Options for user engagement

Options for user engagement: what works and what doesn’t work?

The following table provides a considerable range of practical mechanisms for user engagement. These have been drawn together from a wide range of
sources and synthesized in order to minimise, where possible, overlap between the different methods. For each, the typical pros and cons have been
highlighted. Where it is particularly relevant or important, the size of groups typically involved in the mechanism, plus an indicative sense of the cost of the
approach, are highlighted.

The purpose of the table is to provide an overview of what practical methods are available.

Note: means by which to give information are not generally included within this table. They include: leaflets, posters, websites, organisation newsletters,
exhibitions, mailouts, fact sheets, advertising, media, videos, photography, text messaging etc.

Table: Practical mechanisms for user engagement

Method Which part of Description Typical pros Typical cons
involvement
continuum

21st Century Participation 21st Century Town Meetings involve a • Combines large number of • High cost
Town Meetings large number of people (between 500 participants with considered dialogue • Can raise expectations to
and 5,000) in deliberating on local, • Gathers clear and instant information unrealistic levels if not
regional or national issues and make use on what participants think about an managed well
of modern technology, including wireless issue, including demographic data on • Reliant on technology
voting pads and networked laptops. They what different groups feel
combine the benefits of small-scale, • The immediacy and scale of the event
face-to-face discussions with those of can energise the participants
large group decision-making.

Area Forums Forums for Area Forums are meetings held in a • Encourage openness and • Tend to be attended by the
debate particular locality. Often the meetings are transparency around council decisions 'usual suspects' although
attended by local councillors, together • Discussions can be tailored to the many try hard to attract
with senior representatives from the local concerns of local residents particularly young people
authorities, the Police, Primary Care • Provide a direct interface between and residents from black and
Trusts and other key local organisations, elected representatives and the minority ethnic communities
to debate key topics and answer communities they represent • Individual workshops may be


involvement
continuum

residents' questions face-to-face. dominated by one person or
particular viewpoint

Citizens’ Juries Forums for Citizens’ Juries consist of a small panel • High profile demonstration of public • As with all activities involving
debate of non-specialists, modelled on the engagement a limited number of people,
structure of a criminal jury. The group set • Jurors broadly reflect the jurors are open to criticisms
out to examine an issue of public characteristics of the wider population, of being unrepresentative.
significance in detail and deliver a so bring a degree of • Although jurors are drawn
‘verdict’. representativeness. from the local population,
• Jurors participate as citizens, so, in their views and values may
Citizens’ Juries are particularly theory they are not direct not reflect those of the wider
appropriate for involving the wider public stakeholders, but seeking the best population
in decision-making about setting priorities outcome for local people as a whole. • Jurors may not be able to
and strategic planning choices. NHS • Jurors are provided with information articulate their views and
organisations can pose difficult from a wide range of perspectives, concerns.
questions, for example on the with time to discuss it in detail, and so • Citizens’ Juries involve a
prioritisation of services, which involve are able to come to an informed view. huge amount of resources
value judgements in reaching a decision. • Can provide an informed public view (estimate about £25,000) in
and generate wider public debate terms of planning (months)
The jury consists of 12 to 16 members of and execution.
the public, and members are drawn from • The jury may not be able to
a cross-section of the local population. reach consensus on its
The jury meets for several days, during recommendations
which time it hears evidence from key • Rejecting the jury’s verdict
‘witnesses’ – e.g. health service can be problematic
commissioners, service managers,
interest groups. Jurors are also able to
ask to hear from additional witnesses
identified through the process. After
hearing all the evidence, the jury
considers the issue in depth before
making recommendations to the NHS


involvement
continuum

organisation.

Proceedings are commonly open to the
general public to attend and listen to, but
they are not able to participate. The
process is normally facilitated by an
independent moderator.

