Challenges of client participation in the co-development of social and health care services: Imbalances of control over action and the management of the interactional agenda

Abstract

Client participation is not only about deciding on one's own treatment, but it may also be conceived more generally as the right of the client to influence the planning and development of social and health care services. In this paper, we examine participants' rights to control and influence action in workshops in which social and health care professionals and clients co-develop the social and health care services provided by their municipality. Drawing on conversation analysis as a method, we investigate the interwovenness of the participants' rights to control interaction in the encounter (proximal deontic rights) and their right to decide about those future actions that can have concrete health consequences for them (distal deontic rights). Maintaining that it is the clients' distal deontic rights that underlie the motivation and legitimacy for their participation in the co-development workshops, we ask about the extent to which the clients' distal deontic rights are underpinned and constrained by who has the proximal deontic rights in the situation. The data set involves both face-to-face and online workshops. Our analysis shows that, in the face-to-face workshops, the agenda management by professionals involved control over both proximal and distal action. In the online workshops, the professionals seemed to have technical difficulties that momentarily disrupted the fluency of interaction. Despite these problems, which in principle might have given the clients more space to participate, this did not seem to happen. In contrast, the clients had great difficulties managing the interactional agenda, losing control over both proximal and distal action. Promoting ethical and more balanced client participation in the co-development processes in the future necessitates heightened awareness of the nuanced practices of interaction by which power imbalances are realized.