Specific Detail Info |
Background: This paper explores how community participation can be used in designing rural primary healthcare
services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as
useful in planning services and is understood as particularly relevant in rural settings, partly due to high social
capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to
health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from
top-down standard models to contextual plans arising from population health planning that incorporates
community participation. This paper addresses an evidence gap about the outcomes of using community
participation in (re)designing rural community health services.
Methods: Community-based participatory action research was applied in four Scottish case study communities in
2008–10. Data were collected from four workshops held in each community (total 16) and attended by community
members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings
and selections from workshops are presented.
Results: Community members identified consistent health priorities, including local practitioners, emergency triage,
anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models
to address health priorities. One community did not design a service model and another replicated the current
model despite initial enthusiasm for innovation.
Conclusions: Communities differ in their receptiveness to engaging in innovative service design, but some will
create new models that fit in a given budget. Design diversity indicates that context influences local healthcare
planning, suggesting community participation impacts on design outcomes, but standard service models maybe
useful as part of the evidence in community participation discussions. |