Citizens’ Forums for A Citizens’ Panel is a large, • Panel members are recruited to reflect • Panels are complex and
Panels debate demographically representative group of the demographics of the local resource intensive to recruit,
citizens regularly surveyed to assess community and can therefore be seen maintain and analyse their
public preferences and opinions. as representative of the views of the views. This means they are
wider community. usually run by external
Citizens’ panels are generally used to • Panels generally involve a larger organisations, which can be
build a picture of a community’s priorities, number of people than other forms of expensive.
or to get a measure of public opinion on engagement, and their findings • Panels have all the
a specific issue a health organisation is therefore, tend to hold more credibility. disadvantages associated
working on. • Due to the complexity of recruiting and with surveys in general –
managing the panel and analysing its e.g. more likely to generate
Panels are generally made up of 1,000 to findings, panels are commonly run by quantitative rather than
3,000 people (depending on the size of external organisations (e.g. MORI), qualitative information,
the population they represent) and which gives further independence and potentially exclude people
members reflect the demographics of the credibility. with literacy problems etc.
local community. Membership of the • It can be difficult to maintain
panel is normally for a fixed period, e.g. the enthusiasm of panel
two years, after which response rates members, leading to a
and engagement tend to decline. Three decline in the return rate of
or four times a year, panel members are surveys.
surveyed, commonly by postal survey, on
their views of a particular topic or topics
the organisation is working on. Panel
members may be given additional


involvement
continuum

information in advance or alongside the
survey to support them to develop a
more informed view. Many local
authorities have a citizens’ panel, which
may be used by NHS organisations.

Complaints Getting Scrutiny of complaints received to • Provides high-quality data about • Generally only covers
analysis information identify common themes existing service negative feedback
• Substantial issues can be identified • Groups who tend not to
• Some complaints can be tackled complain will be
before they become a problem underrepresented
• Good service can be noted and • Might be seen by frontline
rewarded staff as additional work
• New ideas from the public can be
passed on and used

Conversation Forums for Conversation Cafés or Open Surgeries • You can determine who the most • It is helpful if the event is run
cafés debate are informal dialogue methods which appropriate participants are, for by someone who is
invite people to take part in discussions example, this could be people that experienced in running
about topical issues in an informal represent a cross-section of the local Conversation Cafés
setting. population or stakeholders in a • Conversation Cafés can be
particular issue, and could include expensive, as you will need
Conversation Cafés are a way of health professionals. to pay for room hire and
enabling a large group of people to • Conversation Cafés enable refreshments, as well as the
discuss questions in an informal and participants to both share knowledge staff time organising them.
creative way. It does this by creating a and generate ideas.
relaxed, café-type environment, in which • The use of mixed and changing
people can talk to others in small groups, groups during the course of the event
and move between groups to meet new means that participants hear the same
people and get a fresh perspective. issue from different perspectives,
developing their own thinking.
Conversation Cafés normally take • Conversation Cafés generate


involvement
continuum

approximately 2 hours. To be successful, qualitative information from a
café consultations really need to involve potentially large group of people.
20 people or more.

Deliberative Participation “Deliberative event” is a generic term for • People can shape public policies or • Requires careful planning
events dialogue events where the focus is on plans and feel they have ownership and good moderation skills
deliberation. Some deliberative events • The organisation has to be
record/measure what the participants prepared to devolve some
think about an issue having had an decision-making
adequate chance to reflect and
deliberate on the questions at hand.

Deliberative Participation Deliberative mapping involves both • The results are considered opinions • Difficult to involve large
mapping specialists and members of the public. It rather than articles of faith or rash numbers and high in cost
combines varied approaches to assess judgement and time-commitment.
how participants rate different policy • Specialists contribute to the process • The results of the process
options against a set of defined criteria. without dominating can be contradictory views
• Combination of different approaches that leave decision-makers
creates a deep and comprehensible without clear guidance.
understanding of public priorities. • Very few people have
practical experience of
running this kind of process.

