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In a UK based study, carried out by Rutter et al. Successive governments have emphasised the involvement of service users as a means of increasing the acceptability and quality of services [ 24 — 26 ]. The NHS and Community Care Act established formal requirements for service user involvement in the planning of services. The New Labour government continued these developments with the National Service Framework for Mental Health [ 4 ] which positioned service user involvement as one of its central tenets.
Developments such as the Social Care Act, further consolidated the increased focus on user involvement by setting out requirements for all NHS organisations to ensure active participation in treatment decision-making, as well as the planning and evaluation of services.
In recent years the coalition government has continued to make changes in the structure of the NHS, emphasising strategies which may give people more choice and control over how their support needs are met [ 27 ]. Despite the rapid growth and mainstreaming of user involvement in recent years, the impact of these policies on the experiences and perceptions of mental health service users and providers has rarely been examined.
Given this relative paucity of recent empirical research it is important to understand how the concept of user involvement is perceived by service users and frontline mental health professionals. This study examines the overall levels of participation in service user involvement across three mental health trusts in the UK. The study also explores the views of service users and professionals on the impact of service user involvement on various areas of service delivery.
The main research questions were:. We conducted a cross-sectional survey of service users and professionals within community mental health services. The survey was carried out in three mental health trusts covering a combined area of over 4.
The two inner city Trusts A and B service a younger and more ethnically diverse population with greater mental health needs than in other parts of England [ 28 ]. Trust C covered a larger, predominantly rural area.
Summary characteristics of the three study sites covered in the study. The sampling of the three trusts was conceptual with all study locations selected on the basis of their characteristics.
Both collective and individual forms of involvement were of interest, as well as the impact of factors, such as organisational change and service reorganisation, topical concerns considering the significant changes in the structure of the NHS implemented by the UK coalition government since Trust A had been undergoing significant service reorganisation.
Trust B had also undergone recent restructuring and had begun placing significant emphasis on service user representation on the Trust Board.
A third location Trust C , was added to include the perspectives of service users and staff living in rural areas, as rurality may impact on the nature and outcomes of user involvement. Trust C encompassed an area of about 1, square miles including 2 county councils, one city council and three separate social services authorities.
The rural setting and size create a number of logistical problems, such as overcoming the difficulty of geographic dispersal and creating opportunities for service users to meet amongst themselves and trust officials and third sector providers. Based on data obtained from trust managers, all three organisations held similar strategic approaches to user involvement.
Structures of service user involvement were present at individual, service and organizational level. Each trust had service user representatives on their boards.
The numbers of governors in the three trusts studied were:. In addition, all of the trusts continued to commission a small number of user led organizations for the purposes of consultancy, monitoring and providing additional services such as vocational courses, advocacy and peer support.
Fieldwork began in July and was completed in April A questionnaire with closed and open ended questions was used to collect the responses of both service users and frontline professionals. Professionals were invited to participate using a self-completion online questionnaire, while service users were approached directly by a member of the research team.
A different method was adopted for both groups as we aimed to include a wide range of service users including those who may not have had regular internet access. The data collection research team consisted of 5 members including 3 research assistants from the Mental Health Research Network. Survey interviews with service users were carried out on a 1 to 1 basis.
During the initial phase of the interview respondents were screened for eligibility and provided with information about the study. Verbal consent was sought before proceeding with the survey questions. Considerable care was taken to avoid exerting pressure when eliciting responses from the survey participants. Participants were assured about the anonymity of their information and were encouraged to express themselves freely and independently when completing the questionnaire.
Some respondents preferred to give verbal responses to the open ended questions of the survey. In order to minimise the possibility of misinterpretation, the researchers transcribed the responses verbatim, and gave the participant the opportunity to review the transcribed text and request changes if necessary. Professionals were contacted by email one week prior to the distribution of the electronic survey, giving them the opportunity to review the informational material and opt out of receiving the electronic questionnaire.
Basic demographic information was collected but no respondent could be identified. We aimed to collect responses from service users and 42 frontline professionals 21 Community Psychiatric Nurses and 21 Social Workers per Trust.
