Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

Patient involvement in primary care mental health:a focus group study

Background: Patient involvement in health care is a strong political driver in the NHS. However in spite of policy prominence, there has been only limited previous work exploring patient involvement for people with serious mental illness. Aim: To describe the views on, potential for, and types of patient involvement in primary care from the perspectives of primary care health professionals and patients with serious mental illness. Design of study: Qualitative study consisting of six patient, six health professional and six combined focus groups between May 2002 and January 2003. Setting: Six primary care trusts in the West Midlands, England. Method: Forty-five patients with serious mental illness, 39 GPs, and eight practice nurses participated in a series of 18 focus groups. All focus groups were audiotaped and fully transcribed. Nvivo was used to manage data more effectively. Results: Most patients felt that only other people with lived experience of mental illness could understand what they were going through. This experience could be used to help others navigate the health- and social-care systems, give advice about medication, and offer support at times of crisis. Many patients also saw paid employment within primary care as a way of addressing issues of poverty and social exclusion. Health professionals were, however, more reluctant to see patients as partners, be it in the consultation or in service delivery. Conclusions: Meaningful change in patient involvement requires commitment and belief from primary care practitioners that the views and experiences of people with serious mental illness are valid and valuable.

Corporate community involvement in Bangladesh:an empirical study

This paper empirically examines a corporate community involvement (CCI) initiative in Bangladesh. Drawing on a conceptual framework of 'collaborative betterment' and 'collaborative empowerment' and by using focus group discussions and interviews, it assesses the initiative to examine the extent to which it meets expectations of the community where it operates. Some of the key findings of the paper include: (i) although the initiative provides vital healthcare services to some of the most vulnerable and desperately poor communities, the level of actual engagement of the local people - the main stakeholders - has been marginal; (ii) when the principles of collaborative betterment and empowerment are considered, it can be concluded that the initiative struggles even as a 'betterment' process; and (iii) notwithstanding the rhetoric and high-blown statements, corporate role in terms of practical efforts in the field has been mostly superficial and limited. © 2012 John Wiley & Sons, Ltd and ERP Environment.

User involvement in UK cancer services:bridging the policy gap

Recent UK government initiatives aim to increase user involvement in the National Health Service (NHS) in two ways: by encouraging service users to take an active role in making decisions about their own care; and by establishing opportunities for wider public participation in service development. The purpose of this study was to examine how UK cancer service users understand and relate to the concept of user involvement. The data were collected through in-depth interviews, which were analysed for content according to the principles of grounded theory. The results highlight the role of information and communication in effective user involvement. Perhaps more importantly, this study suggests that the concept of user involvement is unclear to many cancer service users. This paper argues the need for increased awareness and understanding of what user involvement is and how it can work.

Interest groups in multiple streams:specifying their involvement in the framework

Although interests inhabit a central place in the multiple streams framework (MSF), interest groups have played only a minor role in theoretical and empirical studies until now. In Kingdon’s original conception, organized interests are a key variable in the politics stream. Revisiting Kingdon’s concept with a particular focus on interest groups and their activities—in different streams and at various levels—in the policy process, we take this argument further. In particular, we argue that specifying groups’ roles in other streams adds value to the explanatory power of the framework. To do this, we look at how interest groups affect problems, policies, and politics. The influence of interest groups within the streams is explained by linking the MSF with literature on interest intermediation. We show that depending on the number of conditions and their activity level, interest groups can be involved in all three streams. We illustrate this in case studies reviewing labor market policies in Germany and chemicals regulation at the European level.

The role of enduring involvement in the relationship between reference price and price acceptance in the context of multichannel choice

Understanding online price acceptance and its determining factors can be essential if the companies try to manage different type of channels. The paper aimed to reveal the role of enduring involvement in price acceptance in a multichannel (online and offline) context. The study revealed that the hedonic value of shopping can increase the negative intention of price acceptance in the online channel, but also explored that for the segment without shopping motivations a similar price level can be applied both in the online and in the offline environment.

Transcriptome Analysis Reveals New Insights into the Modulation of Endometrial Stromal Cell Receptive Phenotype by Embryo-Derived Signals Interleukin-1 and Human Chorionic Gonadotropin: Possible Involvement in Early Embryo Implantation

The presence of the conceptus in uterine cavity necessitates an elaborate network of interactions between the implanting embryo and a receptive endometrial tissue. We believe that embryo-derived signals play an important role in the remodeling and the extension of endometrial receptivity period. Our previous studies provided original evidence that human Chorionic Gonadotropin (hCG) modulates and potentiates endometrial epithelial as well as stromal cell responsiveness to interleukin 1 (IL1), one of the earliest embryonic signals, which may represent a novel pathway by which the embryo favors its own implantation and growth within the maternal endometrial host. The present study was designed to gain a broader understanding of hCG impact on the modulation of endometrial cell receptivity, and in particular, cell responsiveness to IL1 and the acquisition of growth-promoting phenotype capable of receiving, sustaining, and promoting early and crucial steps of embryonic development. Our results showed significant changes in the expression of genes involved in cell proliferation, immune modulation, tissue remodeling, apoptotic and angiogenic processes. This points to a relevant impact of these embryonic signals on the receptivity of the maternal endometrium, its adaptation to the implanting embryo and the creation of an environment that is favorable for the implantation and the growth of this latter within a new and likely hostile host tissue. Interestingly our data further identified a complex interaction between IL1 and hCG, which, despite a synergistic action on several significant endometrial target genes, may encompass a tight control of endogenous IL1 and extends to other IL1 family members.

The use of mobile technology in evaluation

Peer reviewed

Childhood Physical Activity Involvement in Active and Inactive Female Adults

Current trends show progressive declines in levels of physical activity from childhood through adolescence and adulthood, most notably for females. The current study examined organized activity involvement in active and inactive females (age 18) using retrospective data. Results indicated that active females participated in significantly more physical activities than inactive females from age 6 to age 18. No significant differences were found between groups for non-physical activities. In addition, parents of active and inactive females were the most influential factor in initiating physical activity. However, parents of active females initiated more physical activity involvement than did parents of inactive females. Results also indicate that certain periods in childhood and adolescence appear to be critical for developing long-term physical activity habits.

Understanding and Developing Parental Involvement In My School

In the early years of the current decade, I spearheaded my school's and school board's participation in a research program on parental involvement led by Kenneth Leithwood from the Ontario Institute for Students in Education (OISE) at the University of Toronto. Despite all the extensive work I did as part of this research program and the ongoing professional reading I have done with respect to parental involvement and engagement, I have yet to share fully the knowledge gained with my staff or our parent community. Therefore, this purpose of this master's project is to provide a means for such dissemination. To do so, I have created two parallel presentations/workshops: one for staff during out first professional development day in September and one for parents at their second Parent Council meeting in October. The final chapter moves beyond these workshops to allow me to reflect on the progress made to date with parental engagement in my school and to look forward toward where I as Principal hope to lead my school community in the future.