Group Deliberation Research Articles

Members of Minority and Underserved Communities Set Priorities for Health Research.

A major contributor to health disparities is the relative lack of resources-including resources for science-allocated to address the health problems of those with disproportionately greater needs. Engaging and involving underrepresented communities in setting research priorities could make the scientific research agenda more equitable, more just, and more responsive to their needs and values. We engaged minority and underserved communities in informed deliberations and report here their priorities for health research. Academic-community partnerships adapted the simulation exercise CHAT for setting health research priorities. We had participants from minority and medically underserved communities (47 groups, n = 519) throughout Michigan deliberate about health research priorities, and we used surveys and CHAT software to collect the demographic characteristics and priorities selected by individuals and groups. The participants ranged in age (18 to 88), included more women than men, and were overrepresented by minority groups. Nearly all the deliberating groups selected child health and mental health research (93.6% and 95.7%), and most invested at the highest level. Aging, access, promote health, healthy environment, and what causes disease were also prioritized by groups. Research on mental health and child health were high priorities for individuals both before and after group deliberations. Access was the only category more likely to be selected by individuals after group deliberation (77.0 vs 84.0%, OR = 1.63, p = .005), while improve research, health policy, and culture and beliefs were less likely to be selected after group deliberations (all, p < .001). However, the level of investment in many categories changed after the group deliberations. Participants identifying as Black/African American were less likely to prioritize mental health research, and those of Other race were more likely to prioritize culture and beliefs research. Minority and medically underserved communities overwhelmingly prioritized mental health and child health research in informed deliberations about spending priorities.

Anti-Social Behavior in Groups

This paper provides strong evidence supporting the long-standing speculation that decisionmaking in groups has a dark side, by magnifying the prevalence of anti-social behavior towards outsiders. A large-scale experiment implemented in Slovakia and Uganda (N=2,309) reveals that deciding in a group with randomly assigned peers increases the prevalence of anti-social behavior that reduces everyone’s payoff but which improves the relative position of own group. The effects are driven by the influence of a group context on individual behavior, rather than by group deliberation. The observed patterns are strikingly similar on both continents.

Monitoring the effects of knowledge communication on conservation managers’ perception of genetic biodiversity – A case study from the Baltic Sea

Despite the attention given to genetic biodiversity in international agreements such as the Convention on Biological Diversity (CBD) Strategic Plan and the Aichi Targets, previous research points at a “conservation genetics gap,” indicating that scientific insights into genetic biodiversity are poorly integrated into practical management. Both researchers and managers call for platforms for knowledge exchange between science and practice. However, few scientific studies on the potential effects of such knowledge transfer have been conducted. The present study is a follow-up to Lundmark et al. (2017), which identified significant effects of two forms of knowledge communication on conservation managers’ concerns and beliefs in regard to Baltic Sea genetic biodiversity. This study departs from Lundmark et al. (2017) and explores (a) whether the identified alterations in knowledge and beliefs persist over time, and (b) whether potential stability differs between different types of policy beliefs as well as between two types of knowledge communication (lecture and group deliberation). The results of this follow-up study show that the positive impacts on managers’ self-assessed knowledge remained, while the effects on policy beliefs largely had vanished a few months after the knowledge communication. Thus, changes in beliefs seem perishable, suggesting that continuity is more important than the form of educational efforts.

Does Group Deliberation Mobilize? The Effect of Public Deliberation on Willingness to Participate in Politics.

Proponents of public deliberation suggest that engaging in deliberation increases deliberators' subsequent participation in other forms of politics. We evaluate this "deliberative participation hypothesis" using data drawn from a deliberative field experiment in which members of medically underserved communities in Michigan deliberated in small groups about the design of that state's Medicaid program. Participants were randomly assigned to deliberate about the program in a group or to think about the decision individually, and then completed a post-survey that included measures of willingness to engage in a variety of political acts. We measured willingness to engage in common forms of political participation, as well as willingness to participate in particularistic resistance to adverse decisions by insurance bureaucracies. Contrary to the claims of much of the existing literature, we find no impact of deliberation on willingness to engage in political participation. These results suggest that the ability of public deliberation to increase broader political engagement may be limited or may only occur in particularly intensive, directly empowered forms of public deliberation.

