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Open Access Highly Accessed Research article

Community participation to design rural primary healthcare services

Jane Farmer1* and Amy Nimegeer2

Author Affiliations

1 La Trobe Rural Health School, La Trobe University, Bendigo, Victoria 3552, Australia

2 School of Nursing, Midwifery and Health, University of Stirling, Stirling FK9 4LA, Scotland

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BMC Health Services Research 2014, 14:130  doi:10.1186/1472-6963-14-130

Published: 21 March 2014

Abstract

Background

This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services.

Methods

Community-based participatory action research was applied in four Scottish case study communities in 2008–10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented.

Results

Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation.

Conclusions

Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions.

Keywords:
Community participation; Primary health care; Rural health; Healthcare reform; Community engagement; Co-production; Population health planning