Abstract：
BACKGROUND: Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider-led initiatives to gain community input, raising concerns about power imbalances inherent in invited forms of participation. This paper provides an alternate view, exploring how, in a period following reforms, community actors forge network alliances to (re)gain legitimacy and capacities to coproduce health services with system providers.
METHODS: A longitudinal case study traced the network-building efforts over 3 years of a working group formed by citizens and community actors working with seniors, minorities, recent immigrants, youth and people with disabilities. The group came together over concerns about reforms that impacted access to health services and the ability of community groups to mediate access for vulnerable community residents. Data were collected from observation of the group\'s meetings and activities, documents circulated within and by the group, and semi-directed interviews. The first stage of analysis used social network mapping to reveal the network development achieved by the working group; a second traced network maturation, based on actor-network theory.
RESULTS: Network mapping revealed how the working group mobilized existing links and created new links with health system actors to explore access issues. Problematization appeared as an especially important stage in network development in the context of reforms that disrupted existing collaborative relationships and introduced new structures and processes.
CONCLUSIONS: Network-building strategies enable community actors to enhance their capacity for coproduction. A key contribution lies in the creation of \'organizational infrastructure\'.
UNASSIGNED: The lead researcher was embedded over 3 years in the activities of the community groups and community residents. Several group members provided comments on an initial draft of this paper. To preserve the anonymity of the group, their names do not appear in the acknowledgements section.
METHODS: A longitudinal case study traced the network-building efforts over 3 years of a working group formed by citizens and community actors working with seniors, minorities, recent immigrants, youth and people with disabilities. The group came together over concerns about reforms that impacted access to health services and the ability of community groups to mediate access for vulnerable community residents. Data were collected from observation of the group\'s meetings and activities, documents circulated within and by the group, and semi-directed interviews. The first stage of analysis used social network mapping to reveal the network development achieved by the working group; a second traced network maturation, based on actor-network theory.
RESULTS: Network mapping revealed how the working group mobilized existing links and created new links with health system actors to explore access issues. Problematization appeared as an especially important stage in network development in the context of reforms that disrupted existing collaborative relationships and introduced new structures and processes.
CONCLUSIONS: Network-building strategies enable community actors to enhance their capacity for coproduction. A key contribution lies in the creation of \'organizational infrastructure\'.
UNASSIGNED: The lead researcher was embedded over 3 years in the activities of the community groups and community residents. Several group members provided comments on an initial draft of this paper. To preserve the anonymity of the group, their names do not appear in the acknowledgements section.
摘要：
背景：响应，综合和可持续的卫生系统要求社区在服务设计和提供中发挥积极作用。当前的许多文献都集中在提供者主导的举措上，以获得社区投入，引起人们对邀请参与形式固有的权力失衡的担忧。本文提供了另一种观点，探索如何，在改革后的一段时间里，社区行为者建立网络联盟，以（重新）获得与系统提供者共同生产卫生服务的合法性和能力。
方法：一项纵向案例研究追踪了由公民和社区行为者与老年人合作组成的工作组在3年中的网络建设工作。少数民族,最近的移民,青年和残疾人。该小组聚集在一起，担心改革会影响获得医疗服务的机会，以及社区团体调解弱势社区居民获得医疗服务的能力。数据来自对小组会议和活动的观察，在小组内部和由小组分发的文件，半定向采访。第一阶段分析使用社交网络映射来揭示工作组实现的网络发展；第二阶段跟踪网络成熟，基于行动者网络理论。
结果：网络映射揭示了工作组如何调动现有链接并与卫生系统参与者建立新链接以探索访问问题。在破坏现有合作关系并引入新结构和流程的改革背景下，问题化似乎是网络发展中一个特别重要的阶段。
结论：网络建设战略使社区行为者能够提高其联合生产能力。关键贡献在于创建“组织基础架构”。
UNASSIGNED：首席研究员参与社区团体和社区居民的活动超过3年。一些小组成员对本文的初稿提出了意见。为了保持团体的匿名性，他们的名字不会出现在确认部分。
方法：一项纵向案例研究追踪了由公民和社区行为者与老年人合作组成的工作组在3年中的网络建设工作。少数民族,最近的移民,青年和残疾人。该小组聚集在一起，担心改革会影响获得医疗服务的机会，以及社区团体调解弱势社区居民获得医疗服务的能力。数据来自对小组会议和活动的观察，在小组内部和由小组分发的文件，半定向采访。第一阶段分析使用社交网络映射来揭示工作组实现的网络发展；第二阶段跟踪网络成熟，基于行动者网络理论。
结果：网络映射揭示了工作组如何调动现有链接并与卫生系统参与者建立新链接以探索访问问题。在破坏现有合作关系并引入新结构和流程的改革背景下，问题化似乎是网络发展中一个特别重要的阶段。
结论：网络建设战略使社区行为者能够提高其联合生产能力。关键贡献在于创建“组织基础架构”。
UNASSIGNED：首席研究员参与社区团体和社区居民的活动超过3年。一些小组成员对本文的初稿提出了意见。为了保持团体的匿名性，他们的名字不会出现在确认部分。
