Service User Participation Research Articles

Participação direta em coprodução é democrática? Controle vetorial da dengue em Campo Grande – MS

A abordagem de coprodução considera a participação ativa dos usuários essencial para a implementação de políticas, estando essa maior influência direta nos rumos de política pública alinhada a princípios democráticos. Com a intenção de compreender melhor essa relação entre participação dos usuários e democracia em coprodução, o objetivo deste artigo foi caracterizar a participação dos usuários na coprodução do controle vetorial da dengue em Campo Grande – MS, Brasil. Os dados coletados em cinco bairros do município foram analisados por meio de análise de conteúdo. Constatou-se que, nos casos pesquisados, os usuários: (i) são incluídos no relacionamento com os profissionais, (ii) são capazes de produzir resultados de política pública e (iii) se beneficiam desses resultados alcançados. No entanto, para o alcance de uma plena participação democrática em coprodução, ainda falta aos usuários influenciar outros processos de políticas públicas – não limitando sua participação (apenas) à execução de ações propostas pelo poder público.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries.

Mending the gaps in social work education and research: two examples from a Swedish context

ABSTRACTThe gap-mending concept is an analytical tool that helps teachers and researchers in social work to reflect upon what, in their practice, increases, maintains or mends gaps between professionals and service user groups. The article suggests a theoretical background on how gaps in social work practice can be challenged. This includes theories about power and recognition. It then moves on to describe the development of gap-mending strategies in research and education at the School of Social Work at Lund University. Lund University was one of three partners that took the initiative to the international network PowerUs that has focused on gap-mending strategies in social work education. The authors have been working over 10 years in collaboration with service user participation in the education of social workers and in different research projects. In the article, they give examples of gap-mending practices and of challenges that they have faced. The first example is an experimental course that has been given since 2005 where social work students study together with students from service user organizations in a university course. The second example is an attempt to combat homelessness in several Swedish municipalities. Supported by researchers, the development project has been a collaboration between homeless groups, politicians and social workers.

From service-user to social work examiner: not a bridge too far

The engagement of service-users in social work education has now become a recognised and accepted imperative. There are various ways in which this engagement can be formulated. This paper will address one such area that of developing a meaningful role for service-users in the assessment of social work learning. In partnership with a drugs rehabilitation centre in Dublin and University College Dublin (UCD), the authors worked with service-users in developing a curriculum and assessment method for a module on a Masters of Social Work programme. This paper describes how mixed-method research approach was used to engage both service-users and students in exploring and evaluating the assessment process. Both participant groups gave their informed consent to participate in focus groups, assignments, feedback and reflection activities. The findings indicated that service-users were keen to influence the way that social workers carried out assessments, and that social work students were, in turn, influenced by these views. The paper concludes with an appeal for such participatory approaches to social work education and learning where service-users can play meaningful roles in the important areas of student learning.

Distinctive Roles: Engagement, Innovation, and the Liaison Model

Bent on improving the teaching and learning experience, enhancing the productivity of researchers, and increasing the visibility of research outputs, libraries are redistributing staff, reallocating resources, and reorganizing internal structures, all to better partner campus-wide. Nowhere is the impact of this push for service innovation and user engagement greater than on the workload, direction, and even future of liaison librarian programs. This article provides brief historical context as it explores a cross section of libraries that recently redefined or restructured their liaison roles and begins a larger look at the corresponding impact of organizational climate and structure that may influence future success.

User Satisfaction Model for e-Learning Using Smartphone

Level of smartphone usage can be used as an indicator of technological progress of a region. This study aims to explore and make user satisfaction model for e-learning using smartphone applications in Mulawarman University. The purpose of the research is to make user satisfaction model for e-learning using smartphone, and to produce and to recommend e-learning content for research and e-learning. The components that would be evaluated in this research are focused on the following matters: User satisfaction for e-Learning using Smartphone; Service quality, Information quality, User participation, and Benefit. Where service quality consists of demeanor, responsiveness, competence and tangible. Information quality consist of completeness, relevancy, accuracy, and currency. User participation consist of training provider, user understanding and participation. Benefit consist of easier to the job and increase productivity. The research method used Path Diagram, Structural Equation Model, Lisrel and Manova Analysis. Total of respondent are 178 students which are consist of 83 females and 95 males. The statistical value in the model of e-learning user satisfaction has a highly significant correlation values and strong construction between variables, which is evidenced by the size of the construct reliability values above 0.70 and the value of its variance extracted 0.50 The model can be considered in developing an e-learning application in the future.

