Public Advisors Research Articles

"Necessity is the mother of invention": Experiences of accessing and delivering dementia-related support services by information communication technology during the pandemic in the UK.

The remote delivery of dementia-related support services by information communication technology, defined as any hardware or software, including the telephone and videoconferencing software, increased during the coronavirus pandemic. To guide the future use of information communication technology, this study explored the experiences of delivering and accessing social care and support services during the pandemic in the UK. Remote semi-structured interviews with social care and support providers, people with dementia and family carers were conducted between May-December 2022. Topic guides were co-developed with two public advisors (one former family carer, one person with dementia) and garnered information on delivering and accessing services during the pandemic. Audio recordings were transcribed verbatim. Employing a mixture of inductive and deductive analytic approaches, a thematic analysis was conducted. Twenty-one interviews (n = 14 social care and support providers; n = 6 family carers; n = 2 people with dementia) were conducted. Three themes were generated: adapting to changing circumstances; responding to unmet needs by information communication technology and information communication technology should be a tool, not the default. Social care and support providers' creativity and motivation facilitated the adoption of information communication technology, however, available resources and guidance varied. While some people with dementia and family carers benefitted from accessing services by information communication technology to address some needs, the format was not suitable for everyone. Beyond the coronavirus pandemic, the use of information communication technology within service delivery needs to be carefully considered, to avoid disenfranchising some people with dementia and family carers, while empowering people with the option of how to access services. Digital training and guidelines advising the use of information communication technology within service delivery may facilitate its improved use during the current landscape, and amidst future pandemics.

Evaluation of Public Involvement in Doctoral Research Using a Four-Dimensional Theoretical Framework.

Working together and co-production with public advisors have become popular among health researchers. This practice extends to doctoral researchers who involve public advisors at different stages of their research or throughout their doctoral journey. A doctoral researcher and two public advisors jointly evaluated public involvement in doctoral research. Using the established public involvement evaluation framework by Gibson and colleagues, public advisors and a doctoral researcher mapped and evaluated their experiences of public involvement in doctoral research. The four-dimensional framework allowed the authors to reflect on (1) the strength of the public voice, (2) the number of ways in which public advisors had an opportunity to get involved, (3) whether the discussion was about the public or organisation's (doctoral researcher, university or funder) concerns and (4) if the organisation changed or resisted feedback. Results are presented in a diagrammatic and narrative way. Public advisors saw themselves as having a stronger voice in doctoral research than the doctoral researcher perceived. All agreed that there existed multiple ways for public advisors to be involved. Public advisors' feedback was taken on board, but it was also limited due to restrictions of what the doctoral programme allowed. Public advisors ensured that the doctoral research was more relevant to the public. The ongoing involvement also shaped the doctoral researcher's thinking and views. Two public advisors were involved throughout the 3 years of this doctoral research. They co-evaluated this involvement and are co-authors of this paper.

Coproducing Health Information Materials With Young People: Reflections and Lessons Learned.

This paper describes and critically reflects on how children and young people (CYP) acted as public advisors to coproduce health information materials about Long Covid for younger audiences. This work was underpinned by the Lundy model, a framework which provides guidance on facilitating CYP to actively contribute to matters which affect them. Coproduction activity sessions took place with CYP in schools as well as video conferences with a CYP stakeholder group and CYP with Long Covid. Activities encouraged CYP to focus on the content, format, and design of materials and used problem-based and collaborative learning to encourage engagement with the project. Using a range of methods and open discussion, CYP codesigned a series of Long Covid health information materials for younger audiences. Sixty-six CYP (aged 10-18), and two young adults were involved. CYP codesigned specifications for the final materials and provided feedback on early designs. The project led to the development of a series of health information materials targeted at CYP: a short social media campaign with six short videos and a 12-page illustrated leaflet about Long Covid; released on social media and distributed in local area. All the CYP were positive about the project and their involvement. Involving CYP led to the development of innovative and engaging information materials (influence). Developing rapport was important when working with CYP and this was facilitated by using approaches and activities to establish an environment (space) where the CYP felt comfortable sharing their views (voice) and being listened to (audience) by the adults in the project. Working with external groups who are willing to share their expertise can help the meaningful involvement of voices 'less heard'. One CYP coapplicant contributed to the project design and facilitation of PPIE sessions, 64 CYP were involved in the PPIE sessions to design and feedback on materials. Two young adult media producers worked with CYP to produce these materials, another CYP supported this process. Three public contributors were involved in the preparation of this manuscript.

