Jessica Drinkwater
Patient influence on general practice service improvement decision making: a participatory research mixed-methods intervention study
Drinkwater, Jessica; MacFarlane, Anne; Twiddy, Maureen; Meads, David; Chadwick, Ruth H.; Donnelly, Ailsa; Gleeson, Phil; Hayward, Nick; Kelly, Michael; Mir, Robina; Prestwich, Graham; Rathfelder, Martin; Foy, Robbie
Authors
Anne MacFarlane
Dr Maureen Twiddy M.Twiddy@hull.ac.uk
Reader in Mixed Methods Research
David Meads
Ruth H. Chadwick
Ailsa Donnelly
Phil Gleeson
Nick Hayward
Michael Kelly
Robina Mir
Graham Prestwich
Martin Rathfelder
Robbie Foy
Abstract
BACKGROUND: Health policy promotes patient participation in decision making about service organisation. In English general practice this happens through contractually required patient participation groups (PPGs). However, there are problems with the enactment of PPGs that have not been systematically addressed. AIM: To observe how a co-designed theory-informed intervention can increase representational legitimacy and facilitate power sharing to support PPGs to influence decision making about general practice service improvement. DESIGN AND SETTING: Participatory action research to implement the intervention in two general practices in the North of England was undertaken. The intervention combined two different participatory practices: partnership working involving externally facilitated meetings with PPG members and staff; and consultation with the wider patient population using a bespoke discrete choice experiment (DCE). METHOD: To illustrate decision making in PPGs, qualitative data are presented from participant observation notes and photographed visual data generated through participatory methods. The DCE results are summarised to illustrate how wider population priorities contributed to overall decision making. Observational data were thematically analysed using normalisation process theory with support from a multi-stakeholder co-research group. RESULTS: In both general practices, patients influenced decision making during PPG meetings and through the DCE, resulting in bespoke patient-centred action plans for service improvement. Power asymmetries were addressed through participatory methods, clarification of PPG roles in decision making, and addressing representational legitimacy through wider survey consultation. CONCLUSION: Combining participatory practices and facilitated participatory methods enabled patients to influence decision making about general practice service improvement. The policy of mandatory PPGs needs updating to recognise the need to resource participation in a meaningful way.
Citation
Drinkwater, J., MacFarlane, A., Twiddy, M., Meads, D., Chadwick, R. H., Donnelly, A., Gleeson, P., Hayward, N., Kelly, M., Mir, R., Prestwich, G., Rathfelder, M., & Foy, R. (2024). Patient influence on general practice service improvement decision making: a participatory research mixed-methods intervention study. The British journal of general practice : the journal of the Royal College of General Practitioners, 74(745), e552-e559. https://doi.org/10.3399/BJGP.2023.0263
Journal Article Type | Article |
---|---|
Acceptance Date | Oct 18, 2023 |
Online Publication Date | Dec 14, 2023 |
Publication Date | Aug 1, 2024 |
Deposit Date | Nov 1, 2023 |
Publicly Available Date | Feb 28, 2024 |
Journal | The British journal of general practice : the journal of the Royal College of General Practitioners |
Print ISSN | 0960-1643 |
Publisher | Royal College of General Practitioners |
Peer Reviewed | Peer Reviewed |
Volume | 74 |
Issue | 745 |
Article Number | BJGP-2023-0263.R2. |
Pages | e552-e559 |
DOI | https://doi.org/10.3399/BJGP.2023.0263 |
Keywords | General practice; Patient participation; Participatory research |
Public URL | https://hull-repository.worktribe.com/output/4429758 |
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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0
Copyright Statement
© 2023 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0/). Published by British Journal of General Practice.
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