Snow M Elizabeth, Tweedie Katherine, Pederson Ann
Centre for Health Evaluation & Outcome Sciences (CHÉOS), University of British Columbia, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
BMC Health Serv Res. 2018 Mar 15;18(1):181. doi: 10.1186/s12913-018-2969-1.
Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, "one-size-fits-all" approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges-highly gendered health and social experiences. The project's purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning.
Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model.
The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning.
A one-size-fits-all approach to patient engagement is not appropriate given patients' diverse barriers to meaningful participation in healthcare planning. Instead, planners need a repertoire of skills and strategies to align the purpose of engagement with the capacities and needs of patient participants. Just as services need to meet diverse patients' needs, so too must patient engagement experiences.
最近，患者参与已被视为支持医疗保健规划的一项有前景的策略。然而，常用于患者参与的普遍主义、“一刀切”方法的背景和结构可能无法使不同的患者参与旨在满足其需求的项目的决策。具体而言，标准的患者参与方法忽视性别差异，可能无法促进那些因药物使用、低收入、暴力经历、无家可归和/或心理健康挑战（这些都是高度性别化的健康和社会经历）而被边缘化的人群的参与。该项目的目的是开发一种启发式模型，以协助规划者让那些传统上未被纳入医疗保健规划的患者参与进来。
我们采用定性研究方法，回顾了文献，并就使边缘化人群参与健康服务规划的问题对患者和医疗保健规划者进行了访谈。基于这些意见，我们创建了一个模型和规划手册，以协助医疗保健规划者让边缘化患者参与健康服务规划，并在两个正在进行健康服务设计的临床项目中进行了试点。试点的结果用于完善该模型。
对访谈和文献的分析确定了权力和性别是参与的障碍，并提出了支持不同人群参加患者参与活动并进行有意义参与的建议。让边缘化人群参与不能简化为一个单一的既定过程，而应被理解为一个将参与方法与特定情况相匹配的迭代过程。这一过程的基础是让边缘化人群有意义地参与医疗保健规划的原则。
鉴于患者在有意义地参与医疗保健规划方面存在各种障碍，“一刀切”的患者参与方法并不合适。相反，规划者需要一系列技能和策略，以使参与的目的与患者参与者的能力和需求相匹配。正如服务需要满足不同患者的需求一样，患者参与体验也必须如此。
