Designing a Model for Participatory Health Policy at the Local Level

Abstract

Background. Today, the participation of local levels in the health policy process is emphasized, which can be used as a means to more appropriately solve the problems of local communities and support the health system in achieving its goals. This study aimed to design a health policy model based on participation at the local level. Methods. This multi-method study was conducted to design a model for participation in health policymaking at the local level during three phases of systematic review, semi-structured in-depth interview, and Delphi technique. The purpose of the systematic review was to identify the factors affecting this participation, which was done by searching for suitable keywords in English and Persian databases. The objective of the qualitative phase was to identify the barriers and facilitators of participation. To this end, 16 people were selected by purposive sampling method and semi-structured interviews were conducted. The elements and components of the initial model were provided to experts in this field through the Delphi technique to confirm the items and validate them, so that the final model could be designed. Results. The influential factors for participation included individual, environmental, and contextual factors, which were identified from a systematic review of 21 articles. Facilitators obstacles, challenges, advantages, and disadvantages of local level participation in the policymaking process were identified through the results of a qualitative study, which were categorized into three main themes, including the participation process, the beneficiaries of the process, and the strategies to facilitate participation. Finally, the health policy model based on participation at the city level was validated and finalized using the opinion of experts. Conclusion. Participation in the health policy process requires the use of facilitators and the removal of obstacles. Local levels in terms of health issues in Iran involve complex and diverse challenges that can be solved through real participation.