Patient and Public Involvement/engagement

This article discusses 10 barriers to the involvement of service users/survivors in learning and teaching about mental health in higher education, suggesting ways of overcoming each. The paper is addressed to mental health trainers and educators, some of whom will be mental health service users/survivors. We have not looked at the involvement of carers/relatives in learning and teaching here. They also clearly have an important role to play and some of what we have written will have relevance to their involvement.

Objective: To synthesise the evidence on implementing family involvement in the treatment of patients with psychosis with a focus on barriers, problems and facilitating factors.

Design: Systematic review of studies evaluating the involvement of families in tripartite communication between health professionals, ‘families’ (or other unpaid carers) and adult patients, in a single-family context. A theoretical thematic analysis approach and thematic synthesis were used.

Data sources: A systematic electronic search was carried out in seven databases, using database-specific search strategies and controlled vocabulary. A secondary manual search of grey literature was performed as well as using forwards and backwards snowballing techniques.

Results: A total of 43 studies were included. The majority featured qualitative data (n=42), focused solely on staff perspectives (n=32) and were carried out in the UK (n=23). Facilitating the training and ongoing supervision needs of staff are necessary but not sufficient conditions for a consistent involvement of families. Organisational cultures and paradigms can work to limit family involvement, and effective implementation appears to operate via a whole team coordinated effort at every level of the organisation, supported by strong leadership. Reservations about family involvement regarding power relations, fear of negative outcomes and the need for an exclusive patient–professional relationship may be explored and addressed through mutually trusting relationships.

Conclusions: Implementing family involvement carries additional challenges beyond those generally associated with translating research to practice. Implementation may require a cultural and organisational shift towards working with families. Family work can only be implemented if this is considered a shared goal of all members of a clinical team and/or mental health service, including the leaders of the organisation. This may imply a change in the ethos and practices of clinical teams, as well as the establishment of working routines that facilitate family involvement approaches.

L’implication de personnes avec une expérience vécue des problèmes de santé mentale dans l’organisation des soins de santé mentale ne cesse de gagner du terrain, mais elle soulève encore de vives résistances de la part des professionnels de la santé mentale. Cet article dresse un bilan de leur implication au regard de la littérature scientifique internationale, en distinguant leur implication dans
l’organisation des soins et dans l’intervention clinique en santé mentale. Si leur présence n’a pas pour effet de bouleverser le champ de la santé mentale, tant dans la façon dont les soins se donnent que dans la préséance toujours accordée aux savoirs professionnels sur les savoirs acquis au cours de l’expérience, elle a toutefois contribué à améliorer l’accessibilité et la qualité des soins, à promouvoir le respect des droits des patients et à mieux prendre en compte leur réalité.

Participatory evaluation has been increasingly used in health promotion (HP) and various forms of participatory evaluation have been put into practice. Simultaneously, the concept of participation has become more important for evaluation research in general, which is equally diverse and the subject of various discourses. This study addresses the issue of how the concept of participation has been established in HP evaluation practice. An analytical framework was developed, which served as a basis
for a literature review, but can also be used as a general framework for analyzing and planning the scope of participation by various stakeholders within different phases of participatory evaluation. Three dimensions of participation, which refer to decision making (decision power, deliberation) and action processes are distinguished. The results show that only a few articles discussed participatory evaluation processes and participatory (evaluation) research was largely put forth by participatory (action) research
in communities. The articles analyzed referred mostly to three stakeholder groups – evaluators, program staff and beneficiaries – and to participation processes in the initial evaluation phases. The application of the framework revealed that decision power seems to be held predominantly by program staff, evaluators seem to be more involved in action processes and beneficiaries in deliberation processes.

Keywords:
Participatory evaluation
Participatory research
Participation
Health promotion
Framework

Aim: This paper reports on the results of stakeholder consultation in the development of “high risk” foot services in the Australian Capital Territory.
Method: Three consultation approaches were used including a survey of service users, two workshops with a range of stakeholders and in-depth interviews with thirteen people with diabetes who have a previous history of a lower extremity ulcer or amputation.
Results: The consultation phase identified a number of important issues for the improvement of lower limb services, including the need to improve communication between health service providers, the need for services to be accessible, and the barriers accessing appropriate footwear. Service users did not want a single, co-located tertiary model of foot care. Instead, the consultation led to an integrated, 'virtual' approach to the delivery of foot care services.

