New impulses from international development for more comprehensive and balanced public engagement evaluation

摘要

Public engagement in health research has gained popularity because of its potential to co-create knowledge, generate dialogue, and ground research in the priorities and realities of the target groups. However, public engagement that achieves these objectives could still entail unforeseen negative consequences or a wasteful use of resources. Although the evaluation of public engagement has evolved in recent years, we lack consistent evaluation criteria for systematic and transparent assessments of success and failure. This article introduces standard evaluation criteria from the field of development aid evaluation (effectiveness, efficiency, impact, relevance, sustainability) to promote more systematic and comprehensive evaluation practice. I apply these criteria to the public engagement component of a recent research project into antimicrobial resistance, antibiotic use, and health behaviour in Thailand and Laos. Considering village-level engagement workshops, international exhibitions of photo narratives of traditional healing in northern Thailand, and social media communication, I demonstrate that activities that seem to achieve their objectives can still have problematic characteristics in other dimensions. I conclude that these five generic evaluation criteria can broaden our understanding of public engagement. Their more widespread use in evaluations can help build a more comprehensive and balanced evidence base, even if only a sample of public engagement projects and programmes can be evaluated systematically.SPECIAL ISSUE: Antimicrobial ResistanceKEYWORDS: Public engagement, patient and public involvement, participatory research, health research, evaluation, Thailand, LaosBackgroundPublic engagement remains high on researchers’ and funders’ agendas, and it has particular prominence in health research. The UK Medical Research Council (MRC) advises for instance that, ‘effective public engagement is a key part of the MRC’s mission and all MRC-funded establishments are encouraged to dedicate resources to support this area of work’ and the Wellcome Trust has awarded more than ￡30 million for dedicated public engagement projects between 2005 and 2018 [1,2].Also framed as science communication, community engagement, or patient and public involvement in health research, the broad definition of public engagement has evolved from the unidirectional transfer of scientific knowledge from researchers to the lay public, to bidirectional and collaborative ‘engagement’ with the users of research and non-academics more broadly [3–7]. Such engagement aims at broadening the appreciation and impact of research, but collaborative relationships are also intended to improve relevance and ethical aspects of health research and policy – for instance by enabling scientists to learn from their target populations and define and guide research and practice in a participatory fashion [8–12].In global health research and policy, public engagement activities tend to cluster around the instrumental rather than collaborative end of the spectrum, involving typically behaviour change interventions, health education campaigns, or activities to ‘mobilise’ communities for instance to vaccinate their children [13–17]. The types of activities employed for these purposes include, for example, online information platforms, science festivals and museum events, theatre performances, radio shows, or information workshops for high school students [6,18–21]. Public engagement following the collaborative strand involves longer-term interaction and partnerships such as the establishment of community health committees to advise the local health system and researchers [5,22].Whether it is framed as a dialogue or as an intervention to educate and mobilise, public engagement can have unintended consequences in spite of its potential benefits and the motivation of researchers. Target and non-target groups can experience negative consequences and outright harms, like misunderstandings, suppression, or stigmatisation. For example, as a form of health communication, public engagement does not only help to expand knowledge and spark curiosity, but it can also create resistance or actions with problematic consequences [23,24]. In Denmark, public awareness raising about drug resistance has eventually culminated in leaflets that advocate not to have sex with pig farmers [25]. In The Gambia [13], radio programmes, theatre performances, and consultative workshops were used to encourage community participation vaccine trials, but these activities eventually reproduced an artificial, dichotomous distinction between ‘accepting’ and ‘refusing’ communities (the idea that people’s participation in the trial should be expected, and that refusal to participate is a problem, caused by ignorance). The failure to enact bidirectional communication cemented misunderstanding, discredited communities’ understanding of the trial, and obscured local struggles of care practices a