Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research

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Despite policy mandates and growing evidence of its benefits, PPI implementation in mental health research remains inconsistent. Little attention has been given to the state of scientific knowledge on PPI capacity strengthening in mental health research that can support more meaningful implementation. The aims of this scoping review are to: determine the state of knowledge concerning PPI in mental health research capacity-strengthening initiatives; identify the outcome measures used to evaluate the impact of capacity strengthening initiatives for PPI on contributors, research processes, and policy; and map the barriers and enablers to the implementation of capacity strengthening initiatives for PPI. Methods This scoping review will follow JBI and PRISMA-ScR guidelines. Sources will include peer-reviewed articles, grey literature, and organisational materials describing training or skill-building initiatives for adult PPI contributors in mental health research. Searches will be conducted in MEDLINE, Embase, PsycINFO, and CINAHL, supplemented by hand-searching, targeted internet searches, and stakeholder consultation. Data extraction will capture descriptive details, initiative content, outcomes, and contextual factors, with barriers and enablers categorised according to the Consolidated Framework for Implementation Research (CFIR) domains. Conclusion This review will provide the first comprehensive synthesis of capacity-strengthening initiatives for PPI contributors in mental health research. Findings will inform the development of a co-designed blueprint for capacity-strengthening for PPI contributors, and progress broader efforts to embed lived experience expertise and general public perspectives equitably within mental health research systems. 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Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.12688/hrbopenres.14287.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] Shaakya Anand-Vembar https://orcid.org/0000-0002-9315-1865 1,2 , Brian Keogh https://orcid.org/0000-0001-6349-486X 1 , Agnes Higgins https://orcid.org/0000-0002-0631-1884 1 , [...] Greg Sheaf https://orcid.org/0000-0003-1571-1772 3 , Yulia Kartalova-O’Doherty https://orcid.org/0009-0009-3260-3459 1 , Olivia Longe https://orcid.org/0009-0009-1072-7709 1 , Lorna Staines 4 , David McEvoy 4 , Allyson J Gallant https://orcid.org/0000-0002-2933-7470 5 , Caroline Wilson 4 , Leona Ryan https://orcid.org/0000-0003-2385-3439 6 , Christine FitzGerald 7 , Caoimhe Nic Aodha 8 , Chelsea Ryan https://orcid.org/0009-0007-2538-3473 8 , Michelle Doody 8 , Nikki Horkan 8 , Nora Hanney 8 , Oisín Breen 8 , Robyn Thomas https://orcid.org/0009-0007-5612-8328 8 , Sarah Watters 1 , Louise Doyle https://orcid.org/0000-0002-0153-8326 1 , David Cotter 4 , Catherine D Darker https://orcid.org/0000-0002-1561-7076 5 , Mary Cannon 4 , John Lyne 4 , Colm McDonald 2 , Colm Healy 4,9 , Gary Donohue 6 , Sarah Burke https://orcid.org/0000-0001-9419-1642 10 , Karen O'Connor 11 , David Mongan 4 , Rebecca Murphy 7 , Donal O'Keeffe https://orcid.org/0000-0001-6541-996X 1,8 Shaakya Anand-Vembar https://orcid.org/0000-0002-9315-1865 1,2 , Brian Keogh https://orcid.org/0000-0001-6349-486X 1 , [...] Agnes Higgins https://orcid.org/0000-0002-0631-1884 1 , Greg Sheaf https://orcid.org/0000-0003-1571-1772 3 , Yulia Kartalova-O’Doherty https://orcid.org/0009-0009-3260-3459 1 , Olivia Longe https://orcid.org/0009-0009-1072-7709 1 , Lorna Staines 4 , David McEvoy 4 , Allyson J Gallant https://orcid.org/0000-0002-2933-7470 5 , Caroline Wilson 4 , Leona Ryan https://orcid.org/0000-0003-2385-3439 6 , Christine FitzGerald 7 , Caoimhe Nic Aodha 8 , Chelsea Ryan https://orcid.org/0009-0007-2538-3473 8 , Michelle Doody 8 , Nikki Horkan 8 , Nora Hanney 8 , Oisín Breen 8 , Robyn Thomas https://orcid.org/0009-0007-5612-8328 8 , Sarah Watters 1 , Louise Doyle https://orcid.org/0000-0002-0153-8326 1 , David Cotter 4 , Catherine D Darker https://orcid.org/0000-0002-1561-7076 5 , Mary Cannon 4 , John Lyne 4 , Colm McDonald 2 , Colm Healy 4,9 , Gary Donohue 6 , Sarah Burke https://orcid.org/0000-0001-9419-1642 10 , Karen O'Connor 11 , David Mongan 4 , Rebecca Murphy 7 , Donal O'Keeffe https://orcid.org/0000-0001-6541-996X 1,8 PUBLISHED 18 Nov 2025 Author details Author details 1 Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 2 School of Medicine, University of Galway, Galway, Ireland 3 University of Dublin, Ussher Library, Trinity College Dublin, Dublin, Ireland 4 Royal College of Surgeons in Ireland, Dublin, Ireland 5 Trinity College Dublin Department of Public Health and Primary Care, Dublin, Ireland 6 School of Psychology, University of Galway, Galway, Ireland 7 Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, Ireland 8 Mental Health Ireland, Dublin, Ireland 9 Centre for Clinical Brain Sciences, The University of Edinburgh Division of Psychiatry, Edinburgh, Scotland, UK 10 Trinity College Dublin Centre for Health Policy and Management, Dublin, Ireland 11 University College Cork Department of Psychiatry and Neurobehavioral Science, Cork, Ireland Shaakya Anand-Vembar Roles: Conceptualization, Data Curation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Brian Keogh Roles: Conceptualization, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Agnes Higgins Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Greg Sheaf Roles: Data Curation, Methodology, Resources Yulia Kartalova-O’Doherty Roles: Writing – Review & Editing Olivia Longe Roles: Writing – Review & Editing Lorna Staines Roles: Writing – Review & Editing David McEvoy Roles: Writing – Review & Editing Allyson J Gallant Roles: Writing – Review & Editing Caroline Wilson Roles: Writing – Review & Editing Leona Ryan Roles: Writing – Review & Editing Christine FitzGerald Roles: Writing – Review & Editing Caoimhe Nic Aodha Roles: Writing – Review & Editing Chelsea Ryan Roles: Writing – Review & Editing Michelle Doody Roles: Writing – Review & Editing Nikki Horkan Roles: Writing – Review & Editing Nora Hanney Roles: Writing – Review & Editing Oisín Breen Roles: Writing – Review & Editing Robyn Thomas Roles: Writing – Review & Editing Sarah Watters Roles: Writing – Review & Editing Louise Doyle Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing David Cotter Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Writing – Review & Editing Catherine D Darker Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Mary Cannon Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing John Lyne Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Colm McDonald Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Colm Healy Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Gary Donohue Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Sarah Burke Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Karen O'Connor Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing David Mongan Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Rebecca Murphy Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Donal O'Keeffe Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Public and Patient Involvement collection. Abstract Background Public and Patient Involvement (PPI) in mental health research is increasingly recognised as a moral and ethical imperative, necessary to increase the relevance and effectiveness of translation of research findings. Despite policy mandates and growing evidence of its benefits, PPI implementation in mental health research remains inconsistent. Little attention has been given to the state of scientific knowledge on PPI capacity strengthening in mental health research that can support more meaningful implementation. The aims of this scoping review are to: determine the state of knowledge concerning PPI in mental health research capacity-strengthening initiatives; identify the outcome measures used to evaluate the impact of capacity strengthening initiatives for PPI on contributors, research processes, and policy; and map the barriers and enablers to the implementation of capacity strengthening initiatives for PPI. Methods This scoping review will follow JBI and PRISMA-ScR guidelines. Sources will include peer-reviewed articles, grey literature, and organisational materials describing training or skill-building initiatives for adult PPI contributors in mental health research. Searches will be conducted in MEDLINE, Embase, PsycINFO, and CINAHL, supplemented by hand-searching, targeted internet searches, and stakeholder consultation. Data extraction will capture descriptive details, initiative content, outcomes, and contextual factors, with barriers and enablers categorised according to the Consolidated Framework for Implementation Research (CFIR) domains. Conclusion This review will provide the first comprehensive synthesis of capacity-strengthening initiatives for PPI contributors in mental health research. Findings will inform the development of a co-designed blueprint for capacity-strengthening for PPI contributors, and progress broader efforts to embed lived experience expertise and general public perspectives equitably within mental health research systems. READ ALL READ LESS Keywords public and patient involvement, capacity-strengthening, co-production, mental health, lived experience, participatory methods Corresponding Author(s) Shaakya Anand-Vembar ( [email protected] ) Close Corresponding author: Shaakya Anand-Vembar Competing interests: No competing interests were disclosed. Grant information: The VISTA Programme is funded by the Health Research Board Ireland Applied Programmes Grant [APRO-2023-23]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Anand-Vembar S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Anand-Vembar S, Keogh B, Higgins A et al. Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.12688/hrbopenres.14287.1 ) First published: 18 Nov 2025, 8 :123 ( https://doi.org/10.12688/hrbopenres.14287.1 ) Latest published: 07 May 2026, 8 :123 ( https://doi.org/10.12688/hrbopenres.14287.2 )  There is a newer version of this article available. Suppress this message for one day. Background Researchers and health systems are increasingly engaging people with lived experience of health conditions, their families/carers, and the public in research ( Health Service Executive (HSE), 2021 ; National Health Service (NHS), 2025 ; National Institute for Health and Care Research (NIHR), 2019 ; Vaughn & Jacquez, 2020 ). This is broadly referred to as ‘participatory research’, which emphasises conducting research with intended beneficiaries rather than on or about them ( Cornwall & Jewkes, 1995 ; NIHR, 2019 ; Vaughn & Jacquez, 2020 ). Frameworks such as participatory action research ( Baum et al. , 2006 ), citizen science ( Bonney et al. , 2009 ), and community-based participatory research ( Israel et al. , 2001 ; Wallerstein & Duran, 2006 ) share this principle of co-production. A commonly used term in the healthcare and health systems context is ‘Public and Patient Involvement’ (PPI), which emerged from patient advocacy movements and now encompasses patients (also known as service users or lived experience contributors), families, healthcare professionals, policymakers, and the public ( Gilfoyle et al. , 2022 ; HSE, 2021 ). Often, research employing PPI will try to engage several of these stakeholders at once—and these identities are not mutually exclusive ( Gilfoyle et al. , 2022 ; HSE, 2021 ; NHS, 2025 ; Vaughn & Jacquez, 2020 ). Levels of involvement range from advisory roles to fully integrated research team membership, with responsibilities for shaping research questions, methodologies, and interpretation of data ( Bell et al. , 2023 ; Gallant et al. , 2025 ). Over the last 10–15 years, national policies in the United Kingdom (UK) and Ireland, as well as prominent funding and publishing bodies, have promoted or mandated the use of PPI within health research. For instance, the UK’s NIHR and UK Research and Innovation (UKRI) have developed standards and resources to encourage PPI uptake ( NIHR, 2019 ; UKRI, 2025 ), while the Irish Health Service Executive (HSE) and the PPI Ignite Network have developed similar resources that emphasise equity, accessibility, fair compensation, clear roles, and training for PPI contributors ( HSE, 2021 ; PPI Ignite Network, 2025 ). The Health Research Board and Research Ireland evaluate grant applications partly on how projects plan to enact PPI, and journals such as BMJ and The Lancet Psychiatry increasingly require statements about PPI usage as a condition for publication ( BMJ, 2018 ; Davis et al. , 2024 ). These developments reflect a growing recognition of lived experience expertise and general public perspectives as central to increasing the rigour, quality, and real-word relevance of health research. Beyond institutional mandates, PPI is also a moral and ethical imperative, helping to redress decades of epistemic injustice by valuing the knowledge of those with direct experience of health challenges ( Downs, 2025 ; McGorry et al. , 2024 ; Rose & Kalathil, 2019 ). Impact of PPI on contributors, research outcomes, and service provision Evidence of the impact of PPI use in health research seems to be strongest at the project level. Several reviews on health and mental health care show that PPI: improves recruitment and retention ( Ennis & Wykes, 2013 ), enhances design and dissemination ( Allen et al. , 2020 ; Blackburn et al. , 2018 ; Mockford et al. , 2012 ), and empowers contributors by building confidence, ownership, and trust ( Brett et al. , 2014 ; Richmond et al. , 2023 ). PPI contributors have reported creating positive relationships with healthcare services after traumatic experiences in the mental health system, and developing new collaborative partnerships as a result of their participation in various aspects of the research cycle ( Allen et al. , 2020 ). At the service provision level, some evidence suggests positive outcomes for mental health services. A review of nine studies by Ezaydi et al. (2023) found that co-produced mental health services were associated with increased attendance, treatment completion, fewer hospitalisations, and greater trust in the services. In-depth involvement of service users sometimes led to structural or cultural changes with potential long-term effects. However, such studies remain rare, and most focus on short-term outcomes. At the policy and systems level, evidence is much weaker. A scoping review of healthcare research by Baumann et al. (2022) found that most studies describing and evaluating PPI assessed the PPI process itself rather than long-term policy impacts. Werner et al. (2025) similarly highlighted the lack of data on systemic impacts of PPI in psychiatric research, attributing this to limited standardisation of PPI impact measures and a lack of studies explicitly designed to evaluate long-term effects. This gap in evidence may stem from the fundamental issue of low levels of PPI/co-production utilisation in mental health-related research, highlighted by the relatively small number of studies deemed eligible in reviews (e.g. Ezaydi et al. , 2023 ). In a scoping review by Gonzales and Jones (2024) , only 2 out of the 23 studies that measured service user perspectives reported service user involvement