User participation in mental healthcare has increased considerably in many countries around the world in the past decades. However, users' voices are still incipient in other countries. This was the case of Suriname where user participation emerged just recently with the creation of a client council at the national mental healthcare service (PCS). The PCS client council was implemented as a result of a project involving a transnational partnership between stakeholders in Suriname and the Netherlands. Employing a qualitative research approach, this paper examines the client council implementation process and analyses stakeholders' expectations for its future performance, benefits and disadvantages. The paper concludes that the client council offers a space from which traditionally excluded users can renegotiate their identities, develop new skills, influence care provision and exercise their citizenship. For genuine participation to emerge, however, it will be necessary to invest in effecting cultural and organisational change in mental healthcare, tackling power differentials between care providers and users, resourcing the council and reducing the stigma attached to mental illness. Transparency, consultation, negotiation and full collaboration are also identified as key elements to foster productive transnational partnerships, especially when they involve stakeholders belonging to countries with a colonial history.

This document was produced by members of the Developers of User and Carer Involvement in Education (DUCIE) Network: Editor Chris Essen, Jill Anderson, Marion Clark, Joan Cook, Lynne Edwards, Jo Fox, Ian Light, Alison MacMahon, Lisa Malihi-Shoja, Reshma Patel, Sam Samociuk, Alan Simpson, Lynn Tang and Nicky Westerby.

Cet article analyse les mécanismes de participation de personnes détentrices de savoirs expérientiels de différentes réalités, dont les problèmes de santé mentale, l’itinérance, la toxicomanie et la pauvreté, dans le projet Chez-soi Montréal (2009-2013). Cette analyse nous permet de caractériser leur rôle au sein du projet, dans et hors des comités dans lesquels elles siégeaient. Nous mettons l’accent sur l’idée de monopole professionnel pour expliquer l’implication relativement superficielle des pairs dans ce projet, ainsi que sur les facteurs ayant limité un plus grand partage du pouvoir décisionnel, pourtant souhaité par plusieurs acteurs au sein du projet. Ce faisant, par le biais de cette analyse, nous illustrons et mettons en contexte des enjeux qui se détachent de la littérature sur la participation d’usagers ou d’anciens usagers des services sociaux et de santé à des projets de recherche et d’intervention dans le domaine de la santé et des services sociaux.

Patients' engagement in healthcare is at the forefront of policy and research practice and is now widely recognized as a critical ingredient for high-quality healthcare system. This study aims to analyze the current academic literature (from 2002 to 2012) about patient engagement by using bibliometric and qualitative content analyses. Extracting data from the electronic databases more likely to cover the core research publications in health issues, the number of yearly publications, the most productive countries, and the scientific discipline dealing with patient engagement were quantitatively described. Qualitative content analysis of the most cited articles was conducted to distinguish the core themes. Our data showed that patient engagement is gaining increasing attention by all the academic disciplines involved in health research with a predominance of medicine and nursing. Engaging patients is internationally recognized as a key factor in improving health service delivery and quality. Great attention is up to now paid to the clinical and organizational outcomes of engagement, whereas there is still a lack of an evidence-based theoretical foundation of the construct as well as of the organizational dimensions that foster it.

This infographic poster summarises the rationale for and process used to co-create a publications training course with and for patient advocates. This free, practical, online, interactive, modular, and evidence-based course can be accessed here: https://wecanadvocate.eu/patients-in-publications/

Background
Patient and public engagement is growing, but evaluative efforts remain limited. Reviews looking at evaluation tools for patient engagement in individual decision making do exist, but no similar articles in research and health systems have been published.

Objective
Systematically review and appraise evaluation tools for patient and public engagement in research and health system decision making.

Methods
We searched literature published between January 1980 and February 2016. Electronic databases (Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO) were consulted, as well as grey literature obtained through Google, subject‐matter experts, social media and engagement organization websites. Two independent reviewers appraised the evaluation tools based on 4 assessment criteria: scientific rigour, patient and public perspective, comprehensiveness and usability.

Results
In total, 10 663 unique references were identified, 27 were included. Most of these tools were developed in the last decade and were designed to support improvement of engagement activities. Only 11% of tools were explicitly based on a literature review, and just 7% were tested for reliability. Patients and members of the public were involved in designing 56% of the tools, mainly in the piloting stage, and 18.5% of tools were designed to report evaluation results to patients and the public.

