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Quality citizen participation in processes of policy development is crucial to a democracy interested in equity of voice for all its citizens. Citizens with less political power, however, are often absent from policy development for a variety of reasons, despite legislative and advocacy efforts for inclusion. In policy development processes, community representatives are a mechanism for traditionally marginalized or disadvantaged citizens to have a voice; yet the question remains how to effectively utilize that voice. This question stems from research demonstrating an increase in quantity citizen participation but not in quality citizen participation, which is more interested in the process of policy development as opposed to a final product. To understand quality citizen participation, a critical ethnography guided by a socio-ecological perspective allowing for the investigation of contextual as well as individual factors impacting policy development processes was conducted to assist in advancing knowledge about the best practices necessary to facilitate quality citizen participation in policy development. The policy development process explored in this qualitative study was the context provided by three CHCs in a Midwestern state. Information was gathered about these three CHC boards from multiple sources to best represent the context surrounding participation on the boards and that participation experience from the perspective of board members. The data analyzed included: descriptive statistics of seven counties which comprised the patient community of the three CHCs participating in the study, descriptive statistics of the patient communities of those three CHCs, interviews with national and state policy experts, the clinic directors and board chairs of the three CHCs and interviews with 16 board members of the three CHCs. Analysis of these data identified individual, relational, organizational, community and public policy level factors which impacted the participation of board members of three CHCs. For example, the education and background experiences of board members (individual) as well as relationships between board members and the management teams of the clinics (relational) facilitated the quality of their participation on the boards. Contextual knowledge of economic, political, and cultural factors were discovered for each of the three clinics, and proved important to understanding the quality of participation of board members.
Social work educators and practitioners will benefit from the advancement of knowledge about what factors facilitate the quality of citizen participation in policy development processes. The results of this study suggest that practitioners interested in empowering consumers to have a role in the provision of services need to understand what facilitates the quality of citizen participation to ensure that consumers have a legitimate voice in policy development and implementation processes. The results of this study also inform our understanding of citizen participation in multiple policy development processes. For example, because legislators will benefit when barriers to the quality of citizen participation are identified, educators teaching social work students about macro practice will have concrete lessons to draw from; practitioners who work with non-elected members of boards will benefit from barrier identification allowing them to assist in the empowerment of future board members engaged in policy development on a wide variety of boards; and finally actual board members, especially those representing traditionally disadvantaged or marginalized communities, will benefit from knowledge gleaned from similar experiences, and educators teaching social work students about the benefits of advocacy and empowerment could assist to make their participation more effective.