Designing a Framework for Attracting Public Participation in the Iranian Health System: A Comparative and Mixed-Method Study

Abstract

Background: Public participation strengthens the public presence in healthcare. Objectives: This study aimed to determine the dimensions of attracting public participation in the Iranian health system. Methods: A mixed-method research was conducted from May 2019 to July 2020. A comparative study (using the documents of five countries that were selected purposefully), tool design and validation (through holding two expert panels with the participation of 26 people who were selected based on the inclusion criteria), and finalization of the participation framework (field test with the participation of 283 recruited people based on the inclusion criteria) were performed. Exploratory and confirmatory factor analyses (CFA) were applied using SPSS-v26 and AMOS-v26. Results: Forty-eight components on five factors, including citizenship rights and customer orientation, socioeconomic factors, communication with people and non-governmental organizations, research and technology, and managerial and organizational factors with impact factors of 0.967, 0.951, 0.957, 0.944, and 0.955 were loaded, respectively. The CFA denoted the approval of the framework with the five mentioned factors. Conclusions: In this study, a framework was developed and approved during different stages. Using this framework, healthcare policymakers can adopt the best strategies for engaging public participation and improving the effectiveness of decisions through evidence-informed policymaking.

Barriers to community participation in primary health care of district health: a qualitative study

“…In confirmation of this finding, a study by Dejman et al raised the lack of a suitable structure for the management of grassroots at the level of the Ministry of Health and some other institutions as an important issue in organizing community participation by all managers and founders of the program [ 43 ]. Various studies have reported the effective factors in appealing to public participation in the health system such as the existence of a specific structure for attracting community participation in the health system [ 44 , 45 ]. Having the proper organizational structure for participation is essential.…”

“…Another obstacle to public participation is a lack of the community’s role in developing plans and programs. In this regard, participants in the study of Dejman et al have expressed the lack of public participation in the decision-making process at high levels in community-based governmental programs to be one of the important obstacles [ 44 ]. Considering the fundamental role of community participation in all administrative levels of the health system, creating formal organizational structures for this purpose can act as a basis for the existence of systemic thinking in the health system in order to use social participation.…”