Moving towards a more inclusive patient and public involvement in health research paradigm: the incorporation of a trauma-informed intersectional analysis

Developing a Quality Improvement Framework to Enhance the Health System User Experience for Individuals Living With Type 1 Diabetes: The Reshape T1D Study

INTRODUCTION

User experience design aims to create products and services that are accessible, usable, and enjoyable. The Reshape T1D study aims to apply these principles to understand how individuals living with T1D interact with and experience healthcare to inform T1D clinical quality improvement.

METHODS

Using a community-based participatory research design, we involved four patients and four clinicians as co-researchers throughout the research. A questionnaire and virtual semi-structured interview were applied across a purposeful sample of 41 adults living with T1D across Alberta, Canada, between September 2021 and May 2022. Audio recordings were transcribed verbatim and de-identified before coding. Thematic analysis was conducted on coded participant discourse through multiple coders.

RESULTS

Participants indicated the need for a centralized hub that provides consistent, reliable, and up-to-date T1D education and resources and an emphasis on access to mental health resources within T1D care settings. Providing greater flexibility for appointment types (ie. in-person, virtual, etc.) and after-hours access contributed to better self-management and prevented emergency room visits. Participants desired a choice as to who comprises their T1D care team and for teams to address patient needs specific to their reality. We identified that medical trauma had long-term impacts on perceptions of healthcare and contributed to a reluctance to seek future care. Women expressed challenges in discussing reproductive health with their clinicians. Diabetes online communities provide an adjunct to clinical care through peer support. Cost and access to the latest technology are ongoing barriers for many participants, especially concerning publicly funded programmes that use advanced insulin pump therapy, continuous glucose monitoring, and automated insulin delivery systems. A quality improvement framework emerged through data analysis, and findings were synthesized into actionable recommendations for ongoing clinical quality improvement.

CONCLUSION

Our findings highlight how important health system user suggestions are for more equitable, accessible, and empathetic healthcare for individuals living with T1D. Further work is needed to explore health system user experiences with clinicians and healthcare administrators to effectively carry out T1D clinical quality improvement.

Conducting Intersectional Analysis in Nursing Research

Intersectionality allows nurses to be attuned to the many forms of social marginality present in society that ultimately impact upon health and well-being. However, while intersectionality is often named and well-defined in terms of the theoretical implications, less direction is provided regarding how these principles are actualized in various methodological approaches. This article presents our experiences as a large team of researchers working with a variety of marginalized populations in living out intersectionality in nursing research. We explore a variety of different methods and analysis approaches and how intersectionality is integrated in an authentic and meaningful way.

Adapting a consensus process for survivors of domestic abuse and child maltreatment: a brief report about adopting a trauma-informed approach in multistakeholder workshops

PURPOSE

Among health researchers, there is a growing appreciation of the importance of the involvement of service users and members of the public. This recognition has not only resulted in involvement guidelines and improved research ethics but also an increasing use of consensus processes with service users and members of the public to determine research priorities and questions and to agree outcomes to be measured in intervention studies. There is, however, limited advice about how to safely involve survivors of violence and abuse in consensus-based studies.

METHODS/RESULTS

This commentary provides an overview of the adaptations made to a process of core outcome set development, to ensure that survivors of violence and abuse felt safe, heard and supported, and able to contribute in a meaningful way.

CONCLUSIONS

We advocate for an iterative process of listening to and learning from survivors, as well as buy-in from funders to ensure research studies are appropriately resourced and involve sufficient planning time.

Developing Guidelines for Conducting Stigma Research With Transgender and Nonbinary Individuals: Protocol for Creation of a Trauma-Informed Approach to Research

BACKGROUND

Transgender and nonbinary individuals have received increasing attention within HIV research, with studies documenting the pervasive role stigma plays in creating and sustaining health inequities. However, the proliferation of HIV stigma research with this population has also raised concerns about research practices that may unintentionally stigmatize or retraumatize the very communities they are designed to benefit. Conducting stigma research is critical for generating accurate information about HIV epidemiology, risk and protective factors, and intervention strategies for transgender and nonbinary individuals. Yet, little research has directly examined the experiences of transgender and nonbinary individuals when participating in these studies or identified specific research practices (eg, recruitment materials or study framing, choice of specific survey measures, data collection protocols, and researcher behaviors) that may influence study participation, retention, and data quality. Equally important, research has not adequately examined the potential for unintended harm due to emotional distress experienced by participating in such research and what specific strategies might mitigate against potential distressful research experiences.

OBJECTIVE

This study aimed to develop a set of empirically based trauma-informed guidelines for conducting HIV-related stigma research with transgender and nonbinary individuals to increase researchers' capacity to recruit and retain transgender and nonbinary individuals in HIV-related stigma research, enhance the quality of data collected, and reduce unintentional harm in stigma research methodology.

METHODS

The study will engage in primary data collection using both qualitative and quantitative methodology. First, we will use in-depth qualitative interviews with 60 participants representing 3 participant groups: researchers, mental health clinicians, and transgender and nonbinary individuals who have participated in HIV-related and sexual health research. Second, the qualitative findings will be used to develop an initial set of survey items representing a preliminary set of guidelines. Third, we will engage 75 participants in a 3-round modified Delphi method, to refine the guidelines and promote their acceptability among key stakeholders.

RESULTS

The study is funded by the National Institute of Mental Health starting in July 2022 and data collection began January 2023. The study's findings underscore the critical importance of adopting a trauma-informed approach to HIV stigma research with transgender and nonbinary individuals.

CONCLUSIONS

To make meaningful strides in stigma research, it is imperative to examine experiences of stigma that may happen within the research context and identify strategies for improving data quality and reducing unintentional harm in study recruitment, methodology, implementation, and dissemination.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/66800.

'Motivating Implicit Chinese to Express Themselves Is the Biggest Barrier': A Qualitative Study of Chinese Researchers' Perceptions of Barriers and Facilitators to Patient Engagement in Research

BACKGROUND

Patient Engagement in Research (PER) has demonstrated benefits for patients, researchers and research outcomes. However, China lacks substantial experience in implementing PER. The implementation of PER in China faces unique challenges due to social-cultural differences. This study explores the perspectives of Chinese researchers to identify barriers and facilitators, aiming to guide future PER initiatives and enhance the role of patients in research.

METHOD

Purposive sampling was employed to recruit clinical researchers with diverse healthcare backgrounds in China. Semi-structured interviews, conducted by a qualified researcher, followed interview guidelines derived from a literature review and pilot study modifications. Thematic analysis was applied using QSR Nvivo 8.0.

RESULTS

A total of 13 participants were included. Five main themes were identified from interview: (1) selection of patients for research engagement, (2) strategies to alleviate the patient burden in implementing PER, (3) strategies to encourage patients for active expression, (4) benefits to attract patient engagement and (5) researcher's preparation.

CONCLUSION

The cultural trait of 'reservedness' in Chinese culture hinders active expression by patients in the research engagement process. Researchers tend to recruit patients with specific characteristics and emphasize the importance of aligning benefits with patient values to motivate engagement. Addressing patient burden is crucial, and researchers should be well-prepared before PER. These findings underscore the necessity of adopting culturally adapted strategies in PER to effectively address specific challenges.

PATIENT OR PUBLIC CONTRIBUTION

The public participated in the interpretation of the interview results, enriching our understanding of the results.

The Acceptability, Safety and Impact of a Play Co-Developed With Public Contributors as a Format for Disseminating Research on a Sensitive Subject

INTRODUCTION

Patient and public involvement (PPI) and dissemination of research findings are key parts of the pathway to research impact; however, traditional approaches often fail to engage non-academic audiences. Creative methods such as co-developed plays can be effective ways of making the research process and findings more engaging and accessible to the public. Not much is known about how to safely involve patients and the public in the development and delivery of plays disseminating research on sensitive subjects. Members of a PPI group on a study about mindfulness for women with a history of domestic abuse co-developed and performed a play about their experiences. This study aimed to evaluate the impact, acceptability and safety of a co-developed play in publicizing PPI and findings from research on domestic abuse.

METHODS

We conducted a mixed-methods study with the play team and audience. We collected 20 quantitative and 56 qualitative survey responses from audience members, carried out 4.25 h of direct observations of play performances and interviewed seven audience members and eight play team members. Data were analyzed using the framework method and descriptive statistics, using a 'following a thread' approach to integrate qualitative and quantitative findings in themes answering our study aim.

