Community participation in rural primary health care: intervention or approach?

Preston, Robyn; Waugh, Hilary; Larkins, Sarah; Taylor, Judy

doi:10.1071/py09053

Cited by 73 publications

(89 citation statements)

References 26 publications

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“…By uncovering an underlying mechanism from the field of health policy, and proposing the possible mechanisms derived from various disciplines, advocates and healthcare practitioners can better understand how to optimally involve the public in health policy and program planning. This could encourage the use of public participation in health policy-making by dispelling the prevailing scepticism surrounding its value -a scepticism due to the dearth of evidence supporting its effectiveness (Draper et al 2010;Preston et al 2010), and the claim by several health practitioners and policymakers that it is time-consuming and costly (Foley and Martin 2000).…”

Section: The Concept Of Public Participation Effectivenessmentioning

confidence: 99%

Understanding the factors that make public participation effective in health policy and planning: a realist synthesis

Pagatpatan

Ward

2017

Aust. J. Prim. Health

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Abstract. Although researchers argue for the importance of involving the public in developing health policy, there has been little focus on central research questions -such as what techniques of public participation work, in what circumstances, and why. This paper presents a realist synthesis which identifies and explains the underlying mechanisms and specific contextual factors that lead to effective public participation in health policy and planning. Peer-reviewed, English language literature was searched, which resulted in 77 articles for review and synthesis. This synthesis uncovered the underlying mechanism of 'political commitment' that generates public participation effectiveness. The other three possible underlying mechanisms, namely: 'partnership synergy', 'inclusiveness' and 'deliberativeness', were found to potentially provide further explanation on public participation effectiveness for health policy and planning. The findings of this review provide evidence that can be useful to health practitioners and decision-makers to actively involve the public when drafting public health policies and programs and, more importantly, guide them in deciding which strategies to best employ for which contexts.

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Section: The Concept Of Public Participation Effectivenessmentioning

confidence: 99%

Understanding the factors that make public participation effective in health policy and planning: a realist synthesis

Pagatpatan

Ward

2017

Aust. J. Prim. Health

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“…[61][62][63] The research team concluded that attempting to 'type' NDC approaches to CE by focusing primarily on engagement activities and their immediate goals (as these typologies tend to do) was likely to be problematic given the complexity of CE in a regeneration programme such as NDC. We felt that it was important to include other potentially salient issues, particularly dimensions of local relationships that have been identified as important factors shaping engagement processes in NDC areas, such as trust and tension between communities and public agencies, 64,65 and between different community groups.…”

Section: Developing a Typology Of New Deal For Communities Approachesmentioning

confidence: 99%

The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation

et al. 2015

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BackgroundThis study was set in 39 neighbourhoods involved in a government-funded regeneration programme called New Deal for Communities (NDC) that began in 1998. We tested whether or not different approaches to engage residents in decision-making in these areas had different social and health impacts.MethodsFirst, NDC approaches to community engagement (CE) were grouped into four types. We then assessed the impact of these types and whether or not their cost-effectiveness could be calculated. We used existing data from surveys and from NHS and government sources. New data were collected from interviews with residents of NDC areas and former staff. We have also made these data publicly available so that other researchers can assess impacts over a longer time period.ResultsThe four CE types included an empowering resident-led approach (type A), in which residents had a lot of control over decisions, and an instrumental professional-led approach (type D), in which CE was more often used to promote the priorities of public sector organisations. Type B was initially empowering but over time became instrumental and type C balanced empowerment and instrumental approaches from the beginning. There were few statistically significant differences in health and social impacts by CE type. However, when there were statistically significant differences, the results suggest that type A, and to a lesser extent, types B and C approaches may have had better outcomes than the type D approach in relation to levels of participation and trust between residents, control or influence over decisions, social cohesion and mental health. NDC areas with a type D approach were the only ones where residents’ ‘sense of control’ deteriorated over time. Residents of these areas were less likely to feel that the NDC had improved their area and to experience improvements in mental health. However, some aspects of cohesion and trust improved in type D areas. The findings of our economic analyses are mixed. It was difficult to cost engagement activities, measures of effectiveness were not robust and relating costs that could be calculated to specific measures of effectiveness was difficult. There were almost as many negative as positive scores, making the calculation of cost-effectiveness an arbitrary exercise.ConclusionsOur results are consistent with a theory that the greater the levels of control that residents have over decisions affecting their lives the more likely there are to be positive impacts. It is plausible that an empowerment approach to CE would help build trust and community cohesion, and that having a greater influence over NDC decisions could lead to more people feeling that the NDC initiative had improved an area. Conversely, our results are also consistent with a theoretical position which suggests that instrumental approaches, which try to engage residents in agendas that are not theirs, will have relatively little positive impact and that community cohesion and well-being may be undermined. The study has not produced firm evidence on the effectiveness of different approaches to CE. However, the findings do suggest that programmes involving CE will be more likely to have positive impacts if the approaches to CE are experienced as more empowering and less instrumental (i.e. less focused on the agendas of external agencies). Future methodological research is needed to develop better measures of empowerment at the collective level and more robust approaches to empowerment on health and well-being at the population level.FundingThe National Institute for Health Research Public Health Research programme.

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“…The activities, albeit in various combinations, are also evident across projects presented in a recent review of empirical studies in the literature linking community participation and health outcomes (Preston et al, 2010).…”

Section: Project Activities Across the Joint Initiativementioning

confidence: 98%

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

McEvoy

MacFarlane

2012

Prim Health Care Res Dev

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There are now several decades of history of community participation in health, with significant international evidence to suggest that there is much to be gained by primary health services and disadvantaged communities working in partnership. In this paper we provide an overview of community participation in primary care, establishing the policy context in which a recent 'Joint Initiative on Community Participation in Primary Health Care' was developed in Ireland. This Initiative was designed to support the involvement of disadvantaged communities and groups in the development of primary health care services at local level. An independent formative evaluation of the Joint Initiative took place between September 2009 and April 2010. We present a summary of key findings from this evaluation. We pay particular attention to the issue of sustaining community participation in newly developed Primary Care Teams (PCTs) in the current and changing economic climate, an issue considered crucial if the documented positive impacts of the Joint Initiative are to be maintained and the potential for health gains in the longer term are to be realised. We then argue that the Joint Initiative referred to in this paper clearly provides a strong prototype for community participation in PCTs in Ireland. We also ask whether it can be replicated across all PCTs in the country and embedded as a core part of thinking and everyday health care. We highlight the need for research to build knowledge about the ways in which innovations such as this can be embedded into ongoing, routine healthcare practice. This research agenda will have relevance for policy makers, practitioners and evaluators in Ireland and other healthcare jurisdictions.

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Community participation in rural primary health care: intervention or approach?

Cited by 73 publications

References 26 publications

Understanding the factors that make public participation effective in health policy and planning: a realist synthesis

Understanding the factors that make public participation effective in health policy and planning: a realist synthesis

The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation

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

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