Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study

Evaluating a grant development public involvement funding scheme: a qualitative document analysis

BACKGROUND

Undertaking Patient and Public Involvement (PPI) when developing health and social care research grant applications is critical. However, researchers may not have any funding to undertake PPI when developing grants. In response, the National Institute for Health and Care Research- Research Design Service for Yorkshire and the Humber in the United Kingdom, provided Public Involvement Fund Awards of up to £600 to fund PPI activity when researchers were developing grant applications. Researchers provided post-activity reports about how they utilised the Public Involvement Fund. These reports were analysed with the aim of evaluating the usefulness of the Public Involvement Fund and to provide learning about supporting researchers to undertake PPI when developing grants.

METHODS

The project was a qualitative document analysis of 55 reports. Initially a researcher coded four reports and three Public Contributors provided feedback. Researchers coded the remaining reports and identified key findings. A workshop was held with the three Public Contributors to develop the findings.

RESULTS

Researchers accessing the Public Involvement Fund award were generally early career researchers or clinicians who did not have other sources of funding for pre-grant PPI input. Researchers felt the award was useful in enabling them to conduct PPI, which strengthened their grant applications. Some researchers found that the award limit of £600 and guidance encouraging expenditure within three months, made it difficult to undertake PPI throughout the full grant development process. Instead, the majority of researchers consulted Public Contributors on one or two occasions. Researchers struggled to recruit diverse members or run group sessions due to the time pressures of grant deadlines. Researchers wanted training on undertaking PPI alongside the financial support.

CONCLUSIONS

Researchers, especially early career researchers found having a Public Involvement Fund award instrumental in enabling them to undertake PPI when developing grant applications. It would be beneficial for similar schemes to be widely available. Schemes need to provide sufficient funding to enable meaningful PPI and allow researchers to hold the award for long enough to facilitate involvement during the whole grant development process. Researchers continue to need training on undertaking PPI.

COCCOS study: Developing a transition program for adolescents with chronic conditions using Experience-Based Co-Design. A study protocol

BACKGROUND

During adolescence, adolescents and young adults (AYAs) are expected to transfer their care from the pediatric environment towards an adult-focused setting. To prevent an abrupt transfer of care, it is recommended to provide AYAs with chronic conditions an adequate transition program. The aim of this paper is to describe the study protocol for the development of a transition program for AYAs with common chronic conditions (COCCOS study), using the Experience-Based Co-Design (EBCD) methodology.

METHODS AND ANALYSIS

A qualitative, participatory study is conducted in Flanders (Belgium). Study participants are AYAs (n≥15, 14-25 years old, diagnosed with type 1 diabetes, asthma, or obesity), their families, and healthcare providers (n≥15). The study is composed of eight EBCD stages: clinical site observations, in-depth interviews, trigger film, healthcare providers' feedback event, AYAs' feedback event, joint event, co-design workshops, and a celebration event. Photovoice will take place as a starting point of EBCD. Data will be analyzed using thematic analysis.

RESULTS

Data collection has started in January 2023 and is expected to be completed in May 2024. As of August 2023, over 15 clinical site observations have been conducted. A total of 18 AYAs, two parents, six healthcare providers have been enrolled and a total of 20 interviews have been conducted.

CONCLUSION

Advancing transitional care is essential for tackling negative health outcomes. Applying the innovative participatory EBCD methodology will reveal key elements of transitional care for AYAs with common chronic conditions in the development of a person-centered transition program.

PRACTICE IMPLICATIONS

Study findings will apply key elements of transitional care of AYAs with chronic conditions in the development of an adequate transition program.

Gaps between needs of patient and public involvement and interests of researchers on pancreatic cancer

OBJECTIVE

Identify whether there were gaps between needs of end-users and interests of researchers focusing on pancreatic cancer.

METHODS

A questionnaire for end-users (patients, close family, others) and researchers was developed to measure value from the perspective of different stakeholder groups. Two separate literature analyses were conducted to assess the prevalence and impact of patient and public involvement (PPI).

RESULTS

Significant gaps were found between end-users and researchers in valuing basic research (15 vs 25 points, p = 0.005) and treatment (36 vs. 26 points, p = 0.015), but not in early diagnosis, risk factors, or quality of life. PPI was absent from the top 100 cited publications on pancreatic cancer research and was featured in 0.1% of all studies within the field.

CONCLUSIONS

Gaps existed between needs of end-users and interests of researchers on basic research and treatment. PPI constituted an insignificant part of the overall pancreatic cancer research literature and had negligible impact in terms of citations.

PRACTICAL IMPLICATIONS

To help close the gaps, PPI should be incorporated throughout the research process. The impact of PPI can be enhanced by prestigious journals in consideration of journal policies and encouragements and by dissemination at academic conferences.

Public involvement in Australian clinical trials: A systematic review

BACKGROUND

Public involvement enhances the relevance, quality, and impact of research. There is some evidence that public involvement in Australian research lags other countries, such as the United Kingdom. The purpose of the systematic review was to establish the rates and describe the characteristics of public involvement in Australian clinical trials.

