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Balancing Trade-Offs in Patient and Public Involvement and Engagement in Rapid Evaluation: Reflections and Lessons
Pei Li Ng1, Raj Mehta2, Angus I G Ramsay1
1Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, UK.
Background:
Patient and public involvement and engagement (PPIE) is recognised as essential to high-quality health and care research. However, there is limited guidance on how to sustain meaningful involvement in rapid evaluations characterised by compressed timelines and shifting priorities.
Objective:
To reflect on how PPIE developed within the NIHR Rapid Service Evaluation Team (RSET) and to identify practical lessons for navigating tensions between influence, feasibility, and equity in time-pressured contexts.
Methods:
This practice-based critical reflection draws on internal documentation, shared reflections, and evaluation activities from 13 rapid evaluations (2018-2026). Using the International Association for Public Participation (IAP2) Spectrum as a guiding tool, we mapped RSET's PPIE approach across three phases: Early Phase, Developing Maturity, and Current Position, highlighting trade-offs in practice.
Results:
Early involvement was meaningful but ad hoc, constrained by limited infrastructure and resources. As the programme matured, more structured yet flexible approaches were introduced, including a standing PPIE panel, tailored involvement aligned to lived experience, and earlier engagement at key decision points. Involvement practice required ongoing negotiation of trade-offs, including Depth vs Speed, Inclusivity vs Practicality, Consistency vs Flexibility, Relationship-building vs Time, and Value vs Feasibility.
Conclusions:
Meaningful PPIE in rapid evaluations is achievable when involvement is planned intentionally, responsive to context, and supported by strong collaboration and communication. Rather than pursuing full co-production, effective involvement focuses on relationships and influence where it adds most value, offering transferable lessons for involvement practice in fast-paced research settings.
Patient Or Public Contribution:
This paper examines PPIE practice. Public contributors were involved in the programme, contributed to the development of PPIE approaches and practices, and reflected on their experiences. One co-author was a public contributor who helped shaped the interpretation and lessons presented in this paper.
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