Is it consumer or community participation?: examining the links between 'community' and 'participation'
ABSTRACT 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.
SourceAvailable from: Nerida Hyett[Show abstract] [Hide abstract]
ABSTRACT: Rural Australians generally experience poorer health than their city counterparts. Rural Australia is a vast geographical region, with significant diversity, where there is good health and prosperity, as well as disadvantage. The purpose of this issue brief is to provide evidence on how the health of rural Australians can be improved through community participation initiatives, which are currently being funded and delivered by health services and networks. Rural Australians need innovative health services that are tailored to the local context and meet increasing healthcare demands, without increases to expenditure. There are community participation approaches supported by research that can improve existing practice. Avoiding duplication, including the current work of Medicare Locals and Local Hospital Networks, is important for ensuring good outcomes from community participation initiatives. The following recommendations are made to improve practice: • New ways to contract and pay for health services are needed, which use ideas developed with communities, within current budgets • State and federal government competitive grants and tenders should prioritise proposals that demonstrate effective community participation approaches • Community-based services, such as community health centres, Medicare Locals and Local Health Networks, have an important role to play in facilitating community participation, including: o Building partnerships between existing services and leveraging existing participation strategies, rather than developing new services or standalone initiatives – to leverage available funds and maximise outcomes o Employment of a jointly-appointed, paid community leadership position across existing community-based health services, to avoid duplication and overcome barriers of over-consultation and volunteer fatigue • Formal and robust evaluation of initiatives is necessary to guide future policy and research A national innovative online knowledge sharing portal is required to share best practice in rural community participation, save time and money on ineffective approaches, and to support the rural health workforce.
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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 · 1.66 Impact Factor
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ABSTRACT: This bibliography is intended to provide readers with a guide to the literature published in English on patient and public involvement (PPI) in health and social care research