Participation: If we want to make progress, we must speak clearly

Participation is now recognized to be an important issue in many aspects of health care. However, if we want to further our understanding and improve the ways we support patient, consumer, user, lay, or public participation in health care, we need to be clear what we mean by participation and whose participation in what type(s) of activities we are interested in and why. Progress is hampered both by uncritical adoption of the politically correct position that more participation, whatever that is conceived to be, is always a good thing and by debates that are more heated than informed. I suspect that many disputes are born of a lack of clarity: disputants often fail to recognize that they hold different understandings, definitions and images of participation...