FINDINGS

We developed three integrated themes with ten sub-themes. The 'Value' theme summarized the plays' impact on audience understanding, potential mechanisms of impact and its effectiveness in depth over breadth of dissemination. The 'Re-traumatization' theme described potential harms of the play, the risks of re-traumatizing actors and distressing audiences. The 'Reducing the risks' theme summarized ways of reducing these risks of harm.

CONCLUSION

A play co-developed and performed by study PPI members raised awareness of domestic abuse. However, there were divergent opinions on its value in disseminating messages about PPI in research on sensitive subjects. The value of the play for research dissemination was linked to its ability to emotionally engage the public, and to its accessibility. Implementing strategies to reduce the risk of re-traumatizing audience members and the project team is recommended.

PATIENT OR PUBLIC CONTRIBUTION

Everyone with direct experience of co-creating and performing the play contributed to this study. This included four public contributors: a community theatre producer, two actors with lived experience of domestic abuse who were members of the study PPI group and one community actor already working with the community theatre. A participatory workshop with PPI contributors was held to refine our research questions and data collection instruments, using a public involvement evaluation tool, The Cube. PPI contributors checked and commented on the draft manuscript.

The Use of Arts-Based Methods to Enhance Patient Engagement in Health Research

INTRODUCTION

Patient and care partner engagement in research (PER) is important in generating knowledge to improve healthcare. Arts-based methods (ABM) use art in the research process to share aesthetic knowledge, which is knowledge that may be too complex to share only verbally. Together, PER and ABM are potentially synergistic, as both are participatory, problem-focused, dialogic, and collaborative; yet little is known of the utility of ABM for PER.

METHODS

A narrative review was performed to identify, collate, and summarize the ways ABM has been used with PER and share the impacts of ABM on PER. The databases CINAHL, Scopus, and PubMed were searched, and 15 articles were included.

RESULTS

A wide variety of ABM were used for PER, with some studies using multiple ABMs. The use of ABM for PER was reported to be decolonizing, shifted power from researchers to people with lived experience, and reduced tokenism. People with lived experience shared their knowledge directly through their art, deepening the understanding of their emotions, feelings, and relationships.

CONCLUSION

Researchers should consider the benefits of the participatory nature of ABM and explore how to engage people with lived experience in their work beyond data collection. Researchers engaging people with lived experience should consider using ABM as a way to operationalize PER to elicit aesthetic knowledge and strengthen power equalization.

PATIENT OR PUBLIC CONTRIBUTION

No patients or members of the public contributed to this review due to a lack of funding to support their meaningful involvement.

Co-Designing a Digital App to Support Young People's Patient and Public Involvement and Engagement (VoiceIn): Development and Usability Study

Background

While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people's involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meetings or group discussions can further compound this difficulty. The VoiceIn app and digital platform were codeveloped by a multidisciplinary team of young people, mental health researchers, and software designers, and enables young people to engage directly with PPIE opportunities via a mobile app.

Objective

This paper aims to describe how VoiceIn was developed through a series of co-design workshops with relevant stakeholders, specifically (1) how the initial design of VoiceIn was informed and driven by focus groups with young people, mental health professionals, and PPIE leads; (2) how VoiceIn was refined through collaboration with the aforementioned stakeholders; (3) the priorities for an app to support PPIE; (4) the key features necessary in the PPIE app; and (5) the recommended next steps in testing and deploying the digital platform.

Methods

Initial co-design workshops took place with young people, mental health professionals, and PPIE leads to identify key features of an app to support PPIE. A series of VoiceIn design prototypes were developed and iterated based on the priorities and preferences of the stakeholders. The MoSCoW (must have, should have, could have, won't have) prioritization method was used throughout the process to identify priorities across the different stakeholder groups.

Results

Co-design with young people, mental health professionals, and PPIE leads supported the successful development and improvement of the VoiceIn app. As a result of this process, key features were identified, including allowing for various modes of providing feedback (eg, polls and comments), reviewing project updates, and expressing interest in categories of research. The researcher platform was developed to support multimedia uploads for project descriptions; a jargon detector; a dedicated section for providing project updates; and a visually appealing, user-friendly design. While all stakeholder groups emphasized the importance of allowing app users to engage with the app in various ways and for there to be ongoing progress updates, group differences were also noticed. Young people expressed a desire for incentives and rewards for engaging with the app (eg, to post on their public social media profiles), and mental health professionals and PPIE leads prioritized flexibility in describing the project and its PPIE needs.

Conclusions

A co-design approach was pivotal to the development of the VoiceIn app. This collaborative approach enabled the app to meet the divergent needs of young people, mental health professionals, and PPIE leads. This process mirrored the aspirations of PPIE initiatives by cocreating a digital health research tool with key stakeholders.

Engaging people with lived experience of dementia in research meetings and events: insights from multiple perspectives

This perspective article describes the experiences of engaging people with lived experience of dementia in research meetings and events from the perspectives of people with lived experience, researchers, trainees, audience members and others. We outline examples of engagement from different events and describe a video project, initiated by people with lived experience, conveying diverse views about becoming integral collaborators in the Canadian Consortium on Neurodegeneration in Aging (CCNA) annual Partners Forum and Science Days. We also report evaluation data from audiences and present a series of tips and strategies for facilitating this engagement, including practical considerations for supporting people with lived experience.

Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis

BACKGROUND

The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers.

AIM

To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement.

METHODS

A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline.

RESULTS

A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play.

CONCLUSIONS

Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.

An end to the "muffin meeting": Conceptualizing power and navigating tokenism in patient engagement for health leaders

Patient engagement is emerging as a priority for Canadian health leaders. Alongside the proliferation of patient engagement efforts in healthcare organizations and networks, awareness that tokenism can potentially occur within such efforts, as well as strategies to mitigate it, are gaining increased attention. While many actions associated with more tokenistic forms of patient engagement have been identified, this article posits there is a need to pay critical attention to the concept and role of power in enabling these actions in the first place. Of particular importance is how power and knowledge work to shape healthcare organizations and can create unequal relations with the patients they seek to engage. Drawing on the literature, this article serves as a theoretical roadmap for health leaders to think critically about power, as well as a set of prompts that can be used to reflexively consider their role in navigating power dynamics in the context of patient engagement efforts. This article contends that building awareness of power is a critical step for health leaders and organizations and that navigating power differences is a necessary leadership competency for engaging patients in decision-making throughout all stages of healthcare improvement and organizational change efforts.

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.

Development and evaluation of a clinical simulation-based educational innovation on sexual orientation and gender identity in emergency medicine

INTRODUCTION

Sexual orientation and gender identity (SOGI)-diverse patients are marginalized and poorly cared for in the emergency department, yet well-designed educational interventions to meet this gap are lacking. We developed, implemented, and assessed a novel multi-modal SOGI curriculum on health and cultural humility for emergency medicine physician trainees.

METHODS

We conducted a prospective, single-arm evaluation of our educational intervention. A convenience sample of emergency medicine resident physicians (n = 21) participated in the facilitated curriculum including didactic and clinical simulation components. Participants completed a pre- and post-curriculum evaluation that assessed clinical skills, preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients. The content of the module was based on a scoping literature review and national needs assessment of Canadian emergency physicians, educators, and trainees along with expert collaborator and input from patient/community partners. The curriculum included a facilitated pre-brief, didactic presentation, clinical simulation modules, and a structured de-brief. Participant clinical skills were evaluated before and after the educational intervention. Our primary outcome was change in clinical preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients pre- and post-intervention.

RESULTS

Our patient-centered, targeted emergency medicine SOGI health and cultural humility training resulted in a significant improvement in resident self-rated clinical preparedness, attitudes, and knowledge in caring for SOGI-diverse patients. This training was valued by participants.

CONCLUSION

We have designed an effective, patient-centered curriculum in health and cultural humility for SOGI-diverse patients in EM. Other programs can consider using this model and developed resources in their jurisdictions to enhance provider capacities to care for this marginalized group.

The concept of intersectionality in bioethics: a systematic review

BACKGROUND

Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a "traveling concept", which also made its way into bioethical research.

METHODS

We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included.

RESULTS

The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies.

CONCLUSIONS

This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions.