Electronic Forums for A range of techniques that aim to impart, Blogs: Blogs:
discussion debate exchange and receive information • Open and transparent, although often • There can be offensive,
groups electronically. They can be used to target anonymous. personal, pointless and
existing patient and carer groups, interest • Allows anyone to contribute and in inappropriate comments
groups and support groups or set up for their own time. written in response to blogs.
a specific purpose. • Allows different views to be aired and • Content may need to be
discussed. moderated.
Blogs are online journals or noticeboards • Some bloggers have become famous • People may need to be
where people or organisations can in their own right. encouraged to contribute to


involvement
continuum

provide commentary and critique on • Engages people that may not normally the website and post their
news or specific subjects such as be involved in face-to-face comments.
politics, local events or health matters. consultations. • Blogs rarely allow people to
Some blogs function like personal online participate actively beyond
diaries. responding to existing posts

Online forums are web tools that allow Online forums: Online forums:
discussions to be held online. They allow • Participants can access it at any time • Limited deliberation on
participants to post their own comments • Anonymity of internet can help people online forums, many people
online, which distinguishes them from feel comfortable stating their views just post their comments and
one-way communication tools such as • Feedback can be gathered quickly do not engage with what
email bulletins. • Online forums combine the others have said
spontaneity of verbal communication • Limited to those with internet
Webchats are based on the concept of with the clear records of written access
instant messaging. This is a new and communication • Can be difficult to get people
informal way to gather information from to post
different stakeholders and to answer • Requires moderation - un-
specific questions they may have. moderated Online Forums
Participants are invited to contribute to are often chaotic but
the discussions, but normally anyone can anonymous and
observe the proceedings online even if unaccountable moderators
they cannot contribute. can also frustrate
participants

Webchats: Webchats:
• The discussion between the person • Users expect a fast
answering questions and the response from those
stakeholders or general public is in answering the questions that
'real time' - there is little or no delay in may not always be possible.
responses. • The webchats may not have
• The discussion is structured but the any direct policy input even
person answering the questions could though participants are


involvement
continuum

participate in more than one webchat discussing directly with a
simultaneously; relevant person
• The discussion can be aimed at
appropriate participants
• The webchat can be publicised on the
normal website and the discussions
can be left posted on it.
• There is a sense of the webchat being
an event and more personal than
other online forums.

ePanels Getting ePanels are a way for councils or other • Can be run alongside traditional offline • As with all online methods,
information organisations to carry out regular online activities and their strength is seen to there is the potential that
consultations with a known group of be as a way of increasing participation ePanels don't encourage the
citizens. in local democracy, particularly participation of those people
amongst young people or those who without ready access to the
are time poor. internet.
• Enables local authorities to reduce • If too much is asked of
their administrative costs - no paper participants – such as too
questionnaires or postage is required, many follow-up emails from
there are limited additional costs to ePanels – then this can lead
run a focus group or live chat (just the to alienation from the
cost of online facilitators), data input is process, and calls for
not necessary and analysis is responses may be ignored.
generally quicker and can be
immediate depending on the type of e-
consultation being used.
• Open and transparent, although often
anonymous.
• Allows anyone to contribute and in
their own time.
• Allows different views to be aired and


involvement
continuum

discussed.
• Engages people that may not normally
be involved in face-to-face
consultations.

Focus groups Forums for Focus groups are guided discussions of • Allows you to identify a framework for • Generally involve only a
debate a small group of people. They are discussion, whilst providing freedom small number of people
normally one-off sessions, although for participants to contribute the relative to the wider target
several may be run simultaneously in content. population, so are not good
different locations. • Useful for providing an overview of for gathering quantitative
issues and identifying issues to be information and are open to
explored in more detail or with a the criticism that participants’
greater number of people later. views are unrepresentative.
• Good way to explore issues in depth • Resource intensive to set
and get qualitative data. up, run, analyse and report
• Interaction between participants may on.
generate further thinking and ideas. • Confidentiality harder to
• Facilitator can ask for responses to be ensure.
clarified or seek further information in • May generate a large
particular areas as issues emerge. amount of information that,
• Can be an empowering and learning due to the more flexible
experience for participants. approach, is not directly
• Can bring similar people together and comparable across groups.
help in forming an on-going group for • Requires a skilled facilitator
consultation and involvement. to ensure everyone is
• Good way to involve those who cannot enabled to participate fully.
read or write, wish to communicate in
languages other than English, or have
other communication needs.