Truth tracking performance of social networks: how connectivity and clustering can make groups less competent

Our beliefs and opinions are shaped by others, making our social networks crucial in determining what we believe to be true. Sometimes this is for the good because our peers help us form a more accurate opinion. Sometimes it is for the worse because we are led astray. In this context, we address via agent-based computer simulations the extent to which patterns of connectivity within our social networks affect the likelihood that initially undecided agents in a network converge on a true opinion following group deliberation. The model incorporates a fine-grained and realistic representation of belief (opinion) and trust, and it allows agents to consult outside information sources. We study a wide range of network structures and provide a detailed statistical analysis concerning the exact contribution of various network metrics to collective competence. Our results highlight and explain the collective risks involved in an overly networked or partitioned society. Specifically, we find that 96% of the variation in collective competence across networks can be attributed to differences in amount of connectivity (average degree) and clustering, which are negatively correlated with collective competence. A study of bandwagon or “group think” effects indicates that both connectivity and clustering increase the probability that the network, wholly or partly, locks into a false opinion. Our work is interestingly related to Gerhard Schurz’s work on meta-induction and can be seen as broadly addressing a practical limitation of his approach.

Encountering Dissimilar Views in Deliberation: Political Knowledge, Attitude Strength, and Opinion Change

Conversing with diverse points of view stands as the central tenet of deliberative democracy, yet empirical evidence has suggested mixed outcomes related to perspective change as a result of deliberative encounters. I propose a difference‐driven model that suggests individual predispositions moderate the processing of dissimilar views when changing policy preferences. My analysis is based on a random sample of over 400 voters at a California‐wide deliberative event, where participants discussed proposals for reforming the state politics. I find that encountering more and different arguments transforms policy attitudes. Yet it is more difficult for people to change their minds on issues about which they hold strong beliefs. Some evidence suggests that different psychologies are at play for people who enter deliberation with substantial or weak political knowledge and for those who deliberate while holding strong or moderate prior opinions. Well‐grounded strong opinions are resistant to change, while well‐grounded moderate opinions are persuadable in deliberative groups. Uninformed positions can become entrenched in like‐minded groups, yet they can be adjusted once participants deliberate with dissimilar views, especially opinions that are held strongly without good informational ground. The findings urge deliberative forums that introduce participants to diverse perspectives to foster a considered public opinion.

Long-term views on chronic kidney disease research priorities among stakeholders engaged in a priority-setting partnership: A qualitative study

BackgroundPatients and stakeholders are increasingly engaging in health research to help address evidence‐practice gaps and improve health‐care delivery. We previously engaged patients, caregivers, health‐care providers (HCPs) and policymakers in identifying priorities for chronic kidney disease (CKD) research.ObjectiveWe aimed to explore participants' views on the research priorities and prioritization process 2 years after the exercise took place.DesignIn this qualitative descriptive study, individual interviews were conducted and analysed using an inductive, thematic analysis approach.Setting/participantsParticipants resided across Canada. We purposively sampled across stakeholder groups (CKD patients, caregivers, HCPs and policymakers) and types of engagement (wiki, workshop and/or steering committee) from the previous CKD priority‐setting project.ResultsAcross 23 interviews, participants discussed their research priorities over time, views on the prioritization process and perceived applicability of the priorities. Even though their individual priorities may have changed, participants remained in agreement overall with the previously identified priorities, and some perceived a distinction between patient and HCP priorities. They tended to balance individual priorities with their broader potential impact and viewed the prioritization process as systematic, collaborative and legitimate. However, participants acknowledged challenges to applying the priorities and emphasized the importance of communicating the project's outcomes upon its completion.ConclusionTwo years after engaging in CKD research prioritization, stakeholder participants remained in agreement with the previously identified priorities, which they felt reflected group deliberation and consensus. Rapport and communication were highlighted as key elements supporting effective engagement in research prioritization.

