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class="vector-toc-list"> <li id="toc-Terminology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Terminology"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Terminology</span> </div> </a> <ul id="toc-Terminology-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Benefits_and_impact" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Benefits_and_impact"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Benefits and impact</span> </div> </a> <ul id="toc-Benefits_and_impact-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Types_of_involvement" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Types_of_involvement"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Types of involvement</span> </div> </a> <ul id="toc-Types_of_involvement-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Barriers_and_issues" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Barriers_and_issues"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Barriers and issues</span> </div> </a> <ul id="toc-Barriers_and_issues-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Reporting" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Reporting"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Reporting</span> </div> </a> <ul id="toc-Reporting-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Around_the_world" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Around_the_world"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Around the world</span> </div> </a> <button aria-controls="toc-Around_the_world-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Around the world subsection</span> </button> <ul id="toc-Around_the_world-sublist" class="vector-toc-list"> <li id="toc-International_initiatives" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#International_initiatives"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>International initiatives</span> </div> </a> <ul id="toc-International_initiatives-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-European_Union" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#European_Union"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>European Union</span> </div> </a> <ul id="toc-European_Union-sublist" 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sector</div> <p class="mw-empty-elt"> </p> <figure typeof="mw:File/Thumb"><a href="/wiki/File:NIHR_public_involvement_infographic.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0f/NIHR_public_involvement_infographic.png/325px-NIHR_public_involvement_infographic.png" decoding="async" width="325" height="183" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0f/NIHR_public_involvement_infographic.png/488px-NIHR_public_involvement_infographic.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0f/NIHR_public_involvement_infographic.png/650px-NIHR_public_involvement_infographic.png 2x" data-file-width="1600" data-file-height="900" /></a><figcaption>Involving patients in research contributes to new knowledge.</figcaption></figure> <p><b>Public involvement</b> (or <b>public and patient involvement</b>, <b>PPI</b>) in <a href="/wiki/Medical_research" title="Medical research">medical research</a> refers to the practice where people with health conditions (patients), <a href="/wiki/Caregiver" title="Caregiver">carers</a> and members of the public work together with researchers and influence what is researched and how. Involvement is not the same as <a href="/wiki/Research_participant" title="Research participant">participation</a> which means taking part in research, for example taking a drug in a <a href="/wiki/Clinical_trial" title="Clinical trial">clinical trial</a>.<sup id="cite_ref-:1_1-0" class="reference"><a href="#cite_note-:1-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Definition">Definition</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=1" title="Edit section: Definition"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Public involvement in medical research can be defined as research being carried out "<i>with</i>" or "<i>by</i>" members of the public rather than "<i>to</i>", "<i>about</i>" or "<i>for</i>" them. Through PPI patients, carers and people with lived experience work alongside researchers to influence and contribute to how research is designed and conducted. Members of the public involved in research are frequently referred to as public members or public contributors.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Terminology">Terminology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=2" title="Edit section: Terminology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Researchers and others use different terms to describe how they interact with the public, and this can vary across organisations and countries. The terms <i>involvement</i>, <i>engagement</i> and <i>participation</i> are sometimes used interchangeably.<sup id="cite_ref-:6_5-0" class="reference"><a href="#cite_note-:6-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/National_Institute_for_Health_and_Care_Research" title="National Institute for Health and Care Research">National Institute for Health and Care Research</a> (NIHR) uses the term public partnerships to encompass the components of involvement, engagement and participation. It can be summarised as "a term to collectively describe ways in which patients, service users, carers and members of the public work with researchers, and health and care professionals, in the creation and use of health and care research".<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The NIHR's terminology differentiates <i>involvement</i> from <i>participation</i> where people take part in a research study and <i>engagement</i> which is sharing information and knowledge about research with the public.