Empower Service Users Research Articles

Factors and Processes Facilitating Recovery from Coercion in Mental Health Services-A Meta-Ethnography.

Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it is important to understand how the experience can be processed so that its consequences are managed. A systematic review and meta-ethnography was used to synthesise findings from qualitative studies that examined service users', staff's and relatives' experiences of recovery from being exposed to coercive measures in mental health care settings. We identified, extracted and synthesised, across 23 studies, the processes and factors that were interpreted as significant to process the experience. Recovery from coercion is dependent on a complex set of conditions that support a sense of dignity and respect, a feeling of safety and empowerment. Being in a facilitating environment, receiving appropriate information and having consistent reciprocal communication with staff are the means through which these conditions can be achieved. People employ strategies to achieve recovery, both during and after coercion, to minimise its impact and process the experience. The findings point to the importance of mental health care settings offering recovery-oriented environments and mental health professionals employing recovery-oriented practices, that would empower service users to develop strategies for managing their mental distress as well as their experiences in mental health care in a way that minimises traumatisation and fosters recovery.

Is the NHS low-calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification.

Obesity and Type 2 Diabetes Mellitus (T2DM) are chronic conditions with significant personal, societal, and economic impacts. Expanding on existing trial evidence, the NHS piloted a 52-week low-calorie diet programme for T2DM, delivered by private providers using total diet replacement products and behaviour change support. This study aimed to determine the extent to which providers and coaches adhered to the service specification outlined by NHS England. An observational qualitative study was conducted to examine the delivery of both one-to-one and group-based delivery of programme sessions. Observations of 122 sessions across eight programme delivery samples and two service providers were completed. Adherence to the service specification was stronger for those outcomes that were easily measurable, such as weight and blood glucose, while less tangible elements of the specification, such as empowering service users, and person-centred delivery were less consistently observed. One-to-one sessions were more successful in their person-centred delivery, and the skills of the coaches delivering the sessions had a strong impact on adherence to the specification. Overall, the results show that there was variability by provider and delivery mode in the extent to which sessions of the NHS Low-Calorie Diet Programme reflected the intended service specification. In subsequent programmes it is recommended that one-to-one sessions are used, with accompanying peer support, and that providers improve standardised training and quality assurance to ensure specification adherence.

Interventions Aimed at Alleviating Loneliness and Social Isolation among the Older Population: Perspectives of Service Providers

Background. Older people are one of the groups particularly vulnerable to loneliness due to factors such as deteriorating health, widowhood and death of friends/family, fewer confiding relationships, and being more likely to live alone. In the United Kingdom, services to alleviate and/or prevent loneliness can be classified as foundation services, direct interventions, gateway services, and structural enablers. Service managers and personnel involved in the delivery of interventions for older people are well-positioned to report on the mechanisms that contribute to the effectiveness of interventions. This study aimed to elicit from the perspective of a range of service providers, the barriers and facilitators of successful service provision, and the reduction of loneliness among older people. Methods. Semistructured interviews were conducted with 23 service managers of services providing an intervention to older people in Northern Ireland. Services were eligible for inclusion if they reported a goal of preventing or reducing loneliness and/or social isolation among older people. Transcripts were analysed using thematic analysis. Results. Eight themes were produced representing barriers or facilitators of successful service delivery, including characteristics of the service (person-centred approach, empowerment of service users and staff/volunteers, personal qualities of staff and volunteers, and funding for service provision) and characteristics of the wider community were services were located (hard to identify and/or reach lonely people; education and awareness of services; family and community structures; and accessible, affordable, and safe public transport). Conclusion. Developments in this area should prioritise integrated, systemic solutions that harness capacity and partnership working within communities, grounded in the principles of empowerment, inclusion, self-determination, and collective action.

