Community Participation In Primary Health Care Research Articles

Knowledge of health rights and community participation in primary care

Background/Aims Primary care providers are encouraged to promote community participation in care, so that patients are engaged in health priorities and solutions. This study assessed the level of knowledge regarding health rights and community participation in a town in Mizan-Aman, Ethiopia. Methods A community-based cross-sectional study design was used. A structured questionnaire was administered to 374 community health leaders assessing their knowledge of health rights and the level of community participation in primary care, according to five indicators: leadership, organisation, management, resource mobilisation and needs assessment. Results A total of 326 out of 374 questionnaires were returned. The majority (n=205, 62.9%) had limited knowledge of health rights, while 189 (58%) indicated poor community participation in primary healthcare. There was no significant association between knowledge of health rights and level of community participation. Conclusions Knowledge of health rights is generally lacking in these communities, as is public participation in primary care service planning. A community-based health education programme is needed to raise awareness of patient rights and enhance community participation in primary care.

Local Government and Primary Health Care service delivery in South-Western Nigeria 2010–2015

Primary Health Care (PHC) is implemented by the local governments in Nigeria based on the notion that healthcare service delivery is efficient when it is closer to people. With the adoption of analytical research through secondary sources of data, this study assesses the local government performance in PHC service delivery and examines the challenges it faced in the south-western Nigeria states of Lagos, Ogun, and Ondo in the period of 2010–2015. The findings showed various PHC programmes implemented by the local governments of the selected states, which include Maternal and Child Reduction, Investment Case and Eko Free Malaria in Lagos state, Araya and Gbomoro in Ogun state, as well as the Mother and Child Hospitals and Agbebiye in Ondo state. However, findin gs showed similar challenges encountered by the local governments, which include multiplicity of stakeholders in the disbursement of PHC funds, lack of fiscal decentralisation of revenue to the local government, diversion of PHC funds as compared to other projects, and poor community participation in PHC, irregularity of or interference in the local government elections by the state government, exclusion and deviation from the key principles of PHC and lack of continuity in PHC programmes implemented. The general conclusion from the study is that the local government performance in PHC service delivery is weak. In order to enhance the present local government performance in PHC, the study recommends for the application and implementation of local government constitutional role in the management of the PHC service delivery.

Primary healthcare nurses' involvement in patient and community participation in the context of chronic diseases: An integrative review.

Primary healthcare nurses' potential to enable patient and community participation has been increasingly acknowledged. A conceptual understanding of their contributions within a broad range of participation processes is still lacking. The aims of this study were to develop a conceptual framework that provides information on the role of primary healthcare nurses in shaping participation processes with patients and communities in the context of chronic diseases and to identify conditions that enable or hinder the promotion of patient and community participation by nurses. An integrative review was conducted. Twenty-three articles published from 2000 to 2019 were included in the analysis: 19 retrieved from PubMed and CHINAL and 4 added through other sources. An inductive data analysis and quality appraisal of studies were conducted. The analysis reveals four areas where nurses are involved in facilitating patient and community participation: (1) sharing understanding of health problems and needs, (2) developing resources and facilitating patient education for self-management, (3) raising patients' voices as an advocate in service development and (4) supporting individual and community networks. The conditions affecting nurses' engagement in fostering participation processes are as follows: (1) care priorities and overall workload, (2) nurses' attitudes towards participation and (3) users' acceptance of nurses as partners. Future research can use the framework as a basis for empirical studies investigating nurses' involvement in pursuing patient and community participation. Interventions should focus less on indirect forms of participation, like patient education or advocacy, but should also focus on active forms of participation. Research is needed on nurses' involvement in community participation processes. This framework can be used and adapted in future research on patient and community participation in primary healthcare. It describes areas of participation and the facilitators and barriers within the broad range of activities of primary healthcare nurses.

The role of community participation in primary health care: practices of South African health committees.

Community participation is an essential component in a primary health care (PHC) and a human rights approach to health. In South Africa, community participation in PHC is organised through health committees linked to all clinics. This paper analyses health committees' roles, their degree of influence in decision-making and factors impacting their participation. Data were collected through a mixed-methods study consisting of a cross-sectional survey, focus groups, interviews and observations. The findings from the survey were analysed using simple descriptive statistics. The qualitative data were analysed using thematic content analysis. Data on health committees' roles were analysed according to a conceptual framework adapted from the Arnstein ladder of participation to measure the degree of participation. The study found that 55 per cent of clinics in Cape Town were linked to a health committee. The existing health committees faced sustainability and functionality challenges and primarily practised a form of limited participation. Their decision-making influence was curtailed, and they mainly functioned as a voluntary workforce assisting clinics with health promotion talks and day-to-day operational tasks. Several factors impacted health committee participation, including lack of clarity on health committees' roles, health committee members' skills, attitudes of facility managers and ward councillors, limited resources and support and lack of recognition. To create meaningful participation, health committee roles should be defined in accordance with a PHC and human rights framework. Their primary role should be to function as health governance structures at facility level, but they should also have access to influence policy development. Consideration should be given to their potential involvement in addressing social determinants of health. Effective participation requires an enabling environment, including support, financial resources and training.