Rational social and political polarization

Public discussions of political and social issues are often characterized by deep and persistent polarization. In social psychology, it’s standard to treat belief polarization as the product of epistemic irrationality. In contrast, we argue that the persistent disagreement that grounds political and social polarization can be produced by epistemically rational agents, when those agents have limited cognitive resources. Using an agent-based model of group deliberation, we show that groups of deliberating agents using coherence-based strategies for managing their limited resources tend to polarize into different subgroups. We argue that using that strategy is epistemically rational for limited agents. So even though group polarization looks like it must be the product of human irrationality, polarization can be the result of fully rational deliberation with natural human limitations.

Using a deliberative forum for engaging health system and health plan leaders to prioritize research topics

Background: Including stakeholders in the process and outcomes of comparative effectiveness research (CER) can help ensure that research questions are relevant and findings are communicated to individuals who need them for decision-making. Yet limited strategies are available to assist researchers with stakeholder engagement.While health system leaders’ perspectives are increasingly recognized as valuable for CER planning, their inclusion in the stakeholder pool raises challenges due to differences in culture, training, incentives, priorities and language norms.Objective: To convene and evaluate a deliberative forum for engaging health system leaders and other stakeholders in order to shape health system research priorities for the PaTH Clinical Data Research Network, a member of the National Patient-Centered Clinical Research Network (PCORnet).Methods: Breakout sessions and large group deliberation solicited diverse perspectives and explored benefits and challenges of different research questions. Topic reframing, narrative integration and dynamic updating techniques facilitated communication across diverse backgrounds. Participants included 29 health system and health plan leaders, clinicians, clinical researchers and patients from the network’s 6 participating health systems. Main measures were audience response system (ARS) polling on general topic preferences and survey data on measures of engagement and deliberation success.Results: A slate of 10 specific research topics was vetted; after deliberation, the group converged to favor the characterization of high utilizers of healthcare. Audience response polling revealed opinion shifts. Participants reported high levels of satisfaction with the experience and rated it highly for markers of deliberative quality (e.g., opportunity for active participation and adequate discussion, respect for others’ opinions and awareness of different perspectives). Fifty-four percent noted their views on the issues changed. Most participants learned from the experience (93%) and agreed that the process helped them to empathize with the challenges of others (85%).Conclusions: A deliberation forum can incorporate diverse stakeholders into CER, enabling participants to inform and learn from each other’s perspectives while shaping a person-centered research trajectory.

Between cheap talk and epistocracy: The logic of interest group access in the European Parliament's committee hearings

Improving policy deliberation is a central objective for the European Union's institutions. Focusing on the European Parliament's committee hearings as an understudied area of European governance, we aim to understand their role, and their capacity to improve its procedural legitimacy. Building on theoretical work on interest group access and deliberation we argue that hearings can serve three purposes: (i) coordinative; (ii) epistemic; (iii) enhancing public participation. We construct a set of measures and assess an entire population of participants in hearings (2009–14), concentrating on three committees. Our analyses show that hearings serve a hybrid purpose between coordinative and epistemic. At the top end, we observe a core group of gatekeepers representing the dominant constituencies. Simultaneously, research organizations are granted unique access as experts that de‐politicize debates. Theoretically, we contribute to discussions on interest group access while providing an innovative set of tools for its measurement, and the first dataset of its kind.

Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage.

Background: As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and deliberative democracy. Methods: We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in language and culture. Results: Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping (94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care (90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to current levels (74%). Following group deliberation, they tended to change their views back to below current coverage for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as appropriate and fair. A significant number would have added nothing. Conclusion: Swiss participants who have engaged in a priority setting exercise accept complex resource allocation trade-offs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage was achieved.

