 65/75 (87%) living in disadvantaged areas (SIMD quintiles 1-3)). Retention at 12 weeks, defined by completion of outcome measures at 12 weeks, was 65 (87%). Participation in at least one asset for a minimum of 9 out of 12 weeks of the intervention was achieved by 55 (73%). All intervention components were acceptable, with the loyalty card being the most popular and the soup cafés the least popular. The mean average cost of the soup ingredients, per participant, over the 12 weeks was £12.02. Outcome data showed a small decrease in weight and BMI and a small increase in health-related quality of life, mental well-being and social connectedness.

CONCLUSIONS

The ELLY study recruited and retained participants from two disadvantaged communities in Scotland. The study was acceptable to participants and feasible to deliver. A full trial is warranted to determine effectiveness and cost-effectiveness, with consideration of scalability.

TRIAL REGISTRATION NUMBER

The ELLY feasibility study was not pre-registered.

Co-creating tools for embedding meaningful patient and public involvement and engagement in real-world data and evidence research in the pharmaceutical industry setting: a multistakeholder participatory co-design study

OBJECTIVES

This study aimed to (1) gauge patients understanding and expectations of real-world data and evidence (RWDE) research and (2) use this understanding and patients lived experience to co-create resources and a framework for embedding meaningful patient and public involvement and engagement (PPIE) in RWDE research within the pharmaceutical industry setting.

SETTING AND PARTICIPANTS

An academic organisation, a pharmaceutical company and a PPIE panel of 12 patients or carers partnered to form the project team. The PPIE panel was purposively selected to maximise diversity.

DESIGN

Participatory and co-design methods were used to engender an understanding of the PPIE perspective on RWDE research and the PPIE role within that. Interactive workshops explored understanding and expectations of RWDE research as well as perceived barriers and facilitators of PPIE within each stage of the RWDE research cycle. Workshops were audio and video recorded, with notes captured. Summaries were analysed thematically and shared back with the PPIE panel for validation and further reflection.

RESULTS

We identified a lack of trust and understanding of real-world data, its collection and use and the need to educate the public and researchers. Four themes were identified for meaningful PPIE in RWDE research; equality, diversity and inclusion; feeling valued; ownership and understanding and evaluating impact. We co-created learning resources (video, infographic) and a novel PPIE framework, incorporating potential PPIE activities, resources and support needs for use by researchers conducting RWDE research.

CONCLUSIONS

To our knowledge, this is the first project to explore the practicalities of PPIE in RWDE research from the perspective of patients and carers. Some findings confirm PPIE experience and guidance derived from other areas, with some specific insights into the pharmaceutical industry. These underpin the PPIE framework to enable robust and meaningful PPIE in RWDE research. This article includes a plain language summary in the supplement.

Women's health and healthcare experiences in the years after gestational diabetes or hypertensive disorders of pregnancy

BACKGROUND

Pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), affect a significant proportion of women in Australia, with long-term implications for cardiovascular disease (CVD) risk. Despite existing preventive measures, participation in ongoing health monitoring remains low. This study aims to explore women's preferences and experiences regarding preventive healthcare after GDM and HDP, and to identify their unanswered questions about the association between these conditions and future CVD risk.

METHODS

A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group (LEE Group) to plan, conduct, and interpret focus groups with women who had experienced either GDM or HDP. Participants were recruited through health consumer and community organisations and took part in two focus groups conducted via Zoom. The focus groups involved a stimulus presentation about CVD and GDM or HDP, facilitated group discussion about participants' health and healthcare since their pregnancy, and Nominal Group Technique to prioritise participants' questions about their CVD risk. Focus groups were audio recorded and transcripts from each group were analysed thematically. Synthesised Member Checking was used to verify the trustworthiness of findings.

RESULTS

Twelve women participated in the focus groups, with distinct themes emerging from the GDM and HDP focus groups. Participants were previously unaware of the association between their pregnancy complication and increased risk of future CVD and wished to know more. Three themes were generated from the GDM focus groups: 'a distressing diagnosis'; 'degrees of diabetes'; and 'balancing motherhood and self-care'. Two themes were generated from the HDP focus groups: 'women's concerns were dismissed' and 'wanting follow up at the right time and with the right person'. The 'top ten' questions from each group focussed on improving maternity care, preventing CVD, and (for the HDP group) concerns beyond CVD.

CONCLUSIONS

Women's capacity to engage in preventive health after GDM and HDP is influenced by their maternity care experiences and the accessibility of primary care pathways. Future interventions should focus on improving woman-centred maternity care, ensuring seamless transitions to primary care, and addressing the social determinants of health for new mothers.

Pelvic pain & endometriosis: the development of a patient-centred e-health resource for those affected by endometriosis-associated dyspareunia

BACKGROUND

We recognized a paucity of accessible, evidence-based, empowering patient-centred resources for those with endometriosis-associated dyspareunia. Affecting more than 50% of people with endometriosis, dyspareunia can significantly impact relationships, chronic pain and the ability to have a family. We aimed to develop a patient-centred educational website for those affected by endometriosis-associated dyspareunia.

METHODS

To develop a functional and meaningful website for endometriosis-associated dyspareunia, we utilized a Knowledge to Action framework, supplemented with a patient-centred research design and technology-enabled knowledge translation. Our patient partners influenced the direction and scope of the project, provided critical feedback throughout the development process, and approved website revisions prior to launch. The website was developed in five phases; (1) needs assessment interviews and focus groups with key stakeholders, (2) landscape analysis of pre-existing websites, (3) development, (4) usability testing and qualitative interviews, and (5) revisions and launch.

RESULTS

Phase 1 and 2 emphasized a need for comprehensive yet plain language explanations of pain mechanisms and strategies for pain management. Rigorous consultation with key stakeholders informed the creation of the preliminary website in phase 3. Usability testing in phase 4 identified five main categories of usability problems, most of which were considered minor. Phase 4 qualitative interviews identified users' overall impressions of the preliminary website, including that the website could help people understand their pain and describe their pain to partners and healthcare providers, as well as feel empowered to seek healthcare and validated in their experiences. User suggestions, combined with usability testing, informed revisions in phase 5.

CONCLUSION

We developed an educational website for endometriosis-associated painful sex where people can find evidence-based etiologies for pain, pain management options, and actionable resources. Based on the data collected through qualitative interviews with patients, this website can potentially empower people to seek health care. The strength of the website development approach used was the inclusion of qualitative user insights in addition to the commonly completed user tests. The patient interviews provided insights into the potential impact of the website and, thus, ensured that we not only created a functional website that meets end users' needs, but a website that is also meaningful to those affected by this condition.

Heart2Heart: a digital peer support programme for people with heart disease: protocol for a community-based, investigator-blinded randomised controlled trial conducted in Australia

INTRODUCTION

Cardiac rehabilitation is known to reduce morbidity and improve quality of life in people living with heart disease, however, adherence, access and completion of these programmes is suboptimal. Peer support may offer an opportunity to close this service gap. The aim of the study is to determine whether the effectiveness of a digital peer support programme for people living with heart disease is effective in improving social connectedness, clinical and patient-reported outcomes and experience measures.

METHODS AND ANALYSIS

Heart2Heart is a community-based randomised controlled trial with 6 months follow-up for the primary outcome and 6 and 12 months for secondary outcomes. Approximately 752 adults with a diagnosis of heart disease in the past 12 months will be recruited from the general community and Australian cardiac rehabilitation programmes. Control group will participate in usual care, while intervention group will have access to a 6 months intervention that enables peer support via an interactive mobile application, in addition to usual care. The intervention includes online discussion groups, access to resources and facilitated conversations with health professionals. Primary outcome is social connectedness at 6 months follow-up. Secondary outcomes (6 and 12 months) will be all-cause/cardiovascular disease hospital admissions, all-cause mortality, lifestyle (sufficiently physically active, not smoking, sufficient fruit and vegetable consumption), proportion taking prescribed medications and health service utilisation (medical appointments, cardiac rehabilitation, participation in any other in-person peer support activities). Patient-reported outcome and experience measures including self-efficacy, quality of life, satisfaction and programme engagement will be analysed at 6 months. Process measures will include application analytics, barriers and facilitators to engagement with the intervention from participant's perspective. An intention-to-treat analysis will be used.

ETHICS AND DISSEMINATION

Ethical clearance was obtained from Western Sydney Local Health District Ethics Committee. Heart2Heart has potential to improve social connectedness and provide a valuable addition to traditional cardiac rehabilitation.

TRIAL REGISTRATION NUMBER

ACTRN12624000386538.

Foundational guidelines for enhancing neurotechnology research and development through end-user involvement

Neurotechnologies are increasingly becoming integrated with our everyday lives, our bodies and our mental states. As the popularity and impact of neurotechnology grows, so does our responsibility to ensure we understand its particular implications on its end users, as well as broader ethical and societal implications. There are many different terms and frameworks to articulate the concept of involving end users in the technology development lifecycle, for example: 'Public and Patient Involvement and Engagement' (PPIE), 'lived experience', 'co-design' or 'co-production'. The objective of this tutorial is to utilise the PPIE framework to develop clear guidelines for implementing a robust involvement process of current and future end-users in neurotechnology, with emphasis on patient involvement. After an introduction that coveys the tangible and conceptual benefits of user involvement, we first guide the reader to develop a general strategy towards setting up their own PPIE process. We then help the reader map out their relevant stakeholders and provide advice on how to consider user diversity and representation. We also provide advice and tools on how to quantify the outcomes of the engagement. We consolidate advice from various online sources to orient individual teams (and their funders) to carve up their own approach to meaningful involvement. Key outputs include a stakeholder mapping tool, methods to measure the impact of engagement, and a structured checklist for transparent reporting. Enabling end-users and other stakeholders to participate in the development of neurotechnology, even at its earliest stages of conception, will help us better navigate our design around ethical, social, and usability considerations, and deliver more impactful technologies. The overall aim is the establishment of gold-standard methodologies for ensuring that patient and public insights are at the forefront of our scientific inquiry and product development.