METHODS

We reviewed evidence of public involvement in all Australian randomised controlled trials published in the first 6 months of 2021. To determine the quality of public involvement, we used the five-item short-form version of the Guidance of Reporting Involvement Patients and the Public, version 2.

RESULTS

In total, 325 randomised controlled trials were included, of which 17 (5%) reported any public involvement. Six trials reported public involvement in setting the research aim and seven in developing study methods. The authors of one study reflected on the overall role and influence of public involvement in the research.

CONCLUSION

Rate of public involvement in Australian clinical trials is seemingly substantially lower than those reported in countries with similar advanced public health care systems, notably the United Kingdom. Our observations may be explained by a lack of researcher skills in how to involve the public and the failure by major funding agencies in Australia to mandate public involvement when deciding on how to award grant funding.

Demonstrating the learning and impact of embedding participant involvement in a pandemic research study: the experience of the SARS-CoV-2 immunity & reinfection evaluation (SIREN) study UK, 2020-2023

BACKGROUND

Participant involvement in research studies is not a new concept, yet barriers to implementation remain and application varies. This is particularly true for pandemic response research studies, where timeframes are condensed, pressure is high and the value and inclusion of participant involvement can be overlooked. The SIREN Participant Involvement Panel (PIP) provides a case study for participant involvement in pandemic research, working in partnership with people who the research is for and about.

METHODS

SIREN and the British Society for Immunology (BSI) recruited and ran two phases of the PIP, involving 15 members in total over a 16-month period. Phase 1 ran between January and August 2022 and Phase 2 between October 2022 and March 2023. Activity figures including recruitment interest and PIP meeting attendance were recorded. To evaluate how the PIP has influenced SIREN, feedback was collected from (a) researchers presenting at the PIP and (b) PIP members themselves. Evaluation at the end of Phase 1 informed our approach to Phase 2. Thematic grouping was planned to identify key lessons learned.

RESULTS

Applications increased from n = 30 to n = 485 between Phase 1 and Phase 2 of the PIP, a more than 15-fold increase. The SIREN PIP positively impacted the design, implementation and evaluation phases of the study and sub-studies. Feedback from PIP members themselves was positive, with members highlighting that they found the role rewarding and felt valued. Learnings from the PIP have been condensed into five key themes for applying to future pandemic response research studies: the importance of dedicated resources; recruiting the right panel; understanding motivations for participant involvement; providing flexible options for involvement and enabling the early involvement of participants.

CONCLUSIONS

The SIREN PIP has demonstrated the value of actively involving people who research is for and about. The PIP has provided an active feedback mechanism for research and demonstrated a positive influence on both SIREN study researchers and PIP members themselves. This paper makes the case for participant involvement in future pandemic research studies. Future work should include improved training for researchers and we would support the development of a national PIP forum as part of future pandemic research preparedness.

Digital intervention for public health: searching for implementing characteristics, concepts and recommendations: scoping review

Studying the impact of digital interventions on public health can help ensure that the offered services produce the desired results. In order to address these factors, the subsequent study uses a scope review to evaluate the state of the field while concentrating on ideas and suggestions that represent factors that have been crucial in the management of digital intervention for public health. To shed light on the traits, ideas and suggestions related to public health digital intervention, a scoping review was carried out. Five electronic databases were used to locate pertinent research that were published before February 2022. All texts were examined, and study abstracts were scrutinized to determine their eligibility. The last analysis of this study included fifteen publications; five reviews, four qualitative studies, two quantitative studies, one viewpoint study, one mixed-method study, one perspective study, and one interventional study. The key ideas for digital interventions in population management and health studies are presented in this overview. Many concepts, implementation characteristics and recommendations have been raised which highlight the future role of these interventions to enhance public engagement and health equity.

Analysing breast cancer survivors’ acceptance profiles for using an electronic pillbox connected to a smartphone application using Seintinelles, a French community-based research tool

Introduction: Up to 50% of breast cancer (BC) survivors discontinue their adjuvant endocrine therapy (AET) before the recommended 5 years, raising the issue of medication non-adherence. eHealth technologies have the potential to support patients to enhance their medication adherence and may offer an effective way to complement the healthcare. In order for eHealth technologies to be successfully implemented into the healthcare system, end-users need to be willing and accepting to use these eHealth technologies.

Aim: This study aims to evaluate the current usability of eHealth technologiesin and to identify differences in BC SURVIVORS BC survivors accepting a medication adherence enhancing eHealth technology to support their AET to BC survivors that do not accept such a medication adherence enhancing eHealth technology.

Methods: This study was conducted in 2020 including volunteering BC survivors belonging to the Seintinelles Association. Eligible participants were women, diagnosed with BC within the last 10 years, and been exposed to, an AET. Univariable and multivariable logistic regression analyses were performed to investigate medication adherence enhancing eHealth technology acceptance profiles among BC survivors. The dependent variable was defined as acceptance of an electronic pillbox connected to a smartphone application (hereafter: medication adherence enhancing eHealth technology).

