By Julie Clayton, Patient and Public Involvement and Engagement Lead, Bristol Brain Centre and Centre for Academic Primary Care, University of Bristol, Victoria Wilson, Patient and Public Involvement and Engagement Advisor, Centre for Academic Primary Care, University of Bristol and Shoba Dawson, Senior Research Fellow in Inclusive Research, School of Medicine and Population Health, University of Sheffield

Between them, the authors have over 20 years of experience supporting patient and public involvement (PPI) in health research, and conducting research in the field. In this blog they share their top 10 tips for improving diversity in research, drawing on the insights and reflections of individuals and communities they have worked with.

The challenge

“I have a grant deadline coming up – I need to talk to a diverse group of patients!”

We frequently hear this from research colleagues and know they are under pressure from funders to include the voices of a wide range of people, to make sure their health research projects are relevant to everyone in society.

After five years working across the culturally and ethnically diverse city of Bristol, where more than 92 languages are spoken, and building a public panel of more than 80 people interested in health research, it seems that we have only scratched the surface of who is ‘out there’.

This is from an admittedly university-centric view – the people we have ‘found’ of course have been there all along, but we just hadn’t introduced ourselves.
The flip side of this human coin is that community groups often tell us that they are fed up with research teams that come and go, helicopter-fashion, often asking the same questions, and disappearing.

“We don’t want researchers to come and collect data and go. We have a lot to contribute to the research, to contribute ideas.”

So to try to ensure some continuity, and avoid researchers reinventing the wheel, we would like to share our most valuable tips on how best to build diversity in research, and would love to hear what you think of them.

Building trust

A key lesson, overall, is to think beyond the lifespan of individual projects. Instead, take time to build relationships and trust with the communities that you wish to work with in the future.

Trust is an especially important issue – for community members to know that they can trust what researchers are telling them about what will happen if they take part in research. This is easier through conversation rather than correspondence.

One PPI contributor said, “I have letters all the time from the NHS – it’s just a piece of paper – I don’t see any human connection on there – that helps a lot – if I hear it from the person that’s doing the research that makes a connection.”

Our top 10 tips

1. Consult and build trust with local communities – explain the purpose of the research and why you are targeting a particular community.
2. Talk to community groups – people who can influence families, friends, neighbours.
3. Advertise locally in the communities you wish to recruit, through different media such as printed flyers and WhatsApp groups.
4. In study advertising, use images that represent a range of people.
5. Recruit via GP practices that serve diverse populations (for example, through the ‘GPs at the Deep End’ network)
6. Give opportunities for people to contribute their ideas and experiences.
7. Employ community workers as PPI co-applicants and co-researchers to help build trust and break down barriers.
8. Be aware of language and cultural barriers and use translations where appropriate.
9. Open up access to research via community-based clinics or a special referral pathway – with appropriate design and ethics approval.
10. Create easy-read versions of study recruitment materials, to improve access for people with lower literacy, cognitive impairment, or people for whom English is not their first language.

For more insights and links to useful resources for improving diversity and inclusion in research, see our recent report.

We hope you find these tips useful. Feedback is welcome. Please send comments to julie.clayton@bristol.ac.uk.