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Stakeholder engagement in healthcare research in India – A systematic review

Health Research Policy and Systems volume 23, Article number: 57 (2025) Cite this article

Abstract

Background

Stakeholder engagement is increasingly crucial in healthcare research, particularly in diverse and complex settings such as India. Stakeholder engagement in health research is about collaborating with key parties such as patients, healthcare providers and policymakers to ensure the research is relevant and impactful by addressing real-world needs, thereby enhancing its quality and effect on healthcare practices.

Aim

The purpose of this study was to summarize the evidence on stakeholder engagement in healthcare research and its influence on research outcomes and healthcare policies in India.

Methods

The evaluation was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted in PubMed, SCOPUS, ProQuest, EMBASE, Web of Science, CINAHL Indian Citation Index and J-Gate, focussing on stakeholder involvement in healthcare settings in hospitals and communities in India. Various research methodologies were employed, with studies not centred on healthcare stakeholder engagement or unrelated sectors being excluded. Tools such as the Critical Appraisal Skills Programme checklist for qualitative studies and the mixed methods appraisal tool were used to evaluate the quality of the studies. Data synthesis was carried out using the descriptive/narrative synthesis approach.

Results

We included 25 articles on the basis of our eligibility criteria. These articles comprised reviews, theories of change, quantitative studies, reports, mapping, commentaries, conference proceedings, qualitative studies, experience papers and mixed methods research. The review examined different types and methods of engaging stakeholders in healthcare research projects, evaluated their influence on evidence-based practice, and investigated their relevance to reaching “hard-to-reach” populations. Overcoming financial, time, knowledge and logistical barriers and gaining support from international and governmental bodies can lead to more inclusive research with a significant impact.

Conclusions

Findings suggest that stakeholder engagement contributes to more contextually relevant and ethically grounded research, though challenges related to power dynamics, resource allocation and inclusivity remain prevalent. The review concludes by providing recommendations for enhancing stakeholder engagement practices in future healthcare research in India, emphasizing the need for capacity-building and inclusive frameworks that ensure diverse voices are represented.

Peer Review reports

Introduction

Stakeholders in healthcare, defined as individuals or groups responsible for or impacted by health-related decisions influenced by research evidence, encompass a diverse range of entities, including patients, caregivers, families, advocacy organizations, healthcare providers, payers, purchasers, policymakers, product manufacturers, researchers and the press [1,2,3,4]. The growing emphasis on protocols that involve diverse stakeholders, particularly in patient-centred care policies, highlights the increasing importance of stakeholder engagement in healthcare research [1, 3]. Researchers must identify and involve key stakeholders across various healthcare system levels, including policymakers, healthcare providers and community healthcare workers [4,5,6].

India’s healthcare system faces several significant challenges, including a high out-of-pocket expenditure, with nearly 75% of healthcare costs borne by individuals, leading to the financial burden on households. Furthermore, issues such as limited access to quality care, especially in rural areas, and a shortage of trained medical professionals, worsen the situation [7]. The quality of care in India’s healthcare sector is inconsistent, ranging from internationally recognized institutions to facilities that offer inadequate services. With the rise of chronic conditions, government and nongovernment research institutes, researchers and policymakers must collaborate to enhance healthcare quality and implement evidence-based initiatives [8,9,10]. Identifying key stakeholders and implementing successful healthcare initiatives are essential for offering continuous patient support, tailored education and enhancing healthcare providers’ capacity to address challenges in complex situations [11, 12]. As efforts to improve care quality grow, public and private sectors address issues with data reliability and measurement complexities, prioritizing accuracy enhancements, refining methodologies and seeking innovative solutions [8, 13]. The effectiveness of stakeholder engagement in research is influenced by structural, cultural and individual practices, affecting its practical implementation [4, 14].

Healthcare research has evolved from a solitary scientist approach to a more inclusive model, emphasizing multidisciplinary team science [15]. Recent advancements involve actively engaging stakeholders in various medical research activities [16]. Their involvement focusses on building shared understandings, which are crucial for accepting and implementing recommendations rather than just practical reasons [17]. There is a significant gap in the existing literature regarding the lack of systematic approaches for implementing sustainable stakeholder engagement in healthcare research, especially in ensuring long-term impacts on care quality and integration within healthcare systems. On the basis of existing evidence, researchers conducted a systematic review to uncover stakeholders’ diverse roles and responsibilities, demonstrating their contributions to healthcare research. The findings highlight the feasibility and potential adoption of stakeholder engagement at different levels of healthcare research whilst also revealing various approaches to implementing sustainable stakeholder engagement to improve care quality within healthcare systems.

