Université de Sherbrooke.
Milbank Q. 2014 Jun;92(2):319-50. doi: 10.1111/1468-0009.12060.
In the past 50 years, individual patient involvement at the clinical consultation level has received considerable attention. More recently, patients and the public have increasingly been involved in collective decisions concerning the improvement of health care and policymaking. However, rigorous evaluation guiding the development and implementation of effective public involvement interventions is lacking. This article describes those key ingredients likely to affect public members' ability to deliberate productively with professionals and influence collective health care choices.
We conducted a trial process evaluation of public involvement in setting priorities for health care improvement. In all, 172 participants (including 83 patients and public members and 89 professionals) from 6 Health and Social Services Centers in Canada participated in the trial. We video-recorded 14 one-day meetings, and 2 nonparticipant observers took structured notes. Using qualitative analysis, we show how public members influenced health care improvement priorities.
Legitimacy, credibility, and power explain the variations in the public members' influence. Their credibility was supported by their personal experience as patients and caregivers, the provision of a structured preparation meeting, and access to population-based data from their community. Legitimacy was fostered by the recruitment of a balanced group of participants and by the public members' opportunities to draw from one another's experience. The combination of small-group deliberations, wider public consultation, and a moderation style focused on effective group process helped level out the power differences between professionals and the public. The engagement of key stakeholders in the intervention design and implementation helped build policy support for public involvement.
A number of interacting active ingredients structure and foster the public's legitimacy, credibility, and power. By paying greater attention to them, policymakers could develop and implement more effective public involvement interventions.
在过去的 50 年中，个体患者在临床咨询层面的参与得到了相当的关注。最近，患者和公众越来越多地参与到改善医疗保健和决策制定的集体决策中。然而，对于指导有效公众参与干预措施的制定和实施的严格评估却缺乏。本文描述了那些可能影响公众成员与专业人员进行富有成效的协商并影响集体医疗保健选择的关键因素。
我们对公众参与制定医疗保健改善优先事项进行了试验过程评估。共有来自加拿大 6 个卫生和社会服务中心的 172 名参与者（包括 83 名患者和公众成员以及 89 名专业人员）参加了试验。我们对 14 次为期一天的会议进行了录像，2 名非参与观察员做了结构化记录。我们使用定性分析展示了公众成员如何影响医疗保健改善的优先事项。
合法性、可信度和权力解释了公众成员影响力的变化。他们的个人患者和护理人员经验、提供结构化的准备会议以及访问社区的基于人群的数据为他们的可信度提供了支持。通过招募平衡的参与者群体以及公众成员有机会从彼此的经验中汲取经验，合法性得到了加强。小组成员的审议、更广泛的公众咨询以及侧重于有效小组流程的调解风格有助于缩小专业人员和公众之间的权力差距。让利益攸关方参与干预措施的设计和实施有助于为公众参与制定政策支持。
一些相互作用的积极因素构建并促进了公众的合法性、可信度和权力。政策制定者如果更加关注这些因素，就可以制定和实施更有效的公众参与干预措施。
