Recommendations for service user involvement in healthcare education: A World Café event

Recommendations for service user involvement in healthcare education: A World Café event | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Recommendations for service user involvement in healthcare education: A World Café event Pauline Boland, Sarah Dillon, Glenn Curtin, Ciaran Purcell, Aoife Lily Gallagher, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7237769/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction Service users can enrich healthcare education, leading to deeper empathy and person-centred communication skill development for students. However, there remains gaps in understanding service user perspectives on their role and the ways in which the experience could be enhanced, with tokenism an ongoing risk to this educational experience for both service users and students. This study collected perspectives from healthcare service user about their role as educators, to gain clarity on how this potentially transformative and socially important element of healthcare education can be maximised safely. Methods A World Café methodology was employed, which is a collaborative research approach positioning the service user as expert, enabling a deep understanding of their experiences in health education. This method also aims to mitigate potential power imbalances between the service user and researchers. Twelve service users (or representatives of service users) attended a two-hour World café event. Data were analysed using content analysis and feedback was sought from participants on preliminary findings. Results Trusting relationships with both students and academic staff were the fundamental starting points for service users to engage as partners in healthcare education. A series of recommendations generated by the discussions during the World Café offer clear guidance for how this trust can be initiated and maintained. Respect for the service user perspective, having students and staff recognise the value of their experiences and practical supports were core across recommendations. Conclusion The role of service users is vital for authentic learning for students and for universities committed to engaging the wider community in higher education. Care is recommended by academic staff when inducting new services users as educators, as well as preparing students, ensure students respectfully and actively engage with service users. Practical supports, such as a visit to teaching venue or availability of lecturers to tie service user experience to wider curriculum, are welcomed by service users. Service Users Healthcare Education World Café Participatory methods Figures Figure 1 Introduction Service user involvement (SUI) in healthcare education is recognised as essential if healthcare practitioners are going to deliver client-centred care. From a student standpoint, SUI in healthcare education can enhance curriculum relevance ( 1 ), create a more authentic learning environment, enhance empathy and communication skills ( 2 – 4 ), and improve application of clinical knowledge ( 5 ). Service user involvement in healthcare education can manifest in many ways, most commonly during traditional lectures where an SUs shares their experiences ( 6 ). Other ways SUI can occur include small group discussions with students, curriculum planning and design, role-play activities, co-developing learning assessment or resources, contributing to student assessments directly or indirectly ( 7 ) and, to a lesser extent curriculum evaluation ( 8 ) or for interviews for either students applying for healthcare programmes or other SUs becoming part of curriculum support ( 5 ). The requirement for SU feedback on broader curricula, by healthcare accrediting or regulatory bodies, is an increasing driver to develop a clear understanding of practice in this learning space ( 7 ), alongside the imperative for higher education institutions to deliver authentic, clinically relevant learning to healthcare professional students ( 9 ). Despite the importance and potential benefits of service users in this context, SUI in healthcare education programmes can be limited ( 7 , 10 ). Recognition and reimbursement of the SU role and adequate compensation are ongoing issues ( 8 ) and possible power issues can come into play ( 11 ) - for example, negotiation which happens between academic staff and SUs before and during SUI learning activities. There can be a lack of clarity on the expectations that students, academic staff and SUs have for SUI ( 12 ), with tokenism remaining a serious risk ( 13 , 14 ). Training for SUs in an educator role can be haphazard ( 7 ) and SUI can either address or, when not well planned and supported, maintain ableism ( 15 ). In the [Blind for Peer Review] (offering Level 9 and some Level 8, programmes across Human Nutrition and Dietetics, Physiotherapy, Occupational Therapy and Speech and Language therapy), we have been developing an understanding of our current SUI with our curriculum, with the goal of developing co-produced short- and long-term enhancements to this element of learning. We identified the need for an open consultation with current, previous and potential SUs or related stakeholders (patient representatives and/or family supporters and/or community members) to elicit their perspective on this topic and generate recommendations to develop this element of pedagogy and collaboration. Methods This study was completed using a World Café format ( 16 ). For this study, we considered service users to be “experts by experience” of living with a health condition, engaging with a healthcare service and contributing to health care education. World Café methodology offers a speedy yet comprehensive research design, when a range of stakeholder perspectives are required ( 17 ), and particularly adaptable to those living with a disability ( 18 ). In addition, this methodology has generally been acceptable to a diverse range of underserved communities, who may often be otherwise left out of consultation opportunities ( 19 ). Practical considerations of using this method included embedding feedback loops during the real-time data collection and adherence to fundamental principles of co-design congruent with World Café methodology ( 20 ): the facilitators were not positioned as experts on the topic at hand and we took an open reflexive communication approach throughout the discussions, avoiding leading questions or summaries. Recruitment Recruitment occurred via social media, advocacy organisations, current placement providers in the community and existing SUs contributing to research and teaching were also invited, direct e-mail contact with a broad range of patient/population representative groups. We offered funding via vouchers to recognise their time and provided refreshments during the event and lunch afterwards. Data collection was through audio and written material gathered at each table in the World Café, as well as feedback from participants to preliminary findings after the event. A key ethical consideration is that some people in this World Café may have had disclosed or undisclosed cognitive or communication challenges and all were given the option of attending with a support person and the opportunity to disclose any accommodations they might benefit from, in advance of attending. Five researchers (Blind for Peer Review] were available on the day to be able to spend time checking in with individual participants informally. All participants were provided with an information sheet in advance and completed easy read consent forms on the day of the event. This study was approved by [Blind for Peer Review]. Data Collection The World Café lasted two hours, with an opportunity for SUs to discuss before and afterwards informally with each other and the researchers, which aided those new to the group to be comfortable to share their thoughts. There was no expectation to necessarily reach consensus, and diverse perspectives were encouraged and valued. Consistent with most World Café formats ( 18 ), there was an overview of work completed to date on SUI at [Blind for Peer Review] institution and an outline of the World Café format was provided (See Appendix). There were four facilitators, one at each table. One facilitator ‘floated’ as support for facilitators and/or participants. Over two hours, participants moved between discussion areas, engaging with different groups and facilitators. Discussions were audio-recorded, and notes were documented on a flipchart. All had an opportunity to take part in four groups x 20 mins each focusing on either SUI in practice/fieldwork education or in the university setting (More details in the Appendix). Groups were mixed up with each 20-minute change in topic and participants were encouraged to physically move between sessions, to stimulate debate hearing different perspectives and with different facilitators ( 20 ). All were encouraged to move around the room reviewing written notes at the end of the event; however the group expressed a preference for facilitators to summarise key discussion points at that time, and they could contribute ideas or correct any errors in interpretation at that point. Analysis Description Following participant reflections at the end of the World Café, all five researchers present completed audio fieldnotes and summary sheets on the day. Content analysis ( 21 ) was applied initially, where researchers chose a broad surface structure (manifest analysis), with a focus on adhering to the words and meaning expressed by participants, resulting in recommendations directly attributable to the preferences of the participants rather than overly interpreted by researchers ( 18 ). All researchers involved engaged in their own group reflection before and after the event. Thereafter one researcher [Blind for Peer Review] transcribed all audio data and developed a preliminary summary, focused on key points of agreement and difference of ideas (Table 1 ) and the recommendations for staff, students and SUs (Table 2 a, Table 2 b and Table 2 c). These tables were peer reviewed by all researchers and thereafter sent by e-mail to all participants five months after the event had taken place. A voucher was offered at this time to recognise this ongoing consultation. Findings in tables presented below were developed following this further consultation. Table 1 Agreement and areas of debate Agreement • Student engagement with service users is crucial and should be continued and developed, as real-life experiences are vital for future healthcare professionals to understand (as much as possible). • Students develop empathic communication and confidence by engaging with service users, family, or community members. This