A positive deviant approach to examining the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes

ObjectivesDuring the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities. MethodsA Women’s Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified “positive deviant” organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed. ResultsThe change in the inequality gap for the maternal indicator ranged from a reduction of −0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from −0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff ‘stepping in’ where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified. ConclusionsHarnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.

Mapping gender and sexual minority representation in cancer research: a scoping review protocol.

Addressing the risk of people from gender and sexual minority (GSM) groups experiencing inequities throughout the cancer continuum requires a robust evidence base. In this scoping review, we aim to map the literature on cancer outcomes among adults from GSM groups and the factors that influence them along the cancer continuum. This mixed-methods scoping review will follow the approach outlined by JBI. We will systematically search electronic databases for literature in collaboration with a health sciences librarian. Two reviewers will screen titles and abstracts to determine eligibility based on inclusion criteria, and then retrieve full text articles for data extraction. Results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Quantitative data will be qualitized through a narrative interpretation and pooled with qualitative data. We will use meta-aggregation to synthesize findings. This protocol was developed in collaboration with GSM patient and public advisors. We will engage people from GSM groups, community organizations and knowledge users in disseminating results. This review will direct future research efforts by expanding the wider body of research examining cancer disparities across the cancer continuum that GSM groups experience, identifying literature gaps and limitations, and highlighting relevant social determinants of health that influence cancer outcomes for adults from GSM groups.

A virtuous cycle of co-production: Reflections from a community priority-setting exercise.

Co-production is gaining increasing recognition as a good way of facilitating collaboration among different stakeholders, including members of the public. However, it remains an ambiguous concept as there is no definitive or universal model of co-production or clarity on what constitutes a good co-production approach. This paper draws on the reflections of the academic researchers, practitioners and public advisors involved in co-producing a priority-setting exercise. The exercise was conducted by the Primary and Community Health Services (PCHS) Theme of the National Institute for Health and Care Research Applied Research Collaboration for Kent, Surrey and Sussex (NIHR ARC KSS). We collected data through written and verbal reflections from seven collaborators involved in the PCHS priority-setting exercise. We used Gibbs' model of reflection to guide the data collection. We then analysed the data through an inductive, reflexive thematic analysis. A common thread through our reflections was the concept of 'sharing'. Although co-production is inherently shared, we used the virtuous cycle to illustrate a sequence of sharing concepts during the research cycle, which provides the underpinnings of positive co-production outcomes. We identified six themes to denote the iterative process of a shared approach within the virtuous cycle: shared values, shared understanding, shared power, shared responsibilities, shared ownershipand positive outcomes. Our results present a virtuous cycle of co-production, which furthers the conceptual underpinnings of co-production. Through our reflections, we propose that positive co-production outcomes require foundations of shared values and a shared understanding of co-production as a concept. These foundations facilitate a process of shared power, shared responsibilitiesand shared ownership. We argue that when these elements are present in a co-production exercise, there is a greater potential for implementable outcomes in the communities in which the research serves and the empowerment of collaborators involved in the co-production process. Three members of the public who are public advisors in the NIHR ARC KSS were involved in the priority-setting exercise that informed this paper. The public advisors were involved in the design of the priority-setting exercise and supported participants' recruitment. They also co-facilitated the focus groups during data collection and were involved in the data analysis, interpretation and preparation of the priority-setting report. For this current manuscript, two of them are co-authors. They provided reflections and contributed to the writing and reviewing of this manuscript.

Social prescribing practices and learning across the North West Coast region: essential elements and key challenges to implementing effective and sustainable social prescribing services

IntroductionSocial prescribing has become an important feature of the UK primary care offer. However, there remains limited evidence on how best to implement and deliver social prescribing programmes to maximise effectiveness and long-term sustainability.AimTo explore social prescribing practices and experience of implementing social prescribing programmes across National Institute for Health and Social Care Research (NIHR) Collaborative Leadership for Applied Health and Care Research (CLAHRC) North West Coast (NWC) and NIHR Applied Research Collaboration (ARC) NWC region to identify key learning points that can be applied to other settings.MethodWe held a learning exchange workshop attended by practitioners and Public Advisors who had been involved in implementing and evaluating eight different social prescribing programmes with the support of NIHR CLAHRC NWC. We followed this with an online survey of social prescribing practice and priorities within the NIHR ARC NWC area. We used the findings from the workshop and survey to develop an initial model of the elements needed to successfully implement and sustain a working social prescribing programme.FindingsWe identified three core essential elements for a successful social prescribing programme: a personalised approach; meaningful service-user and community involvement; and whole systems working. These core elements need to be supported with adequate resources in the form of continuity of funding and adequate community resources to refer people to, capacity building and appropriate evaluation.ConclusionWe were able to use a learning exchange workshop to both facilitate learning between practitioners and begin the process of identifying the ingredients needed for a successful social prescribing programme, which may be built on with further research.

