There are growing efforts to identify the characteristics of physicians who face misconduct allegations. We aimed to analyze disciplinary actions in relation to violations and to identify variables that may influence outcomes, to determine the risk of bias in adjudication procedures. In Phase 1, we deployed a survey to patients, family members, and physicians in a healthcare network to develop a severity hierarchy for types of violations and disciplinary actions. In Phase 2, we analyzed a subset of discipline summaries published by the provincial regulatory college between 2010 and 2019 and characterized violations, disciplinary actions, and their associations. Phase 1: Seventeen physicians and 11 patients or family members completed the survey. Sexual misconduct was rated as the most severe type of violation (mean: 4.79, range: 1–5). License revocation was rated as the most severe disciplinary action (4.46). Phase 2: Overall, there were higher severity violations for men physicians relative to women (4.13 vs. 4.02, 95% CI: 0.03, 0.21). The corresponding disciplinary actions were rated as moderate, mean severity 3.19 (SD: 0.280), with no difference by gender, and these were disproportionate to the severity of violations. Our findings suggest that adjudication processes may have room for improvement.

This cross-sectional study evaluates the prevalence of hearing loss among specific patient populations in Alberta and explores participant perceptions about patient-health care worker communication and potential solutions.

Background: People with hearing loss may have difficulty communicating with health care providers if not properly supported. Hearing loss is common among people with kidney failure. Outpatient hemodialysis centers may present communication barriers due to noisy machines and overlapping conversations. Tools, such as assistive listening devices, exist to help people with hearing loss communicate. If and how they should be used in the outpatient hemodialysis setting is unclear. Understanding the patient perspective is an important first step before implementing such solutions. Objective: Describe the communication-related experiences of patients with hearing loss when conversing with health care providers during hemodialysis treatment, focusing on perceptions about communication tools. Design: Qualitative descriptive. Setting: Outpatient hemodialysis centers in Calgary and Edmonton, Alberta, Canada. Participants: Adults with kidney failure receiving maintenance hemodialysis with self-reported hearing loss. Methods: Semi-structured individual interviews. Interviews were audio-recorded, transcribed, and abductively coded using a validated communication framework, a strategy to guide communication access in practice, and participants’ experiences. Results: Fourteen patients participated between October 2023 and January 2024. Patient perceptions about communication tools varied. We identified three themes that describe these differences: (1) communication tools may be needed in transitional or clinically complex situations, (2) patients with their own resources may rely less on center-provided tools, and (3) awareness and self-advocacy for support varies across patients. Limitations: The major limitation of this study is the lack of representation from patients with language barriers and those belonging to the Deaf community or with overlooked hearing difficulties. Consequently, results may not be transferable to all patients with hearing loss in Alberta or elsewhere. Conclusions: Communication support needs are both person-specific and context-dependent, varying across and within patients. Not all patients that may benefit from communication tools will be comfortable asking or accepting help. Clinicians should routinely check in with patients about their communication needs and offer a variety of tools to accommodate as needed.

Background:New brain-heart clinical practice guidelines recommend provision of patient decision aids (PtDAs) to support people with or at risk of brain and heart conditions. We aimed to identify and appraise the quality of PtDAs addressing brain-heart conditions and their consideration of health equity. Methods:We conducted an online environmental scan to identify publicly available PtDAs. Two reviewers independently searched, extracted data, and appraised their quality using International Patient Decision Aid Standards (IPDAS) criteria, the Patient Education Materials Assessment Tool (PEMAT), and the PROGRESS-Plus framework for health equity. Results:Of 2549 resources identified, 51 PtDAs were eligible. Nine addressed a combined brain-heart decision, 36 addressed primarily cardiovascular conditions with brain implications, and 6 addressed primarily brain conditions with heart implications. Few focused on brain-heart conditions concomitantly. None addressed dementia, and only one addressed depression as a primary condition with cardiovascular risk addressed as a secondary consideration. The mean IPDAS essential criteria score was 5.8 of 7 (SD 1.5, range 1-7). For PEMAT-P (for printable materials), 91% PtDAs achieved an adequate understandability rating (≥ 70%), and 56% achieved an adequate actionability rating (≥ 70%). The most frequently reported PROGRESS-Plus healthy equity items were age (80%), gender/sex (45%), and socioeconomic status (39%). Conclusions:Brain-heart guidelines recommend PtDA use, but our environmental scan highlighted the need for more of these important interventions. Few PtDAs focused on brain and heart conditions concomitantly, none addressed dementia, and only one addressed depression, which frequently coexist with cardiac conditions. PtDAs also lacked actionable guidance within an equity-informed framework to support quality decisions and decision-making processes for all.