<sup id="cite_ref-:6_5-1" class="reference"><a href="#cite_note-:6-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Benefits_and_impact">Benefits and impact</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=3" title="Edit section: Benefits and impact"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are a variety reasons and benefits why researchers involve the public in research.<sup id="cite_ref-:02_8-0" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Besides the added value it is also often a requirement for receiving funding for research.<sup id="cite_ref-:1_1-1" class="reference"><a href="#cite_note-:1-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Involving members of the public can improve the quality of research and make it more relevant and accessible. People with current or past experience of illness can provide a different perspective than professionals and compliment their knowledge. Through their personal knowledge they can identify research topics that are relevant and important to those living with an illness or using a service. They can also help to make the research more grounded in the needs of the specific communities they are part of. Public contributors can also ensure that the research is presented in <a href="/wiki/Plain_language" title="Plain language">plain language</a> that is clear to the wider society and the specific groups it is most relevant for.<sup id="cite_ref-:02_8-1" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_9-0" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Involving the public in research is considered a way of serving broader democratic principles because people affected by research have the right to have a say in it.<sup id="cite_ref-:02_8-2" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> This also makes research more transparent and accountable for society.<sup id="cite_ref-:02_8-3" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Public involvement can also make research more <a href="/wiki/Research_ethics" title="Research ethics">ethical</a>. For example public members can help participants of a clinical trial understand what the research is about so they can make informed consent have an overall better experience.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>Public members and patients have a range of reasons why they decide to get involved in research.<sup id="cite_ref-:02_8-4" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> These can include altruistic motivations, such as wanting to make a difference by contributing to a better healthcare or helping others with a shared condition get better care and treatments.<sup id="cite_ref-:02_8-5" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_9-1" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Reasons for involvement can also stem from interest in a health topic or in research in general.<sup id="cite_ref-:0_9-2" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> It can also be a form of volunteering, working to ensure the representation of a community or a way to gain new skills.<sup id="cite_ref-:02_8-6" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Despite PPI becoming a more widely accepted part of the research process, the term PPI is sometimes perceived to be vague as a concept<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> and there are questions around what counts as good public involvement.<sup id="cite_ref-:2_14-0" class="reference"><a href="#cite_note-:2-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> One of the initiatives aiming to improve the quality and consistency of public involvement in research is the <i>UK Standards for Public Involvement</i>. These were developed through a collaboration of organisations, researchers and practitioners, research funders and public partners across the United Kingdom. The standards provide a description of what good public involvement looks like and can be used as a tool to help people and organisations improve their PPI.<sup id="cite_ref-:2_14-1" class="reference"><a href="#cite_note-:2-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> The six UK Standards for Public Involvement are summarised as: </p> <ul><li>inclusive opportunities,</li> <li>working together,</li> <li>support and learning,</li> <li>governance,</li> <li>communications,</li> <li>impact.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li></ul> <p>Further tools for supporting meaningful patient involvement include the Patient Engagement Quality Guidance developed by the global coalition Patient Focused Medicines Development. The document lists seven quality criteria including shared purpose, respect and accessibility, transparency, and sustainability.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Types_of_involvement">Types of involvement</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=4" title="Edit section: Types of involvement"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are different approaches to involving the public in research which correspond to different levels of influence that public members have in a research project:<sup id="cite_ref-:02_8-7" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <ul><li><i>Consultation</i>. Asking members of the public for their views about a specific part of research and using these to make decisions.</li> <li><i>Collaboration</i>. An ongoing partnership between researchers and the involved members of the public. Decisions about the research are shared.</li> <li><i>Co-production</i>. Working together from the start to the end of the research project. <a href="/wiki/Co-production_(approach)" title="Co-production (approach)">Co-production</a> requires efforts to make sure that participants share power and responsibility.