A Bibliometric Analysis of Healthcare Intervention-Related Studies Reporting Patient and Public Involvement and Engagement

BACKGROUND/OBJECTIVES

Patient and public involvement and engagement (PPIE) has gained global recognition as an innovative healthcare research practice. PPIE engages end-users throughout the research process, improving intervention effectiveness, resource efficiency, and user satisfaction. Despite its increasing inclusion in studies, comprehensive bibliometric reviews of healthcare intervention-related studies reporting PPIE are scarce. This study aims to conduct a bibliometric analysis of healthcare intervention-related studies reporting PPIE in recent decades to identify key worldwide bibliometric features, themes, and trends.

METHODS

The analysis includes 10,624 relevant English articles published in the Web of Science (WoS) Core Collection up to 26 November 2024. Search terms were selected based on PPIE conceptualization, interventional types, and related healthcare terms. Using WoS descriptive analysis and CiteSpace, we examined bibliometric features and identified major international themes and trends.

RESULTS

There has been a significant increase in the number of healthcare intervention-related studies reporting PPIE over the past five years, especially from the United States and the United Kingdom, with a recent rise in Asia. However, cross-national collaboration remains limited. Key research themes identified include "community participation", "health equity", "coronary heart disease", "web-based patient empowerment", "mental illness", and "obesity prevention", with growing interest in "mobile health" and "digital health".

CONCLUSIONS

This study provides a comprehensive and up-to-date overview of the bibliometric characteristics and evolving trends in healthcare intervention-related studies reporting PPIE. It highlights global regions with limited PPIE implementation, suggests pathways for further development, and identifies key research themes. The study offers researchers and practitioners valuable insights into tracking PPIE trends in healthcare interventions and fostering collaborations on evidence-based PPIE studies with leading scholars and institutions worldwide. Additionally, the findings drive innovations aimed at improving patient and public healthcare outcomes.

A qualitative study regarding older people's goals of care in relation to frailty status: finding meaning in 'smaller things' in life

BACKGROUND

Increasingly frailty assessment is part of the shared decision-making process of older patients. However, little is known of the role of frailty in goals of care among the diverse group of older persons.

OBJECTIVE

To explore the role of frailty in older people's perspectives on goals of care in case of acute and/or severe disease.

METHODS

We conducted semi-structured interviews with people aged ≥70 years in the Netherlands (n = 26), which were purposively sampled based on a self-reported Clinical Frailty Scale. The interviews were analysed using thematic content analysis to compare frailty subgroups.

RESULTS

Three themes regarding goals of care emerged: (1) preserving well-being in one's lifeworld through life goals; (2) goals related to care, as access to appropriate care, good contact with care professionals and a dignified end-of-life; (3) differences in attainment and adaptation of goals of care according to frailty status. The first two themes appeared to be independent of frailty status. However, differences were seen in theme 3, as fit older people primarily strengthened their capacity to attain goals of care, while frail older people primarily adapted the meaning ascribed to goals of care and had higher acceptance of the life cycle.

CONCLUSION

Goals of care that older people want to attain are driven by life goals, independent of frailty. Therefore, older people with varying frailty status could be treated similarly in goal-setting and life goals. However, different support may be needed for the attainment and adaptation of their goals of care.

Using Intervention Mapping to co-design a psychosocial service with youth experiencing mental illness

BACKGROUND

Descriptions of service development processes in the youth mental health sector are lacking. Further, youth with lived experience of mental illness are rarely involved in service design. Intervention Mapping (IM) is a well-established framework for program development, implementation and evaluation, yet its applicability in the youth mental health sector is unknown. This paper describes the use of IM methodology to co-design and develop a psychosocial service to support youth aged 10-25 years experiencing mental illness in Tasmania, Australia.

METHODS

The six steps of IM were followed: 1) needs assessment; 2) define program outcomes and objectives; 3) program design; 4) program production; 5) implementation planning; and 6) evaluation planning.

RESULTS

Key outputs of each IM step are described. The service was successfully co-designed with young people at the centre of each step. The service includes wrap-around psychosocial support from lived-experience peer-support workers; outreach; and flexible frequency/intensity/duration to achieve young people's psychosocial goals.

CONCLUSIONS

This is the first study to document the use of IM in co-designing a psychosocial service with youth experiencing mental illness. IM may provide a valuable roadmap for the youth mental health sector in supporting collaborative service design, implementation and evaluation planning, and systematic documentation of service development.

Public Involvement to Enhance Care Home Research; Collaboration on a Minimum Data Set for Care Homes

INTRODUCTION

Information on care home residents in England is captured in numerous data sets (care home records, General Practitioner records, community nursing, etc.) but little of this information is currently analysed in a way that is useful for care providers, current or future residents and families or that realises the potential of data to enhance care provision. The DACHA study aimed to develop and test a minimum data set (MDS) which would bring together data that is useful to support and improve care and facilitate research. It is that utility that underscores the importance of meaningful public involvement (PI) with the range of groups of people affected. This paper analyses the involvement of family members of care home residents and care home staff through a PI Panel.

OBJECTIVES

The objective for the PI activities was to consistently bring the knowledge and perspectives of family members and care home staff to influence the ongoing design and conduct of the DACHA study.

METHODS

The bespoke methods of PI included a dedicated PI team and a PI Panel of public contributors. Meetings were recorded and minutes agreed, resulting actions were tracked and reflections on the PI recorded. A democratic, social relations approach was used to frame the analysis.

RESULTS

A PI panel met 17 times. All meetings included both family members and care home staff. Analysis of the records and reflections developed the following themes about the operation of the PI: deepened understanding of the data environment in care homes; Influence on the pilot MDS; aiming for best research practices with care homes; personal/professional development for PI members; expectations of the project. Learning points for future research projects are developed.

CONCLUSIONS

PI shaped the design and conduct of the DACHA study, grounding it in the needs and perspectives of people using and providing social care. Data research has a huge responsibility to accurately incorporate relevant public perspectives. There is an implicit assumption that records and data are objective and 'speak for themselves' however there can be unintended consequences from introduction of new data requirements in practice.

PATIENT OR PUBLIC CONTRIBUTION

Public contributors to this manuscript include family members of older people living in care homes and staff of care homes. The wider study also involved as the public, older people living in care homes. Public contributors helped develop the project, contributed throughout the conduct of the study and some chose to be involved in preparing this manuscript.

What Do Women (With Serious Knee Injury) Want to Know About Knee Health? Identifying Research Priorities With a Consumer Advisory Group

OBJECTIVES: To (1) establish a women's knee health consumer advisory group (CAG) via an evidence-informed process and (2) identify the CAG's research priorities to inform future projects. DESIGN: Mixed-methods priority-setting study. METHODS: The CAG was established, grounded in a participatory action research approach and using the Patient Engagement in Research Framework, to inform a 4-phase process: (1) understand, (2) plan, (3) undertake, and (4) evaluate. We identified the CAG's priorities for knee health research via a mixed-methods approach using the nominal group technique (NGT). We adopted a constructivist epistemology, using reflexive thematic analysis to construct codes and themes inductively. RESULTS: Six women (mean age of 35 years) joined the CAG, generating, reviewing, and discussing 70 ideas during NGT phases 1 to 3. We constructed 14 codes, grouped into 3 key themes: (1) best practice management and support for serious knee injury and rehabilitation, (2) social and gendered factors; and (3) physical, psychological, and personal factors. Voting and ranking (NGT phases 3-6) revealed the CAG's highest priority for future research was "Knowledge of, and access to specialised knee rehabilitation and practitioners." CONCLUSION: Establishing a CAG was an achievable and novel approach to identifying consumer priorities to enhance women's knee health outcomes. Women wanted improved access to information and best-practice care via genuine therapeutic relationships with practitioners who understand the gendered-social rehabilitation environment. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 15 January 2025. doi:10.2519/jospt.2025.12869.

Patient perspectives of shared decision-making in emergency surgery

AIM

Shared decision-making (SDM) is now considered the gold standard approach to counselling and obtaining patient consent. Research into patient perceptions of SDM is lacking and barriers to its implementation remain, specifically in the time-pressurized, high-risk emergency general surgery (EGS) setting. The aim of this work was to explore what EGS patients understand about SDM, gaining insight into their perspectives and experiences to understand the potential barriers both clinicians and patients may face.

METHOD

This work consisted of two parts: part 1 was an initial scoping review to inform the development of part 2-a patient and public involvement (PPI) exercise. The scoping review determined the quantity and quality of research in this area enabling long-listing of known SDM concepts. This long-list developed questions and structured discussions for the PPI exercise. Responses were transcribed, then analysed using thematic analysis.

RESULTS

The scoping review found limited evidence for both the implementation of SDM in EGS and patients' perspectives. Seven papers considered SDM in other settings that allowed long-listing of the values and concepts for the PPI exercise. Nine patients and four supporters were identified from an established EGS database. After open discussion of the values and SDM concepts, thematic analysis was performed that identified two key themes: patient perceptions of how surgeons make decisions, and patient experiences of EGS decision-making. Five subtheme analyses showed participants were not aware of surgeons' use of '30-day mortality' and could not quantify surgical risk, feeling time pressures and out of control. Almost all relied on surgeons to make their decision, valuing the surgeon's opinion over their own.

CONCLUSION

With no previous reported evidence, this work provides the first patient insights into SDM in the EGS setting. With multiple barriers identified, further work is essential to increase implementation of this gold standard approach to patient consent.

Best Practices Guidelines for the Engagement of People With Lived Experience and Family Members in Mental Health and Substance Use Health Research: A Modified Delphi Consensus Study

INTRODUCTION

People with lived experience of mental health and/or substance use conditions and their families (PWLE) are increasingly engaged in research, yet rigorous guidelines for engagement are lacking. This study aims to co-design best practice guidelines to support the authentic, meaningful engagement of PWLE in mental health and/or substance use health research.

METHODS

A multi-panel modified Delphi study was conducted with 61 expert panelists (35 PWLE and family members, 26 researchers/research support staff from across Canada). Participants rated 56 recommendations for importance and clarity. Consensus was defined as ≥ 70% of participants rating items at 6 or 7 on a 7-point Likert scale ('very important' or 'essential'). Qualitative feedback was analysed using content analysis to identify new items and reviewed for improvements in item clarity. After each round, items not meeting the established threshold of importance were removed. Items with low clarity scores were reworded. A PWLE advisory panel was actively involved throughout the study's design, implementation, interpretation, and reporting, ensuring that the perspectives of people with lived experience were integrated throughout the research process.