Characteristics of Group Deliberation by an Elementary Teacher Learning Community in Reorganizing a Social Studies Lesson Plan for the Sixth Graders

Characteristics of Group Deliberation by an Elementary Teacher Learning Community in Reorganizing a Social Studies Lesson Plan for the Sixth Graders

Aggregated knowledge from a small number of debates outperforms the wisdom of large crowds

The aggregation of many independent estimates can outperform the most accurate individual judgement 1–3 . This centenarian finding 1,2 , popularly known as the 'wisdom of crowds' 3 , has been applied to problems ranging from the diagnosis of cancer 4 to financial forecasting 5 . It is widely believed that social influence undermines collective wisdom by reducing the diversity of opinions within the crowd. Here, we show that if a large crowd is structured in small independent groups, deliberation and social influence within groups improve the crowd’s collective accuracy. We asked a live crowd (N = 5,180) to respond to general-knowledge questions (for example, What is the height of the Eiffel Tower?). Participants first answered individually, then deliberated and made consensus decisions in groups of five, and finally provided revised individual estimates. We found that averaging consensus decisions was substantially more accurate than aggregating the initial independent opinions. Remarkably, combining as few as four consensus choices outperformed the wisdom of thousands of individuals. The collective wisdom of crowds often provides better answers to problems than individual judgements. Here, a large experiment that split a crowd into many small deliberative groups produced better estimates than the average of all answers in the crowd.

La técnica Delphi: Un método de consenso para la investigación en servicios de salud en Latino América

El método de consenso es un grupo de técnicas de investigación utilizado con poca frecuencia para la investigación de servicios de salud en América Latina. El método de consenso proporciona a los investigadores la capacidad de lograr una estimación cuantitativa a través de un enfoque cualitativo. El método de consenso representa un enfoque epistemológico de las ciencias inexactas. Este método que incluye el grupo nominal y la técnica Delphi es útil cuando se requiere un acuerdo de expertos sobre la formulación de recomendaciones, especialmente cuando la evidencia científica no está disponible, las evidencia existentes se debate, o si existe un pequeño equilibrio entre el riesgo-beneficio. El objetivo general es llegar a una conclusión válida, o consenso, de una deliberación grupal repetitiva en respuesta a una pregunta de investigación bien definida. La técnica Delphi es un método esencial para lograr consenso en áreas donde no existía anteriormente evidencia, es limitada, de baja calidad y / o sujeta a debate. Existen cuatro áreas generales en las que los investigadores deberían considerar la técnica Delphi, que incluyen 1) El problema de la investigación no se presta a técnicas analíticas precisas, pero puede beneficiarse de juicios subjetivos sobre una base colectiva; 2) La población de investigación presenta diversos antecedentes con respecto a la experiencia y pericia; 3) Se requieren más sujetos que puedan interactuar eficazmente frente a frente; y 4) El tiempo, los costos y la logística harían inviable las reuniones frecuentes de todos los involucrados. La técnica Delphi crea un entorno estructurado para que los expertos evalúen la mejor información disponible relacionada a una pregunta de investigación y formulen soluciones para responder a esta pregunta a través de un proceso concreto. En general, la técnica Delphi es un poderoso método de investigación cualitativo que debe utilizarse en la investigación de servicios de salud en América Latina.

Strategic planning in an academic radiation medicine program.

In this paper, we report on the process of strategic planning in the Radiation Medicine Program (rmp) at the Princess Margaret Cancer Centre. The rmp conducted a strategic planning exercise to ensure that program priorities reflect the current health care environment, enable nimble responses to the increasing burden of cancer, and guide program operations until 2020. Data collection was guided by a project charter that outlined the project goal and the roles and responsibilities of all participants. The process was managed by a multidisciplinary steering committee under the guidance of an external consultant and consisted of reviewing strategic planning documents from close collaborators and institutional partners, conducting interviews with key stakeholders, deploying a program-wide survey, facilitating an anonymous and confidential e-mail feedback box, and collecting information from group deliberations. The process of strategic planning took place from December 2014 to December 2015. Mission and vision statements were developed, and core values were defined. A final document, Strategic Roadmap to 2020, was established to guide programmatic pursuits during the ensuing 5 years, and an implementation plan was developed to guide the first year of operations. The strategic planning process provided an opportunity to mobilize staff talents and identify environmental opportunities, and helped to enable more effective use of resources in a rapidly changing health care environment. The process was valuable in allowing staff to consider and discuss the future, and in identifying strategic issues of the greatest importance to the program. Academic programs with similar mandates might find our report useful in guiding similar processes in their own organizations.