</li> <li><i>User controlled research</i>. Research that is actively directed and managed by service users and their organisations. They make decisions about the issues and questions looked at by the research.</li></ul> <p>Initiatives such as co-production or user controlled research in which decision-making and agenda setting power is shared with or held by patients are considered examples of <a href="/wiki/Lived_experience_leadership" title="Lived experience leadership">lived experience leadership</a>.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Academic journals continue to develop ways to ensure patient involvement is reported transparently and meaningfully.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Researchers have called for <a href="/wiki/Lived_experience_leadership" title="Lived experience leadership">patients to lead</a> this reporting, to ensure their expertise is not co-opted.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>There are wide range of ways how the public can be involved in different stages of research. These include:<sup id="cite_ref-:02_8-8" class="reference"><a href="#cite_note-:02-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <ul><li><i>Identifying and prioritising research</i>. People with lived experience help to identify the right topics to ensure that the research is looking at what matters to them.</li> <li><i>Commissioning research</i>. Involving members of the public in deciding which research proposals should get funding. Public members can also continue monitoring the research projects that get funded.</li> <li><i>Designing research</i>. Public members help designing the research to make sure it is feasible, ethical and relevant. This happens usually before applying for funding.</li> <li><i>Managing research</i>. Public involvement in the steering group or managing committee that oversees the research.</li> <li><i>Undertaking research</i>. Members of the public help carrying out the research. This can include, for example, gathering evidence, reviewing literature, conducting interviews and focus groups, and analysing the results.</li> <li><i>Disseminating (sharing) research</i>. Public members help sharing the findings of research. They can be consulted on the ways of <a href="/wiki/Science_communication" title="Science communication">dissemination</a>, help summarising the research in plain language, work on accessibility issues.</li> <li><i>Implementing research</i>. Public members influencing how the result is taken into practice and making sure it leads to action.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li></ul> <p>Public involvement can be short-term and task-based or long-term across a research project or an institutional programme.<sup id="cite_ref-:0_9-3" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Barriers_and_issues">Barriers and issues</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=5" title="Edit section: Barriers and issues"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are a wide range of challenges and issues that can block the involvement of patients or hinder the process from being effective.<sup id="cite_ref-:0_9-4" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Systematic issues can include a lack of adequate funding for implementing PPI.<sup id="cite_ref-:0_9-5" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:3_23-0" class="reference"><a href="#cite_note-:3-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p>From the perspective of public members, many individual factors can influence if they can be involved in a meaningful way. Potential difficulties for patients might arise from health status, accessibility of locations, self-confidence, language proficiency and available free time.<sup id="cite_ref-:3_23-1" class="reference"><a href="#cite_note-:3-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Issues might include public members not feeling that their contributions matter or that they gain anything by being involved. A vague definition of the role and uncertainty about the goal can also be a barrier for public members.<sup id="cite_ref-:3_23-2" class="reference"><a href="#cite_note-:3-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p>Health professionals' lack of knowledge and understanding of public involvement theory and techniques can also be a barrier to public involvement.<sup id="cite_ref-:3_23-3" class="reference"><a href="#cite_note-:3-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Involving patients simply as <a href="/wiki/Tokenism" title="Tokenism">tokens</a> or being dismissive about their contributions can lead to ineffective PPI and a negative impact on those involved.<sup id="cite_ref-:0_9-6" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Power imbalances between people, hierarchical or elitist attitudes by medical professionals can also impair the experience and quality of patient involvement.<sup id="cite_ref-:3_23-4" class="reference"><a href="#cite_note-:3-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Reporting">Reporting</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=6" title="Edit section: Reporting"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Despite evidence that public involvement can have a positive influence on health research, evaluation of its impact has been reported to be anecdotal and weak.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> This has led to the creation of multiple measuring tools to assess the impact of public involvement in research.