in the actual study design or implementation. Furthermore, Chinsen et al. (2025) ’s systematic review of co-design in mental health interventions with young people found that their involvement was largely marginal. Challenges in implementing PPI in mental health research One key challenge for PPI is the demand for narrow forms of evidence focused on standardised evaluation processes that simplify nuanced and heterogeneous experiences ( Armstrong & Byrom, 2025 ) and thus may be inadequate in measuring how each PPI contributor shaped the methods, results, and impact of a study. A lack of fully embedded approaches, together with inadequate use and reporting of evaluation measures, limits PPI’s potential to drive larger-scale changes in health systems and research processes ( Baumann et al. , 2022 ; Biddle et al. , 2021 ; Brotherdale et al. , 2024 ; Mockford et al. , 2012 ). Tokenism—superficial involvement that fails to provide decision-making opportunities or address power inequities ( Brotherdale et al. , 2024 ; Ocloo & Matthews, 2016 ; Ocloo et al. , 2021 ; Pinfold et al. , 2025 ; Richmond et al. , 2023 )—is another common barrier, reinforcing unequal relationships between service users and researchers. Power imbalances impede participation by encouraging an ‘us vs. them’ mentality through labelling (‘PPI members’ vs. ‘researchers’), compartmentalising tasks, creating a false sense of decision-making power, discouraging critique of academic viewpoints, and limiting contact with senior researchers ( Allen et al. , 2020 ; Richmond et al. , 2023 ). There are specific considerations for PPI in mental health research. For example, affective or cognitive effects of psychiatric medications may be brought to the forefront and impact PPI contribution in unforeseen ways. A systematic review linked sedatives such as benzodiazepines to impaired social cognition ( Haime et al. , 2021 ); echoing a meta-analysis associating them with deficits in working memory, processing speed, attention, and expressive language ( Crowe & Stranks, 2018 ). Other medications, including certain types of antipsychotics, have also been associated with cognitive impairment ( Haddad et al. , 2023 ; Joshi et al. , 2021 ). Such changes may influence contributors’ engagement, relationships, and preferred tasks in research projects. Navigating side effects can also form part of the “expertise” of PPI contributors when generating knowledge about relevant topics, such as the impact of iatrogenic harm ( Okkenhaug et al. , 2024 ). Socio-emotional and cognitive effects arising from mental health difficulties also shape PPI contributors’ experiences. Low self-esteem, common both as a precursor to, and consequence of, mental health conditions, is linked to poorer wellbeing outcomes, while higher self-esteem is a protective factor ( de la Barrera et al. , 2022 ; Hilbert et al. , 2019 ; Keane & Loades, 2017 ; Rizwan & Ahmad, 2015 ). In PPI contexts, medication effects may converge with these socio-emotional and cognitive effects, producing varied impacts at individual, group, and project levels ( Allen et al. , 2020 ; Richmond et al. , 2023 )—it is important for research teams to consider how these experiences can in fact provide unique insight into topics being studied. Stigma further undermines participation, and researchers holding stigmatising beliefs about the abilities of people with mental health difficulties has been widely documented ( Allen et al. , 2020 ; Biddle et al. , 2021 ; Evans & Papoulias, 2020 ; Paul & Holt, 2017 ; Richmond et al. , 2023 ; Susanti et al. , 2020 ; Wadman et al. , 2019 ). While teams often support PPI in principle, they may emphasise the ‘risks’ of close collaboration. One study noted that “Poor health, especially mental health, was recognized as a significant barrier to effective co-production,” though some clinicians acknowledged the need for extra support ( Holland-Hart et al. , 2019 , p. 96). Institutional processes can also deter participation, as illustrated by a lived experience research assistant who described being compelled to disclose highly sensitive personal information during Human Resource procedures, finding the process “distressing and re-traumatising” ( Richmond et al. , 2023 , p. 224). Another dimension of stigma is the privileging of academic over experiential knowledge, reinforcing the ‘us vs. them’ divide, and deepening epistemic injustice. Rose and Kalathil (2019) explore this issue within mental health research, arguing that within current academic contexts, “co-production between professionals and service users is fundamentally an unequal relationship” ( Rose & Kalathil, 2019 , p. 8). Given the automatic privileging of academic or ‘rational’ forms of knowledge production in these settings, knowledge stemming from lived experience enters the field at a disadvantage. Paul and Holt (2017) observed that “The value placed on experiential knowledge vs. knowledge held within the research community emerged as a particularly complicated aspect of PPI in practice” ( Paul & Holt, 2017 , p. 7). Addressing this injustice in the long term requires not just individual- or team-level strategies, but systemic reconstruction involving a re-evaluation of the very principles underpinning mental health research. Capacity-strengthening for PPI in mental health research It is evident that unique barriers arise when implementing PPI in mental health research. Yet little attention has been given to the state of scientific knowledge on PPI capacity strengthening in mental health research that can address these. Research capacity strengthening is defined by Centre for Capacity Research and Science for Africa Foundation (2024) as “enhancing the capacity of individuals and organisations to conduct, manage, share and apply research, while enabling national and sub-national research systems to effectively support both research and the linkages between research and practice.”. It is considered a long-term process that can be applied at the individual, institutional, or national level, and can be applied to improving the quality of PPI in mental health research. Several studies on PPI in research have highlighted the lack of, and need for, targeted training of PPI contributors, and point to skill-building activities ( Brett et al. , 2014 ; Holland-Hart et al. , 2019 ; Ocloo et al. , 2021 ; Opie et al. , 2023 ; Paul & Holt, 2017 ; Susanti et al. , 2020 ). An important gap in training for PPI contributors is in research literacy ( Allen et al. , 2020 ; Bedenik et al. , 2025 ). Tailored training for mental health research PPI contributors may help reduce tokenism, offer support in the ‘emotional work of using one’s lived experience identity, enhance skills sharing and support relationship building across research teams; and enhance comprehension and prevent overload from technical information ( Allen et al. , 2020 ; Capobianco et al. , 2023 ; Werner et al. , 2025 ). In a rapid review of training programmes for lived experience workforces, an analysis of 26 studies found that specialised, mental health-related training programmes resulted in improvements in confidence, communication skills, reflective listening, problem-solving, and overall improvements in job performance within the mental health services context ( Opie et al. , 2023 ). This points to the benefits that targeted capacity strengthening could bring to mental health research as well. Moreover, implementation science provides tools to move PPI in mental health research beyond principles into practice by identifying the conditions that enable or hinder its meaningful adoption and sustainability. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al. , 2022 ) is particularly useful for examining how organisational culture, leadership, resources, and external policy drivers shape the extent to which PPI is embedded and valued within mental health research systems. CFIR comprises five overarching ‘domains’ indicating the systemic level at which a barrier or enabler sits (i.e., the innovation design itself, the outer setting, the inner setting, the individual level, and the implementation process). Each of these domains also contains several sub-constructs (39 in total) into which barriers and enablers are categorised. This framework has been successfully adapted for social science and health research over the years, including in some recent scoping/systematic reviews in the area of mental health ( Garavito et al. , 2023 ; Higgins et al. , 2020 ; Le et al. , 2022 ; Mutschler et al. , 2022 ; Piat et al. , 2021 ; Rangachari et al. , 2022 ; Roshan et al. , 2025 ). Considering that there is no standardised guidance on what the capacity strengthening of PPI contributors in mental health research should look like, this scoping review aims to describe existing training programmes, onboarding activities, and other skill-building initiatives directed at PPI members in this area, and identify and categorise barriers and enablers to implementing these initiatives. Objectives The scoping review aims to: 1) Describe the content and implementation processes of capacity-strengthening initiatives utilised to strengthen PPI in mental health research. 2) Describe outcome measures used to evaluate the experience or impact of the identified capacity-strengthening initiatives on lived experience contributors and broader research or policy implementation goals. 3) Use the Consolidated Framework for Implementation Research (CFIR) to map identified barriers and enablers of implementing capacity-strengthening initiatives. Methodology The scoping review protocol has been informed by the guidelines set forth by the Joanna Briggs Institute Manual for Evidence Synthesis ( Peters et al. , 2020 ) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) standards ( Tricco et al. , 2018 ). Some minor modifications to standard JBI protocol have been made in order to accommodate the specific needs of this review. The review is pre-registered with Open Science Framework ( https://osf.io/ndz67/ ). This scoping review is the first step in a process evaluation of the enactment of PPI within a broader research programme entitled Vision To Action for Promoting Mental Health and Recovery – An Implementation Science Approach to “Sharing the Vision” (VISTA; https://vista-apro.eu/. ) VISTA aims to develop comprehensive implementation blueprints to enact several recommendations from Ireland’s ‘Sharing the Vision’ mental health policy ( Department of Health, Ireland, 2021 ). The review findings will be applied to the PPI process currently being undertaken in VISTA, as well as to the PPI capacity-strengthening training blueprint that will be co-designed towards the end of the programme for eventual implementation in Recovery Colleges across Ireland. PPI contribution A PPI panel of seven members, ranging from people with lived experiences of mental health difficulties, family members/carers, and public representatives, has been involved in the development of this protocol, and will be regularly consulted for the data synthesis and write-up of the review. The broader VISTA research programme is underpinned by this PPI panel, with each panelist embedded in one of the project’s work packages. As part of VISTA’s PPI process, before beginning to work together on research, the PPI panellists and academics underwent an induction phase involving capacity-strengthening activities such as team-building, crafting a personal narrative around recovery and mental health, consensus-building, influencing, and research literacy training. Eligibility criteria Eligibility criteria for literature to be included is detailed in Table 1 . The review uses a slightly modified version of the JBI’s PCC framework ( participants, concept, context), with the addition of outcomes as a final criterion to accommodate the review’s focus on barriers and enablers. In this review, concept will encompass any capacity-strengthening initiatives (such as training, webinars, educational materials, or workshops) that have been used with PPI contributors as the primary target in the research study. Table 1. Eligibility criteria and operationalisation of the JBI’s PCC framework. Include Exclude Participants • Adults who are PPI/lived experience contributors/general public representatives in mental health research • Research team members (academics) who may incidentally also receive capacity-strengthening training. • Adults who are only participants/data subjects in mental health research • Adults who are PPI/lived experience contributors in non-mental health research • Studies in which over 50% of PPI contributors are under 18 years of age. Concept • PPI/lived experience/co-production within the research project at any stage of the research project (from design to dissemination) • Specific, purposeful capacity-strengthening initiatives focused on strengthening capacity to co-produce or engage with the research in mental health (examples of areas of capacity strengthening: teamwork, disclosure, confidence, public speaking, presentation, negotiation, ethics, personal development, professional development, values, principles) • Interventions that are not focused on capacity-strengthening for the purpose of co-producing research • Interventions that are only aimed at academic team members/researchers. Context • Mental health research that incorporates PPI/lived experience insights in the research design and conduct • Research in social sciences that are not related to mental health • Mental health research that does not incorporate any aspects of PPI or co-production Outcome • Barriers and enablers to implementation of capacity- strengthening initiatives • Evaluation of the PPI members’ experiences of the capacity- strengthening initiatives • Barriers and enablers that are not related to specific capacity- strengthening initiatives for PPI members in mental health (e.g. barriers/enablers to convincing researchers to take up PPI in their research) Types of Data Sources • Published, peer-reviewed academic journal articles • Journal opinion pieces and editorials • Grey literature (key organisation websites and related materials, additional resources from key stakeholders, unpublished theses, journal editorials) • Articles published in English • Evidence syntheses articles (e.g. scoping, systematic, umbrella reviews, meta-analyses) • Conference proceedings, papers, and presentations. Literature and resources dealing with mental health research will be considered; these sources must pertain to adults who are lived experience PPI contributors. Studies in which over 50% of PPI contributors are under 18 years of age will be excluded. Additionally, sources must also describe, to a meaningful extent, the upskilling, training, or capacity-strengthening of PPI contributors, and this capacity-strengthening should be aimed at enhancing the engagement of the PPI contributors in research projects (e.g. research literacy modules/manuals, ethics and data protection training, public speaking and presentation skills). Lastly, we will consider literature that indicates, implicitly or explicitly, barriers and enablers relating to the implementation of these capacity-strengthening initiatives. We will not consider: sources that do not have a mental health focus; sources that do not pertain to lived experience PPI members; sources that