Enabling the participation of marginalized populations: case studies from a health service organization in Ontario, Canada

Abstract

We examined efforts to engage marginalized populations in Ontario Community Health Centers (CHCs), which are primary health care organizations serving 74 high-risk communities. Qualitative case studies of community participation in four Ontario CHCs were carried out through key informant interviews with CHC staff to identify: (i) the approaches, strategies and methods used in participation initiatives aimed specifically at engaging marginalized populations in the planning of and decision making for health services; and (ii) the challenges and enablers for engaging these populations. The marginalized populations involved in the community participation initiatives studied included Low-German Speaking Mennonites in a rural town, newcomer immigrants and refugees in an urban downtown city, immigrant and francophone seniors in an inner city and refugee women in an inner city. Our analysis revealed that enabling the participation of marginalized populations requires CHCs to attend to the barriers experienced by marginalized populations that constrain their participation. Key informants outlined the features of a 'community development approach' that they rely on to address the barriers to marginalized peoples' involvement by strengthening their skills, abilities and leadership in capacity-building activities. The community development approach also shaped the participation methods that were used in the engagement process of CHCs. However, key informants also described the challenges of applying this approach, influenced by the cultural values of some groups, which shaped their willingness and motivation to participate. This study provides further insight into the approach, strategies and methods used in the engagement process to enable the participation of marginalized populations, which may be transferable to other health services settings.

Involvement in maternal care by migrants and ethnic minorities: a narrative review

“…service users and care professionals) [25,26] and which can lead to disparate outcomes regarding decision-making (from full willingness to make decisions to preferred delegation) [27]. Understanding migrants and ethnic minorities' experiences with and preferred forms of involvement is crucial for imbuing guidelines and policies with sensitivity to diversity [28][29][30], implementing care centred on people's needs, values and preferences [31][32][33] and avoiding the reproduction of inequalities through promotion of inadequate or undesired participation [34,35]. This paper aims to synthesise existing knowledge about migrant and ethnic minority involvement in maternal care by providing a narrative review of empirical studies on this issue.…”

Scope and Limitations of Municipal Health Councils: A Case Study

“…In this way, the institutionalization of participation mechanisms can become an instrument for maintaining power relations in society, since the more structured are consistently favored. There is, therefore, a risk that participation will favor those who are better educated and wealthier (De Freitas & Martin, ), thereby reinforcing existing patterns of social exclusion (Montesanti, Abelson, Lavis, & Dunn, ; Serapioni, ). This situation has been described by Fredriksson and Tritter (, p. 103) as a paradox, in which “increasing opportunities of participation may increase the overrepresentation of the already well represented.”…”

Chronic pain as a human rights issue: setting an agenda for preventative action

“…Case studies are particularly helpful in giving rich information about issues which may be used for future research and for setting agendas for future, larger-scale studies [12,13]. For the current research, the case-study approach outlined by Kaminer et al [14] in their work on continuous traumatic stress in South Africa was followed.…”

“…A key feature of their approach to case studies is the careful attention not only to the personal context of health issues but also to the political context. It is also essential in case studies on health issues which comment on health-system organisational factors to attend closely to the health-system context in which illness is experienced and treated [11,13,15]. Stake [16] has produced a detailed checklist on issues of quality in case-study research, and this checklist was followed in writing the present case study.…”