Centre for Implementation Science, Health Services, Population and Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, UK.
National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) At King's College Hospital NHS Foundation Trust, London, UK.
Health Res Policy Syst. 2021 Jan 20;19(1):8. doi: 10.1186/s12961-020-00644-3.
The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients have led to a renewed focus on strengthening PPI. There is a growing awareness of the benefits of PPI in research as well as a need to address power inequities and a lack of diversity and inclusion. This review was undertaken to look at evidence for theories, barriers and enablers in PPI across health, social care and patient safety that could be used to strengthen PPI and address a perceived knowledge and theory gap with PPI in patient safety.
We searched MEDLINE, EMBASE and PsycINFO from inception to August 2018, using both MeSH and free-text terms to identify published empirical literature. Protocols in PROSPERO were also searched to identify any systematic reviews in progress. The extracted information was analysed using a narrative approach, which synthesises data using a descriptive method.
Forty-two reviews were identified and grouped by key outcomes. Twenty-two papers mentioned theory in some form, 31 mentioned equality and diversity (although with no theory mentioned in this area), and only 19 cited equality and diversity as a barrier or enabler. Thirty-four reviews identified barriers and enablers at different organisational levels: personal/individual; attitudes; health professional; roles and expectations; knowledge, information and communication; financing and resourcing; training; general support; recruitment and representation, PPI methods and working with communities and addressing power dynamics.
The review findings suggest that a commitment to PPI and partnership working is dependent on taking a whole system approach. This needs to consider the complex individual and organisational enablers and constraints to this process and address imbalances of power experienced by different groups. Addressing equality and diversity and use of a theory-driven approach to guide PPI are neglected areas. The long tradition of involvement across health and social care can provide considerable expertise in thinking about ways to strengthen approaches to PPI. This is especially important in patient safety, with a much newer tradition of developing PPI than other areas of healthcare.
英国的患者和公众参与（PPI）在医疗保健中的出现可以追溯到 20 世纪 70 年代。最近，受伤害患者的运动促使人们重新关注加强 PPI。人们越来越意识到 PPI 在研究中的益处，也需要解决权力不平等以及缺乏多样性和包容性的问题。进行这项审查是为了研究 PPI 在健康、社会保健和患者安全方面的理论、障碍和促进因素的证据，这些证据可以用于加强 PPI，并解决患者安全方面 PPI 知识和理论差距的问题。
我们从 1978 年开始在 MEDLINE、EMBASE 和 PsycINFO 上进行了搜索，使用 MeSH 和自由文本术语来确定已发表的实证文献。还在 PROSPERO 中搜索了方案，以确定正在进行的任何系统评价。使用叙述方法分析提取的信息，该方法使用描述性方法综合数据。
确定了 42 项综述，并根据关键结果进行了分组。22 篇论文以某种形式提到了理论，31 篇论文提到了平等和多样性（尽管在该领域没有提到理论），只有 19 篇论文将平等和多样性作为障碍或促进因素。34 项审查在不同的组织层面确定了障碍和促进因素：个人/个体；态度；卫生专业人员；角色和期望；知识、信息和沟通；融资和资源；培训；一般支持；招聘和代表性；PPI 方法和与社区合作以及解决权力动态。
审查结果表明，对 PPI 和伙伴关系工作的承诺取决于采取整体系统方法。这需要考虑到这一过程的复杂的个人和组织促进因素和制约因素，并解决不同群体经历的权力不平衡问题。平等和多样性的处理以及使用理论驱动的方法来指导 PPI 是被忽视的领域。健康和社会保健领域长期以来的参与传统可以为加强对 PPI 的方法提供相当多的专业知识。在患者安全方面，这一点尤为重要，因为与其他医疗保健领域相比，发展 PPI 的传统要晚得多。
