The snakes and ladders of user involvement: Moving beyond Arnstein

Individual user involvement at Healthy Life Centres: a qualitative study exploring the perspective of health professionals

“…This implies that the HLC professionals in our study seem to use their MI expertise as means of helping the users decide for themselves, described by Tritter as direct individual and proactive involvement where the user actively helps to shape his or her own service (Tritter, 2009). Similar to our findings, other studies state that the same user may wish to be involved at different levels and that this may change over time in the same context (Rise, Westerlund, Bjørgen, & Steinsbekk, 2014; Thompson, 2007; Tritter & McCallum, 2006). …”

“…MI is described as a clinical method and goal-oriented guiding style for enhancing intrinsic motivation to move from ambivalence to enduring change (Miller & Rollnick, 2009, 2013; Rollnick, Miller, & Butler, 2008). This means that while MI can be considered as a client-centred counselling method, being goal-oriented in having intentional direction towards change (Miller & Rollnick, 2009, 2013), user involvement can be viewed as an approach, policy or ideology where the process of involvement in itself is valuable (Beresford, 2012; Tritter & McCallum, 2006). User involvement is also a requirement and democratic right in many countries and some therefore argue that involvement is always of value, in its own right, irrespective of its impact (Beresford, 2012; Snyder & Engström, 2016; Staley, 2015).…”

“…Hence, when seeing MI and user involvement as the same concept, one may fail to recognize that, for some users, involvement itself may be a goal and thus forget to consider the process as well as an outcome (Angel & Frederiksen, 2015; Tritter & McCallum, 2006). This highlights the need for clarification between the HLC professional and user about the user’s expectations and preferences for involvement, and to what extent involvement is desirable and achievable in each individual case (Angel & Frederiksen, 2015).…”

Citizen participation and discontent in three Southern European health systems

“…The recognised virtues of participation in healthcare systems highlighted by literature on the subject include the following: a) the capacity to strengthen the voice of health service users as a strategy for overcoming the democratic deficit that characterizes heath systems after the managerial reforms of the 1990s (Cooper et al, 1995); b) users' experiences and their knowledge, as a means of improving the quality of healthcare decisions (Charles and DeMaio, 1993;Bovemkamp et al, 2009;Lehoux et al, 2009); c) citizen participation as a means of increasing the legitimacy and accountability of healthcare systems (Tritter and McCallum, 2006); d) the fact that citizen participation brings community needs and health service responses closer together (Franskish et al, 2002); e) the fact that the public healthcare system is more effective when decisions reflect the users perspective (Scuthfield et al, 2006;Matos, 2011).…”

“…It is important to stress that participatory activities applied to the sphere of healthcare, such as citizens' juries, deliberative voting processes, focus groups, etc. also reveal constraints, specifically in terms of representativeness, since participation schemes fail to take into account the social diversity of communities, especially excluded groups, (Frankish et al, 2002;Tritter and McCallum, 2006); the potential for influence and the power imbalance between the sponsors of the deliberative process and the participants (Serapioni and Duxbury, 2012) and the lack of any assessment focussing on the effectiveness of participation in healthcare issues (Rowe and Frewer, 2004;Lehoux et al, 2009). There is also a serious risk of idealising such practices, likening them to magic formulas for solving the problems of the health system (Zakus and Lysack, 1998;Rifkin, 2009) and a resistance on the part of healthcare professionals and managers to implementing the outcomes of public participation in healthcare deliberative processes (Martin, 2008).…”