Planning of Primary Health Care - Research Proposal Example

A Qualitative Study on the Involvement of public in the Planning of Primary Health Care for the Year 2005 Normally people differ in their perceptions of the various advancements made in the health system now - a- days. In lieu of this, Anderson, Shipherd, and Salisbury (2005) conducted a qualitative study, to investigate the participation of the public in the process of prognosticating primary health care. To facilitate proper investigation in this area individual and focus group interviews were conducted, in the unprivileged areas, more specifically in Weston-Super-Mare (WSM) and in Bristol. Design The study is deemed to be an exploratory study, wherein the investigators aim to examine two existing projects to further comprehend the involvement of the public in the area of public health. The design of the study was broadly based on a case analysis, where the necessary details were researched and compared. A qualitative design was used by the investigators to obtain results after comparisons were made. This design technique was quite useful in helping the respondents to freely express their thoughts and emotions. In addition to this, the first project showed specific themes that can be used in the further investigation of this project (Anderson et al. 2006). Sample Out of the different approaches for the study, the approach used for the research in Bristol was that of a purposive, stratified approach, where a mixed group of people, involving residents and professionals actively participated. The involvement of people is normally classified into different levels, namely low, medium, and high, respectively. The low level is the type wherein people do not have a direct input in the planning process. Medium level, on the other hand, comprises of the involvement of people who have been present during some of the meetings. Lastly, the high level of involvement mostly comprise of people who have been actively present during meetings, and have given their inputs regarding pertinent manners (Anderson et al. 2006). The interviewees from Bristol were people who came from different backgrounds, different age groups, gender, and different experiences from work. The kind of involvement each interviewee had in relation to work was also taken into consideration (Anderson et al. 2006). Three local residents comprised of the WSM public focus group. The said group of professionals comprised of six participants, which included the practice manager, a general practitioner, the building administrator, the manager of the Healthy Living Center, and two curates. Analysis The interviews were recorded transcribed and then sent for further analysis. The data that was collected was studied and compared accordingly. The transcriptions produced were then read and identified by the researchers, before being sent for discussion. The themes and codes that were associated with the latter, had been double checked for further verification. As the themes were finalized, these were organized accordingly to show the different characteristics of involvement in the public (Anderson et al. 2006). Results of the Study For this study, the three main themes were identified. These include power, process, and partnership. Partnership This theme was considered to be critical in terms of its relationship and partnership with people. This may be due to the fact that people are able to convey their messages across even in the presence of traditional boundaries. For the interviewees, the main goal was to show that the involvement of the locals was present in their development. The interviewees wanted to convey that their location and origins were flexible and accessible. Furthermore, it was also evident that the interviewees were directive and remote. From the interviews conducted, it became evident that there were those people who became more involved than the others even at the start of the Most of the people showed dynamic personalities, especially in showing their case, which in turn became highly politicized. Moreover, one of the residents in Weston became highly affected and became active in their involvement in activities promoted in the community. For the residents of Bristol, evolution took place. The study involved this particular stage wherein conflict became more evident. To make matters worse, the people were furious with the circumstances, while the reception staff were in a dilemma as t how best to handle the situation. The different effects these had on people caused others to withdraw and have negative reactions towards the situation. Underlying factors have been attributed to the said implications, which included the differences in perceptions regarding the different stages of development. A similar issue has been witnessed in Weston, wherein transition was seen in the concept of delivery. From the interviews conducted, it became evident that many of the participants became totally involved while the others did not. Most of the participants showed keen interest in the proceedings and got involved in it. Moreover, one of the residents in Weston showed great concern and therefore became an active member by helping out in activities promoted within the community. Gradually, a great change or evolution took place in Bristol as things looked brighter for its residents. At this stage in the study, there were many conflicting views. While some participants were contented, others had conflicting thoughts and ideas. Some of them were furious with the circumstances and this placed most of the reception staff in a sort of dilemma. The reactions of some of them influenced the actions of the others making them have a negative outlook of the whole situation. A similar issue has been witnessed in Weston, wherein transition was seen in the concept of delivery. Process Communication played an important role in this study. Participants were updated through publications made in newsletters and events. Many of the members were outstanding in their contribution of decision making within the group. The main objective in the group was to meet with many people from both the health and local authorities which eventually led to the formation of good and healthy policies. Furthermore, these interests were supported by the workers of the health development team, and ushered by the managers. The active involvement of the people was beneficial to the community and also helped in the cooperation of the people, especially by attending the meetings. Besides the development of the Bristol Health Park, more tasks became operational. More services were now running, and difficulty in sustaining the projects became more evident. Furthermore, several other processes began to resurface with the purpose of giving more importance to the commercial aspect. In addition to this, the views of the regular people were now given less importance than before. As a result, the people felt more intimidated and the gatherings and participation of the people became quite limited. A similar experience was witnessed in WSM. The people in that particular area experienced a threat of having the medical services withdrawn. Fortunately, the people responded in a positive manner, wherein the community worked together to fix the problems experienced. Most people became motivated in achieving a Healthy Living Center. The Board of Directors comprised the members of the Residents Group, the Project Steering Group, and the Consultation Group. From the onset the rules for the formation of the group was thoroughly discussed and it became evident that support and training were necessary. One of the main concerns of the process was to maintain contact with the people and at the same time to cater to the needs of the people. The fact that was quite evident was that there was good communication between the people and the process. Power From the study, it was evident that people still preferred the traditional style other than the conventional one. The reason for this was that