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Health Expect. 2015 Aug;18(4):489-503. doi: 10.1111/hex.12048. Epub 2013 Jan 31.

Do not forget the professional--the value of the FIRST model for guiding the structural involvement of patients in rheumatology research.

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Department of Medical Humanities, VU Medical Centre, EMGO Institute, Amsterdam, The Netherlands.
Athena Institute, VU Amsterdam, Amsterdam, The Netherlands.



The FIRST model describes five practical components that enable equal collaboration between patients and professionals in clinical rheumatology research: Facilitate, identify, respect, support and training.


To assess the value of this model as a framework for setting up and guiding the structural involvement of people with arthritis in health research.


The FIRST model was used as a framework during the guidance of a network of patient research partners and clinical rheumatology departments in the Netherlands. A 'monitoring and evaluation' approach was used to study the network over a period of 2 years. Data were collected using mixed methods and subjected to a directed content analysis. The FIRST components structured the data analysis. During monitoring meetings, refined and additional descriptors for each component were formulated and added if new items were found.


The FIRST model helps to guide and foster structural partnerships between patients and professionals in health research projects. However, it should be broadened to emphasize the pivotal role of the principal investigator regarding the facilitation and support of patient research partners, to recognize the requirements of professionals for training and coaching and to capture the dynamics of collaboration, mutual learning processes and continuous reflection.


FIRST is a good model to implement sustainable relationships between patients and researchers. It will benefit from further refinement by acknowledging the dynamics of collaboration and including the concept of reflection and relational empowerment. The reciprocal character of the five components, including training and support of researchers, should be incorporated.


FIRST model; patient participation; patient research partners; qualitative research; rheumatology; user involvement

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