社区参与被视为以公民为中心和可持续医疗保健系统的关键,因为公民参与设计,服务和政策的实施和改进被认为是为了更紧密地适应社区自身的需求和经验。组织一直在努力接触并让处境不利的公民参与进来。本文研究了如果,为什么,当低收入公民希望参与其中时。
对于这个定性的现实主义案例研究,在两个荷兰城市对(20)低收入公民进行了19次采访(一次)。此外,与由专业人员和公民组成的参考小组讨论了结果,以丰富结果并确保结果具有正面有效性。
结果显示了低收入公民希望参与的四种不同方式:(a)以实际/自愿的方式;(b)作为伙伴;(c)作为非专业专家;(d)根本不参与。影响公民的兴趣和参与能力的因素包括公民自己对他们获得的服务的体验和个人情况,例如他们的精神或身体健康,金融危机的程度,家庭情况,家庭环境。目前没有受访者参与,但是所有人都有改善健康(护理)服务和政策的想法。公民对他们访问的服务的体验是一些人参与其中的动力,因为他们希望确保其他人不会有同样的挣扎,而对于其他人来说,他们自己的需求和冷漠的系统仍然是一个太高的障碍。为了能够参与,公民需要继续支持自己的健康(护理)和财务状况,更好的沟通和服务的可访问性,实际支持(例如,训练和公共汽车通行证)和对其输入的识别(例如,货币补偿)。
研究表明,公民对所获得服务的体验会影响他们是否以及如何参与健康和护理服务。尽管所有与会者都有改善服务和政策的坚实想法,他们受到官僚主义的阻碍,非个人和无法访问的系统。组织似乎低估了接触低收入公民所需的投资以及确保他们参与所需的支持。
公民和PPI组织是参考小组的成员,他们帮助制定了研究问题和招聘策略。当地参考小组还有助于解释和完善初步发现。
Community engagement is seen as key to citizen-centred and sustainable healthcare systems as involving citizens in the designing, implementation and improvement of services and policies is thought to tailor these more closely to communities\' own needs and experiences. Organizations have struggled to reach out to and involve disadvantaged citizens. This paper examines how if, why, and when low-income citizens wish to be involved.
For this qualitative realist
case-study, 19 interviews (one dyad) were held with (20) low-income citizens in two Dutch municipalities. Additionally, the results were discussed with a reference panel consisting of professionals and citizens to enrich the results and to ensure the results had face validity.
The results showed four different ways in which low-income citizens wished to be involved: (a) in a practical/volunteer way; (b) as a buddy; (c) as a lay expert; (d) not involved at all. The factors affecting citizens\' interest and capacity to participate include citizens\' own experiences of the services they access and their personal situations, e.g. their mental or physical health, extent of financial crisis, family situation, home environment. None of the interviewees was currently involved, but all had ideas for improving health(care) services and policies. Citizens\' experiences of the services they accessed acted as a motivator for some to be involved as they wanted to ensure others would not have the same struggles, while for others their own needs and an apathetic system remained too high a barrier. To enable involvement, citizens need continued support for their own health(care) and financial situation, better communication and accessibility from services, practical support (e.g., training and bus passes) and recognition for their input (e.g., monetary compensation).
The study shows that citizens\' experiences of the services they accessed influenced if and how they wanted to be involved with health and care services. Despite the fact that all participants had shared solid ideas for improving services and policies, they were hindered by a bureaucratic, impersonal and inaccessible system. Organizations seem to underestimate the required investments to reach out to low-income citizens and the support required to ensure their involvement.
Citizens as well as PPI organizations were members of the reference panel who helped formulate the research questions and recruitment strategy. The local reference panel also helped to interpret and refine the initial findings.