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Patient and Public Involvement (PPI) is considered good practice in all health research including literature reviews. Reporting of involvement practice in realist reviews has been inconsistent leaving gaps in understanding of best practice. Realist reviews are theory driven and explain how interventions work, for whom and in which circumstances. PPI in realist reviews provides a link between programme theory and real-world experiences and can be achieved through a 'stakeholder group' bringing lived and professional experience together. This paper discusses experiences of a stakeholder group with seven members with lived experience and eight members with professional experience in a realist review focused on how community mental health crisis services work. A mental health crisis is a time of distress when people need urgent support. Many different agencies can respond to mental health crises, but despite this, people often find it hard to navigate to the right help at the right time. Reflections on involvement in four stakeholder meetings alongside practical examples of involvement activities used during the realist review are discussed. Having two researchers co-lead the stakeholder group from both lived and professional experience perspectives provided a bridge between the different expertise within the stakeholder group. Engagement with a voluntary organisation provided support to lived experience stakeholders, which sustained their involvement over time. Social connectedness was needed to establish trust between stakeholders. This required informal social contact between stakeholders that needed to be planned, especially for online meetings. To maintain the emotional wellbeing of the stakeholders during their involvement, safe spaces for discussion are needed and these are best planned in partnership with the stakeholders. We concluded that consideration of ways to provide opportunity for informal contact in online meetings may improve the experience of the stakeholders. Careful consideration of ways to sustain stakeholders' contribution over time are needed. The emotional impact of involvement should be considered when planning realist reviews. This may include built in flexibility in the involvement to include small expertise specific breakout groups, individual meetings, and should be planned in partnership with the stakeholders. Plain English Summary: Involving people with experience of accessing mental health services (PPI) in literature reviews is good practice. We know less about how to do this in 'realist' literature reviews. Realist reviews explain how things work, who they work for, and in what situations. PPI can help researchers to link theory with people's real-life experience. Researchers do this in a 'stakeholder group' that brings people with experience of accessing services together with professionals. This paper shares experiences of a stakeholder group with seven PPI members and eight professional members. Stakeholders supported a realist review about how community mental health crisis services work. A mental health crisis is a time of distress when people need urgent support. Many different services can help, but people still find it hard to get the right help at the right time. The researchers thought carefully about the stakeholder group membership to make sure everyone felt able to join in. We have written about how the stakeholders learned together about doing realist reviews and the activities the stakeholders took part in. Due to Covid-19, the stakeholder meetings moved online. Although online meetings worked well, being in a room together was better for the stakeholders to get to know each other. Support from voluntary organisations as well as informal contact with stakeholders between meetings helped people to stay involved over time. Planning safe spaces to talk, could help avoid stakeholders being upset by being involved in realist reviews. [ABSTRACT FROM AUTHOR]

Abstract Patient and Public Involvement (PPI) is considered good practice in all health research including literature reviews. Reporting of involvement practice in realist reviews has been inconsistent leaving gaps in understanding of best practice. Realist reviews are theory driven and explain how interventions work, for whom and in which circumstances. PPI in realist reviews provides a link between programme theory and real-world experiences and can be achieved through a ‘stakeholder group’ bringing lived and professional experience together. This paper discusses experiences of a stakeholder group with seven members with lived experience and eight members with professional experience in a realist review focused on how community mental health crisis services work. A mental health crisis is a time of distress when people need urgent support. Many different agencies can respond to mental health crises, but despite this, people often find it hard to navigate to the right help at the right time. Reflections on involvement in four stakeholder meetings alongside practical examples of involvement activities used during the realist review are discussed. Having two researchers co-lead the stakeholder group from both lived and professional experience perspectives provided a bridge between the different expertise within the stakeholder group. Engagement with a voluntary organisation provided support to lived experience stakeholders, which sustained their involvement over time. Social connectedness was needed to establish trust between stakeholders. This required informal social contact between stakeholders that needed to be planned, especially for online meetings. To maintain the emotional wellbeing of the stakeholders during their involvement, safe spaces for discussion are needed and these are best planned in partnership with the stakeholders. We concluded that consideration of ways to provide opportunity for informal contact in online meetings may improve the experience of the stakeholders. Careful consideration of ways to sustain stakeholders’ contribution over time are needed. The emotional impact of involvement should be considered when planning realist reviews. This may include built in flexibility in the involvement to include small expertise specific breakout groups, individual meetings, and should be planned in partnership with the stakeholders.

