[Barriers and opportunities for social participation in health: the main social actors' perceptions]

Analysing barriers to and opportunities for user involvement as perceived by the social actors involved in implementing Colombian policy regarding social participation in health.

An exploratory qualitative study was carried out in the Colombian towns of Tuluá and Palmira between 2000 and 2001. There were 10 focus groups having 260 users and leaders. Semi-structured individual interviews were given to health personnel (36) and policy-makers (3). Narrative content, mixed categories and data segmentation by informants and topics were then analysed.

Users and leaders considered their own lack of knowledge, apathy and fear of revenge as barriers for participation. However, there were institutional factors such as lack of institutional transparency, limited receptiveness and responsiveness regarding participation. These opinions were shared by policy-makers. Most health personnel identified users' knowledge and attitudes as barriers for participation; few mentioned any institutional barriers such as the behaviour of personnel, institutional opacity and the lack of resources for fostering work in the community. Opportunities for participation were described in terms of suitable and possible scenarios. Users perceived their great ability to achieve change through their direct participation appeared to them as presenting an important opportunity.

Users' and leaders' perceptions of the current barriers and opportunities seemed to show that they are critical of their own reality and constitute important potential actors for becoming key interlocutors with institutions and the state. A similar attitude would be necessary on the part of institutional actors to build a real and permanent participatory culture.