The Participation of Marginalized Populations in Health Services Planning and Decision Making

Abstract

<p>Community participation has been identified as a key facilitator of community health among marginalized populations in international health statements. However, knowledge gaps in the community participation literature regarding marginalized populations has been attributed to the lack of consistent definitions of community participation, ambiguity about the features of community participation initiatives (e.g., methods and strategies) that are appropriate for marginalized populations, and limitations of existing community participation frameworks in specifying the ways and means in which different marginalized populations might effectively participate, as well as in recognizing that community participation is highly contextual and situational. All of these factors have made it difficult to draw broader conclusions about the impact of participation methods and strategies for marginalized populations from evaluations of participation initiatives.</p> <p>The overall purpose of this thesis is to better understand how to involve marginalized populations in the planning and decision-making for local health services. First, a critical interpretive synthesis (CIS) was conducted to better understand the role of community development principles used in community participation initiatives with marginalized populations and the factors contributing to the influence of the principles in enabling the participation of these populations. Second, an in-depth comparative case study of four community participation initiatives in Ontario Community Health Centres (CHCs)—which are primary health care organizations serving 74 high-risk communities throughout the Province of Ontario—was conducted to identify the core features of participation initiatives with marginalized populations, and reflect on the particular challenges of engaging marginalized populations. Third, four focus groups were held at four Ontario CHCs to examine the role of frameworks as mechanisms for translating knowledge about community participation practice with marginalized populations. Overall, this thesis broadens our understanding of community participation with marginalized populations in the context of local health services planning and decision making. Specifically, this thesis contributes a theoretical basis for future research and provides practical knowledge for planning and evaluating community participation initiatives with marginalized populations.</p>