Sustainability pathways in European waste management for meeting circular economy goals

This study explores trends in recycling rates and municipal solid waste landfilling to construct a circularity index (CI) forecasted up to 2035. This projection is contrasted with the pathways that countries must adopt to attain set targets. We further estimate the impact of the CI on factors such as sustainability performance, innovation, commodity trade balance, and waste reduction. Moreover, we provide policy implications useful for designing industrial and environmental strategies, including accelerating permit approval times for waste treatment facilities, introducing more flexibility in state aid rules, empowering service users or waste generators, implementing tax credits, and leveraging specialized funds. These strategies are aimed at supporting the recycling industry to stimulate convergence and achieve circular economy objectives.

Provision of COVID-19 treatments to non-hospitalised patients in Northern Ireland: an evaluation

Abstract Background The first UK interim clinical commissioning policy for the treatment of non-hospitalised patients with COVID-19 was published in December 2021. A service was established in Northern Ireland, with implementation and developments overseen by a multi-agency group. We investigated the reach, uptake and equity of the programme to understand performance and offer recommendations for improvement. Description of the problem Data were extracted for 16 December 2021 to 16 December 2022. The objectives were to: 1) describe referrals over time using weekly aggregate returns sourced from the commissioning agency for all of NI and; 2) for a subset of providers, to describe treatment acceptance and those treated by age group, sex, deprivation quintile and all-cause mortality using anonymised, linked administrative data. Treatment acceptance was analysed using logistic regression. Results Overall, 16,454 patients were referred of whom 9,536 (58%) were eligible for treatment. Of these, 5,849 (61.3%) accepted, 1,215 (12.7%) declined, 1,140 (12%) were already an inpatient and the remainder unknown (1,332; 14%). Using the subset, treatment acceptance was associated with increasing age (likelihood ratio test (LRT) P = 0.02) but not deprivation (LRT P = 0.83). Of those treated (3,645 people) the majority were aged 18-64 years (68%) and were female (59%). Just 8% lived in the ‘most deprived’ quintile, compared to 20% in all others. The 28-day all-cause mortality for those recommended treatment was <1%. Lessons This was a rapidly established service which has treated 5,849 people. Acceptance of treatment increased with age but was not affected by deprivation. However, a higher percentage of those treated were from least deprived areas. Recommendations include monitoring equitability of access and a greater focus on those eligible for treatment but who decline, both highlighting the importance of engaging and empowering service users to make an informed choice around COVID-19 treatment. Key messages • Almost 6,000 people in the community have received a COVID-19 treatment since the inception of the service in Northern Ireland. • Equitability of access should continue to be monitored.

Supporting Service Recipients to Navigate Complex Service Systems: An Interdisciplinary Scoping Review

This scoping review aimed to identify potential factors from across eight disciplines’ approaches to complexity that could be positively applied to supporting services users to navigate health and social care. The illustrative example of families where a parent has mental health challenges is used as those families often have a wide range of complex needs both for the parent/s and children. These complexities can result in the involvement of multiple services and interventions. However, in attempting to respond to complex family needs, health and social care services may unintentionally increase the complexity and associated stress for the family. Two broad themes were identified within the multidisciplinary literature including testing service developments with a view to reduce or manage complexity and approaches to support service users to navigate complexity. Specific learning from the scoping review can be applied to health and social care services to encourage a focus on service users’ expectations, understandings, and experiences of services; carefully consider the relationship between the service design and the service user’s behaviour; and finally reinforce the importance of service user involvement (or coproduction) within service development and consideration of the relationship between the service user and provider. The knowledge drawn from this scoping review can inform the development and evaluation of current services and guide the development of future services. It can also help consider approaches to empower service users to navigate the complexity of services.

