CE Handbook - Chapter 5: Engaging Citizens in Informing Strategic Plans, Priorities, Policies, and Guidelines (Focus Area 2)

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Outside of CIHR, most examples of citizen engagement (especially in government settings) involve policy development. The Canadian Policy Research Networks Handbook cites the need for democratic renewal in Canada, as "research indicates that Canadians are increasingly frustrated with and disconnected from their democratic structures and processes." Citizen engagement (CE) deepens representative democracy and, in the face of this "democratic deficit," aims to reinvigorate people's faith in the overall process.Footnote 20 According to the Health Canada Policy Toolkit for Public Involvement in Decision Making, active CE processes occur throughout the policy development process and begin with the assumption that citizens add value and bring important new perspectives.Footnote 21

Since CIHR is a health research funder, it may be difficult to imagine how the policies, guidelines, and strategic priorities that we develop match up against (political) public policy development across the country. However, as a senior scientist with the Centers for Disease Control in the United States emphasizes, the need to engage citizens is just as strong in our work as it is in other government arenas: "I picked the subset of science policy, which involves values, as the place to engage the public and do work together because citizens are the experts on our values and they should be at the table when both science and values are under consideration."Footnote 22

This chapter outlines some of the ways in which CIHR has engaged citizens in the development of guidelines and Institute strategic plans. A solid foundation for such engagement exists through these examples. Section 5.2 illustrates how the Decision Tree Model (introduced in Chapter 2) and the key elements of the planning process (introduced in Chapter 3) can be applied to the development of strategic plans, priorities, policies, and guidelines. The case study at the end of the chapter provides insight into challenges that may arise during the strategic planning process and how they can be overcome.

5.1 Citizens' Input at CIHR

Some of the most compelling examples captured in the inventory of CIHR's CE activities involve guidelines, strategic plans, or priorities that were developed with substantial input from lay participants. These include the following:

  • ARCHIVED - CIHR Guidelines for Health Research Involving Aboriginal People
    These Guidelines were prepared by the Ethics Office, in conjunction with the Institute of Aboriginal Peoples' Health, to assist researchers and institutions in carrying out ethical and culturally competent research involving Aboriginal people. The intent is to promote health through research that is in keeping with Aboriginal values and traditions. The guidelines will assist in developing research partnerships that will facilitate and encourage mutually beneficial and culturally competent research.

    A comprehensive, nationwide strategy for consultation with Aboriginal communities, researchers, and institutions was built on the ACADRE (Aboriginal Capacity and Developmental Research Environments) network, which is a unique university-based resource with links to academic research communities and partnerships with regional First Nation, Inuit, and Métis communities.Footnote 23 The Ethics Office, along with the National Council on Ethics in Human Research, also conducted workshops and consultations with Aboriginal communities, researchers, and members of research ethics boards to obtain feedback on the draft guidelines.

  • Privacy Best Practices in Health Research (Ethics Office)
    These best practices were created in response to issues and concerns raised by the broader research and research ethics community about the impact of current and new legislation on health research and the tensions that exist between data access and privacy protection.

    Open and targeted consultations were conducted in 2004 on a draft document on privacy best practices in health research. The consultations were advertised widely and included an opportunity for the general public to provide comments on an online draft document with embedded questions. The consultations also included small group dialogue sessions with citizens.

  • Institute of Aging Forum: Mobility in Aging Strategic Initiative
    This forum was designed to provide participants with the opportunity to gain an understanding of and appreciation for how different disciplines and sectors approach research-to-action issues in Mobility in Aging. Participants worked in small break-out groups to share best practices and realities in crossing disciplines and in researcher-stakeholder collaborations aimed at mobilizing research to action. They were also asked to provide guidance on future useful partnered activities and funding opportunities under the Mobility in Aging Initiative.

    The forum discussed the value of and challenges to designing collaborative programs of research. Engaging relevant researchers and research-users/stakeholders must be started early in the collaboration process as it takes time to build relationships and trust, and to develop common goals. Participants represented a range of perspectives, expertise, and experience and included a cross-section of research users: those who could or should use research findings and evidence in their decisions on policies, programs, etc., such as health institution administrators, health care providers (e.g., physicians, nurses, physiotherapists), formal and informal caregivers, social and frontline workers, policy decision-makers, the media, health charities, the private sector, and the general public.