RESULTS

Three Delphi Rounds were conducted. In Round 1, importance ratings ranged from 51.7% to 96.7% of participants ranking the items above the established threshold (average 80.1%), with clarity ratings ranging from 39.3% to 86.9% (average 70.7%) and an average importance coefficient of variation (CV) of 0.16. Four items were deleted, two new items were added and fifty-five items were revised. In Round 2, 60 (98.4%) participants responded. Importance ratings ranged from 57.6% to 96.7% (average 80.2%; average CV = 0.20). Clarity ratings ranged from 50.9% to 93.2% (average 77.9%). Five items were deleted and eleven revised. In Round 3, 60 (98.4%) participants provided importance ratings ranging from 66.7% to 98.3% (average 80.8%; average CV = 0.20), and clarity ratings ranging from 63.3% to 94.9% (average 81.1%). Three items were deleted and nine were revised. Forty-four final best practices are proposed.

CONCLUSION

These co-developed best practice guidelines offer recommendations for meaningful PWLE engagement in mental health and/or substance use health research. By following these guidelines, research teams can ensure that PWLE contributions are genuinely valued and effectively integrated, ultimately enhancing the quality and impact of the research and fostering authentic collaboration.

PATIENT AND PUBLIC INVOLVEMENT

People with lived experience were engaged throughout the project as key team members, from a patient-oriented research perspective. They are also co-authors on this manuscript.

Rapid Review of Literature Reporting the Experience of Patient and Public Involvement in Prison and Forensic Mental Health Research

Health research authorities around the world are increasingly committed to embedding public involvement in health and social care research. However, such involvement in internationally published prison and forensic mental health research remains rare. It is therefore particularly important to understand how people are experiencing collaborative research in this field, barriers they may encounter and how these might be overcome. The aim of this review is to explore how academic, practitioner and lived-experience researchers have experienced collaborating on prison and forensic mental health research since a previous review of the topic in 2016. A rapid review of literature was completed by searching three databases (MEDLINE, EMBASE and PsycINFO) between 2016 and July 2023 in addition to Google and Google Scholar searches and hand searching the reference lists of all screened-in documents. We used Reflexive Thematic Analysis to review the screened-in papers. We had lived-experience involvement in this study, which is outlined in our Supporting Information. The database search returned 733 unique articles. Internet searches revealed 10 potentially relevant documents. 20 documents were eligible for inclusion; 15 journal articles, three book chapters, a whole book and a PhD thesis. In the analysis, four overarching themes were developed: the positive psychological impact on lived-experience researchers; it is interpersonally, emotionally and practically challenging; facilitators of the collaborative research process; and positive impact of involvement on the research. Our findings build on the previous review by providing evidence that collaborating on research can have a positive psychological impact on people with lived experience in this setting. It also documents further challenges that are unique to the forensic setting. There was minimal reporting of the experiences of forensic mental health patients involved in research; most included documents focused the experiences of current or former prisoners. Further studies in the topic area are still needed, which utilise a research method to analyse the experiences of conducting collaborative research.

How can patients shape digital medicine? A rapid review of patient and public involvement and engagement in the development of digital health technologies for neurological conditions

INTRODUCTION

Patient and Public Involvement and Engagement (PPIE) involves working 'with' or 'by' patients and the public, rather than 'to,' 'about,' or 'for' them, and is integral to neurological and digital health research. This rapid review examined PPIE integration in the development and implementation of digital health technologies for neurological conditions.

METHODS

Key terms were input into six databases. Included articles were qualitative studies or PPIE activities involving patient perspectives in shaping digital health technologies for neurological conditions. Bias was evaluated using the NICE qualitative checklist, with reporting following PRISMA guidelines.

RESULTS

2,140 articles were identified, with 28 included. Of these, 25 were qualitative studies, and only three were focused PPIE activities. Patient involvement was mostly limited to one-off consultations during development.There was little evidence of PPIE during implementation, and minimal reporting on its impact.

CONCLUSIONS

PPIE has been inconsistently reported in this research area, highlighting the need for more guidance and best-practice examples This review used a UK-based definition of PPIE, which may have excluded relevant activities from other countries. Future reviews should broaden terminology to capture PPIE integration globally.

Reporting community involvement in autism research: Findings from the journal Autism

LAY ABSTRACT

There has been a growing push for the Autistic and autism communities to be more actively involved in autism research. From January 2021, the journal Autism made it a rule for authors to report whether they involved community members in their work; and if they did, how they had done so. In this study, we wanted to see how this new rule has changed things. Our team of Autistic and non-autistic researchers read all 283 articles published in Autism in 2019, about 2 years before the rule was in place, and in 2022, about 1 year after. We recorded what each article was about and how the community was involved. We found there was an increase in how often articles talked about community involvement - from about 10% before the rule to over 50% after. Most of these studies, however, only involved community members giving advice, with the researchers making most decisions about the research. This was especially true for applied research (like wellbeing) rather than basic science (like causes of autism). Also, some of these articles were unclear or did not give enough information for us to understand how the community was involved. This tells us that while it is promising that more community involvement is reported, researchers need to describe this involvement more clearly. It is also important for community members to have a bigger say in research by sharing power with the researchers or even leading the research themselves.

Evaluating Process and Outcomes of Public Involvement in Applied Health and Social Care Research: A Rapid Systematic Review

OBJECTIVE

Public Involvement (PI) in applied health and social care research has grown exponentially in the UK. This review aims to synthesise published UK evidence that evaluates the process and/or outcome(s) of PI in applied health and social care research to identify key contextual factors, effective strategies, outcomes and public partner experiences underpinning meaningful PI in research.

METHODS

Following a pre-registered protocol, we systematically searched four databases and two key journals for studies conducted within the UK between January 2006 and July 2024. A team of public partners and researchers carried out independent dual screening and data extraction. Included studies were narratively synthesised via Framework Synthesis.

RESULTS

Nineteen studies evaluated the PI process with a range of populations including National Health Service (NHS) users, carers, and low-income communities. No specific outcome evaluations were identified. Through their experience, public partners described important components of meaningful PI such as mutual respect and seeing and contributing to change, as well as some unintended harms of involvement. Harms related to 'experiencing negative attitudes', 'emotional burden of involvement', 'frustration and disappointment' and 'further marginalisation'. Meaningful PI was underpinned by structural, organisational, interpersonal and individual factors; as well as practical and principle-based strategies of involvement. Both public partners and researchers reflected on a range of outcomes of meaningful PI including changes to the research process and longer term impacts on organisations, researchers and public partners.

CONCLUSIONS

PI in research must be facilitated at multiple levels to reduce unintended harm and encourage meaningful and impactful outcomes. Findings are summarised within a model which gives an overview of priorities for individual researchers, organisations and funders to ensure best practice is achievable. From a methodological perspective, researchers should prioritise robust, transparent and co-produced approaches to evaluating PI to increase knowledge in the field.

PATIENT AND PUBLIC INVOLVEMENT

A regional public advisory network provided insight on the relevance and acceptability of the review concept. Our core research team included three public partners. Public partners contributed to the development of the initial review protocol, abstract and full-text screening, reviewing findings and their interpretation and writing the final report.

Protocol for a Field Trial of a Hearing and Vision Support Intervention for People Living in Long-Term Care in Australia

INTRODUCTION

Hearing and vision impairments are prevalent among residents in long-term care settings. Hearing and vision impairments frequently go unsupported, affecting residents' quality of life and healthcare costs. This paper describes the protocol for a pre-post evaluation and process evaluation of a pragmatic sensory support intervention (SSI) that was developed with residents, informal caregivers and long-term care workers.

METHODS AND ANALYSIS

A prospective pre-post-intervention trial within long-term care will be conducted, including three groups: residents (n = 87), informal caregivers (n = 87) and long-term care workers (n = 40). Outcome measures include health-related quality of life and well-being measures relevant to each group measured at baseline, 3- and 6-months post-intervention. Health resource and sensory device utilisation will be captured from routine data and by direct observation. Qualitative interviews, including a representative sample of residents and informal caregivers, will be conducted as part of a simultaneous process evaluation. Generalised linear models and paired t-tests will be used to evaluate the effects on residents' and caregivers' quality of life and sensory device use. The cost-effectiveness of the intervention will be examined using within-trial analysis, economic modelling and budget impact assessment. A process evaluation will use descriptive statistics and thematic analysis to assess the intervention's reach, adoption, implementation, acceptability, mechanisms of change and contextual influences.

CONCLUSION

Hearing and vision impairments are common but under-supported in older adults in long-term care. This protocol involves a systematic evaluation of the effectiveness and implementation challenges of a pragmatic SSI to optimise hearing and vision function and improve the quality of life for long-term care residents and their caregivers.

Service users' experiences of, and engagement with, a nationally implemented digital diabetes prevention programme

OBJECTIVES

Type 2 diabetes mellitus (T2DM) may be prevented by promoting weight loss through adopting healthier behaviours (e.g., improved diet and increased physical activity). In 2016, the National Health Service (NHS) in England introduced a 9-month face-to-face T2DM prevention intervention, delivered by four independent providers. Since 2019, the NHS Digital Diabetes Prevention Programme (NHS-DDPP) was offered to increase accessibility of the programme. This research aimed to understand how service users engaged with, and experienced using the NHS-DDPP.

DESIGN

Qualitative interviews.

METHOD

Semi-structured interviews were conducted with service users (n = 45) who took part in one of the four NHS-DDPP providers' programmes and transcribed verbatim. Transcripts were thematically analysed using a framework approach.

RESULTS

Two overarching themes were produced: 'Personalized Guidance' and 'Path to Success'. Service users valued having health coach support, which provided personalized guidance throughout the programme, alongside access to different app features to suit their needs (e.g., educational content, tracking health behaviours, group support). Service users described self-monitoring, feedback from their health coach and support from their social circle as helpful towards changing their health behaviours. This enabled them to visualize their progress and provided accountability.

CONCLUSION

Service users emphasized how human contact alongside this digital behaviour change programme improved their experiences and engagement with the programme. Digital health interventions could consider how to better incorporate support from health coaches, friends and family to help users in making behavioural changes. Future digital health interventions should consider how best to harness non-digital elements to promote behaviour change.

