Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran

Revisando Conceptos de Acceso, Trayectorias, Participación y Conocimiento Tácito en Investigaciones Sobre Pacientes y Cobertura en Salud

OBJECTIVES

This study aimed to characterize 5 approaches that have been developed in research on patients and health coverage, which reveal information from the perspective of patients: (1) access to healthcare, (2) therapeutic trajectories, (3) social participation in decision making on health coverage, (4) tacit knowledge, and (5) communities of practice.

METHODS

This is a narrative literature review, based on searches performed in PubMed/MEDLINE and Web of Science, between August and December 2021. A total of 45 scientific articles were selected for analysis, which were complemented by a gray literature search that provided 6 additional manuscripts.

RESULTS

Improving access to health services requires an understanding of the meaning of the concept of access from the users themselves. The patient trajectory approach contributes by emphasizing that the focus of analysis must adopt the patient's perspective, given that it provides valuable information for the decision making on health coverage. In addition, the role that social participation has in the process to grant trust and legitimacy is described. Tacit knowledge makes explicit the importance of revealing it as a source of information that adds value to the decision-making process. Finally, communities of practice are described as spaces where new ways of experiencing the disease originate, as well as ways of relating to the health system and its actors.

CONCLUSIONS

The article raises the relevance that various social actors know these approaches, as well as strategies to integrate them into the assessment processes in terms of health coverage.

Designing a Framework for Attracting Public Participation in the Iranian Health System: A Comparative and Mixed-Method Study

Background: Public participation strengthens the public presence in healthcare. Objectives: This study aimed to determine the dimensions of attracting public participation in the Iranian health system. Methods: A mixed-method research was conducted from May 2019 to July 2020. A comparative study (using the documents of five countries that were selected purposefully), tool design and validation (through holding two expert panels with the participation of 26 people who were selected based on the inclusion criteria), and finalization of the participation framework (field test with the participation of 283 recruited people based on the inclusion criteria) were performed. Exploratory and confirmatory factor analyses (CFA) were applied using SPSS-v26 and AMOS-v26. Results: Forty-eight components on five factors, including citizenship rights and customer orientation, socioeconomic factors, communication with people and non-governmental organizations, research and technology, and managerial and organizational factors with impact factors of 0.967, 0.951, 0.957, 0.944, and 0.955 were loaded, respectively. The CFA denoted the approval of the framework with the five mentioned factors. Conclusions: In this study, a framework was developed and approved during different stages. Using this framework, healthcare policymakers can adopt the best strategies for engaging public participation and improving the effectiveness of decisions through evidence-informed policymaking.

Themes for evaluating the quality of initiatives to engage patients and family caregivers in decision-making in healthcare systems: a scoping review

OBJECTIVE

To identify the key themes for evaluating the quality of initiatives to engage patients and family caregivers in decision-making across the organisation and system domains of healthcare systems.

METHODS

We conducted a scoping review. Seven databases of journal articles were searched from their inception to June 2019. Eligible articles were literature reviews published in English and provided useful information for determining aspects of engaging patients and family caregivers in decision-making to evaluate. We extracted text under three predetermined categories: structure, process and outcomes that were adapted from the Donabedian conceptual framework. These excerpts were then independently open-coded among four researchers. The subsequent themes and their corresponding excerpts were summarised to provide a rich description of each theme.

RESULTS

Of 7747 unique articles identified, 366 were potentially relevant, from which we selected the 42 literature reviews. 18 unique themes were identified across the three predetermined categories. There were six structure themes: engagement plan, level of engagement, time and timing of engagement, format and composition, commitment to support and environment. There were four process themes: objectives, engagement approach, communication and engagement activities. There were eight outcome themes: decision-making process, stakeholder relationship, capacity development, stakeholder experience, shape policy/service/programme, health status, healthcare quality, and cost-effectiveness.

CONCLUSIONS

The 18 themes and their descriptions provide a foundation for identifying constructs and selecting measures to evaluate the quality of initiatives for engaging patients and family caregivers in healthcare system decision-making within the organisation and system domains. The themes can be used to investigate the mechanisms through which relevant initiatives are effective and investigate their effectiveness.