This page provides further information on the design framework ‘Involvement’ theme, including the background and supporting material, and the development process.
Background and supporting material
Another important structural feature of embedded research initiatives was the involvement of various actors. We initially sought to establish whether initiatives involved people other than those researchers and health service staff working within them (e.g. patients and members of the public). Our data, however, showed that ‘involvement’ was broader and more complex than we envisaged and encompassed four sub-themes: who is involved in the initiative; the scale and location of their involvement; the activities they are involved in; and the mechanisms for their involvement.
The very nature of embedded research initiatives meant that all initiatives involved multiple groups of actors. The most obvious groupings were those working in front-line and/or managerial roles within the health setting and those from academic settings. Indeed, the active involvement of individuals from these groups was often an explicit part of the embedded researchers role. Patients and members of the public, however, were rarely explicitly involved in the initiatives we uncovered and published accounts point to dissonance between intended and actual patient involvement (Eyre et al. 2015; 2017; Cunliffe & Scaratti, 2017). Of those that did include patients or members of the public, the majority limited their involvement to the knowledge work being undertaken within the initiative (e.g. a well-bounded service evaluation or improvement project). They tended not to be involved in the design or operation of the embedded research initiative itself.
There was a similar picture for other groups of stakeholders. Whilst advisory groups provided a relatively well-worn path for involvement, these groups usually related to the work being undertaken by the embedded researchers rather than the conceptualisation or operationalisation of the initiative as a whole.
Cunliffe, A. L. and Scaratti, G. (2017) ‘Embedding Impact in Engaged Research: Developing Socially Useful Knowledge through Dialogical Sensemaking’, British Journal of Management, 28(1): 29-44.
Eyre, L., Farrelly, M. and Marshall, M. (2017) ‘What can a participatory approach to evaluation contribute to the field of integrated care?’, BMJ Quality & Safety, 26(7): 588-94.
Eyre, L., George, B. and Marshall, M. (2015) ‘Protocol for a process-oriented qualitative evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme using the Researcher-in-Residence model’, Bmj Open, 5(11).
Development and adaptation process
This theme was originally labelled PPI and included three sub-themes (scale and location of contribution, type of contribution, contribution mechanisms). The theme did not come directly from our scoping or literature review work, but was a pre-determined by virtue of being included in our proposal as an area of interest.
During the workshop participants focused on PPI in general and at times seemed to struggle to relate this to embedded research initiatives. Insights from participants concerned the ‘forgotten’ nature of PPI, how to make PPI meaningful, genuine and authentic and how best to facilitate PPI. There was also some discussion which suggested that participants found it difficult to distinguish between involving patients and publics in service provision more generally and involving them in the embedded research initiative itself (either at the level of the initiative or in specific projects within the initiative).
One of the key insights to emerge from the workshop, however, was the need to focus on the involvement of all stakeholders, not just patients and publics. This resulted in the shift of name for the theme and the inclusion of the first sub-theme (who to involve). We also adapted the language in the sub-themes to consistently refer to involvement, rather than contribution.