Understanding Compliance Dynamics in Community Justice Settings

This article seeks to expand the existing literature on compliance in community justice settings by highlighting the importance of service user participation in efforts to achieve compliance. The article’s central argument is that although co-productive strategies can enhance service user participation, the degree to which co-production is achievable in penal supervision is perhaps uncertain, and has received insufficient theoretical or empirical attention. To address the gap in knowledge, the article draws on the data generated from a study of compliance in Wales, United Kingdom, and employs the Bourdieusian concepts of habitus, field, and capital to argue that the convergence of two key factors undermines the viability of co-productive strategies in penal settings. One factor is the service users’ habitus of powerlessness which may breed passivity rather than active participation. The second also relates to the power dynamics that characterize penal supervision contexts. Within these contexts, practitioners are statutorily empowered to implement and enforce the requirements of community orders. In the current target-focused policy climate in England and Wales, practitioners may prioritize measurable compliance over forms of compliance that stem from service user participation and engagement perhaps because these are not readily quantifiable.

Service Users’ Involvement and Engagement in Interprofessional Care

Interprofessional care is joint working between health care professionals by pooling their skills, knowledge and expertise, to make joint decisions and learn from each other for the benefits of service users and healthcare professionals. Service users involvement is considered as one of the important aspects of planning, management and decision making process in the delivery of health care to service users. Service users' involvement is not the same as public involvement and partnership arrangements in health care. The active involvement and engagement of service users in health care positively contributes to improve quality of care, to promote better health and to shape the future of health services. Service users are always at the centre of health care professionals' values, work ethics and roles. Moreover, service users centred interprofessional team collaboration is very important to deliver effective health services.

Service user engagement in quality improvement: applying the national involvement standards

Purpose National and local policy supports the involvement of patients at all levels in the design, delivery and improvement of health services. Whilst existing approaches to support involvement have been described and disseminated, including the 4Pi National Involvement Standards, their application in quality improvement is rarely reported. The paper aims to discuss this issue. Design/methodology/approach A quality improvement initiative within a mental health trust was developed with a multi-disciplinary team, including those with professional experience of delivering or improving care and those with lived experience. The aim of the initiative was to improve the physical health of inpatients within an acute mental health unit. This case study aims to describe how the integration of concepts from the 4Pi National Involvement Standards (Principles, Purpose, Presence, Process and Impact) provided a framework for engaging and involving service users. The case study also aims to describe how co-design was included within the 4Pi approach and supported the development of a tool to aid improving physical healthcare. Findings The 4Pi National Involvement Standards provided a guiding framework for the involvement of service users within a quality improvement initiative. Value of the approach was realised through the co-design of a tool developed by service users, along with healthcare professionals, to facilitate discussion and support shared-decision making about inpatients’ physical health. Practical implications Identifying “ways that work” for service user involvement is crucial to move beyond the policy rhetoric or tokenistic involvement. Involvement in quality improvement initiatives can bring benefits both to services and the service users themselves. Originality/value Whilst the 4PI approach is recognised as a useful framework for involvement, few examples exist of its practical applications within a quality improvement setting.

Mend the gap – strategies for user involvement in social work education

A major strand in social work’s history has been its paternalistic character, partly due to a philanthropic tradition, but also to the tendency to import an individualist expert model into social work practice. As a result, gaps have arisen between expert and experiential knowledge. In this article, so called ‘gap mending strategies’ developed by the international network PowerUs are discussed. PowerUs consists of teachers and researchers from schools of social work and representatives from service user organizations in nine European countries. The gaps as the network identifies them are presented and we share some processes within our practices that mend or maintain gaps between service users and professionals. Two main strategies will be explored in more detail—a strategy that has been developed in the UK of mainstreaming service user participation in all stages of social work education, and a strategy that has been developed in Scandinavia of developing joint courses for social work students and students from service user organizations. A main conclusion is that alliances between educational institutions and service user organizations will be important to get a fuller understanding of what gaps we are facing and how they best could be mended.

The Dynamics of Service User Participation and Compliance in Community Justice Settings

AbstractThis article draws on insights from within and beyond the parameters of criminal justice research, and from key models of community justice supervision, to illuminate the dynamics of service user participation and compliance in community justice settings. In doing so, the article provides a multifaceted analysis of how service user participation in setting the goals of supervision intersects with factors that could engender compliance. It identifies these factors as: service user agency; positive self‐identity; empowerment; self‐efficacy; and responsive services. Several complexities vitiate service user participation. The article proposes the co‐production of compliance as an antidote that can neutralise the complexities.

Involving People with Profound and Multiple Learning Disabilities in Social Work Education: Building Inclusive Practice

Service user and carer engagement is a foundational requirement of social work education. Despite this, questions remain about how diverse experiences are represented and who might be excluded from involvement. This paper focusses on one group of people who it is suggested are excluded from involvement, people with profound and multiple learning disabilities. Evidence is presented which demonstrates the extent to which this group have been marginalised and excluded from processes of involvement. The paper then provides a case study of one universities’ experience of developing work in this area, when a man with profound and multiple learning disabilities was commissioned to design and deliver specialist teaching for a group of qualifying social work students. We argue that the main barrier to inclusive involvement for people with profound and multiple learning disabilities is the attitudes and assumption of others about what they are capable of. We demonstrate how involvement in social work education helps to address these barriers by challenging the assumptions of students, the academy and society more broadly.

Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial.

