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.

| WORSLEY ET AL users and members of the public in health research is now a central funding criterion for the National Institute for Health Research (NIHR). A growing body of evidence demonstrates benefits of PPI to research outcomes, [2][3][4] ensuring that research ideas are genuinely useful for patients and carers. 5 Patients and members of the public also accrue benefits including acquisition of new skills, personal development, support and friendship, and feelings of satisfaction and empowerment.
Beresford 8 identifies consumerist and democratic models of involvement in research. Consumerist efforts are 'framed mainly in democratic approaches are 'primarily concerned with people having more say in agencies, organizations, and institutions which impact upon them and being able to exert more control over their own whereas democratic approaches are rooted in people's lived experiences and draw upon philosophies of human rights, participation, inclusion and autonomy.
A democratic impulse framed terms such as 'user-led' or 'usercontrolled' research; however, the term 'coproduction' is increasingly used to describe a democratization formed around alliances between public and professionals. 9,10 Coproduction and service user involvement are also increasingly encouraged in mental healthcare research. For example, an evaluation of a service responsible for psychiatric care in Amsterdam involved a team of researchers and experts by experience collaborating in all phases of the study including the design, strategic decision making, data generation and interpretation. Although this enriched the conclusions and ideas for improvement, collaborative reflection on the participatory processes revealed complex relational dynamics in the coproduction of knowledge in such research. 11 Coproduction is increasingly widely used in the design of applied health research, enabling people with lived experience to influence the aims, content, focus and methods. For example, Staniszewska and colleagues involved parents who had experience of having a pre-term baby in the development of a research grant bid. As parents' experiences and perspectives provided the focus for research meetings, user involvement impacted development of the research questions and methods. Good working relationships facilitated the process, whilst lack of financial support for public members, the time-consuming nature of the process and professionalized research language were identified as barriers. 12 According to Oliver and colleagues, however, coproduction is not free of cost or risk. Examples of practical costs associated with coproduction include managing group dynamics and administrative tasks such as arranging spaces.    Research professionals therefore helped public advisors feel comfortable.
A safe space was established as trust and mutual respect grew over time: Since I've been in with this research and the people, Indeed, some public advisors thought that the researchers were trying to steer the meetings in a certain direction: There were some who were just a bit nasty who thought the academics had their own agenda (PA1).
There was one lady that was really dominant and was better educated than myself but she thought all of the academics were taking over (PA2).
As some public members felt their views were marginalized, this created for some a sense of 'us and them': What was stressful was that some of the public ad-

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Implicit to this process was that there had to be a singular output, which was a grant proposal reflecting the research paradigm. This underpinning output, destination and constraint was problematic because, although the likelihood of rejection was talked about often in the group, public advisors were disheartened by the feedback from the NIHR: That was disappointing. There was a hell of a lot of effort. I actually wrote about a 100-page proposal on my ideas At what scale do you put in effort that's been put into it. All the thinking, again it was coproduced, but the academic side of it and all the help and the work that they put into it. I thought it was very disappointing (PA2).
Although there were layers of constraint on the discussion, including meeting the requirements of a formal grant proposal, time constraints were also felt, perhaps as a consequence of using a seedcorn grant from the LCCG to fund the process: It just limits the amount of time you've got to be able to do something like this. It becomes a pressured thing rather than a wanted thing and a necessary thing As true coproduction takes time, the process felt rushed towards the end. This was due, in part, to the way in which public advisors were  Separate funding streams may better serve public involvement in research to be founded on authentic coproduction instead of partial inclusion or tokenistic engagement.
The reported research has limitations. First, although eleven service users and members of the public from across the NWC of with pointed or heated contributions not to be discounted. 22 There remains, however, a need to bring together diverse and contentious perspectives under a process of careful deliberation that facilitates ease, confidence and concern for each other among all present.
Beginning the process with a reparative session to deal with perceived or real power differentials as well as with the 'hurts' experienced within mental health care and research may have minimized negative impacts and enabled the process to maximize benefits.
To conclude, establishing trust from the outset enables different perspectives and opinions to be expressed and challenged, which subsequently can thoroughly enrich the research process and its outputs.
| A public advisor was involved in the planning stages and designing the interview topic guide.