Do we all agree what "good health care" looks like? Views from those who are "seldom heard" in health research, policy and service improvement.
The aim of this study was to ask whether there are shared ideas about what good health care looks like that apply across different populations and conditions. Do priorities among "seldom heard" groups differ from mainstream views and, if so, how might we understand these differences?



Focus groups were recruited with the help of our study patient representatives. Participants discussed and prioritized a set of eight "core components" of good care. We recorded and transcribed the data for thematic analysis.



We recruited people who are seldom heard in health and policy research for separate focus group discussions (one each with illegal drug users, Irish Travellers, migrant workers, young men and learning disabled people). We also ran a reference group of educated, older adults and an online group with people with long-term conditions.



There were few differences in what participants thought was important in health care but considerable differences in their expectations that they might personally receive good care. Differences related to participants' previous experiences. The drug users group reported particularly poor experiences and low expectations of good care.



Differences in what is regarded as an entitlement or privilege in health care underline the persistence of structural and relational differences in how services are experienced. While we can be reassured that core aspects of care are similarly prioritized across different patient groups, including those who are seldom heard, a more intractable challenge remains: how to provide equitable health care for marginalized groups in an unequal society.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sara
0000-0002-7406-1610
S
Ryan
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Jenny
J
Hislop
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sue
S
Ziebland
D001291:Attitude of Health Personnel; D006233:Persons with Disabilities / Q000523:psychology; D055030:Drug Users / Q000523:psychology; D017144:Focus Groups; D006801:Humans; D010358:Patient Participation / Q000523:psychology; D057766:Policy; D011369:Professional-Patient Relations; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012959:Socioeconomic Factors; D013997:Time Factors; D014171:Transients and Migrants / Q000523:psychology; D035862:Vulnerable Populations / Q000523:psychology*
focus groups; good health care; health inequalities; qualitative research; seldom heard groups