Assessing Patient Organization Participation in Health Policy: A Comparative Study in France and Italy

Document Type : Original Article


1 Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece

2 Community Mental Health Centre, University Mental Health Research Institute, Athens, Greece

3 Department of Surgery, University of Rome Tor Vergata, Rome, Italy

4 Europa Donna France, Paris, France

5 Bulgarian National Patients’ Organization, Sofia, Bulgaria

6 FSNB Health & Care, Paris, France


Even though there are many patient organizations across Europe, their role in impacting health policy decisions and reforms has not been well documented. In line with this, the present study endeavours to fill this gap in the international literature. To this end, it aims to validate further a previously developed instrument (the Health Democracy Index - HDI) measuring patient organization participation in health policy decision-making. In addition, by utilizing this tool, it aims to provide a snapshot of the degree and impact of cancer patient organization (CPO) participation in Italy and France. 
A convenient sample of 188 members of CPOs participated in the study (95 respondents from 10 CPOs in Italy and 93 from 12 CPOs in France). Participants completed online a self-reported questionnaire, encompassing the 9-item index and questions enquiring about the type and impact of participation in various facets of health policy decisionmaking. The psychometric properties of the scale were explored by performing factor analysis (construct validity) and by computing Cronbach α (internal consistency).
Findings indicate that the index has good internal consistency and the construct it taps is unidimensional. The degree and impact of CPO participation in health policy decision-making were found to be low in both countries; however in Italy they were comparatively lower than in France.
In conclusion, the HDI can be effectively used in international policy and research contexts. CPOs participation is low in Italy and France and concerted efforts should be made on upgrading their role in health policy decision-making.


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  • Receive Date: 26 October 2016
  • Revise Date: 31 January 2017
  • Accept Date: 27 March 2017
  • First Publish Date: 01 January 2018