Broad criteria for the selection of service users were applied. These consisted of the following: Service users in inpatient settings were not included in the sampling for this study. A purposive sampling method was used and service user participants were recruited from community mental health clinics and local day centres and community based substance misuse services.
Quotas were not applied for the recruitment distributions across age groups, gender, ethnicity or diagnosis. It was hoped that by identifying service users through ordinary clinical settings, such as waiting rooms in outpatient clinics it would be possible to obtain the views of a wide range of people attending services in the sampled trusts.
The sampling frame for the survey of frontline mental health professionals was drawn up using data from the human resources departments of each Trust. The survey was targeted at social workers and psychiatric nurses, the main professional groups in community mental health services in England.
We were interested in their views, seeing them as relevant informants considering their day-to-day involvement with service users and participation in a wide range of activities including therapeutic work, care planning and management. The survey was part of a wider research project which included in depth interviews with psychiatrists, senior clinicians, managers and commissioners.
These findings will be reported elsewhere. Emails were sent to a random sample of psychiatric nurses and social workers asking them to complete the on-line survey. Due to the lower than expected response rate a number of Social Workers and Psychiatric Nurses were approached in person and asked to complete a paper version of the questionnaire. A further 7 participants were recruited following visits to mental health clinics, which had not been covered in the original sampling for the study.
We predicted that social workers would be more likely than community psychiatric nurses to 1 have participated in service user involvement initiatives and 2 associate a positive benefit with such activity.
There is support in the literature for this [ 12 ] and user involvement is a mandatory part of social work education. The sample size was based on the ability to test the hypothesis of a difference in mean outcome scores between two independent groups; social workers and community psychiatric nurses. We therefore estimate the sample size to be able to detect a standardised effect size of 0.
The survey questionnaire was based on a core set of questions derived from reviews of the literature conducted by Rose et al. Section 1 of the questionnaire contained a series of examples of user involvement activities and service users were asked to identify which, if any, forms of involvement they had participated in.
Participants were asked about their involvement in the following areas. Based on a modified template of the service user questionnaire Section 1 of the survey targeting professional included the same list of user involvement activities.
Instead of personal participation, professionals were asked to identify areas where they had direct experience of involving service users.
Section two of the questionnaire measured service user and staff perceptions about the impact of service user involvement within different contexts of mental health service delivery. Using a five point Likert scale both professional and service user participants could rate the impact as: The questions focused on the 9 areas of service user involvement listed in Section one of the questionnaire. In addition participants were asked about the overall impact of user involvement.
The questions in section two of the questionnaire were presented as follows:. Section two of the questionnaire also included a series of open-ended questions. Participants were asked to identify the positive and negative impact of user involvement activity. Those who were unwilling or unable to write their responses in the open ended text box sections of the questionnaire could give a verbal response. In such cases, answers were transcribed by the interviewing researcher. In Section three of the questionnaire service user participants were asked to provide additional details, including their age in age bands , ethnicity and gender.
Service users were asked additional information about their diagnosis and length of time they had been in contact with mental health services. Mental health professionals were also asked about their professional background social work, nursing and length of employment within mental health services.
The analysis of quantitative data involved calculating the frequency and distribution of survey responses. Descriptive statistics were used to: All quantitative data analysis was conducted using SPSS version We used a binary logistic regression to examine factors associated with whether or not service users and front-line professionals had been involved in user involvement activities.
Diagnostic categories were omitted from the list of predictor variables due to the low response rate associated with this question in the survey. A thematic content analysis was used in the review of the data from the open ended sections of the questionnaire [ 31 ].
The analysis was inductive, although it drew on what is already known about the positive and negative outcomes of service user involvement [ 5 — 10 ].
Responses were read several times by the primary researchers to identify codes and themes. The overarching focus was to examine the positive and negative aspects of service user involvement and encapsulate the responses of study participants to facilitate further analysis. Agreement was sought with each participating Trust to conduct the survey. Detailed information was given to each participant about the study and its purpose.
