Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews

Josephine Ocloo*, Sara Garfield, Bryony Dean Franklin, Shoba Dawson

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

1 Citation (Scopus)
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The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970’s. 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, thirty-one mentioned equality and diversity (although with no theory mentioned in this area), and only nineteen 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.
Original languageEnglish
Article number8
Number of pages21
JournalHealth Research Policy and Systems
Issue number1
Publication statusPublished - 20 Jan 2021


  • systematic review of reviews
  • patient and public involvement
  • theory
  • barriers and enablers
  • health
  • social care and patient safety

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