Background: Care for mild to moderate chronic kidney disease (CKD) entails self-management from patients and clinical support from primary care and nephrology. To address the gap in self-management resources, My Kidneys My Health was codeveloped to support patients with CKD. Health care providers play a critical role in the implementation of patient resources; however, there is a gap in understanding providers' perspectives in this role. Objective: This study develops and evaluates strategies to implement My Kidneys My Health into routine primary care and general nephrology clinical care. Methods: Health care providers working in Alberta, Canada, who support patients with CKD were invited to participate in our multistep study, guided by the Quality Implementation Framework. In step 1, we followed qualitative descriptive methodology to identify barriers and enablers to implementation using a directed content analysis and a deductive coding approach. Participants were invited to complete semistructured interviews from October 2021 to May 2022. In step 2, we identified, prioritized, codeveloped, and launched implementation strategies based on step 1 results using behavior change theory. Participants were invited to use the materials during the implementation period (May to October 2022). Website engagement was tracked through Google Analytics and document distribution tracking. In step 3, we conducted follow-up interviews with participants (October to December 2022) to evaluate implementation based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, following the same qualitative approach as step 1. Effectiveness was out of the scope of this study. Results: A total of 16 health care providers participated in step 1 qualitative interviews (8 from nephrology clinics and 5 from primary care or nonambulatory care). Participants shared an individual-level readiness and interest in sharing My Kidneys My Health with their patients. The key barriers to implementation included awareness, memory, time, motivation, and innovation accessibility. Implementation strategies were co-designed and implemented by step 1 participants (ie, educational sessions and materials, reminders, and implementation coaching). Notably, 9 health care providers participated in step 3 qualitative interviews. Participants shared their approach to tailoring implementation based on their patients and integrating the resource into their current practices. The resources developed were highly used by participants, with positive feedback on their usability and accessibility. Participants expressed motivation to continue sharing My Kidneys My Health; however, awareness and accessibility require further adaptations that can improve sustainability of implementation. Our rigorous approach allowed us to address behavior change and sustainability of implementation of My Kidneys My Health, as well as identify appropriate and tailored implementation strategies. Conclusions: There is a readiness to implement self-management supports for patients with early-stage CKD. A theory-informed approach and strategic implementation strategies can support sustainability. International Registered Report Identifier (IRRID): RR2-10.1007/s43477-022-00038-3

Long-term care homes (LTCHs) implemented various models of care during the COVID-19 pandemic. The purpose of this study was to identify these models of care and provide suggestions on best practices that could be integrated into LTCHs in efforts to improve resident care. The project included a quantitative survey and semi-structured key informant interviews with LTCH managers across Canada. Our objectives were to 1) identify models of care that were used to support resident care in Canadian LTCHs during the COVID-19 pandemic and to describe their intervention components, processes of implementation, and perceived impact; 2) determine whether LTCHs planned to sustain models of care implemented during the COVID-19 pandemic. Our results show that the most frequently reported models of care were related to healthy food options, exercise, music and art programs, and planned social activities for residents. Five barriers were identified in relation to implementing these models of care, which included: lack of funding, resources, or staffing; staff not being familiar with/reluctant to use the model; lack of resident buy-in; fear of COVID-19; and pandemic regulations. Common facilitators to implementation were also identified and included: staff support; resident/family buy-in; funding, legislation and/or resources provided; familiarity with model prior to COVID-19; and collaboration with other LTCHs. LTCHs perceived the models to be effective and planned to sustain most implemented models. LTCH managers discussed the need for funding and legislation to improve LTCHs and support the implementation of promising models of care. This study provides insight into the models of care implemented during the pandemic crisis period in Canadian LTCHs, how effective they were perceived to be, and plans for sustainment beyond the pandemic period.

