Intended for healthcare professionals

Journal Journal

Health Expectations

BMJ 1999; 319 doi: (Published 18 September 1999) Cite this as: BMJ 1999;319:789
  1. Michel Wensing, research fellow
  1. Centre for Quality of Care Research, Universities of Nijmegen and Maastricht, Netherlands

    Blackwell Science, Annual subscription £180

    ISSN 1369 6513

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    Health Expectations is a new journal, established in 1998 and published quarterly from 1999. It focuses on “things done with the active involvement of patients, users or citizens” rather than “things done to them.” These include “involvement of patients and their advocates in decisions about individual health care; involvement of users and their representatives in service design, delivery, and evaluation; and involvement of consumer advocates and the general public in debates about health care.”

    The four issues published so far contained 16 research papers, seven “viewpoints” or literature reviews, and 25 reviews of books or resources in 219 pages. Most of the published research concerns the involvement of individual patients, focusing on information aids and patient satisfaction. The remaining research papers deal with surveys on users' opinions about specific topics that are relevant to health policy making. The viewpoints and literature reviews refer to debates about the organisation and delivery of health care, while the reviews cover books on user involvement and information aids for users and patients.

    The format of the articles is similar to that in most medical journals, although the papers are somewhat longer than usual. Examples of the published research include a pilot study of an information aid for women with a family history of breast cancer, a survey of the use of evidence by healthcare user organisations, an in-depth analysis of shared decision making in consultations for upper respiratory tract infections, an interview study on the relation between expectations and satisfaction of patients who considered surgery for gynaecological cancer.

    Health Expectations has certainly expanded the opportunities to read and publish articles on involvement of patients and users in health care. Concentrating such papers into one journal should make it much easier to learn about new developments in the subject, as such articles were previously scattered among many journals. Health Expectations may therefore stimulate further research and development in this subject. One limitation is that it is not very interactive: it does not yet have a section for letters to the editor or a website for responses to published papers. Another limitation, also mentioned by the editors, is that the journal has a strong British orientation.

    A major danger is that the journal will become (or be regarded as) a promoter of involvement of patients and users as such. The editors are aware of this danger, as one of them writes in an editorial that “progress is hampered by the politically correct position that more participation is always a good thing.” Furthermore, at least one of the papers reports on negative consequences of greater patient participation: patients who received more information on coronary angiography were less satisfied with the care they received. It is crucial that the editors maintain this critical and balanced approach.

    I am not sure whether Health Expectations has a long term future. The interest in patients' and users' involvement in health care is currently fashionable, but that may disappear, and well designed studies in the subject may increasingly be published in established healthcare journals. In the meantime, however, Health Expectations should provide an important forum for research and debate on the subject.