skill is essential for future healthcare professionals. • Service users can benefit from meeting with students. • This unique educational role, where service users support student learning, should be fairly recognized by educational institutions. This includes valuing service user involvement, supporting them in practical ways, and offering monetary reimbursement for on-campus/university work. • Service users generally prefer in-person to online formats for teaching students. • The long-term sustainability of service user involvement in student education depends on university staff interactions, as students come and go. Reliable points of contact for service users with university staff are crucial for ongoing communication. • Service users value students who truly listen, understand the service user perspective about their condition and past healthcare experiences, and have developed supportive non-verbal communication skills. • Service users suggested providing tools during student training to help them manage stress they are likely to face due to resource shortages and stressed clients, that healthcare educators support students with developing resilience skills, recognizing the emotional challenges of working in health services and avoiding burnout for future healthcare professionals. • Service users encourage students to share their ideas for change within the healthcare setting during fieldwork or placements, valuing the fresh perspectives they bring. Areas of debate • The best time for students to engage with service users varied from either ‘the start’ of their education programmes, to later in their course, when students had achieved more core knowledge and skills. • The value on textbooks/academic knowledge students might have varies – many wanted students to have adequate knowledge and some skills when they interact with them, but also an open mindedness about who they are meeting and those individual perspectives and backgrounds. Table 2 a Recommendations for students Role Recommendation World Café Participant Quotations Students 1. See and listen to the person as an individual and not a diagnosis/disease,, assume nothing (be person centred) 2. Show good etiquette – includes putting away phones (showing respect and attention), engagement by asking questions and respecting the expertise of the service user. 3. Discuss and respect boundaries of confidentiality 4. Limit jargon during conversations as this can become a barrier to relationship development and trust 5. Consider non-verbal cues (eye contact, body language) – this can affect how much a service user will open up about their experience. 6. Be prepared to meet people who have had positive and negative experiences of healthcare services and staff 7. Be adaptable to change before and during time learning from service users. Actually, to hear that real life, you're not just reading some textbook It's also important for students to be able to talk to you, not down to you So some students come in with the attitude, ‘What do they [community members] know?’ Yeah, they're coming with pre-conceptions. There is nothing worse than having nobody ask questions. ... it’s not okay to be on your phone all the time. I mean, if I was in that room, I would have been horrified, you're [students are] not listening. We'll [service users] be more comfortable and free to open up and discuss things, that what I have to say is going to be respected. Language matters...about how to talk to people about their condition or how to talk about the condition. Follow up comment: I believe the language used around service users can be the first hurdle to developing the trusting relationship. Eye contact could be so important because if that wasn't maintained with the patient, I think it could leave the patient feeling quite uncomfortable I've had positive healthcare experiences, but I've also had very negative ones. So I'm reluctant to share those because we live in Ireland. Yes, everybody knows everybody. Students have to be adaptable to the theory that they've learned, because they might need to think outside the box. So just they need to be flexible and adaptable in their practise. Because I when you see a student coming out and things don't work the way they think it should, it's just sometimes you have to adapt to a different way. Table 2 b Recommendations for Staff Role Recommendation World Café Participant Quotations Staff 1. Plan with service users around any teaching session - at the university or in fieldwork/practice sites 2. Negotiate ground rules/expectations with students and service users in advance – help to establish trust early so that both can o learn from each other openly 3. Clearly outline the physical set up/ location of rooms (e.g. distance to bus-stop, accessible car parks, rest rooms, sound and mic availability, if desks need to be moved around and agree if students will do that). Offer, if possible, a visit to the teaching space for service users in advance, to see physical space (or send a video). 4. Ensure service users and staff link the learning from service users with other learning, before and after the interaction. 5. Ensure practice educators maintain an openness to student’s perspectives as their fresh ideas might help overall practice in healthcare We need to know what's going to happen - What are the questions you might get asked? That preparation with the lecturers who invited you in. Just to set out the rules and to let everyone know that there will be engagement and everyone’s opinion will be respected and valued. The lecturer, whoever that's organised you to come in, make sure students know that whatever is said within the room, stays within the room. How do you get access to a classroom, how many people are going to be in the room. How long are you going to be kept in the room? Not knowing these things can cause some people anxiety. Or some people have to think about mobility. But ‘you never said there were five steps outside the building’. What is the topic? Where do we go with the topic? What have the students done with the topic before? Students should report and talk to management (supervisors/managers on healthcare placements) as well as service users, because they (students) are fresh people coming in and management can be stuck in a way. Because you have to have old heads with new heads for something to change... You need a balance. Table 2c Recommendations for Service Users Service users Be aware of diversity in the room of students in terms of different backgrounds based on ethnicity, economics, culture, etc. Consider in advance what information they personally want to share or not (confidentiality) Ask for lecturer support in design and/or delivery of the session, if desired For long term engagement with service users – staff or students must give feedback about any work that happens in conjunction with service users, including training sessions or related project work from fieldwork/practice education. Exactly how people would like to be addressed. Go out first (planning visit with staff) because you'll get the knowledge about how the students would like to be addressed. I’d be a bit nervous about what questions they (students) might ask me. The side effects of the condition for me, that can be too personal But you have to watch your sharing. Because we all have a choice about what we share. But then if you're asked the question (from students), I think you have to say sorry, I don't feel comfortable answering that, you must have confidence. The first couple of times I did it [teaching students], I had no idea what was being looked for. So, I think having somebody who delivers a module and contributes their experiences as it progresses is beneficial. This is the work I [the student] hoped to get done*. But when I'm finished, if you give me a couple of weeks, I will get back to you [service user] again, with the feedback. Because sometimes when they're gone, they're gone. They're not allowed to come back. And I think that's very wrong because they've done all that piece of work and built a relationship with that person. Follow up comment: I think the lecturers should keep in touch with the service users as the students come and go *Relates to students working with community members on placement around collaborative projects Results Description of World Café participants The population are presented in a summary of those attending here, as it was a small group with quite distinctive reasons for qualifying as SUs, further demographic or descriptive details could risk their anonymity. For these reasons, alongside the difficulties accurately identifying individuals on audio-recording at World Café tables, no unique identifiers are included with participant quotes. Twelve people attended this event, three men and nine women. Participants came with a broad range of experiences qualifying them to represent service user perspective: three participants were older people, one of whom was also a family carer and another had a mobility disability, two other participants were members of an urban regeneration community who had recently supported community engaged placements with allied health students (one of these participants was also the mother and advocate of a child with a complex disability). Another man lived with a rare neurological disease, three other participants represented patient advocacy groups (older people, people living with mental health diagnoses and people living with diabetes). Two community members who provide services to people with chronic pain and trauma also attended. One woman was a wheelchair user and stroke survivor. The World Café was held at a wheelchair accessible venue. Key findings There were broad areas of agreement and ongoing debate during the World café and when following up afterwards with participants and these are outlined in Table 1 . Insert about here - Table 1 Agreement and areas of debate A key priority agreed by all participants was that trust must be established between service users and students and, at times, with staff from the university for service user involvement to be effective and ongoing. Trust was seen as crucial to successful SUI, whether students are interacting with service users during placements or in the classroom, or between university staff and SUs. As one participant shared feedback on preliminary findings: I couldn’t agree more with the primary goal of establishing trust between student practitioners and service users. As a service user myself I feel that the language used to describe us can have a marked effect on our subconscious and can affect the relationship between service users and the students. Insert about here - Fig. 1 Importance of trust for successful service user involvement The ways in which trust