NIHR Race Equality Framework: development of a tool for addressing racial equality in public involvement

BACKGROUND

While there has been a long recognition of the importance of race equality in health and care research, there is a lack of sustained action among research funding and research performing organisations to address racial equality in public involvement. This paper describes how the UK's National Institute for Health and Care Research (NIHR) convened a Race Equality Public Action Group (REPAG), which co-developed with public contributors and stakeholders a Race Equality Framework - a tool for addressing racial equality in public involvement.

METHODS

The REPAG, through meetings and discussions, defined the focus of the Framework, and developed an initial draft of the Framework. Public contributors identified the need for broader consultation with other public members. Three community consultation events with a total of 59 members of Black African-, Asian- and Caribbean-heritage communities were held to seek their views on health and care research generally and on the draft Framework specifically. The draft Framework was modified and piloted among 16 organisations delivering health and care research. Following feedback from the pilot, the Framework was modified and prepared for publication.

RESULTS

The Framework is designed as a self-assessment tool comprised of 50 questions pertaining to five domains of organisational activity: 1) individual responsibility, 2) leadership, 3) public partnerships, 4) recruitment, and 5) systems and processes. The questions were co-designed with REPAG public members and provide key concepts and elements of good practice that organisations should consider and address on their path to achieving racial competence. The accompanying materials provide implementation guidance with 20 detailed steps, case studies of actions taken in seven pilot organisations, and links to additional resources. The pilot demonstrated the feasibility of conducting a meaningful self-assessment over a period of three months and the usefulness of the results for developing longer-term action plans.

CONCLUSION

The Framework represents the first self-assessment tool for addressing racial equality in public involvement. Co-design with REPAG public members enhanced its authenticity and practicality. Organisations in the field of health and care research and any other organisations that use partnerships with the public are encouraged to adopt the Framework.

"Counteract the gaslighting" - a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers

BACKGROUND

Intimate partner sexual violence (IPSV) is a prevalent but misunderstood form of gender-based violence with significant impacts women's health and well-being. Research suggests that IPSV has a specific context and unique impacts, but little is known about how to tailor service responses. To address this gap, we explored help-seeking experiences and needs among IPSV survivors after disclosure.

METHODS

This study draws on qualitative data from a subsample of women who participated in a cross-sectional survey about the service needs of intimate partner violence survivors. Women who reported IPSV and provided information about IPSV-specific help-seeking needs after disclosure were included in the analysis. Open-ended text responses of 37 IPSV survivors were analysed using thematic analysis.

RESULTS

IPSV was invisible and silenced in service responses. Three themes suggest potential ways forward. In the first theme, 'Don't dismiss it', women needed providers to take their disclosures seriously and listen to the significant impacts of IPSV on their well-being and safety. In the second theme, 'See the bigger picture', women needed service providers to understand that IPSV fits into broader patterns of abuse, and that psychological abuse and coercive control impacts women's ability to consent. In the third theme, 'counteract the gaslighting', women needed providers to educate them about the continuum of IPSV and help them label IPSV as a form of violence.

CONCLUSIONS

Our exploratory findings extend the limited evidence base on IPSV and highlight a need for further in-depth research to explore a tailored approach to supporting IPSV survivors. To avoid contributing to the silencing of IPSV survivors, service responses should recognise the harmful and sexualised nature of IPSV, challenge cultural stereotypes that minimise IPSV, and understand that co-occurring psychological abuse may exacerbate shame and prevent women from articulating the source of their distress.

Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy

OBJECTIVE

We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET).

DESIGN

Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach.

METHODS

Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery.

RESULTS

NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability.

CONCLUSIONS

Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.

Centring the voices of survivors of child sexual abuse in research: an act of hermeneutic justice

Survivors of child sexual abuse (CSA) are known to hold silence and create distance between themselves and service providers for self-protection, as groomed behaviour or to protect the listener from vicarious trauma. Silence for many survivors has also been reinforced as a beneficial action by previous experiences of disclosing and being rejected, challenged, or disbelieved. How can researchers be sure the same dynamic is not playing out in research interviews? Generating reliable research data is an imperative and an act of epistemic justice that enables CSA survivors to testify to the suffering caused by abuse and subsequent trauma distress and to contribute to social discourse for change. Fricker, however, notes that the precursor to testimonial justice is hermeneutic justice. Hermeneutic justice pivots on the dual action of accurate understanding and interpretation, but CSA experiences may be beyond the comprehension of untraumatised listeners because their own frame of reference renders them unable or unwilling (even if unconsciously) to entertain the truth of such human depravity and cruelty. If survivors are not understood, their testimonies can be misconstrued or oftentimes excluded from the generation of epistemic knowledge, leaving the survivors unable to make sense of, and process, their experiences. These are crucial issues for researchers in the field of CSA and other crimes of sexual and gendered abuse. This study considers the operationalisation of a participatory research approach held within a lived experience research paradigm. Such methodologies advocate for peer involvement, which is becoming more widely recognised as supporting testimonial justice and the accurate understanding and interpretation of survivors' testimonies. The issue of validating the methodology and methods is considered, exploring a rigorous data audit and researcher reflexivity as contributors to trustworthy data. Peer and participant safety when researching through lived experience is addressed. Data from a doctoral research study are used to illustrate this article.

We're here too: child health information-seeking experiences and preferences of Red River Métis families - a qualitative study

BACKGROUND

Red River Métis families need access to meaningful and appropriate resources when their children are sick. At the invitation of the Manitoba Métis Federation (MMF) to partner in this research, our aim was to understand Red River Métis parents' experiences and preferences for seeking child health information when their child is acutely ill, to inform the adaptation of existing parent resources.

METHODS

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

RESULTS

Analysis generated four themes: (1) We're here too; (2) We are not all the same; (3) Finding trustworthy information; and (4) Information needs to be widely available. Red River Métis pride was prominent in the results. Parents provided tangible ways to modify existing parent resources, including adding information on how to access Elders, healers and/or traditional medicines and showing different family structures, transport, living situations, Métis names, and incorporating Métis languages. While most parents reported looking for child health information online, they also stressed the need to provide multiple options, including information sheets, recognizing that parents seek information in different contexts. Parents also emphasized the importance of accessible, safe spaces to find child health information, including local schools, community centres, healthcare organizations and the MMF.

CONCLUSION

There is a lack of child health information created specifically for Red River Métis families. The development of this information can support their information needs and preferences and the ongoing efforts to revitalize Red River Métis culture and language. Study findings will inform the adaptation and dissemination of existing child health resources to ensure they reflect Red River Métis parents' information needs and preferences. This research is a critical step in addressing an identified need for Red River Métis families to have culturally relevant and meaningful child health resources, and in the pursuit of equitable care for all children in Canada.

TRIAL REGISTRATION

N/A.

Designing an intervention to help the quitters quit: A qualitative, intervention co-design study

Objective

E-cigarettes are increasingly being provided by publicly funded stop smoking services. Our objectives were to understand the challenges and establish the means by which services could best support the use and subsequent discontinuation of e-cigarettes for this purpose.

Methods

Semi-structured interviews and co-design workshops with service users and providers of a stop smoking service.

Results

Thematic analysis was conducted. Interviews identified: 1. a reluctance to use e-cigarettes for cessation, 2. struggle to quit e-cigarettes (dependency, fear of relapse, compensatory "puffing") and 3. service development needs (consistency of approach). Co-design workshops suggested: 1. facilitation of e-cigarette use through understanding previous failed attempts, 2. offering a longer, two-staged approach to tobacco then e-cigarette cessation, careful timing of behavioural strategies and 3. enhanced communication between providers.

Conclusions

Our study suggests additional modifications to smoking cessation support measures when e-cigarettes are used for smoking cessation to address the challenges posed by public health guidance: "smokers should switch to vaping and vapers should stop smoking completely".

Innovation

Our study is the first to consider experiences of service users and providers about the challenges of using e-cigarettes for cessation; our co-design group of providers informed nine strategies needed to support this approach in practice.

Respect for the journey: a survivor-led investigation of undergoing psychotherapy assessment

PURPOSE

Psychotherapy assessments are key decision points for both clients and services, carrying considerable weight on both sides. Limited research indicates that assessments have immediate and long-term impacts on clients, particularly where trauma has been experienced, affecting engagement with therapy. Understanding assessments from clients' perspectives can inform service development and improve client experience.

METHODS

This is a survivor-led exploration of clients' experiences of undergoing assessment for talking therapies. Interviews were conducted with seven people who had undergone assessment for psychological therapies in third sector and NHS services. Interviews were recorded, transcribed and analysed thematically.

