Assessing the environment for engagement in health services: The Audit for Consumer Engagement (ACE) tool

Ashfaq Chauhan, Bronwyn Newman, Ramesh Lahiru Walpola, Holly Seale, Elizabeth Manias, Carlene Wilson, Reema Harrison

Research output: Contribution to journalArticleResearchpeer-review


Introduction: Although it is widely accepted that the physical environment can impact health quality and care outcomes, its impact on consumer engagement with health services has not been examined. Currently, no tools exist that assess the opportunities for consumer engagement offered within the physical environment. We aimed to develop and validate an environmental audit tool to assist health services and researchers to assess the extent to which the physical environment in health services creates and supports opportunities for consumer engagement. Method: An iterative, team-based approach in partnership with diverse stakeholders was used to develop the Audit for Consumer Engagement (ACE) tool. A four-stage process consisting of desktop review, concept clarification, identification of domains and validation was implemented. The tool was validated in one cancer service via face and content validation and inter-rater reliability was also assessed. Results: The ACE tool was demonstrated to comprise four main domains (access and signage information; resources for consumers; resources to support diversity; and consumer engagement events or activities) measured with 17 items. Face and content validity was achieved, and preliminary reliability analysis indicated substantial agreement between the two researchers for all four domains with an average of 86% agreement. Conclusion: The ACE is a novel tool that is practical, relevant and reliable, and developed in partnership with consumers and health service providers. The tool can be used by health service providers, researchers and consumer agency groups to assess opportunities for consumer engagement offered within the physical environment of cancer services. The ACE tool has the potential to be used as a guide for enhancing consumer engagement opportunities and for research purposes. Further evidence about the validity of the tool is required, including criterion-related validity and utility in other health settings. Patient/Public Contribution: This project is part of a wider ‘CanEngage’ project that includes a consumer investigator and is supported by a consumer advisory group. This study was completed in active partnership with members of a consumer advisory group from diverse backgrounds. Feedback was sought from the members throughout the development process of the tool with findings discussed with the CanEngage group members in scheduled meetings.

Original languageEnglish
Pages (from-to)3027-3039
Number of pages13
JournalHealth Expectations
Issue number6
Publication statusPublished - Dec 2022
Externally publishedYes


  • audit tool
  • consumer engagement
  • facility design
  • health service design
  • physical environment

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