A crucial part of theory-driven realist thinking is retroduction, the process of looking backwards for explanation of how and why things may be. Conducted early in the realist evaluation process, it provides a foundation for evidenced 'theory gleaning'. Despite retroduction being an inherent part of the realist process, it is often 'hidden' in realist reports. This paper explains the thinking behind, alongside an example of, a framework created by the authors to make transparent the retroductive process as used in a realist evaluation of two community End of Life Care services. The approach makes visible the application of the 'sociological imagination' and lends robustness to hypotheses by establishing how the authors utilised: wide-ranging potential generative causation; stakeholder and Patient and Public Involvement feedback; literature scoping; and substantive theories at the middle range, specifically Transitions Theory. These stages led to the development of Initial Programme Theories, with a clear history of genesis. [ABSTRACT FROM AUTHOR]

Abstract Introduction Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15–19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries. Method and analysis We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances. Ethics and dissemination Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293).

Introduction: Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15–19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries. Method and analysis: We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances. Ethics and dissemination: Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293). [ABSTRACT FROM AUTHOR]

Realist research is increasingly used to evaluate complex interventions. However, it can be challenging to codify and implement, with few examples to guide the process. This article describes how a team of social care leaders, practitioners and researchers developed initial program theories for the Trauma Consultancy Service (TraCS) in early learning settings, as the first phase of a realist evaluation. It explores conceptualisation of realist terminology, design and facilitation of realist interviews, and data coding and analysis using retroductive reasoning. Qualitative interviews with the TraCS team focused on understanding contextual factors, resources provided by TraCS consultants, changes in educators' reasoning and how components interacted to generate educator and child outcomes. Eight program theories capture how TraCS supports educators to develop a trauma-informed lens and practice. This research contributes to understanding of the benefits of welfare sector-driven consultancy in early childhood. [ABSTRACT FROM AUTHOR]

Rehabilitation services in education settings are evolving from pull-out interventions focused on remediation for children and youth with special education needs to inclusive whole-school tiered approaches focused on participation. A limited number of discipline-specific practice models for tiered services currently exist. However, there is a paucity of explanatory theory. This realist synthesis was conducted as a first step towards developing a middle-range explanatory theory of tiered rehabilitation services in education settings. The guiding research question was: What are the outcomes of successful tiered approaches to rehabilitation services for children and youth in education settings, in what circumstances do these services best occur, and how and why? An expert panel identified assumptions regarding tiered services. Relevant literature (n = 52) was located through a systematic literature review and was analysed in three stages. Several important contextual characteristics create optimal environments for implementing tiered approaches to rehabilitation services via three main mechanisms: (a) collaborative relationships, (b) authentic service delivery, and (c) reciprocal capacity building. Positive outcomes were noted at student, parent, professional, and systems levels. This first-known realist synthesis regarding tiered approaches to rehabilitation services in education settings advances understanding of the contexts and mechanisms that support successful outcomes. [ABSTRACT FROM AUTHOR]