5.2 Including Citizens in the Consultation Process

To illustrate how the Decision Tree Model can be applied to a realistic CIHR situation, we'll go through the steps using a fictitious example. This is the scenario:

  • A new program is going to be developed that will offer strategic funding opportunities focusing on establishing specific research themes on environmental impacts on health. One of the proposed themes of the funding program will be on influences of the social environment on health - home/family, daycare, school, workplace, recreation, care-settings, neighbourhood and community, region, society and nation. This is not an Institute-led program; instead, it is a pan-CIHR initiative that touches upon the mandates of several Institutes and branches.
  • The research funded through this program may touch all four research pillars, but emphasis will likely be on pillars two, three and four (clinical, health services and policy, and population and public health research).

Strategic priorities for the program need to be decided before it can begin. What kind of impact will this program have on Canadians (generally) or target populations (specifically)? Clearly, there is room for discussion here. The process of establishing priorities for this program must be open, transparent, and interactive, involving all relevant communities of scientists representing CIHR pillars in clinical, health services, and population health research — and their multitude of partners (non-governmental agencies, affected populations, provincial governments, industry, and interested Canadians).

The cross-Institute planning committee has determined they would like to pilot a citizen engagement activity that will capture citizens' values, needs and preferences to discuss social influences on health that will inform the research themes. The overarching goal of the exercise is to consider these contributions in a productive conversation which can take place in community settings. The committee would like to gather information which will inform the decision criteria for the research theme. If successful, the pilot will be replicated across regions and leverage contributions from partner organizations.

For this example, let's say that our answers to the Decision Tree Questions (Section 2.2) are those checked:

  1. Reasons for CE
    [X] understand values
    [X] hear diverse perspectives
    [X] experiential check-in
    [ ] access untapped knowledge
    [ ] risk management
    [ ] evaluation
    [X] prioritization
    [ ] public demand
    [ ] historical injustices
  2. Input in Decision Lifecycle
    [ ] define the issue
    [X] gather information
    [X] establish decision criteria
    [ ] develop alternatives
    [ ] make decision
    [ ] implement decision
    [ ] evaluate decision
  3. Target audiences
    [X] affected individuals
    [ ] individuals from general public
    [X] primary groups
    [ ] secondary groups
  4. Contributions of Citizens
    [X] explore ideas
    [ ] validate ideas
    [X] suggest ideas
    [ ] reconcile ideas and values
  5. Type of Interaction
    [ ] listening
    [ ] discussion
    [X] dialogue
    [ ] collaboration

The level of engagement that we've chosen is Dialogue, so our answers will map onto the CE Approaches Matrix (Section 2.3) through the Approaches for Dialogue chart:

Table Legend:

  1. Roundtables
  2. Open space technology
  3. World cafes
  4. Study circles
  5. Deliberative dialogues
  6. Deliberative polls
  7. Online discussion boards
  8. Charrettes
  9. Citizen juries
  10. Consensus conferences
Why? Reasons For Engagement A B C D E F G H I J
Understand values X X X X X X
Hear diverse perspectives X X X X X
Experiential check in X X X X X
Access untapped knowledge X X X X X X
Risk management X X X
Evaluation X X X X
Prioritization X X X X X X
Public demand X X X
Historical injustices X X X X X X
When? Decision-making stage
Defining the issue X X
Gathering information X X X X X
Establishing decision criteria X X X X
Developing alternatives X X X X X X X X
Evaluating alternatives X X X X X X
Making the decision X X X X X
Implementing the decision X
Evaluating the decision
Who? Identify target audience
Primary groups X X X X X
Secondary groups X X X X
Affected individuals X X X X X X
General public X X X X X X
What? Type of contribution
Explore ideas X X X X X X X
Validate ideas X X X X
Suggest ideas X X X X X X X X
Reconcile ideas and values X X X X X X X X X X

Based on these answers, it appears that our best choices for CE activities are World Cafés and Consensus Conferences (these activities match all of our criteria); to give ourselves more options, however, we should also look into Study Circles and Deliberative Dialogues (the activities that meet most of our criteria).