Conclusion
A growing number of evaluation tools are available to support patient and public engagement in research and health system decision making. However, the scientific rigour with which such evaluation tools are developed could be improved, as well as the level of patient and public engagement in their design and reporting.

This article provides an extensive literature review on the changing role of users in innovation, with a particular focus on the healthcare sector. Users have been specifically analyzed by many scholars worldwide due to their significant role as a source of innovation beyond the traditional assumption which considers customers as mere passive adopters of products and services. The increasing, but still scarce, number of studies on this topic has demonstrated the benefits of patient involvement and how a close and continuous relationship between patients and practitioners can lead to permanent cycles of improvements and innovation in healthcare outcomes. In addition to a user-centered approach, innovative patients are actively developing new solutions for their own treatments, likewise for other patients with similar diseases.

Web 2.0 technologies have enabled new methods of engagement, moving from static mono-directional sources of information to interactive user-led experiences. Use of Web 2.0 technologies for engagement is gaining momentum within the health sector however this is still in its infancy in biobanking research. This paper reports on findings from focus groups with biobank participants to gauge their views on a Web 2.0 dynamic consent interface. The findings from this study suggest that participants would welcome more interactive engagement with biobanks, and the opportunity to hear more about how their data and samples are being used in research. We propose that by adopting Web 2.0 tools for dynamic consent, we can move towards an 'Engagement 2.0' model whereby research participants have the opportunity for more interactive engagement with medical research, setting up a two-way communication channel between participants and researchers, for the benefit of both.

The Ontario SPOR Support Unit’s Patient Partnership Working Group (PPWG) has commissioned a patient-led study to investigate patient views on “ladders of engagement” frameworks, using IAP2’s Public Participation Spectrum (IAP2 Spectrum) as an example. Objectives of the study include determining what relevance such frameworks hold for patients and discovering if there is opportunity to reimagine a framework from a patient perspective. To gain insights into these questions, eight (8) patients were interviewed, the findings of which are discussed in this paper.

Conversations with engaged patients revealed diverse motives, preferences, and intentions related to engaging in research. The participants had differing understandings of key concepts such as partnership, meaningfulness, and what constitutes ‘good’ engagement. As a result, the interviewed patients did not relate easily to the IAP2 Spectrum. They felt it did not accurately reflect their experiences, and some thought it was not a desirable or helpful model from their perspective. Some patients were in agreement, however, that the IAP2 Spectrum may be useful in familiarizing newly engaged patients with researchers’ views on engagement.

As a way to more easily talk about and analyze patient views, the participants were identified as belonging to one of three groups: patients who volunteer to provide their perspectives and feedback; patients with pre-existing professional-level research experience who volunteer their skills; and patients who seek to shape the practice of patient engagement by providing consulting to researchers and health institutions and organizations. Sorting the participants in this way was instructive as it helped to illuminate some of the tensions within the engaged patient community, particularly as they relate to the increasing “professionalization” of patients. In particular, participants were divided on whether meaningful contribution to engagement activities requires full partnership with researchers. In addition, there was concern among some participants that research-related training for patients may affect patients’ abilities to maintain their unique patient perspectives, considering the intensive socialization into research practice that training provides. Another notable finding was that some participants felt that patients who advise on the practice of patient engagement do not necessarily represent the views and preferences of all engaged patients.

While there are no easy solutions to resolving these tensions, this study helps to shed light on patient views on engagement in research and offers ideas for further investigation.

The purpose of this summary report is to describe the context, purpose, and benefits of
meaningfully engaging persons with lived experience of mental health and addiction issues
in system-level work. “System-level engagement” refers to engagement that happens at the
highest tier of decision-making (governmental, institutional, and organizational) to promote
change in culture, policies, and procedures across organizations and services. This
summary report outlines common barriers and facilitators to meaningful engagement at
the system level, as well as outcomes related to this work. It also highlights examples of
engagement frameworks from Canada, the United Kingdom, and the United States. There
are many successful practices to draw from; the evidence does not point to a one-size-fits-all approach. Rather, the literature outlines the importance of creating a “receptive context”
that combines individual, organizational, structural, political, and cultural conditions for
meaningful engagement (1). That said; engagement frameworks are most meaningful
when they meet the needs of all stakeholders involved.
Three key findings:
 Meaningful engagement refers to genuine, equitable, and affirming processes to
integrate the perspectives and expertise of people with lived experience within the
mental health and addiction system, from policy development to point-of-care (2).
 Through their expertise, persons with lived experience can enhance how the mental
health and addiction system works.
 Shifts in organizational culture and practices, as well as practitioner beliefs, are
required to facilitate meaningful engagement of persons with lived experience in
improving the mental health and addiction system.

