Developing a model of citizenship for application within health and social care contexts: a community-based participatory approach

BackgroundCitizenship as a concept has often been understood in terms of the duties, rights, obligations, and functions a person has as a member of society. In health and social care policy and practice, the term has broader reach. This study explored what citizenship means to people with recent experience of mental illness, a long-term physical health condition, or involvement with the criminal justice, as well as to people who did not primarily identify as having experienced any of these major life disruptions. The aim was to develop an empirical model of citizenship to be applied within health and social care contexts.MethodsWe employed a mixed-methods, community-based, participatory research approach, with recruitment taking place between June, 2016, and February, 2019. Ten focus groups (n=77 participants) were conducted to generate statement items about the meaning of citizenship, and concept-mapping sessions with participants from the stakeholder groups (n=45) were held to categorise and rate each item in terms of importance and achievement. The number of statement items generated was further reduced after an online survey to ask participants (n=242) to rate items according to their clarity and relevance to the concept of citizenship. Multidimensional scaling and hierarchical cluster analysis were used to develop a five-cluster model of citizenship.Findings110 statement items about the meaning of citizenship were generated from a total of 703 items extracted from the focus groups, and were further reduced to 58 following the online survey. We identified five clusters representing the personal meanings of citizenship for participants: building relationships, autonomy and acceptance, access to services and supports, values and social roles, and civic rights and responsibilities. These clusters informed the development of the empirical model of citizenship to be applied within health and social care policy and practice.InterpretationThis multidimensional model of citizenship provides an empirical framework for policy makers and practitioners to set citizenship-based initiatives that contribute to the recovery and social inclusion of people who have experienced major life disruptions. This model will inform the development of a citizenship tool to facilitate discussions around citizenship.FundingTurning Point Scotland, The Scottish Recovery Network and Health and Social Care Alliance Scotland.