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Sökning: WFRF:(Schön Ulla Karin) > Umeå universitet

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1.
  • Dahlqvist Jönsson, Patrik, 1974-, 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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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.
  • Grim, Katarina, 1971-, et al. (författare)
  • Legitimizing user knowledge in mental health services : Epistemic (in)justice and barriers to knowledge integration
  • 2022
  • Ingår i: Frontiers in Psychiatry. - Lausanne : Frontiers Media S.A.. - 1664-0640. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • Including the voices and knowledge of service users is essential for developing recovery-oriented and evidence-based mental health services. Recent studies have however, suggested that challenges remain to the legitimization of user knowledge in practice. To further explore such challenges, a co-production study was conducted by a team of researchers and representatives from user organizations in Sweden. The aim of the study was to explore the barriers and facilitators to the legitimacy of user knowledge, as a central factor in sustainably implementing user influence in mental health practice. A series of workshops, with representatives of mental health services and user organizations were conducted by the research team to explore these issues. The analysis built on the theoretical framework of epistemic injustice, and the underlying aspects, testimonial, hermeneutic and participation-based injustice, were utilized as a framework for a deductive analysis. Results suggest that this is a useful model for exploring the complex dynamics related to the legitimacy of user knowledge in mental health systems. The analysis suggests that the legitimacy of user knowledge is related to the representativeness of the knowledge base, the systematic formulation of this knowledge inapplicable methods, access to resources and positions within the mental health system and participation in the process of integrating this knowledge-base in mental health contexts. Legitimizing user knowledge in practice additionally challenges mental health systems to support readiness for change in working environments and to address the power and role issues that these changes involve. Copyright © 2022 Grim, Näslund, Allaskog, Andersson, Argentzell, Broström, Jenneteg, Jansson, Schön, Svedberg, Svensson, Wåhlstedt and Rosenberg.
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4.
  • 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. - Järfälla : 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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5.
  • Grim, Katarina, 1971-, et al. (författare)
  • The Legitimacy of User Knowledge in Decision-Making Processes in Mental Health Care : An Analysis of Epistemic Injustice
  • 2019
  • Ingår i: Journal of Psychosocial Rehabilitation and Mental Health. - : Springer Science and Business Media LLC. - 2198-9834 .- 2198-963X. ; 6, s. 157-173
  • Tidskriftsartikel (refereegranskat)abstract
    • The experience-based knowledge of users is considered to provide vital input in shared decision making (SDM). However, mental health service users frequently express having negative experiences from meetings with providers, which are of an epistemic nature (e.g., being ignored or not regarded as credible). This study aimed to explore the barriers involved in legitimizing user knowledge in decision-making processes. Interview data from service users and providers were viewed from a theoretic framework of epistemic injustice. Abductive content analysis was conducted on data collected during a project to develop and implement SDM in mental health services. In describing obstacles to legitimize user knowledge, service users highlighted relational issues: being dependent, often dismissed and choosing to edit their testimonies. Service providers typically described workflow issues, users’ insufficient decision- making competence and users’ vulnerability to stress factors. The findings suggest that greater epistemic justice might be achieved by a SDM process in which the service user is engaged as a full partner in collaboration in various activities related to their care.
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6.
  • Markström, Urban, et al. (författare)
  • Developing sustainable service user involvement practices in mental health services in Sweden : the “Userinvolve” research program protocol
  • 2023
  • Ingår i: Frontiers in Psychiatry. - Lausanne : Frontiers Media S.A.. - 1664-0640. ; 14, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The purpose of this paper is to outline the protocol for the research program “UserInvolve,” with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. Methods: This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022–2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. Results or conclusion: The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field. Copyright © 2023 Markström, Näslund, Schön, Rosenberg, Bejerholm, Gustavsson, Jansson, Argentzell, Grim, Engdahl, Nouf, Lilliehorn and Svedberg.
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7.
  • Rosenberg, David, 1957-, et al. (författare)
  • Establishing a Recovery Orientation in Mental Health Services : Evaluating the Recovery Self-Assessment (RSA) in a Swedish Context
  • 2015
  • Ingår i: Psychiatric rehabilitation journal. - Washington, DC : American Psychological Association (APA). - 1095-158X .- 1559-3126. ; 38:4, s. 328-335
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Although there has been an emphasis on developing knowledge regarding recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Instruments, which present the components of recovery as measurable dimensions of change, may provide a framework for program development. Involving users is an essential factor in the utilization of such tools. The purpose of this study was to evaluate the psychometric properties of the Recovery Self-Assessment (RSA) measure and its potential for being utilized in a Swedish context.METHODS: The sample consisted of 78 participants from 6 community mental health services targeting people with serious mental illnesses in a municipality in Sweden. They completed the RSA at the study baseline and two weeks later. User panels participated in the translation and administration of the RSA and the reporting of results.RESULTS: The Swedish version of the RSA had good face and content validity, satisfactory internal consistency, and a moderate to good level of stability in test-retest reliability. The user panels contributed to establishing validity and as collaborators in the study.CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Establishing the RSA as a valid and reliable instrument with which to focus on the recovery orientation of services is a first step in beginning to study the types of interventions that may effect and contribute to recovery oriented practice in Sweden. © 2015 APA, all rights reserved
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8.
  • Rosenberg, David, 1957-, et al. (författare)
  • Establishing a Recovery Orientation in Swedish Mental Health Services : From attitudes to instruments.