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Examples include: </p> <ul><li>GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup></li> <li>Public Involvement in Research Impact Toolkit (PIRIT)<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup></li> <li>Public Involvement Impact Assessment Framework (PiiAF)<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup></li> <li>The 'cube' framework<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Around_the_world">Around the world</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=7" title="Edit section: Around the world"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="International_initiatives">International initiatives</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=8" title="Edit section: International initiatives"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The International Patient and Public Involvement (PPI) Network was established in 2017. It brings together organisations and individuals from across the globe with the aim to share expertise and evidence-based good practice.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="European_Union">European Union</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=9" title="Edit section: European Union"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 2012 the <a href="/wiki/Innovative_Medicines_Initiative" title="Innovative Medicines Initiative">Innovative Medicines Initiative</a> launched the European Patients’ Academy on Therapeutic Innovation (EUPATI) which provides education for patients to enable them to meaningfully contribute to medical research and medicine development. Besides its international activity, EUPATI also has national platforms in more than 20 countries.<sup id="cite_ref-:5_31-0" class="reference"><a href="#cite_note-:5-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> EUPATI's publications include guidance documents on patient involvement in <a href="/wiki/Regulation_of_therapeutic_goods" title="Regulation of therapeutic goods">medical product regulation</a>, ethical reviews of trials, research and development, and <a href="/wiki/Health_technology_assessment" title="Health technology assessment">health technology assessment</a>.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="United_Kingdom">United Kingdom</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=10" title="Edit section: United Kingdom"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the UK, patient and public involvement is acknowledged in key pieces of legislation on healthcare such as the Health and Social Care Act and the NHS Constitution.<sup id="cite_ref-:3_23-5" class="reference"><a href="#cite_note-:3-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/National_Institute_for_Health_and_Care_Research" title="National Institute for Health and Care Research">National Institute for Health and Care Research</a> (NIHR), a research funder in England, is considered a pioneer in the development and implementation of PPI.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> The NIHR requires public involvement to be included in its funding programmes.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> They produce various resources such as the <i>Learning for Involvement</i> website which hosts training materials and best practices to support researchers with public involvement.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> The NIHR also funds the <a href="/wiki/James_Lind_Alliance" title="James Lind Alliance">James Lind Alliance</a>, an organisation that brings together patients, carers and clinicians to identify unanswered questions or uncertainties for future research to look at.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>The Shared Learning Group on Involvement aims to encourage shared learning about the involvement of people with lived experience (also called service users, patients, carers and other terms) between charities working in the UK.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Canada">Canada</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=11" title="Edit section: Canada"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Patient_engagement_in_Canada" title="Patient engagement in Canada">Patient engagement in Canada</a></div> <p>In Canada the term patient engagement is used by the <a href="/wiki/Canadian_Institutes_of_Health_Research" title="Canadian Institutes of Health Research">Canadian Institutes of Health Research</a> (CIHR). Their Strategy for Patient-Oriented Research (SPOR) sets out the framework for patient engagement, stating that patients need to be involved in all aspects of research. SPOR is also the name of the scheme that provides funding for patient-oriented research.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Canadian_Cancer_Society" title="Canadian Cancer Society">Canadian Cancer Society</a>, a non-profit cancer research funder also developed a patient engagement strategy and involves patient partners in research funding decisions.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="United_States">United States</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=12" title="Edit section: United States"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the US, the <a href="/wiki/Patient-Centered_Outcomes_Research_Institute" title="Patient-Centered Outcomes Research Institute">Patient-Centered Outcomes Research Institute</a> (PCORI) engages patients and funds research based on matters relevant to them.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> The Clinical Trials Transformation Initiative (CTTI), a partnership between the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a>, the <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a>, and others, also runs a project exploring the best practices for patient engagement and incorporating patient perspectives in clinical trials.