Purpose of Program: Our team co-developed My Kidneys My Health , an online platform designed with patients with non-dialysis-dependent chronic kidney disease and care partners to provide tailored education and self-management support. While My Kidneys My Health has seen increased use and positive user feedback since its development and launch in 2021, there are opportunities to improve its cultural relevance, accessibility, and usefulness for diverse populations. In this report, we describe our approach to addressing these elements by adapting My Kidneys My Health content and knowledge mobilization strategies. Sources of Information: Patients and care partners in Canada have identified the lack of accessible, person-centered resources as a major barrier to effective self-management for non-dialysis-dependent chronic kidney disease. Digital heath tools can meet this need by delivering consistent, evidence-based education and support in a user-friendly format. Through our program of research with Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), we have co-developed My Kidneys My Health through a series of patient-oriented research studies. Methods: Our program objectives are to (1) understand and address gaps in sexual health support for individuals with non-dialysis-dependent chronic kidney disease; (2) build relationships with Indigenous communities in Alberta to understand and share self-management learnings; and (3) improve accessibility to My Kidneys My Health content for diverse populations. To guide the adaptation and implementation of My Kidneys My Health , our team adopted the following Can-SOLVE CKD phase 2 pillars: (1) Implementation Science and Knowledge Mobilization, (2) Indigenous Cultural Competency, (3) Incorporation of Equity, Diversity, and Inclusion principles in Knowledge Mobilization and Implementation Efforts, and (4) Patient Engagement and Capacity Building. We used the Can-SOLVE CKD Pathway to Implementation and applied the Map2Adapt framework. Key Findings: Primary care and nephrology providers expressed readiness to integrate My Kidneys My Health into clinical workflows, and collaborative partnerships with initiatives like Kidney Check enhanced knowledge sharing. We initiated relationship building with the Stoney Nakoda Tsuut’ina Tribal Council Ltd. Health Department (G4 Health), including in-person meetings with the health directors, and co-development of engagement packages and communications designed to reflect our culturally safe methodologies. We addressed accessibility barriers by updating website features and new printable materials on key self-management topics, with French translations. Results from our mixed methods sexual health study underscored the need for tailored, credible resources for people with non-dialysis-dependent chronic kidney disease. Findings from our ongoing environmental scan will inform a sexual health resource inventory for integration into My Kidneys My Health . Patient partners reported meaningful involvement that shaped project priorities, design, and knowledge mobilization. Limitations: Significant time and resources are required to support meaningful Indigenous engagement, which contributed to delays in the project timeline. In Alberta, we have had ongoing healthcare restructuring disrupting relationship building with key decision-makers and creating uncertainty around partner roles. Finally, a permanent solution to accommodate and maintain My Kidneys My Health will be needed after the research is completed. Implications: Our work exemplifies an integrated, patient-oriented approach that emphasizes implementation science, equity, cultural competency, and capacity-building. As we move forward, our focus will remain on enhancing accessibility, relevance, and sustainability to ensure that all people living with non-dialysis-dependent chronic kidney disease can access trusted, evidence-based support to live well with kidney disease.

Mental health disorders typically emerge in early life and can be modified through prompt intervention. Mental health literacy is the multi-dimensional knowledge of mental health disorders to recognize, manage, or prevent mental health disorders. Enhancing youth mental health literacy through information communication technologies already adopted by youth may be an accessible and effective approach to address the ongoing mental health crisis. We used an interconnected, three phase process following co-design methods to determine evidence-based consensus statements to conceptualize and develop the Youth MindTrack and to inform future digital tools to support youth mental health literacy. In Phase I, a scientific team (N = 21; 24% youth) adhered to deliberative dialogue and priority setting methods to develop strategic priorities. Phase II consisted of a modified Delphi consensus process to determine evidence-based consensus statements (N = 352 (13% youth) Round 1; N = 87 (33% youth) Round 2). Semi-structured focus groups in Phase III were conducted to refine the consensus statements (N = 16, 25% youth) and design the digital mental health literacy tool (N = 24, 33% youth). Twenty-one consensus statements encompassing four domains were produced: (1) Understanding mental health (N = 4); (2) Exercising mental health (N = 6); (3) Engaging with digital support (N = 8); and (4) Evaluating digital support (N = 3). Content analysis of discussions identified 16 themes mapped to the domains of mental health literacy and user-interface, design considerations for digital tools on mental health literacy more broadly. The resulting design of the Youth MindTrack tool to support mental health literacy included four main interactive sections designed to be downloaded and completed by youth on a digital device. We determined 21 evidence-based consensus statements that underpinned the conceptualization and development of the Youth MindTrack: a downloadable digital tool to support youth mental health literacy. The data supports proceeding to pilot testing to assess the tool's usability, acceptability, and perceived effectiveness prior to implementation, and provides evidence that an iterative and participatory research-based process with youth can help adapt health technology to their needs.