Forum theatre Forums for Forum theatre is an interactive form of • Combines high quality, innovative and • Forum theatre requires the
debate theatre that encourages audience interactive theatre with social skills and ability amongst the


involvement
continuum

interaction and explores different options objectives. organisers to create a
for dealing with a problem or issue. This • Acts as an ambassador for the arts in powerful and meaningful
technique is used to work with socially the social sector. play.
excluded and disempowered groups. • Provides an entertaining and • Forum theatre requires
meaningful way for working with actors with the skills to
socially excluded groups. improvise around the
• Challenges established perceptions. audience participation.
• Powerful tool for exploring solutions to • Forum theatre is rarely
difficult problems linked directly to decision
• Develops skills of the actors, whom making.
are often people for socially excluded
groups.

Health panels Participation Health panels have primarily been used • Panels are made up of people • The information given to
to explore people’s views on ‘live’ policy recruited for their characteristics in panel members is drawn up
issues and the allocation of health terms of age, gender, ethnicity and by professionals, who can
service resources. Participants are location of residence, rather than their only anticipate the type of
usually recruited using a quota sampling particular interests or knowledge information needed from
technique to reflect the socio-economic about health issues, and represent a their own perspective.
make-up of the area. Membership is cross-section of the population. • It may be unknowingly
refreshed on a regular basis. • Complex issues can be discussed and selective or inadequate.
deliberated by people in an informed • If too many issues are
way. discussed there may be
• Panels can provide useful views on insufficient time to allow
resource allocation and priorities much debate and panel
between treatments. members may end up just
• Panels receive relevant information giving their views, rather
beforehand to enable them to give than the reasoning behind
reasoned and informed opinions. them and developing their
• Taking the views of panels into own thinking.
account when making decisions can • The success of the panel
help to demonstrate accountability. discussion is heavily


involvement
continuum

• Panels can meet at regular intervals, dependent on the skill of the
which helps develop a dialogue with facilitator.
local people. • Panels do not provide
quantitative information
because the number of
people taking part is too
small.

Interviews Getting One-to-one interviews can be conducted • Possible to get a good cross section of • Expertise is needed in
information face-to-face or on the ‘phone. the population and reach specific preparing the questions.
groups e.g. by using interviewers who • Setting up interviews can be
Semi-structured interviews allow for more speak community languages. time consuming.
qualitative information, and aim to get • Semi-structured interviews provide a • Without significant
feedback or explore and issue and framework for discussion and freedom investment of resources, the
enable interviewees to express their own to explore people’s views in more number of people
feelings and concerns. detail. interviewed is likely to be
• Can specifically target the comparatively low, so
Structured interviews can be used to get characteristics of people you want to findings are open to criticism
quantitative data, but are less flexible for interview. that they are not
getting qualitative information, as they do • May involve people who would find it representative.
not provide an opportunity for users’ difficult to attend an event or feel • Analysis of findings from
views and perceptions to be explored in inhibited speaking in a group semi-structured interviews is
any detail. Their findings are easier to • Independent view can be achieved by time consuming and requires
analyse than those from semi-structured using external organisations to do the skill.
interviews. interviewing. • Some client groups may
• Response rate can potentially be necessitate the interviewer
improved by using community to be chaperoned or have
organisations –although beware of CRB clearance.
potential bias in the reporting.

