Abstract
This article describes partial results from a case study of community participation in “New Directions for a Healthy B.C.”, a now-abandoned health reform policy. For this study, focus groups were conducted to explore the perspectives of traditionally under-represented citizens in understanding reasons for nonparticipation and to identify strategies for fostering participation in the health reform process. The findings indicate that participating in traditional ways — committee meetings, public fora, completing surveys — was not relevant to the realities of these individuals. Yet, rather than merely refusing to be involved, focus group members extended an invitation for health planning group members to experience their daily lives; an idea that is referred to in the literature as ‘experiential participation’. In order to foster broad-based participation in community health initiatives, the findings from this study argue for a new understanding of, and appreciation for what actually constitutes participation.
Résumé
Cet article décrit les résultats partiels d’une étude de cas impliquant la participation de la communauté sur „les nouvelles directives pour une Colombie-Britannique en bonne santé”, programme de réforme sur la santé maintenant annulé. Pour cette étude, des groupes d’observation furent établis afin d’étudier le point de vue de citoyens habituellement sous-représentés et pour comprendre les raisons de leur manque de participation ainsi que pour identifier les stratégies qui inciteront leur participation au processus de réforme sur la santé. Les résultats indiquent qu’une participation de type tradi-tionnel (réunions de comités, forum au public, sondages) ne s’accordait pas à la réalité quotidienne de ces individus. Cependant, plutôt que de simplement refuser de s’impliquer dans les recherches, les membres des groupes d’observation ont invité les autres participants à venir observer leur vie de tous les jours — un concept auquel on fait souvent référence sous le terme de „participation expérimentale.” Afin d’encourager une vaste participation aux initiatives sur la santé au niveau de la communauté, les résultats de cette étude montrent à la fois une nouvelle compréhension et une nouvelle appréciation des éléments constituant réellement la participation.
References
- 1.United Nations. Community Involvement in Primary Health Care: A Study of the Process of Community Motivation and Continued Participation. Geneva: WHO; 1977. [Google Scholar]
- 2.World Health Organization. Expert Committee on the Health Education of the Public. Geneva: WHO Technical Report Series; 1954. [PubMed] [Google Scholar]
- 3.World Health Organization. Alma-Ata 1978 Primary Health Care. Geneva: WHO; 1978. [Google Scholar]
- 4.World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: WHO Regional Office for Europe; 1986. [Google Scholar]
- 5.World Health Organization. Concept and Principles of Health Promotion, a Discussion Document. Copenhagen: WHO Regional Office for Europe; 1984. [Google Scholar]
- 6.Christenson JA, Robinson JW, editors. Community Development in Perspective. Iowa: Iowa State University Press; 1989. [Google Scholar]
- 7.Roberts H. Community Development: Learning and Action. Toronto: University of Toronto Press; 1979. [Google Scholar]
- 8.Harris EM. Accessing community development research methodologies. Can J Public Health. 1992;83(1):S62–S66. [PubMed] [Google Scholar]
- 9.Canadian Public Health Association Board of Directors Issue Paper. Focus on health — public health in health services restructuring. Can J Public Health. 1996;87(1):I1–I56. [PubMed] [Google Scholar]
- 10.Prior D, Stewart J, Walsh K. Citizenship: Rights, Community and Participation. London: Pitman Publishing; 1995. [Google Scholar]
- 11.Chrislip D. National Civic Review. 1995. Pulling together — creating a constituency for change; pp. 21–29. [Google Scholar]
- 12.Wolf M. Social Policy. 1993. Involving the community in national service; pp. 14–20. [Google Scholar]
- 13.Syme GJ, Nancarrow BE. Predicting public involvement in urban water management and planning. Environment and Behavior. 1992;24(6):738–58. [Google Scholar]