Multimorbidity, the coexistence of multiple chronic diseases or conditions, poses a major challenge for health-care systems worldwide. Traditional research has largely relied on cross-sectional studies, offering limited insight into multimorbidity evolution over time. This Personal View advocates for a paradigm shift towards longitudinal approaches that capture multimorbidity trajectories. Tracking the sequence, pace, and severity of disease accumulation can enhance our understanding of underlying mechanisms, inform early interventions, and improve patient care. Drawing on expert discussions from an international workshop held in Bielefeld, Germany, in May, 2024, we outline key themes and findings to guide future research on the dynamic processes underlying multimorbidity trajectories. Specifically, we summarise previous work, examine the challenges and opportunities of existing data resources, and highlight priority areas for further investigation. Advancing this field will require the standardisation of longitudinal multimorbidity phenotypes, integration of health and social care processes, and testing the usefulness of trajectories for patient-relevant outcomes and risk stratification. Progress will also depend on methodological innovation, patient and public involvement, harmonisation of diverse data sources, and close interdisciplinary collaboration. Ultimately, a trajectory-based framework for multimorbidity research can enable more personalised, efficient, and equitable health-care strategies, improving outcomes in ageing populations.

BACKGROUND:Good communication is essential for high quality healthcare. People with hearing loss face communication challenges during health encounters, which may compromise their experience with care and outcomes, especially in noisy or stressful acute care facilities. Tools and strategies to facilitate two-way communication with these patients and other members of their healthcare team may help address this gap. This study describes the communication-related experiences of patients with hearing loss in Alberta hospitals, which can help inform future strategies in this setting. METHODS:Drawing on qualitative description, we conducted focus groups and individual interviews with people with hearing loss who had a recent hospital experience in Alberta, Canada. Focus group and interview transcripts were abductively coded and analyzed, guided by established communication frameworks to explore experiences and opportunities for change. RESULTS:Fourteen people participated in 3 focus groups and 3 interviews. Overall, participants perceived hospitals as not meeting their communication needs. We identified 3 themes: 1) Hearing loss is an invisible disability; 2) Communication is a team effort; 3) Every patient has different needs in different situations. CONCLUSIONS:Patients with hearing loss experience communication gaps while in hospital, possibly related to the invisibility and stigma of hearing loss, the lack of awareness about how to identify and accommodate different communication needs, and systemic barriers. Strategies to identify patients' communication needs, train healthcare providers, and increase the uptake of communication tools may help improve communication in this population.

