Creating a collaborative and impactful research environment: community partner reflections on the DeStress-II study

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However, research ‘impact’ is often only considered in terms of study findings and their wider implications for policy and practice. Less attention has been placed on understanding the motivations and experiences of individuals who engage in research in a PPI role, or any impact they feel this has within their lives. Understanding this is important, particularly in areas such as mental health where there is significant potential for power differentials in the research experience. The DeStress-II project developed a training resource for primary care practitioners to deliver supportive consultations with people experiencing poverty related mental distress. The resource was developed collaboratively with a team of Community Partners with lived experience from three regions of the UK. This paper presents the experiences of the Community Partners who were involved in all aspects of the research, developing and delivering the training, co-producing an online training resource and supporting the analysis of its implementation. We focus on what they feel helped to sustain their engagement, and the impacts of this at both an individual and group level. Methods : A reflective evaluation using data from two focus groups and individual semi-structured interviews with Community Partners (n=10). Results : Findings highlight the importance of extending the notion of impact beyond traditional boundaries of academic research to also consider individual and collective patient and public benefits of involvement. Community partners identified key factors supporting their engagement including (i) a dedicated Community Connector role; (ii) feeling part of and valued within the research team; (iii) the development and quality of relationships. Community Partners identified impact at a personal level, including growth in confidence and a desire to create a legacy of work that continued beyond the life of the research project. Conclusions : Understanding how patient and public involvement in research is experienced is an important element of research impact. Dedicated time and resources are needed to ensure researchers can create environments which foster and support positive personal impact when working with people with lived experience. Patient and public participation impact mental health poverty primary healthcare co-production. Background Patient and public involvement (PPI) in research can meaningfully improve the relevance and impact of research. 1,2,3 Whilst patient and public involvement is now mandated by most national research funders in the UK 4 research involvement ‘impact’ is too often considered only in terms of the study findings and their wider implications for policy and practice. 5,6 This approach to understanding and capturing impact aligns with a consumerist approach to PPI in which involvement supports the securing of research outcomes. However, an alternative framing of public involvement views it through a rights-based lens in which the processes of engagement and involvement themselves deliver impact through individual and group-based empowerment. 7,8,9 Relatively little attention has been placed on understanding the broader motivations and experiences of those individuals who engage in research in a PPI role, the factors which help sustain their engagement, or any impact they feel their involvement in the research has had within their wider lives. Understanding this is important, particularly in areas such as mental health where there is significant potential for power differentials in both clinical settings and within the research experience itself. 10,11 Better understanding of how researchers can create the conditions for more meaningful involvement of people with poor mental health experiences is therefore needed both to strengthen approaches to public involvement and reduce power variance. 11 In this paper, we adopt a relational approach to research impact that recognises how involvement can support individual and collective development, particularly when processes are inclusive, values-led and effectively resourced. This approach draws on empowerment theory and co-production literature, 13,14 which demonstrate the importance of mutual trust and respect and shared control over the duration of research projects. We apply this theory to the experiences of Community Partners involved in the DeStress-II project. The DeStress II project DeStress is an interdisciplinary research programme exploring the links between poverty and mental health and working with patients and healthcare providers to understand how patients can be better supported within primary healthcare. This work began with a qualitative study (DeStress-I, 2016–2019) exploring the ways poverty-related mental distress was experienced in low-income communities and responded to within primary healthcare settings. This was followed by a second phase of work (Destress-II, 2021–2024) which aimed to co-design and deliver a training intervention to support primary care practitioners to hold more effective consultations with patients experiencing poverty-related mental distress. Community Partners played a central role in shaping the structure and content of the training as well as its delivery. The first phase of DeStress-II involved training delivered in-person by teams comprising a GP, a Community Partner (a person with lived experience of poverty-related mental distress) and an academic researcher. Within the training sessions, Community Partners (CP) spoke to primary care teams about the intersections between poverty and mental health, with most drawing on their own experiences to impart key learning objectives. They also spoke from a patient’s perspective about what they felt made for a positive or negative consultation experience within primary care. Training was delivered in 53 practices across three areas of England. Feedback helped us to refine the training and develop this as an online resource that has now been made freely available to GP practices across England (for more information on the process of developing the training see Thomas et al. 2024 ). 15 Feedback received from primary care teams consistently attested to the power of the community partner narratives within the training. The online resource therefore includes a wide range of community partner narratives and a simulated consultation demonstrating what CPs felt that a positive GP consultation could look like. This paper reports on the experiences of the community partners who worked alongside academics and practitioners to co-develop and deliver this training resource. We explore how Community Partners were supported to remain involved over the duration of the research, their experiences of personal development and the resulting peer support and sense of collective purpose. Engagement of Community Partners Recruitment and retention of community partners in DeStress II evolved through a multi-phased, adaptive process beginning in late 2021. Opportunities for involvement in the research were advertised through the networks of three university PPI teams as well as via a range of local community groups across the three research sites. Those expressing an interest in taking part were invited to attend an initial online workshop to understand more about the study (November 2021) being co-chaired by experienced community co-researchers from DeStress I. Nineteen community partners initially signed up and indicated that they were willing to consider co-delivering the training within primary care. To address the understandable apprehension raised amongst the community partners, informal, peer-led ‘drop-ins’ were set up to provide regular and sustained support throughout the project, and to build space for collective learning and confidence-building. Challenges related to mental health and confidence were often expressed, particularly at the start of the project, necessitating additional one-to-one support alongside reassurances that people could engage flexibly, according to what was possible for them at the time. The CPs were located across the three study sites and were supported remotely and in person, by a Community Connector. This role enabled and facilitated the CPs to design their own ways of working together to support the project (and themselves), during the project and after its official end date. The Community Connector acted as a link between the CPs, academic researchers and GP trainers supporting both communication and continuity. As the DeStress-II research progressed, the CPs were encouraged to attend weekly meetings with the wider research team to involve them with strategic decision making and to ensure their input on the content and dissemination of the online training resource. Bringing together the reflections of the community partners, this co-authored paper explores the experiences of the CPs involved in the DeStress-II project. Rather than focusing on the research outcomes and outputs (reported in Thomas et al. 2024 ), 15 this paper reports on the CP’s experiences of supporting the delivery of the project, the factors and processes that they felt supported their sustained engagement and the impact they feel research involvement had within their broader lives. As a result, we offer insights into how research projects can be consciously created and an involvement culture sustained which centres lived experience and empowerment through flattening traditional hierarchies in how mental health research is conducted. Methods This paper provides a reflective evaluation of the engagement approach used within DeStress II from the perspectives of community partners who were involved in the project. They and the wider research team felt that understanding and documenting motivations and experiences of involvement would provide an important opportunity for reflective learning which could inform other research. It was agreed that focus groups would provide an appropriate forum for this, although individual interviews were also offered when this was more convenient for participants. Community partners felt that it was appropriate for the focus groups and interviews to be facilitated by academic members of the research team in each locality. In total 10 CP participants were included in the data collection (see Table 1 ). Four participants were male, six were female. Three were from a South Asian background; seven were from a white British background. Table 1 Numbers and format of CPs by region. Region Focus group numbers Individual interviews South-West 3 0 North-West 3 1 North Thames 0 3 Table 1 GRIPP2 1. Aim – Report the aim of PPI in the study Plain English Summary (p. 2): states the paper reports CPs’ experiences, factors sustaining engagement, and impacts at individual and group levels. Abstract (p. 2): reiterates aim to present experiences of CPs across all aspects of the project. Background (pp. 3–4): frames the rationale for focusing on PPI experiences. 2. Methods – Provide a clear description of the methods used for PPI Methods (pp. 7–8 ) : reflective evaluation using focus groups and interviews (n = 10); CPs co-developed questions, reviewed interpretations, checked findings, selected quotes, and co-authored the paper. 3. Study results – Outcomes (positive and negative) of PPI Results ( pp. 9–16 ) : Positive outcomes – increased confidence, sense of community, peer support, feeling valued, influencing training, legacy work, healing/validation, wider opportunities. Challenges/negatives – initial apprehension, stigma, low confidence, concerns about framing experiences, need for strong support (Community Connector, peer drop-ins). 