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• Moving Beyond Tokenism: a public health response on Researcher in Residence models
  Duika L. Burges Watson
  Published on: 13 May 2016

• Published on: 13 May 2016

  Moving Beyond Tokenism: a public health response on Researcher in Residence models

  • Duika L. Burges Watson, Lecturer
  • Other Contributors:
    • Mandy Cheetham, Avril Rhodes, Keiran Conaty, Val Bryant

  Marshall et al's (2014) paper was highlighted as an exemplar of stakeholder participation by a speaker at a recent public health research conference, held in Newcastle. Participants gave useful feedback about many of the core issues raised, which we reflect here.

  Marshal et al's (2014) 'Researcher in Residence' models are suggested as a means of co-engaging academics and practitioners in the promotion of evide...

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  Marshall et al's (2014) paper was highlighted as an exemplar of stakeholder participation by a speaker at a recent public health research conference, held in Newcastle. Participants gave useful feedback about many of the core issues raised, which we reflect here.

  Marshal et al's (2014) 'Researcher in Residence' models are suggested as a means of co-engaging academics and practitioners in the promotion of evidence-informed service improvement. But participants at our event raised questions about public involvement as key stakeholders from earlier on in the research process. In the experience of our presenters and participants, research that starts from questions derived from both academics and participants (i.e. that is co-produced) is more likely to address patient needs than questions driven by academics, funders or institutions.

  Important (though hardly novel) questions remain. Are academics open enough to co-produced research ideas? Is there sufficient willingness to see questions differently, to work differently, and to enable tacit knowledge and patient and public experience to be valued as a legitimate contribution to the research process? Public stakeholders at our event expressed hunger to know how to engage with academia, but felt the opportunities to do so were unclear. There is much to learn from Patient and Public Involvement (PPI) in research.

  As others have observed, effective patient and public involvement (PPI) requires difficult conversations about vested interests (Greenhalgh et al 2014) and power and status among stakeholders (Centre for Social Justice 2012). Discussions about paying research participants can present thorny issues for some, among wider concerns around how public views are sought/used/valued/acknowledged. PPI raises philosophical questions around 'independent research' and what this means, as well as similarly tricky issues around what expertise and experience 'counts' (for researchers and the public) and how to address institutional barriers and facilitators to its use.

  Public health, classically defined as 'organised community effort' to prevent disease, prolong life and promote health (Winslow 1920 cited in Lang and Raynor BMJ 2012), presents a unique set of challenges. The relocation of public health responsibilities to local government raises questions about the different cultures of research and evidence use, the place of public involvement and democratic accountability, and how to use opportunities to address the social determinants of health. The exemplars used by Marshall et al (2014) are all drawn from clinical settings, and models of PPI may need adapting for use in public health.

  Our event showcased pockets of good practice and highlighted different methods to involve patients and the public, including in public health (see www.fuse.ac.uk). Some of these have been published elsewhere (Centre for Social Justice 2012, Lewis and Russell 2014). Taken together with feedback from those with experience of PPI, we can discern some underlying principles to guide meaningful PPI in research (which may also support research use in practice). Though not comprehensive, these include the need to; clarify motives; reach out to marginalised groups; use existing networks; take account of context; be reflexive and adaptive; value different forms of knowledge and expertise; be committed to the possibilities of facilitating change.

  Neither in public health nor clinical settings have we 'cracked it' in terms of PPI. Our conference opened a black box of similarities and contrasts between PPI in public health and clinical settings - requiring different approaches. Learning opportunities can flow in both directions, recognising the complexity inherent in PPI in population health interventions (Best et al 2009).

  The researcher in residence model introduced by Marshall et al (2014) is one approach to co-production. However, we argue that early involvement in setting research agendas is more likely to meet the needs of the public. There are critical blocks to effective engagement, for example silo thinking, the "paradigm shift" (Hunter 2009) required in academia, and specific skills amongst researchers. New ways of doing research must have co-production at their core - they must be collaborative and engage stakeholders from the start of the research process, when questions are being formulated, through to dissemination.

  References Best, A., Terpstra, J.L., Moor, G. Riley, B., Norman, C.D., Glasgow, R.E. (2009) Building knowledge integration systems for evidence-informed decisions Journal of Health Organization and Management, Vol. 23, issue 6, pp 627 - 641.

  Centre for Social Justice and Community Action, Durham University and the National Co-ordinating Centre for Public Engagement (2012) Community- based participatory research. A guide to ethical principles and practice, available from www.publicengagement.ac.uk

  Hunter, D. J. (2009) Leading for Health and Wellbeing: the need for a new paradigm Journal of Public Health, Volume 31, No. 2, pp 202-204

  Lang, T and Raynor, G (2012) Ecological public health: the 21st century's big idea? British Medical Journal 345: e5466. 21 August.

  Lewis and Russell (2011) Being embedded: A way forward for ethnographic research Ethnography 2011 12: 398. DOI: 10.1177/1466138110393786

  Lomas, J (2007) the in-between world of knowledge brokering British Medical Journal, 334, (7585): 129.

  Conflict of Interest:

  All authors were members of the organising committee for Beyond tokenism: PPI with impact Enriching patient and public involvement in public health research, October 16th 2014. The event was sponsored by the Newcastle Institute of Social Renewal, Newcastle University Faculty of Medical Science, Fuse Centre for Translational Research in Public Health and Involve North East.

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  Conflict of Interest:
  None declared.

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