Medicine & Health

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  • (2022) Godinho, Myron
    Thesis
    To achieve Universal Health Coverage and the United Nations’ Sustainable Development Goals’ by 2030, the World Health Organisation recommended the use of social enterprise, digital technology, and citizen engagement in the delivery of Integrated People-Centered Health Services (IPCHS). We aimed to develop and test a framework for using social enterprise, digital health, and citizen engagement to deliver IPCHS and achieve the WHO strategic vision for 21st-century primary care. We conducted a hermeneutic review of frameworks, models, and theories on social enterprise, digital health, citizen engagement, and IPCHS. This involved multiple iterative cycles of (i) searching and acquisition, followed by (ii) critical analysis and interpretation of literature to assemble arguments and evidence for conceptual relationships. This process identified a set of constructs that we synthesized into a conceptual framework to provide theoretical grounding for an empirical inquiry into how social enterprises use digital technology to engage citizens in co-creating IPCHS. We tested this preliminary framework with two community health alliances (CHAs) in South Western Sydney (SWS), namely the Wollondilly Health Alliance and the Fairfield City Health Alliance (FCHA). Each CHA comprised the local council of the local government area (LGA), the SWS Local Health District, and the SWS Primary Health Network who collaborated to address the health challenges faced by local communities. We developed comparative case studies using a combination of documentary analysis and semi-structured interviews with stakeholders from both CHAs. The reassignment of CHA staff to address the COVID-19 pandemic limited CHA operations and prevented many CHA stakeholders from participating in the case study, possibly introducing selection bias. Nonetheless, findings from the case studies yielded evidence for several of the conceptual relationships between social enterprise, digital health citizen engagement, and IPCHS identified in our initial framework; but also suggested that greater organizational maturity was required for the CHAs to operate as social enterprises. Considering these findings, we revised our initial framework, and then used it to develop a maturity model to suggest how health organizations like CHAs can achieve greater organizational maturity to operate as social enterprises that use digital technology to engage citizens in co-creating IPCHS.