Journal Article

Communities, health‐care organizations and the contingencies and contradictions of engagement: A case study from Chile

Montenegro, Cristian R., Mercado, Nérida

2020

Overview

Context Despite a growing interest in service‐user involvement in mental health services, the interaction between health institutions and local groups is only beginning to receive attention, particularly in global south settings. Objective Looking at a participatory initiative in Chile, this study explores how, under unfavourable administrative conditions, health organizations approach and work with communities. Methods We interviewed policy‐makers (5), local professionals (10), service users and community representatives (6) linked to a concrete participatory initiative. Participant observation in relevant meetings helped to enrich the interpretations. Thematic analysis was applied to interview transcripts and field notes. Findings The findings present a sequence of actions starting with the creation of a network of community‐based groups. A set of problems ensued, related to the group's diversity, internal representation, decision‐making and funding processes. In response, processionals implemented simultaneously bureaucratic and democratic adjustments, developing a vision of community that ignored the particularities—including the motivations—of local groups. Discussion and conclusion Based on these findings, we argue that participatory initiatives should be studied as on‐going achievements shaped by broad policy orientations and local configurations of interest. In the process, they produce ad hoc forms of knowledge and visions of community that provide orientation to the agents involved.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Administrative Personnel / Bureaucracy / Case studies / Chile / Citizen participation / Community / Community mental health services / Community Participation / community‐institutional relations / Contingencies / Decision Making / Delivery of Health Care, Integrated - economics / Health care industry / Health services / Humans / Initiatives / Interviews / Meetings / Mental disorders / Mental health / Mental health care / Mental health services / Mental Health Services - economics / Motivation / organizational / Organizational Case Studies / Organizations / Original Research Paper / Original Research Papers / Participant observation / Policy making / Professional ethics / Professionals / Qualitative Research / Reforms / self‐help groups / service‐user involvement / Southern Hemisphere / User involvement / Work organization