Experience Co-design is the involvement of experts from diversified fields for designing the optimal experience. While experience designing concepts have been the center stage in design of Information Technology applications and mobile devices, it has not been of much interest in healthcare. But with advent of consumerism catching up and the importance of patient satisfaction and patient experience gaining momentum in healthcare, experience co-design is again an idea that requires adaptation and adoption into mainstream healthcare delivery system with participation of the patients, family, physician, nurses and all stakeholders involved in the healthcare. Experience design is not just related to patient, but also should be adopted for enhancing employee engagement and experience. Employee satisfaction and positive experience of the employee will help in better productivity and efficiency of the employee and the employee being able to deliver better care for the patient as well. This paper introduces the importance of experience co-design in healthcare delivery system.

Background: This article describes a method for successful engagement of patients and family members in all stages of a 5-year comparative effectiveness research trial to improve transitions of care for patients from chronic kidney disease to end-stage kidney disease.Methods: This project utilized the Patient-Centered Outcomes Research Institute's conceptual model for engagement with patients and family members. We conducted a qualitative analysis of grant planning meetings to determine patient and family member Co-Investigators' priorities for research and to include these engagement efforts in the research design. Patient and family member Co-Investigators partnered in writing this paper.Results: Patients and family members were successfully engaged in remote and in-person meetings to contribute actively to research planning and implementation stages. Three patient-centered themes emerged from our data related to engagement that informed our research plan: kidney disease t...

Die Forderung nach Partizipation und Beteiligung ist seit den 1990er Jahren fixer Bestandteil internationaler Debatten zur Reform der Gesundheitssysteme. Während in einigen europäischen Ländern (UK, NL, D) bereits umfassende und
koordinierte Beteiligungsstrategien zu beobachten sind, gibt es in Österreich erst vereinzelte Maßnahmen, die sehr unterschiedliche Ansätze verfolgen. Vor diesem
Hintergrund wird in diesem Artikel ein Spektrum möglicher Beteiligungsformen auf unterschiedlichen Ebenen des Gesundheitssystems eingeführt. Anhand dieses Spektrums wird anschließend eine Standortbestimmung zur Beteiligung von Patienten und Bürgern im österreichischen Gesundheitssystem vorgenommen. Abschließend werden Perspektiven für künftige Beteiligungsstrategien im österreichischen Gesundheitssystem diskutiert.

Participation is a key principle in health promotion. Numerous methods and tools are available and several models are used to guide and evaluate participatory endeavours in the health field. Recently, however, the lack of conceptual clarity and the normative underpinning of participation have been criticized and more substantiation by social theories has been suggested. To identify theoretical approaches applied to the topic so far and elaborate their potential contribution, a systematic literature review was conducted. Very few papers were identified that included substantial use of social theories. Their main arguments were grouped and critically discussed within a framework of three key questions. The first analyses the functions of participation and expands either the ‘democratic’ or ‘utilitarian’ perspective commonly suggested. The second asks how lay actors can be constituted as interested and competent stakeholders within their socio-political environments. The third complements an actor-focused perspective by elaborating participatory processes as asymmetric and conflictual. We conclude that the theoretical contributions available offer relevant stimulation for the conceptualization and implementation of participation in health promotion. Future theoretical work could benefit from cross-fertilization with theoretical debates in other areas of health promotion and from more explicitly elaborating the social context within which participation takes place.
Keywords health promotion; participation; lay participation; decision-making; social theory

Aim and Objectives: This paper explores patients' perspectives on infection prevention and control. Background: Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed frontline clinicians' practices; patients' roles have been less explored. Design: Video-reflexive ethnography. Methods: Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including eleven hours of video footage. This paper focuses on eight occasions where video footage was shown back to patients in one-on-one reflexive sessions. Findings: Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. Conclusion: This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. Relevance to clinical practice: This study suggests that if clinicians seek to reduce infection rates they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours and assist them to support appropriate patient self-care behaviour.