can be established are outlined in the following summary of recommendations for students, SUs and academic staff (Table 2 a, Table 2 b and Table 2 c). Insert about here - Table 2 a Recommendations for students Insert about here - Table 2 b Recommendations for university staff Insert about here - Table 2 c Recommendations for service users Feedback from participants during and after the World Café event Participants appreciated the time taken and opportunity for them to meet other people at different tables to stimulate ideas and build confidence sharing their thoughts. Many were keen to meet again and asked about this possibility over the lunch at the end of the World Café. During the feedback on preliminary findings, all those who returned comments (6/12) expressed gratitude for the invitation and opportunity to give further feedback and could see the value of this approach and their perspectives in shaping best practice for the education of healthcare students, and ultimately, improvements in healthcare delivery: I commend those involved in drawing up this report, the language is easy to understand and I look forward to its implementation which will greatly improve the experience of the health service for all involved … Having gone through the attached documents I really think the team have captured everything that was discussed on the day … thank you for including us in the process. Discussion This study is the first the authors are aware of which uses a World Café methodology to collect and explore the perspectives of service users about what would help or restrict their abilities to contribute to healthcare education. The findings are rich in detail about practical ways where students and academic staff can enhance this role, as well as guidance from service users to other potential service users about taking care of themselves while maximising their contribution and experience if engaging with healthcare students. Key Point 1: Trust was a fundamental cornerstone for developing the relationships required for sustainable service user involvement is interesting. Trust could be established by negotiating power and rules of engagement between students and service users, as well as and staff and students using language as preferred by service users. Such mechanisms can break down the academic divide often present between higher education institutions and the communities they serve, to genuinely engage with diverse groups who can support student learning and, in turn, that those communities be supported to have a voice ( 14 , 22 ). Key Point 2: Ongoing relationships between service users and staff are critical to a sustained SUI in healthcare education programmes. In line with other studies ( 22 ), to realise the potential of SUI, institutional commitment to the recruitment and retention of SUs requires increased recognition and transparency about this role and related processes. To achieve this, the time needed to build and sustain trust with patient-related organisations and communities is vital and needs to be acknowledged in the academic workload. Enhanced roles for service users could support sustainability, such as involvement in student selection for programmes, during student assessment or curriculum review, however these positions require significant administrative and institutional support to be realised ( 6 , 22 ). Key point 3: Interestingly, when it came to student competency development, SUs prioritised communication and ‘hands-on’ skills over ‘book learning’. Service users were motivated that healthcare students grapple with the complexity and diversity of life outside of university classroom learning. Service users recognised SUI can support such learning, which is in line with other literature on the value of SUI ( 2 , 4 ). Service users perceived that their fresh perspectives could enhance existing services which had possibly underserved them at times, an idea that has received little attention in research ( 23 ). The optimism of SUs about healthcare students could encourage students to work on the confidence needed to observe and suggest changes in practice. Recommendations and future studies These findings will be distributed to current and future staff at [blind for peer review] and will form the basis of good practice (and review of same) for service user involvement in our curriculum. Furthermore, the results here add to a small but growing body of evidence about how best to support service users in their vital role working with healthcare students ( 4 , 10 ). To develop further understanding and ensure a service user perspective, designing studies with service users as part of the research team would be a logical next step, to identify priority questions and appropriate methods ( 19 ). Other consensus approaches, for example, could further develop best practice recommendations with wider service user groups, as has been used in healthcare service design to good effect ( 24 ). While the evidence from students about how experiences learning from SUs is steadily developing ( 5 ), there is potential to link students and service users to co-create learning experiences ( 25 ). This approach could pose challenges to academic staff on pedagogical direction ( 15 ) and related accountability for education to external regulatory and accrediting bodies. However, such co-design could also represent the next step in maximising engaged learners and empowering the service users we aim to support. Finally, service user involvement in practice education (as opposed to the traditional classroom learning environment) is an area which has a lack of allied health representation, with most studies from a recent review on this topic centred in Medicine and Nursing ( 26 ). Strengths and limitations This study was the first of its kind in [country blind for peer review]. The diversity of people who attended (mix of genders, experiences and advocacy group members), who all remained fully engaged for over 2 hours, was a strength of this participatory approach, leading to rich and illustrative data. A floating facilitator helped when groups at tables might be flagging or stuck and also to support latecomers. While the planned walk/roll through of summaries across tables at the end did not happen, partly as all were ready for lunch, it was encouraging that all participants stayed on and were very enthusiastic about follow up. Despite the flexibility of World Café events, they are not without their limitations. The participants are not representative of all service users, given service users can be a diverse group including children, people with complex health conditions and at different ages and with socio-demographic backgrounds. For this event, despite extensive advertising, there were many potential SU groups who did not attend, possibly as a full morning in-person event required more effort and planning. Having hybrid and/or online events may have enabled more people to engage ( 27 ). Conclusion The role of service users is vital for authentic learning for students and for universities committed to engaging the wider community in higher education. There are practices that can support service users when starting or developing their role, the responsibility for which lies with students, academic staff and service users themselves. Abbreviations SU – Service user SUI – Service user involvement Declarations Ethical Approval Statement : This study received ethical approval from the University of Limerick Education and Health Science Faculty Ethics committee Reference: 2023_05_12_EHS Consent to participate : All participants provided informed consent. Data availability statement : The datasets generated and/or analysed during the current study are not publicly available due to representation from very small/niche groups of people posing a risk to de-anonymisation agreed during data collection, however fully anonymised data are available from the corresponding author on reasonable request. Funding statement: This work was funded by a Strategic Alignment of Teaching and Learning Enhancement grant from the National Teaching Forum for the Enhancement of Teaching and Learning in Higher Education in Ireland, awarded November 2023 Competing Interests: The authors declare that they have no competing interests. Author’s contributions: PB, AG and SD designed this study, applied for funding for the event, recruited participants, collected and analysed data and prepared the first and subsequent drafts for dissemination. GC and CP supported recruitment and data collection and contributed to publication. AG supported design of the study, recruitment and preparation of the manuscript for publication. All authors read and approved the final manuscript Clinical Trial Number: Not applicable Consent to publication: Not applicable Acknowledgments: We wish to thank Elaine Storan, administrator at the School of Allied Health, for invaluable support planning and running the event where these data were collected. References Henriksen AH, Ringsted C. Learning from patients: students’ perceptions of patient‐instructors. Med Educ. 2011;45(9):913-9. doi: 10.1111/j.1365-2923.2011.04041.x Świtaj P, Grygiel P, Krzyżanowska-Zbucka J, Sonik J, Chrostek A, Jahołkowski P, et Wciorka J Anczewska M. The evaluation of the impact of anti-stigma training led by “experts by experience” on participants’ attitudes towards persons with mental illness. Psychiatr Pol. 2019;53:1219 – 1236. doi.org/10.12740/PP/109818 Cullen M, Cadogan C, George S, Murphy S, Freeney S, Fitzpatrick R, et al. Key stakeholders’ views, experiences and expectations of patient and public involvement in healthcare professions’ education: a qualitative study. BMC Med Educ. 2022;22(1):305. doi.org/10.1186/s12909-022-03373-z Gordon M, Gupta S, Thornton D, Reid M, Mallen E, Melling A. Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58. Med Teach. 2020;42(1):4-16. doi:10.1080/0142159X.2019.1652731. Jobling H, Sayuri Ii S. The impact of service user involvement in health and social care education: a scoping review. Practice. 2024;36(3):193-211. doi.org/10.1080/09503153.2023.2248414 Towle A, Bainbridge L, Godolphin W, Katz A, Kline C, Lown B, Madularu I. Solomon P, Thistlewaite J. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64-74. doi: 10.1111/j.1365-2923.2009.03530.x Soon YE, Murray CM, Aguilar A, Boshoff K. Consumer involvement in university education programs in the nursing, midwifery, and allied health professions: a systematic scoping review. Int J of Nurs Stud. 2020;109:103619. doi:10.1016/j.ijnurstu.2020.103619. Scanlan JN, Logan A, Arblaster K, Haracz K, Fossey E, Milbourn BT, et al. Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand. Aust Occup Ther J. 2020;67(1):83-93. doi: 10.1111/1440-1630.12634 Lee J, Campbell S, Choi M, Bae J. Authentic learning in healthcare education: A systematic review. Nurs Educ Today. 