Social support services for dementia during the COVID-19 pandemic: A longitudinal survey exploring service adaptations in the United Kingdom.

To understand how the delivery of dementia-related social support services across the UK adapted during the pandemic. We devised a two-part online and telephone longitudinal survey. Providers participated between March and June 2021, and again 3 months later. Information relating to services delivered and delivery methods employed was collected before and during the pandemic at two timepoints (T1 and T2). A total of 75 participants completed the survey at T1, with 58 participants completing the survey at both timepoints. Thirty-six participants had complete data at T1. Day care centres and support groups were the most delivered primary services. During the pandemic, services shifted from in-person to remote or hybrid. While in-person services started to resume at T2, most services remained hybrid. At T2, the frequency of service delivery increased, however, a decreasing trend in usage was observed across survey timepoints. The telephone was the most employed format to deliver remote and hybrid services, however, reliance on videoconferencing software significantly increased at T1. Videoconferencing software was often used alongside the telephone and emails to remotely deliver services. Services were able to adapt and provide support to some service recipients. Complementing novel approaches to service delivery with more traditional formats may facilitate access to service recipients with limited digital literacy. Following the easing of public health measures, many service recipients may be reluctant to engage with in-person services. Thus, the provision of in-person and remote services needs to be carefully balanced amidst the current hybrid landscape. Two public advisors (a former unpaid carer and a person living with dementia) were involved in designing and piloting the tool, interpreting the results and disseminating the findings. Both public advisors have experience in delivering dementia-related social support services before and or during the pandemic in the United Kingdom.

Reflections on contributing to health research: A qualitative interview study with research participants and patient advisors.

The aims of this study were to explore individuals' experiences of contributing to health research and to identify the types of impact that are perceived as important by participants or patient and public advisors. Specifically, research led by NMAHPP clinicians (Nursing, Midwifery, Allied health professions, Healthcare science, Psychology and Pharmacy). Semi-structured one-to-one interviews were conducted with health research participants and patient or public advisors. Interviewees were recruited from five UK sites and via social media. Interview transcripts were analysed using Thematic Analysis to identify key themes and areas of disagreement. Twenty-one interviews were completed, and four main themes were identified. The first, optimising research experiences, included personal reflections and broader recommendations to improve participant experiences. The second, connecting health research with healthcare, described research as key for the continued development of healthcare, but illustrated that communication between research teams, participants, and clinicians could be improved. The third theme explored the personal impacts of contributing to research, with interviewees recalling common positive experiences. The final theme discussed capturing research impacts. Interviewees highlighted potential priorities for different stakeholders, but emphasised that financial impacts should not be the sole factor. Individuals who were involved in NMAHPP health research recalled positive experiences and reported good relationships with their research teams. They felt that their contributions were valued. Suggested strategies to optimise the research experience focused on simplifying documentation, clear signposting of the research activities involved, and feedback on the research findings. Routine sharing of relevant research data with clinicians was also recommended. Personal impacts included a deeper understanding of their health condition or health more broadly, and increased confidence interacting with healthcare and other professionals. These findings will be used to inform development of a framework to capture the impact of NMAHPP research.

Public contributors' preferences for the organization of remote public involvement meetings in health and social care: A discrete choice experiment study.

