JMIR Publications

ABSTRACT

Background:

Public deliberation is an approach used to engage persons with diverse perspectives in discussions and decision-making about issues affecting the public that are controversial or values-laden. Because this approach has been used increasingly to inform critical public health policy decisions, experts have called for transparent assessment of deliberation quality. Several frameworks have been developed to assess quality by evaluating deliberant remarks to determine whether deliberation goals were meet, but frameworks rarely address facilitator performance. Our research team developed a framework to evaluate facilitator performance by assessing facilitator fidelity to key principles of public deliberation.

Objective:

The objective of this report is to describe how the framework was used to assess facilitator fidelity in a four-site public deliberation project on the acceptability of minor self-consent in biomedical HIV prevention research.

Methods:

Deliberations were held with minor adolescents, parents, caregivers, and community members at four cities throughout the United States. The deliberations included four 2-hour sessions and were conducted on a video platform. A total of 88 individuals participated in the sessions that were facilitated by 18 team members. The sessions were recorded and transcribed verbatim. Facilitator remarks were highlighted and pre-determined coding rules were used to code the remarks to one of six principles (i.e., equal participation, expression of diverse opinions, respect for others, adoption of a societal perspective, reasoned justification of ideas, compromise and movement to consensus). A variety of display tables were used to organize the codes and calculate the number of facilitator remarks that were consistent or inconsistent with each principle during each session across all sites. A content analysis was conducted on the remarks to describe how facilitator remarks aligned, or did not align, with each principle.

Results:

Seven hundred and thirty-three remarks (733) were coded to one of the principles; 508 (69%) were coded as consistent with a principle and 225 (31%) were coded as inconsistent. The counts therefore provided affirmation that the majority of the facilitator remarks were aligned with the principles of deliberation suggesting good facilitator fidelity. By comparing the number of consistent and inconsistent remarks coded to each principle at each site and considering the results of the content analysis of deliberant remarks, areas where facilitator fidelity can be strengthened were identified. Results indicated that facilitators should focus more on encouraging quieter members to participate, refraining from expressing personal opinions, promoting adoption of a societal perspectives and reasoned justification of opinions, and inviting deliberants to articulate their areas of common ground.

Conclusions:

Results provide an example of how a framework for assessing facilitator fidelity was used in a four-site deliberation. The framework will be refined to better address issues related to balancing personal and public perspectives, managing plurality, and mitigating social inequalities. Clinical Trial: N/a