Results: Overall, 23% of the participants already use a connected device or health application on a regular basis. The mean age of the participants was 52.7 (SD 10.4) years. In total, 67% of 1268 BC survivors who participated in the survey declared that they would accept a medication adherence enhancing eHealth technology to improve their AET. BC survivors accepting a medication adherence enhancing eHealth technology for their AET, are younger (OR = 0.97, 95% CI [0.95; 0.98]), do take medication for other diseases (OR = 0.31, 95% CI [0.13; 0.68]), already use a medication adherence enhancing eHealth technology or technique (OR = 1.74, 95% CI [1.06; 2.94]) and are willing to possess or currently possess one or more connected devices or health applications (OR = 2.89, 95% CI [2.01; 4.19]).

Conclusion: Understanding acceptance profiles of BC survivors is fundamental for conceiving an effective eHealth technology enhancing AET among BC survivors. Hence, such profiling will foster the development of personalized medication adherence enhancing eHealth technology.

From testers to co-creators: the value and approaches to successful patient engagement in the development of eHealth solutions - Qualitative Expert Interviews Study

Background

Research has shown that patient engagement is most commonly done at the beginning of research or to test readily available prototypes and less commonly done in other phases such as the execution phases. Previous studies have reported that patients are usually assigned a consultative rather than a decision-making role in health service planning and evaluation.

Objective

This study had 2 objectives: to better understand the challenges and opportunities in the inclusion of patients in the development of eHealth technologies and ideas on how to overcome the identified gaps and to create a research-based end-to-end practical blueprint that can guide the relevant stakeholders to successfully engage patients as cocreators in all human-centered design phases rather than mere testers of preplanned prototypes.

Methods

Key informant interviews were conducted using in-depth semistructured interviews with 20 participants from 6 countries across Europe. This was followed by a focus group to validate the initial findings. Participants encompassed all the relevant stakeholder groups including patient experts, eHealth experts, health technology providers, clinicians, pharma executives, and health insurance experts.

Results

This study shows that engaging patients in eHealth development can help provide different types of value; namely, identifying unmet needs, better usability and desirability, better fit into the patient journey, better adoption and stickiness, better health outcomes, advocacy and trust, a sense of purpose, and better health equity and access. However, the participants agreed that patients are usually engaged too late in the development process, mostly assuming a sounding role in testing a ready-made prototype. The justification for these gaps in engagement is driven by some prominent barriers, notably compliance risks, patient-related factors, power dynamics, patient engagement as lip service, poor value perception, lack of resources, mistrust, and inflexibility. On the positive side, the participants also reflected on facilitators for better patient engagement; for instance, engaging through engagement partners, novel approaches such as the rise of professional patient experts, embedding patients in development teams, expectation management, and professional moderation services.

Conclusions

Overcoming the current gaps in patient engagement in eHealth development requires consolidated efforts from all stakeholders in a complex health care ecosystem. The shift toward more patient-driven eHealth development requires education and awareness; frameworks to monitor and evaluate the value of patient engagement; regulatory clarity and simplification; platforms to facilitate patient access and identification; patient incentivization, transparency, and trust; and a mindset shift toward value-based health care.

Attitudes and Expectations of Clinical Research Participants Toward Digital Health and Mobile Dietary Assessment Tools: Cross-Sectional Survey Study

Background

The adoption of health technologies is key to empower research participants and collect quality data. However, the acceptance of health technologies is usually evaluated in patients or healthcare practitioners, but not in clinical research participants.

Methods

A 27-item online questionnaire was provided to the 11,695 members of a nutrition clinical research participant database from the Nantes area (France), to assess (1) participants' social and demography parameters, (2) equipment and usage of health apps and devices, (3) expectations in research setting and (4) opinion about the future of clinical research. Each item was described using frequency and percentage overall and by age classes. A global proportion comparison was performed using chi-square or Fisher-exact tests.

Results

A total of 1529 respondents (81.0% women, 19.0% men) completed the survey. Main uses of health apps included physical activity tracking (54.7%, age-related group difference, p < 0.001) and food quality assessment (45.7%, unrelated to age groups). Overall, 20.4% of respondents declared owning a connected wristband or watch. Most participants (93.8%) expected the use of connected devices in research. However, protection of personal data (37.5%), reliability (35.5%) and skilled use of devices (28.5%) were perceived as the main barriers. Most participants (93.3%) would agree to track their food intake using a mobile app, and 80.5% would complete it for at least a week while taking part in a clinical study. Only 13.2% would devote more than 10 min per meal to such record. A majority (60.4%) of respondents would accept to share their social media posts in an anonymous way and most (82.2%) of them would accept to interact with a chatbot for research purposes.

Conclusions

Our cross-sectional study suggests that clinical study participants are enthusiastic about all forms of digital health technologies and participant-centered studies but remain concerned about the use of personal data. Repeated assessments are suggested to evaluate the research participant's interest in technologies following the increase in use and demand for innovative health services during the pandemic of COVID-19.