do not describe any capacity-strengthening initiatives; sources whose capacity-strengthening attempts are not at least partially targeted towards PPI contributors; sources whose upskilling/capacity-strengthening is not aimed at the enhancement of co-production capabilities; and sources that do not mention or allude to barriers or enablers relating specifically to the capacity-strengthening initiatives. The review will screen published and unpublished literature that addresses the review’s aims, and will include quantitative, qualitative, and mixed methods designs. Systematic reviews, scoping reviews, umbrella reviews, and meta-analyses will be excluded; however, their reference lists will be manually checked for relevant primary sources. Conference proceedings, papers, and presentations will be excluded. A grey literature strategy (described below) will also be used, as it is expected that much of the relevant details on specific training for PPI contributors and research teams will be found in guidelines, training materials, and other community-based and non-peer reviewed sources. The scope of what the review would consider under mental health research, as well as the preferred terminology to use in this area, was decided on in consultation with VISTA’s lived experience PPI team members. The phrase ‘mental health difficulty’ was seen by both researchers and lived experiences contributors as the most comprehensive and least stigmatising term to use through this review and is the term used in the ‘Sharing the Vision’ ( Department of Health, 2020 ) policy. We will consider research dealing with any of the mental and behavioural difficulties outlined in the International Classification of Diseases—11 th Revision (ICD-11) ( World Health Organisation, 2022 ). Search strategy & information sources The concepts comprising the search strategy include: PPI/Lived Experience, Mental Health, and Specific Capacity-Strengthening Initiatives. After the research team compiled lists of terms found in the literature for each concept, the study librarian selected the most relevant terms to include in the search string (outlined in Table 2 )—this search string was then modified for the following databases: MEDLINE (EBSCOhost), Embase (Elsevier), PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). The search did not have language, geographical, or time limitations to obtain all relevant studies. The search will be limited to studies published in English. Before commencing the data extraction stage, one of the researchers (SAV) will hand-search the reference lists of included studies to check for any additional studies that may meet the inclusion criteria. Table 2. Search Strategy Used. General terms Search Strategy for Databases Concept 1: Public and Patient Involvement/Lived Experience/Co-Production Lived experience, consumer, service user, patient, public, family, carer (either/or), PPI (((consumer* OR famil* OR patient* OR public OR “service user*”) NEAR/1 (involv* OR “lived experience*”)) OR “co-research*” OR “co-produc*” OR coresearch* OR coproduc* OR “PPI”) AND Concept 2: Mental Health Specific mental health difficulties/diagnoses as guided by the ICD-11 (anxiet* OR anxious OR depress* OR "eating disorder*" OR ((mental*) NEAR/2 (disorder* OR health* OR ill*)) OR "mood disorder*" OR psychiatric OR psychosis OR psychotic OR schizophreni* OR "self harm*" OR suicid* OR bipolar* OR obsessive* OR traumatic* OR personality* OR substance* OR dissociative*) AND Concept 3: Specific capacity-building/strengthening initiatives used in the study Capacity building, capacity strengthening, toolkit, education, training, learning, initiative, competency building/strengthening, upskill, skill building, supports (((capacity OR competency OR skill*) NEAR/1 (build* OR strengthen*)) OR education* OR initiative* OR learning OR support* OR training OR toolkit* OR upskill*) Grey literature will be obtained through multiple avenues. Firstly, websites of key national and international PPI-related community, healthcare, and research organisations, and related materials such as guidelines or standards published by them, will be assessed for relevant information. Examples of such organisations are PPI Ignite, INVOLVE, the McPin Foundation, PPI-related web pages of national health systems such as the HSE and NHS, and blogs of lived experience PPI contributors and researchers. Secondly, sources such as unpublished theses (via open university repositories) and journal editorials will be considered. Lastly, key stakeholders working in the PPI space (such as prominent lived experience/PPI advocates, lived experience researchers, experts in the field of co-production, and other key community members) will be contacted directly to source additional, potentially unpublished resources on capacity-strengthening. Screening Database search results will be uploaded onto Covidence ( Covidence systematic review software, 2025 ), where duplicates will be removed, and further screening will take place. At the title and abstract level, all references will be screened by two independent reviewers. Full texts will also be reviewed independently by two reviewers, and reasons for excluding articles will be recorded and used in the PRISMA flow chart. At each of these stages, screening will first be pilot-tested on 20% of the studies before continuing; conflicts between reviewers will then be closely monitored, and regular conflict resolution meetings between the reviewers will take place to resolve them—if needed, a third person from the team will be invited to resolve the conflict. If a significant number of conflicts arise during these first two stages, a further 10% of articles will undergo pilot-testing. Regular meetings will be held with the review team to ensure that there is a standardised approach to screening. Data extraction Data extraction will occur via the extraction function on Covidence; once data is initially extracted there, it will be transferred to NVivo ( Lumivero, 2024 ), and if needed, on Microsoft Excel ( Microsoft Corporation, 2025 ). Here, additional descriptive and thematic analyses will be performed. The JBI data extraction template has been modified to address review objectives 1 and 2 (Appendix A). The template will capture the studies’ descriptive information (e.g., authors and year of publication, country, study design, aim), population characteristics (e.g., sample size and type, age range, and description of the research team) details of the intervention (e.g., details of the capacity-strengthening initiatives, gaps in training identified, any PPI monitoring or evaluation tools used), context (e.g., mental health area/difficulty, challenges identified relating to mental health needs of PPI contributors). This set of data addresses aims one and two of the review. Data relevant to the review’s third aim (identifying barriers and enablers) will be collected in line with CFIR; Appendix C; Damschroder et al. , 2022 ). This review will structure significant information relating to the implementation of PPI capacity-strengthening initiatives according to the 39 constructs of CFIR, thereby extracting specific pieces of data that can be more easily translated for use in future implementation projects. The data extraction template (Appendix A) will first be pilot tested on 20% of studies by two independent reviewers before being used for the remaining studies, with regular discussions between the reviewers to resolve any problems with the template or major differences in the extracted data. In case the template must be revised, the amended template will be reflected in the published scoping review. Analysis and presentation of findings Data synthesis will occur in NVivo (and Excel as needed). Scoping review findings will be presented in line with JBI and PRISMA-ScR guidelines ( Peters et al. , 2020 ; Pollock et al. , 2022 ; Tricco et al. , 2018 ). A descriptive narrative account of the existing quantitative, qualitative, and mixed methods literature will be provided; augmented by tables that provide an overview of included study characteristics and methodologies used. Findings will focus on mapping, summarising, and charting available evidence; identifying knowledge gaps; clarifying concepts; and reviewing research conduct. This account will clarify how the scoping review results relate to, and address, its research aims. To achieve this, for aim 1 (capacity-strengthening initiative content and implementation processes) and aim 2 (outcome measures), a basic descriptive analysis will be conducted. For aim 3 (implementation barriers and enablers), data will be analysed deductively by mapping individual study findings to the CFIR. Limitations While the review takes steps to achieve comprehensiveness, some limitations still arise. Firstly, as this is a scoping review (rather than a systematic review), quality and risk-of-bias assessments will not be conducted. Additionally, we expect a large portion of the literature that will be analysed will be derived from non-peer reviewed or unpublished sources such as websites and documentation of community-level initiatives. Combined with the restriction to English-only literature, these limitations will reduce the extent to which the review’s findings can be used as an evidence base for policy or clinical guidelines. Furthermore, given the decentralised nature of the non-peer reviewed sources, and the review’s use of subject matter experts in identifying grey literature, some relevant resources may be missed in the literature search, particularly those that may not yet be published. Despite the limitations, this review will mark the first time that capacity-strengthening for PPI in mental health research contexts has been examined in a systematic way, and will springboard to support PPI capacity-strengthening both within and beyond the VISTA programme. Conclusion This scoping review aims to gather and consolidate existing information on capacity-strengthening initiatives for PPI contributors in mental health research, identifying barriers and enablers to implementing these initiatives within research contexts. To do this, the review grounds itself in an implementation science-based approach, utilising a detailed framework, the CFIR, to extract and analyse data related to barriers, enablers, and outcomes of capacity-strengthening initiatives. This approach will allow the research team to more effectively comment on how relevant domains of research settings can be modified to reduce some of the major challenges and inequities of PPI. Ethics and consent Ethical approval and consent were not required for this scoping review Data availability Underlying data No data are associated with this article. Extended data This protocol is preregistered on Open Science Framework: “Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research” ( Anand-Vembar et al. , 2025 ) https://doi.org/10.17605/OSF.IO/EYHGM This project contains the following extended data: 1) Supplementary File 1: PPI ScR PCC Chart and Search Strategy Table.docx ( https://osf.io/eyhgm/files/n92ke ) 2) Supplementary File 2: PPI ScR Appendices.docx (Includes PRISMA ScR Checklist, Data Extraction Tool, CFIR diagram; https://osf.io/eyhgm/files/qwxk3 ) Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Universal). 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Reference Source Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 18 Nov 2025 ADD YOUR COMMENT Comment Author details Author details 1 Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 2 School of Medicine, University of Galway, Galway, Ireland 3 University of Dublin, Ussher Library, Trinity College Dublin, Dublin, Ireland 4 Royal College of Surgeons in Ireland, Dublin, Ireland 5 Trinity College Dublin Department of Public Health and Primary Care, Dublin, Ireland 6 School of Psychology, University of Galway, Galway, Ireland 7 Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, Ireland 8 Mental Health Ireland, Dublin, Ireland 9 Centre for Clinical Brain Sciences, The University of Edinburgh Division of Psychiatry, Edinburgh, Scotland, UK 10 Trinity College Dublin Centre for Health Policy and Management, Dublin, Ireland 11 University College Cork Department of Psychiatry and Neurobehavioral Science, Cork, Ireland Shaakya Anand-Vembar Roles: Conceptualization, Data Curation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Brian Keogh Roles: Conceptualization, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Agnes Higgins Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Greg Sheaf Roles: Data Curation, Methodology, Resources Yulia Kartalova-O’Doherty Roles: Writing – Review & Editing Olivia Longe Roles: Writing – Review & Editing Lorna Staines Roles: Writing – Review & Editing David McEvoy Roles: Writing – Review & Editing Allyson J Gallant Roles: Writing – Review & Editing Caroline Wilson Roles: Writing – Review & Editing Leona Ryan Roles: Writing – Review & Editing Christine FitzGerald Roles: Writing – Review & Editing Caoimhe Nic Aodha Roles: Writing – Review & Editing Chelsea Ryan Roles: Writing – Review & Editing Michelle Doody Roles: Writing – Review & Editing Nikki Horkan Roles: Writing – Review & Editing Nora Hanney Roles: Writing – Review & Editing Oisín Breen Roles: Writing – Review & Editing Robyn Thomas Roles: Writing – Review & Editing Sarah Watters Roles: Writing – Review & Editing Louise Doyle Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing David Cotter Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Writing – Review & Editing Catherine D Darker Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Mary Cannon Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing John Lyne Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Colm McDonald Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Colm Healy Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Gary Donohue Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Sarah Burke Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Karen O'Connor Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing David Mongan Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Rebecca Murphy Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Donal O'Keeffe Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The VISTA Programme is funded by the Health Research Board Ireland Applied Programmes Grant [APRO-2023-23]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 07 May 2026, 8:123 https://doi.org/10.12688/hrbopenres.14287.2 version 1 Published: 18 Nov 2025, 8:123 https://doi.org/10.12688/hrbopenres.14287.1 Copyright © 2025 Anand-Vembar S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Anand-Vembar S, Keogh B, Higgins A et al. Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.12688/hrbopenres.14287.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 18 Nov 2025 Views 0 Cite How to cite this report: Sangwan RK. Reviewer Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r52834 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-52834 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Jan 2026 Ramesh Kumar Sangwan , Indian Council of Medical Research National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15719.r52834 The protocol is conceptually strong , rooted in participatory research, epistemic justice, and implementation science, and clearly justified as the first systematic mapping of capacity-strengthening initiatives for PPI in mental health research.