Skip to main content

Research Repository

See what's under the surface

Advanced Search

Representativeness, legitimacy and power in public involvement in health-care management

Martin, Graham P.

Authors

Graham P. Martin graham.martin@nottingham.ac.uk



Abstract

Public participation in health-service management is an increasingly prominent policy internationally. Frequently, though, academic studies have found it marginalized by health professionals who, keen to retain control over decision-making, undermine the legitimacy of involved members of the public, in particular by questioning their representativeness. This paper examines this negotiation of representative legitimacy between staff and involved users by drawing on a qualitative study of service-user involvement in pilot cancer-genetics services recently introduced in England, using interviews, participant observation and documentary analysis. In contrast to the findings of much of the literature, health professionals identified some degree of representative legitimacy in the contributions made by users. However, the ways in which staff and users constructed representativeness diverged significantly. Where staff valued the identities of users as biomedical and lay subjects, users themselves described the legitimacy of their contribution in more expansive terms of knowledge and citizenship.
My analysis seeks to show how disputes over representativeness relate not just to a struggle for power according to contrasting group interests, but also to a substantive divergence in understanding of the nature of representativeness in the context of state-orchestrated efforts to increase public participation. This divergence might suggest problems with the enactment of such aspirations in practice; alternatively, however, contestation of representative legitimacy might be understood as reflecting ambiguities in policy-level objectives for participation, which secure implementation by accommodating the divergent constructions of those charged with putting initiatives into practice.

Journal Article Type Article
Publication Date Jan 1, 2008
Journal Social Science & Medicine
Print ISSN 0277-9536
Electronic ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 67
Issue 11
APA6 Citation Martin, G. P. (2008). Representativeness, legitimacy and power in public involvement in health-care management. Social Science and Medicine, 67(11),
Publisher URL http://dx.doi.org/doi:10.1016/j.socscimed.2008.09.024
Related Public URLs http://www.nottingham.ac.uk/~lqzgpm
http://www.elsevier.com...description#description
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

Files

Martin_(2008c).pdf (204 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





You might also like



Downloadable Citations

;