Learning from the community: iterative co-production of a programme to support the development of attention, regulation and thinking skills in toddlers at elevated likelihood of autism or ADHD

Programmes designed to support children with known, or increased likelihood of, autism or ADHD often focus on reducing behaviours central to a clinical diagnosis. However, supporting children to pursue their own goals and cope with everyday life through fostering executive function (EF) development, without enforcing neuro-normative assumptions, may be more acceptable to neurodivergent people, and more beneficial. The co-production process for this neurodiversity-affirming programme involved: Review of research priorities identified during published public-and-clinician consultations; iterative programme development through two pilot rounds with a general community sample; and consultation with stakeholders (parents with a connection to autism or ADHD, alongside early years specialists, psychologists and therapists) to check acceptability of the proposal, and refine the logic model and materials. The logic model for the resultant programme-Supporting Toddlers with a connection to autism or ADHD to develop strong Attention, Regulation and Thinking skills (START)-involves three mechanisms of change: The child has appropriate play-based opportunities to practise EF skills; Parenting behaviours linked to strong EFs are encouraged; Parents are empowered to improve environmental-fit for their child so that EF stressors are reduced.

Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials

OBJECTIVE

To estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of life, and physical recovery for adults who have received surgery.

DESIGN

Systematic review with network and component network meta-analyses of randomised controlled trials.

DATA SOURCES

Medline, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science were initially searched 1 March 2022, and updated on 25 October 2023. Certainty in findings were assessed using the Confidence in Network Meta-Analysis (CINeMA) approach.

MAIN OUTCOME MEASURES

To compare treatments and to compare individual components informed by partnership with patients, clinicians, researchers, and health system leaders using an integrated knowledge translation framework. Eligible studies were any randomised controlled trial including adults preparing for major surgery who were allocated to prehabilitation interventions or usual care, and where critical outcomes were reported.

RESULTS

186 unique randomised controlled trials with 15 684 participants were included. When comparing treatments using random-effects network meta-analysis, isolated exercise (odds ratio 0.50 (95% confidence interval (CI) 0.39 to 0.64); very low certainty of evidence), isolated nutritional (0.62 (0.50 to 0.77); very low certainty of evidence), and combined exercise, nutrition, plus psychosocial (0.64 (0.45 to 0.92); very low certainty of evidence) prehabilitation were most likely to reduce complications compared with usual care. Combined exercise and psychosocial (-2.44 days (95% CI -3.85 to -1.04); very low certainty of evidence), combined exercise and nutrition (-1.22 days (-2.54 to 0.10); moderate certainty of evidence), isolated exercise (-0.93 days (-1.27 to -0.58); very low certainty of evidence), and isolated nutritional prehabilitation (-0.99 days (-1.49 to -0.48); very low certainty of evidence) were most likely to decrease length of stay. Combined exercise, nutrition, plus psychosocial prehabilitation was most likely to improve health related quality of life (mean difference on Short Form-36 physical component scale 3.48 (95% CI 0.82 to 6.14); very low certainty of evidence) and physical recovery (mean difference in meters on the six min walk test 43.43 (95% CI 5.96 to 80.91); very low certainty of evidence).When comparing individual components using component network meta-analysis, exercise and nutrition were the individual components most likely to improve all critical outcomes. The certainty of evidence for all comparisons across all outcomes was generally low to very low due to trial level risk of bias and imprecision; however, results for exercise and nutritional prehabilitation were robust with exclusion of high risk of bias trials.

CONCLUSIONS

Consistent and potentially meaningful effect estimates suggest that exercise prehabilitation, nutritional prehabilitation, and multicomponent interventions including exercise may benefit adults preparing for surgery and could be considered in clinical care. However, multicentre trials that are appropriately powered for high priority outcomes and that have a low risk of bias are required to have greater certainty in prehabilitation's efficacy.

REGISTRATION

International prospective registry of systematic reviews CRD42023353710.

Patient and public involvement in the co-design and assessment of unobtrusive sensing technologies for care at home: a user-centric design approach

BACKGROUND

There is growing interest in developing sensing solutions for remote health monitoring to support the safety and independence of older adults. To ensure these technologies are practical and relevant, people-centred design is essential. This study aims to explore the involvement of various stakeholders across different developmental stages to inform the design and assess the capabilities of unobtrusive sensing solutions being developed as part of the Advanced Care Research Centre (ACRC), Edinburgh, UK.

METHODS

This study was conducted in two phases. In Phase I (Ideation), discussions were held with stakeholders (n = 19), including senior geriatricians (n = 2), healthcare and care home professionals (n = 4), PPI experts (n = 2), researchers (n = 4) and public members aged 65 and above from the ACRC Patient and Public Involvement (PPI) Network (n = 7). The goal was to identify clinically significant health parameters and design preferences. Based on this, prototypes of unobtrusive sensors for monitoring movement, hydration, and respiration were developed. In Phase II (Development and Co-Design), an in-person PPI workshop was conducted with PPI experts (n = 2), researchers (n = 4) and PPI members (n = 8). The developed prototypes were demonstrated, and qualitative feedback was collected through focus group discussions on themes such as acceptability, usability, privacy, data sharing, and functionality enhancement.

RESULTS

Stakeholder input from Phase I emphasized the importance of non-contact sensing technologies that maintain privacy. Movement, hydration, and respiration were identified as critical health parameters. In Phase II, PPI members were optimistic about the prototypes, valuing their unobtrusive design and privacy-preserving features. Key themes identified included (1) the need for user-customized alarms, (2) clear data-sharing protocols, and (3) the importance of embedding sensors into familiar household objects. Suggestions for refining the prototypes included adding functionality for detecting deviations in daily routines and integrating feedback mechanisms for caregivers.

CONCLUSIONS

Involving diverse stakeholders from the early stages of technology development enhanced the relevance and acceptability of unobtrusive sensing solutions. This study highlights the importance of integrating public perspectives into the design process. For successful implementation, developers of healthcare technologies should prioritize privacy, usability, and clear communication with end-users and caregivers.

Exploring the purpose and stages of patient and public involvement and engagement (PPIE) in audiology research: a case study approach

BACKGROUND

Patient and Public Involvement and Engagement (PPIE) has become an integral component of contemporary audiology research. It aims to capture diverse views and experiences, essential for evaluating the long-term impact of technological advancements and care models on individuals. Traditional inclusion methods, such as focus groups, may exclude individuals with additional needs or communication difficulties, necessitating the development of more inclusive approaches.

METHODS

This study explores PPIE's purpose and stages in two recent audiology studies, adhering to the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) criteria. The authors describe their attempts to optimise participation by PPIE volunteers in two studies. The methods sought to engage volunteer PPIE contributors who might otherwise have not known about or contributed views of research methods. Specifically, our novel methods for engagement meant reaching out deliberately to marginalised communities and using individual, relationship building approaches, rather than relying on previously described focus group style meetings. Flexible engagement methods were developed to include marginalised communities with lower levels of research engagement. In the first study, the Hearing Loss and Patient Reported Experience Study (HeLP) developed the first Patient-Reported Experience Measure (PREM) in audiology. The study involved creating a conceptual framework, developing a prototype questionnaire, and validating it through test-retest procedures. The second study conducted an ethnographic analysis of adults with dementia and hearing loss in care homes, employing environmental audits, ethnographic observations, and semi-structured interviews.

RESULTS

The HeLP study successfully developed a culturally meaningful and accessible PREM, capturing the experiences of individuals with hearing loss, including those from South Asian communities. PPIE contributors highlighted the need for non-judgmental, empathetic approaches and culturally sensitive language. The PPIE component of the ethnographic study emphasises the importance of creating appropriate communication environments and implementing tailored inclusion strategies to address barriers faced by PPIE contributors in their participation.

CONCLUSIONS

The findings stress the necessity of inclusive PPIE methods in audiology research. Building meaningful relationships with PPIE contributors ensures a wide range of perspectives, informing research design and conduct. The study highlights the challenges of traditional focus groups and the benefits of flexible, personalised engagement methods. By prioritising relationship building and nuanced conversations, researchers can develop interventions that better align with users' needs, preferences, and lifestyles. This approach contributes to the growing body of literature advocating for more inclusive and representative PPIE practices in health research, ultimately enhancing the relevance and impact of audiology studies.

Protocol for the development of a global core outcome set for the surgical treatment of differentiated thyroid cancer: a literature review and international Delphi survey

INTRODUCTION

There is a lack of consensus on the optimal surgical strategy for differentiated thyroid cancer (DTC), partly due to inconsistent reporting of outcomes. This limits the ability to compare study results, hindering the ability to draw conclusions regarding novel treatment strategies. The development of a core outcome set (COS) reduces heterogeneity in the selection and reporting of clinical trial outcomes. Currently, there is no COS for the surgical treatment of DTC. We aim to reach a global consensus among patients and physicians on the COS for the surgical treatment for patients with DTC of all ages.

METHODS AND ANALYSIS

The DTC-COS development will consist of three phases: first, an extensive literature review will be performed to identify reported outcomes in studies regarding surgical treatment for DTC in patients of all ages. Second, a 2-step or 3-step Delphi procedure will be performed to identify a final set of core outcomes out of the selected outcomes from the literature review. For this Delphi survey, both healthcare professionals and patients will be invited. Third, an (online) expert meeting with participants from every stakeholder group is organised to ratify the final core outcome set. The final COS will be reported in accordance with the COS-Standards for Reporting statement.

ETHICS AND DISSEMINATION

The medical research ethics committee of the Amsterdam UMC confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) does not apply to this study and that full approval by the committee is not required. The study is registered in the COMET initiative database (registration number 2597). Results will be presented in peer-reviewed academic journals and at (international) conferences.

TRIAL REGISTRATION NUMBER

COMET initiative database 2597.

The person-based approach to intervention development: A scoping review of methods and applications

Background

The person-based approach (PBA) has emerged as a prominent methodology guiding the development of digital and hybrid health behaviour change interventions over the last decade, and there is a salient need to understand its utilization.

Objective

This study aims to describe which elements of the PBA have been utilised in intervention development research, for which populations, and how this has been reported.

Methods

A search for intervention development papers published between 2015 and 2023 using forward citation searches was undertaken in Scopus, using two seed articles. Results are presented using frequency counts, and qualitative data were summarised using content analysis.