Civic media literacy as 21st century source work: Future social studies teachers examine web sources about climate change

Civic media literacy entails understanding complex topics and events that are increasingly mediated by digital sources of information and where it can be challenging to evaluate the reliability merits of these sources. The goal of this study was to discern the ways undergraduate preservice social studies teachers with different climate change beliefs read and evaluated the reliability of four diverse Web sources about the complex socioscientific topic of climate change. Findings highlight clear alignment between most participants with climate change beliefs at either end of a beliefs continuum with less alignment for participants with climate change beliefs toward the middle of a continuum. Findings also point to the benefits of whole group deliberation to help participants more critically evaluate a Web source that opposed the scientific consensus about climate change. In an age of “alternative facts,” this study points to the importance of students and educators having opportunities to evaluate, discuss, and determine the credibility of a range of online sources.

Supporting the "Archstone of Democracy": Cooperative Extension's Experiment with Deliberative Group Discussion

Cooperative Extension has a rich history of providing research-based knowledge and functioning as a catalyst for change through community engagement. It is via this second dimension of its identity that Extension has long played a role in creating space for public issues to be understood through deliberative discussion. Rather than view the use of deliberation and discussion as only a recent development in Extension's approach to engaging citizens about public issues, I highlight efforts and challenges related to Extension's experiment with deliberation and discussion in the 1930s and 1940s and use this historic perspective to identify important implications for Extension today.

Political apathy amongst students: A case study of Nelson Mandela Metropolitan University

The primary motivation for this research, in which a qualitative method was employed, was to examine political apathy amongst students at Nelson Mandela Metropolitan University. The secondary motivation was to question whether youth political apathy threatens the consolidation of democracy. The researchers arranged four focus groups at Nelson Mandela Metropolitan University. A purposive sampling technique was utilised. All 50 participants in the study were Nelson Mandela Metropolitan University undergraduate and postgraduate black students, with ages ranging from 21 to 35 years. The researchers encouraged participants to have maximum participation in the focus group deliberations. The researchers also made use of elite interviews in the study. The findings of this study suggest that political apathy does exist amongst students at Nelson Mandela Metropolitan University. Most of the participants in the focus groups indicated that young people in post-apartheid South Africa have no interest in politics.

Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study

During a catastrophe, health-care providers may face difficult questions regarding who will receive limited life-saving resources. The ethical principles that should guide decision-making have been considered by expert panels but have not been well explored with the public or front-line clinicians. The objective of this study was to characterize the public's values regarding how scarce mechanical ventilators should be allocated during an influenza pandemic, with the ultimate goal of informing a statewide scare resource allocation framework. Adopting deliberative democracy practices, we conducted 15 half-day community engagement forums with the general public and health-related professionals. Small group discussions of six potential guiding ethical principles were led by trained facilitators. The forums consisted exclusively of either members of the general public or health-related or disaster response professionals and were convened in a variety of meeting places across the state of Maryland. Primary data sources were predeliberation and postdeliberation surveys and the notes from small group deliberations compiled by trained note takers. Three hundred twenty-four individuals participated in 15 forums. Participants indicated a preference for prioritizing short-term and long-term survival, but they indicated that these should not be the only factors driving decision-making during a crisis. Qualitative analysis identified 10 major themes that emerged. Many, but not all, themes were consistent with previously issued recommendations. The most important difference related to withholding vswithdrawing ventilator support. The values expressed by the public and front-line clinicians sometimes diverge from expert guidance in important ways. Awareness of these differences should inform policy making.

Show me the money! An analysis of underserved stakeholders' funding priorities in Patient Centered Outcomes Research domains.

Develop an accessible exercise to engage underserved populations about research funding priorities; analyze the criteria they use to prioritize research; contrast these criteria to those currently used by Patient Centered Outcomes Research Institute (PCORI). Academic and community partners collaborated to develop an Ipad exercise to facilitate group deliberation about PCOR funding priorities. 16 groups (n = 183) of underserved individuals in both urban and rural areas participated. Recordings were qualitatively analyzed for prioritization criteria. Analysis yielded ten codes, many of which were similar to PCORI criteria, but all of which challenged or illuminated these criteria. Directly involving underserved populations in determining funding criteria is both feasible and important, and can better fulfill PCORI's goal of incorporating patient priorities.