4. Discussion and conclusions – Outcomes, extent of influence, positive and negative effects Discussion ( pp. 17–18 ) : CP involvement influenced study design, training delivery, and online resources; highlights empowerment, flattening hierarchies, and wellbeing impacts; notes limitations (online format, emergent processes, replication challenges). Conclusions (pp. 20–21 ) : meaningful involvement required resources, shared power, and relational practices; CPs influenced all aspects of the project and left an enduring legacy. 5. Reflections/critical perspective Strengths and Limitations (pp. 18–20 ) : critical reflection: what worked well (drop-ins, Community Connector, collaborative analysis, relationships), what may not transfer easily (ad hoc processes, reliance on resources). Notes continuation of CP collaboration beyond the project as evidence of deeper impact. A focus group and interview schedule were developed with community partners to support the discussions. The questions were broad and open ended but explored multiple aspects of the CPs experience with the project, co-production of the research, reasons for sustained engagement and individual and collective impact. Interviews and focus group discussions were audio-recorded via Microsoft Teams and then transcribed verbatim. Transcriptions were uploaded to NVivo 14. Two authors (JH, AM) individually read the transcripts and identified themes. They then met to discuss and agree these before re-visiting clean transcripts in NVivo to code with these specific themes in mind and identify quotes they felt exemplified the content of the themes. Direct reflections on the training delivery and development were excluded as this was not the purpose of this paper. Once coding was completed, the authors agreed an overview of the main themes and anonymised supporting quotes. This was then presented to the CPs at a weekly online drop-in session to check they agreed with the findings and to clarify that what they felt was important was represented in the data. Final quotes to exemplify the themes were selected and agreed by all CP co-authors. For this reason, quotes used in this paper are not attributed to any particular participant. This process reflects our approach to collaborative analysis with CPs reviewing interpretations and refining the manuscript to ensure findings remained true to their lived experiences. Following CP feedback on this overview the paper was drafted (AM, JH), shared and re-drafted with further feedback from all the co-authors. All authors contributed to the final draft of the paper. Ethics The study was approved by the Frenchay REC (IRAS303179). Results Reflecting on their work with DeStress II it became clear that community partner involvement and relationship building with each other extended beyond simply supporting research findings and outputs. Initial motivation for involvement was key, alongside a number of factors which helped to ensure the ongoing engagement of community partners, including (i) a dedicated Community Connector Role; (ii) feeling part of and valued within the research team; and (iii) the development and quality of relationships. Community Partners also identified impact at a personal level, including growth in confidence and a desire to create a legacy of work focused on mental health that continued beyond the life of the research project. Motivation for involvement Community Partners described various reasons they participated in the project including both personal and from a position of collective advocacy. A consistent theme was wanting to improve things for others based on their own experiences of distress, disempowerment or exclusion. Sharing lived experience Amongst the CPs there was a strong sense of wanting to improve care for those living with poor mental health. The CPs gave a number of reasons underlying this, including: (i) their own poor experiences of primary care consultations for mental distress; ii) the need to raise awareness amongst health providers around the dual challenges of poverty and poor mental health; iii) the need to combat mental health stigma in certain communities (e.g., South Asian communities); iv) recognition that primary care providers were under considerable pressure, and could benefit from targeted training to better support the high number of consultations for poverty related mental distress they had to deal with, I wanted to feedback, help, in any way I could. Even if it just helps one person, me telling my story, that’s why I wanted to be part of the project. People are not familiar with this type of service, people have not been educated, people feel they cannot share this because the other members of the community will know that somebody has got mental health problems and they’re asking for help, so these are many barriers. First culturally [mental health] is stigmatised, second language barrier, third they do not know, they have not been educated, they do not know these services are available. CPs described feeling compelled to use their own personal knowledge and experience of poor mental health to help educate and raise awareness amongst primary care providers, particularly when their own experiences had been negative, For me, I've had such a battle and been in such a terrible place for so long. When I got help – which was not through the NHS at all - and I started to feel better, I knew somehow I had to try and use my voice to share how terrible it [poor mental health] is, because I didn’t want anybody to be in that place I was in. I was in a place where I didn’t think I could be reached, I didn’t think anyone could help me, and not just once – it was up and down over eight, nine years. [it’s the] the very fact that we’re doing it, and that all for me is historical because of my experiences with having a bad GP and the stigma of mental health… that’s all been historical. And seeing things change for the better and understanding other people’s lives. Enabling reflection and increasing personal knowledge In addition to wanting to better educate medical professionals about the ways wider socio-economic circumstances impacted on mental health, CPs also spoke about how involvement had increased their own knowledge and understanding of their own mental health. In particular, CPs described feeling validated about aspects of their mental health that had seemed intuitive (e.g., the influence of poverty), but the complexity of which had not ever (they felt) been recognised explicitly by professionals. …to be able to join knowing that intuitively and then have my understanding validated and supported and to know that as much as there may have been negative experiences, the general consensus or understanding seems to be that these nuances, important nuances… well whatever it is, it’s just important that they are understood, that depression is understood in a more complex understanding, that mental distress is understood and that actually a lot of the mental distress may never have happened without the context of poverty is very healing in a longer-term process to realise. Seeing a difference and feeling valued For the two CPs who had been involved in the initial DeStress study (Destress I), the ability to see small changes in health care professionals’ understanding and approaches to mental health over time was important and encouraged sustained engagement, For me, what I think is the doctors’ surgeries are changing, from when we first started, I think back in 2016, from then to now… It’s completely different. It was a positive thing to do, not just for my own mental health, but seeing how far they’ve [GPs] come and seeing the difference between then and now. CPs also spoke about how their involvement and influence within the wider team meant that they felt their contributions and ideas were valued, I've loved hearing more about the project and I do really feel, as I said earlier, we've definitely been listened to in shaping the new online training. I know everybody’s voices… And [CP’s] ideas of one to one, a bit of roleplay has been used, so they’ve definitely listened to us and used our ideas. It’s been good. These reflections reinforce the importance of recognising PPI contributors not solely as possessing knowledge for use by the research team but as co-producers of research, being heard and shaping the process and outcomes. CPs spoke about how their involvement in Destress felt different to other research projects they had been part of. This seemed to be due to two distinct factors: (i) the strength of the focus on co-production; and (ii) the support provided by the Community Connector. Whilst distinct factors in how the research was delivered and how CP involvement was supported, the support and genuine commitment to coproduction created a sense of community which was fostered throughout the project, The difference is that I think the DeStress project was very thorough and also very engaging and coproduced […] It wasn’t a – what’s the word – tick-box exercise for coproduction, it actually is a full coproduction. So that’s the difference between this project and say some other sort of things that I’ve been involved with. I have been working for the last eight years as a full-time public advisor and never seen this unique technique of having a drop-in session where you can ask for help Having a Community Connector role ensured that dedicated time was available to help ensure that CP’s needs for engaging in the project could be met. This included ensuring that CPs were contacted in a way and at a time that worked best for them, and supporting CPs with logistical issues such as paying their expenses in advance and ensuring they could get to the training location without undue anxiety, Some of the projects I've worked on previously, it’s felt very much like you come in, do your bit, go home, and that’s that. This hasn’t felt like that. It really feels like every angle of everything… Even things like transport was taken into consideration. For some of the face to face, it was ‘How are you going to get there? Do you know where you're going, where to park?’ All those nitty gritty things were really thought of and sometimes that’s not something everyone takes into consideration or cares about. So I really appreciated the whole wraparound. It’s felt really well supported in every angle. I think that’s sometimes we don’t talk about enough, but it’s really nice to see in a project Pairing community partners with GPs for co-delivery of the training also helped foster mutual respect and trust, flattening traditional hierarchies and supporting sustained involvement in the research. Ultimately, the conditions which enabled the recruitment and retention of the CPs were underpinned by flexible and adaptive processes, peer support mechanisms, and the meaningful integration of lived experience in a central, action-oriented role rather than an advisory capacity. Feeling valued and part of a community One of the most dominant reflections from CPs centred around the development of a sense of community and the feelings of value and support they found within this. This appears to have been formed and sustained both from being with each other as well as through interactions with the wider research team. Having the opportunities to spend time with the other CPs was valued on a number of levels including support for the delivery of training and in terms of making friendships. Peer support CPs newer to the role of research collaboration valued the support offered by the more research-experienced CPs and felt reassured by them being able to take the lead in delivering the training until their own confidence to deliver training to healthcare practitioners had built. The regular drop-in created safe space not only for building skills and confidence, but also for sharing feelings and building solidarity. Over time, this opportunity for peer support contributed to a sense of collective efficacy. I just wanted to say I don’t think we’d have ever got to that point, of all being able to be that brave, if we hadn't had the drop-in sessions Community Connector role The role of the Community Connector was perceived by the CPs as crucial to both the success of the project and their continued engagement with it. The Community Connector provided effective and reassuring communication and support (at an individual and group level) that sustained activity and motivation to be involved. This role served as a central connection between the CPs, and also with the wider research team and training delivery partners (GPs). Part of this role involved hosting the bi-weekly drop-in sessions which helped to build trust both within the CPs as a group, and with the Community Connector. As trust built, CPs felt able to voice concerns over training delivery and their ability to do it ‘right’. For example, one CP spoke to the Community Connector about her concerns over framing her experiences of primary care consultations when she didn’t feel they had been positive, Because I didn’t really have anything positive, I didn’t want to go in with them thinking I was being negative, which I was trying not to be, but it really helped because I was getting myself in a right old state and I said to [Community Connector] about it and she said ‘There's no right or wrong way of doing this. If you haven't got a positive example, what did help you? Try and use some of the ways you did get through it.’ CPs valued the warmth and openness of the Community Connector and explained how having someone in this dedicated role made continued engagement in all aspects of the research much more likely than it may have been otherwise. The Community Connector was perceived both as a professional and a point of contact and support, which was a unique experience for some who had been involved in other research projects, I know from how I got into it, that that relationship, meeting her, the way she made it so easy and comfortable to connect, take away any of the worries and things like that, was really pivotal in my story anyway, and I think all the way through this journey, they, for me been the connection that has linked in but in such a way that hasn’t felt scary and it’s felt comfortable always like I could be very honest with them and they would be honest back It’s just so different, so exceptional, I mean what can you say? They’re a star, so that’s the difference, it’s the professional bit of it and then there’s the friendly bit of it, that’s been in there so yes, definitely, very different. I’ve not come across them all the years I’ve been involved in anything like this If it hadn't been for [Community Connector] ringing I probably wouldn’t have gone as far as I did in both projects. On a more practical level, the relationship with the Community Connector also meant that the less experienced CPs had a point of contact to express any concerns they felt about their involvement in the study. She was able to work with them to find solutions and provide tailored support which CPs felt had increased their confidence. Several CPs for example, felt apprehensive about their initial training sessions. In response, the Community Connector arranged for CPs to observe other online training sessions, either live, or through recorded sessions (with participant’s permission), Right at the start when I’d been given a date that I will be giving a training with the GP trainees online, I was worried; I thought “Oh gosh, maybe I need to look at somebody else, how they delivered it,” so [Community Connector] gave us the opportunity, the recorded session, she recorded and she shared it with us. The flexibility and responsiveness of the Community Connector role created an inclusive space which facilitated different levels of participation and reduced barriers. The role demonstrated the value of dedicated infrastructure and resources to support inclusive research. Engaging with the wider research team Whilst the drop-in sessions were primarily a space for community partners to get to know each other and to share their concerns and experiences, they were also attended regularly by members of the academic research team. CPs felt that this had provided an important opportunity for them to get to know them as ‘people’ rather than as ‘researchers’, It started off as just community partners in the drop-in sessions, and then researchers, and then [academic] came and you came, and sometimes [academic] would drop-in. It made us realise the bigger team weren't so scary, because we were just community partners and I had no experience with anything like this before. So when [academic] came in, it was a bit like oh gosh, I don’t know her, but we chatted and laughed and shared stories. As the project progressed, the CPs were encouraged to participate in the wider academic research team weekly meetings. Whilst confidence for attending these was initially low amongst some of the CPs, the presence of some of the researchers at the weekly drop-in sessions seemed to ease some of the trepidation. Again, the Community Connector took a pivotal role in bridging the gap between the academic researchers and the community partners, I was really worried because I said ‘Oh gosh, [Community Connector], I've got nothing to say.’ She said, ‘But you know most of the people on there.’ As soon as she said I knew [academics] and she would be there, it took away… I’m always doubting myself. I always think I haven't got anything to offer and why would they want me there. But [Community Connector] said ‘It’s fine. If you would like to come, come and see. You don’t have to talk if you don’t want to.’ And I think I attended the Thursday morning meetings for two months and it was great. Through this regular, informal contact and personalised invitations, this CPs’ involvement in research moved from observer to contributor, supporting a key finding of the study that supporting involvement requires attention to building trusting relationships. Personal impact of being involved as a Community Partner CPs identified increased confidence in their skills through their involvement in the project. They spoke about achieving beyond their initial expectations, and of how being involved had led to them viewing their own experience and knowledge as valuable, I saw many of the community partners go from barely believing they could do this process to delivering it with immense power I'm glad I did get to deliver [the training], I did get that experience, so it changed me a lot. I'm a different person from the start of the project and it’s been great. There also appeared to be an increase in confidence which came from being part of the wider research team, where the ethos was one of equality in terms of ideas and input, As much or as little as you want to be, you're part of the project and the journey and you are contributing as well as everyone else. It’s an important cog. All the other people that were involved, they were involving us in the process, so we felt very involved. It wasn’t just like, ‘Oh, here’s a film and we are going to film it and when the film comes out, it’s done and dusted, you ain’t got no input.’ No, we were constantly involved. That’s how I feel. Yes, totally. And I’m very, very proud to be part of that film and that process. This feeling of being genuinely included as active rather than token contributors was central to the value CPs awarded their involvement. It sustained their engagement and served as a catalyst for future engagement in future research. The CPs also spoke of how their increased confidence had generated broader impact beyond their involvement in this project. Through learning about each other’s experiences and helping one another foster their skills they developed deeper supportive relationships and mutual appreciation, Seeing other community partners and how brave and confident they have become after attending those [drop-in sessions] and they all enjoy it Of all the stuff that I do with my working life now, they are all product of what we were doing, so this DeStress has given me… yes, it’s given me another sort of scope on my private life with my work and stuff. Everybody has been really supportive, and the peer support has been brilliant. Just talking about anything and everything, not even related to the project, has really helped me open up about my mental health. It’s all been great. For several CPs, their involvement in DeStress-II provided a stimulus to go on to further paid or voluntary activities. The increased confidence led to the CPs considering other ways to continue their work, including through involvement in other research projects, teaching postgraduate students, and sharing their experiences through mental health platforms and conferences. For one person, this legacy work was felt to be the most powerful impact of their involvement, My personal greatest impact was probably in the community partner forum and in the legacy work where there was an opportunity to get stuck in longer term and I think. [Academic] said I often got concepts on different levels of complexity and was able to make them relatable and relay them [to others]…I think that’s probably the most powerful part. Some CPs explained how their experience of being part of the project had helped their healing from past traumas, validating the conditions which created their experiences and helping increase their self-confidence, Overall, my experience has been…. I mean, it’s been very profound, very moving, very welcoming, very validating of my experience and how difficult it’s been. So it’s been… although stretchy and challenging, conversely, it’s been healing Others spoke of how a sense of acceptance and validation that came from being part of the project team had also had a major impact on them, S,o I just wanted to say that I think we've been a really good team - I'm a very quiet one in the team, but other people have managed to encourage me to talk more. To begin with, I couldn’t talk in the group at all, I never had a voice. So, I'm really thankful for the people who have done that, helped me gently, not forced me into conversation but gently introduced me to be able to talk. That’s been really massive for me, the peer support has been great We've still met up at times of crisis because we’re friends. We are friends…I've been able to keep going because I feel we’re a team and we've had a lot to give and offer and we support each other through it. [Community Connector] has helped us stay together because without the drop-in sessions we wouldn’t have had that bond that we've shared. This enduring sense of community that persisted beyond the end of the project suggests that meaningful involvement can leave a legacy not only in orthodox research outputs or building skills but in new relationships, increased confidence and self-worth. Discussion The findings provide insight into the factors which helped initiate and sustain Community Partner motivation across and beyond the DeStress II project as well as the impacts of research involvement at both a personal and collective level. In line with a recent review of public engagement in mental health research, 16 involvement in DeStress II provided positive opportunities for community partners, including building knowledge and skills, fostering personal confidence and growth, helping people feel heard, valued and less alone in their experiences, and enabling strengthened individual and collective agency to influence health care practice. The Community Connector role was seen as pivotal, providing dedicated time and resource to support and guide CPs as they developed and became more confident in their roles. Time could also be given to the development of trusting relationships with and between the CPs which, in combination with training support, different communication approaches, and financial reimbursement enabled meaningful involvement in all aspects of the research. Having the Community Connector enabled good communication between the whole team, smoothed the flow of information and facilitated different ways for the CPs to influence the research process. In terms of the wider research team, the sharing of (mostly online) spaces and spending time to build relationships, both professional and personal, allowed for a more inclusive approach than may have been developed otherwise. The experience of CPs in this project aligns with frameworks supporting meaningful involvement that emphasise power-sharing and creating trusted relationships which are reinforced by practical resources. 