Community participation in primary care in Ireland: the need for implementation research

McEvoy, Rachel; MacFarlane, Anne

doi:10.1017/s1463423612000163

Cited by 10 publications

(16 citation statements)

References 25 publications

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“…Only six papers included a definition of service user involvement . All six definitions focused on the notion of SUI as involving partnership, collaboration, and notions of ownership and empowerment for service users.…”

Section: Resultsmentioning

confidence: 99%

“…Only six papers included a definition of service user involvement. [33][34][35][36][37][38] All six definitions focused on the notion of SUI as involving partnership, collaboration, and notions of ownership and empowerment for service users. Thus, we inferred that in each case, the researchers were indicating strong aspirations for meaningful service user involvement.…”

Section: Definitionmentioning

confidence: 99%

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A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory

Tierney

McEvoy

Brún

et al. 2014

Health Expectations

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BackgroundThere have been recent important advances in conceptualizing and operationalizing involvement in health research and health‐care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine – normalized – way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization – definition, enrolment, enactment and appraisal.MethodOurs was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory.FindingsTwenty‐six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co‐governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals.ConclusionTo improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co‐governance and dissemination of research processes and findings.

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Section: Resultsmentioning

confidence: 99%

Section: Definitionmentioning

confidence: 99%

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory

Tierney

McEvoy

Brún

et al. 2014

Health Expectations

Self Cite

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“…The participation of ‘lay’ people (consumers, the public and communities) in aspects of health service production is recommended in policy internationally (Australian Commission on Safety & Quality in Health Care [ 1 , 2 ]), and increasingly enacted. Lay participation can be in designing and planning services, evaluating, strategizing and governance [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods

Farmer

Carlisle

Dickson‐Swift

et al. 2018

BMC Health Serv Res

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BackgroundCitizen participation in health service co-production is increasingly enacted. A reason for engaging community members is to co-design services that are locally-appropriate and harness local assets. To date, much literature examines processes of involving participants, with little consideration of innovative services are designed, how innovations emerge, develop and whether they sustain or diffuse. This paper addresses this gap by examining co-designed initiatives through the lens of social innovation – a conceptualisation more attuned to analysing grassroots innovation than common health services research approaches considering top-down, technical innovations. This paper considers whether social innovation is a useful frame for examining co-designed services.MethodsEighty-eight volunteer community-based participants from six rural Australian communities were engaged using the same, tested co-design framework for a 12-month design and then 12-month implementation phase, in 24 workshops (2014–16). Mixed, qualitative data were collected and used to formulate five case studies of community co-designed innovations. A social innovation theory, derived from literature, was applied as an analytical frame to examine co-design cases at 3 stages: innovation growth, development and sustainability/diffusion.ResultsSocial innovation theory was found relevant in examining and understanding what occurred at each stage of innovation development. Innovations themselves were all adaptations of existing ideas. They emerged due to local participants combining knowledge from local context, own experiences and exemplars. External facilitation brought resources together. The project provided a protective niche in which pilot innovations developed, but they needed support from managers and/or policymakers to be implemented; and to be compatible with existing health system practices. For innovations to move to sustainability/diffusion required political relationships. Challenging existing practice without these was problematical.ConclusionsSocial innovation provides a useful lens to understand the grassroots innovation process implied in community participation in service co-design. It helps to show problems in co-design processes and highlights the need for strong partnerships and advocacy beyond the immediate community for new ideas to thrive. Regional commissioning organisations are intended to diffuse useful, co-designed service innovations. Efforts are required to develop an innovation system to realise the potential of community involvement in co-design.

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“…Although theory has been used to understand how far patient and public involvement (PPI) was embedded within health‐care research in certain areas, there has been no use of theory to study community participation in practice despite the call for theoretically informed, empirical analysis of implementation to generate insights and transferrable lessons for community participation in primary care across settings . This is a priority for research, policy and practice …”

Section: Introductionmentioning

confidence: 99%

“…Despite this, and other interim measures such as the national strategy for service user involvement, involvement of patients and communities in the development and running of PCTs is not routine practice across the country, is hard to achieve, and is generally not regarded by service providers as an important resource for PCTs . Therefore, the aforementioned gaps in international literature are also relevant to the Irish context…”

Section: Introductionmentioning

confidence: 99%

Implementing community participation via interdisciplinary teams in primary care: An Irish case study in practice

Tierney

McEvoy

Hannigan

et al. 2018

Health Expectations

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BackgroundCommunity participation in primary care is enshrined in international and Irish health policy. However, there is a lack of evidence about how stakeholders work collectively to implement community participation within interdisciplinary teams; community perspectives are rarely captured, and a theoretical underpinning for implementation of community participation in primary care is absent.ObjectiveTo conduct a theoretically informed, multiperspectival empirical analysis of the implementation of community participation via primary care teams (PCTs) in Ireland.Methods/Design/ParticipantsParticipatory learning and action (PLA) focus groups and interviews were held with 39 participants across four case study sites within a nationally funded programme designed to enable disadvantaged communities to participate in primary care. Normalization process theory (NPT) informed data generation and analysis of how diverse stakeholder groups worked together to implement community participation via PCTs.ResultsThe various stakeholders had a shared understanding of the value of community participation on PCTs. Motivations to get involved in this work varied, but were strong overall. Challenges to enacting community participation on PCTs included problems with the functioning of PCTs and a lack of clarity and confidence in the role of community representatives at PCT meetings. Informal appraisals were positive, but formal appraisal was limited.Discussion and ConclusionThe implementation and sustainability of community participation on PCTs in Ireland will be limited unless (i) the functioning of PCTs is strong, (ii) there is increased confidence and clarity on community representatives’ roles among all health‐care professionals, and (iii) more sophisticated methods for formal appraisal are used.

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Community participation in primary care in Ireland: the need for implementation research

Cited by 10 publications

References 25 publications

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory

Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods

Implementing community participation via interdisciplinary teams in primary care: An Irish case study in practice

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