  • 2015
  • Konferensbidrag (refereegranskat)abstract
    • Introduction: Although there has been an emphasis on developing knowledge of recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Educational initiatives focused primarily on changing attitudes have not produced concrete outcomes. Instruments that define the components of recovery as measurable dimensions of change may provide a framework for implementing recovery-oriented services. Aims: The aim of this study was to investigate whether the use of instruments which measure a recovery orientation in services could provide program level outcome indicators, that could point to concrete needs for change. An additional aim was to study the contribution of peer support workers to this process. Methods: Two internationally tested and validated instruments were distributed to 85 clients from 6 community mental health services targeting people with a diagnosis of psychosis in a municipality in Sweden. These focused respectively on the recovery orientation of services (RSA) and the recovery orientation of relationships with the primary contact person (Inspire). An additional instrument (RKI) was distributed to all staff at these clinics to assess their knowledge of recovery paradigms.  Peer support workers participated in the translation, administration and reporting of results.   Results: The instruments were translated to Swedish, tested and found to have acceptable psychometric properties. The reports produced from these instruments highlighted specific areas for improvement which these user assessments had indicated. These included for example; opportunities to influence services and care plans, to receive support for activities outside of psychiatry, to have their strengths included in assessments and to have more access to experience-based knowledge. The peer support workers provided valuable support to the process and were additionally seen by the clinic staff as a valuable resource in future work.   Conclusions: Instruments which measure a recovery orientation in mental health services can contribute to a focus on specific knowledge, attitudinal and skill gaps that service organisations can target in their quality development activities.  In the present study, staff were more accepting of this feedback since it came directly from their clients and was collected and presented systematically
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9.
  • Rosenberg, David, 1957-, et al. (författare)
  • Ett återhämtningsorienterat arbetssätt i Jönköpings län : erfarenher från ett uppföljningsarbete
  • 2014
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Under de senaste åren har forskning om återhämtning från psykisk ohälsa resulterat i ny kunskap som fått relevans för såväl socialtjänstens som psykiatrins verksamhetsfält. Allt fler verksamheter som ger stöd och vård till människor med psykisk ohälsa syftar att bli mer återhämtningsinriktade. Det innebär att verksamheter fokuserar mer på insatser som främjar individens önskemål och delaktighet, och mindre på omsorgsinriktade insatser som främst fokuserar på symtom eller funktionsnedsättning. De brukare som beskriver sin återhämtning lyfter fram delaktighet, hopp för framtiden, meningsfullhet och egenmakt som centrala i den individuella återhämtningsprocessen. Det utbildningsarbete som sedan 2010 har bedrivits i Jönköpings län kring ett återhämtningsinriktat arbetssätt, dialogutbildningar, resurspersoner och återhämtningsombud, ligger i linje med nationell och internationell forskning och utveckling. Syftet med dessa utbildningar har varit att utveckla värderingar och attityder i socialtjänst och psykiatri för att främja brukares återhämtning samt att omvandla återhämtningsperspektivet till konkreta arbetssätt. Under hösten 2013 kontaktades författarna till denna rapport av representanter från Regionförbundet i Jönköping för en diskussion om hur ett återhämtningsperspektiv kan omvandlas till konkreta arbetssätt. Återhämtningsombud hade utbildats och varit aktiva i de dialogutbildningar som genomförts. Man ville nu genomföra ett utvärderingsarbete av dialogutbildningarna för att undersöka vilken betydelse de hade på personalens förhållningssätt och bemötande, samt studera om det hade haft någon betydelse på brukarnas upplevelser av de insatser de får från psykiatri och socialtjänst. Föreliggande rapport är ett resultat av det utvärderingsarbetet.
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10.
  • Rosenberg, David, 1957-, et al. (författare)
  • Obstacles and possibilities for implementing SDM in Swedish mental health services : Supporting interactivity and participation
  • 2017
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Despite Swedish health care policy, which emphasizes patient participation in the planning of health care services, few programs have concrete methods for achieving this goal. Previous studies have shown that staff attitudes and systems which maintain power differentials, create obstacles for achieving participation despite methods such as SDM.The purpose of the study was to explore implementing SDM with an interactive digital decision tool, designed for users in community mental health services in Sweden. The tool was specifically developed, in collaborative research with users, to overcome disempowering experiences as they attempt to participate in treatment decisions.Method: A process evaluation design (Moore et al. 2015) was utilized in order to investigate obstacles and possibilities for a structured intervention to facilitate participation in decision making. The design utilized in the study included collecting qualitative and quantitative data focused on three identified evaluation components; Context, Implementation and Mechanism of impact.Results: Staff considered that SDM was most appropriate for formal treatment planning and that the use of the digital decision tool, which enabled interactive communication between staff and users, did support the user to be prepared for decisions, as well as helping staff to stay focused on user wishes.SDM was most often used voluntarily by each staff member, based on their experience and attitude, rather than a common practice for the service. Another barrier concerned capacity, with staff sometimes feeling they did not have formal power regarding treatment planning decisions, and expressing doubt as to the patient's willingness and ability to participate in decisions.Discussion: The results suggest that contextual barriers to implementing shared decision making can be addressed by utilizing interactive decision tools which concretely structure the interaction between users and staff and are connected to formally required treatment planning processes that are essential for user participation.
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