2022;119:105596. doi:10.1016/j.nedt.2022.105596. Sy MP, Panotes A, Cho D, Pineda RC, Martin P. A rapid review of the factors that influence service user involvement in interprofessional education, practice, and research. Int J Env Res Public Health. 2022;19(24):16826. doi: 10.3390/ijerph192416826 Felton A, Stickley T. Pedagogy, power and service user involvement. J Psychtr Ment Health Nurs. 2004;11(1):89-98. doi: 10.1111/j.1365-2850.2004.00693.x. Van Rooijen M, Van Dijk-De Vries A, Lenzen S, Dalemans R, Moser A, Beurskens A. How to foster successful implementation of a patient reported experience measurement in the disability sector: An example of developing strategies in co-creation. Res Involv Engagem. 2021;7(1):45. doi.org/10.1186/s40900-021-00287-w Bury A. User involvement in palliative care education: beyond rhetoric and tokenism. In Foyle, L. Hostad, J. Editors. Illuminating the Diversity of Cancer and Palliative Care Education. London: CRC Press; 2018. p. 243-261. doi.org/10.1201/9781315383460 McCutcheon K, Gormley K. Service-user involvement in nurse education: partnership or tokenism? Br J Nurs. 2014;23(22):1196-1199. doi: 10.12968/bjon.2014.23.22.1196. Kalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, et al. Power to the people? A co-produced critical review of service user involvement in mental health professions education. Adv Heal Sci Educ Theor Prac 2024;29(1):273-300. doi: 10.1007/s10459-023-10240-z. Löhr K, Weinhardt M, Sieber S. The “World Café” as a participatory method for collecting qualitative data. Int J Qual Methods. 2020;19. doi.org/10.1177/1609406920916976 Schiele H, Krummaker S, Hoffmann P, Kowalski R. The “research world café” as method of scientific enquiry: Combining rigor with relevance and speed. J Bus Res. 2022;140:280-296. doi.org/10.1016/j.jbusres.2021.10.075 Bumble JL, Carter EW. Application of the World Café to disability issues: A systematic review. J Disabil Pol Stud. 2021;32(3):193-203. doi.org/10.1177/104420732094 McGrath C, Kennedy M-R, Gibson A, Musse S, Kosar Z, Dawson S. World Cafés as a participatory approach to understanding research agendas in primary care with underserved communities: reflections, challenges and lessons learned. Res Involv Engagem. 2023;9(1):101. doi: 10.1186/s40900-023-00509-3. Clements AJ, Sharples A, Bishop J. The World Café method for engaging groups in conversation: Practical considerations and an agenda for critical evaluation. Occup Psych Outlook. 2024;3(1):6-18. doi.org/10.53841/bpsopo.2024.3.1.6 Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus open. 2016;2:8-14. doi.org/10.1016/j.npls.2016.01.001 Towle A, Ong K, Wang L, Kline CC. Patient/public perceptions on engagement with a medical school: What needs to happen to support authentic and sustained participation. Medical Teacher. 2024;46(7):963-970. doi:10.1080/0142159X.2023.2289843. Burman R, Singh G. Power, patients, and change: Young people can help to reimagine healthcare. BMJ; 2025: 388. https://doi.org/10.1136/bmj.r265 Ryan L, Wenke R, Carlini J, Weir KA, Shapiro M, Baglot N, et al. Exploring barriers and solutions to consumer involvement in health service research using a nominal group technique. Res involve engagem 2024;10, 72. https://doi.org/10.1186/s40900-024-00604-z Brand G, Sheers C, Wise S, Seubert L, Clifford R, Griffiths P, Etherton-Beer, C.. A research approach for co‐designing education with healthcare consumers. Med Educ. 2021;55(5):574-81. doi: 10.1111/medu.14411 Bevitt T, Pereira RB, Bacon R, Isbel S. Exploring the concepts of consumer feedback systems for occupational therapy student learning during practice placements: A scoping review. Aust Occup Ther J. 2024;71(6):1089-1105 doi: 10.1111/1440-1630.12984. Kinney D, Kinney W. Adapting the world café method to an online format: insights from novice qualitative researchers. J Participatory Res Methods. 2024;5(3). https://doi.org/10.35844/001c.122576 Additional Declarations No competing interests reported. Supplementary Files AppendixFormatforWorldCafe.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 23 Sep, 2025 Reviewers agreed at journal 23 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers invited by journal 18 Sep, 2025 Editor assigned by journal 17 Sep, 2025 Editor invited by journal 24 Aug, 2025 Submission checks completed at journal 22 Aug, 2025 First submitted to journal 22 Aug, 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. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7237769","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504214950,"identity":"769e6920-85f4-4fc5-9e14-4110cec264ad","order_by":0,"name":"Pauline Boland","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYHACxgMJQNKAgbmBgYHNhoGPgbGBoB6oFpBKtjQGNqK0MCC0HAZqIQDM2c8YHHi4wwbIaGz8XFB2PrGNgbnxAT4tlj05BgcSz6QBGQebpWecuw3UwthsgE+LwQGQlrbDDAY3EhukedvAWtok8Go5/wak5T9IS/Nv3rZzIC3tP/BquQG25QBISxvQlgNgW/DpYLCc8awAqCyZB+iXNmuec8nGbcyMzXgdZs6fvPHhzzY7OXP25sO3ecrsZPvZ2x9+wOswKM2DEGLG6yyEllEwCkbBKBgFuAEAbt1MXDukQzAAAAAASUVORK5CYII=","orcid":"","institution":"Lecturer at School of Allied Health, University of Limerick","correspondingAuthor":true,"prefix":"","firstName":"Pauline","middleName":"","lastName":"Boland","suffix":""},{"id":504214951,"identity":"8dca655a-9572-457e-9e12-1234fbcd22ba","order_by":1,"name":"Sarah Dillon","email":"","orcid":"","institution":"Lecturer at School of Allied Health, University of Limerick","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Dillon","suffix":""},{"id":504214952,"identity":"49ac2c5b-8a54-4472-9c25-6660c28724f5","order_by":2,"name":"Glenn Curtin","email":"","orcid":"","institution":"University Hospital Limerick","correspondingAuthor":false,"prefix":"","firstName":"Glenn","middleName":"","lastName":"Curtin","suffix":""},{"id":504214953,"identity":"55fa1547-c009-461c-8a11-f6a62167f092","order_by":3,"name":"Ciaran Purcell","email":"","orcid":"","institution":"Lecturer at School of Allied Health, University of Limerick","correspondingAuthor":false,"prefix":"","firstName":"Ciaran","middleName":"","lastName":"Purcell","suffix":""},{"id":504214954,"identity":"7b2d2c18-a459-4652-adb1-c4cc3bdb3858","order_by":4,"name":"Aoife Lily Gallagher","email":"","orcid":"","institution":"Lecturer at School of Allied Health, University of Limerick","correspondingAuthor":false,"prefix":"","firstName":"Aoife","middleName":"Lily","lastName":"Gallagher","suffix":""},{"id":504214955,"identity":"d400fa74-261e-4cc6-9c22-8380115430a5","order_by":5,"name":"Anne Griffin","email":"","orcid":"","institution":"University of Limerick, University of Limerick","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"Griffin","suffix":""}],"badges":[],"createdAt":"2025-07-29 01:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7237769/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7237769/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89993335,"identity":"1cea1673-13ba-4e95-b363-a0c05abd152d","added_by":"auto","created_at":"2025-08-27 07:43:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":552557,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImportance of trust for successful service user involvement\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7237769/v1/b8ca6cd405451de22803a1ad.png"},{"id":89996176,"identity":"34d5a278-d3e8-447b-bf1f-13f6aa33e0c5","added_by":"auto","created_at":"2025-08-27 08:07:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2311071,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7237769/v1/90ef7bf4-b441-4e38-b248-ad65fbf9b9ed.pdf"},{"id":89995740,"identity":"084a3e11-b4f7-4f55-927f-77e51effe15d","added_by":"auto","created_at":"2025-08-27 07:59:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15432,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixFormatforWorldCafe.docx","url":"https://assets-eu.researchsquare.com/files/rs-7237769/v1/75a604866a238d951e5d89f8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Recommendations for service user involvement in healthcare education: A World Café event","fulltext":[{"header":"Introduction","content":"\u003cp\u003eService user involvement (SUI) in healthcare education is recognised as essential if healthcare practitioners are going to deliver client-centred care. From a student standpoint, SUI in healthcare education can enhance curriculum relevance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), create a more authentic learning environment, enhance empathy and communication skills (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), and improve application of clinical knowledge (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eService user involvement in healthcare education can manifest in many ways, most commonly during traditional lectures where an SUs shares their experiences (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Other ways SUI can occur include small group discussions with students, curriculum planning and design, role-play activities, co-developing learning assessment or resources, contributing to student assessments directly or indirectly (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and, to a lesser extent curriculum evaluation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) or for interviews for either students applying for healthcare programmes or other SUs becoming part of curriculum support (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The requirement for SU feedback on broader curricula, by healthcare accrediting or regulatory bodies, is an increasing driver to develop a clear understanding of practice in this learning space (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), alongside the imperative for higher education institutions to deliver authentic, clinically relevant learning to healthcare professional students (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the importance and potential benefits of service users in this context, SUI in healthcare education programmes can be limited (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Recognition and reimbursement of the SU role and adequate compensation are ongoing issues (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and possible power issues can come into play (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) - for example, negotiation which happens between academic staff and SUs before and during SUI learning activities. There can be a lack of clarity on the expectations that students, academic staff and SUs have for SUI (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), with tokenism remaining a serious risk (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Training for SUs in an educator role can be haphazard (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and SUI can either address or, when not well planned and supported, maintain ableism (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the [Blind for Peer Review] (offering Level 9 and some Level 8, programmes across Human Nutrition and Dietetics, Physiotherapy, Occupational Therapy and Speech and Language therapy), we have been developing an understanding of our current SUI with our curriculum, with the goal of developing co-produced short- and long-term enhancements to this element of learning. We identified the need for an open consultation with current, previous and potential SUs or related stakeholders (patient representatives and/or family supporters and/or community members) to elicit their perspective on this topic and generate recommendations to develop this element of pedagogy and collaboration.