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

Abstract

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.

COVID-19: Public and patient involvement, now more than ever

“…In Ireland, the Health Research Board (HRB) has been at the fore of promoting PPI in research and with the Irish Research Council, in 2017 launched a joint call entitled PPI Ignite, to support higher education institutions to embed PPI into their organisational structures. The use of different PPI approaches is increasingly evident in research in Ireland ( Dwyer et al , 2020 ; Ní Shé et al , 2019 ; O’Hara et al , 2017 ; O’Shea et al , 2019 ; Tierney et al , 2018 ; Walsh et al , 2018 ).…”

‘Participation is integral’: understanding the levers and barriers to the implementation of community participation in primary healthcare: a qualitative study using normalisation process theory

“…In both the interviews and focus groups sessions, as shown in Table 7, Participatory Learning and Action (PLA) research techniques were used to stimulate data generation [38, 39]. These techniques have been previously used in PHC and have inherent visual and analytical properties that support generation and co-analysis of data with stakeholders [19, 40–42]. Table 7 provides a general description of each technique and an example of how it was incorporated into interviews and focus groups.…”

“…Eccles et al [18] have further argued that we need to see greater use of theoretical approaches in research focused on implementation, on the basis that this will offer (i) frameworks that are generalisable and that can be applied across different settings and individuals, (ii) an opportunity to build knowledge in an incremental manner and (iii) enhanced and more explicit analysis by virtue of using theoretical frameworks. While theory has been used to investigate implementation of community participation on interdisciplinary teams [19] there is, a lack of theoretically informed implementation research in the field of community participation in PHC.…”

Optimising individual and community involvement in health decision-making in general practice consultations and primary care settings: A way forward

“…First, the idea of individual and community involvement in health decision-making needs to make sense to general practitioners so they can see its value and ‘buy into’ it. General practitioners sometimes struggle with ‘newer’ ideas and imperatives such as community participation and PPI [ 23 , 26 ]. Therefore, it is worth emphasising that shared decision-making, community participation and PPI are all underpinned by the same focus on patients/people as experts.…”

“…Second, involving individuals in shared decision-making and communities in health decision-making about services and research takes time and resources . Such interactions require discussion and deliberative thinking [ 4 , 23 , 25 , 26 ]. This is a serious challenge in the context of under-resourced services in the community [ 27 ].…”