Importance:Hearing loss is common and may impact health and quality of life if not properly managed. It is diagnosed following formal audiological assessment, which may not be available or practical. Hearing test software applications (apps) may help identify people who might benefit from audiological assessment, but their diagnostic accuracy has been incompletely studied. Objective:To measure and compare the validity and reliability of 2 commonly recommended apps (hearWHO and SHOEBOX) to detect moderately severe or greater hearing loss. Secondary objectives were to evaluate the apps' ability to detect less severe hearing loss and the diagnostic performance of 2 questionnaires for detecting both severities of hearing loss. Design, Setting, and Participants:This prospective diagnostic accuracy study compared the hearWHO and SHOEBOX apps with a 4-frequency pure-tone average audiological assessment reference standard. All consenting English-speaking patients aged 18 years or older and referred for routine audiological assessment at a publicly funded health center in Calgary, Canada, were included between May 17, 2023, and March 12, 2024. Main Outcome and Measures:The main outcome was the validity and reliability of 4 index tests, including the hearWHO app, SHOEBOX app, Revised Hearing Handicap Inventory-Screening (RHHI-S) questionnaire, and the Single-Item Self-Assessment (SISA) questionnaire, to detect moderate to severe hearing loss. All index test results were compared with an audiological assessment reference standard (hearing loss defined by a better ear hearing threshold of ≥50 dB [more severe denoted as HL50] or ≥20 dB [less severe denoted as HL20]). Test-retest reliability of the 2 apps and C statistics, sensitivity, specificity, and positive and negative predicted values of all index tests were measured. Results:A total of 130 participants were recruited (median [IQR] age, 58 [47-67] years; 82 female [63.1%]). Complete data for each comparison ranged from 123 to 129 participants. The prevalence of HL50 was 16.3% (21 or 130 participants). Neither the hearWHO nor the SHOEBOX app had high test-retest reliability (all κ-values <0.80), with the SHOEBOX having a κ of 0.64 (95% CI, 0.48-0.79) and hearWHO having a κ of 0.32 (95% CI, 0.18-0.46). All C statistics for HL50 were less than 0.80. When testing for HL50, diagnostic performance for both apps was better for the second measurement than the first measurement or the mean. Sensitivity and specificity for the second measurement of SHOEBOX were 0.26 (95% CI, 0.09-0.51) and 1.00 (95% CI, 0.97-1.00), respectively, and for the second measurement of hearWHO, 0.67 (95% CI, 0.43-0.85) and 0.71 (95% CI, 0.62-0.79), respectively. Sensitivity and specificity for the RHHI-S were 0.76 (95% CI, 0.53-0.92) and 0.42 (95% CI, 0.32-0.52), respectively, and for SISA, 0.10 (95% CI, 0.01-0.30) and 0.90 (95% CI, 0.83-0.95), respectively. Using a less stringent diagnostic threshold with SHOEBOX increased sensitivity for HL50 to at least 95% while retaining a specificity of 47% to 54%. Sensitivity and specificity for both apps were higher for HL20. Conclusions and Relevance:These findings suggest that both hearWHO and SHOEBOX have limited test-retest reliability, perhaps because of a learning effect. Both apps may be suitable if a sensitive strategy is desired for identifying people who may benefit from diagnostic audiological assessment, whereas the SHOEBOX app may be preferable if a specific strategy is desired. If neither app is available, the RHHI-S or the SISA could be used depending on whether sensitivity or specificity is desired.

Family and friend caregivers of people with dementia (PwD) experience high distress, but have minimal access to support beyond education. Understanding interventions’ comparative efficacy at improving their mental health is critical. We searched MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, and grey literature from inception until June 13, 2024, for randomized trials (RCTs) comparing any intervention to usual care or other interventions for improving quality of life, burden, distress, or depression or anxiety symptoms in PwD's family or friend caregivers. Independent reviewer pairs conducted study screening, data abstraction, and risk of bias appraisal. We derived standardized mean differences from random-effects network meta-analysis; back-transformed mean differences (MD) on the World Health Organization Quality of Life Scale (psychological health), Zarit Burden Interview, Neuropsychiatric Inventory (distress), Center for Epidemiologic Studies Depression Scale, and Hospital Anxiety and Depression Scale (anxiety) to describe quality of life, burden, distress, and depression and anxiety symptom changes, respectively; and probabilities of exceeding each scale's minimum important difference (pMID). We included 196 RCTs (83 interventions; 27,210 caregivers); 63.8% were at high risk of bias from missing data. Compared to education, psychotherapy (MD 17.4, 95% credible interval 3.5 to 31.7; pMID 95.1%) improved quality of life; education+training (-6.4, -12.2 to -0.9; 57.8%) and caregiver/PwD exercise (-13.1, -26.2 to -0.2; 85.9%) improved burden; mindfulness (-8.3, -12.9 to -3.9; 97.6%) and case management+education (-6.9, -13.0 to -0.3; 82.7%) improved distress; education+psychotherapy+support (-35.3, -44.8 to -25.5; 100%), education+training (-4.0, -6.2 to -1.7; 42.9%), education+psychotherapy (-11.8, -21.0 to -2.6; 94.4%), mindfulness (-5.1, -9.0 to -1.1; 66.4%), caregiver/PwD education (-23.4, -35.9 to -9.9; 99.6%), respite care+education+support (-23.1, -40.2 to -5.5; 98.2%), education+training+perspective-taking (-10.6, -20.7 to -0.6; 89.6%), and education+journaling+psychotherapy (-7.0, -12.9 to -1.3; 83.5%) improved depressive symptoms; and education+training+psychotherapy (-2.2, -3.7 to -0.8; 81.4%), education+support+training (-3.1, -5.6 to -0.7; 89.0%), exercise+meditation (-5.9, -9.2 to -2.7; 99.4%), cognitive behavioural therapy+support (-15.4, -19.6 to -11.1; 100%), caregiver/PwD counselling (-2.6, -5.2 to -0.1; 79.8%), and education+support+psychotherapy (-7.2, -9.8 to -4.6; 100%) improved anxiety symptoms. Intervention combinations, with or without education, were more efficacious than education alone at improving mental health of PwD's family and friend caregivers.

