Evaluating user involvement in primary healthcare

Current health policies, both in the UK and internationally, call for a shift from secondary to primary healthcare, and for increased involvement of service users and communities in decisions about their own care and about the way in which health services are provided. This study investigated the way in which users were involved in two London-based primary healthcare projects. Two projects were selected from a broader sample. A case study approach was adopted and a range of methods used to identify the types of user involvement, users' views of the process and, in one case study, users' preferences for participation. Arnstein's conceptual framework for participation was used in the analysis. In this paper, the findings of the study are discussed in relation to Cohen's notions of breadth, depth and range of participation. The paper illustrates how these notions may provide a mechanism for providers and commissioners of health services to assess their strategies in relation to user or community involvement, and the degree of success they achieve in implementation.