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DEPTH (Dialogue, Evidence, Participation and Translation for Health)

DEPTH (Dialogue, Evidence, Participation and Translation for Health)

Research into community dialogues and participation to promote health, increase equity and amplify less-heard voices.

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We conduct research to understand the implications and effects of community involvement and dialogue in promoting health, planning health services, and quality improvement of existing services.

Our work spans seven key research themes:

Voices and experiences in health
Community participation and citizenship
Dialogues about sexual and reproductive health
Transitions to adulthood
Digital life
Conducting and communicating science in an ethical way
Dialogue and the arts



Find out more about our work on community participation, patient engagement, and dialogues for health

Who we are

Meet the LSHTM team working on community participation and dialogue.

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Welcome to the introductory blog for the new website for our research group, DEPTH. We use the acronym DEPTH to bring together our research in Dialogue, Evidence, Participation and Translation for Health. We are a group of scholars in the Department of Public Health, Environments and Society at London School of Hygiene & Tropical Medicine who take an interdisciplinary approach to health. We conduct research into different types of dialogue and different people’s participation in health with the aim of increasing equity and improving health worldwide, and amplifying less-heard voices. Our new website aims to introduce a wider audience to our public health work. We see it as a space for communication and conversation – not just with academic colleagues, but also in policy debates, in education systems and with the wider public.

We think it is important to show our work to a wide range of audiences, not just specialists, and so we have listed all of our individual or combined efforts on this page, including summaries of each research paper listed in plain English, with concepts summarised and acronyms explained. You can read about the six Research themes that underpin DEPTH here. These research themes include our work on patient and public involvement, dialogues about sexual and reproductive health and young people’s experiences of Sickle Cell, and our work with Imperial College London on the ethics of electronic health records.

Finally, this regularly updated blog will provide a way for us to write about important studies in the field of community involvement, participation and public health. We will talk about our own research, but will also write about current affairs as well as research from elsewhere, when we would like to contribute to debate. We agree that one of the most important things we can do as academics is move beyond our own research specialisms to listen to – and amplify - the perspectives of those who may be less heard. We hope you will find these perspectives as valuable as we do.

We are excited to share with you this website as a portal to some of the pressing issues in sociologies of health. Community dialogue and participation is all about the exchange of ideas and synergies created by learning from each other. We can contribute the expert opinion, but we are just as interested in hearing from you. You can get involved via our new Twitter account, and you can contact us with questions, feedback or even your own blog pitch. Finally, look out for upcoming events on this blog page, where we will post details of future talks, meetings and events, as well as commentaries on new publications and policy.

Thanks again for reading and we look forward to sharing more about our work at DEPTH.

Cicely, Alicia, Catherine and Sam.

Blog Community participation and dialogue for health
Research themes
2 columns Community participation and dialogue for health
Left column Community participation and dialogue for health

We conduct research to understand the implications and effects of community involvement and dialogue in promoting health, planning health services, and quality improvement of existing services.

Voices and experiences in health

Using interviews and other innovative ways to elicit voices and experiences, we explore how social lives and health practices are intertwined. Our work for instance looks at young people’s sexual practice (e.g. the sixteen18 project), transitions to adulthood, including transitions between child and adult healthcare (e.g. This Sickle Cell Life), ways that fertility and contraception are bound up in life experiences and identity, and how people relate sexually with partners they meet online.

We recognise the need to engage with diverse partners and amplify less-heard voices in the coproduction of health knowledge. Our work examines the implications of dialogue for understanding experiences and developing more inclusive forms of knowledge, and explores and questions which voices are heard in conversations about health and which are left out.

Sixteen18 This Sickle Cell Life Patient & Public Engagement

Community participation and citizenship

Our work on community participation and citizenship has involved long term ethnographic explorations of public and patient involvement and engagement in research and quality improvement in the UK National Health Service. This research has helped us build theory around community participation, engagement, and empowerment, their effects, and the implications for citizenship in health. This work also addresses practical aspects of how to make participation successful such as how to create effective and inclusive spaces for participation, and how to orientate organisational culture so it helps rather than hinders participation.

Our international activities include work with the World Health Organization on guidelines on community participation to promote maternal and newborn health, as well as informing the ‘community engagement’ action area of the Global Strategy for Women’s, Children’s and Adolescents’ Health.

Patient & Public engagement

Dialogues about sexual and reproductive health

Much of our work involves dialogues about sexual and reproductive health and practice in diverse communities around the world. Examples include the sixteen18 project which explored young people’s sexual practices in the UK, and our Ghana project where we interviewed women about their fertility practices. Our work shows how introducing and promoting more honest and critical dialogues about sexual and reproductive health improves understanding of complex dynamics in relationships and hidden practices.


Digital life

We are increasingly investigating digital life as a key mediator of dialogue, personhood and community. We are particularly interested in how dialogues are promoted and restrained in increasingly digital lives, and the interrelationships between digital lives and health. Our work includes advising government and providing commentary and analysis on effects of pornography on young people, and theoretical explorations of the use of mobile phone locative media apps such as Grindr and Tinder for sexual partner seeking.