RESULTS

The core theme was 'respect for the journey' reflecting the need expressed by participants for their life experiences prior to the assessment to be given full respect and consideration. Six sub-themes were identified: trauma and desperation, fear of judgement, search for trust and safety, sharing and withholding (a balancing act), feeling deconstructed, and finding hope.

CONCLUSIONS

The findings highlight the heightened emotional power surrounding psychotherapy assessments, reflecting the journey participants had undertaken to reach this point. The dilemma facing clients at the heart of an assessment-how much to share and how much to withhold-demonstrates the importance for services and assessors of treating the journey a client has made to the assessment with care and respect. Findings indicate the value of services and practitioners undertaking a trauma-informed approach to assessment encounters.

La pratique contraceptive moderne chez les adolescentes au Bénin: Tendances, déterminants et perspectives / Modern contraceptive use among adolescents in Benin: trends, determinants and prospects

RésuméLa pratique contraceptive moderne augmente lentement parmi les jeunes générations au Bénin. La présente étude analyse les tendances, les déterminants du recours aux contraceptifs et leurs mécanismes d'actions chez les adolescentes. Les approches socio-écologique et intersectionnelle ont été adoptées, avec une méthode d'étude mixte portant sur les adolescentes de 15 à 19 ans sexuellement actives et non enceintes. Le volet quantitatif recourt aux données des cinq enquêtes démographiques et de santé du Bénin entre 1996 et 2017-18, avec une analyse descriptive et une régression logistique binaire pas à pas. Les données qualitatives collectées par des observations, discussions de groupe et entretiens individuels auprès de différents acteurs nationaux, ont fait l'objet d'analyse de contenu. Les résultats révèlent une prévalence contraceptive moderne basse, passant de 4,6% en 1996 à 13,3% en 2017-18, avec le préservatif comme principale méthode utilisée (8,2%). En 2017-18, la probabilité d'utiliser les contraceptifs était plus élevée chez les adolescentes des ménages riches (OR = 2,3), les scolarisées (OR = 2,3), les célibataires (OR = 2,1), celles fréquentant les services de planification familiale (PF) (OR = 1,8), connaissant le cycle menstruel (OR = 1,6), et économiquement actives (OR = 1,5). Cependant, être Yoruba réduit les chances d'utiliser les contraceptifs (OR = 0,5). Les données qualitatives confirment ces résultats et les complètent en mettant en avant l'effet du cadre juridique favorable à la pratique contraceptive, la stigmatisation sociale des utilisatrices, et les infox véhiculées en communauté. Nous recommandons des efforts pour le maintien des filles à l'école, la généralisation des services de PF pour les adolescents, la communication communautaire, et la subvention des contraceptifs.

Exploring patient perspectives on how they can and should be engaged in the development of artificial intelligence (AI) applications in health care

BACKGROUND

Artificial intelligence (AI) is a rapidly evolving field which will have implications on both individual patient care and the health care system. There are many benefits to the integration of AI into health care, such as predicting acute conditions and enhancing diagnostic capabilities. Despite these benefits potential harms include algorithmic bias, inadequate consent processes, and implications on the patient-provider relationship. One tool to address patients' needs and prevent the negative implications of AI is through patient engagement. As it currently stands, patients have infrequently been involved in AI application development for patient care delivery. Furthermore, we are unaware of any frameworks or recommendations specifically addressing patient engagement within the field of AI in health care.

METHODS

We conducted four virtual focus groups with thirty patient participants to understand of how patients can and should be meaningfully engaged within the field of AI development in health care. Participants completed an educational module on the fundamentals of AI prior to participating in this study. Focus groups were analyzed using qualitative content analysis.

RESULTS

We found that participants in our study wanted to be engaged at the problem-identification stages using multiple methods such as surveys and interviews. Participants preferred that recruitment methodologies for patient engagement included both in-person and social media-based approaches with an emphasis on varying language modalities of recruitment to reflect diverse demographics. Patients prioritized the inclusion of underrepresented participant populations, longitudinal relationship building, accessibility, and interdisciplinary involvement of other stakeholders in AI development. We found that AI education is a critical step to enable meaningful patient engagement within this field. We have curated recommendations into a framework for the field to learn from and implement in future development.

CONCLUSION

Given the novelty and speed at which AI innovation is progressing in health care, patient engagement should be the gold standard for application development. Our proposed recommendations seek to enable patient-centered AI application development in health care. Future research must be conducted to evaluate the effectiveness of patient engagement in AI application development to ensure that both AI application development and patient engagement are done rigorously, efficiently, and meaningfully.

'By identifying myself as Métis, I didn't feel safe…': Experiences of navigating racism and discrimination among Métis women, Two-Spirit and gender diverse community members in Victoria, Canada

OBJECTIVE

Racism acts as a major barrier to accessing health services for Indigenous communities in Canada, often leading to delayed, avoided or lack of treatment altogether. The Métis population is uniquely positioned in urban settings, as they experience discrimination from both Indigenous and mainstream health and social services due to Canada's long colonial history that is ongoing. Yet, Métis are often left out of discussions regarding racism and health service access. This study explores the experiences of racism and health service access among Métis peoples in Victoria, British Columbia.

METHODS

We allied a conversational interview method to explore and understand experiences of self-identifying Métis women, Two-Spirit and gender diverse people (n = 24) who access health and social services in Victoria. Data analysis followed Flicker and Nixon's six-stage DEPICT model.

RESULTS

In this paper, we share the experiences of racism and discrimination of those who accessed health and social services in Victoria, British Columbia Such experiences include passing as White, experiencing racism following Métis identity disclosure and witnessing racism. Passing as White was viewed as a protective factor against discrimination as well as harming participants' sense of identity. Experiences of racism took the form of discriminatory comments, harassment and mistreatment, which influenced the willingness of disclosing Métis identity. Witnessing racism occurred in participants, personal and professional lives, negatively impacting them in indirect ways. Each experience of racism had a negative influence on participants' wellbeing and shaped their experience of accessing health and social services.

CONCLUSIONS

Métis people confront racism and discrimination when attempting to access health and social services through first-hand experiences, witnessing and/or avoidance. While this study contributes to the all too often unacknowledged voices of Métis in Canada, there is a continued need for Métis-specific research to accurately inform policy and practice.

Medical invalidation in the clinical encounter: a qualitative study of the health care experiences of young women and nonbinary people living with chronic illnesses

BACKGROUND

Medical invalidation is a well-documented phenomenon in the literature on chronic illnesses, yet there is a paucity of research capturing the perspectives of young adults living with chronic illnesses, and especially of those who are gender diverse or from groups that face broader societal marginalization. Our study sought to answer the following question: How do young women and nonbinary adults living with chronic illnesses characterize their experiences of medical invalidation and its impact on their health and well-being?

METHODS

This was a patient-oriented qualitative study informed by feminist disability theory. Eligibility requirements included self-identifying as having a chronic illness, self-identifying as a woman or nonbinary person receiving health care in Manitoba, and being between the ages of 18 and 35 years. Participants took part in online arts-based workshops and subsequent focus group discussion in November 2021.

RESULTS

Eight women and 2 nonbinary individuals participated. Medical invalidation was experienced by all of the participants at different points in their illness journeys and took a variety of forms depending on their social location and their particular illness, positioning invalidation as an issue of in/visibility. We identified several consequences of medical invalidation, including internalizing invalidation, overcompensating for their illness, avoiding care and, ultimately, symptom intensification. We also present participants' recommendations to avoid medical invalidation.

INTERPRETATION

This study provides insight into the phenomenon of medical invalidation, understood as the act of dismissing, minimizing or otherwise not taking patient concerns seriously. We suggest person-centred care may not be enough, and critical reflexivity may help avoid unintentionally invalidating patient experiences.

Collaborating with a Youth Council to Improve Chronic Pain Resources

Background

There is a recognized need to involve people with lived experience of chronic pain when developing chronic pain resources.

Aims

The aim of this study was to develop, implement, and evaluate a short-term youth council focused on eliciting youths' recommendations for key features of chronic pain informational resources.