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Global_health">Global health</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=13" title="Edit section: Global health"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <a href="/wiki/Global_health" title="Global health">global health</a> research the equivalent of PPI is called <i>community engagement and involvement</i> (<i>CEI</i>) or <i>community and public engagement</i> (<i>CPE</i>). Similarly to PPI, community engagement is the practice of actively involving local communities in the countries where the research takes place. Global health research often takes place in <a href="/wiki/Developing_country" title="Developing country">low and middle income countries</a> (LMICs) and concerns marginalised communities. Involving these groups in research can reduce the potential for exploitation, address ethical concerns and bridge cultural differences.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diversity_and_inclusion">Diversity and inclusion</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=14" title="Edit section: Diversity and inclusion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In order for research to be relevant for all, the PPI process needs to include members of the public from diverse and inclusive groups.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p>A 2021 survey highlights that the majority of public contributors to NIHR research were predominantly female (57%), 61 years of age and over, white and heterosexual.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Health_Research_Authority" title="Health Research Authority">Health Research Authority</a> found that people from ethnic and lower socioeconomic groups felt less confident about being treated in a dignified and respectful way in research in comparison to white and higher socioeconomic individuals.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Classification_of_ethnicity_in_the_United_Kingdom" title="Classification of ethnicity in the United Kingdom">Black and minority ethnic</a> (BME) involvement in research has widespread support, however it tends to be limited to certain phases of the research cycle and particular ethnicities.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Frameworks_for_diversity">Frameworks for diversity</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=15" title="Edit section: Frameworks for diversity"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Race Equality Framework (REF) was produced as a self assessment tool aiming to help organisations improve racial equity in health and care research. It was co-produced by the Race Equality Public Action Group (REPAG).<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>Similar frameworks exist for research participants, for example, the INCLUDE ethnicity framework<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> and the National Health Service (NHS) guidance for increasing diversity in research participation.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=16" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The development of patient and public involvement in research was influenced by grassroots social movements, national politics and wider societal contexts.<sup id="cite_ref-:4_54-0" class="reference"><a href="#cite_note-:4-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p><p>Emancipatory <a href="/wiki/Disability_studies" title="Disability studies">disability research</a> in the UK in the 1970s can be seen as a forerunner of PPI. This research model was initiated by people with disabilities who were dissatisfied with their treatment and discrimination in society. They were also suspicious of conventional research for serving service providers instead of patients. The model proposed by the movement sought to equilise relationship between researchers and disabled people and make them empowered participants instead of research subjects.<sup id="cite_ref-:4_54-1" class="reference"><a href="#cite_note-:4-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p><p>Another early drive for PPI came during the <a href="/wiki/HIV/AIDS" title="HIV/AIDS">HIV pandemic</a> in the 1980s. <a href="/wiki/HIV/AIDS_activism" title="HIV/AIDS activism">HIV activists</a> lobbied for faster regulatory processes in public health that would serve the interests of patients. As a result to HIV activists work, the US <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA) started a working with patients in 1988.<sup id="cite_ref-:5_31-1" class="reference"><a href="#cite_note-:5-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> In the 1990s HIV activism also influenced the <a href="/wiki/European_Medicines_Agency" title="European Medicines Agency">European Medicines Agency</a> (EMA) to start involving patients in its decision-making.<sup id="cite_ref-:5_31-2" class="reference"><a href="#cite_note-:5-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p>In 1996 the UK's National Institute for Health Research (NIHR) established the advisory body <a href="/wiki/Involve_(think_tank)" title="Involve (think tank)">INVOLVE</a> to support public involvement in the NHS and health and care research.<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> INVOLVE produced a large library of guides, training materials and other resources relating to PPI.<sup id="cite_ref-:4_54-2" class="reference"><a href="#cite_note-:4-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> NIHR set up the Centre for Engagement and Dissemination in 2020 as a successor of INVOLVE.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> The UK government also set out their direction for public involvement in research in the 2006 health research strategy, <i>Best Research for Best Health</i>. It stated: <span class="nowrap" style="padding-left:0.1em;">'</span><i>Patients and the public must be involved in all stages of the research process: priority setting; defining research outcomes; selecting research methodology; patient recruitment; interpretation of findings and dissemination of results.