Start here! Good quality information is essential - the foundation for individuals to make informed choices and decisions, and for participation at any level.
There is evidence that people who have information feel more in control and report better states of health. ¹⁵

But don't think that you have fulfilled your obligation to involve people just by giving them information. It is not sufficient in itself. When analysed, many 'consultations' are no more than attempts to inform service users or the public about decisions that have already been taken. (See Models that describe levels of involvement)

People continue to complain about poor communication and quality of information, despite the work that goes into producing it. The root cause would seem to be that information is provider-led, not user-centred, failing to consider the information needs or characteristics of service users. ¹⁶ 'Changing Childbirth' recommended that service users were involved in the development of information materials ¹⁷, and this is now widely recommended and practised.

The aim of giving information might be:

• Increasing knowledge
• Education - information intended to change attitudes or behaviours
• Empowerment - increasing skills and confidence to enable participation in a dialogue.

Time and money could be saved by adapting communications materials already in use. ¹⁹

It may be more cost-effective to adopt 'good practice' information that has been developed and evaluated elsewhere than to start from scratch. (See Other resources)

The charter for long term care says that local charters should contain information on services available and how to access them, how people can say what they think about services and suggest ways of improving them, and how to complain. People should be helped to give their views through advocacy or representative organisations. ²⁰

Information is generally service or theme specific, so people may need to look for information from a number of sources. They would benefit if agencies could co-operate to produce a joint information pack including information from health, social services, the Benefits Agency, education, leisure and voluntary groups. ²¹ A user-led project group could produce such a pack, in appropriate formats.

"You can expect key information to be available in a form which is accessible to you, for example in different languages, or, as necessary, on tape, and that an interpreting service will be provided if you need it." 22

This is the most commonly used method of providing information about services, policy and planning, although as has been shown, it excludes considerable sections of the population. See 'Some characteristics of the population' and 'Literacy levels'

It is known in education that visual cues help make sense of text for those with poor reading skills.
The one million people who are blind or partially sighted will need large print, Braille or Moon, or tape formats. The RNIB 23 recommends the following to increase readability for the additional 700,000 people who are unable to read newspaper print.

• Black type on white or yellow paper give best contrast. Avoid patterned backgrounds.
• Glossy paper that reflects light can make reading difficult.
• Documents for general readership should be in 12 point type. Large print needs to be a minimum of 14 point, but many people benefit from a larger size.
• Use medium or bold type weights
• Use unjustified right hand margins and space between lines.
• Capital letters are harder to read than lower case.

Studies in the 1980s ²⁴ showed that information from a computer was preferred to printed material, and that increase in knowledge was greater than from oral or written sources. It may be that this effect has declined as computers have become less of a novelty. However, in 1991 when computer literacy was less wide-spread, a study ²⁵ of computer use in 4 Merseyside GP waiting rooms showed that the majority of respondents did not find the system difficult to use. Touch screens have since increased ease of use.

Information via a computer can be used at an appropriate time, and the interactive element may increase effectiveness. For example, questions may be used to check understanding. Graphics make computer information accessible to those with reading difficulty, and voice simulation is becoming more widely available. However, the 'information divide' means that many people who use health and social care services may not have access to computers, or be able to use a computer in privacy.

The feasibility study for the East Riding information system (see box above) recommended an Internet based system.
A number of councils, for example Middlesborough, put their surveys for Citizens' Panel members on their website. Of the first three surveys (1999) 1-2% were completed in this way. A recent community panel survey in North Lincolnshire found that a quarter or more of their panel members had access to the Internet. Others councils, for example, Liverpool use their website to recruit panel members, with application forms available in large print, tape and Braille.

On-line surveys might be a way of increasing the response from younger people, who are usually under-represented. For example, the Internet is being used to consult with primary and secondary school children in 70 schools (Kidscope).
There is potential for giving and requesting information using computer technology, as well as linking people and for on-line discussion groups.

See HealthLINK and Telephone networks

This is a familiar, attention-holding medium which is not literacy or necessarily hearing dependent, although not everyone, especially poorer and older people, own video equipment. A strength of the medium is its ability to simulate discussion and show role models. Videotapes are not expensive to reproduce, but the cost lies in producing a product of the quality people expect.

