Community participation to design rural primary healthcare services

BMC Health Services Research

Amy Nimegeer²  Jane Farmer¹ 

[1] La Trobe Rural Health School, La Trobe University, Bendigo, Victoria 3552, Australia;School of Nursing, Midwifery and Health, University of Stirling, Stirling FK9 4LA, Scotland

关键词: Population health planning;    Co-production;    Community engagement;    Healthcare reform;    Rural health;    Primary health care;    Community participation;   

Others  :  1133231
DOI  :  10.1186/1472-6963-14-130

 received in 2013-08-12, accepted in 2014-03-13,  发布年份 2014

【 摘 要 】

Background

This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services.

Methods

Community-based participatory action research was applied in four Scottish case study communities in 2008–10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented.

Results

Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation.

Conclusions

Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions.

【 授权许可】

   
2014 Farmer and Nimegeer; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Harvey D: A Brief History of Neoliberalism. Oxford UK: Oxford University Press; 2005.
• [2]Organisations for Economic Co-operation and Development: The New Rural Paradigm: Policies and Governance. Paris: OECD Publishing; 2006.
• [3]Wakerman J, Humphreys J, Wells R, Kuipers P, Entwistle P, Jones J: Primary health care delivery models in rural and remote Australia - a systematic review. BMC Health Serv Res 2008, 8:276. BioMed Central Full Text
• [4]McGrail M, Humphreys J: The index of rural access: an innovative integrated approach for measuring primary care access. BMC Health Serv Res 2009, 9:124. BioMed Central Full Text
• [5]Segal L, Leach M: An evidence-based health workforce model for primary and community care. Implement Sci 2011, 93(6):1-8.
• [6]Keleher H: Population health planning for health equity. Aust J Prim Health 2011, 17(4):327-333.
• [7]United States Senate: 111th Congress Session: Patient Protection and Affordable Care Act. (2009). Washington: United States Senate; 2010.
• [8]Australian Government Department of Health & Ageing: Improving Primary Health Care for All Australians. Canberra: Commonwealth of Australia; 2011.
• [9]Primary Health Care Research and Information Service (PHCRIS): Regionally-based needs assessment in Australian primary health care. PHC RIS Policy Issue Rev 2011. http://dspace.flinders.edu.au/xmlui/handle/2328/26599 webcite
• [10]Nimegeer A, Farmer J, West C, Whiston S, Heaney D: Remote Service Futures: health care service design with communities. Inverness: Centre for Rural Health; 2010.
• [11]Scottish Government: Urban Rural Classification 2011–12. Edinburgh: Scottish Government; 2010.
• [12]Wakerman J: Defining remote health. Aust J Rural Health 2004, 12(5):210-214.
• [13]Steel D, Cylus J: Scotland: health system review. Health Syst Transit 2012, 14(9):1-150.
• [14]Matsumoto M, Inoue K, Farmer J, Inada H, Kajii E: Geographic distribution of primary care physicians in Japan and Britain. Health Place 2009, 16:164-166.
• [15]O’Neill NP, Godden DJ: Stroke outcomes in Northern Scotland: does rurality really matter? Rural Remote Health 2003, 3:243.
• [16]Godden D, Heaney D, Farmer J: Contemporary issues in Scottish rural health care. Health Rural Dig 2007., 12
• [17]Farmer J, Iversen L, Baird G: Rural deprivation: reflecting reality. Br J Gen Pract 2001, 51:486-491.
• [18]Humphreys J, Wakerman J: Primary health care in rural and remote Australia: achieving equity of access and outcomes through national reform: a discussion paper. 2009. http://arrow.monash.edu.au/hdl/1959.1/205476 webcite
• [19]Scottish Government: Delivering for remote and rural healthcare. Final Report of the Remote and Rural Workstream. Edinburgh: Scottish Government; 2008.
• [20]Katterl R, Jackson Bowers E, Hagger C, Bywood P: Regionally based needs assessment in Australian primary health care. Adelaide: PHCRIS; 2011.
• [21]Taylor J, Wilkinson D, Cheers B: Is it consumer or community participation? Examining the links between ‘community’ and ‘participation’. Health Soc Rev 2006, 15(1):38-47.
• [22]Rifkin SB: Rapid rural appraisal: its use and value for health planners and managers. Publ Admin 1996, 74:509-526.
• [23]Laverack G: Health promotion practice: building empowered communities. Maidenhead: Open University Press; 2007:22.
