Patient and public involvement statements in British journal of occupational therapy: An important step

The British Journal of Occupational Therapy (BJOT) has updated its author guidance to include Patient and Public Involvement (PPI) statements, where authors declare what involvement has happened as part of the research or article (BJOT, 2021).

This is an important step for the BJOT to take, using its authority as a journal to further the discipline of involvement in research. The wider health research community increasingly recognises involvement as an integral part of research. This has been long championed by the National Institute for Health Research (NIHR) in particular and is reflected in the UK Standards for Public Involvement (UK Public Involvement Standards Development Partnership, 2020).

Publishing editorials that highlight the potential and impact of involvement has been welcomed over recent years, but as a peer-reviewed journal, the BJOT is an integral part of the research process. Therefore, the emphasis the Royal College of Occupational Therapy places on involvement in research applies as much to the BJOT as to individual clinicians and researchers. The BJOT “has a role in setting the tone” (Atkin et al., 2020: p. 416), so should be holding up a mirror to its own practices and policies as well as to the wider occupational therapy profession. This new editorial policy recognises that meaningful involvement is no longer a ‘nice to have’, but is seen as an essential part of the whole research process.

The breadth of OT settings and the perspectives of people who draw on services across health, social care, education and other settings makes the term ‘patients’ contested. The term ‘PPI’ is also often debated. While recognising these tensions and the lack of a universally accepted term, we have chosen to focus on the core principles of this important agenda.

Since we all started working in the field of involvement, the focus has shifted from convincing people why they need to involve users to the how. Recognising that involvement has been embedded into many research processes, part of the “how” is a more nuanced debate about the components that work well, where improvements still need to be made and the wider inclusivity agenda.

These PPI statements are one step towards a more comprehensive approach to involving users in publication. There is an excellent precedent set by the British Medical Journal, and a handful of other journals are starting to follow suit, such as the Journal of Orthopaedic and. Sports Physical Therapy.

From the perspective of people who both ‘draw on’ occupational therapy services, in health and social care, and get involved in research, PPI statements allow opportunities for their contributions to be recognised and acknowledged. People often have much more to offer than just sharing their experiences of illness and services, when involved in an equal partnership in shaping research. There is a strong parallel with good partnership working in clinical practice, when OTs facilitate shared decision making and collaborative care planning, for example, rather than just using an ‘off the shelf’ solution.

The requirement to be transparent about involvement also allows service users to challenge researchers’ accounts - for example questioning when researchers say something was ‘co-produced’, when the user may have found the experience more tokenistic. Too often, professionals or researchers say that something has been ‘co-produced’ without being challenged on what activities and importantly, principles or values underpinned that. This “co-biquity” (Williams et al., 2020) is important to challenge because otherwise we risk labelling poor or lower levels of involvement as co-production, putting people off trying to co-produce again. True co-production values the user as an equal, with valuable skills and knowledge.

The importance of involvement has been well embedded within professional documents from the Royal College of Occupational Therapists, most notably, the Career Development Framework (RCOT, 2017) and RCOT (2019). If given such prominence within these documents, it seems only appropriate that this work is then at least acknowledged when the studies come to be published via a PPI statement.

There are some unique qualities to occupational therapy that make this particularly relevant to the BJOT. The recent RCOT Research Priorities, developed in partnership with the James Lind Alliance and involving users, found person-centred practice as the second most pressing topic for occupational therapy research (Watson, 2021). Within the scope of person-centred practice, we need to be aware of pseudo-person-centredness, and the risk of ‘marking our own homework’, so PPI statements provide one opportunity for such a reflection.

Involvement needs to be recognised as a discipline within research, as essential to good research as sound methodology, ethical approval and financial transparency. We declare and detail these other practices, which enables us to critique them, reflect on their contribution to the paper and to build an evidence base for what works. For example, OT students at university should be learning the skills to critique the way service user involvement has been conducted, and actively discuss this whenever research is being considered. This means it has to be reported. At the moment, it is really difficult to ask the relevant questions since so few papers provide any insight into what involvement took place.

We welcome this first step that BJOT have taken with this new policy regarding PPI statements. These statements will generate data that can be analysed to gain better insights into the extent of involvement, therefore informing and driving further progression and development of the discipline of involvement in all aspects of OT and research. In recognising the work already happening, we can better understand and appreciate the impact of the valuable contributions made by people who draw on our services. This can contribute to the wider reflection that Harries et al. (2020) called for, across and beyond our profession, to continually improve how we ‘do’ the discipline of involvement.