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      Producing co‐production: Reflections on the development of a complex intervention

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          Abstract

          Background

          Patient and public involvement and co‐production are widely used, but nevertheless contested concepts in applied health research. There is much confusion about what they are, how they might be undertaken and how they relate to each other. There are distinct challenges and particular gaps in public involvement in alcohol research, especially when the study focus is on health matters other than alcohol dependence.

          Objective

          To explore how patient and public involvement and co‐production have been interpreted and applied within a multi‐disciplinary research programme in the development of a complex intervention on alcohol and medicine use in community pharmacies.

          Design

          The paper presents the authors' critical reflection on a grounded example of how public involvement concepts have been translated into practice in the intervention development phase of a publicly funded research programme, noting its impact on the programme to date.

          Discussion

          Co‐production adds another layer of complexity in the development of a complex intervention. The research planning requirements for publicly funded research circumscribe the possibilities for co‐production, including impacting on the possibility of stability and continuity over time.

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          Most cited references24

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          GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research

          Background While the patient and public involvement (PPI) evidence base has expanded over the past decade, the quality of reporting within papers is often inconsistent, limiting our understanding of how it works, in what context, for whom, and why. Objective To develop international consensus on the key items to report to enhance the quality, transparency, and consistency of the PPI evidence base. To collaboratively involve patients as research partners at all stages in the development of GRIPP2. Methods The EQUATOR method for developing reporting guidelines was used. The original GRIPP (Guidance for Reporting Involvement of Patients and the Public) checklist was revised, based on updated systematic review evidence. A three round Delphi survey was used to develop consensus on items to be included in the guideline. A subsequent face-to-face meeting produced agreement on items not reaching consensus during the Delphi process. Results One hundred forty-three participants agreed to participate in round one, with an 86% (123/143) response for round two and a 78% (112/143) response for round three. The Delphi survey identified the need for long form (LF) and short form (SF) versions. GRIPP2-LF includes 34 items on aims, definitions, concepts and theory, methods, stages and nature of involvement, context, capture or measurement of impact, outcomes, economic assessment, and reflections and is suitable for studies where the main focus is PPI. GRIPP2-SF includes five items on aims, methods, results, outcomes, and critical perspective and is suitable for studies where PPI is a secondary focus. Conclusions GRIPP2-LF and GRIPP2-SF represent the first international evidence based, consensus informed guidance for reporting patient and public involvement in research. Both versions of GRIPP2 aim to improve the quality, transparency, and consistency of the international PPI evidence base, to ensure PPI practice is based on the best evidence. In order to encourage its wide dissemination this article is freely accessible on The BMJ and Research Involvement and Engagement journal websites. Electronic supplementary material The online version of this article (doi:10.1186/s40900-017-0062-2) contains supplementary material, which is available to authorized users.
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            The dark side of coproduction: do the costs outweigh the benefits for health research?

            Background Coproduction, a collaborative model of research that includes stakeholders in the research process, has been widely advocated as a means of facilitating research use and impact. We summarise the arguments in favour of coproduction, the different approaches to establishing coproductive work and their costs, and offer some advice as to when and how to consider coproduction. Debate Despite the multiplicity of reasons and incentives to coproduce, there is little consensus about what coproduction is, why we do it, what effects we are trying to achieve, or the best coproduction techniques to achieve policy, practice or population health change. Furthermore, coproduction is not free risk or cost. Tensions can arise throughout coproduced research processes between the different interests involved. We identify five types of costs associated with coproduced research affecting the research itself, the research process, professional risks for researchers and stakeholders, personal risks for researchers and stakeholders, and risks to the wider cause of scholarship. Yet, these costs are rarely referred to in the literature, which generally calls for greater inclusion of stakeholders in research processes, focusing exclusively on potential positives. There are few tools to help researchers avoid or alleviate risks to themselves and their stakeholders. Conclusions First, we recommend identifying specific motivations for coproduction and clarifying exactly which outcomes are required for whom for any particular piece of research. Second, we suggest selecting strategies specifically designed to enable these outcomes to be achieved, and properly evaluated. Finally, in the absence of strong evidence about the impact and process of coproduction, we advise a cautious approach to coproduction. This would involve conscious and reflective research practice, evaluation of how coproduced research practices change outcomes, and exploration of the costs and benefits of coproduction. We propose some preliminary advice to help decide when coproduction is likely to be more or less useful.
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                Author and article information

                Contributors
                Role: Associate Professormary.madden@york.ac.uk
                Role: Research Fellow
                Role: Chair of PPI Group
                Role: PPI Group Member
                Role: Associate Professor
                Role: Professor
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                31 March 2020
                June 2020
                : 23
                : 3 ( doiID: 10.1111/hex.v23.3 )
                : 659-669
                Affiliations
                [ 1 ] University of York York UK
                Author notes
                [*] [* ] Correspondence

                Mary Madden, Mental Health and Addiction Research Group, Department of Health Sciences, Faculty of Science, Area 4, Room A/TB/217, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD, UK

                Email: mary.madden@ 123456york.ac.uk

                Author information
                https://orcid.org/0000-0001-5749-2665
                Article
                HEX13046
                10.1111/hex.13046
                7321726
                32233053
                d01f193f-71f2-4969-9c2c-a43810e9f3d3
                © 2020 The Authors Health Expectations published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 October 2019
                : 14 February 2020
                : 16 February 2020
                Page count
                Figures: 3, Tables: 1, Pages: 11, Words: 7920
                Funding
                Funded by: National Institute for Health Research , open-funder-registry 10.13039/501100000272;
                Award ID: PGfAR [RP‐PG‐0216‐20002]
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:28.06.2020

                Health & Social care
                alcohol,community pharmacy,complex interventions,co‐production,medicines review,patient and public involvement

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