​ The aims, review questions, and ... Continue reading READ ALL The protocol is conceptually strong , rooted in participatory research, epistemic justice, and implementation science, and clearly justified as the first systematic mapping of capacity-strengthening initiatives for PPI in mental health research.​ The aims, review questions, and methods are generally coherent and appropriate for a scoping review, with suitable use of JBI methodology, PRISMA-ScR, and CFIR to structure extraction and analysis.​ The major areas needing refinement relate to: operational clarity (PPI definition and boundaries), search/eligibility precision (especially grey literature and non‑English work), outcome/CFIR operationalisation, and tightening some sections for readability. Strong rationale and positioning Background provides an excellent synthesis of the evolution of PPI, its moral/ethical basis, and specific complexities in mental health (medications, stigma, epistemic injustice, tokenism, power).​ Clear articulation that the focus is on capacity-strengthening for PPI contributors rather than generic PPI or generic training, and that this is a neglected area despite policy mandates.​ Clear aims and review questions Aims are explicit: mapping state of knowledge, identifying outcome measures, and mapping barriers/enablers using CFIR.​ The link between aims and the intended use (VISTA programme, blueprint for Recovery Colleges) is well stated and increases policy/practice relevance.​ Methodological robustness Use of JBI Manual and PRISMA-ScR, with explicit description of how reporting will follow these.​ Use of CFIR to structure barriers and enablers, including reference to the updated 2022 articulation and 39 constructs.​ Planned dual pilot of data extraction on 20% of studies with iterative refinement and consensus processes.​ Thoughtful handling of PPI within the review itself PPI panel composition, roles, and induction/capacity-strengthening activities are clearly described, showing meaningful engagement rather than tokenism.​ Positioning the protocol as part of a broader process evaluation of PPI implementation within VISTA is a notable strength.​ Main weaknesses / risks Scope and definitions need sharper boundaries “Mental health research”, “lived experience PPI contributors”, and “capacity-strengthening initiatives” are described, but practical boundaries could be clearer (e.g. interventions that target mixed groups including clinicians; studies where PPI is one component of a broader co‑production/implementation package).​ The exclusion of studies where >50% of contributors are under 18 is stated, but the handling of mixed adult–youth samples (e.g. 30–40% under 18) is not fully clarified; this could lead to inconsistent decisions.​ Outcome conceptualisation is under-specified While the protocol aims to “identify outcome measures used to evaluate the impact of capacity-strengthening initiatives”, there is no explicit categorisation of outcomes (e.g. at contributor, project, service, and system levels) or how purely process-oriented data (e.g. satisfaction, feasibility) will be treated.​ Some outcomes overlap conceptually with CFIR constructs (e.g. self-efficacy, readiness), which may complicate coding unless this is pre‑planned.​ Grey literature strategy could be more explicit and reproducible The protocol acknowledges that much of the relevant material will be in guidelines, training materials, and organisational documents, but the search procedures (databases, key websites, search strings, use of expert networks) remain high-level.​ Reliance on subject matter experts to identify resources is appropriate but risks selection bias without a more structured description of how they will be engaged and how saturation will be judged.​ Language and geographical limitations Restricting to English-only sources is acknowledged as a limitation but may systematically underrepresent non‑Anglophone contexts where PPI and capacity-strengthening are growing (e.g. Latin America, Asia, francophone Europe).​ The protocol might be perceived as heavily UK/Ireland-centric given the policy examples and VISTA context, which may limit transferability if not explicitly addressed in discussion/interpretation.​ Specific, actionable suggestions 1. Clarify scope and operational definitions Add an operational definition box/table early in the methods with: PPI contributor : clarify inclusion of carers, public representatives, peer workers, and whether “peer workforce” roles employed by services are in or out of scope.​ Mental health research : specify inclusion/exclusion of adjacent areas (e.g. substance use, neurodevelopmental conditions, dementia, psychosocial disabilities).​ Capacity-strengthening initiative : make explicit whether you will include: Training embedded in broader implementation packages. One-off workshops versus longitudinal programmes. Interventions aimed at both PPI contributors and researchers if substantial content targets PPI contributors.​ For age criteria, add a sentence on how you will treat studies with mixed adult–youth PPI (e.g. include if ≥50% are adults or if data for adults can be meaningfully disaggregated).​ 2. Tighten eligibility criteria and PCC+O description In the eligibility section, consider presenting the PCC+O framework as a compact table (participants, concept, context, outcomes) with precise operationalisation and examples of borderline cases.​ Under “Outcomes”, specify: Which types of outcome will be extracted (e.g. changes in research literacy, confidence, role clarity, engagement, co‑production quality, project outputs, service changes).​ How purely descriptive or narrative reflections (common in grey literature) will be treated and coded.​ 3. Strengthen the search strategy description Explicitly list: Databases (already present: MEDLINE, Embase, PsycINFO, CINAHL) plus time frame (from inception to a specified date).​ Example search string (PPI terms × mental health × capacity-building/training × research), either in the main text or as an appendix.​ For grey literature, specify: Key portal sites (e.g. NIHR, INVOLVE/NIHR, NHS England, HSE, PPI Ignite Network, mental health NGOs, Recovery Colleges, WHO, etc.).​ How web search engines will be used (e.g. first 3–5 pages of results for defined search strings; date filtering; language limits).​ How you will document and report grey literature sources (e.g. in a PRISMA-ScR flow diagram and supplementary tables).​ 4. Refine data extraction and CFIR mapping plan Expand one short paragraph to clarify: How CFIR constructs will be operationalised for this topic (e.g. pre‑defined coding framework based on Damschroder 2022; allowance for inductive sub-codes within constructs).​ How you will handle data that does not fit CFIR well, including whether an additional inductive thematic layer will be applied.​ For outcome measures (aim 2), specify that you will: Distinguish between validated instruments, ad hoc measures, and qualitative outcome indicators. Capture psychometric properties or at least basic details when available (e.g. scale names, domains, scoring) to inform future evaluation design.​ 5. Reporting and limitations In the limitations section, consider briefly adding: A note on the potential under‑representation of low- and middle-income country contexts due to language and grey literature access constraints.​ A short statement about how findings will be framed as hypothesis‑generating and agenda‑setting rather than as a definitive causal evidence base, in line with the scoping review design.​ Language and structure refinements The manuscript is generally well written, but some paragraphs in the background are very dense and could be broken into shorter units to improve readability for non‑specialist readers.​ Where long citation clusters occur (e.g. lines with 5–7 references), consider checking whether all are needed or whether a smaller set of exemplar references would suffice.​ Check for minor formatting consistency (e.g. hyphenation of co‑production vs co-production, use of em dashes, and consistency in terms like capacity-strengthening vs capacity building). Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Adolescent Health, Maternal & Child Health, Mental Health and Medical Sociology. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sangwan RK. Reviewer Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r52834 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-52834 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 07 May 2026 Shaakya Anand-Vembar , Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 07 May 2026 Author Response Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have ... Continue reading Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened our understanding of the protocol's scope and inclusion criteria, allowed us to develop a more detailed grey literature strategy, and helped us improve the conceptualisation of our outcomes. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis in this document: https://docs.google.com/document/d/1laCzkT8bjSUagmVchmRTrH1ECNonIZ9x/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 3 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened our understanding of the protocol's scope and inclusion criteria, allowed us to develop a more detailed grey literature strategy, and helped us improve the conceptualisation of our outcomes. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis in this document: https://docs.google.com/document/d/1laCzkT8bjSUagmVchmRTrH1ECNonIZ9x/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 3 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Competing Interests: N/A Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 07 May 2026 Shaakya Anand-Vembar , Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 07 May 2026 Author Response Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have ... Continue reading Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened our understanding of the protocol's scope and inclusion criteria, allowed us to develop a more detailed grey literature strategy, and helped us improve the conceptualisation of our outcomes. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis in this document: https://docs.google.com/document/d/1laCzkT8bjSUagmVchmRTrH1ECNonIZ9x/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 3 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened our understanding of the protocol's scope and inclusion criteria, allowed us to develop a more detailed grey literature strategy, and helped us improve the conceptualisation of our outcomes. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis in this document: https://docs.google.com/document/d/1laCzkT8bjSUagmVchmRTrH1ECNonIZ9x/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 3 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Competing Interests: N/A Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Stanyon M. Reviewer Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r52835 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-52835 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Jan 2026 Miriam Stanyon , Derbyshire Healthcare NHS Foundation Trust, Derby, UK Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15719.r52835 This article reports a protocol for a scoping review following JBI guidelines to look for ways to build capacity for involvement of patients and members of the public in mental health research. Barriers and enablers will be categorised according ... Continue reading READ ALL This article reports a protocol for a scoping review following JBI guidelines to look for ways to build capacity for involvement of patients and members of the public in mental health research. Barriers and enablers will be categorised according to the CFIR domains. The methodology for searching and screening is all thorough and well explained. My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Other than this I think this is a very well written protocol. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: PPI in the area of mental health education and research, systematic reviewing, JBI synthesis methods I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Stanyon M. Reviewer Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r52835 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-52835 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 07 May 2026 Shaakya Anand-Vembar , Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 07 May 2026 Author Response April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your ... Continue reading April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your comments on the protocol. Your suggestion regarding the data extraction tool has helped us increase the review's methodological robustness. Please see below for our response to your comment, and please refer to changes in the appendix file, in Appendix A, for the changes pertaining to your comment. We hope that the revisions to the data extraction tool sufficiently address your suggestion. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Reviewer 2 Comment: My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Author Response: Example text for each domain has been added to Appendix A (Data Extraction Tool Informed by CFIR). April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your comments on the protocol. Your suggestion regarding the data extraction tool has helped us increase the review's methodological robustness. Please see below for our response to your comment, and please refer to changes in the appendix file, in Appendix A, for the changes pertaining to your comment. We hope that the revisions to the data extraction tool sufficiently address your suggestion. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Reviewer 2 Comment: My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Author Response: Example text for each domain has been added to Appendix A (Data Extraction Tool Informed by CFIR). Competing Interests: N/A Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 07 May 2026 Shaakya Anand-Vembar , Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 07 May 2026 Author Response April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your ... Continue reading April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your comments on the protocol. Your suggestion regarding the data extraction tool has helped us increase the review's methodological robustness. Please see below for our response to your comment, and please refer to changes in the appendix file, in Appendix A, for the changes pertaining to your comment. We hope that the revisions to the data extraction tool sufficiently address your suggestion. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Reviewer 2 Comment: My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Author Response: Example text for each domain has been added to Appendix A (Data Extraction Tool Informed by CFIR). April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your comments on the protocol. Your suggestion regarding the data extraction tool has helped us increase the review's methodological robustness. Please see below for our response to your comment, and please refer to changes in the appendix file, in Appendix A, for the changes pertaining to your comment. We hope that the revisions to the data extraction tool sufficiently address your suggestion. