This chapter provides guideline developers with advice on how to identify, recruit and support patients and members of the public as participants in guideline development groups. It will also explore how facilitators can overcome some of the main barriers to recruitment and effective involvement. Published literature has highlighted several barriers for involving patient and public members (Armstrong et al. 2017b; Légaré et al. 2011; Ocloo and Matthews 2016), including:

• the developer being unclear of recruitment strategy, including the number or type of patient or public members to recruit to achieve genuine representation
• the developer, patient or public member being unclear of their role in guideline development
• scheduling and planning issues, or having the resources to adequately engage patient and public members
• lack of relevance of the scope to patient and public members
• difficulties in gaining meaningful involvement or avoiding tokenism
• patient or public member not respected, not seen as equal, or feeling devalued
• achieving a breadth of perspective or adequate representativity of patients and the public
• recruitment difficulties
• lack of methodological expertise, skills or knowledge related to guideline development
• patient and public members feeling isolated or lacking in confidence to speak up in a large group of experts.

The 4 sections of this chapter will address these barriers. The first section focuses on the role of patient and public members, including the qualities, experience, type and number, and skills needed. The second section focuses on the recruitment process and strategies. Support, including practical and informal support, group dynamics, training and co-learning, and re-assessment and feedback procedures, is addressed in the third section. The fourth section focuses specifically on the barriers and solutions to recruiting people who might face barriers to participating, such as children, and outlines a series of alternative approaches. Practical examples will be provided, based largely on the expertise and best practice of guideline developers from around the world, These include the National Institute for Health and Care Excellence (NICE) in England, Ärztliches Zentrum für Qualität in der Medizin (ÄZQ) in Germany (or the German Agency for Quality in Medicine [AEZQ]), the Registered Nurses’ Association of Ontario (RNAO) in Canada, and the Scottish Intercollegiate Guideline Network (SIGN) in Scotland. Reference is made to published research where relevant. The advice in this chapter will help guideline developers avoid tokenism, defined as the ‘difference between…the empty ritual of participation and having the real power needed to affect the outcome’ (Arnstein 1969).