Actor roles in co‐production—Introducing intermediaries: Findings from a systematic literature review

AbstractPublic service ecosystems are used to understand how multiple actors co‐produce public services and create public value. Especially interactions between public service providers and service users are essential. However, systematic examinations of these interactions and what roles the different actors play are rare. This study closes this gap by conducting a systematic literature review with three main findings. First, public service providers play an important role: they facilitate co‐production by micromanaging or facilitating collaboration, empowering service users, and translating the results of the process back into the organization. Second, service users contribute to co‐production by providing resources. Third, a new category of actors is proposed: the co‐production intermediary. Intermediaries are formal organizations whose primary role is to support service providers in service delivery. This study comprehensively analyzes the different actors and power constellations between them.

Organizational strategies in promoting person-centered primary care: A participatory concept mapping study

ABSTRACT Despite notable advancements, person-centered implementation is still propelled at a service level. This study aims to empirically determine organizational actions to achieve a person-centered culture through conceptual mapping of essential strategies. A participatory, multi-staged, group concept-mapping approach was employed. Mid and high-level healthcare managers responsible for managing healthcare delivery within the Malaysian Ministry of Health were recruited. In two separate meetings, 12 managers provided a set of related concepts and strategies, while 17 rated the importance and feasibility of implementation strategies. Cluster labels generated from the multidimensional scaling and hierarchical clsuter analysis were: multidisciplinary team, training and education, service user empowerment and quality assurance. The rating of statements created go-zone maps to determine the relative importance and feasibility of each person-centered strategy. Extending professional activities that cover a comprehensive spectrum of services and training healthcare providers on person-centered competency were rated the most important and feasible strategies. Nevertheless, these strategies must be balanced with additional resources to avoid the increasing workload to healthcare providers juggling many different tasks. In conclusion, the participatory evaluation allowed a better understanding of stakeholder-perceived priorities in developing short and long-term strategic plans for person-centered transformational practice and culture development.

HURTing: An Analysis of Service User and Carer Referrals to a UK Social Work Regulator

Abstract In the context of increasing regulation of social workers internationally, this study examines allegations made to a UK social work regulator, the Northern Ireland Social Care Council (NISCC), by service users and carers. A retrospective review of 134 records relating to such allegations during the ten-year period 2006–2015 was undertaken, representing just over one-third (36.4 per cent) of all allegations received. Allegations were made primarily about family and child-care social workers (91.0 per cent) and reflected the four inter-linking categories of concerns about the honesty of social workers, reports that service users/carers were treated unequally, allegations that social workers failed to demonstrate respect in their interactions with service users/carers, and concerns about technical aspects of social workers’ practice. The nature of these allegations forms the acronym HURT that describes both the experiences of service users/carers and the stressful context in which social workers practice. This article concludes that addressing the stress and HURT of both parties is important and makes suggestions regarding how the findings can strengthen the role of the regulator, influence social work practice and empower service users and carers.

Staff perceptions of factors affecting the use of RAS-DS to support collaborative mental health practice

BackgroundThe Recovery Assessment Scale: Domains and Stages (RAS-DS) was designed to be both a recovery outcome measure and a tool to enhance service-user control over their recovery journey. While extensively and globally used in mental health services for the former purpose, routine use for the latter purpose is yet to be realised. The aim of this study was to identify barriers, facilitators and additional supports needed for RAS-DS to be used to support service user participation, goal setting and recovery action planning.MethodsAn online survey was conducted of mental health workers who had engaged with RAS-DS, including fixed choice and open-ended questions. Data were analysed using descriptive statistics and interpretive content analysis respectively.ResultsThe 65 respondents reported more frequent use of RAS-DS as an outcome measure than as a collaboration tool and more than half reported difficulties in using it in this way. Factors that they described as influencing the use of RAS-DS as a tool for collaboration and support included: previous experiences with RAS-DS; organisational supports and policies; awareness of the RAS-DS amongst colleagues; RAS-DS related training and support; staff time and capacity; the format of RAS-DS; service user population or context; and respondents’ own active efforts.ConclusionsExtending the use of RAS-DS, an already widely used tool, to routinely support recovery-oriented practice has both efficiency and service user empowerment benefits. However further work is needed to enable this including: provision of co-designed, accessible training resources; a user platform including built in guidance; and strategies to promote management understanding and valuing of the enhanced recovery-orientation opportunities inherent in RAS-DS use.

