The snakes and ladders of user involvement: Moving beyond Arnstein

Series: Public engagement with research. Part 3: Sharing power and building trust through partnering with communities in primary care research

BACKGROUND

This article focuses on potential strategies to support primary care researchers in working in partnership with the public and healthcare professionals. Partnership working can potentially to improve the relevance and usefulness of research and ensure better research and health outcomes.

DISCUSSION

We describe what we mean by partnership working and the importance of reflecting on power and building trusting relationships. To share power in partnership working, it is essential to critically reflect on the multiple dimensions of power, their manifestations, and your own power. Power can influence relationships and therefore, it is essential to build trust with partners. Next, we outline how the context of primary care research and decisions about who you work with and how to work together, are vital considerations that are imbued with power. Lastly, we suggest different ways of working in partnership to address different dimensions of power. We provide examples from primary care research across Europe regarding how to recognise, tackle, and challenge, invisible, hidden and visible power.

CONCLUSION

We conclude by proposing three calls to actions to encourage researchers working in primary care to consider the multiple dimensions of power and move towards partnership working. First is to use participatory methods to improve the inclusivity of your research. Second is to include patients and the public in decisions about the design, delivery and development of research and its outcomes. Third is to address various systemic and institutional barriers which hinder partnership working.

BC cancer radiation therapists' perspective on the impact of COVID-19 precautions in clinical practice

INTRODUCTION

There were many policy and procedure (P&P) changes implemented in health care facilities to combat the spread of the coronavirus disease 2019 (COVID-19). Common changes included an increase in personal protective equipment usage, room occupancy limits, limitations in visitors/family members and the absence of volunteers. This study evaluated the current views and opinions of Radiation Therapists (RTs) in British Columbia relating to how COVID-19 P&P changes have impacted their clinical practice. The goal was to identify gaps in the areas of RT practice, allow for self-reflection among RTs and potentially guide future P&Ps with patient-centred care at the forefront.

METHODS

A 24-item cross-sectional questionnaire was created and sent via e-mail to all RTs working across the province. Key sections explored in the questionnaire were: 1) patient care delivery, 2) staff-work environment, and 3) work satisfaction. Descriptive analysis was performed on the questionnaire responses.

RESULTS

Of the approximate 300 invited participants, 107 responses were received from all areas of Radiation Therapy (Treatment units, CT simulation, Dosimetry, etc.) and from all cancer centres in the province. RT staff indicated that COVID-19 P&P negatively impacted patient care, including the ability to verbally and non-verbally communicate with patients (82 %), assess for side effects (85 %), and build rapport (62 %). A majority (79 %) of RT staff felt that communication with co-workers had been negatively impacted as well. When queried regarding the impact on staff environment, 51 % of RT staff agreed that the absence of volunteers increased their workload and the responses were polarized (46 % disagree, 35 % agree) when asked if RT staff have enough time for cleaning their clinical areas with new COVID-19 P&Ps in place. 78 % of RTs were aware of where to go with COVID-19 safety concerns and thought they received adequate education concerning COVID P&Ps. When asked to rank the factors that most impacted RT practice, RTs identified increased PPE usage (83 %), absence of volunteers (74 %), and room occupancy limits (70 %) as the leading P&P changes that negatively impacted their practice; while plexiglass barriers (39 %), re-arranged workspaces (37 %) and working remotely (12 %) were the least negatively impactful.

CONCLUSION

The majority of RTs across BC Cancer responding to the questionnaire indicated that their ability to provide patient care and their staff-work environment were negatively impacted by implemented COVID-19 P&Ps. Views regarding COVID-19 P&P training/education was positive, yet there was no consensus regarding whether the changes were implemented smoothly. This study can facilitate reflection among both clinical leadership and RTs on how P&Ps can be implemented in the future and can encourage further retrospective analyses in aiding the development of P&Ps regarding future public health outbreaks.

Reflecting on the Spectrum of Involvement: How do we involve patients as partners in education?

BACKGROUND

The Spectrum of Involvement describes six levels of active patient involvement in healthcare education. Only at the highest levels are patients described as 'equal partners'. Although this framework was never intended to be hierarchical, healthcare educators continue to strive towards aspirations for involving patients as 'equal partners' in education. However, we do not know what these partnerships mean for all stakeholders and how they can be achieved in practice. This study explores key stakeholders' understandings and experiences of patient partnerships in healthcare education.

METHODS

A qualitative case study design was adopted, underpinned by a social constructivist philosophical stance. Semi-structured interviews were conducted with patients (n = 10) and educators (n = 10) from across a Medical School and a Healthcare School. Five focus groups were held with penultimate year students (n = 20) from across the two Schools. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated: (i) equal partnerships are neither feasible nor desirable; (ii) partnership is about being and feeling valued; and (iii) valuing patients as partners. Patients did not always desire the highest levels of involvement, as 'equal partners' in education. All stakeholders agreed that partnership need not be synonymous with equality. Instead, they contended that true partnerships were about valuing patients for their contributions at any level of involvement. Remuneration, student feedback, training and providing institutional access were viewed as important methods of valuing patients as partners.

CONCLUSION

Patients, educators and students questioned the notion that patient partnerships are only achievable at the highest levels of involvement. Critical application of the Spectrum of Involvement in future research and education is encouraged. This study addresses a gap in the literature, providing tangible approaches to valuing patients as partners that are endorsed by all stakeholders. We propose a model for achieving valued patient partnerships in educational practice.

Healthcare providers' perception of caring for older patients with depression and physical multimorbidity: insights from a focus group study

BACKGROUND

The caretaking process for older adults with depression and physical multimorbidity is complex. Older patients with both psychiatric and physical illnesses require an integrated and comprehensive approach to effectively manage their care. This approach should address common risk factors, acknowledge the bidirectional relationship between somatic and mental health conditions, and integrate treatment strategies for both aspects. Furthermore, active engagement of healthcare providers in shaping new care processes is imperative for achieving sustainable change.

OBJECTIVE

To explore and understand the needs and expectations of healthcare providers (HCPs) concerning the care for older patients with depression and physical multimorbidity.

METHODS

Seventeen HCPs who work with the target group in primary and residential care participated in three focus group interviews. A constructivist Grounded Theory approach was applied. The results were analyzed using the QUAGOL guide.

RESULTS

Participants highlighted the importance of patient-centeredness, interprofessional collaboration, and shared decision-making in current healthcare practices. There is also a need to further emphasize the advantages and risks of technology in delivering care. Additionally, HCPs working with this target population should possess expertise in both psychiatric and somatic care to provide comprehensive care. Care should be organized proactively, anticipating needs rather than reacting to them. Healthcare providers, including a dedicated care manager, might consider collaborating, integrating their expertise instead of operating in isolation. Lastly, effective communication among HCPs, patients, and their families is crucial to ensure high-quality care delivery.

CONCLUSION

The findings stress the importance of a comprehensive approach to caring for older adults dealing with depression and physical comorbidity. These insights will fuel the development of an integrated care model that caters to the needs of this population.

Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review

BACKGROUND

Participatory research (PR) involves engaging in cocreation with end users and relevant stakeholders throughout the research process, aiming to distribute power equitably between the end users and research team. Engagement and adherence in previous workplace health promotion (WHP) studies have been shown to be lacking. By implementing a PR approach, the insights of end users and stakeholders are sought in the co-design of feasible and acceptable intervention strategies, thereby increasing the relevance of the research.

OBJECTIVE

This scoping review aims to explore, identify, and map PR techniques and their impact when used in office-based WHP interventions designed to improve physical activity (PA) or reduce sedentary behavior (SB).

