Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
Monash Rural Health, Monash University, Bendigo, VIC, Australia.
Qual Health Res. 2023 Sep;33(11):983-994. doi: 10.1177/10497323231191048. Epub 2023 Aug 7.
While health services are expected to have public involvement in service (re)design, there is a dearth of evaluation of outcomes to inform policy and practice. There are major gaps in understanding why outcome evaluation is under-utilised. The aims of this interpretive descriptive study were to explore researcher participants' experiences of and/or attitudes towards evaluating health service outcomes from public involvement in health service design in high-income countries. Additionally, the aims were to explore barriers and enablers of evaluation, and reasons for the use of evaluation tools or frameworks. Semi-structured interviews ( = 13) were conducted with researchers of published studies where the public was involved in designing health services. Using framework analysis, four themes were developed that captured participants' experiences: Public involvement is hard - evaluation is harder; power, a diversity of agendas, and the invisible public; practical and methodological challenges; and genuineness and authenticity matter. Evaluation is driven by stakeholder requirements, including decision-makers, funding bodies, researchers, and academics, and evaluation tools are rarely used. The public is largely absent from the outcome evaluation agenda. There is a lack of commitment and clarity of purpose of public involvement and its evaluation. Outcome evaluation must be multi-layered and localised and reflect the purpose of public involvement, what constitutes success (and to whom), and use the most appropriate methods. Multi-level supports should include increased resources, such as funding, time, and expertise. Without improved evaluation, outcomes of investment in public involvement in health service design/redesign remain unknown.
虽然卫生服务机构预计将公众参与纳入服务（重新）设计，但评估结果以提供政策和实践依据的工作却很少。人们对为什么评估结果的利用不足理解甚少。本解释性描述性研究的目的是探索研究参与者对来自高收入国家公众参与卫生服务设计的卫生服务结果评估的经验和/或态度。此外，还旨在探讨评估的障碍和促进因素，以及使用评估工具或框架的原因。对参与了设计卫生服务的公众的已发表研究的研究人员进行了半结构化访谈（n = 13）。使用框架分析，确定了四个主题，这些主题捕捉了参与者的经验：公众参与很困难-评估更难；权力、议程多样性和看不见的公众；实际和方法学挑战；以及真实性很重要。评估是由利益相关者的要求驱动的，包括决策者、资助机构、研究人员和学者，很少使用评估工具。公众在结果评估议程中基本缺席。公众参与及其评估的承诺和目的缺乏明确性。结果评估必须是多层次和本地化的，反映公众参与的目的、成功的标准（以及对象），并使用最合适的方法。多层级支持应包括增加资源，如资金、时间和专业知识。如果不改进评估，对卫生服务设计/重新设计中公众参与投资的结果仍将不得而知。
