Moving towards social inclusion: Engaging rural voices in priority setting for health
Abstract Background Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the...
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Health Expectations |
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| Online Access: | https://doi.org/10.1111/hex.13895 |
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| author | Aviva Tugendhaft Nicola Christofides Nicholas Stacey Kathleen Kahn Agnes Erzse Marion Danis Marthe Gold Karen Hofman |
| author_facet | Aviva Tugendhaft Nicola Christofides Nicholas Stacey Kathleen Kahn Agnes Erzse Marion Danis Marthe Gold Karen Hofman |
| author_sort | Aviva Tugendhaft |
| collection | DOAJ |
| description | Abstract Background Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. |
| format | Article |
| id | doaj-art-779ae773fa044fb7bd83efc3b3619d5e |
| institution | Kabale University |
| issn | 1369-6513 1369-7625 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Expectations |
| spelling | doaj-art-779ae773fa044fb7bd83efc3b3619d5e2025-08-23T11:53:04ZengWileyHealth Expectations1369-65131369-76252024-02-01271n/an/a10.1111/hex.13895Moving towards social inclusion: Engaging rural voices in priority setting for healthAviva Tugendhaft0Nicola Christofides1Nicholas Stacey2Kathleen Kahn3Agnes Erzse4Marion Danis5Marthe Gold6Karen Hofman7SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA School of Public Health, Faculty of Health Sciences, University of Witwatersrand Johannesburg South AfricaSchool of Public Health Faculty of Health Sciences, University of the Witwatersrand Johannesburg South AfricaDepartment of Health Policy London School of Economics London UKMRC/Wits Rural Public Health and Health Transitions Research Unit—Agincourt School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg South AfricaSAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA School of Public Health, Faculty of Health Sciences, University of Witwatersrand Johannesburg South AfricaDepartment of Bioethics National Institutes of Health Bethesda Maryland USANew York Academy of Medicine New York City New York USASAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA School of Public Health, Faculty of Health Sciences, University of Witwatersrand Johannesburg South AfricaAbstract Background Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities.https://doi.org/10.1111/hex.13895priority‐settingpublic engagementrural healthsocial inclusionSouth Africa |
| spellingShingle | Aviva Tugendhaft Nicola Christofides Nicholas Stacey Kathleen Kahn Agnes Erzse Marion Danis Marthe Gold Karen Hofman Moving towards social inclusion: Engaging rural voices in priority setting for health Health Expectations priority‐setting public engagement rural health social inclusion South Africa |
| title | Moving towards social inclusion: Engaging rural voices in priority setting for health |
| title_full | Moving towards social inclusion: Engaging rural voices in priority setting for health |
| title_fullStr | Moving towards social inclusion: Engaging rural voices in priority setting for health |
| title_full_unstemmed | Moving towards social inclusion: Engaging rural voices in priority setting for health |
| title_short | Moving towards social inclusion: Engaging rural voices in priority setting for health |
| title_sort | moving towards social inclusion engaging rural voices in priority setting for health |
| topic | priority‐setting public engagement rural health social inclusion South Africa |
| url | https://doi.org/10.1111/hex.13895 |
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