METHODS

The reporting of this scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). A systematic literature search of 5 electronic databases-Web of Science, PubMed, Scopus, Google Scholar, and OpenGrey-was conducted, searching from January 1, 1995, to February 8, 2023. In total, 2 independent reviewers first screened the retrieved articles by title and abstract, and then assessed the full texts based on the inclusion and exclusion criteria. The search strategy and eligibility criteria were developed and guided by an a priori population (office-based working adults), intervention (a PA WHP intervention that took a PR approach), comparison (no comparison required), and outcome (PA or SB) framework. Data were charted and discussed via a narrative synthesis, and a thematic analysis was conducted. The included studies were evaluated regarding the degree of end user engagement throughout the research process and power shared by the researchers, using Arnstein's ladder of citizen participation.

RESULTS

The search retrieved 376 records, of which 8 (2.1%) met the inclusion criteria. Four key strategies were identified: (1) end user focus groups, (2) management involvement, (3) researcher facilitators, and (4) workplace champions. The degree of engagement and power shared was relatively low, with 25% (2/8) of the studies determined to be nonparticipation studies, 25% (2/8) determined to be tokenistic, and 50% (4/8) determined to provide citizen power.

CONCLUSIONS

This review provides a foundation of evidence on the current practices when taking a PR approach, highlighting that previous office-based PA WHP studies have been largely tokenistic or nonparticipative, and identified that the end user is only engaged with in the conception and implementation of the WHP studies. However, a positive improvement in PA and reduction in SB were observed in the included studies, which were largely attributed to implementing a PR approach and including the end user in the design of the WHP intervention. Future studies should aim to collaborate with workplaces, building capacity and empowering the workforce by providing citizen control and letting the end users "own" the research for a sustainable WHP intervention.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2021-054402.

Science Shops as key intermediary structures to respond to the current health research agenda bias: Evidence from the InSPIRES project

INTRODUCTION

To increase the likelihood of research responding to societal needs, intermediary structures such as Science Shops are being created. Science Shops respond to research needs identified and prioritized through participatory processes involving civil society. However, these are not mainstream structures, and most research needs addressed by the scientific community are not defined by a diversity of stakeholders (including citizens) but are mostly prioritized by researchers and funders. Literature shows this often leads to bias between the research topics investigated and the research needs of other relevant stakeholders. This study analyses how 14 Science Shops contribute to decreasing bias in health research agenda setting.

METHODOLOGY

We compare the research priorities identified through participatory processes by the Science Shops, which participated in the European Union-funded project InSPIRES (2017-2021), to the available research addressed in the literature (identified in Web of Science), which we use as a proxy for current research priorities.

RESULTS

Science Shop projects contributed to decreasing the existing bias in health research agenda setting: (1) between drug and nondrug treatments and (2) between clinical trials of treatments for illnesses affecting high-income versus middle- and low-income countries, which leads to a lack of local strategies for high disease burdens in nonhigh-income regions.

CONCLUSION

This study provides the first evidence of Science Shops' effectiveness in addressing current biases in health research agenda setting. We conclude they could play a key role in shaping local, national and international research policies.

Qualitative Systematic Literature Review: Participatory Visual Methods in Community Health Interventions With Migrants

This systematic review investigates how participatory visual methods (PVMs) (1) are applied in community health interventions (CHIs) with adult migrant populations and (2) identify potentials for participation. The search was performed in PubMed in 2021 and 2023. Eighteen articles fulfilled inclusion criteria as they investigated a CHI targeting migrants and used a visual method. We excluded articles that used quantitative methods, articles written in languages other than English, Danish, Swedish, or Norwegian, and the formats reviews, protocols, and theoretical articles. As a framework to graduate the degree of participation, we applied Arnstein's 'A Ladder of Citizen Participation'. Most of the studies took place in the United States, and the most frequent method used was photovoice. We categorize an equal number of articles as 'degrees of citizen power' or 'degrees of tokenism'. We identify the capacity to accommodate the needs of specific target groups to be a strength in PVMs, which has potential to engage migrants in several parts of the research process. Additionally, PVMs can be used to support a change in the participants' lives by facilitating a reflexive process concerning their life situation. However, utilization of PVMs also include a risk of tensions, they can be resource-demanding and potentially exclude certain groups.

Sense of psychological ownership in co-design processes: A case study

INTRODUCTION

Service users are increasingly participating in health research. Although collaborative research is assumed to give users a sense of psychological ownership, little is known about the specific psychosocial processes through which ownership develops and is displayed. The present study yields insight into a process in which service users, researchers and a website designer collaborated to design a website.

AIM

The aim of this study was to explore how participants developed and displayed feelings of ownership during a collaborative process to design a website.

METHODS

A case study design was adopted by which audio recordings were subjected to thematic analysis and interpreted by drawing on the concept of psychological ownership.

FINDINGS

A sense of psychological ownership of the website design process emerged in two distinct and overlapping phases. In the first phase, 'sense of ownership during the early design phase', only researchers and the website designer displayed a sense of ownership, which was facilitated by the research context preceding the collaborative workshops. In the second phase, 'sense of ownership during the collaborative design phase', service users gradually started to develop parallel feelings of ownership that were facilitated by workshop design activities. These activities enabled service users to increasingly control the process, to invest themselves in the process and to gain intimate knowledge of the process and its outcome. Service users' sense of ownership was displayed in their statements about the website and its elements.

CONCLUSION

Participants engaged in codesign processes may develop a sense of psychological ownership at different speeds because of contextual factors. It is important to take this into account as it may complicate the formation of egalitarian work groups.

PATIENT AND PUBLIC CONTRIBUTION

Parents of children with suicidal behaviour and a counsellor participated as service users in a website design process.

Prisoners regulating prisons: Voice, action, participation and riot

Prisoners are a critical source of prison regulation around the world, but regulation by (rather than of) prisoners remains little analysed. In this article, we utilise the 1990 riots at HMP Strangeways (England), as a case study of prisoners (re)shaping imprisonment. We examine prisoners' roles in these riots and subsequent cross-sectoral regulatory activities. We innovatively use the four-phase process of translation from actor-network theory to guide document analysis of (1) Lord Woolf's official inquiry into the riots and (2) the voluntary organisation Prison Reform Trust's follow-up report. We explore how participatory approaches could inform prison regulation through (former) prisoners partnering with external regulators throughout the processes of identifying problems and solutions to establish broader alliances seeking social change.

Implementation and evaluation of participatory advisory boards in mental health research: a research protocol of the 'PART-Beirat' project

BACKGROUND

The use of participatory research approaches in the field of dementia and forensic mental health research has been on the rise. Advisory board structures, involving people with lived experience (PWLE), have frequently been used for guiding and leading research. Yet, there has been limited guidance on the establishment, retention and use of advisory boards in the field of dementia and forensic mental health research.

OBJECTIVE

This project outlined in this research protocol will investigate the benefits and challenges of establishing three patient advisory boards, involving PWLE, practitioners and researchers with the purpose to guide research. Data will be used to develop guidelines for best practice in involving PWLE in dementia and forensic mental health research through advisory boards.

METHODS

The research project will be divided into three phases: Phase I will involve two topic-specific systematic reviews on the use of participatory research with PWLE, followed by an initial study exploring PWLE's, practitioners' and researchers' expectations on research involvement. Phase II will consist of the establishment of three advisory boards, one focusing on dementia, one on forensic mental health and one overarching coordinating advisory board, which will involve PWLE from both fields. Phase III, will consist of interviews and focus groups with advisory board members, exploring any challenges and benefits of involving PWLE and practitioners in advisory boards for guiding research. To capture the impact of involving PWLE in different research phases and tasks, interviews and focus groups will be conducted at four different points of time (0, 6, 12, 18 months). Reflexive thematic analysis will be used for the analysis of data.

DISCUSSION

The project aims to explore the involvement of PWLE and practitioners in guiding research and aims to develop guidelines for best practice in establishing and using patient advisory boards in dementia and forensic mental health research and involving PWLE and practitioners in research.

