scholarly journals Delivering the aims of the Collaborations for Leadership in Applied Health Research and Care: understanding their strategies and contributions

2015 ◽  
Vol 3 (25) ◽  
pp. 1-208 ◽  
Author(s):  
Bryony Soper ◽  
Saba Hinrichs ◽  
Samuel Drabble ◽  
Ohid Yaqub ◽  
Sonja Marjanovic ◽  
...  
Keyword(s):  
Health Research ◽  
Public Involvement ◽  
Scale Up ◽  
Research Programme ◽  
Health Science ◽  
Future Research ◽  
Patient Benefit ◽  
Research Knowledge ◽  
Applied Health Research ◽  
Use Of Research

BackgroundIn 2008, the National Institute for Health Research (NIHR) in England established nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) to develop partnerships between universities and local NHS organisations focused on improving patient outcomes through the conduct and application of applied health research.ObjectivesThe study explored how effectively the CLAHRCs supported the ‘translation’ of research into patient benefit, and developed ways of doing applied research that maximised its chances of being useful to the service and the capacity of the NHS to respond. It focused on three issues: (1) how the NHS influenced the CLAHRCs, and vice versa; (2) how effective multistakeholder and multidisciplinary research and implementation teams were built in the CLAHRCs; (3) how the CLAHRCs supported the use of research knowledge to change commissioning and clinical behaviour for patient benefit.MethodsThe study adopted an adaptive and emergent approach and incorporated a formative evaluation. An initial phase mapped the landscape of all nine CLAHRCs and the context within which they were established, using document analysis, workshops and interviews, and a literature review. This mapping exercise identified the three research questions that were explored in phase 2 through a stakeholder survey of six CLAHRCs, in-depth case studies of two CLAHRCs, validation interviews with all nine CLAHRCs and the NIHR, and document review.Results(1) The local remit and the requirement for matched NHS funding enhanced NHS influence on the CLAHRCs. The CLAHRCs achieved positive change among those most directly involved, but the larger issue of whether or not the CLAHRCs can influence others in and across the NHS remains unresolved. (2) The CLAHRCs succeeded in engaging different stakeholder groups, and explored what encouraged specific groups to become involved. Being responsive to people’s concerns and demonstrating ‘quick wins’ were both important. (3) There was some evidence that academics were becoming more interested in needs-driven research, and that commissioners were seeing the CLAHRCs as a useful source of support. A growing number of completed projects had demonstrated an impact on clinical practice.ConclusionsThe CLAHRCs have included NHS decision-makers in research and researchers in service decision-making, and encouraged research-informed practice. All the CLAHRCs (as collaborations) adopted relationship models. However, as the complexities of the challenges they faced became clearer, it became obvious that a focus on multidisciplinary relationships was necessary, but not sufficient on its own. Attention also has to be paid to the systems within and through which these relationships operate.Recommendations for researchFuture research should compare areas with an Academic Health Science Network (AHSN) and a CLAHRC with areas with just an AHSN, to understand the difference CLAHRCs make. There should be work on understanding implementation, such as the balancing of rigour and relevance in intervention studies; systemic barriers to and facilitators of implementation; and tailoring improvement interventions. There is also a need to better understand the factors that support the explicit use of research evidence across the NHS, and the processes and mechanisms that support the sustainability and scale-up of implementation projects. Research should place emphasis on examining the role of patient and public involvement in CLAHRCs and of the relation between CLAHRCs and NHS commissioners.FundingThe NIHR Health Services and Delivery Research programme.

scholarly journals Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e031187 ◽  
Author(s):  
Maria-Jose Santana ◽  
Sandra Zelinsky ◽  
Sadia Ahmed ◽  
Chelsea Doktorchik ◽  
Matthew James ◽  
...  
Keyword(s):  
Health Research ◽  
Heart Diseases ◽  
Research Priorities ◽  
Research Programme ◽  
Advisory Council ◽  
Future Research ◽  
Prediction And Prevention ◽  
Participatory Health Research ◽  
Working Together ◽  
Oriented Research

