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The legitimacy of user knowledge in decision-making processes in mental health care: An analysis of epistemic injustice
Dalarna University, School of Education, Health and Social Studies, Caring Science.ORCID iD: 0000-0002-7236-0836
Dalarna University, School of Education, Health and Social Studies, Medical Science.ORCID iD: 0000-0003-0581-2895
Dalarna University, School of Education, Health and Social Studies, Social Work. Stockholms universitet.ORCID iD: 0000-0002-3866-5636
Umeå universitet.
2019 (English)In: Journal of Psychosocial Rehabilitation and Mental Health, ISSN 2198-9834Article in journal (Refereed) Accepted
Place, publisher, year, edition, pages
Springer, 2019.
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-30244DOI: 10.1007/s40737-019-00145-9OAI: oai:DiVA.org:du-30244DiVA, id: diva2:1325040
Note

Avtal Springer Compact

Available from: 2019-06-14 Created: 2019-06-14 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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Grim, KatarinaTistad, MalinSchön, Ulla-Karin

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