Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Center for Health Literacy and Rural Health Promotion, Accra, Ghana.
BMC Health Serv Res. 2021 Oct 5;21(1):1047. doi: 10.1186/s12913-021-07085-w.
Actively involving patients and communities in health decisions can improve both peoples' health and the health system. One key strategy is Patient-Public Engagement (PPE). This scoping review aims to identify and describe PPE research in Sub-Saharan Africa; systematically map research to theories of PPE; and identify knowledge gaps to inform future research and PPE development.
The review followed guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 was conducted on Scopus, Medline (Ovid), CINAHL and Embase databases. Independent full text screening by three reviewers followed title and abstract screening. Using a thematic framework synthesis, eligible studies were mapped onto an engagement continuum and health system level matrix to assess the current focus of PPE in Sub-Saharan Africa.
Initially 1948 articles were identified, but 18 from 10 Sub-Saharan African countries were eligible for the final synthesis. Five PPE strategies implemented were: 1) traditional leadership support, 2) community advisory boards, 3) community education and sensitisation, 4) community health volunteers/workers, and 5) embedding PPE within existing community structures. PPE initiatives were located at either the 'involvement' or 'consultation' stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the 'service design' level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the 'individual treatment' or 'macro policy/strategic' level.
This review has successfully identified and evaluated key PPE strategies and their focus on improving health systems in Sub-Saharan Africa. PPE in Sub-Saharan Africa was characterised by tokenism rather than participation. PPE implementation activities are currently concentrated at the 'service design' or health research levels. Investigation of PPE at all the health system levels is required, including prioritising patient/community preferences for health system improvement.
让患者和社区积极参与健康决策可以提高民众的健康水平和医疗体系的效率。其中一个关键策略是患者-公众参与（Patient-Public Engagement，PPE）。本研究旨在确定和描述撒哈拉以南非洲地区的 PPE 研究；系统地将研究映射到 PPE 理论上；并确定知识空白，为未来的研究和 PPE 发展提供信息。
本研究遵循开展和报告范围综述的指南。在 Scopus、Medline（Ovid）、CINAHL 和 Embase 数据库中对 1999 年 1 月至 2019 年 12 月发表的同行评议英文文献进行了系统检索。三位评审员独立进行全文筛选，之后进行标题和摘要筛选。使用主题框架综合法，将合格的研究映射到参与连续体和卫生系统层面矩阵上，以评估撒哈拉以南非洲地区 PPE 的当前重点。
最初确定了 1948 篇文章，但从 10 个撒哈拉以南非洲国家中只选出了 18 篇符合最终综合标准的文章。实施的 5 项 PPE 策略为：1）传统领导力支持，2）社区咨询委员会，3）社区教育和宣传，4）社区卫生志愿者/工作人员，和 5）将 PPE 嵌入现有的社区结构中。PPE 倡议位于参与连续体的“参与”或“咨询”阶段，而非更高阶段。大多数 PPE 研究处于卫生系统的“服务设计”水平，或专注于卫生研究中的参与。没有发现研究报告调查 PPE 在“个体治疗”或“宏观政策/战略”层面的情况。
本研究成功地确定并评估了撒哈拉以南非洲地区的关键 PPE 策略及其改善卫生系统的重点。撒哈拉以南非洲的 PPE 以象征性参与为特征，而非真正的参与。PPE 实施活动目前集中在“服务设计”或卫生研究层面。需要在所有卫生系统层面上调查 PPE，包括优先考虑患者/社区对卫生系统改进的偏好。
