What can a participatory approach to evaluation contribute to the field of integrated care?

Abstract

Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care.

Unknown makes unloved—A case study on improving integrated health and social care in the Netherlands using a participatory approach

“…In line with the EIT and other models (Glasgow et al, ; Horowitz, Robinson, & Seifer, ; Jull, Giles, & Graham, ), the needs and priorities of local stakeholders were the starting point of the improvement process. This approach facilitated the establishment of partnerships between researchers and stakeholders, but also between stakeholders themselves, and it stimulated stakeholders to challenge their established mind‐set and views (Eyre et al, ; Martin Fortin & Moira, ). Theoretically, another key aspect of participatory research is that researchers and local stakeholders share decision‐making, ownership and accountability for the process (Blevins, Farmer, Edlund, Sullivan, & Kirchner, ; Horowitz et al, ; Jull et al, ; Viswanathan et al, ).…”

“…Change strategies, being iterative processes of implementation, evaluation and further refinement, require stakeholder involvement and continuous feedback on process and outcomes in order to learn from past experiences and thus to advance development (van Dongen et al, ; Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, ). Therefore, evaluations of integrated care should not only focus on interventions' outcomes, but also on the process through which such changes happen (Eyre, Farrelly, & Marshall, ; Greenhalgh et al, ; Manojlovich, Squires, Davies, & Graham, ). Participatory research designs, which are characterised by effective partnerships between researchers and local stakeholders and facilitate the development and implementation of locally relevant knowledge, can therefore add a valuable perspective to research on integrated care (Eyre et al, ; Glasgow, ).…”

“…Therefore, evaluations of integrated care should not only focus on interventions' outcomes, but also on the process through which such changes happen (Eyre, Farrelly, & Marshall, ; Greenhalgh et al, ; Manojlovich, Squires, Davies, & Graham, ). Participatory research designs, which are characterised by effective partnerships between researchers and local stakeholders and facilitate the development and implementation of locally relevant knowledge, can therefore add a valuable perspective to research on integrated care (Eyre et al, ; Glasgow, ).…”

Participatory approaches to evaluating integrated care: the vital role for client inclusion and participation

“…We read with interest Eyre and colleagues' publication ‘What can a participatory approach to evaluation contribute to the field of integrated care?’ published in BMJ Quality & Safety on 6 December 2016 1. We agree with many of the points they raised including the need to shift from proving efficacy to promoting real-world implementation of integrated care.…”

Authors' response: ‘What can a participatory approach to evaluation contribute to the field of integrated care?’

“…In our own evaluation of the Waltham Forest and East London integrated care programme,1 2 we worked collaboratively with organisational partners to develop the protocol and the priority focus areas for the evaluation as it progressed. Discussions included the issue of public and service user participation, but the steer was for the evaluation to focus initially on the translation of the integrated care programme from policy to practice, thereby focusing on management and front-line staff.…”