Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran
Keywords:
Patient and public involvement, Conceptual model, Healthcare system, IranAbstract
Introduction: Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system.
Methods: A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics’ involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data.
Results: In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well.
Conclusion: Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and legitimate the representative of people they served for. This model can provide a practical guide for managers and policy makers to involve people in making the decisions that influence their lives.
References
Church J, Saunders D, Wanke M, Pong R, Spooner C, Dorgan M. Citizen Participation in health decision- making: past experience and future prospects. J Public Health Policy. 2002; 23(3): 12-32. doi:
2307/3343116, PMID: 12013713.
Declaration of Alma-Ata. International Conference on Primary Health Care, Alma- Ata, USSR, 6–12
September 1978. Available from: http://www.who.int/hpr/archive/docs/almaata.html
Department of Health. Patient and Public Involvement in the New NHS, London: Stationary Office, 1999.
Health Canada, Public Involvement: Model and Guidelines, Ottawa: Minister of Public Works and
Government Services, 2000.
Kitzhaber JA, 1993. Prioritizing health services in an era of limits: the Oregon experience. B M J. 1993;
(6900): 373-7. doi: 10.1136/bmj.307.6900.373, PMID: 8374424, PMCID: PMC1678226.
World Health Organization, Regional Health Systems Observatory- EMRO, Health Systems ProfileIslamic Republic of Iran, 2006.
Aryankhesal A. The Iranian hospital grading system and its influence on stakeholders’ behavior. PhD
thesis. The University of York, 2010.
Rangrazjedi F, Rabiee R. Patient’s Bill of Rights in Kashan`s hospitals (Iran). Behbood. 2005; 10(1): 62- 71.
Joolaee S, Nikbakht-Nasrabadi, A, Parsa-Yekta, Z, Tschudin V, Mansouri I. An Iranian perspective on
patients' rights. Nurs Ethics. 2006; 13(5): 488-502. PMID: 16961113.
Heyrani A, Maleki M, Marnani AB, Ravaghi H, Sedaghat M, Jabbari M, et al. Clinical governance
implementation in a selected teaching emergency department: a systems approach. Implement Sci. 2012; 7:
PMID: 22963589.
Office of Hospital Management and Clinical Excellence: An introduction to essentials of clinical
governance (in Persian). Tehran, Iran: Ministry of Health and Medical Education; 2011.
Ravaghi H, Mohseni M, Rafiei S, Zadeh NS, Mostofian F, Heidarpoor P. Clinical Governance in Iran:
Theory to Practice. Procedia-Social and Behavioral Sciences. 2014; 109, 1174-9. doi:
1016/j.sbspro.2013.12.607.
Southampton University Hospitals NHS Trust (SUHT). Patient and Public Involvement Strategy 2011- 2014. Available from: http://www.uhs.nhs.uk/
Maloff B, Bilan D, Thurston W. Enhancing public input into decision making: Development of the Calgary
Regional Health Authority public participation model. Family & Community Health. 2000; 23(1): 66-78.
doi: 10.1097/00003727-200004000-00008
Burns KK, Bellows M, Eigenseher C, Gallivan J. Practical’ resources to support patient and family
engagement in healthcare decisions: a scoping review. BMC Health Serv Res. 2014; 14(1): 175. doi:
1186/1472-6963-14-175, PMID: 24735787, PMCID: PMC4005635.
Caddy J, Vergez C. Citizens as Partners: Information, Consultation and Public Participation in Policy- Making. Paris: Organisation for Economic Cooperation and Development; 2001.
Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, Sweeney J. Patient and family
engagement: a model for understanding the elements and developing interventions and policies. Health
Affairs. 2013; 32(2): 223-31. doi: 10.1377/hlthaff.2012.1133.
Cleemput I, Christiaens W, Kohn L, Léonard C, Daue F, Denis A. Acceptability and Perceived Benefits
and Risks of Public and Patient Involvement in Health Care Policy: A Delphi Survey in Belgian
Stakeholders. Value in Health. 2015; 18(4): 477-83. doi: 10.1016/j.jval.2014.12.015.
Whitty JA, Burton P, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. Harnessing the
potential to quantify public preferences for healthcare priorities through citizens’ juries. Int J Health Policy
Manag. 2014; 3(2): 57-62. doi: 10.15171/ijhpm.2014.61, PMID: 25114943, PMCID: PMC4122074.
Christiaens W, Kohn L, Léonard C, Denis A, Daue F, Cleemput I. Models for citizen and patient
involvement in health care policy Part I: exploration of their feasibility and acceptability. Health Services
Research (HSR). Brussels: Belgian Health care Knowledge Centre (KCE). 2012. KCE Reports 195C.