</i><span class="nowrap" style="padding-left:0.1em;">'</span><sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p><p>In the early 2000s, <a href="/wiki/Lived_experience_leadership" title="Lived experience leadership">patient leadership</a> was proposed as a way to redress the variability in involvement initiatives.<sup id="cite_ref-Gordon_59-0" class="reference"><a href="#cite_note-Gordon-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> Despite decades of advocacy, power differentials between patients and others working in the health system continue to exclude patients from setting the agenda in health systems, services, education and research.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> This has led to calls to look beyond mere involvement or engagement and to <a href="/wiki/Lived_experience_leadership" title="Lived experience leadership">lived experience leadership</a> in which decision-making power sits with patients.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p><p>In 2022, a large number of funders, regulators and research organisations in the United Kingdom signed up to a shared commitment to improve public involvement in research across the sector and to enable it to be consistently excellent. The signatories of the Shared Commitment to Public Involvement agreed to: </p> <ul><li>listen to and learn from the people and communities we involve and apply and share that learning;</li> <li>build and share the evidence of how to involve the public and the impact this has;</li> <li>support improvements in equality, diversity, and inclusion in public involvement;</li> <li>promote the UK Standards for Public Involvement.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=17" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Clinical_research" title="Clinical research">Clinical research</a></li> <li><a href="/wiki/Lived_experience_leadership" title="Lived experience leadership">Lived experience leadership</a></li> <li><a href="/wiki/Participatory_action_research" title="Participatory action research">Participatory action research</a></li> <li><a href="/wiki/Community-based_participatory_research" title="Community-based participatory research">Community-based participatory research</a></li> <li><a href="/wiki/Citizen_science" title="Citizen science">Citizen science</a></li> <li><a href="/wiki/Co-production_(approach)" title="Co-production (approach)">Co-production</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Patient_and_public_involvement&action=edit&section=18" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-:1-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-:1_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:1_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output 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research">Clinical research</a> and <a href="/wiki/Design_of_experiments" title="Design of experiments">experimental design</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Overview</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trial</a> <ul><li><a href="/wiki/Protocol_(science)" title="Protocol (science)">Trial protocols</a></li> <li><a href="/wiki/Adaptive_clinical_trial" class="mw-redirect" title="Adaptive clinical trial">Adaptive clinical trial</a></li></ul></li> <li><a href="/wiki/Academic_clinical_trials" class="mw-redirect" title="Academic clinical trials">Academic clinical trials</a></li> <li><a href="/wiki/Clinical_study_design" title="Clinical study design">Clinical study design</a></li> <li><a href="/wiki/Evidence-based_medicine" title="Evidence-based medicine">Evidence-based medicine</a></li> <li><a href="/wiki/Real_world_evidence" title="Real world evidence">Real world evidence</a></li> <li><a class="mw-selflink selflink">Patient and public involvement</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Scientific_control" title="Scientific control">Controlled study</a><br />(<a href="/wiki/Hierarchy_of_evidence#USA" title="Hierarchy of evidence">EBM I to II-1</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">Randomized controlled trial</a> <ul><li><a href="/wiki/Experiment" title="Experiment">Scientific experiment</a></li> <li><a href="/wiki/Blind_experiment" class="mw-redirect" title="Blind experiment">Blind experiment</a></li> <li><a href="/wiki/Open-label_trial" title="Open-label trial">Open-label trial</a></li></ul></li> <li><a href="/wiki/Adaptive_clinical_trial" class="mw-redirect" title="Adaptive clinical trial">Adaptive clinical trial</a> <ul><li><a href="/wiki/Platform_trial" title="Platform trial">Platform trial</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Observational_study" title="Observational study">Observational study</a><br />(<a href="/wiki/Hierarchy_of_evidence#USA" title="Hierarchy of evidence">EBM II-2 to II-3</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cross-sectional_study" title="Cross-sectional study">Cross-sectional study</a> vs. <a href="/wiki/Longitudinal_study" title="Longitudinal study">Longitudinal study</a>, <a href="/wiki/Ecological_study" title="Ecological study">Ecological study</a></li> <li><a href="/wiki/Cohort_study" title="Cohort study">Cohort study</a> <ul><li><a href="/wiki/Retrospective_cohort_study" title="Retrospective cohort study">Retrospective</a></li> <li><a href="/wiki/Prospective_cohort_study" title="Prospective cohort study">Prospective</a></li></ul></li> <li><a href="/wiki/Case%E2%80%93control_study" title="Case–control study">Case–control study</a> (<a href="/wiki/Nested_case%E2%80%93control_study" title="Nested case–control study">Nested case–control study</a>)</li> <li><a href="/wiki/Case_series" title="Case series">Case series</a></li> <li><a href="/wiki/Case_study" title="Case study">Case study</a></li> <li><a href="/wiki/Case_report" title="Case report">Case