Background: Transport initiatives such as 20-mph (≈30-km/h) speed limits are anticipated to result in fewer road casualties and improve perceptions of safety, leading to increases in active travel. Lower speeds may also lead to more pleasant environments in which to live, work and play. Objectives: The main objective was to evaluate and understand the processes and effects of developing and implementing 20-mph speed limits in Edinburgh and Belfast. The focus was on health-related outcomes (casualties and active travel) that may lead to public health improvements. An additional objective was to investigate the political and policy factors (conditions) that led to the decision to introduce the new speed limits. Design: This was a mixed-methods study that comprised an outcome, process, policy and economic evaluation of two natural experiments. Setting: The study was set in Edinburgh, Scotland, and Belfast, Northern Ireland, from 2000 to 2018. Participants: The whole population of each city were participants, as well as stakeholders involved in implementation and decision-making processes. Intervention: The intervention was the implementation of 20-mph legislation, signage, enforcement, and education and awareness-raising in Edinburgh (citywide) and Belfast (city centre). Main outcome measures: The main outcomes measured were speed; number, type and severity of road collisions; perceptions; and liveability. Data sources: The following data sources were used – routinely and locally collected quantitative data for speed, volume of traffic, casualties and collisions, and costs; documents and print media; surveys; interviews and focus groups; and Google Street View (Google Inc., Mountain View, CA, USA). Results: Collisions and casualties – the overall percentage reduction in casualty rates was 39% (the overall percentage reduction in collision rates was 40%) in Edinburgh. The percentage reduction for each level of severity was 23% for fatal casualties, 33% for serious casualties and 37% for minor casualties. In Belfast there was a 2% reduction in casualties, reflecting differences in the size, reach and implementation of the two schemes. Perceptions – in Edinburgh there was an increase in two factors (support for 20 mph and rule-following after implementation) supported by the qualitative data. Liveability – for both cities, there was a small statistical increase in liveability. Speed – mean and median speeds reduced by 1.34 mph and 0.47 mph, respectively, at 12 months in Edinburgh, with no statistically significant changes in Belfast. History, political context, local policy goals, local priorities and leadership influenced decision-making and implementation in the two cities. Limitations: There was no analysis of active travel outcomes because the available data were not suitable. Conclusions: The pre-implementation period is important. It helps frame public and political attitudes. The scale of implementation and additional activities in the two cities had a bearing on the impacts. The citywide approach adopted by Edinburgh was effective in reducing speeds and positively affected a range of public health outcomes. The city-centre approach in Belfast (where speeds were already low) was less effective. However, the main outcome of these schemes was a reduction in road casualties at all levels of severity. Future work: Future work should develop a statistical approach to public health interventions that incorporates variables from multiple outcomes. In this study, each outcome was analysed independently of each other. Furthermore, population measures of active travel that can be administered simply, inexpensively and at scale should be developed. Study registration: This study is registered as ISRCTN10200526. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

Evidence suggests that mental health interventions are more effective when they consider the whole context of schools; addressing the needs of all students, their families, and staff; otherwise known as a whole-school approach (WSA). The UK Government is piloting WSAs to transform mental health and wellbeing by locating educational mental health practitioners in educational settings across England. This study aims to develop a 'bottom-up' understanding of the contextual factors and mechanisms that underlie WSAs in Trailblazer schools in the North East and North Cumbria, to gain insight into the facilitators and barriers of delivering a WSA, and optimal evaluation methods. To undertake a realist evaluation, we included the generation of initial programme theories from existing academic literature and policy documents; 'theory gleaning' interviews with NHS/local authority stakeholders, Trailblazer staff and school senior leaders; refining and development of theories; and individual interviews and focus groups with pupils, parent/carers and school staff. The findings will enable Trailblazer partners to better understand how their WSAs to mental health contain the essential components for transformation in schools in the region. This will contribute to the embedding of continuous evaluation into regional Trailblazers' practice for participating schools, for subsequent annual waves and producing relevant findings for non-Trailblazer schools. Complementing the national evaluation of all 25 Wave 1 Trailblazer pilot sites, this study will generate an explanatory theoretical account of how to optimally design, implement and evaluate WSAs by exploring the contextual factors associated with implementation of WSAs. [ABSTRACT FROM AUTHOR]

