背景:在患者和公众参与卫生服务研究领域,越来越多的运动不仅使患者参与研究,而且使他们成为知识的共同生产者。我们在农村围产期心理健康的案例研究中探索了这种共生研究关系,目的是根据社区合作伙伴的相关生活经验合作开发知识,和学术研究人员的系统知识。
方法:数据是通过社区论坛和随后对不列颠哥伦比亚省农村社会服务计划管理员的访谈收集的。加拿大。社区合作伙伴和学术研究人员使用主题分析原则分别对访谈进行了分析。从项目起源到数据收集,社区合作伙伴和学术研究人员都参与其中,分析,解释,和手稿写作。
结果:学术和社区研究人员确定的共同主题包括对同伴支持的需求,同行支持的障碍,以及精神卫生保健方面的差距。发散,学术研究人员专注于系统层面的挑战,而社区合作伙伴则强调了卫生系统中权力动态的影响。研究人员从共同生产的过程中产生了五个方法论价值命题,包括(a)相互尊重所有观点,(b)拒绝假定的等级制度,(c)对讲真话的承诺,(d)注意过程,(e)贡献的等值。
结论:联合生产突出了健康研究中生活经验的价值,把它放在与科学探究的对话中,并摆脱了通常嵌入传统医疗保健研究中的假定知识的层次结构。将学术研究人员和社区合作伙伴写入我们的论文反映了对保持生活经验的完整性和真实性的承诺,确认其作为知识来源的同等有效性,以及拒绝合格患者的声音。对这种联合生产研究关系的探索为考虑合作方法的未来研究团队奠定了基础。我们建议将共同生产的研究作为解决医疗保健研究中由于某些形式的知识特权而产生的认识论不公正的一种手段,以及对他人的排斥,即来自病人的经验。
联合生产是一种研究方法,社区合作伙伴和学术研究人员共同努力进行研究。我们的联合制作团队由社区合作伙伴组成,他们有在农村地区获得心理健康支持的生活经验,以及在卫生系统设计方面经验丰富的学术研究人员。共同生产强调生活经验的智慧和科学方法的重要性。出现的是既严谨又真实的研究。虽然这种形式的患者合作伙伴研究参与正在增长,很少有研究描述合作的过程。为了解决这个差距,我们提供了一个案例研究,该案例研究了大学研究人员如何与患者合作伙伴合作进行有关农村社区育龄人群心理健康服务的项目。团队在每一步都齐心协力,从最初的研究设计,接触参与者,审查数据,写论文。我们同意我们的方法将遵循尊重所有观点等原则,说实话,注意过程,并确保每个人的贡献得到同等重视。学术研究人员和社区合作伙伴确定了数据中的许多共同主题。社区合作伙伴还强调了医疗保健提供者不平等治疗的患者体验。学术研究人员集中在缺乏获得围产期心理健康支持的问题上。探索这样的观点差异可以对发现进行更丰富的解释。本案例研究为共同生产的价值以及生活经验在改善卫生系统中的重要作用提供了有用的见解。
BACKGROUND: Within the field of patient and public involvement in health service research, there is a growing movement towards not only involving patients in research but engaging them as co-producers of knowledge. We explore such a co-productive research relationship in a
case study on rural perinatal mental health, with the aim of collaboratively developing knowledge based on both the relevant lived experience of a community partner, and the systemic knowledge of academic researchers.
METHODS: Data was gathered through a community forum and subsequent interviews with social service program administrators from rural British Columbia, Canada. Interviews were analyzed separately by the community partner and academic researchers using principles of thematic analysis. Both the community partner and academic researchers were involved from project genesis to data collection, analysis, interpretation, and manuscript writing.
RESULTS: Common themes identified by the academic and community researchers included needs for peer support, barriers to peer support, and gaps in mental health care. Divergently, the academic researcher focused on systems-level challenges while the community partner emphasized the impact of power dynamics within health systems. Researchers generated five methodological values propositions from the process of co-production, including (a) mutual respect for all viewpoints, (b) a rejection of assumed hierarchy, (c) commitments to truth speaking, (d) attention to process, and (e) equivalence of contribution.
CONCLUSIONS: Co-production highlights the value of lived experience in health research, sets it in conversation with scientific inquiry, and moves away from hierarchies of assumed knowledge often embedded in traditional health care research. Incorporating both academic researcher and community partner writing into our paper reflects a commitment to maintaining the integrity and authenticity of lived experience, an affirmation of its equal validity as a source of knowledge, and a rejection of qualifying patient voices. The exploration of this co-production research relationship lays groundwork for future research teams considering collaborative methodology. We suggest co-productive research as a means of addressing the epistemic injustice that arises in health care research from the privileging of certain forms of knowledge, and the exclusion of others, namely that derived from patient experience.
Co-production is an approach to research where community partners and academic researchers work together to carry out a study. Our co-production team was made up of a community partner with lived experience of accessing mental health supports in rural areas, and academic researchers experienced in health systems design. Co-production emphasizes both the wisdom of lived experience and the importance of scientific approaches. What emerges is research that is both rigorous and authentic. While this form of patient partner research involvement is growing, few studies describe the process of collaboration. To address this gap, we present a
case study of how university researchers worked with a patient partner on a project about mental health services for childbearing people in rural communities. The team worked together at every step, from initial study design, to reaching out to participants, reviewing the data, and writing the paper. We agreed our approach would be guided by principles such as respect for all viewpoints, speaking truth, attention to the process, and ensuring that everyone’s contributions were given equal weight. The academic researchers and the community partner identified many common themes in the data. The community partner also emphasized patient experiences of unequal treatment by health care providers. The academic researchers focused on the lack of access to perinatal mental health supports. Exploring differences in perspectives like this allowed for richer interpretation of the findings. This
case study offers useful insight into the value of co-production and the important role of lived experience in improving health systems.