Abstract:
This thesis is an investigation of the understanding and practice of community participation in primary care in Aotearoa New Zealand. The research question can best be summarised as, What structures and processes can be put in place to foster and enhance community participation in primary health care in Aotearoa New Zealand? A key aim of this research was to identify those structures and processes in order to develop a framework for implementing community participation in primary care planning and delivery in New Zealand, in light of the 2001 New Zealand Primary Health Care Strategy. A three-part research process was adopted. Key informant interviews were undertaken with primary care stakeholders, including policymakers, funders, practitioners and community stakeholders. Data collection began in 2002, just as the first PHOs were being established, and concluded in late 2004. An adapted form of grounded theory methodology was used to analyse the data, using inductive approaches in search of common themes, as well as deductive approaches in light of previous research. A draft framework on community participation for primary care was developed, and formed the basis of subsequent stages of the research. Implications of these research findings for health policy and practice in Aotearoa New Zealand include: First, the ownership structure in primary care continues to be a barrier to the implementation of community participation, despite the recent primary care reforms. Second, the addition of population health concepts, including the principles of primary health care and of governance, to GP training and ongoing medical education is critical to provide doctors with the necessary understanding and skills to make the shift from primary medical care to primary health care. Third, if government commitment to the reduction of health inequalities is genuine, further strides must be made in the area of meaningful community involvement in primary care.