Abstract
tBackground: Public involvement in large-scale changes (LSC) to health services is strongly promoted –and even mandated – in several health systems. This scoping review aimed to describe the evidence abouthow public involvement is conceptualised and conducted in LSC, with what impact, and how differentstakeholders perceived this process.Methods: After searching eight databases, 34 publications were included. Data were extracted and chartedusing a standardised form. Findings from the literature were discussed with frontline stakeholders.Results: Public involvement remains poorly defined and its aims lack clarity in LSC. Public meetings aremost often used to gather public views but raise the issue of representativeness. However, evidence in theliterature is scarce about which involvement methods – informative and deliberative – are appropriatefor the different stages of the LSC and with what impact. In several cases, the involved public felt theyhad no influence on decision-making regarding LSC proposals, sometimes leading to an environmentof mistrust. In those instances, the public understood the technical arguments for change and activelyquestioned them, opposed LSC plans and sought alternative routes to voice their views.Conclusion: More research and consideration are needed regarding who should be involved, with whatpurpose and how. We argue that in practice two models of involvement, invited and uninvited partic-ipation, coexist and therefore interactions between the two should be given further consideration inLSC.