Practitioners exploring intertwined challenges and possible solutions for user participation in social services

ABSTRACT

Despite a strong emphasis on user participation in social services, scientific knowledge on how to achieve these goals is limited. The aim of this study is to explore what social work practitioners identify as challenging in implementing user participation and what solutions they propose to be necessary to meet these challenges. Future workshops were applied, combining data from brainstorming processes and from the participants’ analytical work, identifying current obstacles and co-creating solutions. The workshops took place at the Personal Social Services section in a suburban area outside a large city in Sweden with 95 participants. The findings are discussed in relation to a model of participation, where creating openings, opportunities, and obligations are essential. The participants highlighted the need to strengthen commitment to user participation, increased access to knowledge and methods that enhance user participation, and support from management, with increased resources to ensure continuous development and maintenance. Practitioners must be able to engage in user participation, and actions need to be taken at all organizational levels. To overcome a complex and intertwined set of challenges, an intertwined set of solutions is required.

KEYWORDS:

• User participation
• social services
• future workshops

Introduction

User participation includes principles of respect for the knowledge of the user, coordinated and personalized services, which is in line with the core values of social work (Beresford 2013; Levin, Gewirtz, and Cribb 2017; McLaughlin 2009). However, despite a strong emphasis on personalization and user participation both in social services and in health care, the scientific knowledge on how these ideals can be put into practice is limited (McCormack, Dewing, and McCance 2011).

Personalization and user participation are inherent to a person-centred approach to care, which can be defined as an ambition to achieve a therapeutic relationship between practitioners and users, with informal dialogue, that promotes partnership and shared decision-making (McCormack, Dewing, and McCance 2011; Matscheck, Ljungberg, and Topor 2020). The implementation of person-centred care can be complicated by a discrepancy between abstract ideals that advocate personalization and user participation, and an organizational culture that is problem focused and prioritizes professional expertise. Moreover, organizational structures and professional attitudes within social services affect the ability to implement person-centred care and the shift in power that person-centred care requires.

Methods for realizing user influence are needed, from merely being considered as an attitude or an idea that does not necessarily entail any practical consequences (Björk 2019; Grim et al. 2019; Levin, Gewirtz, and Cribb 2017; Nykänen 2019). The wide variety of needs and shifting abilities among its users are obstacles to implementing person-centred care and user participation within social services. If social services are to offer a person-centred care in practice, a variety of support functions are required to enable users with different needs and a varied autonomy to participate (McLaughlin 2011; Swedish National Board of Health and Welfare 2015). Furthermore, social services are multifaceted, which complicates the work of user participation. Certain groups of users, such as receivers of social assistance, are not collectively represented in user organizations. For other groups, such as children or users with mental disabilities or addiction, legislation that allows for compulsory care needs to be taken into consideration, which undoubtedly entails special conditions for user involvement. In addition, the implementation of user participation is complicated in the context of personal social services (PSSs) by the fact that there is a formal asymmetric power hierarchy. The professionals are representatives of public operations and have a sanctioned mandate to make decisions. This means that PSSs have formal decision-making power and formulate the terms of the contact.

In an international comparison, users in Sweden, to a greater extent than users from other countries, indicate that their providers do not spend enough time with them, do not present different treatment options, and do not give them the chance to ask questions (Vårdanalys 2016). Research also shows that Swedish users who want to participate in their care and services have limited access to information, education and support to allow them to do so (Grim et al. 2019). This may be due to a paternalistic tradition in the relationship between user and care provider, and an epistemic injustice devaluing user knowledge and preferences (ibid). Other reasons may be that the professionals are conflicted with many demands in their position, thus, in spite of an endeavour to work with user participation, the professional opinion becomes superior (Matscheck and Piuva 2021). Moreover, it may be structural factors in social work organization, such as compensation incentives and administrative requirements of social work practitioners, which may shorten user time and limit the possibility of dialog between user and practitioner (Herz and Lalander 2019; Swedish National Board of Health and Welfare 2015). For example, although social workers are required by law and regulations to finish administrative tasks within certain time limits, no such requirements exist regarding the quality and the content of their dialog with users (Bessant and Broadley 2014; Ebsen 2018).

The descriptions and definitions of user participation vary in policy texts, mainly regarding the degree of real influence and power for the user, but are nevertheless described with a clear consensus about user participation as something good and desirable. It is usually formulated in terms of collaboration and the texts often do not discuss potential conflicts. This creates an expectation that user participation should be conflict free (Eriksson 2018). In the practice of social services, however, there is no consensus on what user participation entails and how it should be implemented (Nykänen 2019).

