Experiential expertise in the co‐development of social and health‐care services: Self‐promotion and self‐dismissal as interactional strategies

Abstract

Increasing client involvement in the development of social and health‐care services has resulted in clients being invited to present their experiential knowledge in service co‐development groups. Nevertheless, research has shown that their opportunities to really contribute to actual decision‐making are limited. This article investigates how client representatives initiate turns‐at‐talk in the decision‐making context and the way in which professionals respond to them. Using conversation analysis, we analyzed 15 h of recorded interactions in five co‐development workshops. Our data exhibited a systematic pattern that linked client representatives’ self‐promoting and self‐dismissive turns‐at‐talk to specific types of responses from professionals. When the client representatives highlighted the relevance of their experiential knowledge for making decisions, the professionals disregarded their contributions. However, if instead, the client representatives cast their experiential knowledge as irrelevant to the decision‐making activity at hand, the professionals subsequently appreciated this knowledge. Thus, paradoxically, in order to establish the relevance of their views, client representatives diminished their positions as experiential experts.

Patient engagement in the development and delivery of healthcare services: a systematic scoping review

“…In 23 studies (62%), there was a focus on knowledge and capability on how to engage PE stakeholders 24–46. Out of these, a lack of competence was reported as a barrier in nine studies (24%) 26 28 29 31 34 39 40 42 45.…”

“…In 23 studies (62%), there was a focus on knowledge and capability on how to engage PE stakeholders 24–46. Out of these, a lack of competence was reported as a barrier in nine studies (24%) 26 28 29 31 34 39 40 42 45. Lack of technical skills,39 lack of insight in appropriate PE methods,26 lack of understanding legal constraints34 and uncertainty on how to incorporate patient experiences,32 were also reported as PE barriers.…”

“…As shown in table 2, according to 16 (43%) studies, representativeness and/or recruitment had the potential of being both a facilitator and a barrier to meaningful cocreation 25–28 31 34 36 37 39–41 43–45 48 49. Of these studies, nine (24%) took place in the setting of specialised care,25–27 31 34 39–41 44 three (8%) in regional care28 43 45 and four (11%) in the setting of national care 36 37 48 49. Insufficient representativeness was reported as only being a PE barrier in six (16%) studies 34 36 39 40 43 45.…”

“…Of these studies, nine (24%) took place in the setting of specialised care,25–27 31 34 39–41 44 three (8%) in regional care28 43 45 and four (11%) in the setting of national care 36 37 48 49. Insufficient representativeness was reported as only being a PE barrier in six (16%) studies 34 36 39 40 43 45. As examples, old age,37 39 small numbers of patient representatives with time to spare,36 39 40 and professionals recruiting already known patient representatives45 were described as a restriction for sufficient representativeness.…”

“…Insufficient representativeness was reported as only being a PE barrier in six (16%) studies 34 36 39 40 43 45. As examples, old age,37 39 small numbers of patient representatives with time to spare,36 39 40 and professionals recruiting already known patient representatives45 were described as a restriction for sufficient representativeness. Sufficient representativeness was highlighted as a facilitator in six (16%) studies,25 26 31 41 44 49 and representativeness among multiple PE stakeholders were underlined as a facilitator in four (11%) 31 41 44 49.…”