A framework for public involvement at the design stage of NHS health and social care research: time to develop ethically conscious standards

PLAIN ENGLISH SUMMARY

Researchers who conduct studies in health and social care are encouraged to involve the public as early as possible in the process of designing their studies. Before their studies are allowed to start researchers must seek approval from a Research Ethics Committee, which will assess whether the study is going to be safe and ethical for patients or healthy volunteers to take part in. The process of ethical review does not consider how researchers work with patients and the public early on to design their studies. Furthermore, there is no requirement for researchers to seek ethical approval for public involvement. However, in our work advising researchers about public involvement we have found that the ways in which researchers involve the public in the design of their studies are sometimes unintentionally unethical, and this is the focus of our paper. We have observed ten areas where ethical issues may arise because of the actions researchers may or may not take and which might consequently have a negative impact. Therefore, we have used these observations to develop a "framework" to help researchers and the public work together at the early design stage in ways that are ethical. Our intention for the framework is to help researchers be mindful of these ten areas and how easily ethical issues can arise. The framework suggests some ways to overcome the potential issues in each of the ten areas. The ten areas are: 1) Allocating sufficient time for public involvement; 2) Avoiding tokenism; 3) Registering research design stage public involvement work with NHS Research & Development Trust Office at earliest opportunity; 4) Communicating clearly from the outset; 5) Entitling public contributors to stop their involvement for any unstated reasons; 6) Operating fairness of opportunity; 7) Differentiating qualitative research methods and public involvement activities; 8) Working sensitively; 9) Being conscious of confidentiality and 10) Valuing, acknowledging and rewarding public involvement. We looked to see whether any other similar approaches to helping researchers address potential ethical issues when working with the public on designing studies have been published and to our knowledge none exist. Our framework is presented as a draft and believe that it would now benefit from input from researchers and the public to gauge how useful it is and whether there are any other possible situations that it might need to cover.

ABSTRACT

The current paper highlights real life examples of how ethical issues can arise during public involvement activities at the research design stage. We refer to "the research design stage" as the time between the generation of the research ideas and when formal permissions to start the work including ethical approval are granted. We argue that although most researchers work ethically at this early stage, some may still benefit from being informed about ethically conscious approaches to involving the public. The paper highlights 10 ethical issues that we have observed with involving the public at the research design stage. We provide examples of these observed scenarios to illustrate the issues and make suggestions for how they can be avoided to help researchers become more ethically conscious when involving the public at the research design stage. Currently the draft framework comprises: 1) Allocating sufficient time for public involvement; 2) Avoiding tokenism; 3) Registering research design stage public involvement work with NHS Research & Development Trust Office at earliest opportunity; 4) Communicating clearly from the outset; 5) Entitling public contributors to stop their involvement for any unstated reasons; 6) Operating fairness of opportunity; 7) Differentiating qualitative research methods and public involvement activities; 8) Working sensitively; 9) Being conscious of confidentiality and 10) Valuing, acknowledging and rewarding public involvement. The draft framework will help researchers to recognise the ethical issues when involving the public and is intended to be used voluntarily in a self-regulatory way. We believe that the draft framework requires further consultation and input from the wider research community and the public before endorsement by national UK bodies such as INVOLVE and the Health Research Authority (HRA).

Can research development bursaries for patient and public involvement have a positive impact on grant applications? A UK-based, small-scale service evaluation

BACKGROUND

Increasingly, research grant awarding bodies are regarding involvement at all stages of research, including prior to funding, as good practice. However, it is unclear how researchers should pay for this. Therefore, a pre-funding bursary scheme was designed. Up to £500 could be requested for involvement to develop a grant application for which user involvement is a key requisite for the funding body concerned. As the bursary scheme had run for 2 years, an evaluation was conducted to ascertain whether the scheme was effective for incorporating early involvement and in developing the grant proposal.

RESULTS

Twelve applications were made of which all were funded. The mean amount requested was £432.91; with the mean amount awarded £308.72. The involvement activities conducted all used qualitative methodology. Feedback regarding the bursaries was positive: enabling refinement of the research question and design; developing dialogue between the service users and the researchers; and helping with team building, with service users sometimes becoming co-applicants or members of the steering groups. The bursaries provided a learning opportunity – about involvement for the researchers and about research for the service users. The ultimate aim of the scheme was to enhance the research grant. Regarding this, the involvement paid for by the bursary meant that applicants could complete the involvement sections with in-depth information and clarity.

CONCLUSION

For a relatively small financial outlay, appropriate involvement was made possible at an important part of the research process which is usually neglected due to lack of funding. Recommendations for implementation made.