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Psychiatric service staff perceptions of implementing a shared decision-making tool: A process evaluation study
Dalarna University, School of Education, Health and Social Studies, Social Work.ORCID iD: 0000-0002-3866-5636
Dalarna University, School of Education, Health and Social Studies, Caring Science. Karlstad universitet.ORCID iD: 0000-0002-7236-0836
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
2018 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden.

METHOD:

The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact.

RESULTS:

The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations.

CONCLUSION:

The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

Place, publisher, year, edition, pages
2018. Vol. 13, no 1
Keywords [en]
Shared decision making; decision support tool; implementation; process evaluation; psychiatric services
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-26828DOI: 10.1080/17482631.2017.1421352ISI: 000424831900001PubMedID: 29405889Scopus ID: 2-s2.0-85045243442OAI: oai:DiVA.org:du-26828DiVA, id: diva2:1167085
Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2019-08-15Bibliographically approved
In thesis
1. Legitimizing the knowledge of mental health service users in shared decision making: Promoting participation through a web-based decision support tool
Open this publication in new window or tab >>Legitimizing the knowledge of mental health service users in shared decision making: Promoting participation through a web-based decision support tool
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to explore the manner in which user knowledge and user perspectives can be included and supported in shared decision making (SDM) in mental health services.

The thesis consists of four studies. Study I explored what needs service users identify to participate in deliberative processes and decision making in their care. Study II examined how a decision support tool (DST) for SDM can be designed to enhance service users’ ability to have active and meaningful roles in SDM. Study III investigated barriers and facilitators associated with the implementation of a web-based DST designed to provide a concrete structure to support SDM. In study IV, a theoretical analysis was performed to elucidate the barriers associated with user knowledge being expressed and legitimized in decision-making processes.

Methods: A key feature of the project involved a process of exploring decisional and informational needs and of developing, testing and implementing a DST for SDM. Qualitative data have been collected through focus group and individual interviews with service users and service providers, usability testing with service users and checklists.

Findings: The findings show a number of characteristics specific to the mental health service context that need to be considered when developing support for SDM. Decisions were often complex and found to encompass a number of life domains. Issues related to social context and individual recovery highlighted the necessity to include the knowledge perspectives of service users throughout decision processes. In response, phases for preparation and follow-up was emphasized in the DST. The results indicate that supportive structures are required for service users to express their knowledge perspectives and for providers to include them in their decision-making. Moreover, existing barriers related to organizational structures and to power differentials need to be addressed.       

Conclusions and implications: A DST specifically designed for the mental health context, that methodically invites service users to participate in each phase of the decision-making process might function as a guiding structure to validate service users as knowledgeable agents.

Place, publisher, year, edition, pages
Falun: Dalarna University, 2019
Series
Dalarna Doctoral Dissertations in Health Sciences ; 1
Keywords
User knowledge, SDM, Shared decision making, User involvement, User participation, Mental health services, Psychiatry
National Category
Psychiatry Social Work Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30246 (URN)978-91-88679-01-7 (ISBN)
Public defence
2019-09-13, FÖ4, Falun, 13:00 (English)
Opponent
Supervisors
Available from: 2019-06-24 Created: 2019-06-14 Last updated: 2019-08-15Bibliographically approved

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Schön, Ulla-KarinGrim, KatarinaWallin, Lars

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