<p>In this age of accountability, responsiveness, and transparency, governments are increasingly pressured to develop ways to demonstrate the value of public involvement in policy decision-making. Yet the extent to which policy decisions actually reflect citizens’ views and input from public involvement processes remains relatively unknown. The main purpose of my dissertation is to examine the internal dynamics of how public involvement is used in the health policy decision-making process. It is guided by two research questions: i) How is public involvement used in the health policy decision-making process; and ii) What factors influence the use of public involvement in the health policy decision-making process? These questions are explored through three independent but complementary studies: i) through a concept analysis, to clarify the concept of public involvement use in health policy decision-making; ii) through a document analysis, to examine the values and assumptions that underpin current and proposed relationships between publics and government, how these have evolved over time, and the meaning of public involvement itself; and iii) through a literature review and key informant interviews, to identify the range of factors influencing the nature of how public involvement is used. The concept of public involvement use, as presented in this thesis, is a complex<strong><em> </em></strong>concept that may be understood, interpreted and operationalized through three interrelated questions: What is the meaning of use in relation to other similar concepts? What is public involvement used for? And, how do we know public involvement was used in health policy decision-making? The results of this dissertation also reveal numerous tensions that characterize the dynamics of how public involvement is used in policy decision-making. Taken together, the three studies provide insights into ways in which public administrators and policy decision-makers could respond to calls for greater accountability and transparency regarding the use of public involvement in policy decision-making.</p> / Doctor of Philosophy (PhD)

It is widely recognized that coal is and will continue to be a crucial element in a modern, balanced energy portfolio, providing a bridge to the future as an important low-cost and secure energy solution to sustainability challenges. The designer of coal mining operations needs to simultaneously consider legal, environmental, and sustainability goals, along with traditional mining engineering parameters, as integral parts of the design process. However, traditional coal mining planning seldom considers key “sustainability factors” such as societal impacts; dislocation of towns and residences; physical and economic impact on neighboring communities and individuals; infrastructure concerns; post-mining land use habitat disruption and reconstruction; and long-term community benefit. This work demonstrates the advantage of using a systems engineering approach based on the premise that systems can only be optimized if all factors are considered at one time. Utilizing systems engineering and optimization approaches allows for the incorporation of regulatory and sustainability factors into coal mine design. Graphical approaches, based on the use of GIS tools, are shown as examples of the development of models for the positive and negative impacts of coal mining operations. However, this work also revealed that there are significant challenges inherent in optimizing the design of large-scale surface coal mining operations in Appalachia. Regulatory and permitting programs in the United States, which give conflicting and ill-defined responsibilities to a variety of federal and state agencies, often focus on single parameters, rather than the full suite of desirable outcomes for sustainability, and serve as barriers to innovation. Sustainable development requires a delicate balance between competing economic, environmental and social interests. In the context of coal mining in the U.S., the current regulatory frameworks and policy-guidance vehicles impede this balance. To address this problem, and thus effectively and efficiently provide energy resources while protecting the communities and environments, the U.S. will likely need to fundamentally restructure regulatory programs. Ideally, revisions should be based upon the key concepts of public ecology and allow for a systems engineering approach to coal mine design. / Ph. D.

Yes / The importance of involving members of the public in the development, implementation and dissemination of research is increasingly recognised. There have been calls to share examples of how this can be done, and this paper responds by reporting how professional and lay researchers collaborated on a research study about falls prevention among older patients in English acute hospitals. It focuses on how they worked together in ways that valued all contributions, as envisaged in the UK standards for public involvement for better health and social care research. The paper is itself an example of working together, having been written by a team of lay and professional researchers. It draws on empirical evidence from evaluations they carried out about the extent to which the study took patient and public perspectives into account, as well as reflective statements they produced as co-authors, which, in turn, contributed to the end-of-project evaluation. Lay contributors' deep involvement in the research had a positive effect on the project and the individuals involved, but there were also difficulties. Positive impacts included lay contributors focusing the project on areas that matter most to patients and their families, improving the quality and relevance of outcomes by contributing to data analysis, and feeling they were 'honouring' their personal experience of the subject of study. Negative impacts included the potential for lay people to feel overwhelmed by the challenges involved in achieving the societal or organisational changes necessary to address research issues, which can cause them to question their rationale for public involvement. The paper concludes with practical recommendations for working together effectively in research. These cover the need to discuss the potential emotional impacts of such work with lay candidates during recruitment and induction and to support lay people with these impacts throughout projects; finding ways to address power imbalances and practical challenges; and tips on facilitating processes within lay groups, especially relational processes like the development of mutual trust. / Funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research (HSDR) Programme (Project Number NIHR129488).

