Green Gill, Johns Tracey
School of Health and Social Care, University of Essex, Colchester, United Kingdom.
Front Sociol. 2019 Mar 29;4:20. doi: 10.3389/fsoc.2019.00020. eCollection 2019.
Public involvement in applied health research in the UK has become a pre-requisite for receiving funding from some bodies including the National Institute of Health Research. However, much of this involvement has been criticized as being tokenistic with an unequal power dynamic whereby the public voice is consulted but may be ignored. To redress this imbalance more participatory methods of involvement, such as co-production have emerged. This paper explores the relationship and power dynamic between researchers and public partners through the thematic analysis of interviews with fourteen researchers and six public contributors who were involved in projects that were identified as having many features associated with inclusive co-produced research. Public involvement was valued but the integration of scientific and lay knowledge on an equal basis was problematic. In practice, "co-opted relationships" were most common whereby public partners were slotted into a designated role created for them by the researcher/research team. There were though some examples of more equal partnerships being established to share power and decision-making including two cases where the research idea was initiated by the public partner. However, establishing an equal relationship and sharing power was constrained by the hierarchical nature of applied health research as well as issues around governance and accountability. Specifically, the positivist paradigm that predominates in applied health research and tends to privilege classically scientific ways of thinking, was a barrier to experiential knowledge being equally valued. This demonstrates the challenges inherent in establishing equal relationships and suggests that a transformation of research practices, culture and hierarchies is required for power sharing to become a reality. Specifically, the culture of applied health research needs to embrace more democratic participatory approaches, such as those used in research originating from the service user movement, as it is within these ways of working that public partners can more readily share power.
在英国，公众参与应用健康研究已成为从包括国家健康研究所在内的一些机构获得资金的先决条件。然而，这种参与大多被批评为表面文章，存在权力动态不平等的问题，即虽征求公众意见，但可能被忽视。为纠正这种不平衡，出现了更多参与性更强的参与方式，如共同生产。本文通过对14名研究人员和6名公众参与者的访谈进行主题分析，探讨了研究人员与公众伙伴之间的关系和权力动态，这些访谈对象参与了被认为具有许多与包容性共同生产研究相关特征的项目。公众参与受到重视，但在平等基础上整合科学知识和外行知识存在问题。实际上，“被拉拢的关系”最为常见，即公众伙伴被安排到研究人员/研究团队为他们设定的指定角色中。不过，也有一些建立更平等伙伴关系以分享权力和决策的例子，包括两个由公众伙伴发起研究想法的案例。然而，建立平等关系和分享权力受到应用健康研究等级制度以及治理和问责问题的限制。具体而言，应用健康研究中占主导地位的实证主义范式倾向于推崇经典科学思维方式，这是平等重视经验知识的障碍。这表明建立平等关系存在固有挑战，并暗示研究实践、文化和等级制度需要转变，权力共享才能成为现实。具体来说，应用健康研究文化需要接受更民主的参与方法，比如服务使用者运动发起的研究中所采用的方法，因为在这些工作方式中，公众伙伴能够更轻松地分享权力。