the conventional style did not have any competition with the other marginalized agencies. Moreover, the early stages showcased how the professionals and managers became engaged in increasing the influence on local people in the process. This was made possible through the power showcased by some of the locals in the remodeling and decision making of the study, which in turn formed the basis for the people to fit in easily with the required agenda. Though the WSM comprised of certain negative factors, yet this more traditional approach was more popular among the people. It was very evident however, that the exclusivity of the formal processes played a major role in the study. At the end of the study, the residents would have given much of their time as their participation for the said study. Discussion of the Study Discussion of the study was merely focused on the three most important factors that were individually tackled - process, power, and partnership. The interconnection that each of the factors had with each other was considered pivotal in the decision making process. Multiple adaptations were evident in the analysis of the involvement of different individuals and agencies. In addition to this, the research also showcased the importance of the local culture, while taking into consideration the different methods that could be applied. Considering the extent of stress levels of individuals as well as groups that may be involved in the process, it is rather difficult gaining the assurance and support of the majority. During the course of the interviews, it was noticed that most of the respondents exhibited much enthusiasm in sharing their experiences involving primary health care. These were further tapped on when their difficulties were expressed. The lack of amenities and skills seemed to be the main drawbacks during the time of the study. Furthermore, the study also highlighted the fact that learning is a pivotal part of one's life and having sufficient knowledge regarding the health services and the community members was essential in dealing with problems related to it. Limitations Several loop holes and imperfections became evident throughout the study. This was primarily due to the fact that most of the data incorporated in the study was gathered from only one area. The opinions of the professionals were to be taken more into consideration with special reference to their attitude and experience from the point of view of the study. During the research, it had become evident that most of the citizens were very interested in finding solutions to their problems and making decisions, especially on their health care issues. The results also showed that although there were minor problems, everyone was able to accept these problems and work towards removing them. Partnership The results found in the study showed that balance is necessary in achieving success between the people and the health professionals. Partnership is a term used for the relationship that is created between the public and a professional. Such partnerships often entail conflict during the decision making process. Furthermore, partnerships also comprise of the power factor that plays a vital role in the lives of people. The unwillingness to give up power would lead to more problems that could be encountered in the neighborhood. Regardless of the rising tensions, the results still showed that the local health service and the local government were willing to work together to bring positive results. The common purpose of improving the health of the community members which is what made the collaboration a success. Process The 'traditional' model was more applicable during the community events of the study where creative methods were utilized to collect information and opinions. But there were also additional processes, such as participation in policy making within working groups, in which local people were involved directly in the decision making process. The latter 'active' or 'direct' approach is less preferred by health service organizations, which means that local concerns expressed by people who actually experience them, can be reinforced by their peers in decision-making forums. There was evidence from the study that a model of involvement that is conceptualized as a spectrum rather than a hierarchy of approaches which is very pertinent to healthcare planning, where critics have argued that public involvement has rarely developed beyond consultation. The bridge of communication between the people and other professionals was the sole responsibility of Community workers whose job was to mediate and translate all that was needed between them. Their role was challenging in the sense that they had to work across boundaries within the traditional models of consultation by treating everyone as equals especially during the decision making process. Power It was evident all through the study, that the participants felt quite reticent during participation. They found difficulty in articulating their ideas and views when compared to the professionals. This perception that the knowledge of specialized experts is intrinsically of greater value, can lead to the neglect of important sources of lay knowledge particularly relevant to local decisions. However, from the study it was also found that residents can become attuned to functioning well within this culture if they are empowered and supported. This would give them the courage to engage in the planning process and subvert it, by 'let (ting) them have it'. They will ignore (implicit) meeting convention, shifting the focus away from narrowly defined health agendas to broader social objectives that contribute to reducing inequalities in health, thus leading to the reshaping of healthy power relationships. Authors: (Crawford, M. et al 2002) Objective: To investigate how patients could be involved in Health Care Planning. Data Sources: Published and grey sources. Study selection: English written reports between 1966 and October 2000. Data extraction: Qualitative reviews of the effects of planning and development of health care. Results: 31 Of 42 papers were case studies that described patient's involvement through information leaflets. The change in attitude of organizations, in involving patients in the on going process by accepting their positive responses. Conclusions: Evidence has proved that patient involvement has contributed to the implementation of a whole range of services that are not only satisfying but of high quality in care. Known about the topic: To improve service quality, it was highly recommended to involve patients during the planning process. What this study adds: Changes in service provision by involving patients. Result: 294 of the 337 studies that involved patients in planning was excluded because the data was not adequately described. Of the 42 accepted studies, 40 described patient's inititiatives.31 of these were case reports while five were surveys, three were records of meetings and three were findings of research and four described methods of qualitative research. The papers addressed the various models applied in hospitals, the involvement of patients, and the summary of the evidence and results of the findings. Conclusion: Though patients contributed to the development of the various services, yet the effects of the quality and effectiveness was still unknown. Health care providers would essentially need to demonstrate how they involved patients in the whole planning process. Stronger evidence may be necessary for providers when involving patients during the planning of such services. My Comment on this topic: Considering the results of Crawford et al (2002), there was a lack of evidence in all the 42 papers about the effects of public involvement in the area of quality care services, with special regard to the health of patients. In addition, the papers did not have a strong foundation regarding the satisfaction of health care services during the period of public involvement in the work. Read More