Developing a research tool to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals

WHAT IS KNOWN ON THE SUBJECT

Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their career Norway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation We have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool.

WHAT ARE THE IMPLICATIONS FOR NURSES

Applying the 'Global Trigger Tool-Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers. Implementing 'Global Trigger Tool-Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden.

ABSTRACT

INTRODUCTION: There is little consensus on cross-cultural and cross-national adaptation of research instruments.

AIM/QUESTION

To translate and validate a Swedish research tool (GTT-P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process.

METHOD

The GTT-P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross-cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records.

RESULTS

We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co-production was essential for both the translation and adaptation of the research instrument.

DISCUSSION

We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT-P in hospital-based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses.

IMPLICATIONS FOR PRACTICE

When translating and validating the GTT-P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT-P can promote greater patient safety in hospital settings.

Stakeholder perspectives on co-designing a post-registration mental health nursing curriculum: A case study

INTRODUCTION

Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad-hoc and tokenistic, with limited input at the program development level.

AIM

To explore the co-design processes and outcomes of a collaborative revision of an Australian post-registration mental health nursing curriculum.

METHOD

Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co-designing a post-registration mental health nursing curriculum were explored.

RESULTS

Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect.

DISCUSSION

While it was possible to support and augment stakeholder knowledge in the context of post-registration education, co-design processes were ultimately bound by the university's relatively inflexible bureaucratic context.

IMPLICATIONS FOR PRACTICE

To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co-design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development.

Patients' negative experiences with health care settings brought to light by formal complaints: A qualitative metasynthesis

INTRODUCTION

Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices.

AIMS

To synthesise evidence from qualitative primary studies on patients' negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care.

DESIGN

Metasynthesis inspired by Sandelowski and Barroso.

METHODS

A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted.

RESULTS

Twenty-four reports were included, and four main themes were extracted from the metasynthesis: (1) problems with access to health care services; (2) failure to acquire information about diagnosis, treatment and the expected patient role; (3) experiencing inappropriate care and bad treatment; (4) problems with trusting health care service providers.

CONCLUSIONS

Negative patient experiences impact patients' physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care.

RELEVANCE TO CLINICAL PRACTICE

Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritise patient participation.

REPORTING METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

PATIENT OR PUBLIC CONTRIBUTION

Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public.

How well do policymakers address stigma surrounding substance use disorders: lessons from a qualitative review of Scottish Alcohol and Drug Partnerships' strategic plans

Background

Stigma is a significant barrier to the successful implementation of public health policies which aim to reduce harm from substance use disorders. Despite attention being given to stigma in the literature for at least a decade, evidence on what works to reduce it is limited and inconclusive. Without clear guidance, policymakers could be limited in their ability to develop evidence-informed strategies for reducing stigma. In response to a steep incline in drug-related deaths in Scotland since 1996, the Scottish Government has committed to tackling stigma in national drug policy. Scotland's 31 Alcohol and Drug Partnerships are responsible for developing local strategies that aim to tackle harm from substance use disorders. This qualitative review explored how well these strategies respond to stigma and identified approaches mentioned that could have implicit implications for tackling stigma.

Methods

The strategic plans of Alcohol and Drug Partnerships across Scotland were identified and thematically analysed to identify key themes relating to stigma. Content of strategic plans was initially coded under a coding scheme of four broad categories: content that explicitly mentioned stigma; identity, status and power; deservedness of support; and attribution of responsibility for SUDs.

Results

Twenty-four strategic plans were identified and analysed, with four themes emerging: (1) limited clarity and consistency on how stigma will be directly tackled by ADPs; (2) recognition of the positive contribution that people with substance use disorders can make towards decisions about treatment and support; (3) diversion of people with substance use disorders away from the criminal justice system towards quality support underpinned by human rights; and (4) recognition of the complex determinants of substance use disorders and that everyone has a role to play.

Conclusion

Alcohol and Drug Partnerships acknowledged the importance of tackling stigma in their strategic plans but provide limited clarity on how this will be done. This review calls for the inclusion of more evidence-informed strategies for tackling stigma within the Scottish local policymaking context. This requires academic, policymaking and lived experience communities to collaborate to test and evaluate innovative responses to tackling in stigma to strengthen understanding of what works in which contexts.

The immaturity of patient engagement in value-based healthcare-A systematic review

Introduction

In recent years, Value-Based Healthcare (VBHC) has been gaining traction, particularly in hospitals. A core VBHC element is patient value, i.e., what matters most to the patient and at what cost can this be delivered. This interpretation of value implies patient engagement in patient-doctor communication. Although patient engagement in direct care in the VBHC setting is well described, patient engagement at the organizational level of improving care has hardly been studied. This systematic review maps current knowledge regarding the intensity and impact of patient engagement in VBHC initiatives. We focus on the organizational level of a continuous patient engagement model.

Methods

We performed a systematic review following PRISMA guidelines using five electronic databases. The search strategy yielded 1,546 records, of which 21 studies were eligible for inclusion. Search terms were VBHC and patient engagement, or similar keywords, and we included only empirical studies in hospitals or transmural settings at the organizational level.

Results

We found that consultation, using either questionnaires or interviews by researchers, is the most common method to involve patients in VBHC. Higher levels of patient engagement, such as advisory roles, co-design, or collaborative teams are rare. We found no examples of the highest level of patient engagement such as patients co-leading care improvement committees.

Conclusion

This study included 21 articles, the majority of which were observational, resulting in a limited quality of evidence. Our review shows that patient engagement at the organizational level in VBHC initiatives still relies on low engagement tools such as questionnaires and interviews. Higher-level engagement tools such as advisory roles and collaborative teams are rarely used. Higher-level engagement offers opportunities to improve healthcare and care pathways through co-design with the people being served. We urge VBHC initiatives to embrace all levels of patient engagement to ensure that patient values find their way to the heart of these initiatives.

Stories for Change: The impact of Public Narrative on the co-production process

INTRODUCTION

Involving service users in health service design and delivery is considered important to improve the quality of healthcare because it ensures that the delivery of healthcare is adapted to the needs of the users. Co-production is a process used to involve service users, but multiple papers have highlighted the need for the mechanisms and values guiding co-production to be more clearly stated. The aim of this paper was to evaluate the mechanisms and values that guided the co-production approach of the Stories for Change project, which used Public Narrative as part of the co-design process to create change in National Health Service maternity services.

METHODS

This study was conducted using a rapid feedback evaluation approach. Semistructured interviews (n = 16) were the main source of data, six of which were maternity service users, with observations (5 h) and documentary analysis also carried out in parallel. RREAL sheets were used for data analysis to organize data based on key topics of interest.

RESULTS

This study identified three broad mechanisms and values underpinning the co-production approach: creating an open and safe space to share ideas, learning how to tell stories using Public Narrative and having service providers who play a key role in strengthening the health system listen to stories compelling them to action. This study identified the main areas for improvement of the Stories for Change project related to recruitment, the inclusion of participants, the co-design process, the Skills Session and the Learning Event.

CONCLUSION

Our study provided a deeper understanding of the co-production approach that addresses the need to uncover the mechanism and values underlying co-production and co-design approaches. This study expands on the literature pertaining to the influence of storytelling in creating meaningful change in health care. We propose a co-design methodology that uses Public Narrative as a model for service user engagement to help inform future healthcare development processes.

PATIENT OR PUBLIC CONTRIBUTION

The experiences and perceptions of maternity service users and health professionals informed this evaluation. The project organizers were involved in the manuscript preparation stage by providing feedback, and service users wrote a commentary on the project from the lived experience perspective.

