In writing about community participation in health, the term 'community' is used loosely and ambiguously. On analysis, it appears that there is a conceptual shift in health policy to thinking about involvement of consumers in health planning and programs rather than communities. This shift is consistent with a managerialist approach to planning health service delivery. Participative processes are perceived as being initiated and directed by health administrators. Participants in the processes are to be 'representative' of health service consumers, rather than whole communities. However, in many Australian rural communities, there are enduring traditions of community participation in providing governance for local hospitals, developing infrastructure for general practice services, and providing in-kind support. Participation in health services is embedded in the way the community functions. Acknowledging and understanding the ways in which 'community participation' and 'consumer participation' are different may result in more effective participative processes.
"Here, the Scottish Government is invoking both client/consumer (individual) and citizen/community (for the good of society), perspectives [21,24]. A review found over 100 methods for public engagement , including focus groups, participatory appraisal, Planning for Real, citizen’s juries and future visioning. "
[Show abstract][Hide abstract] ABSTRACT: This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services.
Community-based participatory action research was applied in four Scottish case study communities in 2008-10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented.
Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation.
Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions.
BMC Health Services Research 03/2014; 14(1):130. DOI:10.1186/1472-6963-14-130 · 1.71 Impact Factor
"Despite the desire to meaningfully engage communities in health care planning, and the adoption of community participation as central in the health agendas of many countries [4,6,7,11-13,24], researchers continue to debate models, approaches, motivations, definitions and operational challenges [22,25,26]. Most commonly, researchers define communities as groups bounded by geographic location , and participation as collective actions that harness socio-cultural affiliations, customs, values and beliefs through social interactions to influence and localise outcomes . In theoretical terms, participation is understood to be multi-level, depicted as a ladder by Arnstein  (see Figure 1), or as a spectrum (see for example International Association for Public Participation ). "
[Show abstract][Hide abstract] ABSTRACT: Major health inequities between urban and rural populations have resulted in rural health as a reform priority across a number of countries. However, while there is some commonality between rural areas, there is increasing recognition that a one size fits all approach to rural health is ineffective as it fails to align healthcare with local population need. Community participation is proposed as a strategy to engage communities in developing locally responsive healthcare. Current policy in several countries reflects a desire for meaningful, high level community participation, similar to Arnstein's definition of citizen power. There is a significant gap in understanding how higher level community participation is best enacted in the rural context. The aim of our study was to identify examples, in the international literature, of higher level community participation in rural healthcare.
A scoping review was designed to map the existing evidence base on higher level community participation in rural healthcare planning, design, management and evaluation. Key search terms were developed and mapped. Selected databases and internet search engines were used that identified 99 relevant studies.
We identified six articles that most closely demonstrated higher level community participation; Arnstein's notion of citizen power. While the identified studies reflected key elements for effective higher level participation, little detail was provided about how groups were established and how the community was represented. The need for strong partnerships was reiterated, with some studies identifying the impact of relational interactions and social ties. In all studies, outcomes from community participation were not rigorously measured.
In an environment characterised by increasing interest in community participation in healthcare, greater understanding of the purpose, process and outcomes is a priority for research, policy and practice.
BMC Health Services Research 02/2013; 13(1):64. DOI:10.1186/1472-6963-13-64 · 1.71 Impact Factor
"Using empirical data, we describe the dominant themes in each of the partnership types and the instances of competing approaches and build concepts about how these approaches are aligned. A typology of community and health sector partnership approaches The typology of partnership approaches was synthesized from conceptual material about community participation in health activities including writing by Bracht and Tsouros (1990), Hildebrandt (1994), Laverack (2003), Laverack and Labonte (2000), Minkler (2005), Oakley (1989), Preston et al. (2010), Rifkin (1986, 1996, 2001), Rifkin et al. (2000), Taylor et al. (2006) "
[Show abstract][Hide abstract] ABSTRACT: The Australian health system requires novel strategies to implement widespread primary prevention to reduce the burden of chronic illness. One approach is for health sectors to draw on resources available in communities of place and to form partnerships which maximize the relevance and uptake of initiatives designed to promote healthy lifestyles. This article presents a typology of conceptual approaches to community and health sector partnerships, developed through an extensive literature search and empirically tested using in-depth case studies across regional Australia. The article finds that the health sector’s orientation to primary prevention is generally instrumental involving highly targeted outcomes and pre-defined programmes. Communities of place have multifaceted priorities that include building the social and economic sustainability of their community. While these approaches might appear incompatible, careful ‘manipulation’ and ‘massaging’ of instrumental objectives to adjust to community agendas and the presence of ‘boundary crossers’ can lead to successful primary prevention outcomes.
Current Sociology 07/2012; 60(4):506-521. DOI:10.1177/0011392112438334 · 0.90 Impact Factor
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