Farin E
Universitätsklinikum Freiburg i.Br., Abt. Qualitätsmanagement und Sozialmedizin.
Gesundheitswesen. 2011 Jan;73(1):e1-11. doi: 10.1055/s-0030-1247536. Epub 2010 Mar 3.
The great significance of the concept of participation in health care policy is in contrast with the comparatively low resonance that the participation construct ("Teilhabe" in German) has found in scientific circles. It can be argued that this is due in part to the insufficient specification of the term in the ICF ("International Classification of Functioning, Disability and Health") and the lack of suitable measuring instruments. This article deals with the question of what approaches to defining participation currently exist and what methods are conceivable for facilitating the integration of the construct in health services research. Based on a review of German and international literature on participation, the construct is differentiated from related concepts such as "social capital," "social network," "social support," and "community integration". It is recommended that participation should be understood as "social role participation". The possibility this entails of referring to existing research traditions and available studies leads to the necessity that a comprehensive measurement of participation should include five dimensions of this construct: performance, capability, importance, context factors, and satisfaction. A review of the available instruments for measuring participation shows that most of them cover the ICF domains that are important in this context to a sufficient extent. However, there are the following areas for improvement: a) No measuring instrument includes all five relevant dimensions of participation, b) None of the instruments take non-health-related obstacles to participation (context factors) into consideration, c) The possibility of a version with parallel content for proxy assessment is rarely used, d) The published methods available to German-speaking users cover participation only globally or are older and do not incorporate experience with the ICF. In view of the significance of the participation construct in the German health care system, studies on new or ongoing developments of assessment instruments that meet these challenges would be welcomed.
参与式医疗保健政策概念的重大意义与参与这一概念（德语为“Teilhabe”）在科学界相对较低的反响形成了鲜明对比。可以说，部分原因在于《国际功能、残疾和健康分类》（ICF）中该术语的定义不够明确，以及缺乏合适的测量工具。本文探讨了目前存在哪些定义参与的方法，以及可以设想哪些方法来促进这一概念在卫生服务研究中的整合。基于对德语和国际上关于参与的文献的综述，该概念与“社会资本”“社会网络”“社会支持”和“社区融合”等相关概念区分开来。建议将参与理解为“社会角色参与”。这一理解能够参考现有研究传统和现有研究，这就使得有必要对参与进行全面测量，测量应涵盖该概念的五个维度：表现、能力、重要性、背景因素和满意度。对现有的参与测量工具的综述表明，其中大多数在很大程度上涵盖了在此背景下重要的ICF领域。然而，仍有以下几个方面需要改进：a）没有一种测量工具涵盖参与的所有五个相关维度；b）没有一种工具考虑到参与的非健康相关障碍（背景因素）；c）很少使用具有平行内容版本以供代理评估的可能性；d）德语使用者可用的已发表方法仅从整体上涵盖参与情况，或者较为陈旧，没有纳入ICF的相关经验。鉴于参与这一概念在德国医疗保健系统中的重要性，欢迎开展研究以开发能够应对这些挑战的评估工具的新进展或现有进展。
