title: 'Taking off the suit': engaging the community in primary health care decision-making.
abstract: OBJECTIVE
  To explore the process of public involvement in planning primary health care.
  
  
  BACKGROUND
  Recent policy in the UK promotes public involvement in planning health but there have been difficulties in engaging communities in the process. Surveys of health service organizations have found that there has been a failure to adapt to new approaches. It has become important to understand why this has occurred if policy initiatives to encourage involvement are to succeed.
  
  
  METHODS
  Qualitative study. Data collected through individual interviews and focus groups.
  
  
  METHODS
  Two new primary healthcare developments in deprived areas in Bristol and Weston-Super-Mare.
  
  
  METHODS
  Thirty-six professionals and 23 local residents in Bristol; six professionals and three local residents in Weston-Super-Mare.
  
  
  RESULTS
  Three themes were identified: process, partnership and power. The main findings were that exceptional people with a shared commitment to public involvement were necessary to motivate others and develop partnerships. Local people were drawn into the process and with increased confidence became powerful advocates for their community. Creative and varied methods to involve the public were important in achieving balance between professionals and lay people. However, conflicts over practical decisions arose from a lack of clarity over who had power to influence decisions.
  
  
  CONCLUSIONS
  Most of the participants were enthusiastic about their experience of public involvement in planning primary health care. Features crucial to sustainable involvement included a commitment from leaders within statutory agencies, support over a long period to build the confidence of local people, willingness to use informal approaches that are in tune with local culture, and a recognition of the concerns of both service users and providers.
authors.affiliation: Academic Unit of Primary Health Care, University of Bristol, Bristol, UK. e.j.anderson@bristol.ac.uk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Anderson
authors.forename: Michael
authors.initials: M
authors.lastname: Shepherd
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D000328:Adult; D003256:Community Participation; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013222:State Medicine; D006113:United Kingdom