Facilitating consumer participation: an approach to finding the 'right' consumer

From a Single Voice to Diversity: Reframing 'Representation' in Patient Engagement

There has been a growing emphasis on consumer representation in the development of health policy, services, research, and education. Existing literature has critiqued how discourses of representativeness can disempower consumers working in health systems. The context of the current study is consumer engagement in the development of COVID-19 triage policy and practice in a local health service. Consumer engagement has often been an afterthought in the COVID response, with few examples of consumers in agenda-setting or decision-making roles. In the Australian Capital Territory, 26 consumer, carer, and community groups worked together with academics and clinicians to develop these principles. Interviews were conducted with stakeholders (including consumers, clinicians, and other health professionals) to evaluate the development of triage principles. A discursive psychological approach to analysis was used to explore participants' understandings about and constructions of consumers being representative (or not) and how this may reproduce power imbalances against consumers. The results explore two distinct ways in which participants talked about consumer representativeness: the first drawing on rhetoric about consumers as lay members of the public (as distinct from being professionally engaged in the health sector), and the second in terms of consumer representatives being diverse and having intersectional identities and experiences. Expectations about consumers to be representative of the general population may reproduce traditional power imbalances and silence lived experience expertise. These power imbalances may be challenged by a shift in the way representativeness is conceptualised to requiring health services to seek out diverse and intersectionally marginalised consumers.

Optimising service users and carers involvement in nursing and social work pre-registration degrees

The awareness of the contribution of service users and carers' involvement in nursing and social work pre-registration degree education continues to grow. This study explored ways of optimising its beneficial outcomes to students, service users/carers and academic staff. A phenomenology qualitative approach was employed. The study sample was drawn from service users/carers involved in students' education, and adult nursing and social work degree students and academic staff. A total of 38 participants took part. Semi-structured interviews were used to gather views, which was then thematically analysed. This study identified factors that can optimise the beneficial outcomes of service users and carers' involvement to students, service users/carers and academic staff in Adult nursing and Social work pre-registration degree. The findings of this study support the value of service users' and carers' involvement in undergraduate nursing and social work education and offer strategies which support best practice, and optimise and sustain the efficacy and benefits of this approach in a higher education setting. An understanding of issues related to optimising service user and carer involvement may assist in the development of strategies that continue to make service users and carers' involvement in nursing and social work pre-registration degree effective and meaningful to students, service users/carers and academic staff.

Improving Service User Involvement in Mental Health Nursing Education: Suggestions from Those with Lived Experience

Service user involvement in mental health nursing education is increasing and a developing evidence base is demonstrating more positive attitudes towards people labelled with a mental illness. To date, most research on this approach has focussed on the perspectives of nursing students, with very limited research drawing on the expertise and opinions of service users. The aim of this study was to explore potential improvements in mental health nursing education, and ways service user involvement can be enhanced as defined by service users themselves. An international qualitative research project was undertaken involving focus groups with service users (n = 50) from Australia and five European countries. The research was coproduced between Experts by Experience (service users) and mental health nurse academics. Data were analysed thematically. Findings reflected two broad themes: (1) improvements to content, including: further emphasis on developing emotional intelligence, understanding mental distress and broader context of care; (2) Improvements to service user involvement, including: support, format, and teaching and learning techniques. These findings provide direction for maximising the benefits of service user involvement and show the value of the expertise of service users.

Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements

Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.

Doing what we can, but knowing our place: Being an ally to promote consumer leadership in mental health

Consumer participation in all aspects of mental health services is clearly articulated as an expectation of contemporary mental health policy. Consumer leadership has been demonstrated to be beneficial to mental health services. Barriers to implementation have limited the realization of this goal. In this discursive paper, we argue that non-consumers who support consumer partnerships and leadership (known as 'allies') have an important role to play in facilitating and supporting consumers in leadership roles. Allies currently have more potential to influence resource allocation, and might be viewed more credibly by their peers than consumer leaders themselves. We call for allies to ensure their role is one of support and facilitation (doing what they can), rather than directing the content or speaking on behalf of the consumer movement (knowing their place). In the present study, we address the importance of allies for the consumer movement. It proposes some 'rules of engagement' to ensure that allies do not intentionally or otherwise encroach on consumer knowledge and expertise, so that they maintain the important position of supporting consumers and facilitating the valuing and use of consumer knowledge, expertise, and ultimately, leadership.

Recovery as a Lived Experience Discipline: A Grounded Theory Study

Recovery is government mandated and a core facet of mental health reform. However, Recovery implementation in this country (Australia) has been inhibited by a lack of education of, and understanding from, clinicians. A grounded theory study was undertaken to explore the potential and existing role of lived experience practitioners in assisting meaningful implementations of Recovery within the Australian mental health sector. In-depth interviews were conducted with 13 people employed to work from a lived experience perspective. The findings suggest participants have experienced and observed significant barriers to the implementation of Recovery-focused practice while operating in lived experience roles. Three main issues emerged: (1) Recovery co-opted, (2) Recovery uptake, and (3) Recovery denial. For a genuine Recovery-focused mental health system to be developed, lived experience practitioners must be enabled to take their role as Recovery experts and leaders. Lived experience practitioners are the logical leaders of Recovery implementation due to their own internal experience and understandings of Recovery and the wider lived experience movement's development and championing of the concepts.

'Practical' resources to support patient and family engagement in healthcare decisions: a scoping review

BACKGROUND

Extensive literature exists on public involvement or engagement, but what actual tools or guides exist that are practical, tested and easy to use specifically for initiating and implementing patient and family engagement, is uncertain. No comprehensive review and synthesis of general international published or grey literature on this specific topic was found. A systematic scoping review of published and grey literature is, therefore, appropriate for searching through the vast general engagement literature to identify 'patient/family engagement' tools and guides applicable in health organization decision-making, such as within Alberta Health Services in Alberta, Canada. This latter organization requested this search and review to inform the contents of a patient engagement resource kit for patients, providers and leaders.

METHODS

Search terms related to 'patient engagement', tools, guides, education and infrastructure or resources, were applied to published literature databases and grey literature search engines. Grey literature also included United States, Australia and Europe where most known public engagement practices exist, and Canada as the location for this study. Inclusion and exclusion criteria were set, and include: English documents referencing 'patient engagement' with specific criteria, and published between 1995 and 2011. For document analysis and synthesis, document analysis worksheets were used by three reviewers for the selected 224 published and 193 grey literature documents. Inter-rater reliability was ensured for the final reviews and syntheses of 76 published and 193 grey documents.

RESULTS

Seven key themes emerged from the literature synthesis analysis, and were identified for patient, provider and/or leader groups. Articles/items within each theme were clustered under main topic areas of 'tools', 'education' and 'infrastructure'. The synthesis and findings in the literature include 15 different terms and definitions for 'patient engagement', 17 different engagement models, numerous barriers and benefits, and 34 toolkits for various patient engagement and evaluation initiatives.

CONCLUSIONS

Patient engagement is very complex. This scoping review for patient/family engagement tools and guides is a good start for a resource inventory and can guide the content development of a patient engagement resource kit to be used by patients/families, healthcare providers and administrators.