Coproduction with Service Users in Adult Social Work: A Study of Service Users’ and Social Workers’ Experiences in Northern Ireland

Abstract Involving service users, in the delivery of health and social care, is a focal point in social policy discourse. Coproduction has become synonymous with anti-oppressive practice and service user empowerment. This article reports on a qualitative study carried out in Northern Ireland which explored service user involvement in adult social care practice and policy development. Semi-structured interviews were completed with service users (n = 6) and social workers (n = 7); thematic analysis was applied to the resultant data. The study was coproduced with service users who informed the research design and were actively involved throughout each phase of the study. Findings suggest that service users are motivated to participate in coproduction and can feel valued in these roles, but meaningful coproduction is a challenge in the current practice environment. Close working relationships, with clear and consistent communication are difficult to maintain amid the current trend of bureaucratisation in our profession. Findings point towards the need for a service-user/social worker alliance which can challenge problematic organisational cultures. Remuneration for service users, engaged in coproduction, is encouraged, alongside organisational recognition of the time and resource necessary for effective coproduction. A procedural and ethical framework for coproduction practices would also be timely.

Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co-creation of a hospital-based health literacy plan.

People with literacy needs can experience many challenges in accessing, understanding and using health services and health information. Such challenges can adversely impact patient-provider interactions and ultimately, health outcomes. Healthcare providers need to be aware of health literacy (HL) to address the demands of healthcare systems, improve their interactions with communities and patients and promote patient engagement for improved health outcomes. This paper reports on a process of patient and public involvement (PPI) with participants in an adult literacy programme acting as PPI contributors to identify priority areas for a local hospital HL action plan and to develop a protocol for a PPI process with other groups. A qualitative community-based participatory research study design informed by principles of PPI was undertaken, drawing on the tools of participatory and visual methods, open discussion and workshop format to facilitate a process of co-creation. Three workshops with six PPI contributors took place to identify issues to be included in the hospital action plan. PPI contributors identified issues and grouped these into priority areas using discussion and ranking procedures. Key areas prioritised for HL action by the PPI contributors were: verbal communication, emphasising the patient's right to understand, and improved understanding of medication use. These were incorporated into the action plan. The workshop format and process were deemed acceptable to the group and input on improvements will be incorporated into further work in this area. PPI acts as a lever in the knowledge translation process. Genuine engagement with service users can meaningfully contribute to relevant and sustainable changes to services as well as foster the empowerment of service users. Members of the public with literacy needs actively participated in the co-creation of a HL action plan for a local hospital and in the development of a protocol for a patient and public process for HL research.

Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study.

Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders' needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study's findings. The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users' strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. Stakeholders' experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources.

The experience of community mental health teams by people with long-term experience of psychosis

ABSTRACT BACKGROUND The recovery movement has facilitated a move from a palliative approach to care, to one that emphasises the possibility and likelihood of recovery. This study aimed to explore people’s experience of community mental health services, and to explore any changes that have occurred over-time. METHOD A qualitative study was conducted using Interpretative Phenomenological Analysis. Seven individuals who have experience of psychosis and who have been involved with services for 5 years or more, were recruited from community mental health teams in the UK. Interviews were conducted via the telephone using a semi-structured approach. RESULTS Individuals reported a mixed experience of services. Four super-ordinate themes were identified; 1) Grateful for connection; 2) Hesitant about being dissatisfied; 3) The unequal distribution of power; and 4) An enduring vulnerability. DISCUSSION Service-users benefited from a secure and connected relationship with professionals. They were less comfortable about criticising services but did describe some elements of care that were oppressive and isolating. Furthermore, the balance of power continues to favour professionals, with a more equal relationship required if we are to facilitate recovery and empower service-users.