D/2012/10.273/105.
Morgan LM. Community participation in health: perpetual allure, persistent challenge. Health policy plan.
; 16(3): 221-30. doi: 10.1093/heapol/16.3.221, PMID: 11527862.
Momeni M. New topics in operations research, first edition, Tehran, Tehran University press, 2006
Boudioni M, McLaren S. Challenges and facilitators for patient and public involvement in England; focus
groups with senior nurses. Open Journal of Nursing, 2013; 3(07): 472. doi: 10.4236/ojn.2013.37064.
Pivik JR. Practical strategies for facilitating meaningful citizen involvement in health planning.
Commission on the Future of Health Care in Canada. 2002.
Sykes C, Goodwin W. Assessing patient, carer and public involvement in health care. Quality in Primary
Care. 2007; 15(1): 45-52.
Abelson J, Forest PG, Eyles J, Smith P, Martin E, Gauvin FP, 2003. Deliberations about deliberative
methods: issues in the design and evaluation of public participation processes. Social science &
medicine.2003; 57(2): 239-51. doi: 10.1016/S0277-9536(02)00343-X.
Marzano G, Lubkina V, Skurvydas A. Citizens’ participation in healthcare: a productive opportunity or just
a populist ethic idea? Hygeia. 2013; 48(2): 129-36.
Kapiriri L, Norheim OF, Heggenhougen K. Public participation in health planning and priority setting at
the district level in Uganda. Health policy plan. 2003; 18(2): 205-13. PMID: 12740325. 29) Tritter JQ. Revolution or evolution: the challenges of conceptualizing patient and public involvement in a
consumerist world. Health Expect. 2009; 12(3): 275-87. doi: 10.1111/j.1369-7625.2009.00564.x, PMID:
Barnes M, Coelho VS. Social participation in health in Brazil and England: inclusion, representation and
authority. Health Expect. 2009; 12(3): 226-36. doi: 10.1111/j.1369-7625.2009.00563.x, PMID: 19754687.
Armstrong N, Herbert G, Aveling EL, Dixon Woods M, Martin G. Optimizing patient involvement in
quality improvement. Health Expect. 2013; 16(3): e36-e47. doi: 10.1111/hex.12039.
Arnstein S. A ladder of citizen participation. American Institute of Planners Journal. 1969; 35: 216-24. doi:
1080/01944366908977225.
Charles CA, DeMaio S. Lay participation in health care decision-making: a conceptual model. J Health
Polit Policy Law. 1993; 18: 881–904. doi: 10.1215/03616878-18-4-881.
International Association for Public Participation: IAP2 Spectrum of Public Participation
Kolasa K, Hermanowski T, Borek E. Importance of public participation in decision-making process in
healthcare system illustarted with an example of the development of American and Polish scope of health
benefit basket. Przegl Epidemiol. 2013; 67(4): 661-6, 749-54. PMID: 24741914.
Li KK, Abelson J, Giacomini M, Contandriopoulos D. Conceptualizing the use of public involvement in
health policy decision-making. Soc Sci Med. 2015; 138: 14-21. doi: 10.1016/j.socscimed.2015.05.023,
PMID: 26043073.
Linhorst DM, Eckert A, Hamilton G, Young E. The involvement of a consumer council in organizational
decision making in a public psychiatric hospital. J Behav Health Serv Res. 2001; 28(4): 427-38. PMID:
Wait S, Nolte E. Public involvement policies in health: exploring their conceptual basis. Health Econ
Policy Law. 2006; 1(02): 149-62. doi: 10.1017/S174413310500112X.
Crawford MJ, Rutter D, Manley C, Weaver T, Bhui K, Fulop N, et al. Systematic review of involving
patients in the planning and development of health care. BMJ. 2002; 325(7375): 1263. PMID: 12458240.
Pizzo E, Doyle C, Matthews R, Barlow J. Patient and public involvement: how much do we spend and
what are the benefits? Health Expect. 2015; 18(6): 1918-26. doi: 10.1111/hex.12204, PMID: 12458240.
Thurston WE, MacKean G, Vollman A, Casebeer A, Weber M, Maloff B, et al. Public participation in
regional health policy: a theoretical framework. Health Policy. 2005; 73(3): 237-52. doi:
1016/j.healthpol.2004.11.013, PMID: 16039343.
Ridley J, Jones L. User and public involvement in health services: A literature review. 2005; Partners in
Change [Scottish Human Services Trust].
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
