Abstract
BackgroundCommunity participation in primary care is enshrined in international and Irish health policy. However, there is a lack of evidence about how stakeholders work collectively to implement community participation within interdisciplinary teams; community perspectives are rarely captured, and a theoretical underpinning for implementation of community participation in primary care is absent.ObjectiveTo conduct a theoretically informed, multiperspectival empirical analysis of the implementation of community participation via primary care teams (PCTs) in Ireland.Methods/Design/ParticipantsParticipatory learning and action (PLA) focus groups and interviews were held with 39 participants across four case study sites within a nationally funded programme designed to enable disadvantaged communities to participate in primary care. Normalization process theory (NPT) informed data generation and analysis of how diverse stakeholder groups worked together to implement community participation via PCTs.ResultsThe various stakeholders had a shared understanding of the value of community participation on PCTs. Motivations to get involved in this work varied, but were strong overall. Challenges to enacting community participation on PCTs included problems with the functioning of PCTs and a lack of clarity and confidence in the role of community representatives at PCT meetings. Informal appraisals were positive, but formal appraisal was limited.Discussion and ConclusionThe implementation and sustainability of community participation on PCTs in Ireland will be limited unless (i) the functioning of PCTs is strong, (ii) there is increased confidence and clarity on community representatives’ roles among all health‐care professionals, and (iii) more sophisticated methods for formal appraisal are used.
Highlights
This study focuses on the implementation of community participation on primary care teams (PCTs)
Reflexive Monitoring: Can stakeholders formally or informally appraise the impact of community participation on PCTs? Where reflexive monitoring is strong there is agreement that the work has resulted in benefits for individual and wider community, there are clear evaluation mechanisms in place and there is a shared understanding about what changes are required in structures to sustain and embed the work
Data analysis for this study focused on data pertaining to community participation on PCTs and was led by ET
Summary
Community participation in primary care has its origins in the Alma- Ata Declaration of 1978, which stated that “people have the right and duty to participate individually and collectively in the planning and implementation of their health care.” It is defined as:. We focus on collective participation in primary care, which can overcome the reductive individualistic approach to health-care participation[20] and create a more efficient and effective health-care system.[23,24,25,26,27] It has been shown to enhance the delivery and uptake of health interventions to address health inequalities,[28,29,30,31,32] and increase community cohesion and leadership.[31,32,33,34] Despite this international policy context and efforts to implement community participation in primary care, there are major gaps in our understanding of its purpose, processes and outcomes.[32] There are limited data across the multiplicity of stakeholder perspectives on implementing community participation in primary care in practice, and community perspectives are rarely captured.[27] there is a lack of evidence for how the various stakeholders work together in a primary care setting to implement community participation within interdisciplinary teams. This study focuses on the implementation of community participation on PCTs
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