Methods

In this mixed methods instrumental case study, demographic data were collected via Survey Monkey®. Select Patient-Reported Outcomes Measurement Information System® brief measures were used to provide context regarding pain impact within this group. Participants completed an initial interview, which informed youth council workshop delivery. Over two youth council workshops, participants reviewed select informational resources and identified key features of chronic pain resources. Participants evaluated their involvement experience during a second interview. Qualitative data were transcribed and analyzed using directed content analysis. Member-checking occurred during a third workshop, held virtually.

Results

Seven youth self-identifying as girl/woman or demi-girl participated. The youth were satisfied with the youth council experience, highlighting the importance of meeting others, a relaxed environment, and participating in valuable work. A list of youth-identified key features for informational resources was created through the workshops, which includes considerations for audience groups, content, and presentation.

Conclusion

Participants' input into youth council development and meeting others with lived experience contributed to a safe and supportive involvement experience. Youth council involvement supported the development of preliminary recommendations for chronic pain informational resources.

Co-building a training programme to facilitate patient, family and community partnership on research grants: A patient-oriented research project

INTRODUCTION

Patient engagement in patient-oriented research (POR) is described as patients collaborating as active and equal research team members (patient research partners [PRPs]) on the health research projects and activities that matter to them. The Canadian Institutes of Health Research (CIHR), Canada's federal funding agency for health research, asks that patients be included as partners early, often and at as many stages of the health research process as possible. The objective of this POR project was to co-build an interactive, hands-on training programme that could support PRPs in understanding the processes, logistics and roles of CIHR grant funding applications. We also conducted a patient engagement evaluation, capturing the experiences of the PRPs in co-building the training programme.

METHODS

This multiphased POR study included a Working Group of seven PRPs with diverse health and health research experiences and two staff members from the Patient Engagement Team. Seven Working Group sessions were held over the 3-month period from June to August 2021. The Working Group worked synchronously (meeting weekly online via Zoom) as well as asynchronously. A patient engagement evaluation was conducted after the conclusion of the Working Group sessions using a validated survey and semi-structured interviews. Survey data were analysed descriptively and interview data were analysed thematically.

RESULTS

The Working Group co-built and co-delivered the training programme about the CIHR grant application process for PRPs and researchers in five webinars and workshops. For the evaluation of patient engagement within the Working Group, five out of seven PRPs completed the survey and four participated in interviews. From the survey, most PRPs agreed/strongly agreed to having communication and supports to engage in the Working Group. The main themes identified from the interviews were working together-communication and supports; motivations for joining and staying; challenges to contributing; and impact of the Working Group.

CONCLUSION

This training programme supports and builds capacity for PRPs to understand the grant application process and offers ways by which they can highlight the unique experience and contribution they can bring to each project. Our co-build process presents an example and highlights the need for inclusive approaches, flexibility and individual thinking and application.

PATIENT OR PUBLIC CONTRIBUTION

The objective of this project was to identify the aspects of the CIHR grant funding application that were elemental to having PRPs join grant funding applications and subsequently funded projects, in more active and meaningful roles, and then to co-build a training programme that could support PRPs to do so. We used the CIHR SPOR Patient Engagement Framework, and included time and trust, in our patient engagement approaches to building a mutually respectful and reciprocal co-learning space. Our Working Group included seven PRPs who contributed to the development of a training programme. We suggest that our patient engagement and partnership approaches, or elements of, could serve as a useful resource for co-building more PRP-centred learning programmes and tools going forward.

Engaging diverse patients in a diverse world: the development and preliminary evaluation of educational modules to support diversity in patient engagement research

BACKGROUND

Current practices for engaging patients in patient-oriented research (POR) result in a narrow pool of patient perspectives being reflected in POR. This project aims to address gaps in methodological knowledge to foster diversity in POR, through the co-design and evaluation of a series of educational modules for health researchers in British Columbia, Canada.

METHODS

Modules were co-created by a team of academic researchers and patient partners from hardly-reached communities. The modules are presented using the Tapestry Tool, an interactive, online educational platform. Our evaluation framework focused on engagement, content quality, and predicted behavior change. The User Engagement Scale short form (UES-SF) measured participants' level of engagement with the modules. Survey evaluation items assessed the content within the modules and participants' perceptions of how the modules will impact their behavior. Evaluation items modeled on the theory of planned behavior, administered before and after viewing the modules, assessed the impact of the modules on participants' perceptions of diversity in POR.

RESULTS

Seventy-four health researchers evaluated the modules. Researchers' engagement and ratings of module content were high. Subjective behavioral control over fostering diversity in POR increased significantly after viewing the modules.

CONCLUSIONS

Our results suggest the modules may be an engaging way to provide health researchers with tools and knowledge to increase diversity in health research. Future studies are needed to investigate best practices for engaging with communities not represented in this pilot project, such as children and youth, Indigenous Peoples, and Black communities. While educational interventions represent one route to increasing diversity in POR, individual efforts must occur in tandem with high-level changes that address systemic barriers to engagement.

Examining the experiences of Indigenous families seeking health information about caring for sick or injured children: a scoping review

OBJECTIVE

Mapping literature on Indigenous families' experiences seeking child health information and identifying barriers and facilitators to information access.

DESIGN

Scoping review.

DATA SOURCES

We searched Medline, EMBASE, PsycINFO, Scopus and CINAHL for peer-reviewed literature and Google Advanced for grey literature. We screened tables of contents of two Indigenous research journals not consistently indexed in online health databases and used snowball sampling to supplement searches.

ELIGIBILITY CRITERIA

We included full-text, English-language articles, published from 2000 to the time of the search in April 2021, based on: participants (Indigenous families), concept (experiences of families seeking health information) and context (child health).

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted: citation details, study purpose, country of study, publication type, study design, data collection method, Indigenous group, family member participants, home/healthcare setting, child health area, how health information was accessed, and information-seeking barriers and facilitators. Data were examined for patterns and trends, results and implications.

RESULTS

Among 19 papers (representing 16 research projects) included, nine described family/friends and 19 described healthcare professionals as sources of child health information. Barriers include racism/discrimination during healthcare visits, ineffective communication with healthcare providers and structural barriers (eg, transportation). Facilitators include easy access, improved communication and relationships with healthcare providers, and culturally safe healthcare.

CONCLUSION

Indigenous families perceive they do not have access to necessary child health information, which can lead to insensitive, ineffective and unsafe healthcare. A critical gap exists in understanding Indigenous families' information needs and preferences when making decisions about children's health.

Meeting in the middle: experiences of citizenship in community-engaged psychosis research

Purpose

Previous research has highlighted the importance of engaging people with lived experience (PWLE) in the knowledge creation process. However, diverse approaches to engagement exist. In addition, tensions remain in community-engaged research (CER), including how to address structural inequalities in research settings. This study aims to consider how CER interacts with citizenship within and beyond the research context.

Design/methodology/approach

This study discusses the authors’ experiences as a majority-PWLE of psychosis research team in Canada, including successes and challenges the authors experienced building their team and navigating research institutions. This study also reflects on the authors’ pathways through citizenship, prior to and during the research process. This study discusses divergent models of CER and their applicability to the cyclical process of citizenship and community participation.

Findings

Relationships between academic and peer researchers developed organically over time. However, this study was limited by structural barriers such as pay inequality and access to funding. The authors recognize that there are barriers to full citizenship and acknowledge their resources and privilege of being well supported within their communities. Team members built on a foundation of citizenship to access participation in research. This led to opportunities to engage in community spaces, and for PWLE to participate in research as partners and leaders. This study also found that citizenship is a way of giving back, by building a sense of social responsibility.

Originality/value

Academic and peer researchers can reflect on the authors’ experiences to build more inclusive research teams and communities by using a citizenship approach to research participation.

The shiny new object: Deconstructing the patient-oriented paradigm in health sciences

RATIONALE

A 'patient-oriented' research paradigm, also known as patient and public engagement, has infiltrated the field of health sciences and continues to spread. At first blush, it is difficult to reprove anything labelled 'patient-oriented'; however, the patient-oriented paradigm may easily become an ideological 'good', leading to unintended consequences that may well prove more detrimental than beneficial. While patient-oriented research has its roots in more radical forms of patient and public engagement, its recent instantiation betrays its roots and forecloses on more radical forms of engagement, such as critical participatory research.

AIM AND OBJECTIVES

The objective of this article is to deconstruct the patient-oriented research narrative and to demonstrate how such a discourse imposes itself as a dominant approach in health sciences.

