Highlights
- •Clinical practice guideline developers involve patients and members of the public.
- •Developers need rigorously tested tools to evaluate the quality of the involvement.
- •We tested the 12-item Patient Engagement Evaluation Tool and found good performance.
- •The shortened 6-item Patient Engagement Evaluation Tool showed similar performance.
- •The 6-item tool is an efficient and valid tool to measure patient and public involvement.
Abstract
Objective
Study Design and Setting
Results
Conclusion
Keywords
- •The PEET-6 and the PEET-12 were validated to assess patient and public engagement in clinical practice guideline development.
- •The PEET was developed as a theory-informed measure of the extent to which criteria for successful engagement are met across domains including trust, respect, fairness, competency, legitimacy and accountability from a participant's perspective.
- •To minimise response burden, guideline developers may prefer PEET-6.
Key findings
1. Introduction
Buckland D, Bashir N, Moore JE, Straus S, et al. CTFPHC patient engagement protocol. Toronto: Li Ka Shing Institute, St. Michael's Hospital. Available at: http://canadiantaskforce.ca/methods/patient-engagement-protocol. Accessed 22 April 2021.
Procedure Manual Section 9. Engagement With the Public, Stakeholders, and Partners. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-section-9-engagement-public-stakeholders-and-partners. Accessed 11 Nov 2021.
SIGN Patient and public involvement. Available at: https://www.sign.ac.uk/patient-and-public-involvement. Accessed 22 Apr 2021.
NICE Patient and public involvement policy. Available at: https://www.nice.org.uk/about/nice-communities/nice-and-the-public/public-involvement/public-involvement-programme/patient-public-involvement-policy. Accessed 22 Apr 2021.
Procedure Manual Section 9. Engagement With the Public, Stakeholders, and Partners. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-section-9-engagement-public-stakeholders-and-partners. Accessed 11 Nov 2021.
2. Methods
2.1 Participants and engagement activities
Procedure Manual Section 9. Engagement With the Public, Stakeholders, and Partners. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-section-9-engagement-public-stakeholders-and-partners. Accessed 11 Nov 2021.
Buckland D, Bashir N, Moore JE, Straus S, et al. CTFPHC patient engagement protocol. Toronto: Li Ka Shing Institute, St. Michael's Hospital. Available at: http://canadiantaskforce.ca/methods/patient-engagement-protocol. Accessed 22 April 2021.
2.2 Measures
2.2.1 Demographic Characteristics
2.2.2 The PEET
2.2.3 Validation Questions
2.3 Measure Shortening
2.4 Statistical Analysis
- Kwakkenbos L
- Jewett LR
- Baron M
- Bartlett SJ
- Furst D
- Gottesman K
- et al.
- Kwakkenbos L
- Jewett LR
- Baron M
- Bartlett SJ
- Furst D
- Gottesman K
- et al.
3. Results
3.1 Participant characteristics
Demographic Variable | PEET Group |
---|---|
Age in years, mean (SD) | 45.0 (17.9) |
Woman, n (%) | 210 (72.4) |
Residence, n (%) | 15.8 (3.5) |
Rural | 35 (12.4) |
Suburban | 76 (27.0) |
Urban | 171 (60.6) |
Highest education level, n (%) | |
Less than high school | 2 (0.7) |
high school | 36 (12.8) |
College diploma or bachelor's degree | 164 (58.2) |
Graduate or professional degree | 80 (28.4) |
Annual household income, n (%) | |
Less than $25,000 | 0 (0.0) |
$25,000-$29,999 | 73 (26.0) |
$30,000-$39,999 | 29 (10.3) |
$40,000-$49,999 | 25 (8.9) |
$50,000-$59,999 | 33 (11.7) |
