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1.
  • Schön, Ulla-Karin, et al. (författare)
  • Psychiatric service staff perceptions of implementing a shared decision-making tool : a process evaluation study
  • 2018
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - Abingdon : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 13:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden.Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact.Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations.Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.
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2.
  • Grim, Katarina, et al. (författare)
  • Development- and usability testing of a web-based decision support for users and health professionals in psychiatric services
  • 2017
  • Ingår i: Psychiatric rehabilitation journal. - Washington, DC : American Psychological Association (APA). - 1095-158X .- 1559-3126. ; 40:3, s. 293-302
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. Method: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Results: Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. Conclusions and Implications for Practice: This web-based decision aid has the potential to strengthen service users’ experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives.
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3.
  • Lundin, Anette (författare)
  • Rättfärdigade prioriteringar - en kvalitativ analys av hur personal i äldreomsorgen hanterar motstridiga verksamhetslogiker
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Tidigare forskning visar att äldreomsorgspersonal kämpar med två typer av logiker: en ekonomisk logik och en omsorgslogik. Även om båda logikerna behövs för att skapa god omsorg så utmanar de varandra. Dessa utmaningar kommer till uttryck i omsorgspraktiken där personalen ställs in för val och måste göra prioriteringar.Denna avhandling syftar till att förstå hur äldreomsorgspersonal beskriver att de arbetar för att finna balans mellan logikerna och hur de rättfärdigar sina prioriteringar i omsorgen om de äldre personerna. Frågeställningen för avhandlingen är att ta reda på hur personal och enhetschef vid ett kommunalt äldreboende förstår och hanterar interaktionen mellan de två logiker som styr omsorgsarbetet för att främja de äldre personernas välbefinnande. Syftet innehåller tre delsyften: 1) att analysera personalens erfarenheter av och meningsskapande kring de äldre personernas välbefinnande och deras reflektioner kring det omsorgsarbete de utför, 2) att belysa och problematiserade logiker som styr omsorgsarbetet samt 3) att analysera hur personalen rättfärdigar sina prioriteringar i rådande kontext och hur deras förklarbarhet påverkar deras professionella identiteter. Målet är att bidra med socialvetenskaplig kunskap om de överväganden personal gör när de ställs inför att göra prioriteringar i äldreomsorgens praktik.Material samlades in genom 12 individuella intervjuer med personal vid ett kommunalt äldreboende, en intervju med personalens enhetschef och en uppföljande gruppintervju med tre personer ur personalgruppen. Materialet analyserades med tre analysmetoder: fenomenologisk analys, reflexiv analys och positioneringsanalys. Resultatet visar att personalen definierar de äldre personernas välbefinnande som ett behov av att känna sig existentiellt berörd. Denna känsla av existentiell beröring delas in i tre delar: känsla av valfrihet, känsla av njutning och känsla av närhet till någon eller något. Arbetet för att uppnå detta välbefinnande beskrivs innebära ett balanserande av tre tvetydigheter: att vilja värna om de äldre personernas valfrihet och samtidigt hantera institutionella begränsningar, de äldre personernas behov av aktivering å ena sidan och att de inte behöver aktiveras å andra sidan samt att förstå de äldre personernas behov av rutiner samtidigt som det är svårt att veta vilka behov de har. Tvetydigheterna kontextualiserades och de två logikerna som styr omsorgsarbetet analyserades. Analysen visar att enhetschefen skapar en hybrid av den ekonomiska logiken och omsorgslogiken; ekonomi är omsorg och vice versa. Denna hybrid möter motstånd från personalen som skiljer på de båda logikerna genom att tala om ”vård och det där andra”. Personalen upplever att den ekonomiska logiken begränsar deras möjligheter att utföra omsorg i linje med omsorgslogiken. Motsättningar mellan de båda logikerna leder till prioriteringar som rättfärdigas av personalen i syfte att behålla de professionella identiteterna.Den teoretiska analysen bygger på teorier om institutionella logiker, förklarbarhet ochprofessionell identitet. Analyserna visar vikten av att väcka dialog mellan enhetschefer och personal där de diskuterar innebörder av olika värdeord som används på politisk nivå. Sådana diskussioner skulle kunna bidra till mindre motstånd och en högre överensstämmelse mellan verksamhetsmål och praktik. Avhandlingen visar även vikten av att förstå logiker som vertikala istället för horisontellt uppdelade. Alltså, att styrande verksamhetslogiker existerar uppifrån och ned i verksamheter (från politisk nivå till chefsnivå och till praktisk nivå) och att de inte kan delas in i exempelvis en professionslogik och en styrningslogik. Den senare synen kan bidra till potentiella missförstånd eftersom det gör att konflikter kan tolkas existera mellan personal och chef, medan de egentligen existerar mellan olika motstridiga värderingssystem.Slutsatsen är att de båda logikerna behövs för att stödja äldre personers välbefinnande. Ibland är logikerna samspelta och ibland är de i konflikt med varandra. När logikerna ställs mot varandra är det av vikt att komma ihåg att den ekonomiska logiken är lika förhandlingsbar som omsorgslogiken. De två logikerna existerar i samspel och om deras motstridigheter inte belyses finns risk att omsorgspraktiken inte stödjer de äldre personernas välbefinnande.
