The use of citizens' juries in health policy decision-making: a systematic review

Deliberative inclusive approaches, such as citizen juries, have been used to engage citizens on a range of issues in health care and public health. Researchers engaging with the public to inform policy and practice have adapted the citizen jury method in a variety of ways. The nature and impact of these adaptations has not been evaluated. We systematically searched Medline (PubMED), CINAHL and Scopus databases to identify deliberative inclusive methods, particularly citizens' juries and their adaptations, deployed in health research. Identified studies were evaluated focussing on principles associated with deliberative democracy: inclusivity, deliberation and active citizenship. We examined overall process, recruitment, evidence presentation, documentation and outputs in empirical studies, and the relationship of these elements to theoretical explications of deliberative inclusive methods. The search yielded 37 papers describing 66 citizens' juries. The review demonstrated that the citizens' jury model has been extensively adapted. Inclusivity has been operationalised with sampling strategies that aim to recruit representative juries, although these efforts have produced mixed results. Deliberation has been supported through use of steering committees and facilitators to promote fair interaction between jurors. Many juries were shorter duration than originally recommended, limiting opportunity for constructive dialogue. With respect to citizenship, few juries' rulings were considered by decision-making bodies thereby limiting transfer into policy and practice. Constraints in public policy process may preclude use of the ‘ideal’ citizens' jury with potential loss of an effective method for informed community engagement. Adapted citizens' jury models provide an alternative: however, this review demonstrates that special attention should be paid to recruitment, independent oversight, jury duration and moderation.