Covid-19 expanded the use of remote working to engage with public contributors in health and social care research. These changes have the potential to limit the ability to participate in patient and public involvement and engagement (PPIE) for some public contributors. It is therefore important to understand public contributors' preferences, so that remote working can be organized in an optimal way to encourage rather than discourage participation. We use an economic preference elicitation tool, a discrete choice experiment (DCE), via an online survey, to estimate public contributors' preferences for and trade-offs between different features of remote meetings. The features were informed by previous research to include aspects of remote meetings that were relevant to public contributors and amenable to change by PPIE organizers. We found that public contributors are more likely to participate in a PPIE project involving remote meetings if they are given feedback about participation; allowed to switch their camera off during meetings and step away if/when needed; were under 2.5 h long; organized during working hours, and are chaired by a moderator who can ensure that everyone contributes. Different combinations of these features can cause estimated project participation to range from 23% to 94%. When planning PPIE and engaging public contributors, we suggest that resources are focused on training moderators and ensuring public contributors receive meeting feedback. Project resources should be allocated to maximize project participation. We provide recommendations for those who work in public involvement and organize meetings on how resources, such as time and financial support, should be allocated. These are based on the preferences of existing public contributors who have been involved in health and social care research. We had a public contributor (Naheed Tahir) as a funded coapplicant on the UKRI ESRC application and involved members of the North West Coast Applied Research Collaboration (NWC ARC) Public Advisor Forum at every stage of the project. The survey design was informed from three focus groups held with NWC ARC public contributors. The survey was further edited and improved based on the results of six one-to-one meetings with public contributors.

Artificial intelligence and health inequities in primary care: a systematic scoping review and framework

ObjectiveArtificial intelligence (AI) will have a significant impact on healthcare over the coming decade. At the same time, health inequity remains one of the biggest challenges. Primary care is both...

Involvement and engagement of seldom-heard communities in big data research.

ObjectivesPublic involvement and engagement have been growing within big data research. However, seldom heard voices such as migrant and ethnic minorities communities are often underrepresented. This study explored how Polish and South Asian communities in the United Kingdom could be better included in public involvement and engagement activities.
 ApproachWe conducted semi-structured interviews with Polish (n=20) and South Asians (n=20) to elicit their views on big data research, public involvement and engagement. We focused on Polish and South Asian communities as they represent some of the United Kingdom’s largest migrant and ethnic minority groups. Data were analysed using inductive thematic analysis. Public advisors were involved in the analysis. They and one of the researchers come from ethnic minority and offered insider insight into participants' perspectives and thus allowing us to unpick the complexity of experiences and backgrounds.
 ResultsThe majority of participants were willing to become involved or engaged in big data research. However, we found there were multiple barriers to involvement, these included: language (especially for those for whom English is the second language); use of jargon by researchers; time restrictions and unfamiliarity with big data or public involvement. Some participants questioned how much migrants could be involved when they were only in the United Kingdom on a temporary basis. The participants made recommendations for how researchers can mitigate these barriers. Awareness-raising activities would allow people to expand their understanding and build their confidence when speaking about big data research in a second language. Participants spoke of the need for researchers to work more closely with local communities, especially with local gatekeepers.
 ConclusionsThe results indicate that there is no ‘right’ way to involve and engage seldom heard communities around big data research. Researchers need to engage with communities, establish trust and develop a long-lasting relationships. These partnerships should move beyond single projects and aim to benefit both researchers and seldom heard communities.

The value of involving patients and public in health services research and evaluation: a qualitative study

BackgroundPublic and Patient Involvement, Engagement and Participation research encompasses working with patients/service users (people with a medical condition receiving health service treatment), public members, caregivers and communities (who use services or care for patients). The Partner Priority Programme (PPP) was developed by the National Health Service [NHS] and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care [NIHR CLAHRC] NWC to share information and experience on evaluating new services being offered to patients that were seeking to reduce health inequalities, improve people’s health and wellbeing and reduce emergency hospital admissions. This paper seeks to explore an approach developed for involving the public as equal partners within the evaluation and decision-making processes of health and social care services research. The aim of this study was to identify how public advisors were included, the impact of their involvement, and how change occurred within the organisations following their involvement.MethodsA qualitative approach using focus group discussions was adopted to explore the experiences of two cohorts of participants involved in PPP project teams. Focus groups were held with public advisors (n = 9), interns (n = 9; staff or public who received a funded internship for a PPP project), NHS and Local Authority initiative leads (n = 10), and academic facilitators (n = 14). These were transcribed verbatim and analysed using a thematic approach.ResultsThirty-two public advisors were recruited to support 25 PPP projects across the Collaboration for Leadership in Applied Health Research and CLAHRC North West Coast [NWC] partner organisations. Three inter-related themes were conceptualised: 1)“Where it all started - involving public advisors” identified the varying journeys to recruitment and experiences of becoming a public advisor; 2)“Steps toward active involvement and engagement” related to public advisors becoming core team members; and 3) “Collaborative working to enhance public and patient involvement” relayed how projects identified the benefits of working jointly with the public advisors, particularly for those who had not experienced this style of working before.ConclusionsThe findings indicate that the PPP model is effective for embedding Public and Patient Involvement [PPI] within health services research, and recommends that PPI is integrated at the earliest opportunity within research projects and service evaluations through the use of support-led and facilitative programmes.