Results

The review encompasses 239 papers. The PBA has frequently been applied in early stage development of digital interventions for adult populations, prioritising the use of qualitative methods. It has been used globally to develop, adapt, optimise and evaluate digital, hybrid and offline interventions for a wide range of contexts including primary and secondary healthcare, educational, community, and public health settings. Researchers value it as a proven method to identify user needs and preferences in order to create persuasive content.

Conclusion

The PBA is most frequently linked to research undertaken to understand target populations and iteratively design content in early development phases. The PBA provides guidance on combining evidence-, theory- and person-based research, but these three elements are not always evident in the literature. Training focused on these elements, plus exemplar studies and use of reporting guidelines, could make this integrative work more visible in future papers.

Bereaved parent involvement in co-designed stillbirth research: Experiences of Project Engage

BACKGROUND

While benefits of involving consumers in research are well established, bereaved parents face unique challenges, and descriptions of their experiences with co-designed stillbirth research are lacking. The collective experience of 'Project Engage' involved co-designing resources to support bereaved parents' involvement in research.

METHODS

This study aimed to describe and evaluate the involvement of bereaved parents as co-investigators of a stillbirth research project. Descriptive and exploratory methods were used to describe the process of Project Engage, between 2021 and 2023, in which bereaved parents were involved in all aspects. Evaluation was performed through iterative review and reflection to examine barriers and enablers of co-designed stillbirth research.

FINDINGS

The project team co-designed and published 'Getting Involved in Stillbirth Research: A guide for bereaved parents'. Seven co-investigators completed the end-of-phase project evaluation, including five bereaved parents and two researchers without lived experience of stillbirth. Most co-investigators felt that their contribution was highly valued and that project outputs matched their expectations. Enablers of co-design included clear communication, having a shared goal, a supportive team, relevant outputs, and lived-experience researchers on the team. Barriers included research jargon, meeting logistics, support and maintaining engagement, role expectations, and institutional governance processes.

CONCLUSION

The co-design experience was perceived positively by both parents and researchers, with many key facilitators to the teams' success identified. Evaluation of the experiences of bereaved parents and researchers co-designing stillbirth research is vital. The process and recommendations outlined here will guide future best practice for bereaved parent involvement in stillbirth research.

Developing a Neonatal Pulmonary Hypertension Core Outcome Set (NeoPH COS)-A Study Protocol

Pulmonary hypertension (PH) in newborn babies is a relatively rare, heterogeneous condition that has high associated mortality in the neonatal period and beyond. There are limited evidence-based strategies to treat or prevent this condition. Over the last two decades, there has been an increase in the number of studies assessing new therapies and treatment strategies in babies with PH. However, comparison of different treatments between studies is limited by inconsistency in outcome reporting. To address this issue, we aim to develop a core outcome set (COS) for neonates and infants less than 3 months of age, corrected for prematurity, diagnosed with PH, through international consensus with key stakeholders including parents and/or guardians, healthcare professionals and researchers. The development of the COS will be divided into two stages: (1) identification of potential outcomes through a mixed methods systematic literature review and qualitative interviews with parents and/or guardians of babies with pulmonary hypertension; (2) determining core outcomes through an online Delphi survey and consensus meeting. An advisory group with global membership including parents and/or guardians, healthcare professionals, and researchers recruited internationally was formed to guide the COS. The methodology utilized to develop a neonatal PH COS aims to ensure applicability and adoption in international settings and relevance across disciplines. The COS will help to improve trial design and homogeneity of outcomes reported in neonatal trials of PH. This will translate into higher-quality evidence for therapeutic strategies for PH in neonates.

Multi-cancer early detection tests for general population screening: a systematic literature review

Background

General population cancer screening in the United Kingdom is limited to selected cancers. Blood-based multi-cancer early detection tests aim to detect potential cancer signals from multiple cancers in the blood. The use of a multi-cancer early detection test for population screening requires a high specificity and a reasonable sensitivity to detect early-stage disease so that the benefits of earlier diagnosis and treatment can be realised.

Objective

To undertake a systematic literature review of the clinical effectiveness evidence on blood-based multi-cancer early detection tests for screening.

Methods

Comprehensive searches of electronic databases (including MEDLINE and EMBASE) and trial registers were undertaken in September 2023 to identify published and unpublished studies of multi-cancer early detection tests. Test manufacturer websites and reference lists of included studies and pertinent reviews were checked for additional studies. The target population was individuals aged 50-79 years without clinical suspicion of cancer. Outcomes of interest included test accuracy, number and proportion of cancers detected (by site and stage), time to diagnostic resolution, mortality, potential harms, health-related quality of life, acceptability and satisfaction. The risk of bias was assessed using the quality assessment of diagnostic accuracy studies-2 checklist. Results were summarised using narrative synthesis. Stakeholders contributed to protocol development, report drafting and interpretation of review findings.

Results

Over 8000 records were identified. Thirty-six studies met the inclusion criteria: 1 ongoing randomised controlled trial, 13 completed cohort studies, 17 completed case-control studies and 5 ongoing cohort or case-control studies. Individual tests claimed to detect from 3 to over 50 different types of cancer. Diagnostic accuracy of currently available multi-cancer early detection tests varied substantially: Galleri® (GRAIL, Menlo Park, CA, USA) sensitivity 20.8-66.3%, specificity 98.4-99.5% (three studies); CancerSEEK (Exact Sciences, Madison, WI, USA) sensitivity 27.1-62.3%, specificity 98.9- 99.1% (two studies); SPOT-MAS™ (Gene Solutions, Ho Chi Minh City, Vietnam) sensitivity 72.4-100%, specificity 97.0-99.9% (two studies); Trucheck™ (Datar Cancer Genetics, Bayreuth, Germany) sensitivity 90.0%, specificity 96.4% (one study); Cancer Differentiation Analysis (AnPac Bio, Shanghai, China) sensitivity 40.0%, specificity 97.6% (one study). AICS® (AminoIndex Cancer Screening; Ajinomoto, Tokyo, Japan) screens for individual cancers separately, so no overall test performance statistics are available. Where reported, sensitivity was lower for detecting earlier-stage cancers (stages I-II) compared with later-stage cancers (stages III-IV). Studies of seven other multi-cancer early detection tests at an unclear stage of development were also summarised.

Limitations

Study selection was complex; it was often difficult to determine the stage of development of multi-cancer early detection tests. The evidence was limited; there were no completed randomised controlled trials and most included studies had a high overall risk of bias, primarily owing to limited follow-up of participants with negative test results. Only one study of Galleri recruited asymptomatic individuals aged over 50 in the United States of America; however, study results may not be representative of the United Kingdom's general screening population. No meaningful results were reported relating to patient-relevant outcomes, such as mortality, potential harms, health-related quality of life, acceptability or satisfaction.

Conclusions

All currently available multi-cancer early-detection tests reported high specificity (> 96%). Sensitivity was highly variable and influenced by study design, population, reference standard test used and length of follow-up.

Future work

Further research should report patient-relevant outcomes and consider patient and service impacts.

Study registration

This study is registered as PROSPERO CRD42023467901.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR161758) and is published in full in Health Technology Assessment; Vol. 29, No. 2. See the NIHR Funding and Awards website for further award information.

Caregiver perspectives of scoliosis surgery for children with cerebral palsy: a qualitative study

PURPOSE

To explore the perspectives of primary caregivers of children with cerebral palsy (CP) who had spinal surgery for scoliosis.

MATERIALS AND METHODS

A qualitative study was conducted using semi-structured interviews and guided by qualitative description methodology. Participants were caregivers of children with CP aged 5-18, who had undergone spinal surgery for scoliosis in Australia. The research team included a parent with lived experience.

RESULTS

Fourteen participants (8 biological mothers), aged 40-49 years, completed online semi-structured interviews. Four themes were identified emerged. Life with a child with CP underpinned all experiences which were founded on familiarity with their child, medical procedures, and hospitalisation. Three subthemes were parents are the experts in knowing their child, children are vulnerable, and impact on caregivers. Theme 2 involved the significance of decision making to proceed with surgery. Theme 3 underscored a need to be prepared for the surgical journey and, in Theme 4, participants spoke of needing to expect the unexpected.

CONCLUSION

The findings highlight the importance of understanding caregiver experiences and can help inform health professionals and other families in the decision-making process, preparing for and navigating spinal surgery.

Remotely delivered weight management for people with long COVID and overweight: the randomized wait-list-controlled ReDIRECT trial

Long COVID (LC) is a complex multisymptom condition with no known disease-modifying treatments. This wait-list-controlled open-label trial tested whether a remotely delivered structured weight management program could improve respective LC symptoms in people living with overweight. Adults with LC (symptoms >12 weeks) and body mass index >27 kg m-2 (>25 kg m-2 for South Asians) were randomized (n = 234, 1:1) to control (n = 116, usual care) or the remotely delivered structured weight management (n = 118, total diet replacement (850 kcal per day) for 12 weeks, followed by food reintroduction and weight loss maintenance support) via minimization and randomization (80:20) to balance dominant LC symptom, sex, age, ethnicity and postcode-based index of multiple deprivation between groups. The control group received the intervention after 6 months. Participants selected the dominant LC symptom they would most like to improve (fatigue, breathlessness, pain, anxiety/depression or other) as the prespecified respective primary outcome. Individual symptoms were assessed using validated questionnaires and a visual analog scale for those without prespecified scales. At 6 months, the primary outcome improved in the intervention group (change -1.16 (s.d. 1.42), n = 97 analyzed) compared with the control group (change -0.83 (s.d. 1.14), n = 117 analyzed) with a treatment effect of -0.34 (95% confidence interval -0.67 to -0.01), with no excess of serious adverse events. International Standard Randomised Controlled Trial Number Registry registration: ISRCTN 12595520 .

Using Experience Based Co-Design to Develop a Novel Psychological Intervention With People With Intellectual Disabilities and Stakeholders

BACKGROUND

Psychological interventions need to be adapted for use with people with intellectual disabilities to ensure they are engaging, accessible and effective. Co-design allows the experiences of service users and stakeholders to actively shape and develop interventions, to ensure their accessibility.