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Reviewer 2 Comment: My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Author Response: Example text for each domain has been added to Appendix A (Data Extraction Tool Informed by CFIR). Competing Interests: N/A Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Morrow E, Sloan H, Spencer LH and Lynch M. Reviewer Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r51895 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-51895 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Dec 2025 Elizabeth Morrow , Royal College of Surgeons in Ireland, Dublin, Ireland Helen Sloan , Bournemouth University, Poole, England, UK Llinos Haf Spencer , Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland, Ireland Mary Lynch , Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland, Ireland Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15719.r51895 INTRODUCTION Our review of the article by Anand-Vembar and co-authors is intended to complement, enhance, and constructively support this important scoping review by critically engaging with its aims, methodological approach, and conceptual framing. As the authors state, public and ... Continue reading READ ALL INTRODUCTION Our review of the article by Anand-Vembar and co-authors is intended to complement, enhance, and constructively support this important scoping review by critically engaging with its aims, methodological approach, and conceptual framing. As the authors state, public and patient involvement (PPI) has become an increasingly important component of mental health research, reflecting a broader shift towards participatory, inclusive, and ethically grounded health research practices. It is important to foreground the scoping review in the realist questions - what is the evidence on what works, for whom, when, and why, and who may currently be missing out? There is a growing body of evidence to show that meaningful PPI has the potential to enhance the relevance, integrity, acceptability, quality, and impact of research by involving those with firsthand experience or ‘lived experience’ throughout the research process. Additionally, benefits associated with involvement extend beyond improved research relevance and quality to include opportunities for mutual learning between researchers and public contributors, the development of shared understanding through the integration of experiential and academic knowledge, and the redistribution of decision-making power, thereby challenging traditional hierarchies within mental health research and promoting more equitable and collaborative research practices. Thus, PPI can be understood through several conceptual lenses. It may be instrumental, where involvement is used to improve the quality or efficiency of research; normative or democratic, where involvement is valued as an ethical right and a matter of accountability; and substantive, where public contributors’ lived experience shapes and influences research questions, methods, or outcomes. Despite strong policy support and growing expectations from funders and institutions, the implementation of PPI in mental health research remains inconsistent, and researchers often report challenges related to skills, resources, organisational support, and sustainability. Capacity-strengthening initiatives have therefore emerged as a key strategy to support researchers, public contributors, and organisations in developing the knowledge, confidence, and structures required for effective involvement. Article summary The article by Anand-Vembar et al. presents a study protocol for a scoping review that aims to identify and synthesise evidence on the barriers and enablers to implementing capacity-strengthening initiatives for PPI in mental health research. Guided by the Consolidated Framework for Implementation Research (CFIR), the protocol outlines a systematic and theory-informed approach to mapping existing initiatives and the contextual factors influencing their implementation. As a study protocol published in an open-research format, the article does not report findings but instead provides transparency around the planned methods and analytical framework. This review critically examines the article’s rationale, methodological approach, and anticipated contribution to the field, considering its strengths, limitations, and potential value for advancing PPI practice and implementation science in mental health research. Focus of the review In the study protocol, capacity-building is defined as initiatives designed to enhance the knowledge, skills, confidence, and resources of both researchers and public contributors, as well as the organisations that support them, to enable meaningful public and patient involvement (PPI) in mental health research. The concept encompasses both individual-level capacity, such as training and mentoring, and organisational-level capacity, including the development of supportive structures, processes, and cultures for involvement. Importantly, capacity-building is framed not merely as increasing the number of involvement activities but as fostering sustainable, effective engagement. By situating capacity-building within the Consolidated Framework for Implementation Research (CFIR), the protocol positions it within a broader system of enablers and barriers, highlighting the interplay between people, practices, and organisational contexts in shaping successful PPI implementation. GENERAL COMMENTS The study protocol by Anand-Vembar et al. presents a rigorous and transparent plan for a scoping review of capacity-strengthening initiatives for public and patient involvement (PPI) in mental health research. By explicitly mapping barriers and enablers using the Consolidated Framework for Implementation Research (CFIR), the protocol demonstrates a strong theoretical grounding and methodological clarity. While it does not report empirical findings, the detailed approach enhances reproducibility and provides a clear roadmap for subsequent analysis. Moreover, the open-access publication and adherence to open-research principles align with current best practices in research transparency and knowledge sharing, which is particularly relevant for advancing evidence-informed PPI in mental health. Overall strengths of the study protocol are: Transparent methodology: The article clearly outlines the databases, inclusion criteria, and data extraction processes. Focus on capacity-building: Addresses an important gap in PPI research by examining how initiatives are implemented, not just whether they exist. Theoretical framework: Uses CFIR to structure barriers and enablers, providing a robust implementation science lens for the analysis. Open-access publication: Promotes transparency, reproducibility, and early community engagement in the scoping review. Main limitations: Justification could be stronger: The rationale for the review could be strengthened by engaging more with existing literature bases, theory and PPI frameworks. Potentially narrow scope: The review may miss innovative, user-led or informal PPI initiatives not captured in published or indexed literature. Grey literature and stakeholder consultation phases of the review could support a more robust process. Limited discussion of theory and context variability of PPI across international settings CFIR is a suitably broad framework, but alternative implementation frameworks are not discussed and differences across countries, health systems, or cultural contexts may not be fully addressed. Unclear stakeholder involvement in review process: While the review is about PPI, the protocol does not detail whether public contributors were involved in shaping the review question, or exactly how PPI members will be involved in the analysis or interpretation of the scoping review results. Rapidly evolving field: PPI practices and guidelines change quickly; there is a risk the review could miss very recent initiatives or emerging approaches by the time it is completed. Data synthesis challenges: Scoping reviews often map evidence without assessing quality in depth, which may limit actionable recommendations. SPECIFIC COMMENTS Attention to the drivers of PPI in research: The paper does not explicitly acknowledge key drivers of PPI in research, such as policy mandates, high-profile failures within health systems (for example, Bristol Royal Infirmary or Alder Hey), or the advocacy and lobbying roles of consumer, survivor and service user groups. Nor does it clearly link the discussion of involvement to influential policy developments and inquiries, such as the Francis Inquiry, which have been instrumental in shaping contemporary expectations around patient involvement in healthcare and health research. The absence of this contextual and policy grounding risks presenting involvement as an abstract or optional activity, driven primarily by anticipated outcomes, rather than as a practice deeply rooted in historical lessons from system failures, ethical imperatives, research governance and regulatory requirements. Existing research and theory: The authors touch only briefly on several important issues- such as power imbalances, stigma, and limited capacity to contribute to research- each of which represents a substantial area of scholarship in its own right. At a minimum, the authors could acknowledge the breadth of the existing literature on these topics and more clearly articulate how the scoping review will contribute to and intersect with these distinct bodies of work. Engagement with theoretical perspectives of involvement: As it stands the objectives of the scoping review offers limited potential for advancing theoretical understanding of engaged research, as it does not sufficiently engage with existing theories or conceptual models of PPI. Theory building is constrained when a study does not explicitly build on established theoretical frameworks, yet the authors draw almost exclusively on empirical evidence. As a result, substantial bodies of literature and well-established models of involvement- such as Arnstein’s ladder of participation, Hickey and Kipping’s continuum, Tritter and McCallum’s mosaic model, and Smith et al.’s typology of involvement- are absent from the objectives and focus of the analysis. Similarly, existing models of PPI impact, including those developed by INVOLVE, and GRIP2 reporting guidelines are not considered. This lack of theoretical engagement means that the scoping review proposed in the paper appears conceptually underdeveloped and somewhat isolated from the extensive scholarship on patient involvement across health and social care, research, education, and broader traditions of civic engagement and public participation in public sector decision-making. Benefits and beneficiaries of the scoping review: Part of the rationale should be to outline the potential benefits and beneficiaries of this scoping review beyond the immediate benefits to informing the wider study. Consistency of aims and objectives: There is inconsistency between the aims described in the abstract and the main body of the paper. The aim as defined in the abstract is to “determine the state of knowledge concerning PPI in mental health research capacity-strengthening initiatives; identify the outcome measures used to evaluate the impact of capacity strengthening initiatives for PPI on contributors, research processes, and policy; and map the barriers and enablers to the implementation of capacity strengthening initiatives for PPI.” The first part of the aim differs from the aim expressed in the body of the paper, which is described as to “describe existing training programmes, onboarding activities, and other skill-building initiatives directed at PPI members in this area, and identify and categorise barriers and enablers to implementing these initiatives.” The objectives are then set out to: 1) Describe the content and implementation processes of capacity-strengthening initiatives utilised to strengthen PPI in mental health research. 2) Describe outcome measures used to evaluate the experience or impact of the identified capacity-strengthening initiatives on lived experience contributors and broader research or policy implementation goals. 3) Use the Consolidated Framework for Implementation Research (CFIR) to map identified barriers and enablers of implementing capacity-strengthening initiatives. Objective 2 should perhaps be broader to include the outcomes on researchers (skills, professional development, careers), research team dynamics, research environments and cultures. Objective 3 would align more closely with the Consolidated Framework for Implementation Research (CFIR) if it explicitly explored all five interrelated CFIR domains. These include intervention characteristics, which encompass features such as perceived complexity, adaptability, and strength of evidence; the outer setting, referring to external influences such as policy contexts, funding requirements, and stakeholder needs; and the inner setting, which captures organisational factors including culture, leadership engagement, resource availability, and readiness for implementation. In addition, the characteristics of individuals domain examines the knowledge, beliefs, skills, and motivations of those involved in implementation, while the process domain focuses on how implementation is planned, enacted, reflected upon, and evaluated over time. Explicit engagement with these domains would strengthen the theoretical coherence of the objective and enhance its contribution to implementation-informed analysis. Study Design The authors should justify their selection of CFIR and explain how other implementation frameworks exist and have different purposes e.g., RE-AIM, Theoretical Domains Framework (TDF), PARIHS / i-PARIHS, Normalization Process Theory (NPT), EPIS, Knowledge-to-Action (KTA) Framework. Timeframe Both the timeframe for the review and the publication date range of included articles should be explained. Best practice frameworks for PPI The authors should consider alignment of the scoping review and outcomes to be considered, with best practice frameworks for PPI, for example, but not limited to: Public Involvement Impact Assessment Framework (PiiAF) https://piiaf.org.uk/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6022311/ Public Involvement in Research Impact Toolkit (PIRIT) Public Involvement in Research Impact Toolkit (PIRIT) NIHR ARC North East and North Cumbria, Equality, Diversity and Inclusion (EDI) Toolkit https://arc-nenc.nihr.ac.uk/virtual-college/equality-diversity-and-inclusion-edi-toolkit/ GRIPP2 reporting framework https://doi.org/10.1186/s40900-017-0062-2 Stakeholder consultation The stakeholder consultation phase of the scoping review (as advocated by Levac, Colquhoun, and O’Brien, 2010) could be described in more detail, and a stakeholder engagement framework would provide structure, clarify roles and expectations, and ensure systematic and meaningful involvement of public contributors and other stakeholders throughout the review process. As the authors acknowledge, the field of PPI in mental health research has been shaped by several influential