Review question

  1. 1.

    What are the different approaches used for stakeholder engagement in healthcare research?

  2. 2.

    How do stakeholders influence research outcomes and healthcare policy development in India?

Aim To collate and summarize the evidence on various stakeholder engagement approaches used in healthcare research and its role in influencing research outcomes and shaping healthcare policies in India.

Methods

Search strategy

The findings of this systematic review were reported by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [18]. The PRISMA checklist is available in Additional file 1.

A comprehensive search was conducted to find the primary articles in six international databases: PubMed, SCOPUS, ProQuest, EMBASE, Web of Science and CINHAL, using specific keywords. Additionally, we conducted in-depth searches in Indian databases such as the Indian Citation Index and J-Gate. In addition, institutional and non-institutional repositories, including Shodhganga, the National Institute of Science Communication and Information Resources and the Indian Institute of Science’s ePrints@IISc, were examined. Relevant publications were also retrieved from the Campbell Collaboration, the Public Health Foundation of India (PHFI), the WHO, the Indian Institute of Public Health and Indian research funding agencies. Further resources included the Indian Science Abstracts (ISA) and Semantic Scholar. Finally, reference lists of included studies and related systematic reviews were screened for any additional pertinent studies.

The search criteria included specific keywords such as stakeholder OR stakeholder* OR expert* OR collaborator* OR “health professional” OR “health care provider*” OR “community health personnel” OR"Health Services Research"OR “health care” OR “health facility*” OR “health service*” OR “health research”. participant* OR participation OR “stakeholder engagement” OR “stakeholder involvement” OR “stakeholder role*” AND research OR “health research” OR healthcare OR “quality of care” OR “healthcare system” OR Improvement (Table 1).

Table 1 Search strategy used for six databases
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Inclusion criteria

The review included comprehensive primary research carried out in both hospital and community settings within the healthcare domain, providing empirical evidence on stakeholder involvement in healthcare research across India. The type of studies included in the review were various research methodologies such as observational, cross-sectional, descriptive, qualitative and mixed-method studies, alongside review articles, commentaries and conference proceedings emphasizing evidence generation and synthesis in healthcare research. Excluded were studies not specifically addressing stakeholder engagement in healthcare research within the Indian context, as well as those exploring stakeholder involvement in sectors unrelated to healthcare research.

Screening process

Database searches were exported to Rayyan software, and title and abstract screening were conducted independently by two reviewers (R.U.R. and N.S.). Following this, full-text screening was carried out for studies deemed eligible for inclusion in the review. An independent appraisal of studies was conducted by two reviewers, who assessed the studies separately to minimize bias and ensure objectivity. In cases where disagreements arose, a third reviewer was consulted, and consensus was reached on the basis of predefined criteria, including study relevance to the research question, adherence to inclusion/exclusion criteria and methodological quality. This approach ensured a transparent and systematic selection process, maintaining the rigour and reliability of the review. Finally, selected studies were included in the review and subjected to quality assessment and data extraction.

Quality assessment

The Critical Appraisal Skills Programme (CASP) checklist for qualitative studies [19] and the mixed methods appraisal tool (MMAT) checklist for mixed methods studies [20] were used to assess the quality of the included studies. The CASP qualitative checklist consists of two screening questions (yes/no) and eight additional questions (yes/no/cannot tell) if both questions receive a “yes” response. As described by Long and French, study quality was assessed based on the rigour of data analysis and the trustworthiness of the results. Considering these factors alongside the overall checklist score, studies were categorized as high, moderate or lower quality [21]. The mixed methods appraisal tool (MMAT) helps to identify whether the study is qualitative (mapping &theory of change), quantitative (descriptive, non-randomized, randomized) or mixed methods using MMAT’s classification and answering five key questions rated yes, no or can’t tell. A study meeting all five criteria is considered high quality, whilst one failing multiple criteria may be moderate or low [20].

