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Table 2 Summary of the refined Valuing All Voices Framework. This Framework, co-developed with public and patient partners in Manitoba, is intended to provide guidance for research teams seeking to build engagement strategies that are more meaningful, inclusive, and safe. This summary represents stakeholders’ perceptions and definitions of the values important to meaningful and inclusive public and patient engagement and their revisions and feedback on the draft Valuing All Voices Framework

From: Valuing All Voices: refining a trauma-informed, intersectional and critical reflexive framework for patient engagement in health research using a qualitative descriptive approach

Trust
 - Ensuring everyone feels safe and supported
 - Relying on others to care for you
 - Treating people with dignity and respect
 - Believing
 - Loving
 - Cultivating openness and honesty
 - People knowing they can share whatever they need to share
 - Improved when both people have had the same experiences
 - Assuming the best intentions when people appear to be acting difficult or challenging
 - Interpersonal communication and listening
 - Two-way relationships – symbiotic, reciprocal
 - Between family, community, and country; regardless of race or ethnicity
 - Accountability and confidentiality
How to Practice Trust
 - Allow time to build trust
 - Strengths-based approach (framing challenges positively, focus on resilience)
 - Use principles such as OCAP™ (Ownership, Access, Control, and Possession)
 - Maintain open communication and follow-up with participants and partners
Self-Awareness
 - Educating yourself
 - Acknowledging privilege and biases
 - Understanding the impact of discrimination based on ethnicity, gender, class, ability, sexuality, age, size, and/or Indigeneity on individuals’ health and well-being
 - Understanding one’s self
 - Being aware of individual physical presence and navigation of surroundings
 - Being aware of one’s own values and internal state
 - Recognizing we are all works in progress, on journeys of health or recovers, understanding where you are on that, and identifying triggers
 - Being aware of power & knowledge imbalances
 - Assessing own liabilities & assets
How to Practice Self-Awareness
 - Willingness to do work on trauma-informed practice and safety
 - Ensuring support is available (e.g. family)
Understanding & Acceptance
 - Listening and valuing all perspectives, in order to gain appreciation for others’ feelings
 - Compassion
 - Appreciating resilience: supporting individuals’, families’, communities’, and ethnicities’ ability to overcome challenges of all kinds
 - Acknowledging cultural differences
 - Appreciating the courage and strength of vulnerability (resilience)
 - Genuinely valuing others’ experiences
 - Compassionate understanding without judgement
 - Not to be confused with sympathy or pity
 - Empowerment, not enabling
 - Acceptance, NOT tolerance
How to Practice Understanding & Acceptance
 - Balance with critical evaluation (to avoid being pulled into negativity)
 - Cognitive behavioural therapy
 - Sharing stories and hearing other’s stories
 - Foster recovery-oriented, strengths-based approaches, which emphasize hope, social inclusion, and community and personal empowerment
Relationship-Building
 - Acknowledging power imbalances
 - Recognizing opportunities to embrace resistance
 - Understanding the situation
 - Understanding construction of social expectations/structure
 - Understanding different cultural practices
 - Creating a warm & welcoming environment
 - Helping patient & public partners understand the research process, “which mountains can be moved and which ones can’t”
 - Maintaining two-way communication and connection
 - Accountability
 - OCAP (Ownership, Control, Access & Possession)™ principles
How to Practice Relationship-Building
 - Allow time to develop relationships
 - Spend time together
 - Being open and willing to self-disclose
Knowledge Sharing, Education & Communication
 - Educating patient and public partners by outlining the process of research; ensuring follow-up and impact; and potential policy and political influence
 - Using different modes of communication for different literacy levels, audiences
 - Engaging early in the process (integrated knowledge translation)
How to Practice Knowledge Sharing, Education & Communication
 - Outline the research process
 - Discuss expectations
 - Validation (member-checking) of data