Developing sustainable patient and public involvement in mesothelioma research: multi-method exploration with researchers, patients, carers, and patient organisations

BACKGROUND

Rare diseases where prognosis is poor provide limited scope for patient and public involvement (PPI). One such disease is mesothelioma, a cancer of the lung pleura or of the peritoneum caused by exposure to asbestos, where PPI is poorly documented. We undertook to explore how PPI could be facilitated in mesothelioma research.

METHODS

An online survey with mesothelioma researchers (n = 23) assessed the perceived benefits and challenges of PPI in mesothelioma. Six online workshops and thirteen in-depth interviews with patients and the public explored their views on how PPI could be increased in mesothelioma and their motivations to become PPI representatives in the future. The survey data were analysed using descriptive statistics and the interviews, using Thematic Analysis.

RESULTS

In the survey, 26% (n = 6) of the researchers did not include PPI in their research, while 74% (n = 17) did, finding it most beneficial at the stages of applying for funding and dissemination. The main perceived benefits of PPI were clarifying the research question and outcome measures, making research more credible and relevant to patients' needs, and increasing its impact. The main perceived challenges to PPI were the general poor prognosis in mesothelioma, and funding timescales which hindered timely recruitment of PPI representatives. The analysis of the interviews with the patients and public revealed three main themes: "Motivations to become a PPI representative in the future", "Understanding the nature of PPI during the project", and "Perceived challenges to PPI in mesothelioma". Altruism and the need for hope were the main reasons to wish to become involved in PPI in the future. For many participants, the project proved to be a journey of understanding the nature of PPI, a concept that was not easy to grasp from the start. The participants perceived certain barriers to PPI such as high symptom burden in mesothelioma, the abstract concept of PPI, and the use of scientific language.

CONCLUSIONS

The present research provides a detailed picture of the benefits and challenges of PPI in mesothelioma. We recommend long-term engagement with mesothelioma support groups so that researchers achieve meaningful and sustainable PPI in mesothelioma research.

Advancing Health Equity in Community-Based Climate Action: From Concept to Practice

Despite broad agreement that prioritizing health equity is critical to minimizing the health impacts of climate change, there is a lack of clarity about what advancing health equity means in practice. More than reducing health disparities; it also implies engaging and empowering marginalized communities. We propose a typology of health equity processes, focused on building community agency and power, and then apply it to a nonrepresentative, purposive sample of 48 community-based climate actions (CBCAs) selected from lists of projects funded by foundations and state climate programs and from other sources. All CBCAs were in the United States, community-based, active since 2015 or more recently, engaged in climate mitigation or adaptation, and stated health equity aims. Two team members reviewed project reports to assess the engagement of vulnerable and marginalized populations, agency-building, and transformation of community power relationships. Although 33 CBCAs reported efforts to build community agency, only 19 reported efforts to increase community power. City-led CBCAs showed less emphasis on agency-building and power transformation. This typology can support efforts to advance health equity by providing concrete indicators to diagnose gaps and track progress. (Am J Public Health. 2023;113(2):185-193. https://doi.org/10.2105/AJPH.2022.307143).

Changes to utilization and provision of health care in German GP practices during the COVID 19-pandemic: Protocol for a mixed methods study on the viewpoint of GPs, medical practice assistants, and patients

INTRODUCTION

During the COVID-19 pandemic, general practitioners (GPs) continued to be a main point of contact for patients. For GP practices, it was and still is a challenge to meet constantly changing requirements due to the various phases of the pandemic. The aim of the study is to explore retrospectively the subjective experience with supply and utilization of health care services from the perspective of general practitioners, medical practice assistants and patients, in particular regarding instances of underutilization of services for non-Covid related conditions, adjustments due to the pandemic, and the appropriateness of care.

METHODS

The study is carried out within the RESPoNsE research practice network in three of Germany's federal states: Berlin, Brandenburg, and Thuringia (RESPoNsE-Research practice network east). The study follows a convergent mixed method design, and consists of the following sections: a) two anonymous paper-based questionnaires filled out by GPs and medical practice assistants (MPAs), at an interval of 12 to 18 months; b) in-depth qualitative interviews conducted among a subgroup of GPs and MPAs; c) anonymous paper-based questionnaires among patients of participating practices. The idea for the study was derived from discussions with the practice advisory board of the RESPoNsE network. The themes and issues to be explored in the surveys and interviews are developed and discussed in the practice advisory board, the patient advisory board, and with interested MPAs. The questionnaires will be analyzed descriptively, exploring the effect of demographic variables. Qualitative content analysis is used to analyze the data from the interviews and focus groups.

DISCUSSION

The study focuses on the conditions of GP care during the COVID-19 pandemic. A broad insight is provided as GPs and MPAs, as well as patients, are involved. It provides the opportunity to express needs and concerns. The results can support future discussions on lessons learned from the pandemic and necessary changes in health care delivery.

TRIAL REGISTRATION

Trial registration at the German Clinical Trials Register: DRKS00028095.

Primary healthcare professionals' experience with patient participation in healthcare service development: A qualitative study

Objective

How healthcare professionals experience patient participation in health service development impacts its use. This participatory study explores primary healthcare professionals' perceptions of developing health services with patient representatives.

Methods

Four focus group interviews with primary healthcare professionals (n = 26) were conducted. We analyzed data by applying Braun and Clarke's reflexive thematic analysis.

Results

The healthcare professionals perceived having a complementary interprofessional relationship with the patient representatives and regarded them as colleagues. However, the professionals navigated between a position of authority and collaboration, reconciling the need for participation with its challenges, e.g., to identify the representatives' collective representation among their personal experience, to ensure a more evidence-informed result that they and their colleagues would endorse.

Conclusions

Regarding patient representatives as colleagues can blur the line between professionals and representatives' positions and functions and further complicate health service development. Our results indicate a need for skilled facilitators to lead the process.

Innovation

This study identifies issues that professionals are uncertain about when collaborating with representatives to develop primary healthcare services; difficulties that professionals must overcome to collaborate constructively with representatives. Our findings can inform healthcare professionals' education about patient participation on all levels. We have suggested topics to address.

Keeping track of and recognizing the value of Public Involvement work in dementia research

The Public Involvement (PI) of people with dementia is slowly but progressively moving from a "nice to have" to a "must have" element of good-quality dementia research. Research funders and ethics committees increasingly ask for evidence of the planning of such involvement. The actual conduct and outcome of PI are, however, unfortunately typically under or inadequately reported. In this article, we provide an overview of what PI is and why it is important to dementia research and Alzheimer Europe's approach to PI. We draw on our recent experience of compiling a set of examples of PI in different European projects in publicly available sources. This highlighted the difficulty of finding information about PI activities and the almost total lack of details of such activities in formal reports, official records, and/or public project websites. In this article, we emphasize gaps and call for more stringent conditions for the inclusion and reporting of PI work in the context of the approval and funding of dementia research projects. We call for the establishment of obligatory reporting on the nature, specific challenges, and impact of PI in dementia research in formal reports (e.g., to funders), in public project websites, and in peer-reviewed articles. Such reporting should cover several key factors such as who was involved, how they were involved, and what impact PI had on the research process.

Participação pública em saúde e Covid-19 em Portugal

RESUMO Nas últimas décadas, o tema da participação pública em processos de decisão tem estado presente nas agendas políticas, com mais ou menos centralidade, em vários contextos democráticos do mundo. No campo da saúde, a participação pública apresenta-se como estratégia política com potencialidades para garantir maior corresponsabilização entre os atores envolvidos e para incrementar a transparência dos serviços, sendo enfatizada como boa prática que deve ser implementada em prol da qualidade das decisões, mas também de decisões que sejam orientadas para os reais problemas das populações. A pandemia da Covid-19 trouxe pressões adicionais aos sistemas de saúde, constituindo-se como contexto propício à análise da participação cidadã nos processos de decisão que enquadram problemas de saúde na sua relação com a pandemia. Este ensaio apresenta uma análise exploratória sobre a evolução das práticas de participação cidadã nas políticas de saúde em Portugal, destacando alguns dos seus desafios atuais e futuros. Procura-se, assim, compreender como a pandemia teve ressonância na forma como a participação em saúde vinha decorrendo no País, aferindo se, em um período global de crise com características singulares, a pandemia, enquanto problema coletivo, distendeu ou contraiu essas práticas participativas.