Data extraction

Two researchers (R.U.R. and N.S.) conducted data extraction using Excel sheets from various sources. The data we collected includes specific details about the state and country where the studies took place, the titles and objectives of the studies, the samples and sample sizes used and the study designs or methods used. We also noted the approaches or strategies for engaging stakeholders, the types of stakeholders involved, and a detailed description of their roles in each study. We documented the data collection methods, including the tools and techniques used and the statistical analysis approaches employed to interpret the findings. We extracted the overall findings of the studies and recorded information about the funding sources that supported the research.

Results

Study selection

We initially identified 706 records. After 84 duplicates were removed, 622 articles underwent title and abstract screening. Following the inclusion criteria, 592 studies were excluded. Subsequently, we reviewed the full texts of 30 studies. Finally, 25 articles were included, comprising review (N = 3), theory of change (N = 2), quantitative (N = 1), report (N = 3), mapping (N = 4), commentary (N = 1), conference proceeding (N = 1), qualitative (N = 6), experience paper (N = 1) and mixed method (N = 3). The study selection process is illustrated in the PRISMA flow diagram in Fig. 1, whilst Table 2 outlines the characteristics of the included studies.

Fig. 1
figure 1

PRISMA flow diagram

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Table 2 Characteristics of included studies
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Quality appraisal of included studies

In total, nine of the included studies were descriptive and could not be included in the quality appraisal process [3, 22, 25, 29, 31, 32, 41,42,43]. Of the six qualitative studies, two were rated moderate quality [35, 36] and four were rated high [33, 38,39,40] as per the CASP checklist (Table 3). The remaining 10 studies were rated using the MMAT checklist; 6 were rated moderate [24, 27, 28, 30, 34, 44] and 4 were rated high quality [23, 26, 37, 45] (Table 4). Thus, 25 studies were included in the final synthesis.

Table 3 Quality appraisal of included studies using the CASP checklist
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Table 4 Quality appraisal of included studies using the MMAT checklist
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Type of stakeholders

The 25 studies reviewed have diverse stakeholders in the healthcare field. This included healthcare providers such as nurses and doctors, policymakers, government officials, program managers, community leaders, NGOs and international organizations such as UNFPA, UNICEF, and WHO (Fig. 2). These stakeholders played various roles, from decision-making and coordination of healthcare programs to local engagement and providing global health expertise.

Fig. 2
figure 2

Distribution of stakeholder types in selected studies; N = 25

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Amongst the 25 studies, the most commonly involved type of stakeholders were healthcare providers, including nurses, medical officers, physicians and health workers, who appeared across multiple studies (n = 18). Other frequent stakeholders included policymakers (n = 13), government officials (n = 6) and program managers (n = 5), reflecting significant involvement from both healthcare professionals and decision-makers. Additionally, public health personnel (n = 5), NGO representatives (n = 4) and community leaders (n = 5) were commonly engaged, often collaborating with international organizations (n = 2) such as UNFPA, UNICEF and WHO. The studies highlighted various stakeholders from sectors such as health, public health and education, emphasizing cross-sectoral engagement in public health initiatives.

Diverse approaches to stakeholder engagement

Two studies integrating policy reviews with semi-structured interviews highlight the role of technical coordination units and structured change management in securing stakeholder buy-in and large-scale implementation [23, 25]. However, administrative structures alone may not ensure sustainable, community-driven change. Three studies emphasize focus group discussions and workshops as effective platforms for collaborative decision-making in priority-settings [24, 26, 28]. Whilst these participatory approaches enhance inclusivity, they risk dominant voices overshadowing marginalized perspectives, underscoring the need for structured facilitation to balance power dynamics.

Three studies using the Net-Map method effectively aligned stakeholder efforts for policy advocacy in infant and young child feeding (IYCF) [27, 37, 38], though its impact may be limited without policy interventions. Another study employed participatory decision-making for advocacy and policy development, enhancing engagement and relevance [29]. Whilst this approach ensures policies reflect local needs, sustained stakeholder commitment is crucial to prevent fragmentation and loss of momentum.

