Community participation in action: involving communities in primary care teams

Background: The concept of involving communities in healthcare planning is enshrined in health policy across international settings. There is evidence of community participation impacting positively on health services. However, despite this policy context, there are major gaps in our knowledge. It is not routine across all primary health care settings and there is a lack of theoretically informed studies about implementation of community participation on interdisciplinary teams. This theoretically informed study draws on three inter-related projects to explore the perspectives of various stakeholders implementing community participation on primary care teams (PCTs) in Ireland. Method: Based on the pragmatic paradigm and principles of participatory qualitative health research, a case study approach was adopted using a sequential exploratory mixed methods design underpinned by Normalisation Process Theory (NPT). Participants represented health care professionals, GPs, community representatives, patients from marginalised groups and health service planners and policy makers from across a variety of primary health care settings. Data analysis took place at two levels– individual study level and data integration level and was informed by NPT constructs. Findings: Levers to implementation of community participation on PCTs included a shared understanding among stakeholders of the value of the work and good relationships and champions who support community initiatives. Barriers included a lack of resources for PCTs, complex health care structures, mistrust among team members and lack of formal appraisal of outcomes. Conclusion: It is a challenge to sustain community participation on PCTs in an environment where PCTs are struggling to be established. Overall, the lack of universal coherence about the work and poor implementation of PCTs impacts buy in, enactment and appraisals of the work thereby making implementation challenging and sustainability unlikely. The data about levers and barriers reported are important because they provide clear information about activities, processes and relationships that can support implementation.