Is it worth the time?

A recurring challenge or barrier raised by the professionals was the amount of time meaningful, non-tokenistic PPI took out of their working day. Professionals pointed to the additional practical difficulties they encountered in organising a meeting with representatives in comparison to a meeting with colleagues, including having to send paper

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copies of documents prior to the meeting to all representatives, additional emails reminding representatives to attend and liaising with different university departments to ensure representatives received payment. While often finding these tasks frustrating, the professionals did not find them difficult; rather, it was the time required to complete the tasks that made them onerous:

“It is a lot of organisation. It’s not as simple as just kind of saying oh lets hold a group, you have to think of you know, setting the agenda, and sending all the information out in plenty of time, erm… then people say they haven’t got it because the hospital post systems are so rubbish and then you have to send it all out again, and erm… just you know coordinating things like that and finding the time when everyone is free, erm… can be quite time consuming really. Erm.. and then of course all the problems that come after of not getting their money and you are having to chase people all the time and things you know, for one meeting it takes up a good few hours of my time really.” (Rachel, RC)

In conjunction with the additional time it took to organise the meetings, professionals also identified ways in which having meaningful PPI in meetings could result in them lasting longer. They suggested that representatives might need more clarification and explanation than professionals, be more likely to raise issues that had not been thought of and be less concise in their explanations, all of which could lead to lengthier discussions and in turn longer meetings. These issues, combined with the potential need for representatives to have more frequent rest breaks and to arrange the meetings at a time and place convenient to them rather than for the professionals, increased the amount of a professional’s time given to any one meeting:

“It is a fact that if there are lay people in a meeting the meetings take longer.. because whether they ask for explanations or not and sometimes they will do, repeatedly, you do have to erm... take longer explaining things... and so meetings take longer which obviously means that... it puts people off attending or people have to leave half way through and ... so that is a very practical negative consequence it makes things more difficult to organise...[…]… it means the meetings sometimes have to be in the middle of the day …. if you are involving patients, or carers you, you can't easily start a meeting at 8.30, you know meetings with patients and carers traditionally are most successful, or certainly in my field, is they are in the middle of the day like you know 11.30 till 2.45 or something like that. It is a lot more time consuming. But these are all obvious in a sense practicalities and costs you know.” (Fred, NL)

Fred (NL) also suggested that some of the more tokenistic types of PPI were the result of professionals trying to minimise the time commitment to any given meeting:

“So a Professor on a committee may well do everything they possibly can to avoid getting anyone that is going to be argumentative, or make meetings take longer or erm.. put awkward points or view or put things on the agenda that you know are not what the Professor who is chairing the meeting is interested in. Not for, not because

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they are evil, but because they are busy and they want to get business done and they have only got 2 hours for a meeting.”

As well as emphasising the additional time and complexity that PPI introduced to meetings, professionals also identified other practical components of ‘meaningful’ PPI that required their time. These included seeking training for themselves and the representatives, the process of recruiting representatives, support for representatives and allowing time for representatives to provide feedback:

“The problem is that it’s, you can’t expect people in the research development group to be able to get you feedback in 24 hours, 48 hours. Realistically they want a good couple of weeks, or a week to think about things properly, whereas a lot of the academics that we work with and researchers are much more used to, to working to deadlines, and so they probably don’t even start putting bits together until the week of a deadline and, and getting signatures and things all take time, so that has been quite difficult.” (Jess, NC15)

As alluded to by Fred (NL) above, it was a ‘fact’ accepted both by the professionals and representatives that professionals are very busy, with competing demands on their time: “researchers are very busy people..[…]… my heart goes out to most researchers in a sense about, because, they are so busy and so to have another thing to do, to be able to just get this research out” (Adel, NL). As such, they must prioritise how they spend their time. In addition, ‘doing’ PPI is not something that is traditionally allocated as part of a researcher’s academic role. It was evident that the professionals in my research sites believed that the benefits of PPI were worth the cost in time and as such were prepared to be engaged in the PPI process. This seems to mirror heavily Salmon et al’s (2007) research findings in relation to GPs (an accepted ‘busy’ group of professionals) and their decision making about the economy of their time. Salmon et al found that GPs attribute lack of time as their main reason for not engaging in research and that this was seen as morally acceptable. However, when the GPs could identify intrinsic clinical, personal or professional value in a research project, they would release some of their ‘own time’ or ‘work time’ in order to participate. In other words, professionals find time for activities that they personally value but do not find time for things that they do not value:

“I think they [professionals] have come round to that and thought actually, it’s not as bad as I thought you know, and so, it is erm, it seems to work…[..].. we have had to sort of like train them in a sense well look this is going to be beneficial for you, it isn’t just a tick box exercise, if you get the input and you are willing to take it on board, then surely your research is likely to succeed.” (Adel, NL)

15 _{NC= Network (and PPI) coordinator}

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The professionals in my sites clearly valued PPI enough to invest their time in the process. To determine the extent to which time acts as a barrier to PPI would require further investigation with professionals who choose not to partake in PPI, which was outside of the scope of this thesis.

As discussed in the Literature Review (see Section 1.6.1) added time commitment is often highlighted as a consequence of PPI, however there is very little detail about why PPI is time consuming (Boote, Baird, & Beecroft, 2010; Boote, Telford, & Cooper, 2002; Staniszewska, Jones, Newburn, & Marshall, 2007; Trivedi & Wykes, 2002). The professionals in my sites did not express concerns about PPI increasing the overall length of the research project (which to some extent might be compensated for by quicker recruitment) as suggested by Boote, Telford and Cooper (2002), but rather about the amount of their own time needed. Being aware of exactly how PPI incurs additional time allows for it to be budgeted and planned for.