School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia.
ACT Disability, Aged and Carer Advocacy Service, Canberra, ACT, Australia.
Qual Health Res. 2024 Sep;34(11):1007-1018. doi: 10.1177/10497323231221674. Epub 2024 Jan 16.
There has been a growing emphasis on consumer representation in the development of health policy, services, research, and education. Existing literature has critiqued how discourses of representativeness can disempower consumers working in health systems. The context of the current study is consumer engagement in the development of COVID-19 triage policy and practice in a local health service. Consumer engagement has often been an afterthought in the COVID response, with few examples of consumers in agenda-setting or decision-making roles. In the Australian Capital Territory, 26 consumer, carer, and community groups worked together with academics and clinicians to develop these principles. Interviews were conducted with stakeholders (including consumers, clinicians, and other health professionals) to evaluate the development of triage principles. A discursive psychological approach to analysis was used to explore participants' understandings about and constructions of consumers being representative (or not) and how this may reproduce power imbalances against consumers. The results explore two distinct ways in which participants talked about consumer representativeness: the first drawing on rhetoric about consumers as lay members of the public (as distinct from being professionally engaged in the health sector), and the second in terms of consumer representatives being diverse and having intersectional identities and experiences. Expectations about consumers to be representative of the general population may reproduce traditional power imbalances and silence lived experience expertise. These power imbalances may be challenged by a shift in the way representativeness is conceptualised to requiring health services to seek out diverse and intersectionally marginalised consumers.
在卫生政策、服务、研究和教育的制定中,越来越强调消费者的代表性。现有文献批评了代表性话语如何使在卫生系统中工作的消费者失去权力。本研究的背景是消费者参与当地卫生服务部门制定 COVID-19 分诊政策和实践。在 COVID-19 应对措施中,消费者参与通常是事后考虑的,很少有消费者在议程设置或决策角色中的例子。在澳大利亚首都领地,26 名消费者、照顾者和社区团体与学者和临床医生一起制定了这些原则。对利益相关者(包括消费者、临床医生和其他卫生专业人员)进行了访谈,以评估分诊原则的制定情况。采用话语心理学方法对参与者对消费者代表性(或不代表性)的理解和构建进行了分析,并探讨了这可能如何再现对消费者的权力失衡。结果探讨了参与者谈论消费者代表性的两种截然不同的方式:第一种方式是基于消费者作为公众的外行成员(与在卫生部门专业参与不同)的修辞,第二种方式是消费者代表的多样性以及具有交叉身份和经验。期望消费者能够代表普通大众,这可能会再现传统的权力失衡和对生活经验专业知识的沉默。通过将代表性概念化为要求卫生服务机构寻找多样化和交叉边缘化的消费者,可以挑战这种权力失衡。