report</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Outcome_measure" title="Outcome measure">Measures</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Measures_of_occurrence" class="mw-redirect" title="Epidemiological methods">Occurrence</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">Incidence</a>, <a href="/wiki/Cumulative_incidence" class="mw-redirect" title="Cumulative incidence">Cumulative incidence</a>, <a href="/wiki/Prevalence" title="Prevalence">Prevalence</a>, <a href="/wiki/Point_prevalence" class="mw-redirect" title="Point prevalence">Point prevalence</a>, <a href="/wiki/Period_prevalence" class="mw-redirect" title="Period prevalence">Period prevalence</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Measures_of_association" class="mw-redirect" title="Epidemiological methods">Association</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Risk_difference" title="Risk difference">Risk difference</a>, <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">Number needed to treat</a>, <a href="/wiki/Number_needed_to_harm" title="Number needed to harm">Number needed to harm</a>, <a href="/wiki/Risk_ratio" class="mw-redirect" title="Risk ratio">Risk ratio</a>, <a href="/wiki/Relative_risk_reduction" title="Relative risk reduction">Relative risk reduction</a>, <a href="/wiki/Odds_ratio" title="Odds ratio">Odds ratio</a>, <a href="/wiki/Hazard_ratio" title="Hazard ratio">Hazard ratio</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Population_impact_measure" title="Population impact measure">Population impact</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Attributable_fraction_among_the_exposed" title="Attributable fraction among the exposed">Attributable fraction among the exposed</a>, <a href="/wiki/Attributable_fraction_for_the_population" title="Attributable fraction for the population">Attributable fraction for the population</a>, <a href="/wiki/Preventable_fraction_among_the_unexposed" title="Preventable fraction among the unexposed">Preventable fraction among the unexposed</a>, <a href="/wiki/Preventable_fraction_for_the_population" title="Preventable fraction for the population">Preventable fraction for the population</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Other_measures" class="mw-redirect" title="Epidemiological methods">Other</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Clinical_endpoint" title="Clinical endpoint">Clinical endpoint</a>, <a href="/wiki/Virulence" title="Virulence">Virulence</a>, <a href="/wiki/Infectivity" title="Infectivity">Infectivity</a>, <a href="/wiki/Mortality_rate" title="Mortality rate">Mortality rate</a>, <a href="/wiki/Morbidity" class="mw-redirect" title="Morbidity">Morbidity</a>, <a href="/wiki/Case_fatality_rate" title="Case fatality rate">Case fatality rate</a>, <a href="/wiki/Specificity_and_sensitivity" class="mw-redirect" title="Specificity and sensitivity">Specificity and sensitivity</a>, <a href="/wiki/Likelihood_ratios_in_diagnostic_testing" title="Likelihood ratios in diagnostic testing">Likelihood-ratios</a>, <a href="/wiki/Pre-_and_post-test_probability" title="Pre- and post-test probability">Pre- and post-test probability</a></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Trial/test types</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/In_vitro" title="In vitro">In vitro</a></li> <li><a href="/wiki/In_vivo" title="In vivo">In vivo</a></li> <li><a href="/wiki/Animal_testing" title="Animal testing">Animal testing</a></li> <li><a href="/wiki/Animal_testing_on_non-human_primates" title="Animal testing on non-human primates">Animal testing on non-human primates</a></li> <li><a href="/wiki/First-in-man_study" class="mw-redirect" title="First-in-man study">First-in-man study</a></li> <li><a href="/wiki/Multicenter_trial" title="Multicenter trial">Multicenter trial</a></li> <li><a href="/wiki/Seeding_trial" title="Seeding trial">Seeding trial</a></li> <li><a href="/wiki/Vaccine_trial" title="Vaccine trial">Vaccine trial</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Analysis_of_clinical_trials" title="Analysis of clinical trials">Analysis of clinical trials</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Risk%E2%80%93benefit_ratio" title="Risk–benefit ratio">Risk–benefit ratio</a></li> <li><a href="/wiki/Systematic_review" title="Systematic review">Systematic review</a></li> <li><a href="/wiki/Reproducibility" title="Reproducibility">Replication</a></li> <li><a href="/wiki/Meta-analysis" title="Meta-analysis">Meta-analysis</a></li> <li><a href="/wiki/Intention-to-treat_analysis" title="Intention-to-treat analysis">Intention-to-treat analysis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Interpretation of results</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Selection_bias" title="Selection bias">Selection bias</a></li> <li><a href="/wiki/Survivorship_bias" title="Survivorship bias">Survivorship bias</a></li> <li><a href="/wiki/Correlation_does_not_imply_causation" title="Correlation does not imply causation">Correlation does not imply causation</a></li> <li><a href="/wiki/Null_result" title="Null result">Null result</a></li> <li><a href="/wiki/Sex_as_a_biological_variable" title="Sex as a biological variable">Sex as a biological variable</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><b><a href="/wiki/Category:Clinical_research" title="Category:Clinical research">Category</a></b></li> <li><b><a href="/wiki/Glossary_of_clinical_research" title="Glossary of clinical research">Glossary</a></b></li> <li><b><a href="/wiki/List_of_clinical_research_topics" class="mw-redirect" title="List of clinical research topics">List of topics</a></b></li></ul> </div></td></tr></tbody></table></div><div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Science_and_the_public" 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