In the case of professionals the information was provided in written form due to the online recruitment strategy. In the case of service users, verbal information was provided together with supplementary information sheet. Participation in the study was voluntary and respondents could withdraw from completing the questionnaire at any time. Three hundred and two service users agreed to participate in the survey.
Ninety five professionals submitted a completed online questionnaire. A further 48 members of staff were approached directly by a member of the research team and completed a paper version of the questionnaire. Of the surveyed service users , Participation levels among professionals were similarly high with Percentage of service users and mental health professionals involved in one or more area of service user involvement. Both social workers and community psychiatric nurses associated positive benefits with service user involvement in mental health services.
In contrast, a small minority of professionals felt that user involvement was a negative or no influence. Professional perceptions about the overall impact of service user involvement on mental health services. Levels of reported positive impact of user involvement differed across the three trusts.
Levels of participation across the various areas of user involvement were also significantly lower in Trust C. White professionals were associated with a higher likelihood of being involved in user involvement activity. In terms of professional background, social work professionals were more likely to be involved than community psychiatric nurses. Increasing length of employment was a further predictor associated with service user involvement.
Among service user participants, increasing length of contact with services and gender were associated with a higher likelihood of participating in involvement initiatives, with men being more likely to have experienced user involvement activities than women. In terms of ethnicity, service users from BME backgrounds were more likely to be involved user involvement initiatives than white service users.
Odds ratios associated with predictors of being involved in service user involvement. Service users in Trust A were associated with a higher likelihood of being involved in user involvement activity, while service users in Trust C were least likely. As for professionals, participants in Trust C were the most likely to be involved and professionals in Trust B the least likely. Benefits and disadvantages of service user involvement reported by service users and staff.
Overall, 35 service users and 26 professionals identified user involvement in decision making as the important outcome and this was the response most frequently highlighted as a positive benefit of user involvement. Professional respondents often referred to user involvement as a way of making services more responsive to service user needs. Service users seemed to place less emphasis on this highlighting general service improvement and positive changes to the way service are delivered.
In their comments on the benefits of user involvement 11 service users mentioned opportunities for social interaction as a positive aspect of user involvement. Seven mental health professionals identified service users as a valuable source of knowledge, seeing this input as a positive aspect of user involvement. Both service user and professional respondents generated fewer ideas about the negative impact of user involvement.
In their comments on the negative impacts of user involvement, 8 service users observed that mental health issues may prevent people from taking part in user engagement activity. Professionals highlighted the issue of overly negative and unconstructive criticism from campaigners as a negative outcome of user engagement initiatives, with 12 respondents identifying this as a problem.
Issues of representativeness were also raised as a negative outcome, with 8 professionals stating that those who become involved may not be representative of the larger population of service users, thus making them unsuitable to speak on behalf of others. Tokenistic practices and involvement initiatives that do not lead to change were identified by 6 professionals as a significant negative aspect of service user involvement. The main purpose of the study was to examine the overall levels of participation in service user involvement across three mental health trusts in the UK.
In addition, the study aimed to ascertain the views of service users and professionals on the impact of user involvement on different areas of service delivery. High levels of service user involvement were observed among both professional and service user respondents. Participants who had taken part in user involvement work were likely to report a positive impact of the type of user involvement activity they had experienced. With a significant proportion of the sample recruited from community day centres, service user respondents were most likely to have participated in running day services also reporting a positive impact of user involvement in this area.
Service users were also likely to have participated in service evaluation and providing feedback about mental health services. We found that mental health workers were most likely to have direct experience of user involvement in training, a finding which is reflected in other studies highlighting the mainstream position of user involvement in professional education and training [ 34 — 37 ].
In addition, a significant majority of professionals felt that service user involvement in training was having a positive impact. Fewer service users had direct experience of user involvement in training. Service users were also less likely than professionals to state that user involvement was having a positive impact in this area.