5,14 While involvement is often promoted as a mechanism to improve research quality, this study illustrates how inclusive participation can also lead to positive changes to personal wellbeing. The findings support a model of research impact that moves beyond outputs and associated metrics to recognise the positive effects of collaborative involvement on both the individual and the group. 7,8 The work presented here has also provided evidence for the future design of collaborative research projects with people with lived experience of poor mental health. It has demonstrated how allocating resources (community connector role, time and spaces to meet) to involvement in research can help flatten hierarchies, foster trust and shared decision making, and provide a transparent and respectful approach to collaboration. This in turn can have a lasting impact throughout and beyond the life of a research project. 14,5,7 Strengths and Limitations Most of the CP interactions during the DeStress-II project were supported through online and social media channels. Although this was partially due to the project starting during the COVID pandemic it showed that meaningful sustained on-line engagement across a large geographical area is possible. Previous research has suggested that sustained engagement in mental health research can be facilitated through direct support from mental health organisations. 17 Findings reported here suggest that this support can also be provided from within the research team providing it is properly resourced, relationally informed and open to adaptation as required. Some of the strategies and processes that the CPs most valued, such as the twice weekly drop –in sessions evolved based on need and desire of those involved rather than being a planned process, which may limit replication in other projects. In the first stage of the DeStress II project the CPs were involved in delivering training (face to face or online) to GPs and other health professionals and their initial meetings were developed to support each other in that activity. Whilst having this constructive focus helped the development of the group dynamics, this may not be possible in other study scenarios. The twice weekly online drop-in sessions allowed for the forging of collaborative relationships and friendships despite the CPs being diverse in background and experience and coming from geographically dispersed areas. This paper reflects the true co-production that existed throughout and beyond DeStress-II. It highlights the wider impacts of having CPs fully engaged in mental health research beyond the research. The CP group described in the paper, have a shared goal beyond the project, they continue to meet and are looking for other projects in which they can use their lived experience to support meaningful outcomes. A final strength is the collaborative analytic process used to produce this paper. Involving CPs in checking interpretations and selecting quotes meant the research team ensured that analysis was steered by the perspectives of those directly involved. Conclusions This paper has demonstrated how allocating resources to approaches that can help flatten hierarchies, foster trust and shared decision making, and provide a transparent and respectful approach to collaboration can have a lasting impact throughout and beyond the life of a research project. Beyond initial motivators for involvement in research, key factors that supported ongoing CP engagement include (i) a dedicated Community Connector Role; (ii) feeling part of, and valued, within the research team; and (iii) the development and quality of relationships. Supporting collaboration in ways that foster relationships can have a range of influences on the experiences of public participants that go beyond academic research impact. Thought should be given to how best foster and support this type of engagement when working with communities with lived experience. The experience of the DeStress-II CPs shows that meaningful involvement is not simply a matter of including people with lived experience and accessing their knowledge, it requires the creation of conditions where power and control over the research is shared so CPs can influence all aspects of the research over the lifetime of the project. Future projects should consider how resources and in particular those which support relational practice can be embedded throughout a project, especially when working with people who may face intersecting forms of marginalisation. Declarations Ethics approval and consent to participate Ethics approval was granted by the Frenchay REC (IRAS 303179) Consent for publication All authors have provided consent for publication. Availability of data and materials The data are available from the corresponding author on reasonable request. Competing interests No competing interests. Funding The DeStress-II Project was funded by the NIHR ARC Health inequalities consortium. Authors' contributions JH, AM, SH, KG, PP, RC, DS, SA, SG, KH, KC, FH: Acquisition, analysis and interpretation of data, drafting of manuscript. FT, KB, KW: study conceptualisation, design and funding; data interpretation; drafting. OH revision of manuscript. All authors reviewed the manuscript. Acknowledgements The authors would like to acknowledge the contribution of the DeStress Advisory Board, all of our community partners and the people who participated in the research. Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. References Malterud K, Elvbakken KT. 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Power to the people: to what extent has public involvement in applied health research achieved this? Res Involv Engagem. 2016;2:1–13. Purtell R, Rickard W, Wyatt K. Should we? Could we? Measuring involvement. Critical Perspectives on User Involvement. Bristol University; 2011. https://doi.org/10.1332/policypress/9781847427519.003.0020 . p.209 – 16. Purtell RA, Wyatt KM. Measuring something real and useful in consumer involvement in health and social care research. Int J Consumer Stud. 2011;35:605–8. https://doi.org/10.1111/j.1470-6431.2011.01016.x . Lauzon-Schnittka J, Audette-Chapdelaine S, Boutin D, Wilhelmy C, Auger AM, Brodeur M. The experience of patient partners in research: a qualitative systematic review and thematic synthesis. Res Involv Engagem. 2022;8(55). Greenhalgh T, Snow R, Ryan S, Rees S, Salisbury H. Six ‘biases’ against patients and carers in evidence-based medicine. BMC Med. 2015;13:200. Ocloo J, Garfield S, Franklin BD, Dawson S. Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews. Health Res Policy Sys. 2021;19(8). https://doi.org/10.1186/s12961-020-00644-3 . Nierse CJ, Schipper K, van Zadelhoff E, van de Griendt J, Abma TA. Collaboration and co-ownership in research: dynamics and dialogues between patient research partners and professional researchers in a research team. Health Expect. 2012;15:242–54. https://doi.org/10.1111/j.1369-7625.2011.00661.x . Gradinger F, Britten N, Wyatt K, Froggatt K, Gibson A, Jacoby A, et al. Values associated with public involvement in health and social care research: a narrative review. Health Expect. 2015;18:661–75. https://doi.org/10.1111/hex.12158 . Thomas F, Wyatt K, Berzins K, Lee I, Horrell J, McLoughlin A et al. Supporting patients experiencing poverty-related mental distress: Development and evaluation of a training resource in general practices in eleven regions of England. SSM - Mental Health 2024;5(100320). Sheikhan NY, Kuluski K, McKee S, Hiebert M, Hawke LD. Exploring the impact of engagement in mental health and substance use research: a scoping review and thematic analysis. Health Expect. 2023;26:1806–19. 10.1111/hex.13779 . Ashman M, Clibbens N, Thompson J, Gilburt H, Thompson E, Khalid Y. Involving stakeholders with lived and professional experience in a realist review of community mental health crisis services: a commentary. Res Involv Engagem. 2024;10(130). https://doi:10.1186/s40900-024-00662-3 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Nov, 2025 Read the published version in Research Involvement and Engagement → Version 1 posted Editorial decision: Revision requested 15 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 11 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 08 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers invited by journal 16 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 15 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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practice.\u003csup\u003e5,6\u003c/sup\u003e This approach to understanding and capturing impact aligns with a consumerist approach to PPI in which involvement supports the securing of research outcomes. However, an alternative framing of public involvement views it through a rights-based lens in which the processes of engagement and involvement themselves deliver impact through individual and group-based empowerment.\u003csup\u003e7,8,9\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eRelatively little attention has been placed on understanding the broader motivations and experiences of those individuals who engage in research in a PPI role, the factors which help sustain their engagement, or any impact they feel their involvement in the research has had within their wider lives. Understanding this is important, particularly in areas such as mental health where there is significant potential for power differentials in both clinical settings and within the research experience itself.\u003csup\u003e10,11\u003c/sup\u003e Better understanding of how researchers can create the conditions for more meaningful involvement of people with poor mental health experiences is therefore needed both to strengthen approaches to public involvement and reduce power variance.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn this paper, we adopt a relational approach to research impact that recognises how involvement can support individual and collective development, particularly when processes are inclusive, values-led and effectively resourced. This approach draws on empowerment theory and co-production literature,\u003csup\u003e13,14\u003c/sup\u003e which demonstrate the importance of mutual trust and respect and shared control over the duration of research projects. We apply this theory to the experiences of Community Partners involved in the DeStress-II project.\u003c/p\u003e\n\u003ch3\u003eThe DeStress II project\u003c/h3\u003e\n\u003cp\u003eDeStress is an interdisciplinary research programme exploring the links between poverty and mental health and working with patients and healthcare providers to understand how patients can be better supported within primary healthcare. This work began with a qualitative study (DeStress-I, 2016\u0026ndash;2019) exploring the ways poverty-related mental distress was experienced in low-income communities and responded to within primary healthcare settings. This was followed by a second phase of work (Destress-II, 2021\u0026ndash;2024) which aimed to co-design and deliver a training intervention to support primary care practitioners to hold more effective consultations with patients experiencing poverty-related mental distress. Community Partners played a central role in shaping the structure and content of the training as well as its delivery. The first phase of DeStress-II involved training delivered in-person by teams comprising a GP, a Community Partner (a person with lived experience of poverty-related mental distress) and an academic researcher. Within the training sessions, Community Partners (CP) spoke to primary care teams about the intersections between poverty and mental health, with most drawing on their own experiences to impart key learning objectives. They also spoke from a patient\u0026rsquo;s perspective about what they felt made for a positive or negative consultation experience within primary care.