Public participation in health and COVID-19 in Portugal

ABSTRACT In the last decades, public participation in decision-making processes has been an ongoing theme, assuming more or less centrality, within the political agendas in several democratic contexts around the world. In the health domain, public participation has been considered a political strategy with the potential of ensuring greater co-responsibility among the actors involved, as well as to increase health services’ transparency, thus being emphasized as one of the best practices that should be implemented towards the quality of decisions, especially those oriented to the real health problems of the populations. The COVID-19 pandemic brought additional pressures to health systems, constituting itself as a conducive context to the analysis of citizen participation in health decision-making processes. This essay presents an exploratory analysis on the evolution of citizen participation practices in health policies in Portugal, highlighting some of its current and future challenges. The present analysis aims to understand how the pandemic resonated in the way in which participation in the health domain had been carried out in the country, assessing whether, in a singular global period of crisis, the pandemic as a collective problem expanded or contracted these participatory practices.

Co-Creation and Co-Production of Health Promoting Activities Addressing Older People-A Scoping Review

The global population is aging and the promotion of health and well-being for this generation is essential. Co-creative and co-productive practices can be solutions to welfare challenges in local policies. Therefore, this scoping review aimed to understand the extent and type of evidence in relation to the co-creation and co-production of health-promoting activities addressing older people aged 60+ years and to examine the influence of co-creative and co-productive activities on health and well-being, including influential factors for co-creation and co-production. We searched for peer-reviewed and grey literature in ten scientific and five non-scientific databases. From the 2648 studies retrieved, 18 articles were included in this review. Then, an inductive thematic content analysis was applied to the analysis. Three categories related to co-creative and co-productive activities emerged: "Social and physical activities", "Development of age-friendly environments", and "Discussions of healthy and active aging". Facilitating factors for co-creation and co-production were related to the planning and structure of the process and recognition of participants' time and resources, while the recruitment of participants and their time and resources were the main barriers. Future studies should target co-creative and co-productive interventions to concrete areas and specific sub-groups and be aware of factors influencing a co-creative or co-productive relationship with older people.

Patients as experts in the illness experience: Implications for the ethics of patient involvement in health professions education

In response to calls to increase patient involvement in health professions education (HPE), educators are inviting patients to play a range of roles in the teaching of clinical trainees. However, there are concerns that patients involved in educational programs are seen as representing a demographic larger than themselves: their disease, their social group or even patients as a whole. This leads to difficult ethical challenges related to representation, including problems of tokenistic inclusion and of inadvertently essentializing marginalized groups. We propose that conceptualizing patients as experts in their illness experience can help resolve these dilemmas of representation equitably and effectively. Just as clinical experts are involved in HPE to share their expertise and represent their clinical experience, so too should patients be invited to participate in HPE explicitly for their expertise in their illness experience. This framing clarifies the goals of patient involvement as technocratic rather than tokenistic, mandates meaningful contributions by patients, and helps frame patient involvement for learners as the presentation of expert perspectives.

Gaining 'clarity through specificity' in invited patient participation: A case study of a multifaceted participatory practice in the Netherlands

Patient participation is a highly valued principle. Yet, it remains difficult both to achieve it and to assess its added value, as participation is often started without much clarification of what it means or aims to do. In theory, patients may be invited to participate for reasons of democracy, empowerment, knowledge integration and instrumentalism. By making these rationales explicit in a participatory practice in the Netherlands, we aimed to contribute to the long-needed 'clarity through specificity' in participation. Apart from the rationales, our analytic framework included dimensions of the participatory process, reflected by questions like 'Who participates?', 'In what?' and 'With how much control?' We used this framework to conduct and analyse semi-structured interviews (n = 51) with patient participants (20), professionals (14) and researchers (17). We found that the participatory practice included all rationales and that the actual manifestation of an intended rationale very much depended on the design of the dimensions of the participatory process. We conclude that invited participation may gain in clarity by making explicit the rationales for participation. If put at the centre of attention, and made the leading factor in the design of the dimensions of the participatory process, explicit rationales may support the realisation of participation in practice and prevent it from resulting in mere window-dressing.

User involvement in ageing and health research: a survey of researchers' and older adults' perspectives

BACKGROUND

User involvement in research has rapidly increased and is often a precondition to obtain research funding. Benefits such as effectiveness and increased relevance of research are described in the literature, but the evidence to support this is weak. Little is known about ageing and health researchers' experiences and perspectives towards user involvement in research, and their attitudes towards user involvement compared to the attitudes of the users involved are largely unknown. To examine researchers' experiences and perspectives of user involvement in research on ageing and health, and to compare their attitudes towards user involvement to the attitudes of older adults in the general population.

METHODS

A panel study survey was used to elicit responses from researchers in ageing and health as well as from older adults (aged 60 years and older). The researcher sample (N = 64) completed the survey online, while the older adult sample (N = 881) could choose among three different options to complete the survey (online, paper format, telephone). A professional survey company collected the data. Descriptive statistics, exploratory comparisons and descriptive qualitative content analysis were used to analyse the data.

RESULTS

More than half (58%) of the researchers had previous experience of involving different categories of users in a wide range of research activities. The most frequent motivation for involving users was to ensure that the research produced is relevant to the target population. A majority (86%) reported benefits, and more than half (59%) described challenges. Differences in attitudes were found between researchers and older adults in the general population.

CONCLUSIONS

Ageing and health researchers involve users in their research to improve quality and ensure relevance, but there is no consensus among them whether users should be involved in publicly funded research. While several challenges were identified, training, institutional support and resources from funders could alleviate many of these. Findings reveal significant differences in attitudes between older adults in the general population and researchers. Further research with comparable larger samples is needed to confirm and understand the possible consequences such controversy might have and how to solve them. IRRID (International Registered Report Identifier): RR2-10.2196/17759.

Neurodivergent participatory action research for Virtual Reality (VR)

Purpose

This paper aims to raise awareness of and argue for the use of participatory methods for the research and development of Virtual Reality (VR) applications designed for neurodivergent groups. This includes exploring why it is important to meaningfully include neurodivergent groups and the benefits their inclusion provide.

Design/methodology/approach

VR is becoming increasingly widespread as a consumer product and interventional tool. It is vital for researchers and developers to embrace best practices in these early stages of using the technology, making certain that neurodivergent people have the best possible outcomes.

Findings

The neurodivergent community is dissatisfied with many of the research directions currently being undertaken. This dissatisfaction arises from conflicting priorities between different stakeholders and the lack of input from the community. Participatory research brings neurodivergent people into the research process, whether as members of the research team or as consultants at key steps. Effective participatory research ensures that the priorities of the neurodivergent community are better incorporated in research, as well as enabling the development of more effective applications for VR.

Originality/value

Participatory methods are unutilised in the development of applications aimed for neurodivergent people. By describing their use and utility in other areas, this article aims to encourage other VR researchers to take neurodivergent people on board.