scholars in the UK/Ireland context, whose work provides important context for understanding the significance of the scoping review developed by Anand-Vembar et al. Pioneers such as Diana Rose, Peter Beresford, and Alison Faulkner have emphasized the value of lived experience knowledge, service user leadership, and the ethical and social justice dimensions of involvement. Elizabeth Morrow and Fiona Ross have further advanced critical perspectives on PPI, highlighting issues of power, tokenism, and the need for relational, ethically grounded practices in the context of digital society. Methodologically focused scholars, including Sophie Staniszewska and Kristina Staley, have contributed frameworks and evaluation tools to strengthen the rigor and impact of involvement initiatives. Collectively, these authors provide both the conceptual and practical foundations that inform contemporary efforts to enhance capacity for meaningful PPI in mental health research. Methods The scoping review methods are well chosen and referenced. The following points of clarification could enhance the study protocol. Definition of mental health: Enhance and reference the definition of mental health research being applied in the scoping review. Expand upon the core concepts to include alternative terms and international variations of terms for PPI, PPIE etc. Expand the involvement concept to include involvement, inclusion, participation, engagement, co-production, co-creation etc. the literature does reveal multiple modes for engagement of users. See: https://onlinelibrary.wiley.com/doi/10.1111/hex.13299?msockid=22180b9dbc9b602f14011e31bd5f61b1 Clarify which aspects of the research cycle are included – for example, will the scoping review include pre-award involvement e.g., in identifying research priorities, developing tenders or programmes, research commissioning, review, project research, or research evaluation and assessment practices. Or is capacity building limited to only activities within funded research programmes or structures. The scope needs to be clarified for reproducibility. Explain inclusion/exclusion of user-led research traditions, such as Survivor research, Advocacy research, Volunteer research, and whether or not these will be included. Include hand searching of specific journals: Research Involvement and Engagement, Health Expectations, Research for All, BMJ Open, Patient: Patient-Centered Outcomes Research, BMC Health Services Research, BMC Medicine, International Journal of Integrated Care, Journal of Interprofessional Care, Evidence & Policy. Briefly explain ‘Recovery Colleges across Ireland’, for example, grounded in recovery-oriented and strengths-based principles , Recovery Colleges focus on building knowledge, skills, confidence, and self-management strategies. Analysis In the analysis, interrogate where capacity development occurs, such as within research projects or research institutions, or in communities, educational settings, research ready communities, or member-led educational networks such as University of the Third Age (U3A). An often overlooked analytic perspective concerns the economic costs and added value of PPI initiatives and their resourcing supports. The review should explicitly consider economic perspectives, including the application of social cost–benefit analysis and social return on investment frameworks, to assess whether and how PPI generates value relative to its resource requirements. Incorporating an analysis of any existing economic evidence, alongside identifying gaps in this evidence, would strengthen the review by highlighting what is currently known about the economics of PPI capacity-building and where further empirical work is needed. Provide more detail on who, how and when subject experts will be approached and what they will be asked to contribute to the review and analysis of results. Part of the scoping review methodology is to identify gaps; these experts can usefully provide insight into these gaps. Consider ways to analyse diversity, equity and inclusion in PPI capacity development, for example, in terms of accessibility of research leadership opportunities, training programmes and research leadership academies. Specifically considering intersectionality of mental health with personal protected characteristics and PPI. How might marginalised and underserved and underrepresented groups face additional barriers to involvement? Dissemination The authors could expand upon the dissemination and communication strategy for the scoping review findings to target audiences. In particular consider producing a policy briefing for research funders and evaluators, recommendations for practice, and plain English summary of the findings for lay audiences. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Morrow E, Sloan H, Spencer LH and Lynch M. Reviewer Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r51895 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-51895 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 07 May 2026 Shaakya Anand-Vembar , Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 07 May 2026 Author Response April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review ... Continue reading April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened the clarity and coherence of the protocol's background, have helped align its objectives and data extraction tool, and have increased its methodological robustness. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis. Please find our responses to your specific comments in this document: https://docs.google.com/document/d/1U8BUFtADN3v5IAUZsJ4xqdU7YVDspYuB/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript document, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 1 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened the clarity and coherence of the protocol's background, have helped align its objectives and data extraction tool, and have increased its methodological robustness. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis. Please find our responses to your specific comments in this document: https://docs.google.com/document/d/1U8BUFtADN3v5IAUZsJ4xqdU7YVDspYuB/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript document, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 1 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Competing Interests: N/A Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 07 May 2026 Shaakya Anand-Vembar , Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland 07 May 2026 Author Response April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review ... Continue reading April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened the clarity and coherence of the protocol's background, have helped align its objectives and data extraction tool, and have increased its methodological robustness. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis. Please find our responses to your specific comments in this document: https://docs.google.com/document/d/1U8BUFtADN3v5IAUZsJ4xqdU7YVDspYuB/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript document, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 1 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened the clarity and coherence of the protocol's background, have helped align its objectives and data extraction tool, and have increased its methodological robustness. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis. Please find our responses to your specific comments in this document: https://docs.google.com/document/d/1U8BUFtADN3v5IAUZsJ4xqdU7YVDspYuB/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript document, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 1 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Competing Interests: N/A Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 18 Nov 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 07 May 26 read read Version 1 18 Nov 25 read read read Elizabeth Morrow , Royal College of Surgeons in Ireland, Dublin, Ireland Helen Sloan , Bournemouth University, Poole, UK Llinos Haf Spencer , Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland, Ireland Mary Lynch , Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland, Ireland Miriam Stanyon , Derbyshire Healthcare NHS Foundation Trust, Derby, UK Ramesh Kumar Sangwan , Indian Council of Medical Research National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Morrow E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 May 2026 | for Version 2 Elizabeth Morrow , Royal College of Surgeons in Ireland, Dublin, Ireland 0 Views copyright © 2026 Morrow E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer 1. Response to Author’s revisions (version 2) Thank you to the authors for their careful and constructive revisions made in response to our comments. The manuscript has been substantially strengthened, particularly in relation to clarification of aims and objectives, stakeholder consultation processes, PPI contributor involvement, methodological transparency, dissemination considerations, and acknowledgement of review limitations. The revisions improve the coherence and overall rigor of the protocol and better situate the review within the existing mental health PPI literature. Most reviewer comments have now been addressed satisfactorily. However, there remain a small number of conceptual and methodological areas that would benefit from further clarification prior to final acceptance. We recommend consideration of the following comments to strengthen the manuscript. 1. Theoretical grounding of PPI and involvement While the authors have clarified that theoretical frameworks underpinning initiatives will be extracted during the review process, the protocol itself would still benefit from a slightly stronger engagement with the broader theoretical literature on PPI and participation. The original concern was not necessarily that a single theory should structure the review, but that the protocol could more clearly acknowledge its relationship to wider traditions of participation, co-production, and involvement scholarship (for example, participation continuums, democratic participation traditions, or models of power-sharing in involvement). A brief contextual paragraph would help strengthen the conceptual framing of the review in existing theory. 2. Justification for selection of CFIR The additional clarification regarding CFIR is helpful. However, the rationale for selecting CFIR over other implementation science frameworks could still be articulated explicitly, if only briefly. This does not require an extensive comparison with all alternative frameworks, but a concise justification explaining why CFIR is particularly appropriate for analysing implementation barriers and enablers in heterogeneous PPI capacity-strengthening initiatives would improve methodological transparency. 3. Inclusion of user-led and survivor research traditions The clarification regarding search strategy sensitivity is useful; however, it remains unclear whether survivor-led, advocacy-led, or user-led research traditions are conceptually included within the scope of the review. Given the significance and influence of these traditions within mental health research and PPI scholarship, an explicit statement regarding their inclusion/exclusion would improve clarity and reproducibility. It is possibly an area that the PPI contributors to the study will want clarity on too and whether this evidence is to be included. These remaining points are relatively minor and do not detract from the overall quality and importance of the protocol or the potential contribution of this research to theory and practice. Subject to these further clarifications, we believe the manuscript is suitable for acceptance. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Morrow E. Peer Review Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15883.r55202) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v2#referee-response-55202 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Stanyon M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 12 May 2026 | for Version 2 Miriam Stanyon , Derbyshire Healthcare NHS Foundation Trust, Derby, UK 0 Views copyright © 2026 Stanyon M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for making the changes suggested. Your report of changes was thorough and well executed. I approve this article on a very important topic, for indexing and all the best with the review proper. Competing Interests No competing interests were disclosed. Reviewer Expertise PPI in the area of mental health education and research, systematic reviewing, JBI synthesis methods I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Stanyon M. Peer Review Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15883.r55200) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v2#referee-response-55200 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Sangwan R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Jan 2026 | for Version 1 Ramesh Kumar Sangwan , Indian Council of Medical Research National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India 0 Views copyright © 2026 Sangwan R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The protocol is conceptually strong , rooted in participatory research, epistemic justice, and implementation science, and clearly justified as the first systematic mapping of capacity-strengthening initiatives for PPI in mental health research.​ The aims, review questions, and methods are generally coherent and appropriate for a scoping review, with suitable use of JBI methodology, PRISMA-ScR, and CFIR to structure extraction and analysis.​ The major areas needing refinement relate to: operational clarity (PPI definition and boundaries), search/eligibility precision (especially grey literature and non‑English work), outcome/CFIR operationalisation, and tightening some sections for readability. Strong rationale and positioning Background provides an excellent synthesis of the evolution of PPI, its moral/ethical basis, and specific complexities in mental health (medications, stigma, epistemic injustice, tokenism, power).​ Clear articulation that the focus is on capacity-strengthening for PPI contributors rather than generic PPI or generic training, and that this is a neglected area despite policy mandates.​ Clear aims and review questions Aims are explicit: mapping state of knowledge, identifying outcome measures, and mapping barriers/enablers using CFIR.​ The link between aims and the intended use (VISTA programme, blueprint for Recovery Colleges) is well stated and increases policy/practice relevance.​ Methodological robustness Use of JBI Manual and PRISMA-ScR, with explicit description of how reporting will follow these.​ Use of CFIR to structure barriers and enablers, including reference to the updated 2022 articulation and 39 constructs.​ Planned dual pilot of data extraction on 20% of studies with iterative refinement and consensus processes.​ Thoughtful handling of PPI within the review itself PPI panel composition, roles, and induction/capacity-strengthening activities are clearly described, showing meaningful engagement rather than tokenism.​ Positioning the protocol as part of a broader process evaluation of PPI implementation within VISTA is a notable strength.