Talk to us! Communication is a key factor in improving the comfort of MRI research participants.

ContextMagnetic resonance imaging (MRI) is an invaluable diagnostic and research tool. Having an MRI scan is not always comfortable and may deter people from taking part in MRI research. Maximizing comfort during scanning will improve participants’ experiences and image quality.ObjectiveTo define which factors improve comfort during an MRI scan for research by asking people who have participated in MRI research.Setting and participantsPeople who had participated in MRI research during the past two years were invited, as ‘public advisors’ to discuss their experiences together and agree on which factors are most important in ensuring comfort while participating in MRI research.ResultsPublic advisors ranked researcher‐participant communication as the most important factor. In response, an example script to guide MRI researchers in communicating with participants was developed through close consultation between research staff, public advisors and the public. This outlines the often‐missing information necessary to convey to participants, including explaining the reasons behind instructions, managing expectations, providing reassurance, encouragement and progress updates during scanning.ConclusionsDrawing upon personal experiences as MRI research participants, public advisors highlighted the importance of effective and on‐going researcher communication throughout. The example script may be used as a training tool for researchers to help ensure participants’ comfort during scanning.Patient and public contributionAll contributors had previously taken part in MRI research. The project was co‐designed, co‐delivered and co‐authored with a public research partner. Public advisors agreed key factors of importance. External public reviewers and public advisors reviewed example script drafts.

A qualitative evaluation of coproduction of research: 'If you do it properly, you will get turbulence'.

Patients and public members are increasingly involved across the different stages of the research process. Their involvement is particularly important in the conception and design of applied health research where it enables people with lived experience to influence the aims, content, focus and methods. To evaluate the process of coproducing a mental health-related research proposal suitable for funding through a national health research funding body. Reflections from members of the public (n=3) and academic researchers (n=3) were collected through semi-structured interviews. Data were thematically analysed. Thematic analysis identified five overarching themes: valuing the lived experience perspective; matching ambitions to the funded research process; 'Us and them': power, relationships and trust; challenges; and benefits of coproduction. Our findings suggest that for successful coproduction of a research funding application, an open and trusting atmosphere, where equal relationships are established and a shared common goal agreed is essential. Although relationships with research professionals were framed by trust and mutual respect for some public advisors, others felt a sense of 'us and them'. With various tensions played out through interpersonal conflict, difficult conversations and disagreements, coproduction was not a positive experience for all stakeholders involved. Among the learning was that when collaboration of this kind is constrained by time or funding, genuine, impactful coproduction can be more challenging than is generally acknowledged.

A method for scoring the risk of fungicide resistance in vineyards

Because the risk of resistance towards single-site fungicides in populations of Plasmopara viticola and Erysiphe necator, the causal agents of downy mildew (DM) and powdery mildew (PM), respectively, is substantial, fungicide resistance management is important in vineyards. Available methods for assessing resistance risk mainly focus on single fungicides and do not consider the risk of resistance of a complete fungicide schedule, which typically includes multiple fungicides, used solo or in mixture and at different doses, and other actions (behaviors) of the farmer. A simple scoring method (fungicide resistance risk score, FRRS) was developed to account for both (i) the intrinsic risk due to the fungicides used, the target pathogens, and agronomic factors, and (ii) the behavioral risk, which includes how the fungicides are used during the season. FRRSs were then calculated for 10 representative vineyards (10 cases) and ranked from 1 (highest score) to 10 (lowest score). For comparison, 20 assessors (four winegrowers and 16 experts including public advisors, field technicians, and consultants) ranked the same cases based on their individual “perception of risk” from 1 (highest risk) to 10 (lowest risk).When the FRRS-based rankings were compared with the modes of the rankings provided by the assessors, the correlation coefficients were significant for all experts (P < 0.001) and for each category of experts (P < 0.05); i.e., public advisors, field technicians from agro-chemical companies, and consultants; for non-experts, i.e., winegrowers, the FFRS values were significantly correlated with the modes of rankings for PM (P < 0.001) but not for DM (P = 0.293).The results indicated that the use of the new scoring method, i.e., the use of FRRSs, would reduce the variability in assessments of resistance risks and would provide a common method for evaluating resistance risk by both experts and winegrowers.