Conceptualising Inclusion and Participation in the Promotion of Healthy Lifestyles

The central tension in health promotion is between a public health policy presumption that healthy lifestyles have benefits at both the individual and societal levels and should be assertively encouraged, and liberal demands that states should maintain a stance of non-interference concerning private affairs. This tension is heightened when the engagement of marginalised or disempowered groups, such as persons with disabilities, women, or immigrants, enter discussions. This paper examines the concept of inclusion within the context of the promotion of healthy lifestyles, primarily sport and physical activity in community contexts. Using a form of 'reflective equilibrium', it explores a series of distinctions to evaluate critically different accounts of inclusion and offers a novel and somewhat radical approach based on re-interpretations and alignments of participation and hegemonic relationships.

Nothing about us, without us: is for us

BACKGROUND

Public Participation Involvement Engagement (PPIE) is now strongly encouraged across health policy and research. Coproduction, although linked to PPIE is a way of working that can be applied to work collaboratively with participants in health. However, a lack of definition which leads to interchangeable terminology, limited guidance and examples of good practice on how to facilitate the process impedes progress. The Born in Bradford (BiB) research programme consists of a family of observational and longitudinal birth cohort studies (Raynor et al. in BMC Public Health 8:1-13, 2008; Dickerson et al. in BMC Public Health 16(1):1-14, 2016) which include participants from multi-ethnic and socially diverse backgrounds (Uphoff et al. in Int J Equity Health 12:1-12, 2013).

METHODS

This paper aims to highlight our approach to PPIE and coproduction methodologies, to provide an outline of the methods we have utilised to work collaboratively with our cohort populations from diverse communities and how we have managed to overcome challenges to achieve successful PPIE.A secondary aim of this paper is to demonstrate the value of PPIE and coproduction and how it can enhance research.  Some examples from recent years are provided to demonstrate how useful the approach has been for BiB community engagement and community participation. In addition, we discuss the methods we have used and how this methodology has now been embedded into protocol and practice in our research.

RESULTS

Successful and productive PPIE and coproduction occur where stakeholders are taken on board and realise the impact that their involvement can have in terms of policy design and delivery.

CONCLUSIONS

The involvement of participants and the community in research about them becomes more credible when equal partnerships are formed and they are involved in the whole process leading to community ownership of research. Hence, nothing about us, without us-is for us.

Participatory Visual Methods with caregivers of children with Congenital Zika Syndrome in Colombia: A case study

Background: This study explores the acceptability and feasibility of the use of two different Participatory Visual Methods (Participatory Video and Digital Storytelling) in gathering information on the experiences and perspectives of carers of children with Congenital Zika Syndrome within Colombia. Methods: Participatory Video was used to assess the impact of the Juntos parent-support intervention in the lives of carers, and Digital Storytelling was used to explore the healthcare access for these children. In-depth interviews were conducted to probe participants on their views of these methods. Results: One Participatory Video was produced and four Digital Stories. Of the initial eight caregivers who took part in the Participatory Video process, four completed both the Digital Storytelling process and an in-depth interview about their experiences. The main factors shaping participants' experiences related to the skills learned in making the videos, the feeling of collectiveness and the control over the processes. Conclusions: Women with children with Congenital Zika Syndrome have reported feeling marginalised and misunderstood in daily life. This case study found that Participatory Visual Methods is acceptable and feasible. Moreover, these approaches can support groups in different aspects, such as providing a space to share their stories creatively, hear others in similar situations as them and increase the feeling of community.

The role of advocacy and empowerment in shaping service development for families raising children with developmental disabilities

Introduction

Empowerment of families raising children with developmental disabilities (DDs) is essential to achieving rights‐based service development.

Methods

In this qualitative study, we investigated stakeholder perceptions on the role of advocacy and empowerment in developing caregiver interventions for families of children with DDs in a global context. Participants had experience with at least one intervention, namely the Caregiver Skills Training developed by the World Health Organization (WHO). Participants were clinicians, caregivers and researchers representing five continents, and representatives of WHO and Autism Speaks. Two focus group discussions and 25 individual interviews were conducted. Data were analysed thematically.

Results

Three themes were developed: empowerment as independence and as a right; the role and practices of advocacy; and using evidence to drive advocacy. Many professional participants defined empowerment within the realms of their expertise, focusing on caregivers' individual skills and self‐confidence. Caregivers expressed that this expert‐oriented view fails to acknowledge their intuitive knowledge and the need for community‐level empowerment. Participants discussed the challenges of advocacy in light of competing health priorities. The gap between the rights of caregivers and the availability of services, for example, evidence‐based interventions, was highlighted as problematic. Scientific evidence was identified as a key for advocacy.

Conclusion

Rights‐orientated empowerment of caregivers and advocacy may make vital contributions to service development for children with DDs in contexts worldwide.

Patient and Public Contribution

Research questions were revised based on views presented during focus group discussions. Participant feedback on preliminary themes informed the development of the interview guides.

A meta-ethnography of participatory health research and co-production in Nepal

As global health research seeks to decolonialise, democratise, and become more culturally engaging, researchers are increasingly employing participatory and co-productive methods. Working from post-structural perspectives, this meta-ethnographic review explores how such health research in Nepal engages with the epistemological, methodological, and ethical questions it encounters. Five databases including Nepali NepJOL were searched for studies from inception to March 2021. The review included seven studies covering women's group co-production, interviews guided by photo-elicitation, observational methods to explore maternal and child health, mental health, and environmental determinants of health. This meta-ethnography identified that, against the background of a pluralist heritage of health practices, global collaborations involving Nepali researchers and practitioners used participatory research methodology to work with the local populations to improve health and co-production seek primarily to promote Western biomedical and psychosocial interventions. Both advantages and disadvantages were acknowledged. Empirical verification and global acceptance of Western biomedical and psychosocial knowledge were seen as beneficial. Moreover, Western biomedicine was perceived by some as more effective than some local practices in improving health; nevertheless, Nepal faces many challenges that neither can address alone. For participatory and co-productive approaches to become epistemologically enculturated within Nepali health research, researchers need to co-develop more local models and methods which are culturally sensitive and appropriate. Meaningful and effective participatory research can promote active involvement of people who deliver as well as people who use the community-based health care support. These are crucial to optimise sustainable change that global health research partnerships set out to achieve. This meta-ethnography recommends that researchers engage at a deeper level with the epistemological differences between themselves and the communities with whom they seek partnership. Cross-cultural research teams should discuss and address the power differentials which might affect them.

On the Road Together: Issues Observed in the Process of a Research Duo Working Together in a Long-Term and Intense Collaboration in an Inclusive Research Project

Inclusive research practices can lead to progress towards an inclusive society. With this study, we aimed to gain insight into dilemmas and catalysing processes within the long-term collaboration of an inclusive research duo: one non-academic researcher who lives with the label of intellectual disabilities and visual impairment, and one academic researcher. Both researchers kept personal diaries about their collaboration process. Inductive thematic analysis, individually and as a group of authors, was employed. Our findings reveal six necessary conditions for diversity-sensitive work in inclusive research: (a) experiencing belonging within the research group, (b) empowering people in a team through growing self-awareness and competence-building, (c) having room for reflection and searching for various ways of communication, (d) sharing power and ownership of research processes, (e) having enough time to foster the above conditions, and (f) joining in a mutual engagement in accommodating vulnerability in dialogue and collaborative work. Awareness of stigma-related issues and the risk of tokenism is also required.

Arksey and O'Malley's consultation exercise in scoping reviews: A critical review

AIMS

To explore how consultation exercises were described in a convenience sample of recent scoping reviews.

DESIGN

Critical literature review.

DATA SOURCES

We searched PsycINFO, Embase, CINAHL and PubMed in July 2020. Our inclusion criterion was a peer-reviewed journal article reporting a scoping review in Danish, English, Norwegian or Swedish.

REVIEW METHODS

We identified a convenience sample of articles (n = 66) reporting a consultation exercise as part of a scoping review. The descriptions of the consultation were charted, summarized and critically discussed.