METHOD

An adapted model of Experience Based Co-Design (EBCD) was used to co-develop a novel, mental imagery-based psychological intervention for people with mild to moderate intellectual disabilities and anxiety. Involvement in EBCD was evaluated for people with intellectual disabilities and stakeholders using both quantitative and qualitative methods.

RESULTS

Numerous concrete and specific intervention adaptations arose and were implemented. Our findings indicated that all participants were able to engage fully with EBCD, and that participants found the process a positive experience.

CONCLUSIONS

EBCD has likely resulted in a more accessible and engaging intervention which can be now tested within a larger study.

Engaging older adults in the process of aging research: a multimethod study evaluating the experience and efficacy of a citizen advisory group for a dementia risk reduction program

BACKGROUND

Collaborative research with end-users is an effective way to generate meaningful research applications and support greater impact on practice and knowledge exchange. To address these needs, a Citizen Advisory Group (CAG) of nine older adults (ages 64-80, 67% women) was formed to advise scientists on the development of Brain Health PRO (BHPro), a web-based platform designed to increase dementia prevention literacy and awareness. The current study evaluated if the CAG met its objectives, how inclusion of the CAG aligned with collaborative research approaches, and the CAG's experience and satisfaction throughout the development process.

METHODS

An anonymous online survey was administered to the CAG members and 30 scientist/trainee authors of the BHPro chapters. The CAG also participated in an online focus group.

RESULTS

Most CAG members and chapter authors agreed that the CAG met its primary objectives and added unique value to BHPro. Both groups viewed the CAG's involvement as well-aligned with engaged scholarship, co-production, integrated knowledge translation, and, to a lesser extent, participatory research practices. CAG members reported high satisfaction with personal goal attainment, which included learning, collaborating with others, and making a meaningful impact. Content analyses of the focus group revealed three categories: 1) personal benefits related to learning, connection, and feeling valued, 2) value of a masked peer-review process, and 3) an accessible final product.

CONCLUSIONS

Findings suggest that collaborating with end-users in the process of aging research confers personal and scientific benefits for both older adults and researchers.

The impact of living with multiple long-term conditions (multimorbidity) on everyday life - a qualitative evidence synthesis

BACKGROUND

Multiple long-term conditions (MLTCs), living with two or more long-term conditions (LTCs), often termed multimorbidity, has a high and increasing prevalence globally with earlier age of onset in people living in deprived communities. A holistic understanding of the patient's perspective of the work associated with living with MLTCs is needed. This study aimed to synthesise qualitative evidence describing the experiences of people living with MLTCs (multimorbidity) and to develop a greater understanding of the effect on people's lives and ways in which living with MLTCs is 'burdensome' for people.

METHODS

Three concepts (multimorbidity, burden and lived experience) were used to develop search terms. A broad qualitative filter was applied. MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (EBSCO), CINAHL (EBSCO) and the Cochrane Library were searched from January 2000-January 2023. We included studies where at least 50% of study participants were living with three or more LTCs and the lived experience of MLTCs was expressed from the patient perspective. Screening and quality assessment (CASP checklist) was undertaken by two independent researchers. Data was synthesised using an inductive approach. PPI (Patient and Public Involvement) input was included throughout.

RESULTS

Of 30,803 references identified, 46 met the inclusion criteria. 31 studies (67%) did not mention ethnicity or race of participants and socioeconomic factors were inconsistently described. Only two studies involved low- and middle-income countries (LMICs). Eight themes of work were generated: learning and adapting; accumulation and complexity; symptoms; emotions; investigation and monitoring; health service and administration; medication; and finance. The quality of studies was generally high. 41 papers had no PPI involvement reported and none had PPI contributor co-authors.

CONCLUSIONS

The impact of living with MLTCs was experienced as a multifaceted and complex workload involving multiple types of work, many of which are reciprocally linked. Much of this work, and the associated impact on people, may not be apparent to healthcare staff, and current health systems and policies are poorly equipped to meet the needs of this growing population. There was a paucity of data from LMICs and insufficient information on how patient characteristics might influence experiences. Future research should involve patients as partners and focus on these evidence gaps.

Establishing patient partners' roles on research teams: a scoping review

BACKGROUND

There are a myriad of ways patient partners can enact their roles on research teams. International guidelines emphasize the need for a collaborative approach to determining these roles to try to improve research impact and positive patient partner experience. The aims of this review were to: (1) describe how patient partners' roles as co-researchers in health research are determined; and (2) identify factors that influence how these decisions are made.

METHODS

A scoping review was conducted. Four databases were searched plus citation searching occurred. Descriptions of English language studies of any design and commentaries of studies that report on patient partners' or researchers' reflections on their decision-making processes for engagement were included. Two reviewers completed screening and data extraction, with a third to resolve disagreements. Results were summarized and then content analysis was undertaken to synthesize the findings. Two patient partners contributed to the protocol development, screening, data interpretation, and manuscript writing at varying times during the process.

RESULTS

A total of 45 papers (25 commentaries, 19 studies and 1 both a study and commentary) were included in this review. Most papers were from the United Kingdom (n = 15) and Canada (n = 12). Most patient partners had experiences related to chronic conditions rather than acute or time-limited illnesses. The synthesis yielded two categories. The first category, the research and research team attributes shape patient partner roles, encompassed patient partner, researcher and activity related factors that influenced patient partner engagement in activities. The second category, shared and ongoing decision-making, described the decision-making process to determine patient partner engagement, timing of these decisions, and tools to support these decisions.

CONCLUSION

A dynamic, systematic and shared decision-making approach to determining patient partners' roles in the research process has the potential to support meaningful engagement and maximize benefits. Because the research process may evolve over time and patient partners situations can change, there may be a need to renegotiate the patient partner's role.

Involving stakeholders with lived and professional experience in a realist review of community mental health crisis services: a commentary

Patient and Public Involvement (PPI) is considered good practice in all health research including literature reviews. Reporting of involvement practice in realist reviews has been inconsistent leaving gaps in understanding of best practice. Realist reviews are theory driven and explain how interventions work, for whom and in which circumstances. PPI in realist reviews provides a link between programme theory and real-world experiences and can be achieved through a 'stakeholder group' bringing lived and professional experience together. This paper discusses experiences of a stakeholder group with seven members with lived experience and eight members with professional experience in a realist review focused on how community mental health crisis services work. A mental health crisis is a time of distress when people need urgent support. Many different agencies can respond to mental health crises, but despite this, people often find it hard to navigate to the right help at the right time. Reflections on involvement in four stakeholder meetings alongside practical examples of involvement activities used during the realist review are discussed. Having two researchers co-lead the stakeholder group from both lived and professional experience perspectives provided a bridge between the different expertise within the stakeholder group. Engagement with a voluntary organisation provided support to lived experience stakeholders, which sustained their involvement over time. Social connectedness was needed to establish trust between stakeholders. This required informal social contact between stakeholders that needed to be planned, especially for online meetings. To maintain the emotional wellbeing of the stakeholders during their involvement, safe spaces for discussion are needed and these are best planned in partnership with the stakeholders. We concluded that consideration of ways to provide opportunity for informal contact in online meetings may improve the experience of the stakeholders. Careful consideration of ways to sustain stakeholders' contribution over time are needed. The emotional impact of involvement should be considered when planning realist reviews. This may include built in flexibility in the involvement to include small expertise specific breakout groups, individual meetings, and should be planned in partnership with the stakeholders.

Engaging Red River Métis families in Manitoba in the development of child health resources - findings from a qualitative study

BACKGROUND

Most research that includes Red River Métis tends to be pan-Indigenous. Grouping Métis with First Nations and Inuit can diminish their unique and diverse experiences, as well as distinctions-based approaches. Taking a step toward addressing this problem, the Manitoba Métis Federation (MMF; the national government of the Red River Métis) invited researchers within the Canadian network Translating Emergency Knowledge for Kids to partner in this research, which focuses on understanding engagement strategies that can help expose Red River Métis parents to child health research opportunities and build trust and transparency amongst research partners and participants.

METHODS

A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data.

RESULTS

Analysis generated four themes: (a) show me why you are here; (b) make it easier for me to take part; (c) create welcoming spaces; and (d) it should be a give and take experience. Parents emphasized the importance of kinship and personal connections, and said they want to hear about child health study opportunities from trusted organizations. They want researchers to be transparent about their research motivations and to offer multiple ways to participate to help them fit research into their busy lives. Relational approaches within the research process (e.g., creating informal/welcoming environments, gathering over food, fostering shared learning/creative opportunities) are prominent in the findings.

CONCLUSION

There is a dearth of research focused on the distinct experiences of Red River Métis families. Engaging Red River Métis parents early in the research process will help incorporate their preferences and perspectives into the design of a larger project to adapt child health resources. More training is needed to help researchers improve their abilities to engage in self-reflection, listen, recognize power relationships, and demonstrate trust and transparency in each research interaction. It is only through respectful and successful engagement that child health research can be relevant, applicable and positively impact Red River Métis children, families and communities.

Addressing Known hypertensive disOrders of pregnancy in woMen of African descent in Canada (AKOMA): protocol for a mixed method study

Background

Hypertensive disorders of pregnancy (HDP) predispose a woman to maternity-related cardiovascular morbidity and mortality. However, there is limited literature on HDP among women of African descent in Canada.

Methods and design

A convergent mixed-method study will be used to investigate the intersection of self-reported HDP risks in women of African descent in Canada with a history of a HDP (quantitative, cross-sectional survey) and explore the perception and experiences of women of African descent living in Canada with a history of a HDP in relation to the intersection of risk factors (critical qualitative inquiry, interviews). Quantitative analysis will use SPSS V. 27.0 and thematic analysis will be conducted using NVivo V. 12. A joint display will be used to combine the quantitative and qualitative results.

Discussion

Through the lens of intersectionality, the proposed study aims to provide a comprehensive understanding of the intersection of risks for HDP among women of African descent in Canada with a history of HDP. Furthermore, results could inform future strategies to reduce cardiovascular disease risks.

Trial Registration Number

This is registered in the Open Sciences Framework as follows: https://doi.org/10.17605/OSF.IO/R6CKY.