$60,000-$69,999 | 21 (7.5) |
$70,000-$99,999 | 55 (19.6) |
$100,000 or more | 45 (16.0) |
Race/ethnicity, n (%) | |
White | 92 (66.7) |
Asian | 22 (15.9) |
Indigenous Canadian | 14 (10.1) |
Black | 4 (2.9) |
Hispanic | 4 (2.9) |
Arabic | 2 (1.4) |
3.2 Evaluation of the 12 item version of the PEET
3.2.1 Item Statistics and Reliability
Score | Item Responses | |||||||
---|---|---|---|---|---|---|---|---|
PEET Questions | Mean (SD) | 1 n (%) | 2 n (%) | 3 n (%) | 4 n (%) | 5 n (%) | 6 n (%) | 7 n (%) |
1. To what extent do you believe that your ideas were heard during the engagement process? | 5.3 (1.1) | 1 (0.3) | 1 (0.3) | 13 (4.5) | 53 (18.3) | 107 (36.9) | 68 (23.4) | 47 (16.2) |
2. To what extent did you feel comfortable contributing your ideas to the engagement process? | 5.3 (1.1) | 1 (0.3) | 1 (0.3) | 9 (3.1) | 53 (18.3) | 100 (34.5) | 81 (27.9) | 45 (15.5) |
3. To what extent do you believe organizers took your contributions to the engagement process seriously? | 5.5 (1.1) | 1 (0.3) | 0 (0.0) | 9 (3.1) | 44 (15.2) | 100 (34.5) | 72 (24.8) | 64 (22.1) |
4. To what extent do you believe that your input will influence final decisions that underlie the engagement process? | 4.4 (1.2) | 1 (0.3) | 15 (5.2) | 40 (13.8) | 103 (35.5) | 83 (28.6) | 33 (11.4) | 15 (5.2) |
5. To what extent were you able to clearly express your viewpoints? | 5.1 (1.1) | 3 (1) | 10 (3.4) | 36 (12.4) | 103 (35.5) | 91 (31.4) | 37 (12.8) | 10 (3.4) |
6. To what extent were organizers neutral in their opinions (regarding topics) during the engagement process? | 5.5 (1.2) | 2 (0.7) | 1 (0.3) | 12 (4.1) | 42 (14.5) | 92 (31.7) | 61 (21) | 80 (27.6) |
7. To what extent did all participants have equal opportunity to participate in discussions? | 5.4 (1.2) | 1 (0.3) | 3 (1) | 12 (4.1) | 41 (14.1) | 100 (34.5) | 59 (20.3) | 74 (25.5) |
8. To what extent did you clearly understand your role in the process? | 5.4 (1.1) | 0 (0.0) | 0 (0.0) | 16 (5.5) | 39 (13.4) | 106 (36.6) | 77 (26.6) | 52 (17.9) |
9. To what extent was information made available to you either prior or during the engagement process so as to participate knowledgeably in the process? | 5.5 (1.1) | 0 (0.0) | 1 (0.3) | 6 (2.1) | 38 (13.1) | 112 (38.6) | 67 (23.1) | 66 (22.8) |
10. To what extent were the ideas contained in the information material easy to understand? | 5.3 (1.2) | 0 (0.0) | 2 (0.7) | 19 (6.6) | 57 (19.7) | 87 (30) | 77 (26.6) | 48 (16.6) |
11. To what extent did you clearly understand what was expected of you during the engagement process? | 5.4 (1.1) | 0 (0.0) | 1 (0.3) | 15 (5.2) | 38 (13.1) | 99 (34.1) | 81 (27.9) | 56 (19.3) |
12. To what extent did you clearly understand what the goals of the engagement process were? | 5.2 (1.2) | 0 (0.0) | 1 (0.3) | 19 (6.6) | 54 (18.6) | 91 (31.4) | 79 (27.2) | 45 (15.5) |
Validation Questions | ||||||||
1. To what extent do you believe that your values and preferences will be included in the final health advice from this process? | 4.5 (1.1) | 0 (0.0) | 3 (1) | 15 (5.2) | 74 (25.5) | 90 (31) | 74 (25.5) | 34 (11.7) |
2. To what extent would you follow health advice from the Canadian Task Force on Preventive Health Care (if it related to your health condition)? | 5.0 (1.2) | 2 (0.7) | 4 (1.4) | 15 (5.2) | 76 (26.2) | 88 (30.3) | 63 (21.7) | 42 (14.5) |
3. To what extent would you advise others to follow health advice from the Canadian Task Force on Preventive Health Care (if it related to their health condition)? | 5.0 (1.4) | 9 (3.1) | 5 (1.7) | 16 (5.5) | 71 (24.5) | 89 (30.7) | 56 (19.3) | 44 (15.2) |
