Conceptualizing culture change as an impact metric. A scoping review and abductive thematic analysis of culture-related outcomes from patient and public involvement in healthcare and health research.

backgroundPatient and public involvement (PPI) is increasingly integrated into healthcare and health research, yet its role in driving culture change remains poorly understood. Culture change is a complex and multifaceted concept, and it is difficult to define and evaluate. This study set out to identify culture-related outcomes of PPI across clinical, organizational, and research domains, and to develop a framework for conceptualizing culture change as an impact of strategic PPI efforts.

resultsTwenty-two studies met the inclusion criteria, yielding 132 outcomes linked to culture change. These outcomes were thematically synthesized into 15 categories and 5 subcategories and situated within a three-level structure: micro (user socialization process), meso (organizational commitment), and macro (regulatory assumptions). Using abductive thematic analysis, we developed theory across the empirical findings to develop the PPI Culture Change (PPI-CC) model – the first multi-level, empirically grounded, and theory-informed framework to conceptualize how PPI contributes to culture change in healthcare and health research.

conclusionThe PPI-CC model positions culture change as an impact of PPI in its own right. Drawing on multi-cultural and complexity-informed perspectives, it conceptualizes culture change in the context of PPI in healthcare and health research as a multidimensional, iterative, and dynamic process shaped by interaction, feedback, learning, and adaptation across micro, meso, and macro levels. The model should be viewed as a conceptual starting point rather than a practice-ready tool, and it proposes that evaluation of culture change be approached as a process of learning.