Armed with this information, we can turn to the Summary Table of CE Approaches (Table 2) to learn more about what each of these activities may entail. After reading the background information in the Summary Table, doing some research online, and discussing options with the Senior Advisor in the PCE Branch, it seems that the best choice for our scenario is World Cafés. World Cafés are innovative venues for encouraging thoughtful discussion in a casual setting. This approach matches the aims of the planning committee as it allows decision-makers to gather information that will inform the decision criteria as a component of the decision-making lifecycle. Conversations link and build on each other as people move between groups (tables), cross-pollinate ideas, and discover new insights into the questions being posed by the host(s).Footnote 24 The small group discussions and relaxed "café style" atmosphere are designed to encourage full participation from everyone equally—regardless of class, education level, or personal history. This characteristic of World Cafés opens the door to the possibility of combining our CE efforts with the consultations that would be done with policy-makers and researchers (i.e., bring all of the groups together at one event instead of holding separate ones for different crowds); however, the decision to combine the target audiences should rely on the advice of a CE consultant.

Now that we've chosen a CE approach, it's time to develop a plan. As noted in Chapter 3, most CE activities require a group effort. In this case, we'll need to recruit an in-house team, including a communications specialist, the CE Senior Advisor from the PCE Branch, and representatives from the cross-Institute program's planning committee at CIHR. Together the team will answer the key design questions, establish how each of the Guiding Principles will be met in this particular effort and create a plan for the process. For CE expertise (and in this case, precise World Café expertise) an external consultant should also be hired to participate in the planning process and possibly to act as a facilitator at the World Café event(s).

With this team assembled, we can go through the Key Elements of the Planning Process noted in Chapter 3 to ensure that our CE plan considers all of the critical components of a sound CE approach.

It is beyond the scope of this Handbook to delve into the exact details a CE plan for this type of initiative — partly because they would depend on the advice of a CE consultant — but the information provided in Chapter 2 and Chapter 3 of this Handbook, as evidenced above, would help the CE team to generate a "straw dog" for their CE plan. With this head start, the team would be able to work together to decide on specific roles, responsibilities, venues, and approaches.

The case study below illustrates how the Institute of Gender and Health staff, advisory board members, and consultants worked together to develop the Institute's new Strategic Plan for 2009-2012.

Case Study #2: Institute of Gender and Health Strategic Plan — Process Planning

Case Study #2

What: Citizen engagement as part of the Institute of Gender and Health's extensive consultation process in the development of its strategic plan.

Why: The gender, sex, and health stakeholders community is large and diverse; it encompasses both formal and informal aspects of the health care system.

Who: IGH's main focus for the consultation process was the research community, but the Institute also consulted citizens (professional caregivers, advocates, representatives of affected communities, and voluntary health organizations).

How: With the help of consultants, IGH conducted consultations with approximately 250 stakeholders from across the country. Special efforts were made to include every province and territory in some way. In addition, open written submissions/comments were solicited through an open call on IGH's listserv and website.

In 2008, CIHR's Institute of Gender and Health (IGH) engaged in a strategic planning process. The purpose of this process was to identify and describe strategic research directions for the Institute for the period from 2009 to 2012, and to identify possible opportunities for synergy. The strategic planning process was led by IGH's Scientific Director, Dr. Joy Johnson, and a strategic planning working group. They worked in collaboration with IGH's Institute Advisory Board and Institute staff members, under the guidance of process consultants Strachan-Tomlinson.

Consultations with stakeholders in the gender, sex, and health research community were an integral part of this process. IGH primarily targeted researchers during its consultation process, as they had the biggest stake in the Institute's strategic research directions and funding opportunities. However, IGH also consulted with citizens—namely, professional caregivers, advocates, representatives of affected communities, and voluntary health organizations. One important feature of this planning process was to define "expert input" as including citizen perspectives.

The Institute included citizens in its consultation process because the gender, sex, and health stakeholder community is large and diverse and encompasses both formal and informal aspects of the health care systems. It spans all four CIHR research pillars (clinical, biomedical, health services, and population health), a range of disciplines, and various types of research on the continuum from quantitative to qualitative; it also encompasses both theoretical and applied work. Given the breadth of this community, and the potential scope of topics and research processes that fall within the domain of gender, sex, and health research, it was essential that IGH engage in a strategic planning process with the capacity to capture a wide range of issues and perspectives.