APPROACH

Following Derrida's deconstructive approach, we bring to light the unexamined presuppositions, false pretences, and presumed 'goodness' and 'naturalness' of patient-oriented discourse.

DISCUSSION

By deconstructing the patient-oriented narrative we demonstrate how pre-existing power structures (biomedical, economic, etc.) shape the conduct of the approach and serve to depoliticize the truly participatory aspects of research. Rather than being modelled on the evidence-based movement or seen as its natural 'evolution', patient-oriented research should resist by affirming itself as a radical form that is both participatory and emancipatory.

Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial

OBJECTIVES

To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation.

DESIGN

Nonprespecified secondary analysis of a randomized clinical trial.

SETTING

Thirty-one U.S. PICUs.

PATIENTS

Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov ) over 8 years old who completed PTSD screening 6 months after discharge.

INTERVENTIONS

RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care.

MEASUREMENTS AND MAIN RESULTS

PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork ( n = 18, 58%) and happiness ( n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3-458.1 and $40,000-$79,999 OR, 15.6; 95% CI, 1.3-182.8), renal dysfunction (OR 5.3, 95% CI 1.7-16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9-35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen.

CONCLUSIONS

Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.

Patient Engagement in Health Research: Perspectives from Patient Participants

Background and purpose: Over the past decade, patient engagement (PE) has emerged as an important way to help improve the relevance, quality, and impact of health research. However, there is limited consensus on how best to meaningfully engage patients in the research process. The goal of this article is to share our experiences and insights as members of a Patient Advisory Committee (PAC) on a large, multidisciplinary cancer research study that has spanned six years. We hope by sharing our reflections of the PAC experiences, we can highlight successes, challenges, and lessons learned to help guide PE in future health research. To the best of our knowledge, few publications describing PE experiences in health research teams have been written by patients, survivors, or family caregivers themselves. Methods: A qualitative approach was used to gather reflections from members of the Patient Advisory Committee regarding their experiences in participating in a research study over six years. Each member completed an online survey and engaged in a group discussion based on the emergent themes from the survey responses. Results: Our reflections about experiences as a PAC on a large, pan-Canadian research study include three overarching topics (1) what worked well; (2) areas for improvement; and (3) reflections on our overall contribution and impact. Overall, we found the experience positive and experienced personal satisfaction but there were areas where future improvements could be made. These areas include earlier engagement and training in the research process, more frequent communication between the patient committee and the research team, and on-going monitoring regarding the nature of the patient engagement. Conclusions: Engaging individuals who have experienced the types of events which are the focus of a research study can contribute to the overall relevance of the project. However, intentional efforts are necessary to ensure satisfactory involvement.

Understand me: Youth with chronic pain on how knowledge gaps influence their pain experience

Background

There is a perceived lack of readily available resources to support self-management skills in youth living with chronic pain. The perspectives of youth regarding information gaps may improve the effectiveness of resources developed for them.

Aim

The aim of this study was to explore the perspectives of youth living with chronic pain on the interactions among their pain experiences, chronic pain resources and research.

Methods

Using an interpretive paradigm, we interviewed seven participants (age range 12-19 years) diagnosed with chronic pain. Two frameworks for meaningful engagement of citizens in research and policy informed the interview guide. Data were analyzed inductively using content analysis approaches to examine patterns and develop themes.

Results

The participants' perceptions were captured by the overarching theme of "understand me." Four subthemes elaborate on the relationship between the participants' experiences and how their lives could be enhanced through research and knowledge mobilization. In the subtheme "my unique pain experience," the participants help us understand them by chronicling the variation in presentation of their chronic pain. The subtheme "people don't know it's a thing" emphasizes that there is general misunderstanding of chronic pain by the public and in the participants' support systems. The first two subthemes influence the third, which describes how the pain "kind of stops you from living." The fourth subtheme, "knowledge offers hope," offers a solution to dismantling misunderstanding of youth living with chronic pain.

Conclusion

Future work needs to focus on embedding health literacy and knowledge mobilization into health and education structures to promote developmentally relevant self-management skills.

From participants to partners: reconceptualising authentic patient engagement roles in youth mental health research

The value of involving people with lived experience in the research process (ie, patient engagement) is increasingly being recognised within youth mental health research. The wide-reaching benefits of patient engagement have been documented in the literature, including the empowerment of patients, improvement of research outcomes, and increased relevance of research findings. Although various models exist to guide patient engagement, there are key concepts that deserve exploration to ensure the authentic implementation of these models and development of patient roles. Our Personal View aims to: identify and discuss barriers to patient engagement roles in the context of youth mental health research; consider how key concepts of relational empowerment, fluidity, and flexibility can address some of these barriers; and provide tangible recommendations for implementing authentic patient engagement throughout the research process.

Youth engagement in mental health research: A systematic review

INTRODUCTION

Patient engagement in youth mental health research has the potential to inform research on the interventions, services and policies that will benefit youth. At present, there is little evidence to guide mental health researchers on youth engagement. This systematic review aims to describe the impacts of youth engagement on mental health research and to summarize youth engagement in mental health research.

METHODS

We searched the following databases: MEDLINE, EMBASE and PsycINFO, using a combination of subject headings, keywords and synonyms for the concepts 'patient engagement', 'youth' and 'mental health'. Articles that described engaging youth in mental health research were included. Two reviewers performed the study selection. Study characteristics, research activities performed by youth, impacts of youth engagement, challenges, and facilitators to engagement and recommendations for youth engagement described by authors were extracted. Quality appraisal involved determining the level of engagement of youth and the stage(s) of research where youth were involved.

RESULTS

The database search returned 2836 citations, 151 full-text articles were screened and 16 articles, representing 14 studies, were selected for inclusion. Youth were involved at nearly all stages of the research cycle, in either advisory or co-production roles. Youth engagement impacts included enhancing relevant research findings, data collection and analysis and dissemination to academic and stakeholder audiences. Both youth and academic researchers reported personal development across many domains. One negative impact reported was the increase in funding and resources needed for engagement. We produced a list of 35 recommendations under the headings of training, youth researcher composition, strategy, expectations, relationships, meeting approaches and engagement conditions.

CONCLUSIONS

This study provides an understanding of the impacts and recommendations of youth engagement in mental health research. The findings from this study may encourage researchers to engage youth in their mental health research and support youth engagement in funding applications.

PATIENT AND PUBLIC CONTRIBUTION

We consulted three youths with experience being engaged in mental health research about the review findings and the discussion. One youth designed a visual representation of the results and provided feedback on the manuscript. All youth's input informed the way the findings were presented and the focus of the discussion.

Rural primary care workforce views on trauma-informed care for parents experiencing complex trauma: A descriptive study

BACKGROUND

An important service system for rural parents experiencing complex trauma is primary health care.

AIM

To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care.

MATERIAL & METHODS

This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions.

RESULTS

The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches.

DISCUSSION & CONCLUSION

Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.

Trauma and resilience informed research principles and practice: A framework to improve the inclusion and experience of disadvantaged populations in health and social care research

Trauma, socio-economic, cultural and structural issues are associated with poor outcomes for most health conditions and may also make research participation difficult and onerous, perpetuating intervention-generated inequalities by generating evidence from those least in need. Trauma-informed and resilience-informed approaches to care may help address these concerns across health and social care research. These approaches take an empowerment-based response to adversity, and are suitable for integration and extension as Trauma and Resilience Informed Research Principles and Practice (TRIRPP) for studies beyond the topics of resilience and trauma. Four TRIRPP aims were identified: addressing the adversity context that may underpin the lives of research participants and the phenomenon under study; improving study accessibility and acceptability for individuals and populations facing adversity; recognising and addressing traumatisation in potential participants; and recognising and promoting resilience. Recommendations include interview participant control of recording devices, over-sampling of under-represented populations in population surveys, and actively seeking to engage disenfranchised individuals in patient and public involvement from design to dissemination. The practice of research has the power to address adversity and trauma or to perpetuate it at both an individual and a societal level. It is feasible and worthwhile to integrate trauma-informed and resilience-informed approaches across research topics and designs. Further work should extend the TRIRPP recommendations and evaluate their use.

Measuring Social Health Following Pediatric Critical Illness: A Scoping Review and Conceptual Framework

OBJECTIVE

Social health is an important component of recovery following critical illness as modeled in the pediatric Post-Intensive Care Syndrome framework. We conducted a scoping review of studies measuring social outcomes (measurable components of social health) following pediatric critical illness and propose a conceptual framework of the social outcomes measured in these studies.