The mixed and misleading messages within adult social care – implications for the social work role to assess need and plan support

ABSTRACT Concern about the role social workers play in adult social care is long standing. Social workers, whose ethics commit them to supporting the empowerment of service users and to social justice, are required to work within a system that fails to secure either and is widely identified as in long-term crisis, despite a number of unsuccessful efforts to transform it. This article describes a detailed examination of the way one council operates. It reveals the gap between how the council says it does this and how this is experienced. It is suggested that the council, however, is not an exception. It follows the national template. The role social workers are required to play in this scenario is critical. They are key to delivery of the template. With little sign of resistance from the social work system itself, hopes for change rely on the emergence of grassroots and political initiatives that seeks a better future for social care.

Empowerment training to support service user involvement in mental health system strengthening in rural Ethiopia: a mixed-methods pilot study

BackgroundIncreased service user involvement is recommended to improve weak mental health systems in low-and middle-income countries (LMICs). However, involvement is rarely implemented and interventions to support involvement are sparse. In this study we evaluated the acceptability, feasibility and perceived outcomes of an empowerment and training program for service users and health professionals to facilitate service user involvement in mental health system strengthening in rural Ethiopia.MethodsREducing Stigma among HealthcAreProvidErs (RESHAPE) is a training curriculum for service users, their caregivers and aspirational health workers, which uses PhotoVoice methodology, to prepare them in participation of mental health systems strengthening in LMICs. We delivered the RESHAPE training augmented with empowerment content developed in Ethiopia. The interactive face-to-face training was delivered to service users and caregivers (over 10 days), and health professionals (1 day) separately. The study was an uncontrolled, convergent mixed-methods design. The quantitative data consisted of process data, satisfaction questionnaire, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with the service users. Descriptive statistics were performed for quantitative data, and qualitative data were thematically analysed. The findings were integrated through triangulation for convergent themes following analysis.ResultsTwelve service users, 12 caregivers and 18 health professionals were enrolled, and completed the training. Participants valued the content and delivery process; the standard of the training program met their expectations and participation led to positive gains in understanding about mental illness, stigma, service-user involvement and human rights. The qualitative findings identified positive impacts, including increased self-confidence, sense of empowerment, social - and perceived therapeutic benefits.ConclusionsWe found that the RESHAPE training with added content for Ethiopia, delivered using the PhotoVoice methodology, is feasible, acceptable and of value to develop and implement training programmes which can empower service users to be involved in mental health system strengthening in this setting. Further study to assess the impact on health systems strengthening is warranted.

Evaluation of a Drama-Based Experiential Learning Group Programme for Multidisciplinary Staff and People With Lived Experience in Psychiatry

AimsExperiential learning, such as simulation-based training, is widely used in health education. Dramatic self-expression adds another layer through enacted perspective taking, and embodied self-exploration of interaction with others, to foster situated learning. We describe the evaluation of an innovative drama-based experiential learning project involving collaboration between multidisciplinary mental healthcare staff and people with lived experience of mental illness. The programme was facilitated at East London NHS Foundation Trust by a theatre company experienced in delivering workshops with service users. A weekly group programme took place online over 8 weeks during the COVID-19 pandemic and included activities of improvisation, embodied enactments and debriefing. The programme led to co-production of a drama piece that was filmed and distributed online. It was hypothesised that the experiential learning might result in individual benefits for all participants, such as improved well-being and increased mutual understanding of each other's experience of mental health care. The project aimed to improve relationships between healthcare disciplines, and between staff and service users. Additionally, aims were to empower service users, and support staff to practice core interpersonal skills. Objectives of the evaluation were to study the impact of the experiential learning, understand participants’ experience, and explore challenges and benefits.MethodsA mixed methods approach was taken to evaluate the programme. Following completion of the project, participants were invited to complete a questionnaire utilising a Likert scale rating of overall satisfaction with the project, perceived benefit and impact on specific domains such as working with others. One-to-one semi-structured interviews were conducted according to a topic-guide, and qualitative data were analysed using open & axial coding for thematic analysis.Results11 participants, including Psychiatrists, Occupational Therapists and current service users, completed the experiential learning and filming. Questionnaire data suggested participants were highly satisfied with the learning and felt it would be valuable to others. Themes include the positive experience of creativity, dismantling of hierarchy, improved empathy, confidence and connection. Potential challenges were digital inequality and lack of dedicated time for professional development.ConclusionA drama-based experiential learning group programme for healthcare staff and service users is a highly beneficial learning experience. Participants describe changes on a personal level as well as improved understanding of others’ perspectives. This form of experiential learning features collaborative working that aligns with principles of co-production and supports the development of interpersonal skills; the findings suggest that drama-based experiential learning is a useful method in health education to complement knowledge acquisition.