The business of humanity (BoH) approach, integrating stakeholder engagement with community power-sharing, offers strategic benefits [30], though its scalability in resource-limited settings remains uncertain. Systematic outreach and education foster participation and sustainability [31] but require accountability mechanisms and long-term knowledge transfer for lasting impact. Of the four studies, Facilitating direct communication between researchers and decision-makers has been instrumental in translating research findings into actionable policy recommendations [5, 32, 34, 43] but needs sustained collaboration and institutional backing. The theory of change (ToC) framework fosters stakeholder-aligned interventions[45], though its success depends on adaptive learning to meet evolving needs (Table 5).

Table 5 Comparative analysis of stakeholder engagement approaches
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Stakeholder engagement methods in shaping healthcare policies and practices

Of the four studies, participatory approaches, such as facilitated workshops and multisectoral discussions, have fostered collaboration and inclusive healthcare initiatives [24, 28, 29, 38]. However, despite their strengths, these methods are susceptible to dominant voices overshadowing marginalized perspectives. The other four studies used the Net-Map method, which visualizes stakeholder relationships and has clarified roles and improved coordination, leading to more accountable decision-making [27, 31, 33, 37], and whose impact depends on sustained policy interventions and continuous engagement.

Impact on policy implementation and crisis response

Of the two studies, evidence generated from stakeholder engagements has provided policymakers with a clearer understanding of stakeholder dynamics, enabling more informed and adaptable decision-making, particularly during crises such as the COVID-19 pandemic [28, 37]. Whilst virtual platforms improved accessibility, digital literacy and technological disparities remain barriers, necessitating targeted capacity-building for effective participation.

The diagram illustrates a cyclical process for stakeholder engagement in health interventions, emphasizing the integration of engagement and participation to address policy gaps and improve patient outcomes (Fig. 3).

Fig. 3
figure 3

Framework for stakeholder involvement in enhancing healthcare policy and practices

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Expanded applicability in “hard-to-reach” populations

Two studies identified gaps in adolescent mental health policy and non-communicable disease care, highlighting stakeholder engagement’s role in policy development and intervention integration for improved state-level healthcare strategies [22, 24]. Another two studies demonstrated how engaging local actors, including community members and informal providers, strengthens healthcare systems, enhances service delivery and ensures long-term sustainability in marginalized communities [29, 32]. Two studies emphasized targeted interventions’ impact on diagnostic uptake and treatment adherence, with one improving early TB detection and the other increasing ORS and zinc utilization through structured engagement [30, 34]. Another set of studies showcased how peer learning, teamwork and incentives enhance patient engagement and social wellbeing, whilst the Community Health study leveraged diverse communication channels to maintain healthcare responsiveness during COVID-19 [38, 42]. Lastly, one study highlighted the need to recognize overlooked stakeholders in urban poor communities, using an interest–influence matrix to reveal engagement gaps and the necessity of structured involvement for sustained impact [43].

The transparent and inclusive involvement of diverse stakeholders in priority-setting procedures highlights the need to incorporate different socioeconomic groups to create comprehensive healthcare policies [3, 23, 25, 27]. The research findings also emphasized the vital function of national and international institutions in furnishing financial and technical assistance, both of which are important for expanding health-related endeavours [33, 36, 39]. Stakeholder engagement, capacity building and strategic partnerships are critical in extending the reach and impact of health interventions, ensuring that even the most disadvantaged populations receive adequate care and support.

A strategy for collaborative success and impactful decision-making

The stakeholder engagement process is a dynamic blend of collaboration, adaptability and decisive action to foster comprehensive participation and deliver impactful outcomes. Leveraging semi-structured interviews, policy reviews, focus group discussions and the Net-Map technique, this approach captures diverse perspectives, visualizes stakeholder connections and facilitates informed decision-making [22, 24, 26, 30, 33, 34, 36, 42, 43]. Embracing participatory methodologies and change management strategies ensures the implementation of adaptable interventions with genuine stakeholder support [3, 25, 29, 32, 35, 37, 44, 45]. Emphasizing power-sharing and alignment with stakeholders’ needs, frameworks such as the business of humanity and theory of change and systematic outreach and direct communication pave the way for sustainable, evidence-based decisions [31, 33, 35, 40,41,42,43, 45] (Fig. 4).