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was completed using a World Caf\u0026eacute; format (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For this study, we considered service users to be \u0026ldquo;experts by experience\u0026rdquo; of living with a health condition, engaging with a healthcare service and contributing to health care education. World Caf\u0026eacute; methodology offers a speedy yet comprehensive research design, when a range of stakeholder perspectives are required (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and particularly adaptable to those living with a disability (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, this methodology has generally been acceptable to a diverse range of underserved communities, who may often be otherwise left out of consultation opportunities (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Practical considerations of using this method included embedding feedback loops during the real-time data collection and adherence to fundamental principles of co-design congruent with World Caf\u0026eacute; methodology (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e): the facilitators were not positioned as experts on the topic at hand and we took an open reflexive communication approach throughout the discussions, avoiding leading questions or summaries.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eRecruitment\u003c/h2\u003e\u003cp\u003eRecruitment occurred via social media, advocacy organisations, current placement providers in the community and existing SUs contributing to research and teaching were also invited, direct e-mail contact with a broad range of patient/population representative groups. We offered funding via vouchers to recognise their time and provided refreshments during the event and lunch afterwards. Data collection was through audio and written material gathered at each table in the World Caf\u0026eacute;, as well as feedback from participants to preliminary findings after the event.\u003c/p\u003e\u003cp\u003eA key ethical consideration is that some people in this World Caf\u0026eacute; may have had disclosed or undisclosed cognitive or communication challenges and all were given the option of attending with a support person and the opportunity to disclose any accommodations they might benefit from, in advance of attending. Five researchers (Blind for Peer Review] were available on the day to be able to spend time checking in with individual participants informally. All participants were provided with an information sheet in advance and completed easy read consent forms on the day of the event. This study was approved by [Blind for Peer Review].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe World Caf\u0026eacute; lasted two hours, with an opportunity for SUs to discuss before and afterwards informally with each other and the researchers, which aided those new to the group to be comfortable to share their thoughts. There was no expectation to necessarily reach consensus, and diverse perspectives were encouraged and valued. Consistent with most World Caf\u0026eacute; formats (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), there was an overview of work completed to date on SUI at [Blind for Peer Review] institution and an outline of the World Caf\u0026eacute; format was provided (See Appendix). There were four facilitators, one at each table. One facilitator \u0026lsquo;floated\u0026rsquo; as support for facilitators and/or participants. Over two hours, participants moved between discussion areas, engaging with different groups and facilitators. Discussions were audio-recorded, and notes were documented on a flipchart. All had an opportunity to take part in four groups x 20 mins each focusing on either SUI in practice/fieldwork education or in the university setting (More details in the Appendix). Groups were mixed up with each 20-minute change in topic and participants were encouraged to physically move between sessions, to stimulate debate hearing different perspectives and with different facilitators (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). All were encouraged to move around the room reviewing written notes at the end of the event; however the group expressed a preference for facilitators to summarise key discussion points at that time, and they could contribute ideas or correct any errors in interpretation at that point.\u003c/p\u003e\n\u003ch3\u003eAnalysis Description\u003c/h3\u003e\n\u003cp\u003eFollowing participant reflections at the end of the World Caf\u0026eacute;, all five researchers present completed audio fieldnotes and summary sheets on the day. Content analysis (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) was applied initially, where researchers chose a broad surface structure (manifest analysis), with a focus on adhering to the words and meaning expressed by participants, resulting in recommendations directly attributable to the preferences of the participants rather than overly interpreted by researchers (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). All researchers involved engaged in their own group reflection before and after the event.\u003c/p\u003e\u003cp\u003eThereafter one researcher [Blind for Peer Review] transcribed all audio data and developed a preliminary summary, focused on key points of agreement and difference of ideas (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and the recommendations for staff, students and SUs (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ea, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003eb and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ec). These tables were peer reviewed by all researchers and thereafter sent by e-mail to all participants five months after the event had taken place. A voucher was offered at this time to recognise this ongoing consultation. Findings in tables presented below were developed following this further consultation.\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\u003eAgreement and areas of debate\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\u003eAgreement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026bull; Student engagement with service users is crucial and should be continued and developed, as real-life experiences are vital for future healthcare professionals to understand (as much as possible).\u003c/p\u003e\u003cp\u003e\u0026bull; Students develop empathic communication and confidence by engaging with service users, family, or community members. This skill is essential for future healthcare professionals.\u003c/p\u003e\u003cp\u003e\u0026bull; Service users can benefit from meeting with students.\u003c/p\u003e\u003cp\u003e\u0026bull; This unique educational role, where service users support student learning, should be fairly recognized by educational institutions. This includes valuing service user involvement, supporting them in practical ways, and offering monetary reimbursement for on-campus/university work.\u003c/p\u003e\u003cp\u003e\u0026bull; Service users generally prefer in-person to online formats for teaching students.\u003c/p\u003e\u003cp\u003e\u0026bull; The long-term sustainability of service user involvement in student education depends on university staff interactions, as students come and go. Reliable points of contact for service users with university staff are crucial for ongoing communication.\u003c/p\u003e\u003cp\u003e\u0026bull; Service users value students who truly listen, understand the service user perspective about their condition and past healthcare experiences, and have developed supportive non-verbal communication skills.\u003c/p\u003e\u003cp\u003e\u0026bull; Service users suggested providing tools during student training to help them manage stress they are likely to face due to resource shortages and stressed clients, that healthcare educators support students with developing resilience skills, recognizing the emotional challenges of working in health services and avoiding burnout for future healthcare professionals.\u003c/p\u003e\u003cp\u003e\u0026bull; Service users encourage students to share their ideas for change within the healthcare setting during fieldwork or placements, valuing the fresh perspectives they bring.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAreas of debate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026bull; The best time for students to engage with service users varied from either \u0026lsquo;the start\u0026rsquo; of their education programmes, to later in their course, when students had achieved more core knowledge and skills.\u003c/p\u003e\u003cp\u003e\u0026bull; The value on textbooks/academic knowledge students might have varies \u0026ndash; many wanted students to have adequate knowledge and some skills when they interact with them, but also an open mindedness about who they are meeting and those individual perspectives and backgrounds.\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 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ea Recommendations for students\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRole\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecommendation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWorld Caf\u0026eacute; Participant Quotations\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. See and listen to the person as an individual and not a diagnosis/disease,, assume nothing (be person centred)\u003c/p\u003e\u003cp\u003e2. Show good etiquette \u0026ndash; includes putting away phones (showing respect and attention), engagement by asking questions and respecting the expertise of the service user.\u003c/p\u003e\u003cp\u003e3. Discuss and respect boundaries of confidentiality\u003c/p\u003e\u003cp\u003e4. Limit jargon during conversations as this can become a barrier to relationship development and trust\u003c/p\u003e\u003cp\u003e5. Consider non-verbal cues (eye contact, body language) \u0026ndash; this can affect how much a service user will open up about their experience.