​ Main weaknesses / risks Scope and definitions need sharper boundaries “Mental health research”, “lived experience PPI contributors”, and “capacity-strengthening initiatives” are described, but practical boundaries could be clearer (e.g. interventions that target mixed groups including clinicians; studies where PPI is one component of a broader co‑production/implementation package).​ The exclusion of studies where >50% of contributors are under 18 is stated, but the handling of mixed adult–youth samples (e.g. 30–40% under 18) is not fully clarified; this could lead to inconsistent decisions.​ Outcome conceptualisation is under-specified While the protocol aims to “identify outcome measures used to evaluate the impact of capacity-strengthening initiatives”, there is no explicit categorisation of outcomes (e.g. at contributor, project, service, and system levels) or how purely process-oriented data (e.g. satisfaction, feasibility) will be treated.​ Some outcomes overlap conceptually with CFIR constructs (e.g. self-efficacy, readiness), which may complicate coding unless this is pre‑planned.​ Grey literature strategy could be more explicit and reproducible The protocol acknowledges that much of the relevant material will be in guidelines, training materials, and organisational documents, but the search procedures (databases, key websites, search strings, use of expert networks) remain high-level.​ Reliance on subject matter experts to identify resources is appropriate but risks selection bias without a more structured description of how they will be engaged and how saturation will be judged.​ Language and geographical limitations Restricting to English-only sources is acknowledged as a limitation but may systematically underrepresent non‑Anglophone contexts where PPI and capacity-strengthening are growing (e.g. Latin America, Asia, francophone Europe).​ The protocol might be perceived as heavily UK/Ireland-centric given the policy examples and VISTA context, which may limit transferability if not explicitly addressed in discussion/interpretation.​ Specific, actionable suggestions 1. Clarify scope and operational definitions Add an operational definition box/table early in the methods with: PPI contributor : clarify inclusion of carers, public representatives, peer workers, and whether “peer workforce” roles employed by services are in or out of scope.​ Mental health research : specify inclusion/exclusion of adjacent areas (e.g. substance use, neurodevelopmental conditions, dementia, psychosocial disabilities).​ Capacity-strengthening initiative : make explicit whether you will include: Training embedded in broader implementation packages. One-off workshops versus longitudinal programmes. Interventions aimed at both PPI contributors and researchers if substantial content targets PPI contributors.​ For age criteria, add a sentence on how you will treat studies with mixed adult–youth PPI (e.g. include if ≥50% are adults or if data for adults can be meaningfully disaggregated).​ 2. Tighten eligibility criteria and PCC+O description In the eligibility section, consider presenting the PCC+O framework as a compact table (participants, concept, context, outcomes) with precise operationalisation and examples of borderline cases.​ Under “Outcomes”, specify: Which types of outcome will be extracted (e.g. changes in research literacy, confidence, role clarity, engagement, co‑production quality, project outputs, service changes).​ How purely descriptive or narrative reflections (common in grey literature) will be treated and coded.​ 3. Strengthen the search strategy description Explicitly list: Databases (already present: MEDLINE, Embase, PsycINFO, CINAHL) plus time frame (from inception to a specified date).​ Example search string (PPI terms × mental health × capacity-building/training × research), either in the main text or as an appendix.​ For grey literature, specify: Key portal sites (e.g. NIHR, INVOLVE/NIHR, NHS England, HSE, PPI Ignite Network, mental health NGOs, Recovery Colleges, WHO, etc.).​ How web search engines will be used (e.g. first 3–5 pages of results for defined search strings; date filtering; language limits).​ How you will document and report grey literature sources (e.g. in a PRISMA-ScR flow diagram and supplementary tables).​ 4. Refine data extraction and CFIR mapping plan Expand one short paragraph to clarify: How CFIR constructs will be operationalised for this topic (e.g. pre‑defined coding framework based on Damschroder 2022; allowance for inductive sub-codes within constructs).​ How you will handle data that does not fit CFIR well, including whether an additional inductive thematic layer will be applied.​ For outcome measures (aim 2), specify that you will: Distinguish between validated instruments, ad hoc measures, and qualitative outcome indicators. Capture psychometric properties or at least basic details when available (e.g. scale names, domains, scoring) to inform future evaluation design.​ 5. Reporting and limitations In the limitations section, consider briefly adding: A note on the potential under‑representation of low- and middle-income country contexts due to language and grey literature access constraints.​ A short statement about how findings will be framed as hypothesis‑generating and agenda‑setting rather than as a definitive causal evidence base, in line with the scoping review design.​ Language and structure refinements The manuscript is generally well written, but some paragraphs in the background are very dense and could be broken into shorter units to improve readability for non‑specialist readers.​ Where long citation clusters occur (e.g. lines with 5–7 references), consider checking whether all are needed or whether a smaller set of exemplar references would suffice.​ Check for minor formatting consistency (e.g. hyphenation of co‑production vs co-production, use of em dashes, and consistency in terms like capacity-strengthening vs capacity building). Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Adolescent Health, Maternal & Child Health, Mental Health and Medical Sociology. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 07 May 2026 Shaakya Anand-Vembar, Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland Dear Dr Ramesh Kumar Sangwan, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened our understanding of the protocol's scope and inclusion criteria, allowed us to develop a more detailed grey literature strategy, and helped us improve the conceptualisation of our outcomes. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis in this document: https://docs.google.com/document/d/1laCzkT8bjSUagmVchmRTrH1ECNonIZ9x/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 3 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors View more View less Competing Interests N/A reply Respond Report a concern Sangwan RK. Peer Review Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r52834) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-52834 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Stanyon M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Jan 2026 | for Version 1 Miriam Stanyon , Derbyshire Healthcare NHS Foundation Trust, Derby, UK 0 Views copyright © 2026 Stanyon M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article reports a protocol for a scoping review following JBI guidelines to look for ways to build capacity for involvement of patients and members of the public in mental health research. Barriers and enablers will be categorised according to the CFIR domains. The methodology for searching and screening is all thorough and well explained. My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Other than this I think this is a very well written protocol. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise PPI in the area of mental health education and research, systematic reviewing, JBI synthesis methods I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 07 May 2026 Shaakya Anand-Vembar, Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland April 7th, 2026 Dear Dr Miriam Stanyon, We thank you for taking the time to peer review our scoping review protocol; we greatly appreciate your expertise and your comments on the protocol. Your suggestion regarding the data extraction tool has helped us increase the review's methodological robustness. Please see below for our response to your comment, and please refer to changes in the appendix file, in Appendix A, for the changes pertaining to your comment. We hope that the revisions to the data extraction tool sufficiently address your suggestion. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors Reviewer 2 Comment: My one comment for data extraction is that your data extraction method for the third aim is difficult to conceptualise. Maybe in your appendix you could include an example, with example text that would come under the different constructs, or state the kind of elements from an article that may be extracted into the table. Author Response: Example text for each domain has been added to Appendix A (Data Extraction Tool Informed by CFIR). View more View less Competing Interests N/A reply Respond Report a concern Stanyon M. Peer Review Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r52835) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-123/v1#referee-response-52835 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Morrow E et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Dec 2025 | for Version 1 Elizabeth Morrow , Royal College of Surgeons in Ireland, Dublin, Ireland Helen Sloan , Bournemouth University, Poole, England, UK Llinos Haf Spencer , Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland, Ireland Mary Lynch , Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland, Ireland 0 Views copyright © 2026 Morrow E et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions INTRODUCTION Our review of the article by Anand-Vembar and co-authors is intended to complement, enhance, and constructively support this important scoping review by critically engaging with its aims, methodological approach, and conceptual framing. As the authors state, public and patient involvement (PPI) has become an increasingly important component of mental health research, reflecting a broader shift towards participatory, inclusive, and ethically grounded health research practices. It is important to foreground the scoping review in the realist questions - what is the evidence on what works, for whom, when, and why, and who may currently be missing out? There is a growing body of evidence to show that meaningful PPI has the potential to enhance the relevance, integrity, acceptability, quality, and impact of research by involving those with firsthand experience or ‘lived experience’ throughout the research process. Additionally, benefits associated with involvement extend beyond improved research relevance and quality to include opportunities for mutual learning between researchers and public contributors, the development of shared understanding through the integration of experiential and academic knowledge, and the redistribution of decision-making power, thereby challenging traditional hierarchies within mental health research and promoting more equitable and collaborative research practices. Thus, PPI can be understood through several conceptual lenses. It may be instrumental, where involvement is used to improve the quality or efficiency of research; normative or democratic, where involvement is valued as an ethical right and a matter of accountability; and substantive, where public contributors’ lived experience shapes and influences research questions, methods, or outcomes. Despite strong policy support and growing expectations from funders and institutions, the implementation of PPI in mental health research remains inconsistent, and researchers often report challenges related to skills, resources, organisational support, and sustainability. Capacity-strengthening initiatives have therefore emerged as a key strategy to support researchers, public contributors, and organisations in developing the knowledge, confidence, and structures required for effective involvement. Article summary The article by Anand-Vembar et al. presents a study protocol for a scoping review that aims to identify and synthesise evidence on the barriers and enablers to implementing capacity-strengthening initiatives for PPI in mental health research. Guided by the Consolidated Framework for Implementation Research (CFIR), the protocol outlines a systematic and theory-informed approach to mapping existing initiatives and the contextual factors influencing their implementation. As a study protocol published in an open-research format, the article does not report findings but instead provides transparency around the planned methods and analytical framework. This review critically examines the article’s rationale, methodological approach, and anticipated contribution to the field, considering its strengths, limitations, and potential value for advancing PPI practice and implementation science in mental health research. Focus of the review In the study protocol, capacity-building is defined as initiatives designed to enhance the knowledge, skills, confidence, and resources of both researchers and public contributors, as well as the organisations that support them, to enable meaningful public and patient involvement (PPI) in mental health research. The concept encompasses both individual-level capacity, such as training and mentoring, and organisational-level capacity, including the development of supportive structures, processes, and cultures for involvement. Importantly, capacity-building is framed not merely as increasing the number of involvement activities but as fostering sustainable, effective engagement. By situating capacity-building within the Consolidated Framework for Implementation Research (CFIR), the protocol positions it within a broader system of enablers and barriers, highlighting the interplay between people, practices, and organisational contexts in shaping successful PPI implementation. GENERAL COMMENTS The study protocol by Anand-Vembar et al. presents a rigorous and transparent plan for a scoping review of capacity-strengthening initiatives for public and patient involvement (PPI) in mental health research. By explicitly mapping barriers and enablers using the Consolidated Framework for Implementation Research (CFIR), the protocol demonstrates a strong theoretical grounding and methodological clarity. While it does not report empirical findings, the detailed approach enhances reproducibility and provides a clear roadmap for subsequent analysis. Moreover, the open-access publication and adherence to open-research principles align with current best practices in research transparency and knowledge sharing, which is particularly relevant for advancing evidence-informed PPI in mental health. Overall strengths of the study protocol are: Transparent methodology: The article clearly outlines the databases, inclusion criteria, and data extraction processes. Focus on capacity-building: Addresses an important gap in PPI research by examining how initiatives are implemented, not just whether they exist. Theoretical framework: Uses CFIR to structure barriers and enablers, providing a robust implementation science lens for the analysis. Open-access