In this blog post Stephanie Gillibrand, Research Fellow within the REVAL Rapid Evaluation team at The University of Manchester, discusses public and patient involvement and engagement (PPIE) in the context of rapid evaluation.

Drawing on REVAL’s experience over the last year, Stephanie reflects on the process of undertaking PPIE for rapid evaluation, some of the challenges faced, and what has been learnt.

There are well-recognised and persistent questions that remain for researchers undertaking public engagement to support research:

• How do we do public engagement?
• Which groups do we involve? How can we do it in a timely manner?
• When do we involve the public?
• How do we get them to contribute meaningfully?

These are typically driven from wider points of contention and debate: ‘rubber-stamping’ or meaningful engagement, the role of co-production and co-design, etc. Ultimately, these debates circle back to who holds the power in research spaces and how, or if at all, this power is shared with the public and communities.

These are ongoing debates to be grappled with for researchers undertaking PPIE, and it has become clear over the past few months that these are all the more potent questions and complexities to navigate in a rapid research context.

Limited opportunities for co-design

This is not surpassed in the context of rapid evaluative research, and here, it may be that the context is key.

Unlike other research which may materialise more organically, REVAL’s evaluation portfolio is operationalised via the National Institute for Health Research, which funnel evaluation requests from different parts of the health and social care system to us as the REVAL evaluation programme research team.

Here presents the first conundrum from a PPIE perspective. As we receive direct requests with a clear scope and brief, opportunities for co-design in the initial phase of the evaluation are limited to a pre-identified set of stakeholders.

This inevitably leads to a hierarchy of engagement, whereby the engagement space is already occupied by a set of end-users (those within the health-system decision-making realm, often with their own public voice initiatives) who, naturally, will play an important role in shaping the research.

Shortened timeframe

There is also the ‘rapid’ element to address in rapid research. Our directive is to respond and conduct research evaluations rapidly, meaning elements of the traditional research process may be condensed in order to undertake this evaluative research more quickly.

Subsequently, the timeframe in which to identify and access all the relevant stakeholders, including the public and local relevant populations is shortened, thereby adding a practical difficulty which may feed into particular parts of the research development and evaluation lifespan. Herein presents the first area of tension.

Embedding elements of co-production and co-design

Working in this rapid way means we must critically and actively look for opportunities to embed elements of co-production and co-design where feasible and appropriate across the evaluation portfolio.

To start with, this has included taking stock of the wide breadth of stakeholders that we engage with as part of the evaluation progress, including: NHS England policy teams, the Department of Health and other civil servants, other researchers and academics working on overlapping topics; frontline healthcare professionals, commissioners and other health system decision-makers, the VCSE sector, including charities and specialist organisations, individuals with lived experience, carers, service users, and members of the public.

It is then the harder part to consider how we manage this engagement and balance the engagement process across such a large ensemble of players.

Public engagement

A crucial part of successful public engagement is ongoing, meaningful reflection and critique of PPIE practices and approaches. We have embedded space within the REVAL programme for reflection and learning on how we approach and conduct PPIE in the context of rapid research.

This has involved organising several workshops where we have reflected on our co-production approach at the programme and project level; considering aspects of our PPIE approaches that have worked well or less well; and areas where we may be able to more thoroughly embed aspects of co-production

This included reflecting on our day-to-day co-production approaches and PPIE activities at the project level; how we work with our PPI link facilitators; assessing current PPIE tools, methods and approaches and situating this within wider conversations of what we mean by co-production (i.e. engagement ‘vs’ involvement, consultation ‘vs’ co-production).

This has led us to consider what can and should be meant by co-production for rapid evaluative research: with whom, in what contexts and where in the evaluation process?

Areas to address

From these workshops, we’ve identified some areas which we can address to integrate more aspects of co-production with a wider set of players. This includes:

• identifying key external stakeholders (such as charities and specialist organisations) at the earliest available opportunity;
• promoting relationship-building and connections with these groups;
• forming project Advisory Groups earlier on in the evaluation lifespan.

We’ve also built in further mechanisms to assess and reflect on what impact public voice has in our evaluations, and we are holding quarterly meetings with the research team to share best practice and reflect on project-level activities.

Complexities of undertaking PPIE

In and amongst all of this, it has become clear that this process is not straightforward, and the complexities of undertaking PPIE are even more prevalent in the rapid context.

It seems that there is not an existing fit-for-purpose PPIE framework which we can simply ‘lift and shift’ onto the REVAL programme, and so we are working towards developing a re-imagined PPIE framework suitable for evaluative rapid research, which can be utilised by other research teams working in the rapid space.

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