Does not rely on literacy or sight, and good sound quality tapes are not expensive to reproduce. Can be listened to and repeated at leisure. Retaining concentration to listen over longer periods can be difficult for those who are not used to the medium.

Exhibitions

• Site will determine reach to public - specific venues can be chosen to reach specific groups
• Information can be presented in visual form
• Public relations value, but can also be construed as a waste of resources
• With adequate staffing, can be used in an interactive way with the public contributing views and ideas

Information giving to promote understanding of issues

• Better for defined groups than the general public
• Agency in a position to control what information is given
• Limited opportunities for dialogue at this stage
• Need to facilitate participation with childcare, travel costs etc.

Using the media can be a quick and effective way of reaching a wider audience. Local radio and the local newspaper can be used for publicising events, inviting participation, giving information or starting a local debate. Regularly contributing items of interest or having a regular radio slot or newspaper column not only builds a relationship with the media but raises the public profile of the organisation. The 'human' side of the organisation can also come across.

Advantages:

• Can reach a different cross-section of the public, for example, the housebound, older people
• Local radio not literacy dependent
• Radio and 'talking newspapers' reach visually impaired people
• Helps build a perception of the organisation as part of the local community
• Commonly asked questions can be answered
• Media will often use items that are presented to them in 'media style' and with photos

Consider:

• Only fairly simple messages can be communicated
• You may not have control over how information is used (unless buying advertising space) or over the questions asked in interviews
• You need to develop skills to present information in an appropriate form and to take part in interviews

An event that extends an open invitation to members of the public to attend. There is usually a speaker and there may be a panel of people to who will respond to questions from the audience. May be held to introduce a plan, strategy or report, or when there is a specific issue of public interest such as a change in service provision. Some agencies hold regular public meetings.

Some agencies hold meetings that are open to the public, but people are not usually invited to comment on the proceedings. Here the role for the public is of scrutiny, or holding the organisation to account.

Public meetings are often seen as democratic, offering an open invitation to the public to receive information, comment, raise issues, inform decisions and challenge service providers. They are high profile and regarded as good public relations and a way of meeting and listening to the public. However, the cost-benefit ratio is not favourable. This approach usually reaches only a small section of the community. Public meetings are not accessible for many of the people who would use health and social care services. The public relations element may be lost because of the unsatisfactory nature of the interaction and difficulty in providing feedback on the outcome.

Public meetings are most appropriately used to give specific information, and to air a single issue about which the public feels strongly. Using only public meetings as your strategy for involving people is never sufficient, and other forms of dialogue group may be more appropriate.

See Focus group discussions

Consider:

• This is a formal process that excludes many. Poor attendance is wrongly interpreted as lack of interest rather than poor choice of method.
• People attending may have little information about the organisation holding the meeting, what it does, or how it works
• Usually a 'one off' exercise rather than part of an ongoing process
• The audience will contain many different interests, degrees of knowledge and sympathy with the organisation. It is difficult to know where to pitch a presentation
• A glossy presentation suggests that the decision is made, and leaves little room for alternatives
• Opportunities for people to contribute are limited
• The agency agenda may not be that of the public - excluding contributions that seem off the point adds to the impression that the agency is paternalistic and does not listen.
• Issues raised may not be a reliable indicator of public perception or priorities. Interest groups may distort the wider view
• A public meeting creates a setting for conflict between audience members as well as audience and presenters, which the organiser can have little control over

Making the most of a public meeting:

• Think about your aim - is this the best way to achieve it?
• Keep purpose simple - trying to mix all elements, information giving, consultation, holding agency to account etc, will not work.
• Consider timing, location, access, childcare, travel arrangement and cost, to facilitate attendance by as wide a range of people as possible
• Personal invitations get a better response than a general open invitation, but don't rely solely on umbrella groups
• Avoid 'them and us' layouts and settings
• Meet with key groups first for common understanding of purpose and to agree agenda
• Allow time to break into small groups first to give more people chance to contribute, and to allow common themes to emerge

Activities that are really opportunities for giving information are often labelled 'consultation'. True consultation has a dual purpose, both giving information and listening to and considering participants' responses.

See Models that describe levels of participation

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