Conducting and communicating science in an ethical way

Accurate science communication is crucial if people are to make informed decisions about their health. We work with the World Health Organization to ensure that global guidelines are based on the best interpretation of the scientific evidence. We also work with other groups such as COMPare in Oxford to investigate potentially unethical practices in trial reporting. We have debunked false claims about abortion [ref] and also revealed how inappropriately optimistic effectiveness claims about a version of the rhythm method (the Standard Days Method) are being used to heavily promote it in low-income settings.  

Conducting and communicating our research in an ethical way is key to promoting valuable dialogue with a range of people. By acknowledging the gaps in the way that researchers listen to participants, we can think of ways to improve on taking our lead from the participant. We want to amplify the voices that are less heard.

Electronic Health Records

Dialogue and the arts

Communication is a key part of science and we are committed to enhancing public engagement with our work. We have participated in collaborative ventures with artists (e.g. Bloomsbury Festival); framed the relationship between performers and audiences through the idea of co-production (ref); and investigated the future of digital theatre (ref). We are interested in continuing to explore new collaborations in the future.


The co-production of what? Knowledge, values, and social relations in health care
Co-production is becoming a buzzword in healthcare settings. This article, published in PLOS Biology (2017), argues that the concept does not always explain what the implications of co-production might be for participants (or healthcare users more widely). We argue that co-production can be thought of as a process that encourages new ways of thinking about collaboration and participation in healthcare.
Filipe, A; Renedo, A; Marston, C; (2017) / PLOS Biology, 15 (5). e2001403. DOI: 10.1371/journal.pbio.2001403
Experience as Evidence: The Dialogic Construction of Health Professional Knowledge through Patient Involvement
How can we advance knowledge through patient and public involvement? The relationship between healthcare professionals and patients is crucial. This article, published in Sociology (2017), draws on ethnographic work on patient involvement. We show how new knowledge is produced when professionals engage with patients, particularly in how healthcare professionals articulate the relationship between ‘subjective’ patient experience and ‘objective’ evidence.
Renedo, A; Athanasiou, A; Marston, C; (2017) / Sociology. ISSN 0038-0385 DOI: 10.1177/00380
Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions
How can we enhance how communities get involved in service improvements? In this article, published in BMC Pregnancy & Childbirth (2017), we examine the factors affecting implementation of community participation strategies in maternal and newborn health programmes. We find that community participation is stronger where communities see women’s health as a collective responsibility, and where participation is linked into a functioning health system (such as via user groups). We suggest that viewing participation as an ongoing process is crucial to effective participation, as is focusing on creating an environment that enables communities to participate in improving health.
Howard-Grabman, L; Miltenburg, AS; Marston, C; Portela, A; (2017) / BMC Pregnancy and Childbirth, 17 (1). p. 268. ISSN 1471-2393 DOI: 10.1186/s12884-017-1443-0
Improving implementation of health promotion interventions for maternal and newborn health
In this overview article for the BMC Pregnancy and Childbirth series on maternal and newborn health promotion, we present evidence that health promotion interventions may not achieve their objectives because they fail to engage with beneficiaries and the community. We argue that with better formative research, programmes can implement interventions to help individuals and communities access skilled care in pregnancy and childbirth. A participatory approach is key to this success.
Smith, HJ; Portela, AG; Marston, C; (2017) / BMC Pregnancy and Childbirth, 17 (1). p. 280. ISSN 1471-2393 DOI: 10.1186/s12884-017-1450-1
Community participation: essential for transforming women’s, children’s, and adolescents’ health
Community participation can transform health. The Global Strategy for Women’s, Children’s and Adolescents’ Health recognizes that people have a central role in improving their own health. In this article we propose that community participation, including communities working with health services (‘co-production’), will be central for achieving the objectives of the Global Strategy. The paper addresses the role of community participation in promoting health and wellbeing for women, children and young people. We argue that contextualised community participation that is inclusive of under-served groups optimises interventions to improve health. This action relies on participatory approaches that build new relationships across the health system.
Marston C, Hinton R, Kean S, Baral S, Ahuja A, Costello A, Portela A. / Bulletin of the World Health Organization, 2016 94:376–382 doi: BLT.15.168492
The use of information for diabetes research and care: patient views in West London
This study explores the public views on use of electronic health records, finding that people with diabetes would like personal access to such records, and for their medical history to be captured in full. The majority also supported use of their health records for research. The findings support the idea that patients believe in sharing their data for the ‘greater good’.
Zalin, A; Papoutsi, C; Shotliff, K; Majeed, A; Marston, C; Reed, J. (2016) / Practical Diabetes: 33 (3). 81-86a. ISSN 2047-2900 DOI: 10.1002/pdi.2008
Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement
Patient-centred care relies on understanding quality improvement from the perspective of the patient, yet patients are often excluded from this process. In this BMC Health Services Research (2015) article, we explore how patients view quality improvement and how they go about improving health services. The article demonstrates how expectations around who the patient is and how they should behave as a recipient of care can influence how patients negotiate their rights to quality care. For genuine involvement in healthcare, it is important to work with patients to reflect on how neoliberal ideas around personal responsibility might influence how and whether patients demand quality care.
Renedo A, Marston C. / BMC Health Services Research 2015; 15:122 DOI: 10.1186/s12913-015-0770-y
Patient and Public Involvement in Healthcare Quality Improvement: How organizations can help patients and professionals to collaborate
Given that patient participation can improve healthcare, how can organisations help patients and professionals to collaborate? In this article in Public Management Review (2015), we suggest that the ways citizens can participate in healthcare improvement is often unclear, and we highlight how patients can be supported to make an impact. Our findings demonstrate that patients can influence healthcare beyond just providing their views as receivers of care. We draw on ethnographic work within a UK healthcare initiative and outline how patients can use elements of organisational culture to help them collaborate with health professionals for better outcomes.
Renedo, A; Marston, CA; Spyridonidis, D; Barlow, J; (2015) / Public Management Review, 17 (1). pp. 17-34. ISSN 1471-9037 DOI: 10.1080/14719037.2014.881535
Conceptualising the 'community' as a recipient of money - A critical literature review, and implications for health and inequalities
Money may bring about positive changes to health, and giving money to ‘the community’ is becoming more common. This article reviews how governments in different countries give money to the community, exploring how community is conceptualised in this set-up. The article highlights the need for a better understanding of how money affects health and how community is not just a recipient of money, but also something that is constructed through the act of giving money.
Reynolds, J; Egan, M; Renedo, A; Petticrew, M; (2015) / Social science & medicine (1982), 143. pp. 88-97. ISSN 0277-9536 DOI: 10.1016/j.socscimed.2015.08.049
WHO recommendations on health promotion interventions for maternal and newborn health
The LSHTM team provided technical expertise for this World Health Organization recommendation in 2015 on health promotion interventions for maternal and newborn health. The recommendations help countries to establish how best to increase individual, family and community capacity to contribute to maternal and newborn health improvements and skilled care during pregnancy and birth. Recommendations include enhancing community participation in service planning and quality improvement.
Portela A, Smith H, Marston C. / 2015
Spaces for Citizen Involvement in Healthcare: An Ethnographic Study
This theoretical contribution to Sociology (2014) considers participation and involvement in healthcare in terms of the spaces in which these activities take place. We develop the idea of “participatory spaces” with material, temporal and social dimensions, and argue that paying attention to these is important to understand the dynamics and impact of patient involvement. We show how participants play a crucial role, drawing on external resources to try and make participatory spaces more collaborative and productive, which helps build a more positive landscape for healthcare. We also highlight how spaces created for public involvement can hinder patients trying to shape healthcare. Only certain social groups can participate, and their influence is limited when they find participatory spaces difficult to navigate.
Renedo, A; Marston, C; (2014) / Sociology, 49 (3). pp. 488-504. ISSN 0038-0385 DOI: 10.1177/0038038514544208
WHO recommendation on community mobilization through facilitated participatory learning and action cycles with women’s groups for maternal and newborn health
The LSHTM team provided technical expertise for this World Health Organization recommendation on community mobilisation through participatory learning and action cycles with women’s groups for maternal and newborn health. In the report, we set out the importance of interventions in improving maternal and newborn health, family care, community support, and access to skilled care.
Marston C, Portela A. / World Health Organization; 2014 Jun pp. 1–32
Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review
Our systematic review of the effects of community participation on improving the uptake of skilled care for maternal and newborn health examines the extent to which participation improves maternal and newborn health outcomes. We draw on this literature and our own work to set out new theoretical and reporting frameworks to help guide future research.
Marston C, Renedo A, McGowan CR, Portela A. / PLoS ONE 2013; 8(2):e55012
Healthcare Professionals' Representations of 'Patient and Public Involvement' and Creation of 'Public Participant' Identities: Implications for the Development of Inclusive and Bottom-Up Community Participation Initiatives
Community participation, particularly “patient and public involvement”, is seen as important to improving healthcare, but what does it mean? In this foundational article for Community and Applied Social Psychology (2011), we draw on UK ethnographic research to explore how patient understandings of their own involvement in healthcare are influenced by relationships with healthcare providers and their expectations about the role of a patient. We argue that patients may struggle to achieve change without support from professionals, and that these relationships must be examined and developed if successful community participation is to happen.
Renedo, A; Marston, C; (2011) / Journal of community & applied social psychology, 21 (3). pp. 268-280. ISSN 1052-9284 DOI: 10.1002/casp.1092
Who we are
Who we are DEPTH
DEPTH (Dialogue, Evidence, Participation and Translation for Health)
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LSHTM team members working on community participation for health


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