Federal, state and local laws entitle the public to have an active role in the transportation decision making process. However, it remains difficult to engage the public in the long range planning process. The laws requiring public involvement are intentionally vague and don’t prescribe specific approaches, so there is little consistency in public participation approaches and many state, regional, and local transportation agencies choose to do only what is necessary to meet minimum requirements (PBS&J, 2009). The purpose of this study is to examine public participation in transportation planning with specific focus on how the characteristics of public participation, the level of engagement, and deliberation affect the extent to which transportation planning decisions are reflective of public input received. A quantitatively driven mixed methods study was completed in three phases using secondary data, exclusively. Phase I included a review of each Metropolitan Planning Organization (MPO) and a study of the public involvement procedures that were used to develop each MPO’s Metropolitan Transportation Plan (MTP). Phase II focused on the input that was gathered by each MPO for public participation activities conducted during the development of the MTP. In Phase III, the results of Phases I and II were used to conduct a cross tabulation analysis to determine if there was a relationship between the characteristics of public participation, the level of engagement of participation, and the use of deliberation, and the degree to which public input was reflected in the MTP. The findings of this study indicate support for literature based in levels of engagement and the use of deliberation. Despite the design of the participation plan, transportation decisions reflect public input more often when MPOs have broad outreach to the public, higher levels of engagement, and use deliberative public participation techniques. Implications for policy and practice, and recommendations for future research are discussed.

Cognitive difficulties can persist for months and years after stroke and adversely impact confidence, mood and functional recovery. Stroke survivors, carers and healthcare professionals collectively agree that improving cognition is the number one research priority for life after stroke. Future research should include measurements of outcome that service users deem important. Patient reported outcome measures (PROMs) are a means of gaining patient perspectives that can be standardised for use in a trial. PROMs should be developed with service users to incorporate their priorities but people with cognitive difficulties are often systematically excluded from the development and use of PROMs. Study 1 used qualitative interviews (N=16) to explore stroke survivor perspectives on the important and measureable impacts of persisting cognitive problems. The results of this study generated requirements for a PROM that related to conceptual underpinning and face validity of a measurement tool. Study 2 was a systematic review of existing PROMs related to cognition. 20 Identified PROMs were critically appraised against the requirements generated in the qualitative study. No existing PROMs were identified that met all of the qualitative study review criteria. The next stage described in chapter 3, was to develop a new PROM that: utilised the strengths of existing tools; met qualitative study requirements; and was refined through consultation with different stakeholders, prioritising feedback of stroke survivors with cognitive difficulties. The result of this work was the Patient Reported Evaluation of Cognitive State (PRECiS) scale. Study 3 was a psychometric study with stroke survivors (N=164) to test PRECiS in a large sample. Quantitative and qualitative data were collected on acceptability, feasibility and other psychometric properties of validity and reliability. PRECiS demonstrated good acceptability to stroke survivors and performed well psychometrically. Future validation work required for PRECiS is described in discussion chapter 4. Subject to further validation work, PRECiS may be particularly useful for pragmatic trials of cognitive rehabilitation after stroke.

The research programme was relevant to urban planning and in particular to the design of stormwater management schemes that are more environmentally and socially acceptable. It examined social and perception issues relating to stormwater management techniques within residential areas, and in particular to the application of SUDS, mainly ponds, and river management schemes. The thesis arose from a project funded by the Environment Agency of England and Wales through SNIFFER under a programme titled “Social impacts o f stormwater management techniques including river management and SUDS”, SNIFFER Code: SUDS01. The public perception of construction is becoming a matter of increasing importance both in the UK and internationally since socio-economic parameters and public consultation both have to be taken into consideration in the planning and implementation of relevant projects. This research programme endeavoured to match the relevant legislative goals with society’s actual needs. The main aims of the research programme were to obtain an in-depth understanding and knowledge of the perceptions of popular stormwater management practices (SUDS and river management), and to evaluate these techniques from a social perspective. To satisfy these aims the following objectives were set: • To assess public awareness and perceptions of SUDS (particularly retention ponds) in the UK; • To assess professional perceptions of SUDS in the UK; • To assess perceptions of different stormwater management techniques, in three European cities; • To compare perceptions of different stormwater management techniques, SUDS and river management practices; • To link the research findings with trends in perceptions of nature and water. To meet the programme’s aims and to satisfy the objectives, the perceptions of SUDS in the UK (principally ponds) were investigated over a wide range of locations. In addition, the different river management approaches used in three heavily urbanised European cities, Glasgow, London, and Athens were investigated. The results of this research programme provide a means to understand perceptions of stormwater management and to appreciate what types of schemes will be more readily accepted by the public. The research has shown that members of the public hold strong views as to what they like or dislike about SUDS and water management installations in their local area, in spite of the fact that there were demonstrably low levels of public awareness of SUDS. The amenity, recreational value and aesthetics of new schemes seem to be of major importance for public acceptability, while function, efficiency, and maintenance are primarily important in areas facing flooding problems. Other key findings include the fact that there is a general preference for sustainable urban water management and for river restoration schemes compared with more conventional, ‘hard engineering’ approaches, such as culverting of rivers. This preference was expressed both by members of the public and by professionals involved in their planning and implementation. Another important result was that although unfamiliarity can produce negativity, education can influence attitudes positively even in sensitive issues such as safety, and can be used by authorities and planners as a means of enhancing the acceptability of new schemes. Consequently, the results of the surveys can be used as arguments towards the application of informative campaigns which should be taken into account prior to scheme implementation. This information can be utilised not only for stormwater management design, but also for other environmentally friendly constructions which the public may have a low level of awareness. Recommendations are made with respect to public and professional attitudes for improving the public acceptability of new and modified stormwater management systems. Recommendations and barriers to the uptake outlined in this thesis mainly refer to the appearance of schemes rather than technical issues. They are therefore of most use as guidance for improving aesthetics and increasing public acceptability. The outcomes of this research will be of use to policy makers, water companies, local authorities, environment agencies, planners, developers, consultants active in urban development, and researchers in applying wider-accepted practices for the assessment of public perception. Some findings from this research have been presented at several stakeholders’ meetings, at 4 conferences, and are published in the form of papers and reports, including the DTI SR 622 report titled “An Assessment of the Social Impacts of Sustainable Drainage Systems in the UK”, and the Environment Agency & SNIFFER report, SUDS01, 2005, titled “Social Impacts of stormwater management techniques including river management and SUDS”. This publication also constitutes Environment Agency R&D Technical report P2-258.