The prevalence of overweight (15%) and obesity (6%) in children under 5 years of age in Canada are high, and young children with overweight and obesity are at increased risk of the development of chronic disease(s) in adulthood. Prior research has demonstrated very few published trials on effective obesity prevention interventions in young children at risk of obesity, within primary healthcare settings. The aim of this study is to determine if 18–48-month-old children at risk for obesity, who are randomized to receive the Parents Together program (i.e., intervention group), have reduced body mass index z-score (zBMI), compared to those not receiving the intervention, at a 12-month follow-up. Secondary clinical outcomes between the intervention and control groups will be compared at 12 months. A pragmatic, parallel group, 1:1, superiority, randomized control trial (RCT) through the TARGetKids! Practice Based Research Network will be conducted. Young children (ages 18–48 months) who are at increased risk for childhood obesity will be invited to participate. Parents who are enrolled in the intervention group will participate in eight weekly group sessions and 4–5 coaching visits, facilitated by a trained public health nurse. Children and parents who are enrolled in the control group will receive the usual health care. The primary outcome will be compared between intervention arms using an analysis of covariance (ANCOVA). Feasibility and acceptability will be assessed by parent focus groups and interviews, and fidelity to the intervention will be measured using nurse-completed checklists. A cost-effectiveness analysis (CEA) will be conducted. This study will aim to reflect the social, cultural, and geographic diversity of children in primary care in Toronto, Ontario, represented by an innovative collaboration among applied child health researchers, community health researchers, and primary care providers (i.e., pediatricians and family physicians in three different models of primary care). Clinical and implementation outcomes will be used to inform future research to test this intervention in a larger number, and diverse practices across diverse geographic settings in Ontario. ClinicalTrials.gov NCT03219697. Registered on June 27, 2017.

The long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies. Following the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach. After screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings. Future knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.

Abstract Background: The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy-makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS.Methods: Design: We will adapt our overall method from the RAND Appropriateness Method. Following this, we will perform a two-component study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation (iKT) approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. Knowledge synthesis: We will conduct a systematic scoping review following the methodology recommended in the Joanna Briggs Institute Reviewers Manual. We will use the following eligibility criteria: 1) Participants - any stakeholder involved in creating or testing a strategy for PPI; 2) Intervention - any PPI strategy proposed for scaling-up initiatives; 3) Comparator - no restriction; 4) Outcomes: any process or outcome metrics related to PPI; and 5) Setting - HSS. We will search electronic databases (e.g., MEDLINE, Sociological Abstract), hand searching relevant websites, screen the reference lists of included records, and consult experts in the field. Two reviewers will independently select and extract eligible studies. We will summarize data quantitatively and qualitatively and report results using the PRISMA extension guidelines. Delphi study: We will conduct an online Delphi survey to achieve consensus on the relevant strategies for PPI in scaling-up initiatives in HSS. Participants will include stakeholders from low-, middle-, and high-income countries. We anticipate that three rounds will allow an acceptable degree of agreement on research priorities.Discussion: Our findings will advance understanding of how to meaningfully and equitably involve patients and the public in scaling-up initiatives for sustainable HSS.Registration: We registered this protocol with the Open Science Framework on August 19, 2020 (https://osf.io/zqpx7/).