\u003c/p\u003e\u003cp\u003eTraining was delivered in 53 practices across three areas of England. Feedback helped us to refine the training and develop this as an online resource that has now been made freely available to GP practices across England (for more information on the process of developing the training see Thomas et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003csup\u003e15\u003c/sup\u003e Feedback received from primary care teams consistently attested to the power of the community partner narratives within the training. The online resource therefore includes a wide range of community partner narratives and a simulated consultation demonstrating what CPs felt that a positive GP consultation could look like.\u003c/p\u003e\u003cp\u003eThis paper reports on the experiences of the community partners who worked alongside academics and practitioners to co-develop and deliver this training resource. We explore how Community Partners were supported to remain involved over the duration of the research, their experiences of personal development and the resulting peer support and sense of collective purpose.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEngagement of Community Partners\u003c/h2\u003e\u003cp\u003eRecruitment and retention of community partners in DeStress II evolved through a multi-phased, adaptive process beginning in late 2021. Opportunities for involvement in the research were advertised through the networks of three university PPI teams as well as via a range of local community groups across the three research sites. Those expressing an interest in taking part were invited to attend an initial online workshop to understand more about the study (November 2021) being co-chaired by experienced community co-researchers from DeStress I. Nineteen community partners initially signed up and indicated that they were willing to consider co-delivering the training within primary care. To address the understandable apprehension raised amongst the community partners, informal, peer-led \u0026lsquo;drop-ins\u0026rsquo; were set up to provide regular and sustained support throughout the project, and to build space for collective learning and confidence-building. Challenges related to mental health and confidence were often expressed, particularly at the start of the project, necessitating additional one-to-one support alongside reassurances that people could engage flexibly, according to what was possible for them at the time.\u003c/p\u003e\u003cp\u003eThe CPs were located across the three study sites and were supported remotely and in person, by a Community Connector. This role enabled and facilitated the CPs to design their own ways of working together to support the project (and themselves), during the project and after its official end date. The Community Connector acted as a link between the CPs, academic researchers and GP trainers supporting both communication and continuity. As the DeStress-II research progressed, the CPs were encouraged to attend weekly meetings with the wider research team to involve them with strategic decision making and to ensure their input on the content and dissemination of the online training resource.\u003c/p\u003e\u003cp\u003eBringing together the reflections of the community partners, this co-authored paper explores the experiences of the CPs involved in the DeStress-II project. Rather than focusing on the research outcomes and outputs (reported in Thomas et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e),\u003csup\u003e15\u003c/sup\u003e this paper reports on the CP\u0026rsquo;s experiences of supporting the delivery of the project, the factors and processes that they felt supported their sustained engagement and the impact they feel research involvement had within their broader lives. As a result, we offer insights into how research projects can be consciously created and an involvement culture sustained which centres lived experience and empowerment through flattening traditional hierarchies in how mental health research is conducted.\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003eThis paper provides a reflective evaluation of the engagement approach used within DeStress II from the perspectives of community partners who were involved in the project. They and the wider research team felt that understanding and documenting motivations and experiences of involvement would provide an important opportunity for reflective learning which could inform other research.\u003c/p\u003e\u003cp\u003e It was agreed that focus groups would provide an appropriate forum for this, although individual interviews were also offered when this was more convenient for participants. Community partners felt that it was appropriate for the focus groups and interviews to be facilitated by academic members of the research team in each locality. In total 10 CP participants were included in the data collection (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Four participants were male, six were female. Three were from a South Asian background; seven were from a white British background.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNumbers and format of CPs by region.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFocus group numbers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIndividual interviews\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth-West\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth-West\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth Thames\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGRIPP2\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Aim \u0026ndash; Report the aim of PPI in the study\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003ePlain English Summary\u003c/em\u003e (p. 2): states the paper reports CPs\u0026rsquo; experiences, factors sustaining engagement, and impacts at individual and group levels.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAbstract\u003c/em\u003e (p. 2): reiterates aim to present experiences of CPs across all aspects of the project.\u003c/p\u003e\u003cp\u003e\u003cem\u003eBackground\u003c/em\u003e (pp. 3\u0026ndash;4): frames the rationale for focusing on PPI experiences.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Methods \u0026ndash; Provide a clear description of the methods used for PPI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eMethods\u003c/em\u003e (pp. 7\u0026ndash;8\u003cb\u003e)\u003c/b\u003e: reflective evaluation using focus groups and interviews (n\u0026thinsp;=\u0026thinsp;10); CPs co-developed questions, reviewed interpretations, checked findings, selected quotes, and co-authored the paper.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Study results \u0026ndash; Outcomes (positive and negative) of PPI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eResults\u003c/em\u003e \u003cb\u003e(\u003c/b\u003epp. 9\u0026ndash;16\u003cb\u003e)\u003c/b\u003e: Positive outcomes \u0026ndash; increased confidence, sense of community, peer support, feeling valued, influencing training, legacy work, healing/validation, wider opportunities.\u003c/p\u003e\u003cp\u003eChallenges/negatives \u0026ndash; initial apprehension, stigma, low confidence, concerns about framing experiences, need for strong support (Community Connector, peer drop-ins).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Discussion and conclusions \u0026ndash; Outcomes, extent of influence, positive and negative effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eDiscussion\u003c/em\u003e \u003cb\u003e(\u003c/b\u003epp. 17\u0026ndash;18\u003cb\u003e)\u003c/b\u003e: CP involvement influenced study design, training delivery, and online resources; highlights empowerment, flattening hierarchies, and wellbeing impacts; notes limitations (online format, emergent processes, replication challenges).\u003c/p\u003e\u003cp\u003e\u003cem\u003eConclusions\u003c/em\u003e (pp. 20\u0026ndash;21\u003cb\u003e)\u003c/b\u003e: meaningful involvement required resources, shared power, and relational practices; CPs influenced all aspects of the project and left an enduring legacy.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Reflections/critical perspective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eStrengths and Limitations\u003c/em\u003e (pp. 18\u0026ndash;20\u003cb\u003e)\u003c/b\u003e: critical reflection: what worked well (drop-ins, Community Connector, collaborative analysis, relationships), what may not transfer easily (ad hoc processes, reliance on resources). Notes continuation of CP collaboration beyond the project as evidence of deeper impact.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA focus group and interview schedule were developed with community partners to support the discussions. The questions were broad and open ended but explored multiple aspects of the CPs experience with the project, co-production of the research, reasons for sustained engagement and individual and collective impact. Interviews and focus group discussions were audio-recorded via Microsoft Teams and then transcribed verbatim. Transcriptions were uploaded to NVivo 14.\u003c/p\u003e\u003cp\u003eTwo authors (JH, AM) individually read the transcripts and identified themes. They then met to discuss and agree these before re-visiting clean transcripts in NVivo to code with these specific themes in mind and identify quotes they felt exemplified the content of the themes. Direct reflections on the training delivery and development were excluded as this was not the purpose of this paper. Once coding was completed, the authors agreed an overview of the main themes and anonymised supporting quotes. This was then presented to the CPs at a weekly online drop-in session to check they agreed with the findings and to clarify that what they felt was important was represented in the data. Final quotes to exemplify the themes were selected and agreed by all CP co-authors. For this reason, quotes used in this paper are not attributed to any particular participant. This process reflects our approach to collaborative analysis with CPs reviewing interpretations and refining the manuscript to ensure findings remained true to their lived experiences.\u003c/p\u003e\u003cp\u003eFollowing CP feedback on this overview the paper was drafted (AM, JH), shared and re-drafted with further feedback from all the co-authors. All authors contributed to the final draft of the paper.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eThe study was approved by the Frenchay REC (IRAS303179).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eReflecting on their work with DeStress II it became clear that community partner involvement and relationship building with each other extended beyond simply supporting research findings and outputs. Initial motivation for involvement was key, alongside a number of factors which helped to ensure the ongoing engagement of community partners, including (i) a dedicated Community Connector Role; (ii) feeling part of and valued within the research team; and (iii) the development and quality of relationships. Community Partners also identified impact at a personal level, including growth in confidence and a desire to create a legacy of work focused on mental health that continued beyond the life of the research project.\u003c/p\u003e\n\u003ch3\u003eMotivation for involvement\u003c/h3\u003e\n\u003cp\u003eCommunity Partners described various reasons they participated in the project including both personal and from a position of collective advocacy. A consistent theme was wanting to improve things for others based on their own experiences of distress, disempowerment or exclusion.