Question | Corrected Item-total Correlation: 12 item | Corrected Item-total Correlation: 6 item | CFA Factor Loading:12 item model | CFA Factor Loading:6 item model |
---|---|---|---|---|
Questions Included in 6 question PEET | ||||
1. To what extent do you believe that your ideas were heard during the engagement process? | 0.82 | 0.83 | 0.89 | 0.92 |
3. To what extent do you believe organizers took your contributions to the engagement process seriously? | 0.83 | 0.82 | 0.90 | 0.91 |
4. To what extent do you believe that your input will influence final decisions that underlie the engagement process? | 0.59 | 0.59 | 0.73 | 0.75 |
5. To what extent were you able to clearly express your viewpoints? | 0.79 | 0.78 | 0.86 | 0.86 |
7. To what extent did all participants have equal opportunity to participate in discussions? | 0.78 | 0.76 | 0.84 | 0.85 |
9. To what extent was information made available to you either prior or during the engagement process so as to participate knowledgeably in the process? | 0.77 | 0.69 | 0.84 | 0.78 |
Questions in the 12 question PEET removed after first CFA | ||||
2. To what extent did you feel comfortable contributing your ideas to the engagement process? | 0.80 | ———- | 0.87 | ———- |
6. To what extent were organizers neutral in their opinions (regarding topics) during the engagement process? | 0.75 | ———- | 0.82 | ———- |
8. To what extent did you clearly understand your role in the process? | 0.76 | ———- | 0.84 | ———- |
10. To what extent were the ideas contained in the information material easy to understand? | 0.76 | ———- | 0.86 | ———- |
11. To what extent did you clearly understand what was expected of you during the engagement process? | 0.82 | ———- | 0.91 | ———- |
12. To what extent did you clearly understand what the goals of the engagement process were? | 0.79 | ———- | 0.90 | ———- |
3.2.2 Confirmatory Factor Analysis
3.3 Item reduction and 6 item Patient Engagement Evaluation Tool


3.4 Evaluation of the 6 item version of the PEET
3.4.1 Item Statistics and Reliability
3.4.2 Confirmatory Factor Analysis
3.5 Concurrent Construct Validity
4. Discussion
- Stocks S
- Giles S
- Cheraghi-Sohi S
- Campbell S.
5. Conclusion
Item 1 | Item 2 | Item 3 | Item 4 | Item 5 | Item 6 | Item 7 | Item 8 | Item 9 | Item 10 | Item 11 | Item 12 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Item 1 | 1.00 | 0.75⁎⁎ | 0.75⁎⁎ | 0.58⁎⁎ | 0.72⁎⁎ | 0.65⁎⁎ | 0.70⁎⁎ | 0.59⁎⁎ | 0.60⁎⁎ | 0.60⁎⁎ | 0.61⁎⁎ | 0.59⁎⁎ |
Item 2 | 1.00 | 0.70⁎⁎ | 0.48⁎⁎ | 0.75⁎⁎ | 0.64⁎⁎ | 0.62⁎⁎ | 0.60⁎⁎ | 0.60⁎⁎ | 0.65⁎⁎ | 0.63⁎⁎ | 0.60⁎⁎ | |
Item 3 | 1.00 | 0.53⁎⁎ | 0.67⁎⁎ | 0.70⁎⁎ | 0.72⁎⁎ | 0.63⁎⁎ | 0.66⁎⁎ | 0.63⁎⁎ | 0.68⁎⁎ | 0.66⁎⁎ | ||
Item 4 | 1.00 | 0.55⁎⁎ | 0.42⁎⁎ | 0.43⁎⁎ | 0.38⁎⁎ | 0.40⁎⁎ | 0.42⁎⁎ | 0.46⁎⁎ | 0.49⁎⁎ | |||
Item 5 | 1.00 | 0.57⁎⁎ | 0.64⁎⁎ | 0.58⁎⁎ | 0.57⁎⁎ | 0.60⁎⁎ | 0.64⁎⁎ | 0.66⁎⁎ | ||||
Item 6 | 1.00 | 0.59⁎⁎ | 0.62⁎⁎ | 0.66⁎⁎ | 0.64⁎⁎ | 0.61⁎⁎ | 0.59⁎⁎ | |||||
Item 7 | 1.00 | 0.63⁎⁎ | 0.64⁎⁎ | 0.60⁎⁎ | 0.67⁎⁎ | 0.64⁎⁎ | ||||||
Item 8 | 1.00 | 0.67⁎⁎ | 0.63⁎⁎ | 0.73⁎⁎ | 0.68⁎⁎ | |||||||
Item 9 | 1.00 | 0.69⁎⁎ | 0.70⁎⁎ | 0.63⁎⁎ | ||||||||
Item 10 | 1.00 | 0.72⁎⁎ | 0.62⁎⁎ | |||||||||
Item 11 | 1.00 | 0.80⁎⁎ | ||||||||||
Item 12 | 1.00 |
Item 1 | Item 3 | Item 4 | Item 5 | Item 7 | Item 9 | |
---|---|---|---|---|---|---|
Item 1 | 1.00 | 0.76⁎⁎ | 0.57⁎⁎ | 0.75⁎⁎ | 0.70⁎⁎ | 0.61⁎⁎ |
Item 3 | 1.00 | 0.54⁎⁎ | 0.68⁎⁎ | 0.72⁎⁎ | 0.67⁎⁎ | |
