Department of Community Health Sciences, University of Calgary, Canada.
Centre for Health Economics and Policy Analysis, McMaster University, Canada; Clinical Epidemiology and Biostatistics, McMaster University, Canada.
Soc Sci Med. 2015 Oct;142:223-31. doi: 10.1016/j.socscimed.2015.08.024. Epub 2015 Aug 18.
The community participation literature has produced numerous frameworks to guide practice and evaluation of community participation strategies in the health sector. These frameworks are useful starting points for differentiating the approaches for involving people in planning and decision-making for health services, but have been critiqued for being too generic and ignoring that community participation is highly contextual and situational. Health service organizations across Canada and internationally have begun to respond to address this limitation by developing more context-specific community participation frameworks; however, such frameworks do not exist for Ontario Community Health Centres (CHCs)-local primary health care organizations with a mandate to engage marginalized groups in planning and decision-making for health services. We conducted a series of focus groups with staff members from four Ontario CHCs to: (1) examine the factors that would influence their use of a generic framework for community participation with marginalized populations; and (2) improve the "context-specificity" of this framework, to enhance its relevance to CHCs. Participants described the difficulty of organizing the contextual, multi-faceted and situational process of community participation that they experienced with marginalized populations into a single framework, which led them to question the value of using frameworks as a resource for guiding the design, implementation and evaluation of their community participation initiatives. Instead, participants revealed that tacit knowledge, in the form of professional and personal experience and local knowledge of a marginalized population, had a greater influence on guiding participation activities in Ontario CHCs. Our findings suggest that tacit knowledge is an essential feature of community participation practice and requires further exploration regarding its role in the community participation field.
社区参与文献提出了许多框架，以指导卫生部门社区参与战略的实践和评估。这些框架是区分人们参与卫生服务规划和决策方法的有用起点，但也因过于笼统以及忽视社区参与具有高度的情境性和具体性而受到批评。加拿大和国际上的卫生服务组织已开始通过制定更具针对性的社区参与框架来应对这一限制；然而，对于安大略省社区健康中心（CHC）——负责让边缘化群体参与卫生服务规划和决策的本地初级卫生保健组织——来说，还没有这样的框架。我们对安大略省的四个 CHC 的工作人员进行了一系列焦点小组讨论，以：（1）研究影响他们使用通用框架与边缘化人群进行社区参与的因素；（2）提高该框架的“针对性”，以增强其对 CHC 的相关性。参与者描述了将他们与边缘化人群一起经历的具有情境性、多方面和具体情况的社区参与过程组织到一个单一框架中的困难，这使他们质疑使用框架作为指导其社区参与计划的设计、实施和评估的资源的价值。相反，参与者揭示了隐性知识（以专业和个人经验以及对边缘化群体的本地知识的形式）对指导安大略省 CHC 中的参与活动具有更大的影响。我们的研究结果表明，隐性知识是社区参与实践的一个重要特征，需要进一步探讨其在社区参与领域中的作用。
