Consumer engagement in the development and production of research is widely argued as being important for generating meaningful findings that are more likely to translate successfully into practice. 1,2 This engagement may focus on the design of specific research projects and use of the evidence stemming from it in health service planning, policy development, setting priorities, and quality assurance in the delivery of health services. 3 In order for consumers to engage meaningfully in these processes, they must first be provided with and understand the context and background information for the issues under consideration. In research, the same information needs to be provided to allow participants who are consumer representatives to understand the research questions being asked. 4 This is particularly important when working with populations that may have limitations in their capacity to understand the complex information

Disinvestment is the removal or reduction of previously provided practices or services, and has typically been undertaken where a practice or service has been clearly shown to be ineffective, inefficient and/or harmful. However, practices and services that have uncertain evidence of effectiveness, efficiency and safety can also be considered as candidates for disinvestment. Disinvestment from these practices and services is risky as they may yet prove to be beneficial if further evidence becomes available. A novel research approach has previously been described for this situation, allowing disinvestment to take place while simultaneously generating evidence previously missing from consideration. In this paper, we describe how this approach can be expanded to situations where three or more conditions are of relevance, and describe the protocol for a trial examining the reduction and elimination of use of mobilisation alarms on hospital wards to prevent patient falls. Our approach utilises a 3-group, concurrent, non-inferiority, stepped wedge, randomised design with an embedded parallel, cluster randomised design. Eighteen hospital wards with high rates of alarm use (≥3%) will be paired within their health service and randomly allocated to a calendar month when they will transition to a “Reduced” (<3%) or “Eliminated” (0%) mobilisation alarm condition. Dynamic randomisation will be used to determine which ward in each pair will be allocated to either the reduced or eliminated condition to promote equivalence between wards for the embedded parallel, cluster randomised component of the design. A project governance committee will set non-inferiority margins. The primary outcome will be rates of falls. Secondary clinical, process, safety, and economic outcomes will be collected and a concurrent economic evaluation undertaken.

Rationale: Low-value care in public health can be addressed via disinvestment with the support of disinvestment research generated evidence. Consumers' views of disinvestment have rarely been explored despite the potential effects of this process on the care they will receive and the importance of consumer participation in decision-making in public healthcare.Aims and Objectives: This study aimed to understand consumer concerns, perceptions and attitudes towards disinvestment processes, with the goal of providing recommendations to health service researchers and managers to more effectively engage consumers in shared decision-making in public healthcare.Method: We conducted semistructured interviews using four scenarios describing the principles of disinvestment, how and why it could be undertaken, and a fifth scenario that described a real-life application of these principles. These scenarios were presented to participants in a written word document or a digital story during semistructured interviews. Participants were 18 community-dwelling older adults who were recruited via convenience sampling. Questions were addressed to the participants regarding their feelings and concerns towards disinvestment, their participation as consumers in disinvestment processes, as well as their preference for communicating information about disinvestment to patients and families.Results: Four major themes emerged around the negative perception of disinvestment and positive perception of research. Participants were concerned that the removal of a clinical activity was mainly the result of financial constraints in hospital systems. At times, participants indicated that disinvestment and its justifications were not easily understood. Participants expressed a need for consumer advocacy not always through themselves, but via others with more expertize; a single consumer is insufficient in representing the broader consumer perspective. Participants stressed the importance of transparency in relation to research evidence and decision-making outcomes. Face-to-face dissemination of