Operationalizing Patient and Public Involvement in a Multicenter Study on Hospital Nutrition and Dysphagia in Older Adults: The NUTRIFAG Case Study

Background/Objectives: Malnutrition and dysphagia are common and interrelated conditions among hospitalized older adults and are associated with poorer clinical outcomes. Patient and public involvement (PPI) has been increasingly recommended to improve the relevance, usability, and implementation of healthcare research and interventions; however, structured approaches to integrating PPI in hospital research on nutrition and dysphagia remain limited. This study aimed to describe how PPI was designed and embedded within the multicenter NUTRIFAG project and to identify practical lessons for its implementation. Methods: A community case study was conducted within NUTRIFAG, a prospective observational multicenter project assessing nutritional status and dysphagia risk among adults aged ≥65 years admitted to medical and surgical wards in nine Spanish public hospitals. A Citizen Advisory Group (CAG) was embedded in NUTRIFAG as a structured PPI component, and the documentation generated during the PPI process was compiled and synthesized using the GRIPP2 Long Form (GRIPP2-LF) reporting framework. Results: The CAG comprised 17 stakeholders representing patients and family caregivers, patient associations, healthcare professionals, hospital management, and hospital food and catering services. Engagement occurred mainly during the design and dissemination phases and included three virtual meetings supported by iterative email exchanges. PPI contributed to several refinements in dissemination materials, including clearer messaging, the addition of a reading-easy layer, improved posture cues, clearer separation of signs and symptoms, incorporation of QR codes linking to information sources, and improved video accessibility through captions and full-screen display. Conclusions: Embedding a diverse stakeholder advisory group within a multicenter hospital study was feasible and generated documented refinements to communication materials and dissemination processes. Structured PPI may contribute to clearer and potentially more usable healthcare resources for older patients in hospital settings.