To synthesise the evidence on implementing family involvement in the treatment of patients with psychosis with a focus on barriers, problems and facilitating factors. Systematic review of studies evaluating the involvement of families in tripartite communication between health professionals, 'families' (or other unpaid carers) and adult patients, in a single-family context. A theoretical thematic analysis approach and thematic synthesis were used. A systematic electronic search was carried out in seven databases, using database-specific search strategies and controlled vocabulary. A secondary manual search of grey literature was performed as well as using forwards and backwards snowballing techniques. A total of 43 studies were included. The majority featured qualitative data (n=42), focused solely on staff perspectives (n=32) and were carried out in the UK (n=23). Facilitating the training and ongoing supervision needs of staff are necessary but not sufficient conditions fo...

Background: Following an initial NHS Health Check appointment, the National Institute for Health and Care
Excellence (NICE) suggest patients with QRISK2 scores of ≥10% should be offered advice on lifestyle and
the risks and benefits of starting a statin. NICE recommend GPs should ascertain patients’ pre-existing
knowledge of cardiovascular disease risk, explore health beliefs, assess readiness to change, offer support,
and engage family members. Condensing this complex discussion into a short consultation may result in
inadequate patient understanding of the benefits of preventive measures. An alternative approach is
needed. We propose a digital adjunct giving patients the opportunity to interact with their health check
results from home before returning to see their GP. Before embarking on funding applications we sought
the views of patients and members of the public.
Methods: We consulted the Primary Care Research in Manchester Engagement Resource (PRIMER), an
established departmental Patient and Public Involvement (PPI) group (N = 9) and then ran a workshop with
19 members of the public, co-facilitated by 4 members of PRIMER. Following a brief presentation on the
background to the project, attendees were split into four groups and introduced to Ketso, a toolkit for
creative engagement. Ketso was used to encourage group discussions regarding the project idea. Results: This PPI work improved the study design and proposed intervention. Discussions focussed on three
themes: 1) positive feedback, 2) challenges and solutions, and 3) improvements/alternatives. Positive feedback
included benefits to the NHS and patients. Challenges identified related to: 1) access, 2) data security, 3)
engagement, and 4) negative consequences. Workshop members generated various solutions to these
challenges and made additional suggestions for improvement relating to: 1) population (e.g. also including
those with QRISK2 scores ≤10%), 2) duration (e.g. ongoing access to provide continued feedback), and 3)
platform content (e.g. signposting to relevant services).
Conclusions: This PPI work helped identify potential challenges and solutions not previously considered by
the research team. Findings have informed the subsequent intervention design and strengthened the bid for funding. We aim to ensure ongoing patient and public involvement in all future stages.
Keywords: PPI, Patient and public involvement, Public engagement, Health check, Patient records, Lifestyle,
Cardiovascular risk, Funding application

Die Forderung nach Partizipation und Beteiligung ist seit den 1990er Jahren fixer Bestandteil internationaler Debatten zur Reform der Gesundheitssysteme. Während in einigen europäischen Ländern (UK, NL, D) bereits umfassende und koordinierte Beteiligungsstrategien zu beobachten sind, gibt es in Österreich erst vereinzelte Maßnahmen, die sehr unterschiedliche Ansätze verfolgen. Vor diesem Hintergrund wird in diesem Artikel ein Spektrum möglicher Beteiligungsformen auf unterschiedlichen Ebenen des Gesundheitssystems eingeführt. Anhand dieses Spektrums wird anschließend eine Standortbestimmung zur Beteiligung von Patienten und Bürgern im österreichischen Gesundheitssystem vorgenommen. Abschließend werden Perspektiven für künftige Beteiligungsstrategien im österreichischen Gesundheitssystem diskutiert.