\u003c/p\u003e\u003cp\u003e6. Be prepared to meet people who have had positive and negative experiences of healthcare services and staff\u003c/p\u003e\u003cp\u003e7. Be adaptable to change before and during time learning from service users.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eActually, to hear that real life, you're not just reading some textbook\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eIt's also important for students to be able to talk to you, not down to you\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSo some students come in with the attitude, \u0026lsquo;What do they [community members] know?\u0026rsquo; Yeah, they're coming with pre-conceptions.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThere is nothing worse than having nobody ask questions.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e... \u003cem\u003eit\u0026rsquo;s not okay to be on your phone all the time.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI mean, if I was in that room, I would have been horrified, you're [students are] not listening.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eWe'll [service users] be more comfortable and free to open up and discuss things, that what I have to say is going to be respected.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eLanguage matters...about how to talk to people about their condition or how to talk about the condition.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFollow up comment: I believe the language used around service users can be the first hurdle to developing the trusting relationship.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eEye contact could be so important because if that wasn't maintained with the patient, I think it could leave the patient feeling quite uncomfortable\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI've had positive healthcare experiences, but I've also had very negative ones. So I'm reluctant to share those because we live in Ireland. Yes, everybody knows everybody.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eStudents have to be adaptable to the theory that they've learned, because they might need to think outside the box. So just they need to be flexible and adaptable in their practise. Because I when you see a student coming out and things don't work the way they think it should, it's just sometimes you have to adapt to a different way.\u003c/em\u003e\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=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eb Recommendations for Staff\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRole\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecommendation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWorld Caf\u0026eacute; Participant Quotations\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Plan with service users around any teaching session - at the university or in fieldwork/practice sites\u003c/p\u003e\u003cp\u003e2. Negotiate ground rules/expectations with students and service users in advance \u0026ndash; help to establish trust early so that both can o learn from each other openly\u003c/p\u003e\u003cp\u003e3. Clearly outline the physical set up/ location of rooms (e.g. distance to bus-stop, accessible car parks, rest rooms, sound and mic availability, if desks need to be moved around and agree if students will do that). Offer, if possible, a visit to the teaching space for service users in advance, to see physical space (or send a video).\u003c/p\u003e\u003cp\u003e4. Ensure service users and staff link the learning from service users with other learning, before and after the interaction.\u003c/p\u003e\u003cp\u003e5. Ensure practice educators maintain an openness to student\u0026rsquo;s perspectives as their fresh ideas might help overall practice in healthcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eWe need to know what's going to happen - What are the questions you might get asked? That preparation with the lecturers who invited you in.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eJust to set out the rules and to let everyone know that there will be engagement and everyone\u0026rsquo;s opinion will be respected and valued.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe lecturer, whoever that's organised you to come in, make sure students know that whatever is said within the room, stays within the room.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eHow do you get access to a classroom, how many people are going to be in the room. How long are you going to be kept in the room? Not knowing these things can cause some people anxiety.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eOr some people have to think about mobility. But \u0026lsquo;you never said there were five steps outside the building\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eWhat is the topic? Where do we go with the topic? What have the students done with the topic before?\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eStudents should report and talk to management (supervisors/managers on healthcare placements) as well as service users, because they (students) are fresh people coming in and management can be stuck in a way.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eBecause you have to have old heads with new heads for something to change... You need a balance.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2c Recommendations for Service Users\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"935\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eService users\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003col\u003e\n \u003cli\u003eBe aware of diversity in the room of students in terms of different backgrounds based on ethnicity, economics, culture, etc.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003eConsider in advance what information they personally want to share or not (confidentiality)\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eAsk for lecturer support in design and/or delivery of the session, if desired\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eFor long term engagement with service users \u0026ndash; staff or students must give feedback about any work that happens in conjunction with service users, including training sessions or related project work from fieldwork/practice education.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eExactly how people would like to be addressed. Go out first (planning visit with staff) because you\u0026apos;ll get the knowledge about how the students would like to be addressed.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI\u0026rsquo;d be a bit nervous about what questions they (students) might ask me. The side effects of the condition for me, that can be too personal \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBut you have to watch your sharing. Because we all have a choice about what we share. But then if you\u0026apos;re asked the question (from students), I think you have to say sorry, I don\u0026apos;t feel comfortable answering that, you must have confidence.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe first couple of times I did it [teaching students], I had no idea what was being looked for. So, I think having somebody who delivers a module and contributes their experiences as it progresses is beneficial.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThis is the work I [the student] hoped to get done*. But when I\u0026apos;m finished, if you give me a couple of weeks, I will get back to you [service user] again, with the feedback. Because sometimes when they\u0026apos;re gone, they\u0026apos;re gone. They\u0026apos;re not allowed to come back. And I think that\u0026apos;s very wrong because they\u0026apos;ve done all that piece of work and built a relationship with that person.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eFollow up comment: I think the lecturers should keep in touch with the service users as the students come and go\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Relates to students working with community members on placement around collaborative projects\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eDescription of World Caf\u0026eacute; participants\u003c/h2\u003e\u003cp\u003eThe population are presented in a summary of those attending here, as it was a small group with quite distinctive reasons for qualifying as SUs, further demographic or descriptive details could risk their anonymity. For these reasons, alongside the difficulties accurately identifying individuals on audio-recording at World Caf\u0026eacute; tables, no unique identifiers are included with participant quotes.\u003c/p\u003e\u003cp\u003eTwelve people attended this event, three men and nine women. Participants came with a broad range of experiences qualifying them to represent service user perspective: three participants were older people, one of whom was also a family carer and another had a mobility disability, two other participants were members of an urban regeneration community who had recently supported community engaged placements with allied health students (one of these participants was also the mother and advocate of a child with a complex disability). Another man lived with a rare neurological disease, three other participants represented patient advocacy groups (older people, people living with mental health diagnoses and people living with diabetes). Two community members who provide services to people with chronic pain and trauma also attended. One woman was a wheelchair user and stroke survivor. The World Caf\u0026eacute; was held at a wheelchair accessible venue.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eKey findings\u003c/h2\u003e\u003cp\u003eThere were broad areas of agreement and ongoing debate during the World caf\u0026eacute; and when following up afterwards with participants and these are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInsert about here - Table 1 Agreement and areas of debate\u003c/h3\u003e\n\u003cp\u003eA key priority agreed by all participants was that trust must be established between service users and students and, at times, with staff from the university for service user involvement to be effective and ongoing. Trust was seen as crucial to successful SUI, whether students are interacting with service users during placements or in the classroom, or between university staff and SUs. As one participant shared feedback on preliminary findings: \u003cem\u003eI couldn\u0026rsquo;t agree more with the primary goal of establishing trust between student practitioners and service users. As a service user myself I feel that the language used to describe us can have a marked effect on our subconscious and can affect the relationship between service users and the students.