There are many different flavours of co-production. Done well, co-production enriches research and implementation. Done badly, co-production reinforces the ‘top-down’ approach that it tries to address. In this blog, Rob Calder considers the importance of embedding research into practice rather than the other way round. He also tries to engineer a food-based analogy into a blog where it won’t quite fit. 

We need to talk about ’embedding’

I have read enough papers and blogs on this topic to develop bugbears. They’re only words but the way they are used can still irk. ‘We must…’ (endless academic introductions write) ‘…embed user input into our research processes’. ‘We must embed service users into steering groups’. ‘We must embed user involvement into our universities’. ‘We must….’ well you get the idea.

This approach is well intentioned and can have many positive outcomes. I certainly don’t seek to diminish the impact and importance of this work. But, it still rests on a top-down model. Which incidentally is another phrase that is beginning to fray around the edges. Top down. Where’s the top, and does that place service users at the bottom? It doesn’t seem quite right.

The reason that embedding service user input into research reinforces, rather than challenges a ‘top down’ approach is because it still assumes that research is The Thing that Other Things should be embedded into. Research is at the top, and needs to be supported by all the things below it. Standing on the shoulders of giants, practitioners and service user input.

Research principles

The broad principles of practice and research in healthcare suggest that researchers spot techniques that seem to work – either from practice or from research. They then isolate these techniques and test whether they actually do work. The original technique in question is then either discarded or integrated into new practice – and so it continues.

The point of all of this is to improve treatment. Sure, people get a kick out of knowledge for knowledge’s sake, and that’s wonderful. Yes, increasing your understanding of the human condition is a hoot. The point, however, is to understand, prevent, treat and help people who use drugs. This is the end point. Research contributes to this. Research is part of the ‘back end’ and as such should be embedding itself into treatment rather than expecting treatment to be embedded into it.

Go, don’t summon

In the UK there are treatment centres everywhere, NHS and third sector, there are smoking cessation clinics, vaping shops, pubs, clubs, betting shops and pharmacists. Most are approachable, interested and willing to talk. There may be safeguarding processes to go through, but compared with the paperwork for ethics or grant applications? These processes will not pose substantial barriers.

It is not difficult develop contacts with the relevant places and the right people. Go and speak to service users, people quitting tobacco, pharmacists and people who use drugs. If you need to get service user involvement and start setting up a panel, ask yourself the question whether you are going to them, or you are summoning them to you? The difference can be important. Imagine someone calls you into their office and reads through a list of questions; then imagine that same person visits your workplace, sits down next to you and asks you about your experiences. Your response will almost certainly differ with these different approaches.

Co-producing pizza

Allow me a delicious false equivalence. Pizza is delicious (and falsely equivalent) and contains many different elements. People research how to grow better tomatoes, make mozzarella, build pizza ovens, rest pizza dough and so on. They do all of these things so that the resulting pizza can be as good as it possibly can be. But the end point is pizza – the end point is always pizza. The end point isn’t a bigger tomato, a hotter oven or a …er…restier dough? The end point is pizza.

Trying to embed practice into research is as perverse as trying to embed pizza into a tomato – it’s just the wrong way around. The tomato growers, harvesters, transporters need to work hard so that when chef Oetker (other pizza chefs are available) reaches for the tomatoes, they get the best tomatoes possible. The tomato growers shouldn’t expect the chef to attend their steering group on crop rotation. They shouldn’t expect chefs to sit on a panel discussing harvesting techniques.

Rather than working out how best to embed treatment or service user input into research, researchers might consider how best to embed themselves into treatment and service user settings. It might just make for a better pizza.

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