Fig. 4
figure 4

Context and process of stakeholder engagement

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Barriers and challenges

The two studies reported that governance fragmentation hindered stakeholder engagement, making priority-setting difficult and leading to inconsistent health policy implementation [25, 31]. Coordination challenges amongst multiple stakeholders affected funding allocation and program effectiveness across different regions [26, 36]. The other two studies highlighted the need for improved coordination to optimize healthcare resources and ensure sustainable health coverage [44, 45]. Youth engagement remains a significant gap, where young people’s perspectives were overlooked in adolescent health programs [22, 39]. Similarly, another study found that youth voices were largely absent from policy discussions, affecting service accessibility and effectiveness.

Cultural differences, varying awareness levels and inconsistent healthcare infrastructure posed significant barriers to integrating palliative care into ICUs [23]. Another study reported systemic barriers, including resistance from healthcare providers and logistical constraints, affected early cancer screening and intervention efforts [27]. Another one reported task shifting to nurses and non-specialist providers in managing non-communicable diseases faced resistance due to insufficient training, lack of support and administrative hesitations [24]. The other two studies found ensuring inclusivity in priority-setting required balancing diverse stakeholder expectations whilst addressing power dynamics [35, 37]. It is reported that managing conflicting interests amongst policymakers, public health agencies and clinicians was challenging when developing transparent priority-setting recommendations [25].

Socioeconomic disparities impacted stakeholders’ ability to participate in decision-making, with less influential groups struggling to assert their needs [43]. Differences in stakeholder resources affected engagement, particularly in ensuring provider motivation and sustainable intervention delivery [40]. Reliance on external funding made implementation vulnerable to policy and funding shifts, necessitating stronger local capacity-building efforts [26]. Ensuring long-term sustainability of health interventions depended on effective integration within existing public health systems [28].

Discussion

The reviewed studies provide valuable insights into stakeholder engagement, strategies for stakeholder engagement, highlighting its potential benefits and inherent challenges. Stakeholder engagement in healthcare research is crucial for the successful implementation and sustainability of health interventions [24, 28,29,30, 41]. Effective stakeholder engagement ensures that health interventions align with the needs and expectations of diverse populations, a principle widely recognized in global healthcare systems. For instance, integrating palliative care into intensive care unit (ICU) settings demonstrated long-term benefits, such as reduced ICU deaths and improved patient satisfaction [23]. Similar international initiatives have shown that stakeholder-driven palliative care models improve patient-centred outcomes and resource allocation, reinforcing the need for inclusive engagement [46, 47]. Engaging stakeholders such as healthcare providers, patients and families in designing and implementing these interventions ensures they are contextually relevant and more likely to be effective.

Active stakeholder engagement with diverse stakeholders enhances healthcare research quality and relevance by developing standardized outcome measures and ensuring comprehensive, inclusive and effective healthcare strategies [48, 49]. International models, such as the WHO’s participatory governance frameworks, emphasize multisectoral collaboration to co-design health interventions. The reviewed studies also highlight the importance of engaging diverse socioeconomic groups to capture various perspectives. For example, the mPower Heart e-CDSS program leveraged task shifting to involve nurses in non-communicable disease (NCD) management, demonstrating the value of inclusive capacity-building initiatives [24]. Similarly, workshops and priority-setting exercises that included policymakers, clinicians and the public were crucial for co-designing sustainable health interventions [25, 31]. These findings align with international best practices, such as the UK’s INVOLVE framework and the U.S. Patient-Centered Outcomes Research Institute (PCORI), emphasizing patient and community involvement in research design and decision-making [50, 51].

Many studies highlight key barriers to stakeholder engagement in healthcare research [22,23,24,25,26,27,28, 31, 35,36,37, 39, 40, 43,44,45]. Globally, stakeholder engagement in healthcare research is hindered by fragmented intersectoral collaboration, stigma in mental health settings and misaligned regulatory policies that hamper innovation and adoption [52,53,54]. Similar to that in the current review, Governance fragmentation and weak intersectoral coordination hinder effective healthcare policy implementation in India. In contrast, limited youth engagement in policy discussions reduces the relevance of health programs. Additionally, reliance on external funding threatens sustainability, highlighting the need for stronger local engagement strategies.