Training programmes for counsellors and psychotherapists comprise complex combinations of different types of learning activity. However, research into the process and outcomes of therapy training has almost entirely comprised investigations of specific training elements. In addition, studies of training have not taken account of the potential influence of the social and organisational context within which training is delivered. The present paper reports on a realist analysis of learning mechanisms within a professional counsellor training programme in pluralistic-integrative counselling, drawing on multiple sources of data collected over a ten-year period. Training outcomes were oriented toward preparing trainees to be flexible and resourceful practitioners in non-medicalised community settings. Core learning mechanisms included building on pre-existing skills, knowledge and awareness, and acquiring conceptual tools appropriate to a collaborative style of working, within an immersive learning environment that supported focused reflection and engagement with personally challenging learning tasks. Implications for further research on therapist training, and programme design, are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Indonesia has the highest rate of years of life lost to disability or early death from Schizophrenia than any other country in the world. More than 90% of people with mental illness do not get any treatment and tens of thousands of people with psychosis are illegally detained (‘pasung’) in the family home. Civic engagement, a core part of the recent World Health Organisation global strategy, has the potential to address some of these challenges through the development of person-centered models of care. The aim of the study is to develop a testable systems level, culturally appropriate, civic engagement framework for use in Jakarta and Bogor, Indonesia to strengthen local mental health services. Methods A mixed methods study underpinned by a realist approach will be undertaken across four phases in two study sites in Indonesia (Jakarta and Bogor). Phase 1 will explore the use of civic engagement across South East Asia by conducting a systematic review of existing evidence. By surveying 300 mental health professionals, phase 2 will identify the stakeholders, the sources of collaboration and the evidence used by professionals in decision making within local mental health systems and identify potential opportunities for civic engagement within the system. In order to explore the potential use of civic engagement within Indonesian mental health services and identify priorities for a culturally appropriate framework, phase 3 will undertake two focus groups with participants with experience of psychosis or caring for someone with psychosis (n = 20–30). Professionals and other key decision makers in a range of roles across the system at a national (n = 5) and local level (n = 10–15/site) will also take part in semi-structured interviews. Phase 4 will co-produce a civic engagement framework for use in Indonesia by synthesising evidence from phases 1–3 collaboratively with key stakeholders. Discussion Civic engagement is a potential way in which health services in low and middle income countries can address the burden of mental health conditions through the development of person-centred models of care. However, such approaches are underexplored in Indonesia. This study will work with local stakeholders to design a testable civic engagement framework for use in mental health services in Indonesia.

Realist evaluation (RE) is increasingly adopted to assess the effectiveness of social programs. RE goes beyond measurement of outcomes, providing insight into how and why programs work by focusing on how participants experience and respond to programs within certain contexts. A RE was conducted on Healthy Start-Départ Santé (HSDS), an early childhood development program in Canada, created to address the prevalence of overweight and obese children. The first step of the RE was to create an initial program theory (IPT) to identify key contexts and mechanisms relating to the success of the program. Realist methodology can be challenging, time consuming, and resource intensive and there are few practical examples of how to conduct a RE. This article aims to add to the realist methodological literature by describing the construction of the IPT, reflecting on the process used, and providing a starting point for future realist practitioners. [ABSTRACT FROM AUTHOR]

In recent years, the possibilities and pitfalls of qualitative secondary analysis have been the subject of on-going academic debate, contextualised by the growing availability of qualitative data in digital archives and the increasing interest of funding councils in the value of data re-use. This article contributes to, and extends these methodological discussions, through a critical consideration of how the secondary analysis of thematically related qualitative longitudinal (QL) datasets might be utilised productively in qualitative research design. It outlines the re-use of two datasets available in the Timescapes Archive, that were analysed to develop a primary empirical project exploring processes of continuity and change in the context of men’s care responsibilities in low-income families. As well as outlining the process as an exemplar, key affordances and challenges of the approach are considered. Particular emphasis is placed on how a structured exploration of existing QL datasets can enhance research design in studies where there is limited published evidence. [ABSTRACT FROM PUBLISHER]

