Parent participation in decision-making in health-care services for children: an integrative review

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services.

Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services.

A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing.

Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors.

Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM.

Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service.