How Do Healthcare Chaplaincy Spiritual Care Interventions Support Adults’ Mental Health by Integrating Health and Social Care?: A Review of Primary Research Studies Published in English 2010–2019

There is an international movement towards integrated care. This systematized literature review studied healthcare chaplaincy spiritual care interventions that support adult mental health by integrating health and social care. Seventeen relevant studies were found. One analysed individual and family care in a general hospital. Twelve described one-to-one community-based interventions, of which ten concerned general practice healthcare centres. Four involved groups supporting mental health in hospitals or community-centres. Two studies used qualitative approaches, seven quantitative and eight mixed methods. The quality of evidence for the outcomes of interventions was examined. The review found that studies demonstrated shifts in healthcare professionals’ working practices anticipated by Paterson (2014), from hospital towards community bases, from treatment of individuals towards empowering service users to self-manage their health, and in mental health contexts from treatment of individuals towards care in groups.

People's Experience of Shared Decision Making in Musculoskeletal Physiotherapy: A Systematic Review and Thematic Synthesis.

(1) Shared decision making (SDM) has been advocated as a way of improving prudency in healthcare and has been linked to self-efficacy and empowerment of service users. The evaluation of its use in musculoskeletal (MSK) physiotherapy has been vague, but articles suggest that trust and communication are integral. (2) ENTREQ guidelines informed this systematic review and thematic synthesis. PRISMA recommendations steered a systematic literature search of AHMED, CINAHL, MEDLNE, EMBASE and Cochrane databases from inception to September 2021. COREQ was used for quality appraisal of articles alongside critical discussions. Analysis and synthesis included five stages: outlining study characteristics, coding of data, development of descriptive themes, development of analytical themes and integration and refinement. The review aim was to explore people’s experiences of SDM in MSK physiotherapy and to inform our understanding of the conditions needed for successful SDM. (3) Out of 1508 studies, 9 articles were included. Four main themes (trust, communication, decision preferences and decision ability) demonstrated that the majority of people want to participate in decision-making. As described in the capacity and capability model, three core conditions were needed to facilitate someone’s’ ability to participate. (4) People want to be involved in SDM in MSK physiotherapy. For successful SDM, physiotherapists should look to develop mutual trust, utilise two-way communication and share power.

Web Augmentation for Well-Being: the Human-Centred Design of a Takeaway Food Ordering Digital Platform

Abstract Online services have become increasingly centralized, drawing on notions of the ‘platform economy’ to focus on ecosystem value rather than user value. In parallel, there have been efforts by developers to augment these platforms, empowering platform users in the process. We explored a 12-month participatory-action project, focusing on redesigning portions of Just Eat, an online aggregator for takeaway food ordering, building upon theoretical perspectives from public health and Digital Civics. We document our experiences in identifying user behaviours and motivations across multiple design workshops, including the design of a web-augmentation–based template to disrupt platform provider behaviours, empower service users and increase individual agency. Through this case study, we identify opportunities and mechanisms for platform modification, linking augmentation to adversarial design with outcomes that have the potential to improve the well-being of platform users.