The construction industry has an increased focus on using sustainable methods to reach a more sustainable society but is still lacking the social aspect of sustainability. The belief is that this aspect has to be a natural part in construction projects to successfully plan and develop sustainable societies. A method to achieve this could be the use of Social Impact Assessment (SIA), a method frequently used in other countries such as U.S, Australia and Canada. The aim with the thesis is to investigate how this method can be used in a Swedish context, but also how the public in the best manner can be involved in decisions that affect them. To complement the theory with empirical findings a case study is done within Järvalyftet, one of the biggest redevelopment projects in the Stockholm region at the moment. A SIA deals with several areas and issues and is therefore complex to perform in an efficient way. It is consequently important to create a team with mixed disciplines to be able to manage the work and face the different problems in the best possible way. The thesis indicates that public involvement is of major importance to create an acceptance for the planned project among the affected parties in order to reduce both the timeframe and the costs of the project. Further, the thesis indicates that public involvement early on in a project facilitates for the affected people to deal with changes and trade-offs resulting by the project. / Byggbranschen har idag ett större fokus på att använda hållbara metoder i byggandet för att på så sätt nå ett mer hållbart samhälle, men saknar fortfarande fokus på den sociala aspekten inom hållbarhet. För att lyckas med att planera och bygga hälsosamma och hållbara samhällen måste de här aspekterna bli en naturlig del i byggprojekten. En metod för att lyckas med detta kan vara användandet av Social Konsekvensbeskrivning, en metod som ofta används i länder som USA, Australien och Canada. Syftet med detta examensarbete är att undersöka hur denna metod kan användas, men också hur allmänheten på bästa sätt kan bli involverade i beslut som berör dem själva. För att komplettera teorin som använts i arbetet har en case study gjorts inom Järvalyftet, ett av dagens största ombyggnadsprojekt i Stockholmsområdet. En SKB berör många olika områden och frågor och är därför en komplex process att genomföra. Det är följaktligen viktigt att skapa en grupp med varierande yrkesdiscipliner för att hantera arbetet och möta de olika problemen på bästa möjliga sätt. Arbetet visar på att allmänhetens deltagande är av stor betydelse för att skapa förankring bland berörda parter då ett projekt planeras, för att på så sätt minska både projektets tidsram och kostnad. Vidare visar även arbetet att involvering av allmänheten i ett tidigt skede av projektet underlättar för de berörda att hantera de förändringar och avvägningar som projektet medför.

This thesis is devoted to strategic planning of municipalities. To render the life cycle of the strategic document the diploma work uses process models of public policy and is dedicated to the problem of not implemented strategic plans of some cities in the Usti region. Study constructs and analyzes it as a publicly-political problem. This thesis identifies the views on the strategic plans in the cities where it exists, but is not systematically used to managing of the city.

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Yes / Public and patient involvement (PPI) has been shown to have a positive impact on health and social care research. However, adequate examples describing how to operationalise effective PPI, especially in doctoral studies, are lacking. Hence, doctoral researchers new to research, or those with limited experience, can be discouraged from facilitating PPI in their research. This paper aims to describe and discuss in detail the approaches used by four doctoral researchers to incorporate PPI at different stages of their research studies from study design to disseminating findings. We aim to inform other doctoral researchers about the challenges and limitations relating to PPI that we faced. Through these, we share pragmatic recommendations for facilitating PPI during doctoral studies. The description of four case studies demonstrated that PPI could be incorporated at various stages during doctoral research. This has had a beneficial impact on our research study progression, researcher self-esteem and lastly, helped alleviate researcher isolation during doctoral studies. / Supported by Research Design Service Yorkshire and the Humber (RDSYH), the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). This paper presents independent research funded by NIHR under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0317-20010). / Research Development Fund Publication Prize Award winner, July 2019.