Dalarna University's logo and link to the university's website

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.