A concept analysis of public participation in health care and health promotion governance: implications for theory, policy and practice

Purpose: The study focused on investigating the uses of the term “public participation” to clarify an important public policy concept for health governance as a firm foundation for theory building, policy and practice. Key questions concerned: What counts as participation? Who counts as a participant? And, is there legitimated space for dissent within this concept? Method: A combined methodology (Rodrigues, 2006) for the concept analysis of public participation use was adopted after three methods were extensively studied. Procedures were detailed for a systematic, random sampling of the professional, academic, theoretical and empirical literature from 1990 to 2012. Four disciplinary literatures (social work, sociology, political studies, and nursing) relevant to the field of health were surveyed. The databases furnished 336 documents, out of which 120 were randomly selected for study. Each document was read for construct definitions to ascertain the essential features and the contextual basis of the concept. Two distinct analysis phases were performed. Documents were divided by content into either theoretical or empirical studies, then, sorted into use areas. Findings: Analysis found three typical uses (intended, borderline, and contrary) characterized as prudent, spurious, and pernicious types of public participation. Pernicious types account for 40% of the literature surveyed, spurious types account for 37%, followed by prudent types at 23% (though most were failed examples). Normalized inconsistencies between purported ideals and their application were found across all the disciplines. A suggested polarization between theory and practice was strongest in the social work literature, while the nursing literature was striking for its consolidation of spurious and pernicious types. In short, a probability sampling of the literature suggests marginal and contrary uses of the concept predominate in the field. A Trichotomy of Public Participation Use is presented based on the determining criteria found, indicating the need to: affirm constituency interest in participant constructions for open negotiation, not just discussion; admit conflict and dissent as indicators of a healthy functioning democracy; privilege the interests of the poor in public participation designs and practice; and secure commitment from authorities to tie public participation mechanisms to the policy process in representative systems. Implications: The scope of this concept has contracted and continues narrowing by way of normalized contradictions that are well circulated within major discourses. Unless we are prudent with our thinking and theory building, the conceptual architecture for public participation is merely repackaging the master narrative to more effectively disseminate the logics of neoliberalism.

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