Conceptualising and constructing 'diversity' through experiences of public and patient involvement in health research.

Background: Increasing the accessibility of public and patient involvement (PPI) in health research for people from diverse backgrounds is important for ensuring all voices are heard and represented. Critiques of PPI being dominated by 'the usual suspects' reflect concerns over the barriers to involvement in PPI faced by people from minority groups or non-professional backgrounds. Yet, what has received less attention is how undertaking PPI work might produce diverse experiences, potentially shaping the motivation and capacity of people from different backgrounds to continue in PPI. Methods: We conducted qualitative research to explore experiences of the health research PPI field in the UK and to understand how these might shape the accessibility of PPI for people of diverse backgrounds. We conducted in-depth and follow-up interviews with five PPI contributors with experience of multiple health research projects, and a focus group with nine people in professional roles relating to PPI. Interview data were analysed using a narrative approach, and then combined with the focus group data for thematic analysis. Results: The structure, organisation and relationships of health research in the UK all shape PPI experiences in ways that can intersect the different backgrounds and identities of contributors, and can pose barriers to involvement and motivation for some. Navigating processes for claiming expenses can be frustrating particularly for people from lower-income backgrounds or with additional needs, and short-term research can undermine relationships of trust between contributors and professionals. Pressure on PPI coordinators to find 'more diverse' contributors can also undermine ongoing relationships with contributors, and how their inputs are valued. Conclusions: To increase diversity within PPI, and to ensure that people of different backgrounds are supported and motivated to continue in PPI, changes are needed in the wider health research infrastructure in the UK. More resources are required to support relationships of trust over time between contributors and professionals, and to ensure the unique circumstances of each contributor are accommodated within and across PPI roles. Finally, critical reflection on the pressure in PPI to seek 'more diverse' contributors is needed, to understand the impacts of this on those already involved. Plain English summary: Supporting people from different backgrounds to access public and patient involvement (PPI) roles in health research is important. Increasing 'diversity' in PPI is often thought about in terms of the demographic characteristics (eg gender, ethnicity) of people undertaking PPI roles. However, we also need to understand how people experience PPI differently, and what shapes their ability to become and continue being involved. We conducted in-depth and follow-up interviews with five experienced PPI contributors, and a focus group with nine professionals working in roles around PPI in health research in the UK, to explore their views and experiences of the PPI field over time. Our findings show that how health research is organised impacts the motivation of people from different backgrounds to continue doing PPI, where processes for claiming expenses for PPI work can be particularly challenging for people on a low income and / or with additional needs. Relationships with PPI professionals are important for how valued different PPI contributors feel, but professionals' expectations of PPI roles vary and some contributors feel their experience is not always welcomed. PPI coordinators can feel pressured by researchers to recruit new, 'more diverse' contributors to PPI roles, and they worry that this affects the relationships they have with people already doing PPI. Our research shows the need for more support within health research structures to enable people with different backgrounds and experiences to continue to feel valued and motivated in PPI. This will help ensure health research is informed by diverse perspectives. [ABSTRACT FROM AUTHOR]