Participant engagement and involvement in longitudinal cohort studies: qualitative insights from a selection of pregnancy and birth, twin, and family-based population cohort studies

BACKGROUND

Longitudinal cohort studies are pivotal to understand how socioeconomic, environmental, biological, and lifestyle factors influence health and disease. The added value of cohort studies increases as they accumulate life course data and expand across generations. Ensuring that participants stay motivated to contribute over decades of follow-up is, however, challenging. Participant engagement and involvement (PEI) aims to secure the long-term commitment of participants and promote researcher-participant interaction. This study explored PEI practices in a selection of pregnancy and birth, twin, and family-based population cohort studies.

METHODS

Purposive sampling was used to identify cohorts in Europe, Australia and New Zealand. Fourteen semi-structured digital interviews were conducted with cohort study representatives to explore strategies for participant recruitment, informed consent, communication of general and individual information to participants, data collection, and participant involvement. Experiences, resources allocated to PEI, and reflections on future PEI, were discussed. The interview data were analyzed using a content analysis approach and summary results were reviewed and discussed by the representatives.

RESULTS

The cohort studies used various strategies to recruit participants including support from health professionals and organizations combined with information on the studies' web sites and social media. New approaches such as intra-cohort recruitment, were being investigated. Most cohorts transitioned from paper-based to digital solutions to collect the participants' consent and data. While digital solutions increased efficiency, they also brought new challenges. The studies experimented with the use of participant advisory panels and focus groups to involve participants in making decisions, although their success varied across age and socio-economic background. Most representatives reported PEI resources to be limited and called for more human, technical, educational and financial resources to maximize the positive effects of PEI.

CONCLUSIONS

This study of PEI among well-established cohort studies underscores the importance of PEI for project sustainability and highlights key factors to consider in developing PEI. Our analysis shows that knowledge gaps exist regarding which approaches have highest impact on retention rates and are best suited for different participant groups. Research is needed to support the development of best practices for PEI as well as knowledge exchange between cohorts through network building.

Giving children a voice: Concept development and foundation of the first Children's council "mental health" in Germany

Background

As summarized by the Lancet Psychiatry Commission on youth mental health (McGorry et al., 2024), the statistics on mental disorders in children are alarming and highlight the need to expand and optimize research on childhood mental health. Although patient and public involvement (PPI) of those affected has the potential to boost both the acceptance and outcomes of research studies, the active involvement of young children, that is, primary school children, in mental health research has been neglected.

Methods

Based on the results of our systematic literature analysis of PPI of children in mental health research, the concept development of the Children's Council 'Mental Health' was administered in cooperation with several stakeholders and focus groups (practitioners and researchers in the field of clinical psychology and psychotherapy across the lifespan, representatives from three self-help organizations for mental disorders, children's focus group). The concept was further optimized in collaboration with the German Children's Fund (Deutsches Kinderhilfswerk e. V.).

Results

The Children's Council was successfully founded with five children aged between 6 and 9 years. Participation is positively received, and each meeting is evaluated using visual measurements. The results from the meetings are presented and discussed. They serve as basis for concrete recommendations for involving young children in mental health research.

Conclusions

To the best of our knowledge, this is the first structured approach involving young children in mental health research studies. The main goal of our study is the direct and immediate empowerment of children, in this case primary school children at the age of 6-12 years. This is associated with a child-friendly exchange on topics related to mental health, as well as the enhancement of the education process on mental disorders and prevention.

Why do preconception and pregnancy lifestyle interventions demonstrate limited success in preventing overweight and obesity in children? A scoping review investigating intervention complexity, process evaluation components, and author interpretations

Preventing childhood obesity from early life is considered essential. However, evidence from recent systematic reviews has highlighted inconsistent results and limited effectiveness of preconception and pregnancy lifestyle interventions regarding offspring weight outcomes and adiposity. Therefore, to improve our understanding regarding the mixed success of these early life interventions, we conducted a scoping review examining intervention complexity, process evaluation components, and authors' statements. Eligible articles (preconception or pregnancy lifestyle trials with offspring data beyond 1 month of age) were identified by searching databases (PubMed, Embase, and CENTRAL), previous reviews, and performing CLUSTER searches. The Intervention Complexity Assessment Tool for Systematic Reviews (iCAT_SR) was used to evaluate intervention complexity. A thematic analysis provided insight into process evaluation components and authors' interpretations. Finally, an expert consultation on the results was conducted. We identified 40 eligible publications corresponding to 27 trials. Only two trials started before conception. Potential reasons for interventions' limited success included the late intervention initiation, short intervention duration, and insufficient sample size. Few studies reported process evaluations and included stakeholder involvement, which are essential according to the expert group. We discuss current limitations and outline suggestions for future interventions in this field of research.

Engaging communities: A scoping literature review of community-based participatory research in genetics service delivery settings

Genetic counseling (GC) services have the potential to improve health outcomes, yet there are documented disparities in the use of GC services among minoritized racial/ethnic populations. Community-based participatory research (CBPR) is an approach to integrate diverse patient perspectives to improve GC services. The objective of this review was to assess the current state of international CBPR within GC and genetics services from 2006 to 2023. Five databases were searched for inclusion criteria: 1) published in 2006 or later; 2) peer-reviewed publication; 3) primary research studies; 4) community-based AND participatory research; 5) focused on GC, clinical genetics, testing, and/or genetic service delivery. Criteria for evaluating CBPR involvement used a synthesis of best processes framework. Screening of 3,824 studies identified 16 papers (n = 12 qualitative; n = 1 quantitative; n = 3 mixed methods). The majority of studies were conducted within the U.S. (n = 12), focused on cancer (n = 5), involved the Asian/Pacific Islander community (n = 8), and centered around genetic education (n = 12). Community partners most frequently were involved in recruitment (n = 12) and results analysis (n = 12) and least involved in research question development (n = 7) and product creation (n = 6). Studies varied substantially in the integration of 9 CBPR gold standard principles with only three studies addressing all nine principles. Few CBPR projects in GC services exist and a lack of guidelines to assess the quality of CBPR methodologies hindered the appraisal of studies. CBPR represents a promising approach to improve GC services and should be explored by genetics service delivery researchers.

Patients' perspectives on key aspects influencing needling for haemodialysis: A qualitative study

BACKGROUND

For many patients, cannulation ('needling') is essential for haemodialysis. It is associated with anxiety and fear and contributes to the overall burden of treatment. Limited research exists on patient experience of needling and how this might vary by individual and clinical characteristics.

OBJECTIVES

To explore and identify key aspects of needling impacting patients' experiences.

DESIGN

Qualitative, multicentre, cross-sectional, co-produced.

PARTICIPANTS

Adults on haemodialysis with working fistulae or grafts (n = 41).

APPROACH

We used interviews to explore patients' experiences of needling and key aspects contributing to this. Interviews were conducted in two sets: unstructured (n = 24, broadly investigated needling experience) and semistructured (n = 17, refined themes and assessed cultural relevance). Thematic analysis was used to identify themes driving experience and examine variation. A Patient Steering Group comprising people with lived experience of needling was integral to the study.

FINDINGS

A thematic framework capturing patients' view of needling was developed. It defined a core theme (The Nature of needling) and five foundational aspects of needling (Health of the fistula or graft, Steps in needling, The needler, The patient, Organisational context). We identified two further themes important to overall experience, Learning from needling experience and Reciprocity (the two-way interaction between patient and needler). Both interrelated across themes, highlighting the complexity of needling and junctures where patient experience can be influenced.

CONCLUSIONS

Needling is shaped by multiple psychological and relational influences. These findings provide healthcare professionals with a basis to improve patient experience as part of a broader drive to enhance quality in healthcare delivery.

Interventions to improve mental health and well-being in care-experienced children and young people aged less than 25: the CHIMES systematic review

Background

Children and young people with experience of being in care (e.g. foster care, kinship care, residential care or at home with a supervision requirement order) are at higher risk of adverse mental health and well-being outcomes compared to the general population. Despite a range of policy recommendations and interventions, it is not clear what approaches are effective in the United Kingdom, or how context factors give rise to facilitators and inhibitors of implementation and acceptability.

Objectives

The CHIMES review is a complex-systems-informed mixed-method systematic review that aimed to synthesise the international evidence base for interventions addressing the mental health and well-being of care-experienced children and young people (age ≤ 25 years) and to assess the potential transportability of this evidence base to the United Kingdom context.

Data sources

We searched 16 electronic bibliographic databases and 22 websites from 1990 to May 2022. We conducted citation tracking, screened relevant systematic reviews and contacted international experts.

Method

We used a convergent synthesis design. We first constructed an evidence map to confirm review scope before undertaking method-level syntheses for outcome evaluations, process evaluations and economic evaluations. These elements were integrated into a review-level synthesis to identify potential evidence-based interventions that may progress to further development, adaptation and evaluation in the United Kingdom. We conducted stakeholder consultations to prioritise intervention theories, types and outcomes.

Results

We identified 64 interventions from 124 study reports. Interventions were primarily evaluated in the United States and targeted young people's competencies or carers' parenting practices. Meta-analysis reported limited evidence that interventions effectively improved mental health in the shorter term (0-6 months): total social, emotional and behavioural problems (d = -0.15, 95% confidence interval -0.28 to -0.02); internalising problem behaviours (d = -0.35, 95% confidence interval -0.61 to -0.08); externalising problem behaviours (d = -0.30, 95% confidence interval -0.53 to -0.08); depression and anxiety (d = -0.26, 95% confidence interval -0.40 to -0.13) and social-emotional functioning difficulties (d = -0.18, 95% confidence interval -0.31 to -0.05), but these impacts were not observed in the longer term (> 6 months). Five key context factors potentially explain challenges to implementation and acceptability: lack of system resources; the time, cognitive and emotional burden of delivery or participation; interprofessional tensions; the devaluing of young people, meaning that they felt unable to express dissatisfaction with interventions; and the devaluating of carers' expertise and needs. From the evidence, stakeholder consultation identified two priority interventions: (1) mentoring by individuals with knowledge and experience of care and (2) system and ethos change to create harmonisation between organisations and facilitate interprofessional relationships. Well-being and suicide-related behaviours are priority outcomes alongside mental health.

Limitations

The review was limited by a paucity of theory and economic evaluations, so it is unclear how interventions might function or their potential cost-effectiveness. Interventions were insufficiently described, making it challenging to map the evidence base. Outcome evaluations were poorly reported. Due to ongoing restrictions with COVID-19, stakeholder consultations were conducted later than intended with a smaller number of attendees.

