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Abstract

Introduction
Weight stigma and bias in healthcare are well-documented and can deter individuals from participating in research. These sensitivities often foster distrust, creating barriers to recruitment and engagement. Patient and Public Involvement and Engagement (PPIE) strategies are essential to building trust, enhancing transparency and fostering collaboration with under-represented populations.

Methods
This article presents both stages of the PPIE strategy for the Larger Bodies in Radiography (LBinRAD), a multiphased research project which aims to explore experiences and develop services which support person-centred, compassionate care for individuals with larger bodies across medical imaging and radiotherapy services. Stage 1 involved four individuals with lived experience who contributed to developing a UK-wide survey, disseminated via social media to recruit participants living in larger bodies who had accessed radiographic services. Stage 2 created a pool of 28 PPIE representatives, inviting them to participate in five online focus groups designed to: (i) explore participants' perspectives on key priorities, including widening participation; (ii) co-create belief statements to guide future PPIE activities; and (iii) collaboratively shape subsequent research phases.

Results
In Stage One, PPIE consultation shaped language and messaging, leading to the adoption of the term ‘larger body′ and clarification that body weight data would not be collected. A distinct sub-population identifying as taller than average was also recognised. PPIE representatives recommended targeted outreach to relevant social media groups, significantly improving recruitment reach and inclusivity.
In Stage Two, 22 PPIE representatives participated across five focus groups. Listening to their experiences provided valuable insights that helped ensure lived experience remained central to the methodology. These insights informed several key refinements, including broadening inclusion criteria and recruitment locations, exploring language in greater depth, discussing cultural influences, and using varied media and methods to capture data and support co-design.

Conclusion
PPIE was central to the success of Phase 1, shaping the research process and outcomes. Insights and action points from this collaborative approach will guide Phase 2 and future research development. By centring historically marginalised voices, PPIE enhances research inclusivity, relevance, credibility and impact.

Publication Type:	Article
Additional Information:	© 2026 The Author(s). Health Expectations published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	access barriers, challenging topics, inclusion, medical imaging, radiotherapy, representation, sensitivities
Subjects:	R Medicine > RC Internal medicine
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Allied Health
SWORD Depositor:	Symplectic Administrator

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