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4.
  • Schön, Ulla-Karin, 1970- (författare)
  • Kvinnors och mäns återhämtning från psykisk ohälsa
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder. Four studies have been carried.  Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness. The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.
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5.
  • Dahlqvist-Jönsson, Patrik, et al. (författare)
  • Service users' experiences of participation in decision making in mental health services
  • 2015
  • Ingår i: Journal of Psychiatric and Mental Health Nursing. - Chichester : Wiley-Blackwell. - 1351-0126 .- 1365-2850. ; 22:9, s. 688-697
  • Tidskriftsartikel (refereegranskat)abstract
    • Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.
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6.
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7.
  • Grim, Katarina, et al. (författare)
  • Development- and testing of a web-based decision support for users and health professionals in psychiatric services
  • 2017
  • Ingår i: ENMESH. ; , s. 48-48
  • Konferensbidrag (refereegranskat)abstract
    • Aim: Shared decision making (SDM) is considered a central component in a recovery-oriented practice. While decision aids are often regarded as an essential component for successfully implementing SDM they are still largely lacking within psychiatric services.The aim of this study was to utilize a participatory design in order to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the developmental- and usability processes are reported.Methods: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were employed with potential end users who participated as informants in focus group interviews and individual interviews, and as usability and pilot testers.Results: Interviewing and testing identified usability problems which led to refinements making the subsequent prototypes increasingly user friendly and relevant, and which. In each phase of the development process, feedback from potential end-users provided indispensable guidance in the formation of a decision aid for strengthening the position of users by building on an interactive web based environment.Conclusions: The decision aid which resulted from this process has the potential to strengthen service users’ experience of self-efficacy and control as well as giving staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to developing and implementing tools that reflect user perspectives.
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8.
  • Grim, Katarina, et al. (författare)
  • Exploring psychiatric users’ decisional and information needs in Shared Decision Making in the light of Elwyn´s three-step model for Clinical practice
  • 2015
  • Ingår i: Closing the gap between research and policy in mental health. - Málaga : ENMESH. - 9788460827818 ; , s. 118-119
  • Konferensbidrag (refereegranskat)abstract
    • Introduction: Using medication and participating in psychosocial interventions are active processes that often involve complex decision-making. Shared decision making, SDM, provides a model for user and practitioner to cooperatively assess a treatment’s advantages and disadvantages. Decision aid tools adapted to the needs of users have the potential to restructure how people with mental illness and staff work together to arrive at shared decisions about the next steps in treatment or support.Aims: The objective of this study is to investigate decisional and information needs among users with mental illness as a pre-requisite for the design and development of a decision aid aimed at supporting user participation in SDM.Methods: Needs and preferences regarding information transfer in SDM were explored through semi-structured focus group interviews. Participants were adults with psychiatric diagnoses and experience of psychiatric services or close relatives to someone with a psychiatric illness.Qualitative content analysis was used to analyze the data. The transcriptions were initially analyzed in accordance with a conventional, inductive approach. A directed content analysis was then utilized, with Elwyn’s three step model for SDM as a theoretical framework from which to further operationalize the categories rendered in the first step of analysis.Results: The majority of the findings were easily integrated within Elwyn ́s categories. However, some elements which emerged in the data and which are worth noting were not encompassed within Elwyn’s model, such as the wish for information prior to the meeting regarding the time frame and agenda. The importance of heeding the prior knowledge of the user as valuable for the decision process and not solely checking it in order to correct possible misinformation was frequently expressed, as was the value of follow-ups.Conclusions: Even though Elwyn’s model is constructed as a pedagogic tool to be used by staff, while our focus is directed towards creating a tool for users, the application of the model upon our data was indeed helpful in rendering clearly defined and distinguishable codes from our categories. We therefore consider it to be a suitable model to continue to build upon in the development of a decision aid.
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9.
  • Grim, Katarina (författare)
  • Legitimizing the knowledge of mental health service users in shared decision making : Promoting participation through a web-based decision support tool
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • 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.
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10.
  • Grim, Katarina, et al. (författare)
  • Shared decision-making in mental health care : a user perspective on decisional needs in community-based services
  • 2016
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice.Objective: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden.Methods: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.’s model of SDM.Results: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process.Conclusions and Implications for Practice: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system. 
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