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSharing lived experience\u003c/h2\u003e\u003cp\u003eAmongst the CPs there was a strong sense of wanting to improve care for those living with poor mental health. The CPs gave a number of reasons underlying this, including: (i) their own poor experiences of primary care consultations for mental distress; ii) the need to raise awareness amongst health providers around the dual challenges of poverty and poor mental health; iii) the need to combat mental health stigma in certain communities (e.g., South Asian communities); iv) recognition that primary care providers were under considerable pressure, and could benefit from targeted training to better support the high number of consultations for poverty related mental distress they had to deal with,\u003c/p\u003e\u003cp\u003e\u003cem\u003eI wanted to feedback, help, in any way I could. Even if it just helps one person, me telling my story, that\u0026rsquo;s why I wanted to be part of the project.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePeople are not familiar with this type of service, people have not been educated, people feel they cannot share this because the other members of the community will know that somebody has got mental health problems and they\u0026rsquo;re asking for help, so these are many barriers. First culturally [mental health] is stigmatised, second language barrier, third they do not know, they have not been educated, they do not know these services are available.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCPs described feeling compelled to use their own personal knowledge and experience of poor mental health to help educate and raise awareness amongst primary care providers, particularly when their own experiences had been negative,\u003c/p\u003e\u003cp\u003e\u003cem\u003eFor me, I've had such a battle and been in such a terrible place for so long. When I got help \u0026ndash; which was not through the NHS at all - and I started to feel better, I knew somehow I had to try and use my voice to share how terrible it [poor mental health] is, because I didn\u0026rsquo;t want anybody to be in that place I was in. I was in a place where I didn\u0026rsquo;t think I could be reached, I didn\u0026rsquo;t think anyone could help me, and not just once \u0026ndash; it was up and down over eight, nine years.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e[it\u0026rsquo;s the] the very fact that we\u0026rsquo;re doing it, and that all for me is historical because of my experiences with having a bad GP and the stigma of mental health\u0026hellip; that\u0026rsquo;s all been historical. And seeing things change for the better and understanding other people\u0026rsquo;s lives.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEnabling reflection and increasing personal knowledge\u003c/h3\u003e\n\u003cp\u003eIn addition to wanting to better educate medical professionals about the ways wider socio-economic circumstances impacted on mental health, CPs also spoke about how involvement had increased their own knowledge and understanding of their own mental health. In particular, CPs described feeling validated about aspects of their mental health that had seemed intuitive (e.g., the influence of poverty), but the complexity of which had not ever (they felt) been recognised explicitly by professionals.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026hellip;to be able to join knowing that intuitively and then have my understanding validated and supported and to know that as much as there may have been negative experiences, the general consensus or understanding seems to be that these nuances, important nuances\u0026hellip; well whatever it is, it\u0026rsquo;s just important that they are understood, that depression is understood in a more complex understanding, that mental distress is understood and that actually a lot of the mental distress may never have happened without the context of poverty is very healing in a longer-term process to realise.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eSeeing a difference and feeling valued\u003c/h3\u003e\n\u003cp\u003eFor the two CPs who had been involved in the initial DeStress study (Destress I), the ability to see small changes in health care professionals\u0026rsquo; understanding and approaches to mental health over time was important and encouraged sustained engagement,\u003c/p\u003e\u003cp\u003e\u003cem\u003eFor me, what I think is the doctors\u0026rsquo; surgeries are changing, from when we first started, I think back in 2016, from then to now\u0026hellip; It\u0026rsquo;s completely different. It was a positive thing to do, not just for my own mental health, but seeing how far they\u0026rsquo;ve [GPs] come and seeing the difference between then and now.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCPs also spoke about how their involvement and influence within the wider team meant that they felt their contributions and ideas were valued,\u003c/p\u003e\u003cp\u003e\u003cem\u003eI've loved hearing more about the project and I do really feel, as I said earlier, we've definitely been listened to in shaping the new online training. I know everybody\u0026rsquo;s voices\u0026hellip; And [CP\u0026rsquo;s] ideas of one to one, a bit of roleplay has been used, so they\u0026rsquo;ve definitely listened to us and used our ideas. It\u0026rsquo;s been good.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThese reflections reinforce the importance of recognising PPI contributors not solely as possessing knowledge for use by the research team but as co-producers of research, being heard and shaping the process and outcomes.\u003c/p\u003e\u003cp\u003eCPs spoke about how their involvement in Destress felt different to other research projects they had been part of. This seemed to be due to two distinct factors: (i) the strength of the focus on co-production; and (ii) the support provided by the Community Connector. Whilst distinct factors in how the research was delivered and how CP involvement was supported, the support and genuine commitment to coproduction created a sense of community which was fostered throughout the project,\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe difference is that I think the DeStress project was very thorough and also very engaging and coproduced [\u0026hellip;] It wasn\u0026rsquo;t a \u0026ndash; what\u0026rsquo;s the word \u0026ndash; tick-box exercise for coproduction, it actually is a full coproduction. So that\u0026rsquo;s the difference between this project and say some other sort of things that I\u0026rsquo;ve been involved with.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI have been working for the last eight years as a full-time public advisor and never seen this unique technique of having a drop-in session where you can ask for help\u003c/em\u003e\u003c/p\u003e\u003cp\u003eHaving a Community Connector role ensured that dedicated time was available to help ensure that CP\u0026rsquo;s needs for engaging in the project could be met. This included ensuring that CPs were contacted in a way and at a time that worked best for them, and supporting CPs with logistical issues such as paying their expenses in advance and ensuring they could get to the training location without undue anxiety,\u003c/p\u003e\u003cp\u003e\u003cem\u003eSome of the projects I've worked on previously, it\u0026rsquo;s felt very much like you come in, do your bit, go home, and that\u0026rsquo;s that. This hasn\u0026rsquo;t felt like that. It really feels like every angle of everything\u0026hellip; Even things like transport was taken into consideration. For some of the face to face, it was \u0026lsquo;How are you going to get there? Do you know where you're going, where to park?\u0026rsquo; All those nitty gritty things were really thought of and sometimes that\u0026rsquo;s not something everyone takes into consideration or cares about. So I really appreciated the whole wraparound. It\u0026rsquo;s felt really well supported in every angle. I think that\u0026rsquo;s sometimes we don\u0026rsquo;t talk about enough, but it\u0026rsquo;s really nice to see in a project\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePairing community partners with GPs for co-delivery of the training also helped foster mutual respect and trust, flattening traditional hierarchies and supporting sustained involvement in the research. Ultimately, the conditions which enabled the recruitment and retention of the CPs were underpinned by flexible and adaptive processes, peer support mechanisms, and the meaningful integration of lived experience in a central, action-oriented role rather than an advisory capacity.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eFeeling valued and part of a community\u003c/h2\u003e\u003cp\u003eOne of the most dominant reflections from CPs centred around the development of a sense of community and the feelings of value and support they found within this. This appears to have been formed and sustained both from being with each other as well as through interactions with the wider research team. Having the opportunities to spend time with the other CPs was valued on a number of levels including support for the delivery of training and in terms of making friendships.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePeer support\u003c/h2\u003e\u003cp\u003eCPs newer to the role of research collaboration valued the support offered by the more research-experienced CPs and felt reassured by them being able to take the lead in delivering the training until their own confidence to deliver training to healthcare practitioners had built. The regular drop-in created safe space not only for building skills and confidence, but also for sharing feelings and building solidarity. Over time, this opportunity for peer support contributed to a sense of collective efficacy.\u003c/p\u003e\u003cp\u003e\u003cem\u003eI just wanted to say I don\u0026rsquo;t think we\u0026rsquo;d have ever got to that point, of all being able to be that brave, if we hadn't had the drop-in sessions\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCommunity Connector role\u003c/h2\u003e\u003cp\u003eThe role of the Community Connector was perceived by the CPs as crucial to both the success of the project and their continued engagement with it. The Community Connector provided effective and reassuring communication and support (at an individual and group level) that sustained activity and motivation to be involved. This role served as a central connection between the CPs, and also with the wider research team and training delivery partners (GPs). Part of this role involved hosting the bi-weekly drop-in sessions which helped to build trust both within the CPs as a group, and with the Community Connector. As trust built, CPs felt able to voice concerns over training delivery and their ability to do it \u0026lsquo;right\u0026rsquo;. For example, one CP spoke to the Community Connector about her concerns over framing her experiences of primary care consultations when she didn\u0026rsquo;t feel they had been positive,\u003c/p\u003e\u003cp\u003e\u003cem\u003eBecause I didn\u0026rsquo;t really have anything positive, I didn\u0026rsquo;t want to go in with them thinking I was being negative, which I was trying not to be, but it really helped because I was getting myself in a right old state and I said to [Community Connector] about it and she said \u0026lsquo;There's no right or wrong way of doing this. If you haven't got a positive example, what did help you? Try and use some of the ways you did get through it.