Conclusions

The review identified some evidence for interventions impacting mental health in the short term. There is a lack of system-level interventions and approaches that target subjective well-being and suicide-related outcomes. Future intervention might prioritise mentoring and targeting system culture.

Study registration

This study is registered as PROSPERO CRD42020177478.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129113) and is published in full in Public Health Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Listening to the Voice of the Patient in RSV Research

Patient and public involvement in research refers to patients or caregivers with disease experience contributing to the design, conduct or dissemination of results from research. Patient and public involvement has given rise to new fields in healthcare-oriented research and has the potential to transform infectious diseases through interventional trials. Our recommendations and best practices from years of organizing respiratory syncytial virus parent networks are provided.

Emotional literacy programme in special schools for children with a learning disability in England: the ZF-SEND feasibility RCT

Background

Children with a learning disability experience a range of inequalities and adverse life events that put them at greater risk of mental health problems. The construct of emotional literacy has been shown to be a moderating factor of how life stress affects mental health. Teaching emotional literacy in schools may therefore be an effective way to promote positive mental health. There is an identified need for adapted emotional literacy programmes in special schools.

Objectives

To evaluate whether it is feasible to conduct a large-scale randomised controlled trial of the effectiveness and cost-effectiveness of an emotional literacy programme (Zippy's Friends special educational needs and disabilities) for children with a learning disability in special schools. The key aims were to assess the acceptability and feasibility of participating in the trial, data collection and the Zippy's Friends special educational needs and disabilities intervention through quantitative and qualitative data collection.

Design

A feasibility, cluster randomised controlled trial that aimed to recruit and randomise 12 special schools to either deliver the intervention over 1 academic year or continue with practice as usual and to collect data from 96 pupils at baseline (pre randomisation) and 12 months post randomisation.

Setting

Special schools in England and Scotland.

Participants

Pupils with a learning disability, aged 9-11 years, attending special schools in England. Follow-up interviews were conducted with 8 pupils, 4 parents/carers and 11 school staff members.

Intervention

Zippy's Friends for Special Educational Needs and Disabilities is a manual-based, classroom-based emotional literacy programme focused on a problem-solving approach to develop and improve children's emotional literacy. The mainstream programme has been adapted for children with a learning disability by simplifying the activities, shortening the sessions and introducing more repetition.

Main outcome measures

Feasibility and acceptability of: (1) participation in the research trial; (2) the collection of the outcome measure data and (3) the Zippy's Friends for Special Educational Needs and Disabilities intervention.

Results

A total of 8 schools and 53 pupils were recruited. Retention of schools after randomisation (100%) and retention of pupils (100%) met the prespecified progression criteria. For recruitment of schools (20.5% of those approached), pupil engagement with the intervention (50%) and collection of outcome and service use data (62.3%) the criteria were partially met. Fidelity of the intervention delivery (48%) fell just below the progression criteria. Thus, the feasibility and acceptability outcome progression criteria were largely met, suggesting that progression to a full trial is warranted with amendments to the study design.

Limitations

This feasibility trial was conducted during the COVID-19 pandemic, resulting in unusually high absences of pupils and teachers, different classroom arrangements (bubbles) and unprecedented stress and emotional challenges for pupils, parents and teaching staff. The findings are therefore specific to that period and all three main outcomes of this feasibility trial were adversely affected.

Conclusions

The findings of this study indicate that a large-scale randomised controlled trial is feasible provided that a number of amendments to the study design are made to improve: (1) the timing of the project to suit the demands of special schools' yearly timetable; (2) recruitment and (3) outcome and service use data collection.

Future work

On the basis of the current findings, an application for a full trial will be prepared and submitted with a number of amendments.

Trial registration

This trial is registered as ISRCTN83610691.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129064) and is published in full in Public Health Research; Vol. 12, No. 15. See the NIHR Funding and Awards website for further award information.

Maintaining good mental health in people with inflammatory arthritis: a qualitative study of patients' perspectives

PURPOSE

It is well-documented that people with inflammatory arthritis (IA) exhibit a high prevalence of symptoms related to anxiety and depression. Less is known about what contributes to good mental health in people with IA. Therefore, this study aims to explore how some patients maintain good mental health despite living with IA.

METHODS

Explorative qualitative interview study (one focus group, 12 individual interviews, n = 18) utilizing purposeful sampling. All interviews were audiotaped, transcribed, and managed using NVivo14 and employed a reflexive thematical analysis approach.

RESULTS

We identified four main themes: 1) Assisted by a positive outlook on life-how participants' inherent positivity helped them cope with arthritis; 2) Moving towards acceptance of life with arthritis-how participants embraced the reality of living with IA; 3) Counteracting letting arthritis dictate one's life how the participants structured their lives in terms of physical activity and social connections; and 4) Taking responsibility for the trajectory-how the participants were mindful of their bodies and took the initiative to explore new treatments.

CONCLUSION

People living with IA maintain good mental health by engaging in structured physical activity, fostering social connections, and cultivating a positive outlook on life. These insights can inform the development of future treatment and support strategies.

Assessing long-term effectiveness and cost-effectiveness of statin therapy in the UK: a modelling study using individual participant data sets

Background

Cardiovascular disease has declined but remains a major disease burden across developed countries.

Objective

To assess the effectiveness and cost-effectiveness of statin therapy across United Kingdom population categories.

Design

The cardiovascular disease microsimulation model, developed using Cholesterol Treatment Trialists' Collaboration data and the United Kingdom Biobank cohort, projected cardiovascular events, mortality, quality of life and healthcare costs using participant characteristics.

Setting

United Kingdom primary health care.

Participants

A total of 117,896 participants in 16 statin trials in the Cholesterol Treatment Trialists' Collaboration; 501,854 United Kingdom Biobank participants by previous cardiovascular disease status, sex, age (40-49, 50-59 and 60-70 years), 10-year cardiovascular disease risk [QRISK®3 (%): < 5, 5-10, 10-15, 15-20 and ≥ 20] and low-density lipoprotein cholesterol level (< 3.4, 3.4-4.1 and ≥ 4.1 mmol/l); 20,122 United Kingdom Biobank and Whitehall II participants aged ≥ 70 years by previous cardiovascular disease status, sex and low-density lipoprotein cholesterol (< 3.4, 3.4-4.1 and ≥ 4.1 mmol/l).

Interventions

Lifetime standard (35-45% low-density lipoprotein cholesterol reduction) or higher-intensity (≥ 45% reduction) statin.

Main outcome measures

Quality-adjusted life-years and incremental cost per quality-adjusted life-year gained from the United Kingdom healthcare perspective.

Data sources

Cholesterol Treatment Trialists' Collaboration and United Kingdom Biobank data informed risk equations. United Kingdom primary and hospital care data informed healthcare costs (2020-1 Great British pounds); £1.10 standard or £1.68 higher-intensity generic statin therapy per 28 tablets; and Health Survey for England data informed health-related quality of life. Meta-analyses of trials and cohort studies informed the effects of statin therapies on cardiovascular events, incident diabetes, myopathy and rhabdomyolysis.

Results

Across categories of participants 40-70 years old, lifetime use of standard statin therapy resulted in undiscounted 0.20-1.09 quality-adjusted life-years gained per person, and higher-intensity statin therapy added a further 0.03-0.20 quality-adjusted life-years per person. Among participants aged ≥ 70 years, lifetime standard statin was estimated to increase quality-adjusted life-years by 0.24-0.70 and higher-intensity statin by a further 0.04-0.13 quality-adjusted life-years per person. Benefits were larger among participants at higher cardiovascular disease risk or with higher low-density lipoprotein cholesterol. Standard statin therapy was cost-effective across all categories of people 40-70 years old, with incremental costs per quality-adjusted life-year gained from £280 to £8530. Higher-intensity statin therapy was cost-effective at higher cardiovascular disease risk or higher low-density lipoprotein cholesterol. Both standard and higher-intensity statin therapies appeared to be cost-effective for people aged ≥ 70 years, with an incremental cost per quality-adjusted life-year gained of under £3500 for standard and under £11,780 for higher-intensity statin. Standard or higher-intensity statin therapy was certain to be cost effective in the base-case analysis at a threshold of £20,000 per quality-adjusted life-year. Statins remained cost-effective in sensitivity analyses.

Limitations

The randomised evidence for effects of statin therapy is for about 5 years of treatment. There is limited randomised evidence of the effects of statin therapy in older people without previous cardiovascular disease.

Conclusions

Based on the current evidence of the effects of statin therapy and modelled contemporary disease risks, low-cost statin therapy is cost-effective across all categories of men and women aged ≥ 40 years in the United Kingdom, with higher-intensity statin therapy cost-effective at higher cardiovascular disease risk or higher low-density lipoprotein cholesterol.

Future work

Cholesterol Treatment Trialists' Collaboration has ongoing studies of effects of statin therapy using individual participant data from randomised statin trials. Ongoing large randomised controlled trials are studying the effects of statin therapy in people ≥ 70 years old. Future economic analyses should integrate the emerging new evidence.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/140/02) and is published in full in Health Technology Assessment; Vol. 28, No. 79. See the NIHR Funding and Awards website for further award information.

A joint venture: patients' experiences with goal setting in rheumatology rehabilitation - a qualitative study

PURPOSE

To explore how patients with rheumatic musculoskeletal diseases (RMDs) perceive participation in the goal setting process prior to interdisciplinary rehabilitation.

METHODS

We conducted semi-structured interviews with 22 participants admitted to an interdisciplinary rehabilitation stay for patients with RMDs at two Danish rehabilitation centres. Qualitative content analysis was applied.

RESULTS

The participants perceived goal setting as a joint venture between two parties: the health professionals and the participant. Three categories were formed, which described both facilitators and barriers in the process. Responsibility for goal setting described the importance of shared responsibility, or health professionals as experts, taking full responsibility for goal setting. Equipped for goal setting included perceptions of being well prepared for the process, or considerations that goal setting was difficult because of a lack of information. An equal member of the team entailed both the feeling of being recognised as one in the team, or feeling like an outsider.

CONCLUSION

Goal setting is perceived as a challenge by some patients. Participation in goal setting depends on both the capacity and the opportunity to participate which are factors linked to patients' level of health literacy.