Informed People Create Change: Community engagement for health promoting networks (Part 1)
“Would you tell me, please, which way I ought to go from here?" said Alice.
"That depends a good deal on where you want to get to," said the Cat.
Alice's Adventures in Wonderland
What does it all mean?
There is widespread acknowledgement that a more deliberate focus on the people who are meant to be served by health care is needed, but often less clarity about how to go about it. Sometimes people jump directly to "how?" without first sorting out exactly what they are trying to achieve. While different concepts and diffuse motivations remain tangled together, solutions can often remain elusive.
The aim of this series is to discuss the nexus between community engagement and a health promoting network. Community engagement is the 21 st century “buzz” word for competency-based capacity building. It involves people's participation in identifying issues in a health consumer network so as to help plan the complex web of activities required to address people's needs. It is not the only way; but it is a common approach, focused on the broad spectrum of people's concerns (The Millennium Declaration).
Knowledge is power, according to Francis Bacon. Its force is clear in health care — in people's experiences with professionals, and in the science that aims to help them. It permeates decision making processes at all levels.
Developing knowledge through community engagement is the key to building a successful consumer health network, and "ensuring access" is one of its guiding principles. Effective dialogue takes time and effort to build. Yet an understanding of the people relying on health care services is vital to balance the judgements of those sharing the research and service provider cultures. Specialists' views of the world are, by definition, unbalanced and incomplete. Professionalism creates distances from the rest of the population, and vests professionals with a variety of interests which may or may not be consistent with public interests. Processes that acknowledge this bias, and seek to redress it through public participation and community engagement, help build a body of work that is relevant and guided by the realities of people's lives. Because the value of results is determined by the quality of the processes used to achieve them, "ensuring access" needs to refer to the means, as well as the ends.
Why is community engagement important for a health network?
With the rise of consumer movements worldwide, funding bodies, whether governmental or private, have come to expect and require consumer representation. But satisfying the terms and conditions is not the only reason for including consumers. The sharing of perspectives of providers, researchers, and consumers can enrich a project. Although this sharing is an important aspect of consumer involvement, it should be remembered that for consumers the most important thing is to be listened to by providers and have their views taken seriously. "(VMIAC, Developing effective consumer participation in mental health services. The Report of the Lemon Tree Learning Project p. 66)
Community engagement can occur across many levels.
- Participation in treatment and care
- Consumers employed by services as consultants and advocates
- Participation in service delivery and evaluation
- Participation in policy and planning
- Participation in education and training
- Participation in staff recruitment
While these levels represent the opportunities for consumer and carer participation, in practice participation does not occur in all of these areas all of the time. The relationship between attitudes and consumer and carer participation is circular: inappropriate attitudes can act as a barrier to genuine participation; when participation is lacking, inappropriate attitudes are not challenged or changed.
The Planning Cycle
Planning for community engagement is no different from planning for other activities
Source: Enhancing relationships between health professionals and consumer and carers , MHCA 2000 p. 22.
Informed Health Online, http://www.informedhealthonline.org/item.aspx?tabid=37
Project Manager and Editor
24 June 2005