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCPs valued the warmth and openness of the Community Connector and explained how having someone in this dedicated role made continued engagement in all aspects of the research much more likely than it may have been otherwise. The Community Connector was perceived both as a professional and a point of contact and support, which was a unique experience for some who had been involved in other research projects,\u003c/p\u003e\u003cp\u003e\u003cem\u003eI know from how I got into it, that that relationship, meeting her, the way she made it so easy and comfortable to connect, take away any of the worries and things like that, was really pivotal in my story anyway, and I think all the way through this journey, they, for me been the connection that has linked in but in such a way that hasn\u0026rsquo;t felt scary and it\u0026rsquo;s felt comfortable always like I could be very honest with them and they would be honest back\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eIt\u0026rsquo;s just so different, so exceptional, I mean what can you say? They\u0026rsquo;re a star, so that\u0026rsquo;s the difference, it\u0026rsquo;s the professional bit of it and then there\u0026rsquo;s the friendly bit of it, that\u0026rsquo;s been in there so yes, definitely, very different. I\u0026rsquo;ve not come across them all the years I\u0026rsquo;ve been involved in anything like this\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eIf it hadn't been for [Community Connector] ringing I probably wouldn\u0026rsquo;t have gone as far as I did in both projects.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOn a more practical level, the relationship with the Community Connector also meant that the less experienced CPs had a point of contact to express any concerns they felt about their involvement in the study. She was able to work with them to find solutions and provide tailored support which CPs felt had increased their confidence. Several CPs for example, felt apprehensive about their initial training sessions. In response, the Community Connector arranged for CPs to observe other online training sessions, either live, or through recorded sessions (with participant\u0026rsquo;s permission),\u003c/p\u003e\u003cp\u003e\u003cem\u003eRight at the start when I\u0026rsquo;d been given a date that I will be giving a training with the GP trainees online, I was worried; I thought \u0026ldquo;Oh gosh, maybe I need to look at somebody else, how they delivered it,\u0026rdquo; so [Community Connector] gave us the opportunity, the recorded session, she recorded and she shared it with us.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe flexibility and responsiveness of the Community Connector role created an inclusive space which facilitated different levels of participation and reduced barriers. The role demonstrated the value of dedicated infrastructure and resources to support inclusive research.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eEngaging with the wider research team\u003c/h2\u003e\u003cp\u003eWhilst the drop-in sessions were primarily a space for community partners to get to know each other and to share their concerns and experiences, they were also attended regularly by members of the academic research team. CPs felt that this had provided an important opportunity for them to get to know them as \u0026lsquo;people\u0026rsquo; rather than as \u0026lsquo;researchers\u0026rsquo;,\u003c/p\u003e\u003cp\u003e\u003cem\u003eIt started off as just community partners in the drop-in sessions, and then researchers, and then [academic] came and you came, and sometimes [academic] would drop-in. It made us realise the bigger team weren't so scary, because we were just community partners and I had no experience with anything like this before. So when [academic] came in, it was a bit like oh gosh, I don\u0026rsquo;t know her, but we chatted and laughed and shared stories.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e As the project progressed, the CPs were encouraged to participate in the wider academic research team weekly meetings. Whilst confidence for attending these was initially low amongst some of the CPs, the presence of some of the researchers at the weekly drop-in sessions seemed to ease some of the trepidation. Again, the Community Connector took a pivotal role in bridging the gap between the academic researchers and the community partners,\u003c/p\u003e\u003cp\u003e\u003cem\u003eI was really worried because I said \u0026lsquo;Oh gosh, [Community Connector], I've got nothing to say.\u0026rsquo; She said, \u0026lsquo;But you know most of the people on there.\u0026rsquo; As soon as she said I knew [academics] and she would be there, it took away\u0026hellip; I\u0026rsquo;m always doubting myself. I always think I haven't got anything to offer and why would they want me there. But [Community Connector] said \u0026lsquo;It\u0026rsquo;s fine. If you would like to come, come and see. You don\u0026rsquo;t have to talk if you don\u0026rsquo;t want to.\u0026rsquo; And I think I attended the Thursday morning meetings for two months and it was great.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThrough this regular, informal contact and personalised invitations, this CPs\u0026rsquo; involvement in research moved from observer to contributor, supporting a key finding of the study that supporting involvement requires attention to building trusting relationships.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePersonal impact of being involved as a Community Partner\u003c/h2\u003e\u003cp\u003eCPs identified increased confidence in their skills through their involvement in the project. They spoke about achieving beyond their initial expectations, and of how being involved had led to them viewing their own experience and knowledge as valuable,\u003c/p\u003e\u003cp\u003e\u003cem\u003eI saw many of the community partners go from barely believing they could do this process to delivering it with immense power\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI'm glad I did get to deliver [the training], I did get that experience, so it changed me a lot. I'm a different person from the start of the project and it\u0026rsquo;s been great.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere also appeared to be an increase in confidence which came from being part of the wider research team, where the ethos was one of equality in terms of ideas and input,\u003c/p\u003e\u003cp\u003e\u003cem\u003eAs much or as little as you want to be, you're part of the project and the journey and you are contributing as well as everyone else. It\u0026rsquo;s an important cog.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eAll the other people that were involved, they were involving us in the process, so we felt very involved. It wasn\u0026rsquo;t just like, \u0026lsquo;Oh, here\u0026rsquo;s a film and we are going to film it and when the film comes out, it\u0026rsquo;s done and dusted, you ain\u0026rsquo;t got no input.\u0026rsquo; No, we were constantly involved. That\u0026rsquo;s how I feel. Yes, totally. And I\u0026rsquo;m very, very proud to be part of that film and that process.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis feeling of being genuinely included as active rather than token contributors was central to the value CPs awarded their involvement. It sustained their engagement and served as a catalyst for future engagement in future research. The CPs also spoke of how their increased confidence had generated broader impact beyond their involvement in this project. Through learning about each other\u0026rsquo;s experiences and helping one another foster their skills they developed deeper supportive relationships and mutual appreciation,\u003c/p\u003e\u003cp\u003e\u003cem\u003eSeeing other community partners and how brave and confident they have become after attending those [drop-in sessions] and they all enjoy it\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eOf all the stuff that I do with my working life now, they are all product of what we were doing, so this DeStress has given me\u0026hellip; yes, it\u0026rsquo;s given me another sort of scope on my private life with my work and stuff.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eEverybody has been really supportive, and the peer support has been brilliant. Just talking about anything and everything, not even related to the project, has really helped me open up about my mental health. It\u0026rsquo;s all been great.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFor several CPs, their involvement in DeStress-II provided a stimulus to go on to further paid or voluntary activities. The increased confidence led to the CPs considering other ways to continue their work, including through involvement in other research projects, teaching postgraduate students, and sharing their experiences through mental health platforms and conferences. For one person, this legacy work was felt to be the most powerful impact of their involvement,\u003c/p\u003e\u003cp\u003e\u003cem\u003eMy personal greatest impact was probably in the community partner forum and in the legacy work where there was an opportunity to get stuck in longer term and I think. [Academic] said I often got concepts on different levels of complexity and was able to make them relatable and relay them [to others]\u0026hellip;I think that\u0026rsquo;s probably the most powerful part.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSome CPs explained how their experience of being part of the project had helped their healing from past traumas, validating the conditions which created their experiences and helping increase their self-confidence,\u003c/p\u003e\u003cp\u003e\u003cem\u003eOverall, my experience has been\u0026hellip;. I mean, it\u0026rsquo;s been very profound, very moving, very welcoming, very validating of my experience and how difficult it\u0026rsquo;s been. So it\u0026rsquo;s been\u0026hellip; although stretchy and challenging, conversely, it\u0026rsquo;s been healing\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOthers spoke of how a sense of acceptance and validation that came from being part of the project team had also had a major impact on them,\u003c/p\u003e\u003cp\u003e\u003cem\u003eS,o I just wanted to say that I think we've been a really good team - I'm a very quiet one in the team, but other people have managed to encourage me to talk more. To begin with, I couldn\u0026rsquo;t talk in the group at all, I never had a voice. So, I'm really thankful for the people who have done that, helped me gently, not forced me into conversation but gently introduced me to be able to talk. That\u0026rsquo;s been really massive for me, the peer support has been great\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eWe've still met up at times of crisis because we\u0026rsquo;re friends. We are friends\u0026hellip;I've been able to keep going because I feel we\u0026rsquo;re a team and we've had a lot to give and offer and we support each other through it. [Community Connector] has helped us stay together because without the drop-in sessions we wouldn\u0026rsquo;t have had that bond that we've shared.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis enduring sense of community that persisted beyond the end of the project suggests that meaningful involvement can leave a legacy not only in orthodox research outputs or building skills but in new relationships, increased confidence and self-worth.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings provide insight into the factors which helped initiate and sustain Community Partner motivation across and beyond the DeStress II project as well as the impacts of research involvement at both a personal and collective level. In line with a recent review of public engagement in mental health research,\u003csup\u003e16\u003c/sup\u003e involvement in DeStress II provided positive opportunities for community partners, including building knowledge and skills, fostering personal confidence and growth, helping people feel heard, valued and less alone in their experiences, and enabling strengthened individual and collective agency to influence health care practice.