Public involvement in the planning, development and implementation of community health services: A scoping review of public involvement methods

An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments

Background

The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county.

Methods

In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration.

Results

Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems.

Discussion

We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.

“Ain’t I a Woman?”: Feminist Participatory Action-Research with African Migrant Women Living in Spain

There is a growing trend towards a feminization of migration which calls for an urgent intersectional analysis in migration and integration research. Migrant women are exposed to numerous barriers that make difficult to participate in host communities due to the intersections between their gender, ethnicity, migratory status, etc. These barriers range from structural to daily discrimination in the shape of sexism and racism, particularly for women from regions further south of Africa. Undertaken in collaboration with a local NGO in Southern Spain, this study aims to approach African migrant women’s experiences and to promote agency and participation in host communities. It was framed in Feminist Participatory Action-Research (FPAR) based on photovoice. The participants (n = 15) generated and shared photo-narratives about their daily experiences during five sessions that were participatively analyzed, classified into four themes as follows: (1) migratory projects; (2) violence and discrimination; (3) health and social care; and (4) to be and resist as an African migrant woman. Photovoice was valued as a safe, non-hierarchical, and caring environment that promoted agency in participants and reflexivity in researchers. Our results highlight the importance and necessity on undertaking FPAR in collaboration with social organizations for emancipatory research praxis and put the emphasis on photovoice as a transformational method.

Our Healthy Community Conceptual Framework and Intervention Model for Health Promotion and Disease Prevention in Municipalities

This paper introduces the conceptual framework and intervention model of Our Healthy Community (OHC), a new, coordinated, and integrated approach towards health promotion and disease prevention in municipalities. The model is inspired by systems-based approaches and employs a supersetting approach for engaging stakeholders across sectors in the development and implementation of interventions to increase health and well-being among citizens. The conceptual model includes a combination of a bottom-up approach emphasizing involvement of citizens and other community-based stakeholders combined with a top-down approach emphasizing political, legal, administrative, and technical support from a variety of councils and departments in local municipality government. The model operates bidirectionally: (1) by pushing political and administrative processes to promote the establishment of conducive structural environments for making healthy choices, and (2) by involving citizens and professional stakeholders at all levels in co-creating processes of shaping their own community and municipality. An operational intervention model was further developed by the OHC project while working with the OHC in two Danish municipalities. The operational intervention model of OHC comprises three main phases and key actions to be implemented at the levels of local government and community: (1) Local government: Situational analysis, dialogue, and political priorities; (2) Community: Thematic co-creation among professional stakeholders; and (3) Target area: Intervention development and implementation. The OHC model will provide municipalities with new tools to improve the citizens' health and well-being with available resources. Health promotion and disease prevention interventions are developed, implemented, and anchored in the local community by citizens and local stakeholders at municipal and local community levels using collaboration and partnerships as leverage points.

The added value and unintended negative consequences of public involvement processes in the planning, development and implementation of community health services: Results from a thematic synthesis

PURPOSE

Public involvement is widely considered a means to improve health and quality of health services. The research literature reveals ambiguities concerning added value and unintended negative consequences of public involvement processes. The aim of this study is to identify, synthesise and present an overview of added value and unintended negative consequences of public involvement processes in the planning, development and implementation of community health services.

METHODS

Data from 36 peer-reviewed articles retrieved from a systematic search in the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, ProQuest, and Scopus databases in October 2019 and updated in April 2021 were extracted. A three-step thematic synthesis was conducted involving (1) line-by-line text coding, (2) developing descriptive themes and (3) generating analytical themes.

RESULTS

Two main themes along with their corresponding themes provided an overview of the added value of public involvement processes at the individual, service and political levels. Unintended negative consequences concerning individual resources, uncertainty about the effect of involvement and power differences were revealed.

CONCLUSION

Added value of public involvement processes is primarily reported on an individual and service level. The added value seems to be accompanied by unintended negative consequences. Training of professional facilitators and recruitment of participants that come from vulnerable groups could help promote equality in public involvement. Unintended negative consequences need to be further explored in future evaluations in order to achieve the desired goals of public involvement.

Community participation in Australia's National Suicide Prevention Trial

BACKGROUND

National systems-based suicide prevention approaches are increasingly being implemented. Community participation is fundamental to the successful implementation of these approaches, but can be challenging to undertake. We present findings from the evaluation of Australia's National Suicide Prevention Trial (the Trial).

METHODS

We completed consultations with 127 community members and 46 Primary Health Network (PHN) staff. Thematic analysis was undertaken to understand the process of community participation in the planning and implementation of the Trial.

RESULTS

Themes were identified regarding: a collaborative PHN; an engaged and passionate community; maintaining engagement; getting the right people involved; and getting stakeholders to work together. Continuous negotiation about Trial ownership, acceptability of the Trial model, and choice of activities was required. Community participation was somewhat challenging for PHNs, taking much longer than anticipated for a range of reasons.

CONCLUSIONS

Future system-based approaches could benefit from the provision of community participation skills training and support to enable a more coordinated, and perhaps more easily achieved, approach to the involvement of community. Despite a long process of relationship building between stakeholders, this led to improved community cohesion and integration in local suicide prevention, ready for future collaborative work.