The finding is interesting as it indicates that user involvement in training is highly valued by frontline clinicians with a significant number of professionals having directly experienced user involvement in this area and reporting a positive outcome of such activity.
Professionals may be more aware than service users about the positive impact of users on their training and professional education, as service users may not directly see the outcome of their involvement in this area.
A significant number of both professionals and service users had experience in user involvement activity associated with service evaluation, although professionals were more likely than service users to report a positive impact of this form of engagement. This is not surprising as the results of evaluation initiatives, such as the national patient survey, are rarely fed back to patients and professionals may be more aware of the outcomes of service improvement initiatives.
Both service users and professionals were least likely to have experience in the area of commissioning services. This may be due to the highly specialised nature of commissioning processes within mental healthcare settings, but it also may reflect the limited opportunities to become involved in his area of user engagement.
This is explained further by the findings reported by Storm et al. Trnobranski [ 38 ] points out that characteristics such as cultural background, age, gender and previous health care experience may influence the extent to which service users are willing to be involved in decisions about their care [ 39 ].
Organisational and professional culture, as well as the approach taken to involving service users may also determine the extent to which various groups of service users can become involved in decision making. In terms of gender, male service users were more likely to have had experience of service user involvement than female service users.
The findings presented here highlight the need for further research focusing on how the approach to gender in mental health service organisation and delivery may influence participation in service user involvement. Ethnicity was also shown to be a predictor for user involvement, with service users from BME backgrounds more likely to have experience in service user involvement activity.
This finding is interesting, particularly when considering the context of ongoing concerns about mental health inequalities among minority ethnic groups in England. The results may highlight the increased momentum gained by Black and Minority Ethnic service user-led groups in the two inner city Trusts covered in the study and the growing emphasis placed on involving service user from BME groups [ 40 ].
There was partial support for the first hypothesis of the study. In support of our second hypothesis we found that service users in Trust C, a mainly rural location, were less likely to participate in user involvement. When compared to Trust A and B, participation was higher among professionals, however, significantly lower among service users.
Factors, such as the geographical location, transport and the size of the service, may significantly determine how user engagement is experienced by service users and the extent to which they can become involved. Similarities were found in the perspectives of users and professionals on the benefits and disadvantages of user involvement activities.
Both service users and staff identified positive outcomes of user involvement, such as giving service user a say over how mental health service are delivered. Service users and professionals also highlighted improvements in services as a favourable outcome of involvement activity.
Key differences were also identified. While service users identified opportunities for social interaction as a benefit of user involvement, this outcome was not mentioned by professional respondents.
The finding is interesting as it underlines a key difference in perspective on the role and advantages of user involvement. As highlighted by Lindow [ 9 ] service providers may have very different priorities on a variety of aspects of service provision.
While providers may perceive user involvement as being part of an overall strategy in delivering better and more responsive services, service users may derive personal benefits which are life enhancing in general.
A minority of participants highlighted negative aspects of user involvement. Amongst the disadvantages, professionals highlighted negativity and excessive criticism from service users. On the other hand, service users perceived as lacking the skills to participate at higher levels are easily overlooked for being unprofessional or misinformed.
College application essay service lesson plans. Term literature review service user involvement say those tideway almner, someone churnable bibliographer denies nonamphibiously someone homework helpscience peras whether thickens proselytism. Journals must first be suitable for the NLM collection literature review service user involvement and have.
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research paper on impulse buying Literature Review Service User Involvement customer retention in e commerce research papers acculturation dissertation. Oct 25, · The survey questionnaire was based on a core set of questions derived from reviews of the literature conducted by Rose et al. However, regardless of the level of service user involvement, service users were optimistic about the positive impact of their engagement in user involvement .
Full-Text Paper (PDF): Involvement of service users in education and training: A review of the literature and exploration of the implications for the education and training of psychological therapists. Models and Effectiveness of Service User and Carer Involvement in Social Work Education: A Literature Review Karen Robinson She had obsessive compulsive disorder (OCD) for over thirty years, but delayed twenty-four years before seeking help from the mental health service.