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eInsert about here - Fig. 1 Importance of trust for successful service user involvement\u003c/h3\u003e\n\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe ways in which trust can be established are outlined in the following summary of recommendations for students, SUs and academic staff (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ea, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003eb and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ec).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eInsert about here - Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ea Recommendations for students\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eInsert about here - Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003eb Recommendations for university staff\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section4\"\u003e\u003ch2\u003eInsert about here - Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ec Recommendations for service users\u003c/h2\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFeedback from participants during and after the World Caf\u0026eacute; event\u003c/span\u003e\u003c/p\u003e\u003cp\u003e Participants appreciated the time taken and opportunity for them to meet other people at different tables to stimulate ideas and build confidence sharing their thoughts. Many were keen to meet again and asked about this possibility over the lunch at the end of the World Caf\u0026eacute;. During the feedback on preliminary findings, all those who returned comments (6/12) expressed gratitude for the invitation and opportunity to give further feedback and could see the value of this approach and their perspectives in shaping best practice for the education of healthcare students, and ultimately, improvements in healthcare delivery: \u003cem\u003eI commend those involved in drawing up this report, the language is easy to understand and I look forward to its implementation which will greatly improve the experience of the health service for all involved \u0026hellip; Having gone through the attached documents I really think the team have captured everything that was discussed on the day \u0026hellip; thank you for including us in the process.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the first the authors are aware of which uses a World Caf\u0026eacute; methodology to collect and explore the perspectives of service users about what would help or restrict their abilities to contribute to healthcare education. The findings are rich in detail about practical ways where students and academic staff can enhance this role, as well as guidance from service users to other potential service users about taking care of themselves while maximising their contribution and experience if engaging with healthcare students.\u003c/p\u003e\u003cp\u003eKey Point 1: Trust was a fundamental cornerstone for developing the relationships required for sustainable service user involvement is interesting. Trust could be established by negotiating power and rules of engagement between students and service users, as well as and staff and students using language as preferred by service users. Such mechanisms can break down the academic divide often present between higher education institutions and the communities they serve, to genuinely engage with diverse groups who can support student learning and, in turn, that those communities be supported to have a voice (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eKey Point 2: Ongoing relationships between service users and staff are critical to a sustained SUI in healthcare education programmes. In line with other studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), to realise the potential of SUI, institutional commitment to the recruitment and retention of SUs requires increased recognition and transparency about this role and related processes. To achieve this, the time needed to build and sustain trust with patient-related organisations and communities is vital and needs to be acknowledged in the academic workload. Enhanced roles for service users could support sustainability, such as involvement in student selection for programmes, during student assessment or curriculum review, however these positions require significant administrative and institutional support to be realised (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eKey point 3: Interestingly, when it came to student competency development, SUs prioritised communication and \u0026lsquo;hands-on\u0026rsquo; skills over \u0026lsquo;book learning\u0026rsquo;. Service users were motivated that healthcare students grapple with the complexity and diversity of life outside of university classroom learning. Service users recognised SUI can support such learning, which is in line with other literature on the value of SUI (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Service users perceived that their fresh perspectives could enhance existing services which had possibly underserved them at times, an idea that has received little attention in research (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The optimism of SUs about healthcare students could encourage students to work on the confidence needed to observe and suggest changes in practice.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations and future studies\u003c/h2\u003e\u003cp\u003eThese findings will be distributed to current and future staff at [blind for peer review] and will form the basis of good practice (and review of same) for service user involvement in our curriculum. Furthermore, the results here add to a small but growing body of evidence about how best to support service users in their vital role working with healthcare students (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). To develop further understanding and ensure a service user perspective, designing studies with service users as part of the research team would be a logical next step, to identify priority questions and appropriate methods (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Other consensus approaches, for example, could further develop best practice recommendations with wider service user groups, as has been used in healthcare service design to good effect (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile the evidence from students about how experiences learning from SUs is steadily developing (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), there is potential to link students and service users to co-create learning experiences (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This approach could pose challenges to academic staff on pedagogical direction (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and related accountability for education to external regulatory and accrediting bodies. However, such co-design could also represent the next step in maximising engaged learners and empowering the service users we aim to support. Finally, service user involvement in practice education (as opposed to the traditional classroom learning environment) is an area which has a lack of allied health representation, with most studies from a recent review on this topic centred in Medicine and Nursing (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003e This study was the first of its kind in [country blind for peer review]. The diversity of people who attended (mix of genders, experiences and advocacy group members), who all remained fully engaged for over 2 hours, was a strength of this participatory approach, leading to rich and illustrative data. A floating facilitator helped when groups at tables might be flagging or stuck and also to support latecomers. While the planned walk/roll through of summaries across tables at the end did not happen, partly as all were ready for lunch, it was encouraging that all participants stayed on and were very enthusiastic about follow up.\u003c/p\u003e\u003cp\u003eDespite the flexibility of World Caf\u0026eacute; events, they are not without their limitations. The participants are not representative of all service users, given service users can be a diverse group including children, people with complex health conditions and at different ages and with socio-demographic backgrounds. For this event, despite extensive advertising, there were many potential SU groups who did not attend, possibly as a full morning in-person event required more effort and planning. Having hybrid and/or online events may have enabled more people to engage (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe role of service users is vital for authentic learning for students and for universities committed to engaging the wider community in higher education. There are practices that can support service users when starting or developing their role, the responsibility for which lies with students, academic staff and service users themselves.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSU \u0026ndash; Service user\u003c/p\u003e\n\u003cp\u003eSUI \u0026ndash; Service user involvement\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval Statement\u003c/strong\u003e: This study received ethical approval from the University of Limerick Education and Health Science Faculty Ethics committee Reference: 2023_05_12_EHS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: All participants provided informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e: The datasets generated and/or analysed during the current study are not publicly available due to representation from very small/niche groups of people posing a risk to de-anonymisation agreed during data collection, however fully anonymised data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eFunding statement: This work was funded by a Strategic Alignment of Teaching and Learning Enhancement grant from the National Teaching Forum for the Enhancement of Teaching and Learning in Higher Education in Ireland, awarded November 2023\u003c/p\u003e\n\u003cp\u003eCompeting Interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions: PB, AG and SD designed this study, applied for funding for the event, recruited participants, collected and analysed data and prepared the first and subsequent drafts for dissemination. GC and CP supported recruitment and data collection and contributed to publication. AG supported design of the study, recruitment and preparation of the manuscript for publication. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003eClinical Trial Number: Not applicable\u003c/p\u003e\n\u003cp\u003eConsent to publication: Not applicable\u003c/p\u003e\n\u003cp\u003eAcknowledgments: We wish to thank Elaine Storan, administrator at the School of Allied Health, for invaluable support planning and running the event where these data were collected.