Navigating and making sense of urgent and emergency care processes and provision.
citizen panel
emergency care
interview
sense-making
urgent care
Journal
Health expectations : an international journal of public participation in health care and health policy
ISSN: 1369-7625
Titre abrégé: Health Expect
Pays: England
ID NLM: 9815926
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
19
06
2018
revised:
01
11
2018
accepted:
13
12
2018
pubmed:
12
1
2019
medline:
9
9
2020
entrez:
12
1
2019
Statut:
ppublish
Résumé
Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate. To explore how lay people make sense of urgent care provision and processes. Qualitative study, incorporating citizen panels and longitudinal semi-structured qualitative interviews. Two citizens' panels, comprising purposively selected public populations-a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi-structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18-26 years, and from East/Central Europe. A sub-sample of 41 people received a second interview at +6-12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries. Participants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help-seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating "appropriate" use problematic. The focus on help-seeking behaviour, rather than sense-making, makes it difficult to move beyond the polarization of "appropriate" and "inappropriate" service use. A deeper analysis of sense-making might shift the focus of attention and allow us to intervene to reshape understandings before this point.
Sections du résumé
BACKGROUND
Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate.
OBJECTIVE
To explore how lay people make sense of urgent care provision and processes.
DESIGN
Qualitative study, incorporating citizen panels and longitudinal semi-structured qualitative interviews.
SETTING AND PARTICIPANTS
Two citizens' panels, comprising purposively selected public populations-a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi-structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18-26 years, and from East/Central Europe. A sub-sample of 41 people received a second interview at +6-12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries.
FINDINGS AND DISCUSSION
Participants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help-seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating "appropriate" use problematic.
CONCLUSIONS
The focus on help-seeking behaviour, rather than sense-making, makes it difficult to move beyond the polarization of "appropriate" and "inappropriate" service use. A deeper analysis of sense-making might shift the focus of attention and allow us to intervene to reshape understandings before this point.
Identifiants
pubmed: 30632242
doi: 10.1111/hex.12866
pmc: PMC6543158
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
435-443Subventions
Organisme : Department of Health
ID : HS&DR/14/19/16
Pays : United Kingdom
Organisme : NIHR HS&DR programme
ID : 14/19/16
Pays : International
Informations de copyright
© 2019 The Authors. Health Expectations published by John Wiley & Sons Ltd.
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