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To enhance user participation in the complex setting of coordinating support, more knowledge is needed about strategies designed to improve user involvement. This study aimed to explore staff perceptions of barriers and facilitators during the implementation process of the innovation shared decision-making (SDM) in coordinated individual planning (CIP) within the comorbidity field of practice. A mixed methods approach was used, involving the collection and analysis of questionnaire data at two time points, followed by individual and focus group interviews. Data were collected from staff working in social services and healthcare. The data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), focusing on the domains of innovation, inner setting, and individuals involved. Barriers to implementation included among others, perceptions of high workloads, a lack of relational connections between staff from different units, and staff ambiguity regarding user participation. Facilitators included circumstances such as experience with the innovation, a focus on user participation, and the presence of functional collaboration between staff from different organizations prior to implementation. Overall, the findings highlight the importance of relational connections both between users and staff and among staff from different units during the implementation process of SDM in a collaborative setting like CIP. © 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Bakgrund: Brukardelaktighet betonas i lagstiftning och nationella riktlinjer inom både socialtjänsten och hälso- och sjukvården. Forskning visar också att delaktighet har många positiva följder. Trots detta råder det fortfarande oklarheter kring vad brukardelaktighet faktiskt innebär och hur den kan främjas i samordnad individuell plan (SIP) som involverar socialtjänst, hälso- och sjukvården och individen själv. I studien har implementeringen av en reviderad SIP process undersökts. Den reviderade SIP processen är samskapad med brukare och personal i tidigare forskning³. Skillnaden på den ursprungliga SIP processen och den reviderade är främst fokuset på brukardelaktighet genom att arbetssättet delat beslutsfattande (DBF) integreras i den reviderade. DBF syftar till att stärka brukardelaktigheten. Den här studien undersöker hur brukardelaktighet förstås och kan främjas i SIP med fokus på vuxna med samsjuklighet – det vill säga personer som både har psykisk ohälsa, ADHD eller ADD, och problem med alkohol eller droger (i rapporten benämnt som substansbruksproblem). Studien tar sin utgångspunkt i begreppet kunskapsrättvisa, som betonar vikten av att erkänna brukare som kompetenta kunskapsbärare och aktiva deltagare i SIP-processen.

Metod: I studien används kvalitativa metoder för att på olika sätt undersöka brukardelaktighet i SIP. Data samlades in genom individuella intervjuer med brukare och personal samt genom fokusgrupper och framtidsverkstäder – alltså kreativa workshops – med personal från socialtjänst och sjukvård. Samtliga intervjuer har varit semistrukturerade med intervjuguider.

Resultat och diskussion: Brukardelaktighet förstås som en relationell process som bygger på ömsesidigt förtroende mellan brukare och personal. Brukare beskrev initialt låg tillit till personal och betonade vikten av att bli lyssnade på och tagna på allvar. Att arbeta tillsammans över tid och etablera kunskapsrättvisa framhålls i resultaten som centralt för att främja brukardelaktighet i SIP för personer med samsjuklighet. Delaktighet i SIP främjas därmed när brukaren ses som en kunskapsbärare som får möjlighet att forma hela processen – från förberedelse till möte och uppföljning(ar) – tillsammans med personal genom ett löpande kunskapsutbyte. Den reviderade SIP processen bidrog till denna struktur och en känsla av delaktighet.

För att säkerställa användningen av den reviderade SIP processen framkommer behovet av kontaktvägar mellan organisationer, så att personal kan nå varandra och dela kunskap. Vidare visar resultatet att positiva attityder till brukardelaktighet bland personalen är viktiga för att främja delaktigheten. Samtidigt visar resultatet att personal kan känna osäkerhet inför att brukaren styr över agendan till SIP-mötet och att personal lyfter andra saker som brukaren inte samtyckt till i mötet. Resultatet visar också att personal känner osäkerhet inför att diskutera alternativ med brukaren ifall det riskerar att väcka falska förhoppningar. Denna osäkerhet förstås i relation till en omsorgslogik, där personalen vill skydda brukaren, men som samtidigt kan leda till symbolisk delaktighet i SIP processen och begränsa möjligheten till informerade beslut. Personalens samarbete och ömsesidiga erkännande av varandras expertis framstår som centralt för att främja brukardelaktighet i SIP.