ObjectivesThe overall goal of this study is to identify priorities for cardiovascular (CV) health research that are important to patients and clinician-researchers. We brought together a group of CV patients and clinician-researchers new to patient-oriented research (POR), to build a multidisciplinary POR team and form an advisory committee for the Libin Cardiovascular Institute of Alberta.DesignThis qualitative POR used a participatory health research paradigm to work with participants in eliciting their priorities. Therefore, participants were involved in priority setting, and analysis of findings. Participants also developed a plan for continued engagement to support POR in CV health research.SettingLibin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Canada.ParticipantsA total of 23 participants, including patients and family caregivers (n=12) and clinician-researchers (n=11).ResultsParticipants identified barriers and facilitators to POR in CV health (lack of awareness of POR and poor understanding on the role of patients) and 10 research priorities for improving CV health. The CV health research priorities include: (1) CV disease prediction and prevention, (2) access to CV care, (3) communication with providers, (4) use of eHealth technology, (5) patient experiences in healthcare, (6) patient engagement, (7) transitions and continuity of CV care, (8) integrated CV care, (9) development of structures for patient-to-patient support and (10) research on rare heart diseases.ConclusionsIn this study, research priorities were identified by patients and clinician-researchers working together to improve CV health. Future research programme and projects will be developed to address these priorities. A key output of this study is the creation of the patient advisory council that will provide support and will work with clinician-researchers to improve CV health.

scholarly journals The Health Inequalities Assessment Toolkit: supporting integration of equity into applied health research

2020 ◽  
Author(s):  
Ana Porroche-Escudero ◽  
Jennie Popay
Keyword(s):  
Health Inequalities ◽  
Health Research ◽  
Public Involvement ◽  
Routine Data ◽  
Positive Contribution ◽  
Political Commitment ◽  
Structured Interviews ◽  
North West ◽  
The North ◽  
Applied Health Research

Abstract Background Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work. Objective This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users. Methods The evaluation used semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms. Findings HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research. Conclusion If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies.

scholarly journals Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations

2020 ◽  
Author(s):  
Peter W G Tennant ◽  
Eleanor J Murray ◽  
Kellyn F Arnold ◽  
Laurie Berrie ◽  
Matthew P Fox ◽  
...  
Keyword(s):  
Health Research ◽  
Web Of Science ◽  
Directed Acyclic Graphs ◽  
Causal Effects ◽  
Research Review ◽  
Future Research ◽  
Substantial Variation ◽  
Acyclic Graphs ◽  
Confounding Variables ◽  
Applied Health Research

Abstract Background Directed acyclic graphs (DAGs) are an increasingly popular approach for identifying confounding variables that require conditioning when estimating causal effects. This review examined the use of DAGs in applied health research to inform recommendations for improving their transparency and utility in future research. Methods Original health research articles published during 1999–2017 mentioning ‘directed acyclic graphs’ (or similar) or citing DAGitty were identified from Scopus, Web of Science, Medline and Embase. Data were extracted on the reporting of: estimands, DAGs and adjustment sets, alongside the characteristics of each article’s largest DAG. Results A total of 234 articles were identified that reported using DAGs. A fifth (n = 48, 21%) reported their target estimand(s) and half (n = 115, 48%) reported the adjustment set(s) implied by their DAG(s). Two-thirds of the articles (n = 144, 62%) made at least one DAG available. DAGs varied in size but averaged 12 nodes [interquartile range (IQR): 9–16, range: 3–28] and 29 arcs (IQR: 19–42, range: 3–99). The median saturation (i.e. percentage of total possible arcs) was 46% (IQR: 31–67, range: 12–100). 37% (n = 53) of the DAGs included unobserved variables, 17% (n = 25) included ‘super-nodes’ (i.e. nodes containing more than one variable) and 34% (n = 49) were visually arranged so that the constituent arcs flowed in the same direction (e.g. top-to-bottom). Conclusion There is substantial variation in the use and reporting of DAGs in applied health research. Although this partly reflects their flexibility, it also highlights some potential areas for improvement. This review hence offers several recommendations to improve the reporting and use of DAGs in future research.

scholarly journals ‘I’m sure we made it a better study…’: Experiences of adults with intellectual disabilities and parent carers of patient and public involvement in a health research study

2017 ◽  
Vol 23 (1) ◽  
pp. 78-96 ◽  
Author(s):  
Carole Beighton ◽  
Christina Victor ◽  
Iain M Carey ◽  
Fay Hosking ◽  
Steve DeWilde ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Health Research ◽  
Public Involvement ◽  
Patient And Public Involvement ◽  
Future Research ◽  
Self Confidence ◽  
The United Kingdom ◽  
Working Together ◽  
Adults With Intellectual Disabilities ◽  
Group Interviews

Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups’ unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice.

scholarly journals Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

2020 ◽  
Vol 8 (43) ◽  
pp. 1-248
Author(s):  
Ruth Gwernan-Jones ◽  
Ilianna Lourida ◽  
Rebecca A Abbott ◽  
Morwenna Rogers ◽  
Colin Green ◽  
...  
Keyword(s):  
Health Services ◽  
Systematic Reviews ◽  
Health Research ◽  
Grey Literature ◽  
Research Programme ◽  
Dementia Care ◽  
Future Research ◽  
Economic Evaluations ◽  
Experience Of Care ◽  
The Status

