Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Health Information Science


Health Information Science


Kothari, Anita


This study investigates the use of a deliberative dialogue (DD) as a method of patient and public involvement (PPI) in decision-making and priority setting in service delivery and design. A single mixed methods case study was used to evaluate a DD that involved tenants of a rent-geared-to-income building as stakeholders alongside public health, primary care, and social services. Using quantitative survey data and inductive thematic analysis of project documents, focus groups, and field notes, we found that: (1) tenants highly valued actionable outcomes; (2) it is important to recognize diverse types of evidence and knowledge sharing; (3) engaged facilitation is important to balance stakeholder input; and (4) transparency throughout the process is important to maintain trust. Significant influence of the tenants on the planning process and DD discussions was identified. This study situates DDs within the PPI literature and recommends them as a viable method of PPI worth further investigation.

Summary for Lay Audience

Collaboration with diverse groups of stakeholders who are impacted by an issue is a strategy used to ensure that all sides of an issue are considered before setting priorities and implementing solutions. Patient and public involvement (PPI) in health and social care service delivery and design is growing more common as the merit of lived experience is increasingly recognized as a form of evidence and the importance of integrating end-user feedback in processes that affect them becomes more apparent. A literature review was conducted to identify the facilitators and barriers to conducting PPI in service delivery and design. One process that has not been used as a tool for PPI, despite incorporating numerous facilitators recommended in the literature, is deliberative dialogues (DDs). DDs bring together multiple stakeholder groups to discuss an issue with the input of scientific evidence, but have not yet incorporated lay community members as stakeholders. This thesis evaluated a DD that included tenants of a rent-geared-to-income building complex to identify solutions for improving their social environment in collaboration with public health, primary care, and service providers. The planning process and DD, both of which included community tenants, were evaluated to determine how their inclusion modified the traditional DD process, what accommodations were made, and the impact they had on the process as a whole. In total 34 participants attended the DD, 14 of whom were tenants. Twenty-eight surveys were completed by participants and five focus groups were held after the DD to collect participant feedback. All stakeholders involved highly valued the inclusion of tenants. We found that tenants expressed a need for actionable solutions and tangible DD outcomes, which are unusual in traditional DDs. This study identifies DDs as a viable PPI method and demonstrates the merit of recognizing community members as stakeholders in a DD. We recommend that when incorporating community members in DDs, an understanding of context is essential to mitigating power imbalances, balancing contradictory needs of stakeholders, and building trust. Viewing accommodations for community members as part of a holistic process demonstrates that barriers and facilitators are not always independent and must be balanced.