The use of citizens' juries in health policy decision-making: A systematic review

Abstract

Deliberative inclusive approaches, such as citizen juries, have been used to engage citizens on a range of issues in health care and public health. Researchers engaging with the public to inform policy and practice have adapted the citizen jury method in a variety of ways. The nature and impact of these adaptations has not been evaluated. We systematically searched Medline (PubMED), CINAHL and Scopus databases to identify deliberative inclusive methods, particularly citizens' juries and their adaptations, deployed in health research. Identified studies were evaluated focussing on principles associated with deliberative democracy: inclusivity, deliberation and active citizenship. We examined overall process, recruitment, evidence presentation, documentation and outputs in empirical studies, and the relationship of these elements to theoretical explications of deliberative inclusive methods. The search yielded 37 papers describing 66 citizens' juries. The review demonstrated that the citizens' jury model has been extensively adapted. Inclusivity has been operationalised with sampling strategies that aim to recruit representative juries, although these efforts have produced mixed results. Deliberation has been supported through use of steering committees and facilitators to promote fair interaction between jurors. Many juries were shorter duration than originally recommended, limiting opportunity for constructive dialogue. With respect to citizenship, few juries' rulings were considered by decision-making bodies thereby limiting transfer into policy and practice. Constraints in public policy process may preclude use of the 'ideal' citizens' jury with potential loss of an effective method for informed community engagement. Adapted citizens' jury models provide an alternative: however, this review demonstrates that special attention should be paid to recruitment, independent oversight, jury duration and moderation.

Which public and why deliberate? – A scoping review of public deliberation in public health and health policy research

“…Our findings confirm that public participation in deliberative forums is common in public health and health policy research and that Community or citizens' juries are the favored deliberative technique (Street et al, 2014). It is also clear that decision makers are seeking input from multiple publics on issues other than health priority setting.…”

“…It seems public health and health policy researchers may be attuned to this potential and constitute mixed publics in order to compare and combine different perspectives in deliberation. This adds to previous work by researchers including Street et al (2014) and Burgess (2014), who have observed that deliberative processes are more likely to influence public policy when decision-makers are directly involved as research collaborators. However, consistent with much of the critical literature on public engagement exercises, very few of these studies suggested how the information generated might be acted upon, or integrated into policy discussions.…”

“…In our introduction we noted the recent systematic review of the literature on citizens' juries by Street et al (2014). Implicit in Street and colleague's review was a contrast between biased and unbiased publics, and a commitment to the recruitment of unbiased publics as the only path to deliberative legitimacy.…”

“…Contra the role of consumers, citizens are expected to contribute legitimacy to policy discussions, and, potentially, greater consistency with democratic principles. This is the function of a public that Street et al (2014) focused on in their analysis.…”

“…The last decade has seen a convergence by healthcare and public health researchers on deliberative democracy methods as a means to bring people's opinions and values into health policy processes (Abelson et al, 2003;Street et al, 2014). Deliberative methods offer policymakers the promise of greater transparency and public accountability.…”