The impact of rhetoric and reality on community anticipation of risk in the development of multi-purpose services (MPS): A grounded theory study

Aims:The rhetoric of multi-purpose services involves the integration of aged care facilities and other health services (usually hospitals) in small, rural communities while enhancing responsiveness to community needs. This research focussed on the main concerns of participants involved in the development of multi-purpose services in rural NSW.Method:Using a constructivist grounded theory methodology 30 in-depth interviews were conducted with 6 community members, 10 managers and 14 staff members who had been involved in the process of developing multi-purpose services.Findings:The findings presented in this paper reflect the reality of the community members' participation in the development of multi-purpose services as perceived by all groups of participants. The main concern (core category) of all participants which emerged was their anticipation of risk. This anticipation of risk manifested itself in either trust or fear and explained their progression through a three phased social process: driving change, engaging with stakeholders and collaborating. The initial phase (driving change) focussed on whether or not forces initiating the change process were external to or within the local community, with local drivers engendering more trust than external ones. When local community members were actively involved in this phase they had a greater influence in the next phase (engaging with stakeholders). Engaging with stakeholders involved town meetings, forming committees and consulting communities. When community stakeholders felt that this was a superficial process they feared the consequences of decisions. In the third phase, collaborating, influential community members (who had been involved) were again more likely to trust in the multi-purpose service model and to embrace an integrated health service identity. Those stakeholders who felt their involvement had only been superficial were more likely to maintain that the previous hospital services providedbetter health service.Conclusion:This research provides an insight into the perceptions of the rhetoric and reality of community member involvement in the process of developing multi-purpose services. It revealed a grounded theory in which fear and trust were intrinsic to a process of changing from a traditional hospital service to the acceptance of a new model of health care provided at a multi-purpose service.