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Background
Current UK health policy recognises service user, or patient and public involvement (PPI) as an important dimension in health research. PPI is defined as the carrying out of research "'with' or 'by' members of the public rather than 'to', 'about' or 'for' them" (INVOLVE). PPI can be practiced during several phases of the research process, from setting research priorities, to developing research materials and advising over the conduct of research, to analysing data and disseminating results. In this context, there is considerable investment in understanding and evaluating the impact of PPI on the research process and on research findings. For example, emerging evidence suggests that involving patients and public in the conduct of research may contribute to higher rates of recruitment and retention (Lindenmeyer et al. , 2007; Iliffe et al. , 2013; Ennis and Wykes, 2013) and to rich, alternative interpretations of qualitative data (Gillard et al. , 2012) informed by lived experience standpoints. Additionally, there are indications that PPI may strengthen the acceptability of new interventions by local communities (Staley, 2009). However, a more systematic evaluation of PPI impact has proven more challenging, and in particular an answer to the question "how does PPI impact on the implementation of research into practice?" remains elusive.
This scarcity of knowledge is - in part - attributed to poor reporting: a comprehensive presentation of PPI strategies is rarely embedded in the dissemination of research findings, indeed space is rarely provided in peer reviewed publications to do so (Jones et al. , 2015; Staniszewska et al. , 2011). To remedy this, a number of toolkits are currently being proposed to facilitate both the systematic reporting of PPI activities in health and social care research (Staniszewska et al. , 2011) as well as aid in the coherent articulation of the values guiding involvement activities in specific projects (Snape et al. , 2014).
Furthermore, there is a fundamental methodological problem here; namely, it is not possible to use experimental methods to measure the potential impact of service user involvement on the acceptability and sustainability of a health intervention. In the absence of any control condition to indicate otherwise, where we observe the positive impacts of a research programme we cannot, with confidence, attribute (even in part) those...