Background Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also for their carers and the staff who care for them. Improving the experience of care for people living with dementia in hospital has been recognised as a priority. Objectives To understand the experience of care in hospital for people living with dementia, their carers and the staff who care for them and to assess what we know about improving the experience of care. Review methods We undertook three systematic reviews: (1) the experience of care in hospital, (2) the experience of interventions to improve care in hospital and (3) the effectiveness and cost-effectiveness of interventions to improve the experience of care. Reviews 1 and 2 sought primary qualitative studies and were analysed using meta-ethnography. Review 3 sought comparative studies and economic evaluations of interventions to improve experience of care. An interweaving approach to overarching synthesis was used to integrate the findings across the reviews. Data sources Sixteen electronic databases were searched. Forwards and backwards citation chasing, author contact and grey literature searches were undertaken. Screening of title and abstracts and full texts was performed by two reviewers independently. A quality appraisal of all included studies was undertaken. Results Sixty-three studies (reported in 82 papers) were included in review 1, 14 studies (reported in 16 papers) were included in review 2, and 25 studies (reported in 26 papers) were included in review 3. A synthesis of review 1 studies found that when staff were delivering more person-centred care, people living with dementia, carers and staff all experienced this as better care. The line of argument, which represents the conceptual findings as a whole, was that ‘a change of hospital culture is needed before person-centred care can become routine’. From reviews 2 and 3, there was some evidence of improvements in experience of care from activities, staff training, added capacity and inclusion of carers. In consultation with internal and external stakeholders, the findings from the three reviews and overarching synthesis were developed into 12 DEMENTIA CARE pointers for service change: key institutional and environmental practices and processes that could help improve experience of care for people living with dementia in hospital. Limitations Few of the studies explored experience from the perspectives of people living with dementia. The measurement of experience of care across the studies was not consistent. Methodological variability and the small number of intervention studies limited the ability to draw conclusions on effectiveness. Conclusions The evidence suggests that, to improve the experience of care in hospital for people living with dementia, a transformation of organisational and ward cultures is needed that supports person-centred care and values the status of dementia care. Changes need to cut across hierarchies and training systems to facilitate working patterns and interactions that enable both physical and emotional care of people living with dementia in hospital. Future research needs to identify how such changes can be implemented, and how they can be maintained in the long term. To do this, well-designed controlled studies with improved reporting of methods and intervention details to elevate the quality of available evidence and facilitate comparisons across different interventions are required. Study registration This study is registered as PROSPERO CRD42018086013. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 43. See the NIHR Journals Library website for further project information. Additional funding was provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

scholarly journals Use of directed acyclic graphs (DAGs) in applied health research: review and recommendations

2019 ◽  
Author(s):  
Peter WG Tennant ◽  
Wendy J Harrison ◽  
Eleanor J Murray ◽  
Kellyn F Arnold ◽  
Laurie Berrie ◽  
...  
Keyword(s):  
Health Research ◽  
Web Of Science ◽  
Directed Acyclic Graphs ◽  
Causal Effects ◽  
Research Review ◽  
Future Research ◽  
Acyclic Graphs ◽  
Confounding Variables ◽  
Applied Health Research ◽  
Consistent Direction

ABSTRACTBackgroundDirected acyclic graphs (DAGs) are an increasingly popular approach for identifying confounding variables that require adjustment when estimating causal effects. This review examined the use of DAGs in applied health research to inform recommendations for improving their transparency and utility in future research.MethodsOriginal health research articles published during 1999-2017 mentioning “directed acyclic graphs” or similar or citing DAGitty were identified from Scopus, Web of Science, Medline, and Embase. Data were extracted on the reporting of: estimands, DAGs, and adjustment sets, alongside the characteristics of each article’s largest DAG.ResultsA total of 234 articles were identified that reported using DAGs. A fifth (n=48, 21%) reported their target estimand(s) and half (n=115, 48%) reported the adjustment set(s) implied by their DAG(s).Two-thirds of the articles (n=144, 62%) made at least one DAG available. Diagrams varied in size but averaged 12 nodes (IQR: 9-16, range: 3-28) and 29 arcs (IQR: 19-42, range: 3-99). The median saturation (i.e. percentage of total possible arcs) was 46% (IQR: 31-67, range: 12-100). 37% (n=53) of the DAGs included unobserved variables, 17% (n=25) included super-nodes (i.e. nodes containing more than one variable, and a 34% (n=49) were arranged so the constituent arcs flowed in a consistent direction.ConclusionsThere is substantial variation in the use and reporting of DAGs in applied health research. Although this partly reflects their flexibility, it also highlight some potential areas for improvement. This review hence offers several recommendations to improve the reporting and use of DAGs in future research.