Mystery Participation Mystery shopping is a way of auditing • Mystery shopping can help to assess • This method can’t be used
shopper services through the involvement of the customer care aspect of services. when mystery shoppers


involvement
continuum

trained user volunteers. Mystery • As real patients are not involved, there would have to display
shoppers have been described as ‘under are no confidentiality issues. symptoms or be prescribed
cover’ service users. medication for their
conditions.
• Mystery shoppers are not
generally able to explore an
issue in-depth.
• Mystery shoppers do not
necessarily bring expertise
or experience of a service as
a user.

Online Getting Online consultations utilise the internet to • Allows a large number of people to • If not carefully planned,
consultations information ask a group of people their opinion on an contribute online consultations can
issue (typically a policy in the • Gives all participants an 'equal voice' generate unmanageable
development stages). An unlimited • Can reach people who are unlikely to amounts of material
number of participants can be sent respond to traditional engagement • Excludes people who do not
information about the subject or methods or cannot access/navigate
download it online and respond via email • A quick and accessible mode of the internet
or comment on a website. engagement from the participants' • The technology can shape
perspective the process rather than vice-
• Allows participants to discuss an issue versa;
at their convenience (regardless of • Written communication can
location or time); be a barrier for some already
• Anonymity of online processes can marginalised groups;
encourage open discussion; • Any perceived complexity,
such as registration, can be
a barrier to participation

Open space Forums for Open space events are a large group • Open space events can generate • Although the theme is pre-
debate event (15 people upwards), where ideas and thinking completely determined, it is impossible
participants themselves create their own determined by participants. to predict the areas of


involvement
continuum

programme around a pre-determined • Open space events can accommodate discussion that will be
theme. Apart from the theme, there are a large number of people. generated participants,
no speakers and no set agenda, so • Open space events work well with a therefore some areas may
participants decide exactly what is diverse range of participants, in terms be left unexplored.
discussed and when. of background – e.g. health • Open space events can be
professional or other stakeholder – complex to manage on the
Open space events are generally run demographics and other day.
over one to three days, although it is characteristics
possible to run shorter versions. • Participants only need engage in
discussion areas that interest them,
hopefully ensuring that they are fully
involved, rather than disengage at
different pointsduring the process.

Patient diaries Getting These techniques invite participants to • Over time, involving people in keeping • The person completing the
information capture and record their experience of diaries can help to develop a diary will usually feel they
health services in a way that can be fed relationship of trust. have invested a lot of time
back to staff. Staff discuss the insights • Diaries record events and feelings as and effort and will want to
obtained and work with participants to they happen. see some clear actions
make improvements. The techniques can • The use of guide questions enables resulting from it.
be used in a variety of ways – from being you to explore the issues you are • As completion of the diary is
a means of getting information through to interested in. unsupervised, responses to
being a vehicle for working in partnership • The diary approach provides the guide questions may
qualitative information, allowing stray away from the point.
patients and carers to reflect, explain • Diaries can be very time
and suggest ideas and solutions. consuming to analyse.
• Those who have literacy
problems may not be able to
take part.

Public Forums for A meeting for which there has been an • Opportunity to reach a wide range of • Public meetings are
meetings debate open invitation. There may be a set people, and potentially everyone with resource intensive, in terms


involvement
continuum

agenda or discussion may focus on an interest in the issue to be of staff time planning and
issues raised at the meeting. In the past, discussed. running them, and costs
public meetings have tended to be used • Enhances accountability, as the public associated with publicity,
as a method of giving information, but can directly challenge those venue hire, and
may not be the best way to do this. They responsible for decision-making. refreshments.
can be used creatively to get information • Can combine information giving with • Unless well promoted, or
from participants or as a forum for discussion. debating a controversial
debate. issue, there may be a low
turn-out.
• Participants are not
generally required to book in
advance, so numbers are
unknown until the day,
making the design of the
session harder.
• As participants are not
generally required to book,
you have no control over
who attends, and those
attending may be
unrepresentative.
• The event may only attract
interested parties, lobby or
pressure groups.
• There is the potential for
interest groups to ‘hijack’ the
meeting with their particular
issues or views.
• A single meeting is rarely
sufficient, as no one day,
time or location will suit
everyone.