IGH designed a national consultation process to achieve this aim. The process, which included approximately 250 stakeholders (in total) from every province and territory in Canada, comprised the following:

  • Face-to-face consultations with approximately 160 stakeholders in six communities (Vancouver, BC; Kelowna, BC; Calgary, AB; Toronto, ON; Montréal, QC; and Halifax, NS).
  • A focused consultation with 10 participants at the Canadian Conference on International Health in Ottawa, ON (countries represented were Canada, Australia, Thailand, and Nicaragua).
  • Videoconference consultations with approximately 25 stakeholders from St. John's, NL; Charlottetown, PE; Fredericton, NB; Edmonton, AB; and Saskatoon, SK.
  • Key informant interviews with 18 individuals from Canada and the United States. As IGH did not hold a focused consultation in Manitoba, a special effort was made to recruit four key informants from this province.
  • Written submissions solicited through an open call on IGH's listserv and website (nine received).
  • Community consultations with 32 stakeholders in Iqaluit, NU, Yellowknife, NT and Whitehorse, YT.

Consultations took place between May and November 2008. Participants included interested parties from academic institutions, the federal and provincial governments, CIHR, health and community organizations (local, national, and international), as well as individual researchers. Though researchers were the primary target population, citizens were included in the face-to-face consultations, the key informant interviews, and the community consultations in Canada's north. IGH also received several written submissions from interested citizens.

Consultation participants were asked to respond to open-ended questions on key trends and accomplishments in gender, sex, and health research, as well as to identify opportunities and areas where research investment was liable to have the greatest impact. After initial pilot-testing, IGH modified its protocol for the northern community consultations, as the region does not have the same research capacity or infrastructure as more populous southern regions. As such, community consultation participants were asked to frame their comments primarily in terms of key gender, sex, and health issues in their regions.

IGH staff members worked with external consultants and a professional writer to synthesize the notes from all of the consultations, interviews, and submissions into three reports: a report on the face-to-face and videoconference consultations, a report on the interviews and written submissions, and a report on the northern consultations. This structure was chosen because it enabled the reports to reflect the unique characteristics and outcomes of each consultation method.

These reports, as well as a set of background documents developed for the strategic planning process, were shared with IGH's Institute Advisory Board at a strategic planning workshop in November 2008. Information from the background documentation and consultations was reviewed and discussed, and consensus was achieved on six strategic research directions. Feedback on the strategic planning process indicated that IAB members appreciated this comprehensive approach to engaging both researchers and citizens in the Institute's planning process. They also recognized the importance of inclusive and precise definitions of "research" and "expert" in the context of this process.

Citizen engagement added depth and breadth to the knowledge gleaned from IGH's strategic planning process. Professional caregivers, advocates, and representatives of affected communities and voluntary health organizations brought an applied perspective to the consultations. Including this perspective enabled IGH's leadership to ground its strategic research directions in the experiences of those who care for, advocate on behalf of, or live with the health issues that form the core of IGH's 2009-2012 Strategic Plan. In addition, citizen engagement supports knowledge translation about both the planning process and the expectations that citizen engagement would help in implementing the plan. Those consulted made it clear that they valued understanding and contributing to the CIHR planning process, as well as their potential roles in supporting what happens next (e.g., communicating with their communities about potential funding opportunities).

It was sometimes challenging to extend the Institute's reach beyond its immediate community of researchers. For example, the IGH team members responsible for finding potential participants faced some difficulties in identifying non-researcher stakeholders. To address this challenge, these team members conducted focused Web searches and consulted with local experts. The size and diversity of IGH's potential community of interest meant that IGH team members had to be somewhat selective in determining which non-researcher stakeholders would be invited to the face-to-face consultations. In order to ensure that this process did not inadvertently exclude key interest groups, IGH posted an open call for written submissions on its website. This call was also disseminated through other means of communication, such as the website of the Canadian Women's Health Network.

Despite these challenges, the end result-a strategic plan with both theoretical and practical relevance, as well as potential community support for implementation—was well worth the effort.

5.3 Conclusion

This chapter was designed to provide an overview of the ways in which citizens have been included in the development of a number of CIHR's strategic plans, priorities, policies, and guidelines. The examples outlined in this chapter are excellent models for CE, but they are not meant to be prescriptive. As the fictional CE example demonstrates, significant room for creativity exists in the planning process for an activity — so long as the activity still adheres to CIHR's principles for CE. With the tools provided in Chapter 2 and Chapter 3, and the lessons learned from CIHR's previous experiences engaging citizens, CIHR has a solid base to draw from for engaging citizens proactively in our work.

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