DATA SOURCES

PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Registry.

STUDY SELECTION

We identified studies evaluating social outcomes in pediatric intensive care unit (PICU) survivors or their families from 1970-2017 as part of a broader scoping review of outcomes after pediatric critical illness.

DATA EXTRACTION

We identified articles by dual review and dual-extracted study characteristics, instruments, and instrument validation and administration information. For instruments used in studies evaluating a social outcome, we collected instrument content and described it using qualitative methods adapted to a scoping review.

DATA SYNTHESIS

Of 407 articles identified in the scoping review, 223 (55%) evaluated a social outcome. The majority were conducted in North America and the United Kingdom, with wide variation in methodology and population. Among these studies, 38 unique instruments were used to evaluate a social outcome. Specific social outcomes measured included individual (independence, attachment, empathy, social behaviors, social cognition, and social interest), environmental (community perceptions and environment), and network (activities and relationships) characteristics, together with school and family outcomes. While many instruments assessed more than one social outcome, no instrument evaluated all areas of social outcome.

CONCLUSIONS

The full range of social outcomes reported following pediatric critical illness were not captured by any single instrument. The lack of a comprehensive instrument focused on social outcomes may contribute to under-appreciation of the importance of social outcomes and their under-representation in PICU outcomes research. A more comprehensive evaluation of social outcomes will improve understanding of overall recovery following pediatric critical illness.

Patient engagement in healthcare planning and evaluation: A call for social justice

Patient engagement in healthcare planning and evaluation has been promoted as a way to improve healthcare's ability to meet patients' needs. However, populations experiencing oppression and discrimination, such as racism, colonialism, sexism, heterosexism, cisnormativity, ableism, classism, and poverty, are often underrepresented in patient engagement spaces. The context and structure of patient engagement processes may systematically exclude certain populations from participating in meaningful ways or from participating at all. By excluding certain populations from active, meaningful patient engagement, we risk planning and evaluating health services on the basis of the values, needs, and preferences of the dominant population. This, in turn, will further entrench health inequities and preclude the ability to surface ideas that challenge dominant conceptualisations of health and healthcare, thereby reinforcing the status quo rather than promoting healthcare transformation. Recognising that experiences of health, healthcare, and patient engagement processes are mediated through gender, race, ability, sexual orientation, and other dimensions of diversity, it is proposed that processes for engaging patients in healthcare planning and evaluation must by intersectional, attend to systemic and power relations, and truly put patients in the driver's seat of engagement processes. Health services planners and evaluators need to create more inclusive, accessible, and appropriate patient engagement experiences in order to focus on transforming healthcare towards a more socially just system.

Experiences of Using the Digital Support Tool MeeToo: Mixed Methods Study

BACKGROUND

Digital peer support is an increasingly used form of mental health support for young people. However, there is a need for more research on the impact of digital peer support and why it has an impact.

OBJECTIVE

The aim of this research is to examine young people's experiences of using a digital peer support tool: MeeToo. After the time of writing, MeeToo has changed their name to Tellmi. MeeToo is an anonymous, fully moderated peer support tool for young people aged 11-25 years. There were two research questions: (1) What impacts did using MeeToo have on young people? (2) Why did using MeeToo have these impacts on young people?

METHODS

A mixed methods study was conducted. It involved secondary analysis of routinely collected feedback questionnaires, which were completed at two time points (T1 and T2) 2-3 months apart. Questionnaires asked about young people's (N=876) experience of using MeeToo, mental health empowerment, and well-being. Primary data were collected from semistructured interviews with 10 young people.

RESULTS

Overall, 398 (45.4%) of 876 young people completed the T1 questionnaire, 559 (63.8%) completed the T2 questionnaire, and 81 (9.2%) completed both. Descriptive statistics from the cross-sectional analysis of the questionnaires identified a range of positive impacts of using MeeToo, which included making it easier to talk about difficult things, being part of a supportive community, providing new ways to help oneself, feeling better, and feeling less alone. Subgroup analysis (paired-sample t test) of 58 young females who had completed both T1 and T2 questionnaires showed a small but statistically significant increase in levels of patient activation, one of the subscales of the mental health empowerment scale: time 1 mean=1.83 (95% CI 1.72-1.95), time 2 mean=2.00 (95% CI 1.89-2.11), t59=2.15, and P=.04. Anonymity and the MeeToo sense of community were identified from interviews as possible reasons for why using MeeToo had these impacts. Anonymity helped to create a safe space in which users could express their feelings, thoughts, and experiences freely without the fear of being judged by others. The MeeToo sense of community was described as a valuable form of social connectedness, which in turn had a positive impact on young people's mental health and made them feel less isolated and alone.

CONCLUSIONS

The findings of this research showed a range of positive impacts and possible processes for young people using MeeToo. Future research is needed to examine how these impacts and processes can be sustained.

HIV awareness, pre-exposure prophylaxis perceptions and experiences among people who exchange sex: qualitative and community based participatory study

Background

People who exchange sex for money, favors, goods or services, combat higher risk of acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Understanding barriers to STD and HIV related healthcare from the perspective of this stigmatized and marginalized community may improve access to sexual health services including pre-exposure prophylaxis (PrEP). 

Methods

We used community-partnered participatory and qualitative methods to conduct anonymous one-on-one interviews with people who exchange sex to understand their perspectives and experiences related to pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. We conducted twenty-two interviews and coded them to perform thematic analysis. 

Results

We identified five themes: (1) Appreciation of HIV risk and prevention strategies grew from information accumulated over time. (2) PrEP information came from a variety of sources with mixed messages and uncertain credibility. (3) Decision-making about use of PrEP was relative to other behavioral decisions regarding exchange sex. (4) The multi-step process of obtaining PrEP presented multiple potential barriers. (5) Healthcare providers were seen as powerful facilitators to PrEP utilization.

Conclusions

Our findings suggest that PrEP education and care needs to be made more relevant and accessible to individuals who exchange sex.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14235-0.

Survivor-led guidelines for conducting trauma-informed psychological therapy assessments: Development and modified Delphi study

BACKGROUND

Psychological therapy assessments are a key point at which a person is accepted into a service or referred on. There is evidence of service users experiencing harm, dropping out of services and potentially experiencing poor outcomes because of inadequate assessment practices. Approaches to assessment tend to be developed by individual services, with a lack of research identifying what makes a good assessment.

METHODS

This survivor-led study, based in England, aimed to generate guidelines for conducting trauma-informed psychological therapy assessments. The study was guided by a Service User Advisory Group and a Clinician Advisory Group. The study was conducted in three key stages: (i) identifying, modelling and drafting guideline content (ii) modified Delphi study and (iii) guideline finalization. Stage 1 was informed by literature reviews, qualitative research, data workshops with Advisory Groups and an expert consultation. Fifty-nine people with relevant experiences then participated in a single-stage modified Delphi (Stage 2). The guidelines were finalized through an analysis of Delphi open comments and a final expert consultation (Stage 3).

RESULTS

The guidelines evolved through each stage of the process, and all items were deemed important by >90% of Delphi participants. The final trauma-informed guidelines contain eight principles, including 'focus on relationships', 'from systems to people' and 'healing environments'.

CONCLUSIONS

Experiential knowledge was key in generating the guidelines and conceptualizing content, with a consequent focus on areas, such as recognizing power differentials, understanding oppression as trauma and the relational aspects of assessments. Future research should focus on guideline implementation and investigate whether this impacts service user dropout, engagement with therapy, and outcomes.

PATIENT OR PUBLIC CONTRIBUTION

This study is an example of survivor research, with several authors, including the study lead, identifying as survivors. We consider the ways in which our identities as survivor researchers impacted the study findings.

Scoping review of models and frameworks of patient engagement in health services research

OBJECTIVE

To count and describe the elements that overlap (ie, present in two or more) and diverge between models and frameworks of patient engagement in health services research. Our specific research question was 'what are the elements that underlie models and frameworks of patient engagement in health services research?'

DESIGN

Scoping review.

DATA SOURCES

On 6-7 July 2021, we searched six electronic databases (ie, CINAHL, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Evidence Based Practice Database, MEDLINE, PsycINFO and Scopus) and Google Scholar for published literature, and ProQuest Dissertations & Theses, Conference Proceedings Citation Index, Google, and key agencies' websites for unpublished (ie, grey) literature, with no date restrictions. These searches were supplemented by snowball sampling.