scholarly journals From what we know to what we do: enhancing absorptive capacity in translational health research

BMJ Leader ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 18-20
Author(s):  
Graeme Currie ◽  
Tina Kiefer ◽  
Dimitrios Spyridonidis
Keyword(s):  
Absorptive Capacity ◽  
Health Research ◽  
Public Involvement ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Patient And Public Involvement ◽  
System Level ◽  
Science Literature ◽  
Knowledge Brokers ◽  
Research Initiatives

BackgroundGlobally, evidence about what works is slow to translate into frontline healthcare delivery. As a response, government policy has focused on translational health initiatives, such as the National Institute for Health Research funded Applied Research Collaborations in England. Concepts from organisation science prove useful to support such translational initiatives. We critique the application of two organisation science concepts linked to the broad domain of what is commonly termed ‘knowledge mobilisation’ in healthcare settings, specifically ‘knowledge brokers’ and ‘absorptive capacity’, to provide lessons for leaders of translational initiatives.ResultsThe presence of knowledge brokers to ‘move from what we know to what we do’ in healthcare delivery appears necessary but insufficient to have a system level effect. To embed knowledge brokers in the wider healthcare system so they draw on various sources of evidence to discharge their role with greatest effect, we encourage leaders of translational health research initiatives to take account of the concept of absorptive capacity (ACAP) from the organisation science literature. Leaders should focus on enhancing ACAP though development of ‘co-ordination capabilities’. Such co-ordination capability should aim not just to acquire different types of evidence, but to ensure that all types of evidence are used to develop, implement and scale up healthcare delivery that best benefits patients. Specific co-ordination capabilities that support translation of evidence are: clinician involvement in research and its implementation; patient and public involvement in research and its implementation; business intelligence structures and processes at organisational and system level.ConclusionAttention to the dimensions and antecedents of ACAP, alongside the implementation of the knowledge brokering solution, in translational health research initiatives, is likely to better ensure the latter’s success.

scholarly journals A formative evaluation of Collaboration for Leadership in Applied Health Research and Care (CLAHRC): institutional entrepreneurship for service innovation

2014 ◽  
Vol 2 (31) ◽  
pp. 1-124 ◽  
Author(s):  
Andy Lockett ◽  
Nellie El Enany ◽  
Graeme Currie ◽  
Eivor Oborn ◽  
Michael Barrett ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Research ◽  
Institutional Context ◽  
Radical Change ◽  
Future Research ◽  
Institutional Entrepreneurship ◽  
Institutional Practices ◽  
Policy Makers ◽  
Ego Networks ◽  
Applied Health Research

BackgroundCollaborations for Leadership in Applied Health Research and Care (CLAHRCs) are a time-limited funded initiative to form new service and research collaboratives in the English health system. Their aim is to bring together NHS organisations and universities to accelerate the translation of evidence-based innovation into clinical practice. In doing so, CLAHRCs are positioned to help close the second translation gap (T2), which is described as the problem of introducing and implementing new research and products into clinical practice.ObjectivesIn this study, we draw on ideas from institutional theory and institutional entrepreneurship to examine how actors may engage in reshaping existing institutional practices in order to support, and help sustain efforts to close the T2. Our objective was to understand how the institutional context shapes actors’ attempts to close the T2 by focusing on the CLAHRC initiative.MethodsThe study employed a longitudinal mixed-methods approach. Qualitative case studies combined interview data (174 in total across all nine CLAHRCs and the four in-depth sites), archival data and field notes from observations, over a 4-year period (2009–13). Staff central to the initiatives were interviewed, including CLAHRC senior managers; theme leads; and other higher education institution and NHS staff involved in CLAHRCs. Quantitative social network analysis (SNA) employed a web-based sociometric approach to capture actors’ own individual (i.e. ego) networks of interaction across two points in time (2011 and 2013) in the four in-depth sites, and their personal characteristics and roles.ResultsWe developed a process-based model of institutional entrepreneurship that encompassed the different types of work undertaken. First, ‘envisaging’ was the work undertaken by actors in developing an ‘embryonic’ vision of change, based on the interplay between themselves and the context in which they were situated. Second, ‘engaging’ was the work through which actors signed up key stakeholders to the CLAHRC. Third, ‘embedding’ was the work through which actors sought to reshape existing institutional practices so that they were more aligned with the ideals of CLAHRC. ‘Reflecting’ involved actors reconsidering their initial decisions, and learning from the process of establishing CLAHRCs. Furthermore, we employed the qualitative data to develop five different archetype models for organising knowledge translation, and considered under what founding conditions they are more or less likely to emerge. The quantitative SNA results suggested that actors’ networks changed over time, but that important institutional influences continued to constrain patterns of interactions of actors across different groups.ConclusionThe development of CLAHRCs holds important lessons for policy-makers. Policy-makers need to consider whether or not they set out a defined template for such translational initiatives, since the existence of institutional antecedents and the social position of actors acted to ‘lock in’ many CLAHRCs. Although antecedent conditions and the presence of pre-existing organisational relationships are important for the mobilisation of CLAHRCs, these same conditions may constrain radical change, innovation and the translation of research into practice. Future research needs to take account of the effects of institutional context, which helps explain why many initiatives may not fully achieve their desired aims.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals An evidence base to optimise methods for involving patient and public contributors in clinical trials: a mixed-methods study