Item 4 | 1.00 | 0.59⁎⁎ | 0.44⁎⁎ | 0.42⁎⁎ | ||
Item 5 | 1.00 | 0.65⁎⁎ | 0.57⁎⁎ | |||
Item 7 | 1.00 | 0.64⁎⁎ | ||||
Item 9 | 1.00 |
Author Contributions
Acknowledgments
Availability of data and materials
Appendix A: Patient Engagement Evaluation Tool (12-item with 3 validation items)
- 1)To what extent do you believe that your ideas were heard during the engagement process?
- 2)To what extent did you feel comfortable contributing your ideas to the engagement process?
- 3)Did organizers take your contributions to the engagement process seriously?
- 4)To what extent do you believe that your input will influence final decisions that underlie the engagement process?
- 5)To what extent do you believe that your values and preferences will be included in the final health advice from this process?
- 6)To what extent were you able to clearly express your viewpoints?
- 7)How neutral in their opinions (regarding topics) were organizers during the engagement process?
- 8)Did all participants have equal opportunity to participate in discussions?
- 9)How clearly did you understand your role in the process?
- 10)To what extent was information made available to you either prior or during the engagement process so as to participate knowledgeably in the process?
- 11)To what extent were the ideas contained in the information material easy to understand?
- 12)How clearly did you understand what was expected of you during the engagement process?
- 13)How clearly did you understand what the goals of the engagement process were?
- 14)To what extent would you follow health advice from the Canadian Task Force on Preventive Health Care (if it related to your health condition)?
- 15)To what extent would you advise others to follow health advice from the Canadian Task Force on Preventive Health Care (if it related to their health condition)?
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Article info
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Footnotes
Conflict of interest: Dr. Ainsley Moore is Vice-Chair of the Canadian Task Force on Preventive Health Care. Dr. Kyle Silveira is a research coordinator with the Knowledge Translation Program at St. Michael's Hospital, Toronto, Ontario, and conducts patient engagement and other knowledge translation activities on behalf of the Canadian Task Force on Preventive Health Care. Dr. Sharon Straus leads the Knowledge Translation Program at St. Michael's Hospital, Toronto, Ontario and leads patient engagement activities and other knowledge translation activities on behalf of the Canadian Task Force on Preventive Health Care, Dr. Melissa Brouwers is director of the School of Epidemiology and Public Health at the University of Ottawa and leads evidence review and knowledge synthesis work on behalf of the Canadian Task Force on Preventive Health. Dr. Roland Grad is a member of the Canadian Task Force on Preventive Health Care. Dr. Brett Thombs is Chair of the Canadian Task Force on Preventive Health Care.
Funding: The Public Health Agency of Canada supported this work through an agreement with the Sir Mortimer B. Davis Jewish General Hospital. Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not necessarily reflect those of the sponsor or subcontractor. Dr. Wu was supported by Fonds de recherche du Québec – Santé (FRQ-S) Postdoctoral Training Fellowship. Drs. Straus and Thombs were supported by Tier 1 Canada Research Chairs.
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