ELIGIBILITY CRITERIA

We included published and unpublished literature that presented (a) models or frameworks (b) of patient engagement (c) in health services research. We excluded articles unavailable as full text or not written in English.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data from included articles using an a priori developed standardised form. Data were synthesised using both quantitative (ie, counts) and qualitative (ie, mapping) analyses.

RESULTS

We identified a total of 8069 articles and ultimately included 14 models and frameworks in the review. These models and frameworks were comprised of 18 overlapping and 57 diverging elements, that were organised into six conceptual categories (ie, principles, foundational components, contexts, actions, levels and outcomes) and spanned intrapersonal, interpersonal, process, environmental, and health systems and outcomes domains.

CONCLUSIONS

There is little overlap between the elements that comprise existing models and frameworks of patient engagement in health services research. Those seeking to apply these models and frameworks should consider the 'fit' of each element, by conceptual category and domain, within the context of their study.

Supporting the Social-Emotional Well-Being of Elementary School Students Who Are Deaf and Hard of Hearing: A Pilot Study

PURPOSE

Children who are Deaf and Hard of Hearing (DHH), their parents, Teachers of the Deaf, and other community stakeholders were involved in co-designing a web-based resource to support students' social-emotional well-being. The resource was designed to provide families and teachers with strategies to enhance the social and emotional well-being of Grade 4-6 students who are DHH. This study reports outcomes of a pilot study of the web-based resource intervention.

METHOD

A pre-post pilot study was conducted to quantitatively examine reported anxiety, well-being, social relationships, school experience, student-teacher relationship, and parent and teacher self-efficacy. A total of 37 students, their parents (n = 37), and their classroom teachers (n = 40) participated in the intervention program and were provided access to the resource.

RESULTS

In total, 19 students, 22 parents, and 17 teachers completed both pre- and postsurvey measures. Paired t tests revealed that there was a statistically significant increase in parents' self-efficacy scores from pre- to posttest. Multivariate analysis of covariance revealed a significant association between parent use of the website and student-reported improved peer support and reduced school loneliness. No other statistically significant differences were found.

CONCLUSIONS

The use of a web-based resource codeveloped with students who are DHH, their parents, and teachers could potentially be beneficial for the well-being of students who are DHH as well as parents' self-efficacy. Further research is needed to confirm the benefits.

A qualitative UK study exploring counterpublic engagement of marginalized women via a Women's Health Network

Public engagement is at the forefront of health policy and research. The need for engagement with diverse groups and particularly marginalized groups who face increased health inequalities has been recognized. Yet, there is a lack of research that focuses on marginalized women. This article presents data from semi-structured interviews with members of a Women's Health Network (WHN) in Bradford, one of the most deprived areas of England. WHN is a collective of women who aim to improve women and their families' health, with a particular focus on seldom-heard voices. This article critically explores what realistic, representative counterpublic engagement looks like. It reveals the tension between the ideal of public engagement (direct participation) and what happens in practice. Challenges for direct participation of marginalized groups in formal structures require alternative solutions. It is argued that WHN provides an alternative model of counterpublic engagement by bridging the gap between 'seldom-heard' women and healthcare providers. WHN creates and sustains a discursive space between subaltern counterpublics and official public spheres, enabling two-way communication. Furthermore, this article problematizes the terms 'seldom heard' and 'professionals' for assuming homogeneity and masking diversity. It is argued that WHN's bridging model of subaltern counterpublic engagement is successful at amplifying women's voices and promoting women's health because of the network's diverse membership and reach. This diversity enables the authentic representation of varied communities and the discursive movement of issues relating to women's health. WHN thus offers a transferable model of counterpublic engagement in the absence of direct participation.

Meeting ethical challenges with authenticity when engaging patients and families in end-of-life and palliative care research: a qualitative study

BACKGROUND

Delivering high quality, patient- and family-centered care depends upon high quality end-of-life and palliative care (EOLPC) research. Engaging patients and families as advisors, partners, or co-investigators throughout the research lifecycle is widely regarded as critical to ensuring high quality research. Engagement is not only an ethical obligation, it also raises ethical challenges of its own. We conducted a qualitative study to understand ethical challenges and potential solutions when engaging patients and families in EOLPC research.

METHODS

We recruited and interviewed 20 clinical investigators and 22 patients or family caregivers through the Palliative Care Research Cooperative Group (PCRC). Interview transcripts were analyzed using constructivist grounded theory methodology. Analysis sought to identify ethical challenges and potential solutions, as well as to synthesize findings into practical recommendations tailored to engaging patients and families in EOLPC research.

RESULTS

Our study identified 8 ethical challenges considered unique to the EOLPC research context and 11 potential solutions to these challenges. The most frequently described ethical challenges included the need to minimize burdens of engagement for patients and caregivers, challenges of dealing with death and illness, and paternalism or "gatekeeping" (i.e., withholding the opportunity to participate from patients or caregivers). Investigators and patients or family caregivers conceptualized ethics challenges differently; several issues appeared to fall outside a traditional research ethics paradigm and more into the ethics of relationships. We synthesized these findings into 4 practical recommendations hypothesized to support authentic engagement.

CONCLUSIONS

Engaging patients and families in EOLPC research can raise unique ethical challenges. These challenges can be overcome to empower participation, minimize the unique burdens of EOLPC, and promote diversity. Whereas traditional research ethics tend to emphasize protecting research participants who may be vulnerable, an ethics approach based on authentic engagement that explores what it means for investigators and patients or family caregivers to be in a relationship may be needed. Future research is needed to explore this approach and test these recommendations in practice.

Patient and Public Involvement in Dermatology Research: A Review

Patient and public involvement (PPI) in research is defined as research being carried out 'with' or 'by' members of the public, patients, and carers, on both an individual and a group level, rather than simply 'about', or 'for' them. Within dermatology, PPI is increasingly recognised as a vital component of research as it helps to ensure that research remains relevant to the populations we intend to serve. Dermatology scholarship, with its rich psychosocial implications due to the stigma, physical disability, and mental health burdens these conditions may incur, is in a unique position to benefit from PPI to unlock previously inaccessible patient lived experiences or therapeutic consequences. Throughout the rapid growth of PPI, it has been infused throughout the research lifecycle, from design to dissemination and beyond. After first explaining the principles of PPI, we examine the existing evidence base at each research stage to explore whether our specialty has effectively harnessed this approach and to identify any subsequent impact of PPI. Finally, we scrutinise the challenges faced by those implementing PPI in dermatology research.

Missing Persons Alert: Finding the Lost “Person” in Patient-Oriented Research

After a decade of attempts at patient-oriented research, this article seeks to advance the approach, making individuals and communities active partners in health research. Patient-oriented research remains inconsistently implemented, tokenistic, and met with resistance—largely due to the system in which it was conceived and practiced. Patients remain bound by object-oriented medical cosmologies, thus reaffirming the hierarchical system underpinned by professional dominance. Until health research and researchers develop an awareness of the subtle injustices legitimized by the current approach, patient-oriented research will not actualize its mandate. This article does not challenge the healthcare system as that is beyond its scope; instead, it aims to develop further the “what” and “how” of public involvement in health research through the supplement of participatory research methodologies. In effect, setting the early foundations for transformation and encouraging a transition to a more just and equitable healthcare and research ecosystem.

Intersectionality and its relevance for research in dementia care of people with a migration background

BACKGROUND

Despite the care and support needs of migrants affected by dementia differing from the population of the country where they live now, most European countries do not provide specific strategies to address migration in their national dementia plans. The concept of intersectionality provides an innovative approach to dementia care perspectives and methodologies.

OBJECTIVE

The aim is to define intersectionality and to provide examples of applying the concept to dementia care research, focusing on people with a migration background.

METHODS

This article was conceptualized and discussed during virtual INTERDEM taskforce meetings in 2020/2021, while discussing identified literature on intersectionality, migration, and dementia care research.

RESULTS

Using an intersectionality framework allows understanding of a person's lived experience by considering the dimensionality, co-occurrence and interlocking of factors (e.g., sex/gender, socioeconomic status, ethnicity, migration status, geographic location/place).

CONCLUSION

Intersectionality can be applied as a conceptual and methodological approach to identify and address gaps in perspectives and in (dementia care) research to overcome the threat of ignorance, exclusion and discrimination.