Studiens bidrag: Studien bidrar i sin helhet med ny kunskap om förutsättningarna för brukardelaktighet i SIP, med fokus på relationer och förtroende som formas i processer över tid – med betoning på att detta gäller relationer både mellan brukare och personal samt personal sinsemellan. Denna kunskap är viktig i de omställningar som sker nationellt med God och nära vård, ny socialtjänstlag och samsjuklighetsutredningen i vilka delaktighet och samordning betonas.

³ Knutsson och Schön (2020)

In support planning and decision-making processes within social work and healthcare, user participation is emphasised as a core principle. However, the concept of user participation remains ambiguously defined, and a gap persists between the intentions outlined in the literature and policies on the one hand and practical implementation on the other. This dissertation focuses on adults with comorbidity of substance use problems and mental illness/ADD/ADHD or autism within the context of establishing a coordinated individual plan (CIP) – a process that involves collaboration among social service and healthcare staff and the user (i.e. the individual receiving support). The aim of this thesis is to explore how user participation is understood and can be facilitated in CIP.         

In the thesis, a predominantly qualitative approach supplemented by questionnaire data is used. In the first study, a grounded theory approach based on individual interviews with users is used to explore how adults with comorbidity perceive participation in social services. In the second study, data from future workshops and present-and-future stories workshops is analysed to explore staff perspectives on challenges and potential solutions related to user participation, shared decision-making and support coordination in CIP. Following the first two studies, an innovation designed to increase user participation through shared decision-making – namely, a revised CIP process with a new form for documentation – was introduced to staff via training sessions across three sites. In the third study, barriers to and facilitators of the implementation process of this innovation are explored using an approach inspired by explanatory mixed methods that combines staff questionnaires with individual and focus group interviews with staff. Finally, in the fourth study, individual interviews are conducted with users and staff to explore their experiences of the revised CIP process.      

This thesis contributes to an understanding of user participation as a relational process characterised by mutual trust, knowledge-sharing and working together over time. This understanding applies to the shaping of mutual trust not only between users and staff but also among staff members, as this thesis supports an understanding of the importance of staff relations in facilitating user participation in the CIP process. Knowledge sharing and working together over time are shown to be facilitated by the revised CIP process and new form for documentation. Despite these promising experiences with the revised CIP process, several barriers to the implementation are identified, including perceptions of the complexity of the innovation, time constraints and challenges in communication across organisational boundaries. This thesis stresses the importance of prioritising relational processes, with knowledge sharing being built on mutual trust between users and staff and among staff members, in order to unlock CIP’s full potential for coordinated support with user participation. 

PURPOSE: This study aims to explore user and staff experiences of a revised process for coordinated individual planning (CIP) that involves the user alongside staff from social services and healthcare and incorporates shared decision-making (SDM).

METHOD: Eight staff members and five users participated in individual semi-structured interviews. The collected data were analysed using reflexive thematic analysis.

RESULTS: Users and staff experienced that the revised CIP process facilitates emotional security through predictability. This predictability is attributed to the predetermined structure in the CIP process and the user involvement enabled through preparations, as well as the mutual trust that arises from following through on expectations and commitments. Furthermore, the importance of partnerships was highlighted. This refers to the intention of respecting users as contributors, the joint understanding achieved between staff and users, and the continuity of care ensured through staff collaboration.

CONCLUSION: The findings show that incorporating SDM through the CIP process can enhance structure, user involvement, and a sense of emotional security through the process.

Integrated treatment is recommended for users with a comorbidity of mental illness and substance misuse. However, due to a divided support system, coordinated individual care planning (CIP) and user participation are emphasised to provide users with the necessary support. One way of increasing user participation is through shared decision making. However, the challenges are evident why coordination and user participation are not used in practice as intended. To contribute with knowledge to bridge the gap between the intended CIP process and practice, this study examined the problems and solutions perceived by staff. Future workshops were conducted with 17 staff members from social services and health care. Problems and solutions were identified within three main areas: organisation and staff knowledge, coordination among staff, and staff attitudes and user participation. The problems are in agreement with previous research, but this study contributes with knowledge regarding solutions. Overall, the solutions expressed relate to improving collaboration between providers and users and having more resources to conduct this work. However, the study also assents to the question if CIP is the best way to coordinate support or if integrated treatment should be the future. © 2021 Informa UK Limited, trading as Taylor & Francis Group.