De Weger E, Van Vooren N, Luijkx K G, Baan C A, Drewes H W
Department of Quality of Care and Health Economics, Centre for Nutrition, Prevent and Health Services, National Institute for Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
Tilburg University, Tranzo, Tilburg School of Social and Behavioural Sciences, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
BMC Health Serv Res. 2018 Apr 13;18(1):285. doi: 10.1186/s12913-018-3090-1.
Community engagement is increasingly seen as crucial to achieving high quality, efficient and collaborative care. However, organisations are still searching for the best and most effective ways to engage citizens in the shaping of health and care services. This review highlights the barriers and enablers for engaging communities in the planning, designing, governing, and/or delivering of health and care services on the macro or meso level. It provides policymakers and professionals with evidence-based guiding principles to implement their own effective community engagement (CE) strategies.
A Rapid Realist Review was conducted to investigate how interventions interact with contexts and mechanisms to influence the effectiveness of CE. A local reference panel, consisting of health and care professionals and experts, assisted in the development of the research questions and search strategy. The panel's input helped to refine the review's findings. A systematic search of the peer-reviewed literature was conducted.
Eight action-oriented guiding principles were identified: Ensure staff provide supportive and facilitative leadership to citizens based on transparency; foster a safe and trusting environment enabling citizens to provide input; ensure citizens' early involvement; share decision-making and governance control with citizens; acknowledge and address citizens' experiences of power imbalances between citizens and professionals; invest in citizens who feel they lack the skills and confidence to engage; create quick and tangible wins; take into account both citizens' and organisations' motivations.
An especially important thread throughout the CE literature is the influence of power imbalances and organisations' willingness, or not, to address such imbalances. The literature suggests that 'meaningful participation' of citizens can only be achieved if organisational processes are adapted to ensure that they are inclusive, accessible and supportive of citizens.
社区参与日益被视为实现高质量、高效且协作式医疗的关键。然而，各组织仍在探寻让公民参与健康和医疗服务塑造的最佳且最有效的方式。本综述着重介绍了在宏观或中观层面让社区参与健康和医疗服务规划、设计、治理及/或提供过程中的障碍与促进因素。它为政策制定者和专业人员提供了基于证据的指导原则，以实施他们自己有效的社区参与（CE）策略。
开展了一项快速现实主义综述，以研究干预措施如何与背景和机制相互作用，从而影响社区参与的有效性。一个由健康和医疗专业人员及专家组成的本地参考小组协助制定研究问题和搜索策略。该小组的意见有助于完善综述的结果。对同行评议文献进行了系统检索。
确定了八项面向行动的指导原则：确保工作人员在透明的基础上为公民提供支持性和促进性的领导；营造一个安全且值得信任的环境，使公民能够提供意见；确保公民尽早参与；与公民共享决策和治理控制权；承认并解决公民对公民与专业人员之间权力不平衡的感受；对那些觉得自己缺乏参与技能和信心的公民进行投入；创造迅速且切实的成果；兼顾公民和组织的动机。
贯穿社区参与文献的一条特别重要的主线是权力不平衡的影响以及组织是否愿意解决此类不平衡问题。文献表明，只有调整组织流程以确保其具有包容性、可及性并支持公民，才能实现公民的“有意义参与”。
