Ordinary and extraordinary acts of integration: People’s perceptions of integrated health care within their everyday lives
- Publication Type:
- Thesis
- Issue Date:
- 2024
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The World Health Organization published the Framework on Integrated People-Centred Health Services in 2016. An ideal of this framework is that everyone adopts participatory roles, with people’s perspectives equally influencing health decisions, as well as shaping health policy and services.
The thesis drew from my curiosity about the reported absence, or silence, of the individual’s perspective within related policy, practices, or research. Informed by the literature, I engaged in qualitative, interpretative health research. I adopted a phenomenological stance influenced by social constructivism, pragmatism, and feminism perspectives. Case study research was selected to explore the complex, social interactions in the messy, dynamic context of health services. A strength of this research is the personal exploration of my role as the socially situated, reflexive, researcher.
The thesis preserves the voice and experiences of the study participants. I engaged deeply with a purposive sample of 11 participants to provide insights into their reality and subjective meanings related to their recent interactions with the same geographically located integrated health service. My analytic method included synthesis through progressive focusing guided by the three heuristics of understanding, interpreting, and theorizing. I engaged with abductive thinking processes to create metaphors as a form of provocative speculation, and produced an interpretative statement of claim.
This research found that the participants were both influenced by, as well as influencing, their experience. The participants shared how they critically assessed the strengths and limitations of their own and the health service’s effectiveness. They had ideas and were motivated to contribute to, lead, and test changes. They expressed an understanding of their own circumstances, the wider financial and political landscape, and were willing to be activists within their community in raising awareness of the service, in sharing their knowledge and experiences with others, and to lobby and influence health service decisions.
I propose that the embodied knowledge, practical experiences, and motivation to innovate and experiment with integration as a process, where integration happens in the moment, is situated within the individual’s everyday life. Taking this perspective, rather than focusing integration efforts on re-organising internal structures, which Ackoff (2004) described as trying hard to do the wrong thing righter, I propose that community living individuals are well placed to lead from the outside, to collaborate with existing knowledge and power holders, and coproduce change. This would be the right thing to do, even if it is not always done well.
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