Addressing these barriers requires strategic planning and resource allocation. The studies suggest several approaches to enhance stakeholder engagement [23,24,25,26,27,28,29,30,31,32,33,34, 45]. Transparent and inclusive priority-setting ensures diverse voices are considered, leading to equitable healthcare strategies. Innovative methods such as Net-Map enhance stakeholder collaboration, whilst local intermediaries improve accessibility in rural areas. The I-STEM framework, successfully implemented in nine foreign countries, provides a structured approach to overcoming stakeholder engagement barriers through strategic planning and resource allocation [55]. Moreover, the involvement of governmental and international organizations, such as UNICEF and WHO, plays a crucial role in providing financial and technical support, ensuring the sustainability and scalability of health intervention.

Limitations of the review

Despite its contributions, this review has limitations. First, the studies included exhibit methodological heterogeneity, making direct comparisons challenging. Second, reliance on published literature may introduce publication bias, as unpublished but relevant stakeholder engagement initiatives remain unexamined. Third, whilst many studies highlight engagement successes, fewer focus on failed interventions, limiting a balanced understanding of challenges. Future research should adopt mixed-method approaches to provide a more nuanced analysis of stakeholder engagement effectiveness.

Conclusions

Effective stakeholder engagement in healthcare research is essential for developing and implementing contextually relevant, sustainable and equitable interventions. The insights from the reviewed studies highlight the importance of strategic and inclusive approaches to stakeholder engagement, ultimately fostering improved health outcomes and system resilience. The reviewed studies emphasize strategic and inclusive engagement approaches, ultimately fostering improved health outcomes and system resilience. In the Indian context, enhancing stakeholder engagement requires integrating digital tools for consultations and training, institutionalizing standardized engagement frameworks, strengthening capacity-building efforts – particularly in rural and underserved areas – and promoting cross-sector collaborations between government agencies, private entities and community organizations.

Future research directions

Future studies should focus on:

  1. 1.

    Exploring Digital Engagement Methods Examining the role of mHealth apps and virtual platforms in stakeholder engagement.

  2. 2.

    Youth Involvement in Healthcare Research Investigating strategies to increase youth participation in policy development and health initiatives.

  3. 3.

    Evaluating Longitudinal Impact Conducting longitudinal studies to assess the sustained impact of stakeholder engagement on policy and health outcomes.

By implementing these strategies, Indian healthcare research can foster more effective and sustainable stakeholder engagement, ultimately improving health outcomes nationwide.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

CASP:

Critical Appraisal Skills Programme

MMAT:

Mixed methods appraisal tool

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Acknowledgements

We express our gratitude to the Manipal Academy of Higher Education for providing technical assistance.

Funding

Open access funding provided by Manipal Academy of Higher Education, Manipal. No funding was received for this project.

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Authors and Affiliations

  1. Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India

    Remya U. Rajendran, Baby S. Nayak, Tenzin Phagdol & Mamatha Shivananda Pai

  2. Department of Child Health Nursing, SUM Nursing College, Siksha ‘O’ Anusandhan (SOA) University, Bhubaneswar, Odisha, India

    N. Siva

  3. Social Research Institute, Institute of Education, University College London, London, United Kingdom

    Preethy D’Souza

  4. Department of Obstetrics&Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India

    Judith Angelitta Noronha

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  1. Remya U. Rajendran
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Contributions

R.U.R., B.S.N. and N.S. led the conception and design of the work; N.S., T.P., B.S.N. and R.U.R. conducted the analysis and interpretation of the data; R.U.R. and N.S. drafted the work; and N.S., B.S.N., T.P., J.A.N., M.S.P and P.D. substantively revised it. All authors have approved the submitted version (and any substantially modified version that involves the author’s contribution to the study) and have agreed both to be personally accountable for the authors’ own contributions and to ensure that questions related to the accuracy or integrity of any part of the work.

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Correspondence to Baby S. Nayak.

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Rajendran, R.U., Nayak, B.S., Siva, N. et al. Stakeholder engagement in healthcare research in India – A systematic review. Health Res Policy Sys 23, 57 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12961-025-01341-9

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Keywords

Health Research Policy and Systems

ISSN: 1478-4505

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