2015 ◽  
Vol 3 (39) ◽  
pp. 1-142 ◽  
Author(s):  
Carrol Gamble ◽  
Louise Dudley ◽  
Alison Allam ◽  
Philip Bell ◽  
Deborah Buck ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Mixed Methods ◽  
Public Involvement ◽  
Research Collaboration ◽  
Research Programme ◽  
Evidence Base ◽  
Research Community ◽  
Future Research ◽  
Randomised Trials ◽  
Managerial Roles

BackgroundIn comparison with other study designs, randomised trials are regarded as particularly likely to benefit from patient and public involvement (PPI). Using mixed-methods research we investigated PPI from the perspectives of researchers and PPI contributors.MethodsRandomised trials in receipt of funding from the Health Technology Assessment (HTA) programme between 2006 and 2010 were identified. Funding applications and board and referee comments were obtained and data relevant to PPI extracted. Chief investigators (CIs), PPI contributors and UK Clinical Research Collaboration Registered Clinical Trials Units (RCTUs) were surveyed. Interviews were conducted with researchers and PPI contributors.ResultsA total of 111 trials were included. Text relevant to PPI was identified in half of the trials for which the first-stage applications were available, but only one-quarter described PPI within their development. In the second stage of the application, the majority provided some text relevant to PPI, with over half having PPI in their development. Fewer than half of referees commented on PPI, and funding boards rarely provided comments in relation to PPI. Seventy-three per cent (81 of 111) of CIs responded to the survey and 98% (79 of 81) included PPI at some stage in their trial. CIs considered high impact from PPI contributors to occur more frequently in trial setup, with low or no impact being more common during trial conduct, analysis and dissemination. Only one-third of CIs provided PPI contributor contact details but all contributors contacted completed the survey. The majority of contributors felt engaged and valued by the research team. Interviews were conducted with researchers and/or PPI contributors for 28 trials identifying two main influences on perception of PPI impact: whether or not CIs expressed personal goals and plans for PPI; and the quality of their relationship with the PPI contributors. The importance of early engagement was identified, with opportunity for input thereafter limited. Three PPI roles were identified: oversight, managerial and responsive. Oversight roles, as required by funders, were associated with low impact in comparison with responsive or managerial roles. Most researchers could see some value in PPI training for researchers, although those that had received such training themselves expressed concerns about its purpose and evidence base. Training for PPI contributors was considered unnecessary, with conversational approaches preferred, although this did not appear to provide an opportunity for role negotiation. The RCTU survey response rate was 85% (39 of 46). The majority (37 of 39) reported PPI within trials co-ordinated by their unit. Trial characteristics were used by half to determine the approach to PPI. Two-thirds reported recent developments or changes in implementing plans for PPI (21 of 33). Support to PPI contributors was commonly offered through members of staff at the unit.ConclusionsPPI is occurring in the majority of trials funded by the HTA programme, but uncertainty remains about how it is assessed and valued. Early involvement, building a relationship between researchers and contributors, responsive or managerial roles, and having defined goals for PPI were associated with impact. Efficiency could be gained by utilising the RCTU network to identify and tackle challenges, and develop a risk-based approach utilising trial characteristics. Recommendations are made to trial funders and the research community. Given the difficulties for some informants in recalling PPI contributions, future research using a prospective approach would be valuable. Ethnographic research that combines observation and multi-informant interviews is likely to be informative in identifying impact. The research community needs to give further consideration to processes for selecting PPI contributors and models of implementing PPI.FundingThe National Institute for Health Research Health Services and Delivery Research programme and INVOLVE.

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