In the context of modern nursing practice that is embedded within complex social situations, critical discussions about the contribution of major philosophers are relevant and important. Whilst nurse theorists have advanced and shaped nursing as a discipline, other major philosophers can offer much to advance nursing enquiry. In this paper, we focus on philosopher Roy Bhaskar who, amongst others, developed critical realism, a philosophy for social science which connects with how many of us think about the world. Bhaskar's work focuses our attention on the interplay between structure and agency and on the search for the causative or generative mechanisms that explain the social world. Bhaskar was interested in human emancipation, and we suggest his work is of great importance to advance understanding of complex social situations. Critical realism has already been endorsed by a range of disciplines, especially in research which focuses on real problems and acknowledges the complexities of the social world. In recent evidence from healthcare literature, there has been a surge in research using realist methodology (realist evaluation and realist synthesis), which is underpinned by the philosophy of critical realism and which offers a different perspective to understanding nursing and healthcare problems through the realist lens. However, we suggest that sufficient attention is not always paid to the philosophical roots of this methodology. In this paper, we provide insight into Bhaskar's work and demonstrate how research positioned within critical realism and realist methodology can advance nursing and healthcare-related knowledge. Through shining a light on Bhaskar, we illustrate how critical realism philosophy is a natural fit with human and health science enquiry, including nursing. [ABSTRACT FROM AUTHOR]

During the worse phase of the economic downturn, few social policies resisted to the austerity measures imposed to Italy by the European Union. Among them, the most important is the Wage Supplementation Fund, to protect workers and entrepreneurs from bankruptcy and unemployment. Adopting a realist methodology we studied the social mechanisms which are the roots of some political and administrative choices in that period; the public policy decision making approach gave us a theoretical base. Some main mechanisms have been discovered: technical and economic mechanisms overcame politics, social attitudes pushed political choices, the fear of political and social instability drove all parties. [ABSTRACT FROM AUTHOR]

The article describes the usefulness of a realist methodology in linking sociological theory to empirically obtained data through the development of a methodological device. Three layers of analysis were integrated: 1. the findings from a case study about M?ori language education in New Zealand; 2. the identification and analysis of contradictions and vagueness in language education policy; and, 3. the explanation of these contradictions in terms deeper ideological forces underpinning bicultural politics in New Zealand. The paper makes two contributions to the literature. It demonstrates how a realist methodology can link theory and data, specifically in the discussion of the methodological device. It also generalises the findings in terms of how ideologies of ‘culture’ (i.e ‘culturalism’) inform the inclusion of culture in education in New Zealand and internationally. [ABSTRACT FROM AUTHOR]

• Understanding what drives outcomes in family preservation programs is important. • Realist methods applied to focus group data found important demi-regularities. • Practitioners easily share their knowledge of what works for programs and families. • Practitioners clearly articulate what leads to intended and unintended outcomes. Programs for families where children are at risk aim to develop the conditions for safety and care that is rewarding, loving, stable and secure. Understanding what leads to outcomes is less clear, and realist research methods are a useful in unpacking this. The Social Care Theorising Model informed the collection of focus group data from practitioners and team leaders in a family preservation and reunification program being scale up across the state of Victoria in Australia. Demi-regularities (patterns of a program's function that are reasonably stable) were generated to provide a rapid understanding of practice knowledge to inform data-driven decision making. This study combined the methodology from two studies to balance the need for realist informed findings without time and resource intensive processes of program theory development. Twelve demi-regularities were found which were grouped into three socio-ecological themes of family, organisation and system. At the family level, practitioners described what enabled engagement, readiness, the development of a therapeutic relationship and the need for supported closure. The organisational level suggested the preconditions to engagement, the caseload needed to work intensively, management of staff stress and work needed to operationalise goals. The systems level largely described the essential role of the Child Protection Navigator and how they enable service delivery. This study provides an understanding of what works, for whom, when and why in an innovative family preservation and reunification program. [ABSTRACT FROM AUTHOR]