- 14.Henderson LJ. Metropolitan governance: Citizen participation in the urban federation. National Civic Review. 1990;79(2):105–17. [Google Scholar]
- 15.Hutchison P. Community development in recreation services: Why not? Plan Canada. 1998;38(1):5–7. [Google Scholar]
- 16.Ferderber R, Fortier M, Hopkins J. Taking the pulse of Canadian health and health care. Plan Canada. 1997;37(3):26–28. [Google Scholar]
- 17.Levin LS. Public participation in health care quality. J Epidemiol Commun Health. 1995;49:348–53. doi: 10.1136/jech.49.4.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Poulin J, Kauffman S. Citizen participation in prevention activities: Path model II. J Commun Psychol. 1995;23:234–49. [Google Scholar]
- 19.Tuloss JK. Citizen participation in Boston’s development policy. Urban Affairs Review. 1995;30(4):514–37. [Google Scholar]
- 20.Henry G, Basile K. Understanding the decision to participate in formal adult education. Adult Educ Q. 1994;44(2):64–82. [Google Scholar]
- 21.Jones P. Local Transport Today. 1993. Will the public accept it? Involving the community in transport planning. [Google Scholar]
- 22.Sancar FH. An integrative approach to public participation and knowledge generation in design. Landscape Urban Planning. 1993;26:67–88. [Google Scholar]
- 23.Persons GA. Defining public interest: Citizen participation in metropolitan and state policy making. National Civic Review. 1990;79(2):118–31. [Google Scholar]
- 24.Thomas JC. Public Admin Review. 1990. Public involvement in public management: Adapting and testing a borrowed theory; pp. 435–45. [Google Scholar]
- 25.Jewkes R, Murcott A. Community representatives: Representing the “community”? Soc Sci Med. 1998;46(7):843–58. doi: 10.1016/s0277-9536(97)00209-8. [DOI] [PubMed] [Google Scholar]
- 26.Julian D, Reischl R, Carrick R, Katrenich C. Am Planners Assoc J. 1997. Citizen participation — lessons from a local united way planning process; pp. 345–55. [Google Scholar]
- 27.Lomas J, Veenstra G. Policy Options. 1995. If you build it, who will come? pp. 37–40. [Google Scholar]
- 28.Piette D. Community participation in formal decision-making mechanisms. Health Prom Int. 1990;5(3):187–97. [Google Scholar]
- 29.Sullivan M, Scattolon Y. Health policy planning: A look at consumer involvement in Nova Scotia. Can J Public Health. 1995;86(5):317–20. [PubMed] [Google Scholar]
- 30.Sundeen RA. Explaining participation in coproduction: A study of volunteers. Soc Science Q. 1988;69:547–68. [Google Scholar]
- 31.Checkoway B. The politics of public hearings. J Appl Behav Sci. 1981;17(4):566–79. [Google Scholar]
- 32.Gittel M. Limits to Citizen Participation. Beverly Hills, CA: Sage Publications; 1980. [Google Scholar]
- 33.Millbrath LW. Citizen surveys as citizen participation mechanisms. J Appl Behav Sci. 1981;17(4):478–96. [Google Scholar]
- 34.Kathlene L, Martin JA. Enhancing citizen participation: Panel designs, perspectives and policy formation. J Policy Analysis Management. 1991;101:46–63. [Google Scholar]
- 35.Brown C. New Statesman and Society. 1989. Citizens’ rights. [Google Scholar]
- 36.McCarron G, Tenenbein S, Hindley P. Communication, belonging and health. In: Hayes M, Foster L, Foster H, editors. The Determinants of Population Health. Victoria, BC: University of Victoria; 1994. pp. 57–72. [Google Scholar]
- 37.Wharf B. Communities and Social Policy in Canada. Toronto: McLelland and Stewart; 1992. [Google Scholar]
- 38.Young IM. Polity and group difference: A critique of the ideal of universal citizenship. Ethics. 1989;99:250–74. [Google Scholar]
- 39.Freeman C, Littlewood S, Whitney D. Local government and emerging models of participation in the Local Agenda 21 process. J Environment Planning Management. 1996;39(1):65–78. [Google Scholar]
- 40.Wallerstein N. Powerlessness, empowerment and health: Implications for health promotion programs. Am J Health Prom. 1992;6(3):197–205. doi: 10.4278/0890-1171-6.3.197. [DOI] [PubMed] [Google Scholar]
- 41.Singer MA. Public participation in setting health-care priorities: Should it be done and can it be done? Ann Royal Can Phys Surgeon’s College. 1994;27(5):275–78. [Google Scholar]