General Practice and the Community: Research on health service, quality improvements and training. Selected abstracts from the EGPRN Meeting in Vigo, Spain, 17–20 October 2019

Community participation in primary healthcare is enshrined in international policies since the 1970s and has been re-emphasised since then, most recently in the 2018 WHO Astana Declaration (https://www.who.int/primary-health/conference-phc/declaration). The concept comes from a social justice perspective. It emphasises that the participation of communities who experience poverty and social exclusion is essential to the development of primary health care services shaping these services and making them relevant to those with the greatest need. This is important if we are to address the well-documented Inverse Care Law.There is, however, a translational gap between policy and practice. The stability of policies for community participation in primary healthcare is patchy. The implementation of policies into conventional ways of working is patchy. Where implementation has occurred, the coverage of community participation initiatives can be patchy – not all community members are involved. The literature shows a pattern of exclusion whereby so-called ‘hard to reach’ groups are not adequately involved in primary healthcare decision-making. This is the case for refugees and migrants who arrive to settle and integrate into host countries in Europe. The recent WHO Strategy and Action Plan for Refugee and Migrant Health (2016; http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/publications/2016/strategy-and-action-plan-for-refugee-and-migrant-health-in-the-who-european-region) is a call for action to disrupt this pattern of exclusion and improve the health of refugees and migrants.Drawing on the rich tradition of participatory health research is a valuable way forward because it provides important concepts, tools and techniques for research that is more inclusive and primary care practice. This presentation will describe innovative examples of success in family practice settings from around Europe. These have brought together refugees and migrants with primary care stakeholders and enabled them to work together to introduce and sustain changes in clinical practice. This evidence can be used to guide and strengthen community participation in primary healthcare, for all.

\u2018Participation is integral\u2019: understanding the levers and barriers to the implementation of community participation in primary healthcare: a qualitative study using normalisation process theory

BackgroundMany international health policies recognise the World Health Organization’s (2008) vision that communities should be involved in shaping primary healthcare services. However, researchers continue to debate definitions, models, and operational challenges to community participation. Furthermore, there has been no use of implementation theory to study how community participation is introduced and embedded in primary healthcare in order to generate insights and transferrable lessons for making this so. Using Normalisation Process Theory (NPT) as a conceptual framework, this qualitative study was designed to explore the levers and barriers to the implementation of community participation in primary healthcare as a routine way of working.MethodsWe conducted two qualitative studies based on a national Initiative designed to support community participation in primary care in Ireland. We had a combined multi-stakeholder purposeful sample (n = 72), utilising documentary evidence (study 1), semi-structured interviews (studies 1 and 2) and focus groups (study 2). Data generation and analysis were informed by Participatory Learning and Action (PLA) Research Methodology and NPT.ResultsFor many stakeholders, community participation in primary healthcare was a new way of working. Stakeholders did not always have a clear, shared understanding of the aims, objectives and benefits of this way of working and getting involved in a specific project sometimes provided this clarity. Drivers/champions, and strong working partnerships, were considered integral to its initiation and implementation. Participants emphasised the benefits of funding, organisational support, training and networking to enact relevant activities. Health-promoting activities and healthcare consultation/information events were generally successful, but community representation on interdisciplinary Primary Care Teams proved more challenging. Overall, participants were broadly positive about the impacts of community participation, but were concerned about the scope to sustain the work without the ‘protected’ space and resources that the national Initiative afforded.ConclusionsDespite the success of specific activities undertaken as part of a community process in Irish primary healthcare, the likelihood of this becoming a routine way of working in Ireland is low. Analysing the learning from this process using NPT provides theoretically informed recommendations that are transferrable to other settings and can be used to prospectively design and formatively evaluate community participation processes.

Community participation in primary health care projects of the Muldersdrift Health and Development Programme

After numerous teething problems (1974-1994), the Department of Nursing Education of WITS University took responsibility for the Muldersdrift Health and Development Programme (MHDP). The nursing science students explored and implemented an empowerment approach to community participation. The students worked with MHDP health workers to improve health through community participation, in combination with primary health care (PHC) activities and the involvement of a variety of community groups. As the PHC projects evolved over time, the need arose to evaluate the level of community participation and how much community ownership was present over decision-making and resources. This led to the question "What was the level of community participation in PHC projects of the MHDP?" Based on the question the following objectives were set, i.e. (i) to evaluate the community participation in PHC initiatives; (ii) to provide the project partners with motivational affirmation on the level of community participation criteria thus far achieved; (iii) to indicate to participants the mechanisms that should still be implemented if they wanted to advance to higher levels of community participation; (iv) to evaluate the MHDP's implementation of a people-centred approach to community participation in PHC; and (v) the evaluation of the level of community participation in PHC projects in the MHDP. An evaluative, descriptive, contextual and quantitative research design was used. Ethical standards were adhered to throughout the study. The MHDP had a study population of twenty-three (N=23) PHC projects. A purposive sample of seven PHC initiatives was chosen according to specific selection criteria and evaluated according to the "Criteria to evaluate community participation in PHC projects" instrument (a quantitative tool). Structured group interviews were done with PHC projects' executive committee members. The Joint Management Committee's data was collected through mailed self-administered questionnaires. Validity and reliability were ensured according to strict criteria. Thereafter results were analysed and plotted on a radiating arm continuum. The following factors had component scores: organization, leadership, resources, management; needs and skills. A spider graph was produced after each factor's continuum was connected in a spoke figuration that brought them together at the base where participation was at its most narrow. The results are presented and a graph and discussion is provided on each of the PHC projects. The research results indicated that although community participation was broadened, there was minimal success in forcing a shift in power over decision-making and resources. This demonstrated that power over planning and resources should remain in the hands of the partners if community participation was to remain progressive and sustained. Results furthermore indicated that the people-centred approach to With regard to the Joint Management Committee's evaluation of community participation, it was concluded that power over decision-making and resources remained with health professionals rather than with the community, and that a people-centred approach had not been adopted.