Balancing Trade-Offs in Patient and Public Involvement and Engagement in Rapid Evaluation: Reflections and Lessons.

BACKGROUND

Patient and public involvement and engagement (PPIE) is recognised as essential to high-quality health and care research. However, there is limited guidance on how to sustain meaningful involvement in rapid evaluations characterised by compressed timelines and shifting priorities.

OBJECTIVE

To reflect on how PPIE developed within the NIHR Rapid Service Evaluation Team (RSET) and to identify practical lessons for navigating tensions between influence, feasibility, and equity in time-pressured contexts.

METHODS

This practice-based critical reflection draws on internal documentation, shared reflections, and evaluation activities from 13 rapid evaluations (2018-2026). Using the International Association for Public Participation (IAP2) Spectrum as a guiding tool, we mapped RSET's PPIE approach across three phases: Early Phase, Developing Maturity, and Current Position, highlighting trade-offs in practice.

RESULTS

Early involvement was meaningful but ad hoc, constrained by limited infrastructure and resources. As the programme matured, more structured yet flexible approaches were introduced, including a standing PPIE panel, tailored involvement aligned to lived experience, and earlier engagement at key decision points. Involvement practice required ongoing negotiation of trade-offs, including Depth vs Speed, Inclusivity vs Practicality, Consistency vs Flexibility, Relationship-building vs Time, and Value vs Feasibility.

CONCLUSIONS

Meaningful PPIE in rapid evaluations is achievable when involvement is planned intentionally, responsive to context, and supported by strong collaboration and communication. Rather than pursuing full co-production, effective involvement focuses on relationships and influence where it adds most value, offering transferable lessons for involvement practice in fast-paced research settings.

PATIENT OR PUBLIC CONTRIBUTION: This paper examines PPIE practice. Public contributors were involved in the programme, contributed to the development of PPIE approaches and practices, and reflected on their experiences. One co-author was a public contributor who helped shaped the interpretation and lessons presented in this paper.