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

Abstract

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.

The case for a Torres Strait Islander‐driven, long‐term research agenda for environment, health and wellbeing

“…Research design incorporating participatory processes helps balance community values, knowledge and preferences with scientific dimensions, promotes ownership by those affected by a phenomenon and, importantly in Indigenous settings, can ensure democratic integrity in problem‐solving and policy implementation 18–20 . However, there is no consensus about what participation means and how it may be achieved 21,22 . Researchers discuss varying levels of participation, each level progressively increasing power sharing; these often overlook cultural variations to engagement and participation 23 .…”

Improving accountability in education: the importance of structured democratic voice

“…This suggests asymmetry in application where no approach is expected to be universally effective. A recent review by Pagatpatan and Ward (2017), focusing on decision making in health policy, highlights possible challenges when considering structured democratic voice. In their evaluation of 77 articles, they identify four factors that underlie the effectiveness of public participation: political commitment, partnership synergy, inclusiveness, and deliberativeness.…”

“…Synergy involves the ability of different groups to work together to reach a consensus. This can be difficult with a diverse group of stakeholders and requires a long-term relationship to build trust (Pagatpatan and Ward 2017). Recognizing group plurality while highlighting shared identity can help facilitate partnership synergy.…”

Reconceptualising community participation in primary health

“…In their study they challenge the emphasis on fiduciary responsibilities in boards and advisory committee's and reinforce the fundamental importance of participation by directors or advisory committee members who have strong understanding of health and community needs and who use this knowledge in decision making. Pagatpatan and Ward (2017) highlight that effective participation in policy making is characterised by political commitment, partnership synergy, inclusiveness and deliberativeness. There are examples of these factors in this special issue.…”

“…Pagatpatan and Ward (2017) describe their realist synthesis approach to critical analysis of the concept of 'effective' public participation, and they examine the factors that make public participation effective. In this article, questions are asked about the techniques of public participation and whether people must only engage in methods developed and driven by those in the health system.…”