THE ARTICULATION OF PUBLIC VALUES IN HEALTH TECHNOLOGY ASSESSMENT: THE USE OF DELIBERATIVE DISCOURSE

Abstract

Objectives: The use of interactive public engagement methods to elicit public values is becoming routine practice in health system planning, policy and evaluation; however, little systematic attention has been given to the analysis of how these values are articulated. This process will be examined with the use of deliberative discourse methods in the context of health technologies. Approach: The deliberations of a 14-person Citizens’ Reference Panel on Health Technologies were audiotaped and transcribed. The panel provided input to the Ontario Health Technology Advisory Committee in developing its recommendations. Discussion transcripts were analyzed using Gee’s (2005) ‘building tasks’ framework with a focus on identities, relationships, and politics. In depth language-context analysis was then used to study ‘situated meanings’ of social and ethical citizen values. Both levels of discourse analysis were then used to elicit the meso-level dynamics within the citizen panel deliberations. Results: Panel members used the provided materials, personal experience and other sources of information to express their values toward the technologies under review. In the group, members used their occupational, personal and cultural identities and adopted in-group citizen panel roles that involved summarizing small group discussions, challenging other members, providing information, providing expertise, interpreting information and facilitating. These individual roles were similar across meetings and members began to form relationships with their fellow citizens and make connections between the values involved in similar technologies. Conclusion: Discourse analysis methods can be used to draw in-depth insights from public engagement deliberations which contribute important new knowledge to the field of public deliberation and health policy. Further use and refinement of deliberative discourse methods will allow public values to be better understood and more adequately portrayed in the health technology assessment process.