involvement
continuum

Seminars Forums for Seminars are discussion groups that aim • There is an opportunity to put across • Generally involve only a
debate to impart, exchange and receive information to inform the debate, so small number of people
information and views. There is normally can generate informed discussion. relative to the wider target
much greater input from the facilitator • Participants may come from mixed population, so are not good
than in a focus group, and participants backgrounds – e.g. health for gathering quantitative
may well include a mixture of professional, service manager, service information and are open to
professionals, public and patients. user – so will have a (rare) opportunity the criticism that participants’
Depending on the design – for example, to hear views from others’ views are unrepresentative.
you might include perspectives. This can potentially lead • Resource intensive to set
group working, as well as plenary to more informed discussion and up, run, analyse and report
discussions – seminars can thinking. on.
accommodate a range of numbers of • Provides qualitative information about • Confidentiality harder to
people. people’s views. ensure.
• Existing groups with an interest in the • Requires a carefully planned
issues to be discussed are likely to programme and skilled
find this process engaging and chair / facilitator to ensure
rewarding. everyone is enabled to
participate fully.

Surveys and Getting Surveys include a group of techniques • You can potentially gather data from • The questions are
questionnaires information that measure the opinion of a sample of large numbers of people determined by those
people. Depending on the particular • Can be used to target particular designing the survey, and
technique employed, quantitative or groups can omit issues of major
qualitative data or a combination of both • Can be used to give information at the concern to people
will be obtained. Techniques can include: same time • Findings are not in-depth as
• Self-completed questionnaires • You can design a sampling framework there is no opportunity to
• Online surveys to survey a representative sample explore issues, ideas or
• Telephone surveys • Findings can be easier to analyse as experiences further
the questions (and potentially the • People are less likely to
responses) are clearly defined complete questionnaires and
• Findings provide quantitative data on questions that seek more
how many people hold a particular qualitative data


involvement
continuum

view or prefer a particular option • Questionnaires are
• Questionnaires are quick and easy for unsuitable for people who
people to complete, and do not need have problems with literacy,
to be supervised or completed on-site for example, people with
• You could use a professional learning disabilities, and
organisation to do the work, which people who do not speak
would give more independence English as a first language
• Relatively cheap • Depending on how
questionnaires are
distributed and targeted and
the response rate, findings
may be unrepresentative of
your wider target population
• The NHS uses this format
often and you need to
ensure you are not
duplicating work already
underway as there is the
chance of ‘survey fatigue’
with recipients

User groups Participation User groups are groups of service users • By definition, members of the group • Service users on the group
that meet regularly to discuss the quality use the service and therefore bring may be unrepresentative of
of a service and other related topics. The some experience and / or expertise in the views of wider service
forum has a recognised mechanism for the issues. users.
feeding into the decision-making of a • Because the meetings are on-going • A service user forum cannot
project or service. User forums involve basis, you can build a positive capture the views of
longer-term engagement with people relationship with the forum members. potential users who are for
who are key stakeholders and generally • Because forum members are involved some reason unable or
well-informed about the issues and on an on-going basis, they can unwilling to access the
service available. They help to identify develop additional expertise in the service.
the concerns and priorities of other issues.


involvement
continuum

service users and can lead to the early
identification of problems or ideas for
improvements.

World Café Forums for World café is a method that makes use • Creative process for developing new • Requires a clear and
debate of an informal café for participants to ideas relevant question
explore an issue by discussing in small • Informal and inclusive • Cannot be used to make
table groups. Discussion is held in • Has the potential to be cheap and direct decisions
multiple rounds of 20–30 minutes with a easy to organise
plenary at the end of the event.

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