BackgroundService user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders.MethodsA randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences.ResultsDuring the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = −5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = −0.3 to 0.3, p = 0.92).ConclusionsGiving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further.Trial registrationNCT01133587, clinicaltrials.gov.

Co-Production in the Context of Finnish Social Services and Health Care: A Challenge and a Possibility for a New Kind of Democracy

Alongside the ongoing renewal process of the Finnish welfare state, the role of the citizens is also revisited. So far the attention has mainly focused on how the responsibility for service provision is shared between the public sector and the service users, while the role of public services as a part of the democratic system has been more or less ignored. Based on the results from a 3-year participatory action research project called KAMPA, this article will discuss if the development of co-production in the context of public welfare services shows the way forward toward a new kind of society where democracy is an inseparable part of the structures and procedures of the service provision. The data gathered during the project (textual material, interviews, notes from meetings, and observation diaries) are analyzed using thematic analysis. The results show that while legislation and official policies strongly highlight the participation of citizens and service users, there are still many obstacles to overcome at both the attitudinal and practical level. The development of co-production and arenas of a new kind of democracy requires continuity in the attempts and recognition of the achievements, but it also has the potential to demonstrate the way in which a new more lively democratic society can come true in practice.

Perspectives of self-direction: a systematic review of key areas contributing to service users’ engagement and choice-making in self-directed disability services and supports

Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research must continue to investigate the perspectives of service users pertaining to their engagement, as their participation is central to the effectiveness of the approach.

Experience with phlebotomy for people with hepatitis C: a systematic review

Low uptake of treatment remains a considerable challenge in the management of patients with the hepatitis C virus (HCV), and difficulties with phlebotomy contribute to this significantly. This systematic review aimed to locate and synthesise evidence regarding: (i) the impact of phlebotomy experience on access to treatment for HCV and (ii) interventions made to improve the experience of phlebotomy for people with HCV. Abstracts were reviewed for 100 articles, a full-text review was undertaken of 16 and four were subjected to quality appraisal. Analysis of the studies revealed three main issues: (i) how access to phlebotomy was characterised by perceptions of stigma and fear of blood sampling, (ii) the impact of poor phlebotomy experience on treatment access and (iii) lack of communication between service users and service providers. Only one study reported the impact of an intervention to improve phlebotomy experience. Recent treatment developments have the potential to make a significant impact on mortality and morbidity for those living with HCV. However, to introduce appropriate interventions, it is essential to engage service users.

Community-based psychosocial rehabilitation for schizophrenia service users in the north west province of South Africa: A formative study

ABSTRACTPsychosocial support is recognized as important for recovery for service users with schizophrenia, in addition to provision of antipsychotic medication. This study aimed to develop a community-based psychosocial rehabilitation programme for service users with schizophrenia to be facilitated by auxiliary social workers, and to investigate acceptability and feasibility of the programme. A task-sharing approach was adopted in which auxiliary social workers were trained to facilitate psychosocial rehabilitation groups. In-depth individual qualitative interviews were conducted with six group members at baseline, midpoint, and endpoint (18 interviews in total). NVivo10 was used to store data and conduct qualitative framework analysis. Participants reported benefits of the programme, including improvements in group members’ self-esteem, social support, illness knowledge, self-care, and contribution to their households. A key barrier to acceptability was the lack of provision of income generating opportunities. Implementation challenges include difficulties in tracing and engaging service users and families, lack of an appropriate venue, and issues with supply of antipsychotic medication. This study has provided evidence for the benefits and acceptability of this contextually adapted programme. Key barriers to implementation can be addressed through the provision of the necessary resources for auxiliary social worker input in the community.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness.

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-016-0352-z) contains supplementary material, which is available to authorized users.

Getting the most from your treatment: Motivating engagement in women in medium secure forensic settings

BackgroundThe engagement of service users in their treatment within secure settings is a priority, in terms of outcome of treatment, recidivism, and cost efficiency. The present study was designed to assess the effectiveness of a treatment preparatory group for women newly admitted to a medium secure setting.MethodA matched subject pre-test-post-test design was used to evaluate a group program utilising cognitive behavioural and psycho-education components with the aim of developing service users engagement in treatment and overall coping strategies.ResultsTreatment completers (N=25) were matched with a group of women who did not participate in the program (N=25). Clinically significant changes in treatment completers were apparent on ratings of treatment readiness, participation in treatment, hope, self-efficacy, insight and interpersonal relationships. Furthermore, completers were found to attend more therapy sessions post group, compared with those who did not engage in the program, and were rated as having key strengths in terms of insight, attitudes, relationships, coping and treatability.ConclusionA treatment preparatory group that focused on psycho-education, orientation to therapy and coping skills was instrumental in motivating engagement in women newly admitted to medium secure care.

Attending to physical health in mental health services in Australia: aqualitative study of service users' experiences and expectations.

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio-metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question 'what do patients experience and expect of mental health services in relation to their physical health?' To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants' accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health-related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self-care, and mental health services to provide or enable access to health-promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health.