PLEASE NOTE: When you click 'Reply' to any message it will be sent to all RAMESES List members. If you only want to reply to the sender please remove [log in to unmask] from the 'To:' section of your email.

Dear Rebecca, 

you wrote

I am an NHS Physiotherapist and from my clinical experience I know that self-management is a contentious issue amongst some patients who feel they are getting ‘fobbed off’ by an over-stretched NHS.  For this reason I would like to ensure the PPI sessions do not degenerate into a forum for grievances and complaints whilst at the same time not wishing to guide the discussion too much or curtail it and risk losing valuable insights.  Any tips for this?

The rivalry you've mentioned in self-management theory is a good start. Spend time making this more explicit. Your job in the PPI sessions is to ask the participants to explore this rivalry with relative neutrality and move in the direction of gaining consensus. Even in the absence of consensus there may be additional refined or specific points about the rivalry that you can try to assess. 

kind regards,

Justin

Justin Jagosh, Ph.D
Honorary Research Associate
Institute of Psychology, Health and Society
University of Liverpool, United Kingdom
www.liv.ac.uk/cares

Centre for Advancement in Realist Evaluation and Synthesis (CARES)
www.realistmethodology-cares.org

---

From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards <[log in to unmask]> on behalf of REBECCA HUNTER 17027704 <[log in to unmask]>
Sent: June 28, 2019 3:12
To: [log in to unmask]
Subject: Patient and Public Involvement (PPI) in realist research - what does this actually look like?

 

PLEASE NOTE: When you click 'Reply' to any message it will be sent to all RAMESES List members. If you only want to reply to the sender please remove [log in to unmask] from the 'To:' section of your email.

Hello all

 

I am hoping you could help me with the Patient and Public Involvement (PPI) section of my protocol.

 

I am conducting a realist review into digital self-management programmes for patients with chronic low back pain.

 

My review objectives and questions are outlined below:

 

Review objectives

1.       To use a theory-driven approach to identify factors which influence the success or failure of digital self-management programmes to help patients with PNSMLBP self-manage their condition.

 

2.       To produce a set of refined programme theories of causal mechanisms and contextual factors which operate within programmes to facilitate self-management

 

3.       To produce advice for NHS policy makers and practitioners on implementing digital self-management programmes for PNSMLBP which have positive outcomes that are meaningful to patient, clinician, researcher and policymaker.

 

Review questions

1.       What are the mechanisms by which digital self-management interventions for patients with PNSMLBP are believed to produce favourable outcomes for patients?

 

2.       What are the important contexts that determine whether or not the different mechanisms produce favourable outcomes?

 

3.       In what circumstances are digital self-management interventions for PNSMLBP likely to be effective?

 

I was drawn to realist research methods specifically because of the emphasis it places on stakeholder group involvement but now my thoughts are confounded by:

1/what to ask the PPI group and

2/ how to actually go about conducing a PPI group discussion.

 

 

What to ask the PPI group?

 

When my Director of Studies asked ‘What is it that you need from this PPI group?’ ‘What are you asking, and why are you asking it?’ I was incredulous that I couldn’t come up with an answer.  And I still can’t! Why is this so hard?  Surely this is fundamental to my entire research? (Please say others find this aspect hard!) Each time I come up with something, it doesn’t quite hit the mark and potentially side-tracks the whole discussion.

 

Here are were my thoughts so far:

 

1/ I was thinking along the lines of asking the group how they defined self-management did it match with what the NHS considers it to be. 

2/What patients thought of some of the digital solutions being used to promote to facilitate self-management – what did they like, what did they not like, what components were missing? 

3/Theories around fear avoidance, self-efficacy, behavioural change are prevalent in the literature but does the PPI group agree that this is where the focus should be?

4/ Outcomes focusing on disability and pain have traditionally been used to measure the ‘effectiveness’ of self-management interventions but what would the PPI group consider to be a meaningful outcome and how would they go about measuring it?

 

How to conduct a PPI group discussion?

 

I am an NHS Physiotherapist and from my clinical experience I know that self-management is a contentious issue amongst some patients who feel they are getting ‘fobbed off’ by an over-stretched NHS.  For this reason I would like to ensure the PPI sessions do not degenerate into a forum for grievances and complaints whilst at the same time not wishing to guide the discussion too much or curtail it and risk losing valuable insights.  Any tips for this?

 

Finally, perhaps I need to go on further training for this side of things and if so, does anyone know of an online/in person course coming up soon (ish) that may be of help?

 

Many thanks in advance

 

Rebecca

 

Rebecca Hunter

MSK Specialist Physiotherapist, NHS Highland

PhD Student Department of Nursing, University of Highlands and Islands

<image002.png>

 

To UNSUBSCRIBE please see: https://www.jiscmail.ac.uk/help/subscribers/faq.html#join

To UNSUBSCRIBE please see: https://www.jiscmail.ac.uk/help/subscribers/faq.html#join