• [24]Alford J: Engaging public sector clients: from service-delivery to co-production. London: Palgrave MacMillan; 2009. Ch.2 Clients in the Public Sector pp.30-49
• [25]Government S: Better health, better care: action plan. Edinburgh: Scottish Government; 2007.
• [26]Rowe G, Frewer LJ: A typology of public engagement mechanisms. Sci Technol Hum Values 2005, 30(2):251-290.
• [27]Milton B, Attree P, French B, Povall S, Whitehead M, Popay J: The impact of community engagement on health and social outcomes: a systematic review. Commun Dev J 2011, 47(3):316-334.
• [28]Herbert-Cheshire L: Contemporary strategies for rural community development in Australia: a governmentality perspective. J Rural Stud 2000, 16:203-215.
• [29]Hofferth SL, Iceland J: Social capital in rural and urban communities. Rural Soc 1998, 63(4):574-598.
• [30]Woolvin M: Mapping the Third Sector in Rural Scotland: an initial review of the literature. Scottish Government: Edinburgh; 2012.
• [31]Head BW: Community engagement: participation on whose terms? Aust J Pol Sci 2007, 42(3):441-454.
• [32]Wakerman J, Humphreys JS, Wells R, Kuipers P, Jones J, Entwistle P, Kinsman L: Features of effective primary health care models in rural and remote Australia: a case-study analysis. Med J Aust 2009, 191(2):88-91.
• [33]Minkler M: Community-based research partnerships: challenges and opportunities. J Urban Health 2005, 82(2):3-12.
• [34]Lewin K: Action research and minority problems. J Social Issues 1946, 2(4):34-46.
• [35]McTaggart R: Sixteen tenets of participatory action research. In Everyday evaluation on the run. Edited by Wadsworth Y. Sydney, Australia: Allen & Unwin; 1997:79.
• [36]Cohen AP: The Symbolic Construction of Community. London: Routledge; 1985.
• [37]Scottish Agricultural College: Rural Scotland in Focus. Edinburgh: SAC; 2012.
• [38]Nimegeer A, Farmer J, West C, Currie M: Addressing the problem of rural community engagement in healthcare service design. Health Place 2011, 17:1004-1006.
• [39]World Health Organization: Preamble to the Constitution of the World Health Organization. New York: United Nations; 1946.
• [40]Radford K, Shortall S: Socially enterprising communities: their dynamics and readiness for service innovation. Ch. 5. In Community co-production: social enterprise in remote and rural areas. Edited by Farmer J, Hill C, Muñoz S-A. Northampton MA: Edward Elgar; 2012:93-109.
• [41]Portes A: Social capital: its origins and applications in modern sociology. Ann Rev Soc 1998, 24:1-24.
• [42]Farmer J, West C, Whyte B, Maclean M: Primary healthcare teams as adaptive organisations: exploring and explaining work variation using case studies in rural and urban Scotland. Health Serv Manage Res 2005, 18:151-164.
• [43]Hayward C, Simpson L, Wood L: Still left out in the cold: problematising participatory research and development. Soc Rural 2004, 44(1):95-108.
• [44]Renn O, Webler T, Rakel H, Dienel P, Johnson B: Public participation in decision making: a three-step procedure. Policy Sci 1993, 26:189-214.
• [45]Hanlon N, Halseth G: The greying of resource communities in northern British Columbia: implications for health care delivery in already‒underserviced communities. Can Geogr 2005, 49:1-24.
• [46]Commission H: The role and management of community first responders: findings from a national survey of NHS ambulance services in England. London: Commission for Healthcare Audit and Inspection; 2007.
• [47]Prior M, Farmer J, Godden DJ, Taylor J: More than health: the added value of health care to rural communities in Scotland and Australia. Health Place 2010, 16:1136-1144.
• [48]Australian Government Department of Health and Ageing: Rural primary health services program. 2010. http://www.ntml.org.au/sites/default/files/Tenders/PHI%20Operational%20Guidelines%205%20March%202010.pdf webcite [accessed 23/3/2014]
• [49]MacKinnon D, Derickson KD: From resilience to resourcefulness. Prog Hum Geogr 2013, 37(2):253-270.
• [50]Kearns RA, Joseph AE: Restructuring health and rural communities in New Zealand. Prog Hum Geogr 1997, 21(1):18-32.
• [51]Thomson E, Farmer J, Tucker J: Informing debate or fuelling dispute? Media communication of reconfiguration in Scotland’s rural maternity care. Soc Policy Admin 2008, 42(7):789-812.
• [52]Tritter JQ, McCallum A: The snakes and ladders of user involvement: moving beyond Arnstein. Health Policy 2006, 76(2):156-168.