Die gegenwärtige Diskussion um den Begriff Partizipation wird am Beispiel der Gesundheitsförderung aufgegriffen. Soziologische Ansätze haben partizipative Praktiken der Gesundheitsförderung bereits als neue Form der Führung dekonstruiert. Um der Instrumentalisierung von Partizipation entgegenzuwirken, bedarf es einer theoretischen Fundierung des Konzepts. Anhand der soziologischen Systemtheorie wird Gesundheitsförderung als kommunikative Praktik rekonstruiert, deren Erfolg von der überwindung dreier Unwahrscheinlichkeiten (Erreichbarkeit, Verstehen, Akzeptanz) abhängt. Partizipation wird als Strategie erkannt, die sicherstellt, dass Kommunikationsangebote sowohl auf den kulturellen Kontext der Zielgruppe Bezug nehmen (Redundanz), als auch einen Moment der überraschung mit sich führen (Varietät) und damit den Erfolg der Kommunikation sichern. Im Anschluss an die Systemtheorie wird eine Definition vorgeschlagen, durch die Partizipation an Entscheidungsprozessen hinsichtlich der Zeit-, Sach- und Sozialdimension unterschieden werden kann. The current discussion about participation is taken up by the case of health promotion. So far, sociological approaches have deconstructed participative practices within health promotion as a new form of governance. To antagonize the instrumentalization of participation a theoretical foundation of the concept is needed. By means of sociological systems theory health promotion is reconstructed as a communicative practice whose success relies in its ability to resolve three improbabilities (addressability, understanding, acceptance). Thereby, participation is identified as strategy to ensure that communicative offers are more familiar to the cultural context of the target group (redundancy) and carry a moment of surprise with them (variety) — both mechatnisms are central to the success of communication. In reference to systems theory a definition is proposed that distinguishes participation in decision-making processes according to the time, factual and social dimension.

There is a growing consensus among scholars, national governments, and intergovernmental organisations of the need to involve the public in decision-making around the use of artificial intelligence (AI) in society. Focusing on the UK, this paper asks how that can be achieved for medical AI research, that is, for research involving the training of AI on data from medical research databases. Public governance of medical AI research in the UK is generally achieved in three ways, namely, via lay representation on data access committees, through patient and public involvement groups, and by means of various deliberative democratic projects such as citizens’ juries, citizen panels, citizen assemblies, etc.—what we collectively call “citizen forums”. As we will show, each of these public involvement initiatives have complementary strengths and weaknesses for providing oversight of medical AI research. As they are currently utilized, however, they are unable to realize the full potential of their complementarity due to insufficient information transfer across them. In order to synergistically build on their contributions, we offer here a multi-scale model integrating all three. In doing so we provide a unified public governance model for medical AI research, one that, we argue, could improve the trustworthiness of big data and AI related medical research in the future.

The way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, vulnerable patients and carers may be excluded because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient and public involvement and engagement (PPIE) contributors to co-design new tools for the collection and use of patient experience data in multiple health settings. This paper outlines how the range of PPIE and research activities enabled the co-design of new tools to collect patient experience data.

The aim of this project was to find out the priorities for research that could improve fundamental care. 'Fundamental care' covers all aspects of basic care in hospital wards, such as helping with core physical needs, building positive relationships and keeping patients safe. By setting the priorities with patients, carers, the public and health care professionals, research can look at the issues that really matter to people who are receiving or delivering care in hospital wards. Previously, prioritisation exercises have started with a menu of options and asked people to choose from that list. They have also been focused on specific health conditions. Traditionally, there has been little opportunity for patients, carers and the public to contribute to identifying the issues to be prioritised. To develop the priorities for research, we started by exploring what is meant by 'fundamental care', looking at patient and carer accounts and academic and policy reports. Patients, carers, staff, and members of the public were consulted via surveys, interviews and group discussions to share experiences and issues. A list of 15 topics was identified based on what was most commonly mentioned by patients, carers and healthcare professionals as well as what was practical for the CLAHRC Wessex team to research. A workshop with patients, carers and healthcare professionals was held, to decide the top 5 areas. The five priority areas identified were: Nurse staffing Individualised patient care Staff communication Staff attitudes and relationships with patients Information about care/communication

Following an initial NHS Health Check appointment, the National Institute for Health and Care Excellence (NICE) suggest patients with QRISK2 scores of ≥10% should be offered advice on lifestyle and the risks and benefits of starting a statin. NICE recommend GPs should ascertain patients' pre-existing knowledge of cardiovascular disease risk, explore health beliefs, assess readiness to change, offer support, and engage family members. Condensing this complex discussion into a short consultation may result in inadequate patient understanding of the benefits of preventive measures. An alternative approach is needed. We propose a digital adjunct giving patients the opportunity to interact with their health check results from home before returning to see their GP. Before embarking on funding applications we sought the views of patients and members of the public. We consulted the Primary Care Research in Manchester Engagement Resource (PRIMER), an established departmental Patient and ...