Nehla Djellouli1, Lorelei Jones2, Helen Barratt3, Angus I G Ramsay4, Steven Towndrow5, Sandy Oliver6. 1. UCL, Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom. Electronic address: n.djellouli@ucl.ac.uk. 2. School of Health Sciences Bangor University, Bangor, Gwynedd, LL57 2EF, United Kingdom. Electronic address: lorelei.jones@bangor.ac.uk. 3. UCL, Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom. Electronic address: h.barratt@ucl.ac.uk. 4. UCL, Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom. Electronic address: angus.ramsay@ucl.ac.uk. 5. NIHR, CLAHRC North Thames Barts Health NHS Trust The Royal London Hospital, Whitechapel Rd, Whitechapel, E1 1BB, United Kingdom. Electronic address: s.towndrow@ucl.ac.uk. 6. Department of Social Science, 10 Woburn Square, London, WC1H 0NR, United Kingdom; Africa Centre for Evidence, University of Johannesburg, PO Box 524, Auckland Park, 2006, South Africa. Electronic address: sandy.oliver@ucl.ac.uk.
Abstract
BACKGROUND: Public involvement in large-scale changes (LSC) to health services is strongly promoted - and even mandated - in several health systems. This scoping review aimed to describe the evidence about how public involvement is conceptualised and conducted in LSC, with what impact, and how different stakeholders perceived this process. METHODS: After searching eight databases, 34 publications were included. Data were extracted and charted using a standardised form. Findings from the literature were discussed with frontline stakeholders. RESULTS: Public involvement remains poorly defined and its aims lack clarity in LSC. Public meetings are most often used to gather public views but raise the issue of representativeness. However, evidence in the literature is scarce about which involvement methods - informative and deliberative - are appropriate for the different stages of the LSC and with what impact. In several cases, the involved public felt they had no influence on decision-making regarding LSC proposals, sometimes leading to an environment of mistrust. In those instances, the public understood the technical arguments for change and actively questioned them, opposed LSC plans and sought alternative routes to voice their views. CONCLUSION: More research and consideration are needed regarding who should be involved, with what purpose and how. We argue that in practice two models of involvement, invited and uninvited participation, coexist and therefore interactions between the two should be given further consideration in LSC.
BACKGROUND: Public involvement in large-scale changes (LSC) to health services is strongly promoted - and even mandated - in several health systems. This scoping review aimed to describe the evidence about how public involvement is conceptualised and conducted in LSC, with what impact, and how different stakeholders perceived this process. METHODS: After searching eight databases, 34 publications were included. Data were extracted and charted using a standardised form. Findings from the literature were discussed with frontline stakeholders. RESULTS: Public involvement remains poorly defined and its aims lack clarity in LSC. Public meetings are most often used to gather public views but raise the issue of representativeness. However, evidence in the literature is scarce about which involvement methods - informative and deliberative - are appropriate for the different stages of the LSC and with what impact. In several cases, the involved public felt they had no influence on decision-making regarding LSC proposals, sometimes leading to an environment of mistrust. In those instances, the public understood the technical arguments for change and actively questioned them, opposed LSC plans and sought alternative routes to voice their views. CONCLUSION: More research and consideration are needed regarding who should be involved, with what purpose and how. We argue that in practice two models of involvement, invited and uninvited participation, coexist and therefore interactions between the two should be given further consideration in LSC.
Authors: Sarah E Knowles; Dawn Allen; Ailsa Donnelly; Jackie Flynn; Kay Gallacher; Annmarie Lewis; Grace McCorkle; Manoj Mistry; Pat Walkington; Lisa Brunton Journal: Health Expect Date: 2021-10-20 Impact factor: 3.377