Institute for Health & Wellbeing, Leeds Metropolitan University, UK.
Policy Research Institute, Leeds Metropolitan University, UK.
Soc Sci Med. 2014 Mar;104:80-7. doi: 10.1016/j.socscimed.2013.11.058. Epub 2013 Dec 16.
Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained.
公众参与公共卫生计划的形式包括正规的基层卫生工作者（LHW）和其他志愿者角色。这种参与是否应该通过报酬来支持，或者实际上应该得到报酬，这是一个关键问题。本文以英国英格兰的政策为参考，认为将公民参与健康仅视为无偿贡献的时间，并不能说明实践的复杂性和内在动机。本文报告了一项关于支持基层人员在公共卫生角色中发挥作用的方法的研究结果，该研究于 2007-2009 年在英格兰进行。该研究的第一阶段包括对 224 项出版物进行范围界定审查、三次公开听证会和项目登记。研究结果揭示了支付方式的多样性，但也揭示了该主题的争议性。第二阶段在五个公共卫生项目的案例研究中调查了项目支持事项，这些项目主要是为了反映角色类型而选择的。所有五个项目都涉及志愿者，其中两个项目利用支付形式来支持参与。对项目工作人员、基层卫生工作者（有偿和无偿）、外部合作伙伴和服务使用者进行了抽样访谈。本文借鉴基层和专业人士的观点，探讨了支付与社会背景以及给予、接受或拒绝经济支持的各种动机之间的关系。研究结果表明，个人成本并非总是由个人承担，而且经济支持（无论是计时工资还是费用）与福利之间存在潜在冲突。在确定支付的一些优缺点时，本文强调了这个问题的复杂性，而这个问题通常只是表面上得到解决。本文得出结论，为了支持公民参与，应该在考虑到计划管理的实际问题的同时，考虑公平性和价值；然而，需要解决政策冲突，以确保就业和福利权利得到维护。