- 42.Stachenko S. National opportunities for health promotion: The Canadian experience. Health Prom Int. 1994;9(2):105–10. [Google Scholar]
- 43.Green LW, Kreuter MW. Are community organization and health promotion one process or two? Am J Health Prom. 1993;7(3):221. [Google Scholar]
- 44.Bracht N, Tsouros A. Principles and strategies of effective community participation. Health Prom Int. 1990;5(3):199–208. [Google Scholar]
- 45.Powell M, Faghfoury N, Hill K, Nyhenuis P. Knowledge Development for Health Promotion. Ottawa: Health Services and Promotion Branch Working Paper, Health and Welfare Canada; 1989. Fostering public participation; pp. 169–75. [Google Scholar]
- 46.British Columbia Ministry of Health. New Directions for a Healthy British Columbia. Victoria: British Columbia Ministry of Health and Ministry Responsible for Seniors; 1993. [Google Scholar]
- 47.Crabtree B, Miller W. Doing Qualitative Research. Newbury Park, CA: Sage; 1992. [Google Scholar]
- 48.Diekelman N, Schuster R, Lam S. Martin User Guide, Version 2.0. Madison: University of Wisconsin, School of Nursing; 1991. [Google Scholar]
- 49.Patton MQ. Qualitative Research and Evaluation Methods. Newbury Park, CA: Sage; 1990. [Google Scholar]
- 50.Wharf Higgins J. Social marketing and MARTIN: Tools for organizing, analyzing and interpreting qualitative data. Qualitative Health Research. 1998;8(6):867–76. doi: 10.1177/104973239800800611. [DOI] [PubMed] [Google Scholar]
- 51.Paul B, Demarest W. Citizen participation over-planned: The case of a health project in the Guatemalan community of San Pedro La Laguna. Soc Sci Med. 1984;19(3):185–92. doi: 10.1016/0277-9536(84)90209-0. [DOI] [PubMed] [Google Scholar]
- 52.Travers K. Reducing inequities through participatory research and community empowerment. Health Educ Behav. 1997;24(3):344–56. doi: 10.1177/109019819702400307. [DOI] [PubMed] [Google Scholar]
- 53.Gilbert A. Forms and effectiveness of community participation in squatter settlements. Regional Development J. 1987;8(4):56–80. [Google Scholar]
- 54.Hofman N, Davidson G. Moving toward effective decision-making. Plan Canada. 1997;37(3):29–32. [Google Scholar]
- 55.Phillips A. Democracy and difference: Some problems for feminist theory. In: Kymlicka W, editor. The Rights of Minority Cultures. Oxford: Oxford University Press; 1995. pp. 288–302. [Google Scholar]
- 56.Beresford P, Trevillion S. Developing Skills for Community Care. England: Arena; 1995. [Google Scholar]
- 57.Lord J. Personal empowerment and active living. In: Quinney HA, Gauvin L, Wall AET, editors. Toward Active Living. Windsor, ON: Human Kinetics Publishers; 1994. pp. 213–18. [Google Scholar]
- 58.Lusthaus E. Making a contribution: An emerging social role for persons with a mental handicap. Entourage. 1986;1(2):24–31. [Google Scholar]
- 59.Crawshaw R. Grass roots participation in health care reform. Ann Int Med. 1994;120(8):677–81. doi: 10.7326/0003-4819-120-8-199404150-00009. [DOI] [PubMed] [Google Scholar]
- 60.Anderson M, Meaton J, Potter C. Public participation, an approach using aerial photographs at Ashford, Kent. Town Planning Review. 1994;65(1):41–58. [Google Scholar]
- 61.Kubiski WS. Citizen Participation in the ’90s: Realities, Challenges and Opportunities. 1990. [Google Scholar]
- 62.Berry JM, Portney KE, Thomson K. The Rebirth of Urban Democracy. Washington, DC: Brookings Institute; 1993. [Google Scholar]
- 63.Marshall N, Roberts R. That thing called public involvement. Plan Canada. 1997;37(3):8–11. [Google Scholar]
- 64.Glaser MA, Denhardt KG, Grubbs JW. Local government-sponsored community development, exploring relationships between perceptions of empowerment and community impact. Am Review Public Admin. 1997;27(1):76–94. [Google Scholar]
- 65.Kelly K, Van Vlaenderen H. Dynamics of participation in a community health project. Soc Sci Med. 1996;42(9):1235–46. doi: 10.1016/0277-9536(95)00218-9. [DOI] [PubMed] [Google Scholar]
- 66.Schulz AJ, Israel BA, Zimmerman MA, Checkoway B. Empowerment as a multi-level construct: Perceived control at the individual, organizational and community levels. Health Educ Res. 1995;10(3):309–27. [Google Scholar]