\u003c/p\u003e\u003cp\u003eThe Community Connector role was seen as pivotal, providing dedicated time and resource to support and guide CPs as they developed and became more confident in their roles. Time could also be given to the development of trusting relationships with and between the CPs which, in combination with training support, different communication approaches, and financial reimbursement enabled meaningful involvement in all aspects of the research. Having the Community Connector enabled good communication between the whole team, smoothed the flow of information and facilitated different ways for the CPs to influence the research process. In terms of the wider research team, the sharing of (mostly online) spaces and spending time to build relationships, both professional and personal, allowed for a more inclusive approach than may have been developed otherwise.\u003c/p\u003e\u003cp\u003eThe experience of CPs in this project aligns with frameworks supporting meaningful involvement that emphasise power-sharing and creating trusted relationships which are reinforced by practical resources.\u003csup\u003e5,14\u003c/sup\u003e While involvement is often promoted as a mechanism to improve research quality, this study illustrates how inclusive participation can also lead to positive changes to personal wellbeing. The findings support a model of research impact that moves beyond outputs and associated metrics to recognise the positive effects of collaborative involvement on both the individual and the group. \u003csup\u003e7,8\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe work presented here has also provided evidence for the future design of collaborative research projects with people with lived experience of poor mental health. It has demonstrated how allocating resources (community connector role, time and spaces to meet) to involvement in research can help flatten hierarchies, foster trust and shared decision making, and provide a transparent and respectful approach to collaboration. This in turn can have a lasting impact throughout and beyond the life of a research project.\u003csup\u003e14,5,7\u003c/sup\u003e\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eMost of the CP interactions during the DeStress-II project were supported through online and social media channels. Although this was partially due to the project starting during the COVID pandemic it showed that meaningful sustained on-line engagement across a large geographical area is possible. Previous research has suggested that sustained engagement in mental health research can be facilitated through direct support from mental health organisations.\u003csup\u003e17\u003c/sup\u003e Findings reported here suggest that this support can also be provided from within the research team providing it is properly resourced, relationally informed and open to adaptation as required.\u003c/p\u003e\u003cp\u003eSome of the strategies and processes that the CPs most valued, such as the twice weekly drop \u0026ndash;in sessions evolved based on need and desire of those involved rather than being a planned process, which may limit replication in other projects. In the first stage of the DeStress II project the CPs were involved in delivering training (face to face or online) to GPs and other health professionals and their initial meetings were developed to support each other in that activity. Whilst having this constructive focus helped the development of the group dynamics, this may not be possible in other study scenarios.\u003c/p\u003e\u003cp\u003eThe twice weekly online drop-in sessions allowed for the forging of collaborative relationships and friendships despite the CPs being diverse in background and experience and coming from geographically dispersed areas. This paper reflects the true co-production that existed throughout and beyond DeStress-II. It highlights the wider impacts of having CPs fully engaged in mental health research beyond the research. The CP group described in the paper, have a shared goal beyond the project, they continue to meet and are looking for other projects in which they can use their lived experience to support meaningful outcomes.\u003c/p\u003e\u003cp\u003eA final strength is the collaborative analytic process used to produce this paper. Involving CPs in checking interpretations and selecting quotes meant the research team ensured that analysis was steered by the perspectives of those directly involved.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis paper has demonstrated how allocating resources to approaches that can help flatten hierarchies, foster trust and shared decision making, and provide a transparent and respectful approach to collaboration can have a lasting impact throughout and beyond the life of a research project. Beyond initial motivators for involvement in research, key factors that supported ongoing CP engagement include (i) a dedicated Community Connector Role; (ii) feeling part of, and valued, within the research team; and (iii) the development and quality of relationships.\u003c/p\u003e\u003cp\u003eSupporting collaboration in ways that foster relationships can have a range of influences on the experiences of public participants that go beyond academic research impact. Thought should be given to how best foster and support this type of engagement when working with communities with lived experience.\u003c/p\u003e\u003cp\u003eThe experience of the DeStress-II CPs shows that meaningful involvement is not simply a matter of including people with lived experience and accessing their knowledge, it requires the creation of conditions where power and control over the research is shared so CPs can influence all aspects of the research over the lifetime of the project.\u003c/p\u003e\u003cp\u003eFuture projects should consider how resources and in particular those which support relational practice can be embedded throughout a project, especially when working with people who may face intersecting forms of marginalisation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was granted by the Frenchay REC (IRAS 303179)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have provided consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe DeStress-II Project was funded by the NIHR ARC Health inequalities consortium. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJH, AM, SH, KG, PP, RC, DS, SA, SG, KH, KC, FH: \u0026nbsp;Acquisition, analysis and interpretation of data, drafting of manuscript. FT, KB, KW: study conceptualisation, design and funding; data interpretation; drafting. OH revision of manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the contribution of the DeStress Advisory Board, all of our community partners and the people who participated in the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMalterud K, Elvbakken KT. Patients participating as co-researchers in health research: A systematic review of outcomes and experiences. 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Res Involv Engagem. 2024;10(130). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1186/s40900-024-00662-3\u003c/span\u003e\u003cspan address=\"https://doi:10.1186/s40900-024-00662-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient and public participation, impact, mental health, poverty, primary healthcare, co-production.","lastPublishedDoi":"10.21203/rs.3.rs-7583935/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7583935/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Patient and public involvement (PPI) in research can meaningfully improve the relevance and impact of research outcomes. However, research ‘impact’ is often only considered in terms of study findings and their wider implications for policy and practice. Less attention has been placed on understanding the motivations and experiences of individuals who engage in research in a PPI role, or any impact they feel this has within their lives. Understanding this is important, particularly in areas such as mental health where there is significant potential for power differentials in the research experience.\u003c/p\u003e\n\u003cp\u003eThe DeStress-II project developed a training resource for primary care practitioners to deliver supportive consultations with people experiencing poverty related mental distress. The resource was developed collaboratively with a team of Community Partners with lived experience from three regions of the UK. This paper presents the experiences of the Community Partners who were involved in all aspects of the research, developing and delivering the training, co-producing an online training resource and supporting the analysis of its implementation. We focus on what they feel helped to sustain their engagement, and the impacts of this at both an individual and group level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A reflective evaluation using data from two focus groups and individual semi-structured interviews with Community Partners (n=10).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Findings highlight the importance of extending the notion of impact beyond traditional boundaries of academic research to also consider individual and collective patient and public benefits of involvement. Community partners identified key factors supporting their engagement including (i) a dedicated Community Connector role; (ii) feeling part of and valued within the research team; (iii) the development and quality of relationships. Community Partners identified impact at a personal level, including growth in confidence and a desire to create a legacy of work that continued beyond the life of the research project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Understanding how patient and public involvement in research is experienced is an important element of research impact. Dedicated time and resources are needed to ensure researchers can create environments which foster and support positive personal impact when working with people with lived experience.\u003c/p\u003e","manuscriptTitle":"Creating a collaborative and impactful research environment: community partner reflections on the DeStress-II study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 11:30:01","doi":"10.21203/rs.3.rs-7583935/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-15T13:38:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T13:21:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121810374478050481301544682215962991281","date":"2025-10-11T08:15:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T13:33:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236689516692933175523184635610601226044","date":"2025-10-08T08:47:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T07:33:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181215079242952173902568739638558972753","date":"2025-09-16T15:58:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39634801262053201896617619130908083175","date":"2025-09-16T12:43:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-16T07:48:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T05:09:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Research Involvement and Engagement","date":"2025-09-15T13:40:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd3dbcd0-9982-43bd-87d9-d2a2b386b804","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:15:26+00:00","versionOfRecord":{"articleIdentity":"rs-7583935","link":"https://doi.org/10.1186/s40900-025-00811-2","journal":{"identity":"research-involvement-and-engagement","isVorOnly":false,"title":"Research Involvement and Engagement"},"publishedOn":"2025-11-25 15:58:13","publishedOnDateReadable":"November 25th, 2025"},"versionCreatedAt":"2025-09-24 11:30:01","video":"","vorDoi":"10.1186/s40900-025-00811-2","vorDoiUrl":"https://doi.org/10.1186/s40900-025-00811-2","workflowStages":[]},"version":"v1","identity":"rs-7583935","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7583935","identity":"rs-7583935","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}