Using resources wisely in the COVID-19 pandemic: an international list of Choosing Wisely recommendations

BACKGROUND: The novel coronavirus (COVID-19) pandemic has brought forth issues of health system resource limitations into urgent matters of public importance. Our objective was to rapidly develop an international Choosing Wisely list of recommendations for clinicians and the public about using resources wisely in the COVID-19 pandemic. METHODS: Choosing Wisely Canada convened a rapid Delphi process to develop an international Choosing Wisely list for COVID-19. Informed by a rapid review of emerging literature, this process engaged a small group of clinicians and public advisors in Canada (n=10) and internationally (n=8) to develop a candidate list of recommendations. A survey with candidate recommendations was sent to Choosing Wisely clinician leaders in Canada and around the world. Based on survey results and input, list recommendations were modified. RESULTS: The survey was sent to 293 potential respondents and received a 56% response rate in 72 hours (n=163). Respondents were asked to score each of the 9 recommendations on a 5-point Likert scale ranging from 1 strongly disagree to 5 strongly agree followed by free text comment. There were 271 total comments across 9 recommendations. Overall, all 9 recommendations had high levels of agreement with 83%-96% of respondents ranking them as strongly agree or agree. INTERPRETATION: This list of recommendations provides evidence-based statements about using resources wisely in the COVID-19 pandemic. The list reflects international consensus on evidence-based recommendations for both clinicians and the public which were achieved through a rapid consensus building process. TRIAL REGISTRATION: n/a

Collaborative and consultative patient and public involvement in sexual health research: lessons learnt from four case studies

Patient and public involvement (PPI) refers to research carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them.1 PPI can include patients, carers, service...

Opportunities and Challenges for Hurricane Resilience on Agricultural and Forest Land in the U.S. Southeast and Caribbean

Three storms in the 2017 hurricane season caused $265 billion in damages in the U.S. Southeast and Caribbean, including billions in losses in the agriculture and forestry sector. Climate change projections indicate that such disastrous hurricane seasons are becoming more normal. Working land management sectors need to prepare for this future. However, few studies evaluate hurricane resilience strategies, or challenges faced by land managers surrounding hurricane events. Boundary organizations are critical to hurricane preparedness and recovery, advising land managers before hurricanes, and often supporting recovery efforts. Here, we rely on public advisors’ experiences to understand how land managers pursue hurricane resilience. Using focus groups and an online survey of three agencies in the Southeast U.S. and U.S. Caribbean (n = 607), we identify challenges faced by land managers before and after hurricanes, and the strategies they implement to minimize damage. We learn that land managers are faced with many diverse and unique challenges related to hurricanes, but that long-term planning for hurricane events is uncommon compared to shorter-term preparedness and recovery activities. Efforts towards hurricane resilience should incorporate local needs, align with other land management goals, and increase overall resilience to climate change and related stressors. The results of this research can guide state/territorial and national-level prioritizations regarding hurricane resilience, as well as identify research needs on hurricane resilience strategies.

Public involvement in the dissemination of the North West Coast Household Health Survey: Experiences and lessons of co-producing research together.

BackgroundEngaging with the public is a key element of health research; however, little work has examined experiences of public involvement in research dissemination. The aim of this paper was to assess the extent of public involvement, experiences of public advisers and resulting changes in the dissemination of the North West Coast Household Health Survey (HHS).MethodsThree writing groups allowed public advisers to contribute to the dissemination of the HHS. A public workshop was set up to aid the co‐production of the research evidence and discuss the experiences of public advisers involved with the survey in March 2018. A focus group with public advisers was conducted in August 2018 to understand their experiences of involvement. Data were analysed using thematic analysis and coded by two researchers. Writing groups are still on‐going.ResultsFourteen public advisers contributed via three face‐to‐face writing groups, by actively interpreting findings and helping in the write‐up of research articles and by presenting talks at the public workshop. At the workshop, seven public advisors contributed to setting priorities for data analysis from the HHS. Five public advisers took part in the focus group, which highlighted that whilst public advisers were generally satisfied with their involvement, they would like to be involved in more activities.ConclusionsMembers of the public shaped the dissemination of evidence and provided guidance for future steps. Public advisers were mostly positive about their involvement in the dissemination of the HHS, but highlighted the need for more transparency and support from researchers.