RESULTS

The current analysis showed no widely accepted consensus on how to approach and report a consultation exercise in the sample of scoping reviews. The reports of stakeholder consultation processes were often brief and general, and often there were no reports of the effects of the stakeholder consultation processes. Further, there was no discussion of the principal theoretical problems mixing stakeholder voices and review findings.

CONCLUSION

The finding that conventional research ethics and research methods often were suspended could indicate that the stakeholder consultants were in a precarious position because of power imbalances between researchers and stakeholder consultants. We suggest that a consultation exercise should only be included when it genuinely invites participation and reports on the effect of alternative voices.

IMPACT

Scoping reviews are common across a range of disciplines, but they often lack definitional and methodological clarity. In their influential approach to scoping studies, Arksey and O'Malley introduced an optional 'consultation exercise', which has been heralded as a valuable tool that can be used to strengthen the process and outcome of a scoping study and to support the dissemination of the study's findings and its implications. However, there is no clear outline on about how to operationalize consultations of stakeholders in scoping studies/reviews. This article includes recommendations for consultation exercises, including encouraging an aspirational move from 'consultation' to 'participation'.

Participatory Visual Methods with caregivers of children with Congenital Zika Syndrome in Colombia: A case study

Background: This study explores the acceptability and feasibility of the use of two different Participatory Visual Methods (Participatory Video and Digital Storytelling) in gathering information on the experiences and perspectives of carers of children with Congenital Zika Syndrome within Colombia. Methods: Participatory Video was used to assess the impact of the Juntos parent-support intervention in the lives of carers, and Digital Storytelling was used to explore the healthcare access for these children. In-depth interviews were conducted to probe participants on their views of these methods. Results: One Participatory Video was produced and four Digital Stories. Of the initial eight caregivers who took part in the Participatory Video process, four completed both the Digital Storytelling process and an in-depth interview about their experiences.  The main factors shaping participants’ experiences related to the skills learned in making the videos, the feeling of collectiveness and the control over the processes. Conclusion: Women with children with Congenital Zika Syndrome have reported feeling marginalised and misunderstood in daily life. This case study found that Participatory Visual Methods is acceptable and feasible. Moreover, these approaches can support groups in different aspects, such as providing a space to share their stories creatively, hear others in similar situations as them and increase the feeling of community.

How and how well have older people been engaged in healthcare intervention design, development or delivery using co-methodologies: A scoping review with narrative summary

Co-methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. Our aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co-methodologies. We conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. We included peer-reviewed empirical research of any design. Three authors screened papers. Our review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, we have referred to the preferred reporting items for systematic reviews and meta-analyses statement. We data extracted to a bespoke spreadsheet and used the Co:Create Co-production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co-methodologies and reporting. We offer a narrative summary of included papers. Establishing how older people were engaged in co-methodological work was largely straightforward. How well this was done was more challenging, however we have identified gems of good practice and offered directions for future practice. The Co:Create Co-Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence we argue that notions of 'best' and 'scores' are an oxymoron in co-methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances.

A systematic review that evaluates the extent and quality of involving childhood abuse survivors in shaping, conducting and disseminating research in the UK

Despite a well-established understanding of the mental and physical health consequences associated with exposure to childhood abuse, the active voices of survivors are rarely present in shaping, conducting and disseminating research. To explore the extent and quality of involvement with adult survivors of childhood abuse in the UK, we performed a systematic review of research conducted ‘with’ or ‘by’ survivors, and analysed involvement against a new instrument, the Survivor Research Involvement Ladder, which was co-produced drawing from the principles of the Survivors Voices Charter. A search of relevant grey and peer-reviewed literature was conducted, which retrieved 662 sources after removing duplicates. Of these, 116 full-text articles on adult survivors of childhood abuse in the UK were subsequently assessed for involvement (beyond participation as ‘subjects’), of which only 15 (12.9 per cent) reported activities led, co-produced, advised or consulted on by survivors, and these were included in the review. From evaluations and analysis using the ladder, consumerist models were found to be the dominant form of involvement, with survivors filling advisory roles at isolated stages. Survivor-led research was scarce but emerged when survivor-researchers planned, conducted and disseminated their work. This review finds considerable opportunity for improvements in the level, quality and subsequent reporting of research activities involving survivors. The use of the instrument needs replication, validation and further field-testing.

Participatory autism research: Early career and established researchers' views and experiences

LAY ABSTRACT

'Participatory autism research' refers to ways of involving autistic people and their allies (e.g. family members) in making decisions about research. These decisions can include what research gets done, how it gets done and how research findings are used. While there is more and more interest in participatory autism research, we know little about how researchers at different stages of their careers use this approach. To find out more, we discussed these issues with 25 researchers. Fourteen of these were at an early stage of their careers, and 11 were more senior researchers. We spoke to people in individual interviews or in groups. We then used a technique called thematic analysis to analyse our data, which involved us looking for common topics or 'themes' discussed by our participants. What did we find? Our participants told us that participatory autism research was a flexible approach, meaning that autistic people can be involved in research in many different ways. While people viewed this flexibility in a positive way, it also caused some confusion about what does or does not 'count' as participatory research. Our participants also spoke about how important it was to build relationships with those involved in their research, but they also said it could be difficult to communicate well with diverse groups of people who may not have much experience of research. Finally, our participants said it was hard to do participatory research when there was not much time, funding or support available to researchers. In this article, we discuss these findings, focusing on what needs to change to ensure that autistic people and their allies are meaningfully involved in autism research.

"Must you make an app?" A qualitative exploration of socio-technical challenges and opportunities for designing digital maternal and child health solutions in Soweto, South Africa

Participatory and digital health approaches have the potential to create solutions to health issues and related inequalities. A project called Co-Designing Community-based ICTs Interventions for Maternal and Child Health in South Africa (CoMaCH) is exploring such solutions in four different sites across South Africa. The present study captures initial qualitative research that was carried out in one of the urban research sites in Soweto. The aim was twofold: 1) to develop a situation analysis of existing services and the practices and preferences of intended end-users, and 2) to explore barriers and facilitators to utilising digital health for community-based solutions to maternal and child health from multiple perspectives. Semi-structured interviews were conducted with 28 participants, including mothers, other caregivers and community health workers. Four themes were developed using a framework method approach to thematic analysis: coping as a parent is a priority; existing services and initiatives lack consistency, coverage and effective communication; the promise of technology is limited by cost, accessibility and crime; and, information is key but difficult to navigate. Solutions proposed by participants included various digital-based and non-digital channels for accessing reliable health information or education; community engagement events and social support; and, community organisations and initiatives such as saving schemes or community gardens. This initial qualitative study informs later co-design phases, and raises ethical and practical questions about participatory intervention development, including the flexibility of researcher-driven endeavours to accommodate community views, and the limits of digital health solutions vis-à-vis material needs and structural barriers to health and wellbeing.

OUP accepted manuscript

In health promotion research, enthusiasm for patient and public involvement (PPI) is growing. However, a lack of conceptual clarity leads to ambiguities in participatory processes and purposes, and hampers efforts to achieve and evaluate PPI in research. This study provides an overview of its underlying reasons—or rationales—so as to better understand, guide and interpret PPI in research practice. We conducted a critical review to identify typologies of rationales for PPI. We re-categorized the different types of rationales from these typologies based on their content. We illustrated the resulting categories of rationales with examples from a case study on PPI in research on Lyme disease. Five categories of rationales for PPI were identified. The democratic rationale reflects the normative right of citizens to have a voice in research. The consumerist rationale refers to the economic right of stakeholders with interests to have a say. Rooted in social justice, the transformative rationale seeks to empower marginalized groups. The substantive rationale starts from epistemic considerations and aims to improve the quality of knowledge that research generates. The instrumental rationale is of pragmatic origin and refers to improved efficiency and effectiveness of the research. Our overview of categories of rationales can be used as a frame of reference for PPI in health promotion research. Exploring, stating explicitly and reflecting on the underlying reasons for PPI may help to define realistic purposes, select matching approaches and design appropriate evaluation studies. This might also contribute to the conceptualization of PPI.