Introduction: Limited human resources are a major impediment to achieving the UN health-related Millennium Development Goals in a number of Pacific Island Countries (PICs). Lack of education capacity to support competency development in medicine supply management is one of the main issues affecting workforce development in this region, which is characterised by disparate service delivery due to the range of environments in which supply occurs (ie urban, rural and remote), geographical challenges and cultural practices associated with teaching and learning. The supply of medicines, and an adequate pharmacy workforce with appropriate competencies is crucial to ensuring a well-functioning pharmaceutical system. In this region approximately 80% of patients access healthcare in rural areas without a pharmacist, thus local health personnel must be competent in pharmaceutical management relevant to the local context and culture. A new approach involves a partnership between the UN Population Fund Suva Sub-Regional Office, University of Canberra, Ministry of Health officials and the heath personnel within identified PICs, starting with the need to understand local culture and its impact on learning and teaching, and the mapping of competency requirements and an understanding of currently available information and materials. This information will be used to develop and trial new pedagogical approaches to training health personnel involved in essential medicines supply management, to improve medicines availability for patients in their own environment. The focus of this review was to determine what cultural and learning factors need to be considered when developing a curriculum for South Pacific pharmaceutical health personnel who work across a range of practice environments. Methods: A 'realist methodology' consisting of a systematic investigation of the published literature and a targeted review of the 'grey' literature was used. All relevant literature was retrieved and coded manually using broad thematic analysis. Results: The combined bibliographic and 'grey' literature search strategy resulted in the inclusion of 17 full text articles, 44 documents and 10 books. The five themes identified as key to optimising the cultural and learning approaches for the study population included recognition of: (1) past regional experiences of health related training; (2) the impact of South Pacific culture on learning styles; (3) the impact of external influences on curriculum; (4) the challenges of open and distance education in the Pacific; and (5) a distinct South Pacific student learning approach. Conclusions: The results of this 'realist methodology' review provide insights into learning approaches and cultural influences on student learning within PICs. The themes generated will be used to develop a set of principles to inform educators and health personnel involved in pharmaceutical training within PICs. [ABSTRACT FROM AUTHOR]

Background: Indonesia has the highest rate of years of life lost to disability or early death from Schizophrenia than any other country in the world. More than 90% of people with mental illness do not get any treatment and tens of thousands of people with psychosis are illegally detained (‘pasung’) in the family home. Civic engagement, a core part of the recent World Health Organisation global strategy, has the potential to address some of these challenges through the development of person-centered models of care. The aim of the study is to develop a testable systems level, culturally appropriate, civic engagement framework for use in Jakarta and Bogor, Indonesia to strengthen local mental health services. Methods: A mixed methods study underpinned by a realist approach will be undertaken across four phases in two study sites in Indonesia (Jakarta and Bogor). Phase 1 will explore the use of civic engagement across South East Asia by conducting a systematic review of existing evidence. By surveying 300 mental health professionals, phase 2 will identify the stakeholders, the sources of collaboration and the evidence used by professionals in decision making within local mental health systems and identify potential opportunities for civic engagement within the system. In order to explore the potential use of civic engagement within Indonesian mental health services and identify priorities for a culturally appropriate framework, phase 3 will undertake two focus groups with participants with experience of psychosis or caring for someone with psychosis (n = 20–30). Professionals and other key decision makers in a range of roles across the system at a national (n = 5) and local level (n = 10–15/site) will also take part in semi-structured interviews. Phase 4 will co-produce a civic engagement framework for use in Indonesia by synthesising evidence from phases 1–3 collaboratively with key stakeholders. Discussion: Civic engagement is a potential way in which health services in low and middle income countries can address the burden of mental health conditions through the development of person-centred models of care. However, such approaches are underexplored in Indonesia. This study will work with local stakeholders to design a testable civic engagement framework for use in mental health services in Indonesia. [ABSTRACT FROM AUTHOR]