publication: Promotes transparency, reproducibility, and early community engagement in the scoping review. Main limitations: Justification could be stronger: The rationale for the review could be strengthened by engaging more with existing literature bases, theory and PPI frameworks. Potentially narrow scope: The review may miss innovative, user-led or informal PPI initiatives not captured in published or indexed literature. Grey literature and stakeholder consultation phases of the review could support a more robust process. Limited discussion of theory and context variability of PPI across international settings CFIR is a suitably broad framework, but alternative implementation frameworks are not discussed and differences across countries, health systems, or cultural contexts may not be fully addressed. Unclear stakeholder involvement in review process: While the review is about PPI, the protocol does not detail whether public contributors were involved in shaping the review question, or exactly how PPI members will be involved in the analysis or interpretation of the scoping review results. Rapidly evolving field: PPI practices and guidelines change quickly; there is a risk the review could miss very recent initiatives or emerging approaches by the time it is completed. Data synthesis challenges: Scoping reviews often map evidence without assessing quality in depth, which may limit actionable recommendations. SPECIFIC COMMENTS Attention to the drivers of PPI in research: The paper does not explicitly acknowledge key drivers of PPI in research, such as policy mandates, high-profile failures within health systems (for example, Bristol Royal Infirmary or Alder Hey), or the advocacy and lobbying roles of consumer, survivor and service user groups. Nor does it clearly link the discussion of involvement to influential policy developments and inquiries, such as the Francis Inquiry, which have been instrumental in shaping contemporary expectations around patient involvement in healthcare and health research. The absence of this contextual and policy grounding risks presenting involvement as an abstract or optional activity, driven primarily by anticipated outcomes, rather than as a practice deeply rooted in historical lessons from system failures, ethical imperatives, research governance and regulatory requirements. Existing research and theory: The authors touch only briefly on several important issues- such as power imbalances, stigma, and limited capacity to contribute to research- each of which represents a substantial area of scholarship in its own right. At a minimum, the authors could acknowledge the breadth of the existing literature on these topics and more clearly articulate how the scoping review will contribute to and intersect with these distinct bodies of work. Engagement with theoretical perspectives of involvement: As it stands the objectives of the scoping review offers limited potential for advancing theoretical understanding of engaged research, as it does not sufficiently engage with existing theories or conceptual models of PPI. Theory building is constrained when a study does not explicitly build on established theoretical frameworks, yet the authors draw almost exclusively on empirical evidence. As a result, substantial bodies of literature and well-established models of involvement- such as Arnstein’s ladder of participation, Hickey and Kipping’s continuum, Tritter and McCallum’s mosaic model, and Smith et al.’s typology of involvement- are absent from the objectives and focus of the analysis. Similarly, existing models of PPI impact, including those developed by INVOLVE, and GRIP2 reporting guidelines are not considered. This lack of theoretical engagement means that the scoping review proposed in the paper appears conceptually underdeveloped and somewhat isolated from the extensive scholarship on patient involvement across health and social care, research, education, and broader traditions of civic engagement and public participation in public sector decision-making. Benefits and beneficiaries of the scoping review: Part of the rationale should be to outline the potential benefits and beneficiaries of this scoping review beyond the immediate benefits to informing the wider study. Consistency of aims and objectives: There is inconsistency between the aims described in the abstract and the main body of the paper. The aim as defined in the abstract is to “determine the state of knowledge concerning PPI in mental health research capacity-strengthening initiatives; identify the outcome measures used to evaluate the impact of capacity strengthening initiatives for PPI on contributors, research processes, and policy; and map the barriers and enablers to the implementation of capacity strengthening initiatives for PPI.” The first part of the aim differs from the aim expressed in the body of the paper, which is described as to “describe existing training programmes, onboarding activities, and other skill-building initiatives directed at PPI members in this area, and identify and categorise barriers and enablers to implementing these initiatives.” The objectives are then set out to: 1) Describe the content and implementation processes of capacity-strengthening initiatives utilised to strengthen PPI in mental health research. 2) Describe outcome measures used to evaluate the experience or impact of the identified capacity-strengthening initiatives on lived experience contributors and broader research or policy implementation goals. 3) Use the Consolidated Framework for Implementation Research (CFIR) to map identified barriers and enablers of implementing capacity-strengthening initiatives. Objective 2 should perhaps be broader to include the outcomes on researchers (skills, professional development, careers), research team dynamics, research environments and cultures. Objective 3 would align more closely with the Consolidated Framework for Implementation Research (CFIR) if it explicitly explored all five interrelated CFIR domains. These include intervention characteristics, which encompass features such as perceived complexity, adaptability, and strength of evidence; the outer setting, referring to external influences such as policy contexts, funding requirements, and stakeholder needs; and the inner setting, which captures organisational factors including culture, leadership engagement, resource availability, and readiness for implementation. In addition, the characteristics of individuals domain examines the knowledge, beliefs, skills, and motivations of those involved in implementation, while the process domain focuses on how implementation is planned, enacted, reflected upon, and evaluated over time. Explicit engagement with these domains would strengthen the theoretical coherence of the objective and enhance its contribution to implementation-informed analysis. Study Design The authors should justify their selection of CFIR and explain how other implementation frameworks exist and have different purposes e.g., RE-AIM, Theoretical Domains Framework (TDF), PARIHS / i-PARIHS, Normalization Process Theory (NPT), EPIS, Knowledge-to-Action (KTA) Framework. Timeframe Both the timeframe for the review and the publication date range of included articles should be explained. Best practice frameworks for PPI The authors should consider alignment of the scoping review and outcomes to be considered, with best practice frameworks for PPI, for example, but not limited to: Public Involvement Impact Assessment Framework (PiiAF) https://piiaf.org.uk/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6022311/ Public Involvement in Research Impact Toolkit (PIRIT) Public Involvement in Research Impact Toolkit (PIRIT) NIHR ARC North East and North Cumbria, Equality, Diversity and Inclusion (EDI) Toolkit https://arc-nenc.nihr.ac.uk/virtual-college/equality-diversity-and-inclusion-edi-toolkit/ GRIPP2 reporting framework https://doi.org/10.1186/s40900-017-0062-2 Stakeholder consultation The stakeholder consultation phase of the scoping review (as advocated by Levac, Colquhoun, and O’Brien, 2010) could be described in more detail, and a stakeholder engagement framework would provide structure, clarify roles and expectations, and ensure systematic and meaningful involvement of public contributors and other stakeholders throughout the review process. As the authors acknowledge, the field of PPI in mental health research has been shaped by several influential scholars in the UK/Ireland context, whose work provides important context for understanding the significance of the scoping review developed by Anand-Vembar et al. Pioneers such as Diana Rose, Peter Beresford, and Alison Faulkner have emphasized the value of lived experience knowledge, service user leadership, and the ethical and social justice dimensions of involvement. Elizabeth Morrow and Fiona Ross have further advanced critical perspectives on PPI, highlighting issues of power, tokenism, and the need for relational, ethically grounded practices in the context of digital society. Methodologically focused scholars, including Sophie Staniszewska and Kristina Staley, have contributed frameworks and evaluation tools to strengthen the rigor and impact of involvement initiatives. Collectively, these authors provide both the conceptual and practical foundations that inform contemporary efforts to enhance capacity for meaningful PPI in mental health research. Methods The scoping review methods are well chosen and referenced. The following points of clarification could enhance the study protocol. Definition of mental health: Enhance and reference the definition of mental health research being applied in the scoping review. Expand upon the core concepts to include alternative terms and international variations of terms for PPI, PPIE etc. Expand the involvement concept to include involvement, inclusion, participation, engagement, co-production, co-creation etc. the literature does reveal multiple modes for engagement of users. See: https://onlinelibrary.wiley.com/doi/10.1111/hex.13299?msockid=22180b9dbc9b602f14011e31bd5f61b1 Clarify which aspects of the research cycle are included – for example, will the scoping review include pre-award involvement e.g., in identifying research priorities, developing tenders or programmes, research commissioning, review, project research, or research evaluation and assessment practices. Or is capacity building limited to only activities within funded research programmes or structures. The scope needs to be clarified for reproducibility. Explain inclusion/exclusion of user-led research traditions, such as Survivor research, Advocacy research, Volunteer research, and whether or not these will be included. Include hand searching of specific journals: Research Involvement and Engagement, Health Expectations, Research for All, BMJ Open, Patient: Patient-Centered Outcomes Research, BMC Health Services Research, BMC Medicine, International Journal of Integrated Care, Journal of Interprofessional Care, Evidence & Policy. Briefly explain ‘Recovery Colleges across Ireland’, for example, grounded in recovery-oriented and strengths-based principles , Recovery Colleges focus on building knowledge, skills, confidence, and self-management strategies. Analysis In the analysis, interrogate where capacity development occurs, such as within research projects or research institutions, or in communities, educational settings, research ready communities, or member-led educational networks such as University of the Third Age (U3A). An often overlooked analytic perspective concerns the economic costs and added value of PPI initiatives and their resourcing supports. The review should explicitly consider economic perspectives, including the application of social cost–benefit analysis and social return on investment frameworks, to assess whether and how PPI generates value relative to its resource requirements. Incorporating an analysis of any existing economic evidence, alongside identifying gaps in this evidence, would strengthen the review by highlighting what is currently known about the economics of PPI capacity-building and where further empirical work is needed. Provide more detail on who, how and when subject experts will be approached and what they will be asked to contribute to the review and analysis of results. Part of the scoping review methodology is to identify gaps; these experts can usefully provide insight into these gaps. Consider ways to analyse diversity, equity and inclusion in PPI capacity development, for example, in terms of accessibility of research leadership opportunities, training programmes and research leadership academies. Specifically considering intersectionality of mental health with personal protected characteristics and PPI. How might marginalised and underserved and underrepresented groups face additional barriers to involvement? Dissemination The authors could expand upon the dissemination and communication strategy for the scoping review findings to target audiences. In particular consider producing a policy briefing for research funders and evaluators, recommendations for practice, and plain English summary of the findings for lay audiences. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 07 May 2026 Shaakya Anand-Vembar, Trinity College Dublin School of Nursing and Midwifery, Dublin, Ireland April 7 th , 2026 Dear Dr Elizabeth Morrow, Ms. Helen Sloan, Dr Llinos Haf Spencer, and Prof. Mary Lynch, We thank you for taking the time to peer review our scoping review protocol and greatly appreciate your expertise and suggestions. Your comments have provided us with important insights that have strengthened the clarity and coherence of the protocol's background, have helped align its objectives and data extraction tool, and have increased its methodological robustness. We have carefully considered the specific points raised in the review, and have addressed them on a point-by-point basis. Please find our responses to your specific comments in this document: https://docs.google.com/document/d/1U8BUFtADN3v5IAUZsJ4xqdU7YVDspYuB/edit?usp=sharing&ouid=107131347417362362861&rtpof=true&sd=true Please refer to both the tracked changes in the revised manuscript document, as well as tracked changes in the appendix file. Changes pertaining to your comments have been marked as 'Reviewer 1 Comment __’ in the comments within the revised manuscript, for ease of tracking. We hope that the revisions sufficiently address your comments; any suggestions that were found to be out of scope for this review will certainly be considered in the write-up of the final publication. Thank you again for your time and attention, Dr Shaakya Anand-Vembar, on behalf of all authors View more View less Competing Interests N/A reply Respond Report a concern Morrow E, Sloan H, Spencer LH and Lynch M. Peer Review Report For: Barriers and enablers to implementing capacity-strengthening initiatives for public and patient involvement in mental health research: a scoping review protocol informed by the Consolidated Framework for Implementation Research [version 1; peer review: 1 approved, 2 approved with reservations] . HRB Open Res 2025, 8 :123 ( https://doi.org/10.21956/hrbopenres.15719.r51895) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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