Play the Pain: A Digital Strategy for Play-Oriented Research and Action

The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.

A first-hand experience of co-design in mental health service design: Opportunities, challenges, and lessons

In an era of mental health service reform, co-design is emerging as a leading framework to guide the design and implementation of new services. Co-design uses the expertise of clinicians, those with lived experiences of services (both consumers and carers) and provocateurs (curious questioners) to understand a 'problem' and develop innovative strategies to address it. It relies on the creation of a safe environment where power imbalances are acknowledged and mitigated, and decisions are made collaboratively. Understanding how to do this effectively within the mental health sphere, where experiences of uneven power distribution and trauma are common, can feel overwhelming. Building a shared understanding of the opportunities and limitations within co-design is also important to establish its place within broader mental health reform. This paper uses an experiential approach to reflect on a co-design process, offering an opportunity to learn from a specific example. Factors that enhanced co-design included formal, remunerated roles, the allocation of time to establish and maintain an intimate, trusting team culture, and the capacity for all team members to be vulnerable. Equally important, strategies needed to be employed to mitigate the challenges inherent within the process, including the impact of power differences, a push to make fast-paced decisions, and a sense of cynicism remaining from previous projects or experiences. When these factors are attended to, the process of co-design can be dynamic, innovative, and transformational for the people participating in it, the project and the mental health sector.

Involving service users to identify research priorities in a UK forensic mental health service

AIMS AND METHOD

Patient and public involvement (PPI) is a priority for health research. PPI improves the relevance and quality of research. The study aimed to involve service users in identifying research priorities for the service. A two-phase adapted Delphi technique was used to generate a list of research topics from service users in secure in-patient mental health settings and on specialist mental health prison wings. Topic content analysis was undertaken. Service users were further consulted, and research themes were ranked in order of priority.

RESULTS

Of the eight research themes identified, the three given the highest priority by service users were, in descending order, physical health, future plans and moving on, and causes of illness and crime.

CLINICAL IMPLICATIONS

Service users are willing to be involved in setting research priorities for mental health services. Through non-tokenistic PPI, service users can uniquely shape the research agenda of mental health services.

What motivates informal carers to be actively involved in research, and what obstacles to involvement do they perceive?

BACKGROUND

Due to demographic changes and a strained public sector operating in many countries globally, informal care is increasing. Currently, at least 1.3 million adults in Sweden regularly provide help, support and/or care to a family member/significant other. With no sign of an imminent decrease in their caring activities, it is important that informal carers are considered as a key stakeholder group within research that affects them, e.g., the co-design of carer and/or dyadic support interventions. The objective of this descriptive, quantitative study was to investigate informal carers' perceived motivations and obstacles to become involved in research.

METHODS

A cross-sectional survey design was adopted, using first-wave data from a panel study. The data, collected in Sweden between September 2019 and March 2020, included survey responses from 147 informal carers who were either aged 60+ years themselves or were caring for someone who was aged 60+ years.

RESULTS

Our main results showed that informal carers are, in general, interested in research. Slightly fewer were interested in becoming actively involved themselves, but older age was the only characteristic significantly associated with less interest of being actively involved. Two latent motivational dimensions emerged from the factor analysis: 'family motivation' and 'the greater good motivation'. These, according to our results, almost equally valued dimensions, described the differing reasons for informal carers to become involved in research. The most common perceived obstacle was lack of time and it was reported by more women than men.

CONCLUSION

Our study contributes with new knowledge of informal carers' perceived motivations and obstacles regarding carer involvement in research. Paying attention to the differing motivational dimensions held by informal carers could help researchers create conditions for more inclusive and systematic participation of informal carers within research. Thereby, increasing the opportunities for research that is deemed to be of higher societal impact. IRRID (International Registered Report Identifier): RR2-10.2196/17759.

Nederlandse vertaling en eerste stappen in validatie van de PPEET om burger- en patiёntenparticipatie te evalueren

Hoewel het belang van burger- en patiёntenparticipatie wordt erkend, ontbreekt een Nederlandse maat om de impact van participatie te evalueren. De Canadese Public and Patient Engagement Evaluation Tool (PPEET) is een Engelstalig instrument dat ontwikkeld is om participatie te evalueren. Het instrument bestaat uit drie modules, gericht op verschillende betrokkenen in het participatieproces: burger- of patiёntparticipanten, projectcoördinatoren en organisatiemanagers. Wij vertaalden deze naar het Nederlands volgens de ‘vertalen-en-terugvertalen’ methode.

Vervolgens vulden 46 deelnemers de vragenlijsten in, scoorden zijde vragen op helderheid en gaven ze schriftelijk feedback op de formulering van de vragen. De duidelijkheidsscores en aantal volledige antwoorden gaven een beeld van de haalbaarheid van deze Nederlandse vertaling. De eerste stappen in de validatie van de vragenlijst werden gezet door de Cronbach’s alpha (α) te berekenen over de meerkeuze vragen en met een thematische analyse van de antwoorden op de open vragen. De vragenlijst bleek haalbaar en consistent (α ≥ 0,70). De vertaling werd verder verbeterd door vragen te herformuleren en één vraag te verwijderen op basis van de feedback van de deelnemers. Toekomstige projecten kunnen deze vertaalde PPEET toetsen in een grotere groep met aandacht voor constructvaliditeit en na validatie gebruiken om participatie te evalueren en vergelijken.

How People with Lived Experiences of Substance Use Understand and Experience User Involvement in Substance Use Care: A Synthesis of Qualitative Studies

There is a need for more knowledge on how people with substance use problems (SUPs) understand and experience user involvement when receiving care. In this systematic review, we identify and reanalyse the existing qualitative research that explores how people with lived experiences of substance use understand user involvement, and their experiences of key practices for achieving user involvement. We systematically searched seven electronic databases. We applied Noblit and Hare’s meta-ethnography, revised by Malterud, to identify, translate, and summarise the studies. The electronic search resulted in 2065 articles. We conducted a full-text evaluation of 63 articles, of which 12 articles met the inclusion criteria. The primary studies’ synthesis reveals three different understandings of user involvement: user involvement as joint meaning production, points of view represented, and user representation in welfare services. Key practices for achieving user involvement involved seeing and respecting the service user as a unique person, the quality of the interactional process, and the scope of action for people with SUPs, as well as professionals, including issues of stigma, power, and fatalism. The metasynthesis recognises the ambiguity of the concept of user involvement concept and the importance of including the service user’s perspective when defining user involvement. The analysis of key practices emphasises the importance of relational processes and contextual aspects when developing user involvement concepts.

Innovating the Iowa Congregate Nutrition Program: A Needs and Preference Assessment

Participation in the Congregate Nutrition Program (CNP) is declining. This study examined CNP participation motivators, barriers, menu preferences, desired facility attributes, and educational programming to help identify strategies to increase participation. Four focus groups were held (3 = CNP participants only, n = 21; 1 = non-CNP participants, n = 11). They were audio-recorded, transcribed, and analyzed for common themes. All participants were White and food secure (93.8%). The majority were educated (75.8%), female (72.2%), and aged 71-80 years old (53.1%). CNP participation motivators were affordability, healthy meals, socialization, and location convenience. CNP participation barriers were limited awareness, the low perceived need for attending the CNP, and transportation. Ideal CNP characteristics were menu choice, variety of activities, and a welcoming ambiance. Preferred marketing strategies were print advertising and word of mouth. These findings provide insight as to how the CNP may be modified to be more appealing for the older adult population.