Grant: Travel Awards - Institute Community Support

In recent years, various levels of the Canadian government have made changes to their health policies to mandate public involvement (PI). These changes are intended to ensure that Canadians are informed about health issues and engaged on policy decisions. The extent to which health system policy decisions actually reflect citizens' views, however, has been questioned. The study objective is to examine the question of how PI is used in health systems decision-making. We employed qualitative concept analysis to address the lack of clarity about the concept of 'use'. We reviewed the literature (n=84) on the use of public involvement, and conducted semi-structured interviews (n=28) with key informants, including scholars, policy advisors, PI practitioners and consultants. We then synthesized both sets of findings to finalize the concept's definition and key attributes. Our findings suggest that the use of public involvement in policy decision-making is characterized by complex interactions in the polis. These interactions involve multiple effects of how policymakers and government agencies listen, interpret, learn and respond to public input. We also found that issues of power and power differences are critical to understanding how PI is used in policy decision-making. Pre-requisites to 'use' include integrity of the public involvement process, appropriate timing in decision-making, culture of engagement, organization commitment, leadership and competence to use PI in decision-making. The results of using public involvement in decision-making are greater trust, more ethical and better decision-making as well as more sustainable decisions. In sum, this study enhances the understanding of the internal dynamics of involving citizens in health policy decisions. Furthermore, it seeks to address widespread public calls for improved transparency and accountability of decision-making which is a contributor to increased public trust in the health care system.