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHenriksen AH, Ringsted C. Learning from patients: students\u0026rsquo; perceptions of patient‐instructors. Med Educ. 2011;45(9):913-9. doi: 10.1111/j.1365-2923.2011.04041.x\u003c/li\u003e\n\u003cli\u003eŚwitaj P, Grygiel P, Krzyżanowska-Zbucka J, Sonik J, Chrostek A, Jahołkowski P, et Wciorka J Anczewska M. The evaluation of the impact of anti-stigma training led by \u0026ldquo;experts by experience\u0026rdquo; on participants\u0026rsquo; attitudes towards persons with mental illness. Psychiatr Pol. 2019;53:1219 \u0026ndash; 1236. doi.org/10.12740/PP/109818\u003c/li\u003e\n\u003cli\u003eCullen M, Cadogan C, George S, Murphy S, Freeney S, Fitzpatrick R, et al. Key stakeholders\u0026rsquo; views, experiences and expectations of patient and public involvement in healthcare professions\u0026rsquo; education: a qualitative study. BMC Med Educ. 2022;22(1):305. doi.org/10.1186/s12909-022-03373-z\u003c/li\u003e\n\u003cli\u003eGordon M, Gupta S, Thornton D, Reid M, Mallen E, Melling A. Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58. Med Teach. 2020;42(1):4-16. doi:10.1080/0142159X.2019.1652731.\u003c/li\u003e\n\u003cli\u003eJobling H, Sayuri Ii S. The impact of service user involvement in health and social care education: a scoping review. Practice. 2024;36(3):193-211. doi.org/10.1080/09503153.2023.2248414\u003c/li\u003e\n\u003cli\u003eTowle A, Bainbridge L, Godolphin W, Katz A, Kline C, Lown B, Madularu I. Solomon P, Thistlewaite J. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64-74. doi: 10.1111/j.1365-2923.2009.03530.x\u003c/li\u003e\n\u003cli\u003eSoon YE, Murray CM, Aguilar A, Boshoff K. Consumer involvement in university education programs in the nursing, midwifery, and allied health professions: a systematic scoping review. Int J of Nurs Stud. 2020;109:103619. doi:10.1016/j.ijnurstu.2020.103619.\u003c/li\u003e\n\u003cli\u003eScanlan JN, Logan A, Arblaster K, Haracz K, Fossey E, Milbourn BT, et al. Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand. Aust Occup Ther J. 2020;67(1):83-93. doi: 10.1111/1440-1630.12634\u003c/li\u003e\n\u003cli\u003eLee J, Campbell S, Choi M, Bae J. Authentic learning in healthcare education: A systematic review. Nurs Educ Today. 2022;119:105596. doi:10.1016/j.nedt.2022.105596.\u003c/li\u003e\n\u003cli\u003eSy MP, Panotes A, Cho D, Pineda RC, Martin P. A rapid review of the factors that influence service user involvement in interprofessional education, practice, and research. Int J Env Res Public Health. 2022;19(24):16826. doi: 10.3390/ijerph192416826\u003c/li\u003e\n\u003cli\u003eFelton A, Stickley T. Pedagogy, power and service user involvement. J Psychtr Ment Health Nurs. 2004;11(1):89-98. doi: 10.1111/j.1365-2850.2004.00693.x.\u003c/li\u003e\n\u003cli\u003eVan Rooijen M, Van Dijk-De Vries A, Lenzen S, Dalemans R, Moser A, Beurskens A. How to foster successful implementation of a patient reported experience measurement in the disability sector: An example of developing strategies in co-creation. Res Involv Engagem. 2021;7(1):45. doi.org/10.1186/s40900-021-00287-w\u003c/li\u003e\n\u003cli\u003eBury A. User involvement in palliative care education: beyond rhetoric and tokenism. In Foyle, L. Hostad, J. Editors. Illuminating the Diversity of Cancer and Palliative Care Education. London: CRC Press; 2018. p. 243-261. doi.org/10.1201/9781315383460\u003c/li\u003e\n\u003cli\u003eMcCutcheon K, Gormley K. Service-user involvement in nurse education: partnership or tokenism? Br J Nurs. 2014;23(22):1196-1199. doi: 10.12968/bjon.2014.23.22.1196.\u003c/li\u003e\n\u003cli\u003eKalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, et al. Power to the people? A co-produced critical review of service user involvement in mental health professions education. Adv Heal Sci Educ Theor Prac 2024;29(1):273-300. doi: 10.1007/s10459-023-10240-z.\u003c/li\u003e\n\u003cli\u003eL\u0026ouml;hr K, Weinhardt M, Sieber S. The \u0026ldquo;World Caf\u0026eacute;\u0026rdquo; as a participatory method for collecting qualitative data. Int J Qual Methods. 2020;19. doi.org/10.1177/1609406920916976\u003c/li\u003e\n\u003cli\u003eSchiele H, Krummaker S, Hoffmann P, Kowalski R. The \u0026ldquo;research world caf\u0026eacute;\u0026rdquo; as method of scientific enquiry: Combining rigor with relevance and speed. J Bus Res. 2022;140:280-296. doi.org/10.1016/j.jbusres.2021.10.075\u003c/li\u003e\n\u003cli\u003eBumble JL, Carter EW. Application of the World Caf\u0026eacute; to disability issues: A systematic review. J Disabil Pol Stud. 2021;32(3):193-203. doi.org/10.1177/104420732094\u003c/li\u003e\n\u003cli\u003eMcGrath C, Kennedy M-R, Gibson A, Musse S, Kosar Z, Dawson S. World Caf\u0026eacute;s as a participatory approach to understanding research agendas in primary care with underserved communities: reflections, challenges and lessons learned. Res Involv Engagem. 2023;9(1):101. doi: 10.1186/s40900-023-00509-3.\u003c/li\u003e\n\u003cli\u003eClements AJ, Sharples A, Bishop J. The World Caf\u0026eacute; method for engaging groups in conversation: Practical considerations and an agenda for critical evaluation. Occup Psych Outlook. 2024;3(1):6-18. doi.org/10.53841/bpsopo.2024.3.1.6\u003c/li\u003e\n\u003cli\u003eBengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus open. 2016;2:8-14. doi.org/10.1016/j.npls.2016.01.001\u003c/li\u003e\n\u003cli\u003eTowle A, Ong K, Wang L, Kline CC. Patient/public perceptions on engagement with a medical school: What needs to happen to support authentic and sustained participation. Medical Teacher. 2024;46(7):963-970. doi:10.1080/0142159X.2023.2289843.\u003c/li\u003e\n\u003cli\u003eBurman R, Singh G. Power, patients, and change: Young people can help to reimagine healthcare. BMJ; 2025: 388. https://doi.org/10.1136/bmj.r265\u003c/li\u003e\n\u003cli\u003eRyan L, Wenke R, Carlini J, Weir KA, Shapiro M, Baglot N, et al. Exploring barriers and solutions to consumer involvement in health service research using a nominal group technique. Res involve engagem 2024;10, 72. https://doi.org/10.1186/s40900-024-00604-z\u003c/li\u003e\n\u003cli\u003eBrand G, Sheers C, Wise S, Seubert L, Clifford R, Griffiths P, Etherton-Beer, C.. A research approach for co‐designing education with healthcare consumers. Med Educ. 2021;55(5):574-81. doi: 10.1111/medu.14411\u003c/li\u003e\n\u003cli\u003eBevitt T, Pereira RB, Bacon R, Isbel S. Exploring the concepts of consumer feedback systems for occupational therapy student learning during practice placements: A scoping review. Aust Occup Ther J. 2024;71(6):1089-1105 doi: 10.1111/1440-1630.12984.\u003c/li\u003e\n\u003cli\u003eKinney D, Kinney W. Adapting the world caf\u0026eacute; method to an online format: insights from novice qualitative researchers. J Participatory Res Methods. 2024;5(3). https://doi.org/10.35844/001c.122576\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Service Users, Healthcare Education, World Café, Participatory methods","lastPublishedDoi":"10.21203/rs.3.rs-7237769/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7237769/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eService users can enrich healthcare education, leading to deeper empathy and person-centred communication skill development for students. However, there remains gaps in understanding service user perspectives on their role and the ways in which the experience could be enhanced, with tokenism an ongoing risk to this educational experience for both service users and students. This study collected perspectives from healthcare service user about their role as educators, to gain clarity on how this potentially transformative and socially important element of healthcare education can be maximised safely.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA World Caf\u0026eacute; methodology was employed, which is a collaborative research approach positioning the service user as expert, enabling a deep understanding of their experiences in health education. This method also aims to mitigate potential power imbalances between the service user and researchers. Twelve service users (or representatives of service users) attended a two-hour World caf\u0026eacute; event. Data were analysed using content analysis and feedback was sought from participants on preliminary findings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTrusting relationships with both students and academic staff were the fundamental starting points for service users to engage as partners in healthcare education. A series of recommendations generated by the discussions during the World Caf\u0026eacute; offer clear guidance for how this trust can be initiated and maintained. Respect for the service user perspective, having students and staff recognise the value of their experiences and practical supports were core across recommendations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe role of service users is vital for authentic learning for students and for universities committed to engaging the wider community in higher education. Care is recommended by academic staff when inducting new services users as educators, as well as preparing students, ensure students respectfully and actively engage with service users. Practical supports, such as a visit to teaching venue or availability of lecturers to tie service user experience to wider curriculum, are welcomed by service users.\u003c/p\u003e","manuscriptTitle":"Recommendations for service user involvement in healthcare education: A World Café event","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:43:23","doi":"10.21203/rs.3.rs-7237769/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-23T12:14:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290098264883123696314786845086976377072","date":"2025-09-23T09:27:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164766429682580736151623188956109777641","date":"2025-09-18T09:46:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T09:04:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T04:46:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-25T03:58:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-22T12:29:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-22T12:26:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"89fae578-5a42-4be4-8359-e3964b0efa27","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T09:08:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:43:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7237769","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7237769","identity":"rs-7237769","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}