Aim

Knowledge on user participation at a policy level is well documented, but knowledge of how user participation manifests in practice is limited. The aim of this study is to explore what social work practitioners identify as challenging for implementing user participation in their daily work and what solutions they propose are necessary to meet these challenges. User participation in daily work includes planning and conducting service on an individual- as well as on an organizational level, such as acknowledgement of user knowledge, to practice a collaborative and shared decision-making and actively engage in involving the users. User participation as a concept needs to be addressed on all levels simultaneously to have impact, that is on an individual- organizational- and a systemic level. In this study, user participation is explored on an individual and organizational level.

User participation in welfare organizations

The impetus for user participation can be derived from two partially different contexts: on the one hand, a democratizing and equalizing movement (Beresford 2013; Davies, Gray, and Webb 2014); on the other hand, an organizational and knowledge-based approach. The former can be linked to the user movement and other human rights movements from the 1960s and 1970s and their demands for democracy and influence. The latter can be attributed to the effectiveness of organizations and the introduction of ‘new public management’, a perspective also called the consumerist approach. Based on this (latter) movement, user participation is understood as a tool to create efficient services tailored to the needs of users (Eriksson 2018; Nykänen 2019). Today, these two starting points can be understood as intertwined ambitions, with arguments put forward for user participation grounded in the pursuit of democratization, increased quality and efficiency of services, and equalization of power and a strengthened position for the user. Still, there is complexity in the concept of user participation, underpinned by issues of power, workplace culture, and politicization. Some researchers argue that there has been a managerialist thrust towards user participation, which has overshadowed the democratic ambitions (Beresford 2013; Eriksson 2018). An obvious shift of responsibility from the welfare state to the individual has been highlighted as a central aspect of current neoliberal welfare policy. The lack of efficiency, quality, and credibility of social services is considered to be remedied by activating and involving users. User participation is thus formulated as the solution to the problems of welfare organizations, rather than the organizations being formulated as the solution to the problems of users (Eriksson 2018; Johansson 2011).

Addressing issues of power

In this study Shier’s (2001) model of participation is considered to be a relevant framework for analysing participation in social services. This model is a development of Arnstein’s (1969) ladder of citizen participation with an adaptation to the contextual factors of welfare services, suggesting social services remain in power but should strive to involve users in decision-making and responsibility. The model includes five levels of participation and three stages of organizational conditions to achieve these levels. The three stages are (1) openings (attitudes), (2) opportunities (the ability to act on attitudes), and (3) obligations (policy requirements). These stages need to be regarded on every level. The first level describes listening to users. The second level involves the provision of support for users to understand and express their opinions. The third level discusses the issue of taking the user’s views into account in the process of decision-making. The fourth level describes the actual involvement of users in the decision-making processes. The fifth level, which from a power perspective is the ideal goal for user participation, entails that users share power and responsibility in the decision-making process for issues that concern them. According to Shier, the difference between levels one to four and level five is that the involvement in level four (and below) do not necessarily include any real power as presupposed in level five. In relation to previous research on the concept of user participation, this is placed as the highest level in Shier’s model, because it requires a real change in the power dynamics between service user and service provider. An objection to Shier’s model, and the discourse in general on increased user participation, may be that users are expected to be competent and active in relation to social services and in taking responsibility for their own lives. This may contrast with the image of social services users as lacking resources and needing support (Askheim, Beresford, & Heule 2017; Carey 2009).

There is a gap between the ambitious intentions of user participation at the policy level and the prerequisites for the services to realize these intentions (Eriksson 2018; McLaughlin 2011; Vingare, Giertz, and Melin Emilsson 2020). Regardless of a clear ambition in both law and policy documents, knowledge and regulations about how to implement user participation in practice, as well as tools for doing so, are limited (Beresford 2013; Bessant and Broadley 2014). Users tend to be reduced as epistemic subjects, thus, user participation stays symbolic (Razon and Levin 2021). User influence is described as a multifaceted and changing phenomenon, which is defined with a variety of expectations and purposes in different services (Grim et al. 2019; Healy and Darlington 2009; Shier 2001). This ambiguity about the significance of user participation, its definition, and how it can be realized in practice, is described as a major obstacle to its implementation. Although the implementation of user participation is often referred to as occurring within social services organizations on an individual level (Eriksson 2018; Johansson 2011), knowledge is limited about how staff within these organizations define solutions to implement this concept. This study contributes to build on previous studies and fill the knowledge gap on what is required to implement user participation.

Method

Participatory and co-operative design constitute a diversity of methods (Knutsson and Schön 2020), such as future workshop and co creation of prototypes, with the common denominator to equalize power-relations in order to develop more democratic practices (Kensing and Greenbaum 2013). In this study, ‘future workshops’ were used in order to shed light on the broad range of challenges and opportunities for user participation within the everyday practice of social work.

The aim of a future workshop is to lay out and specify current problems within a specific setting and to propose solutions for these problems (Kensing and Greenbaum 2013). For this study, a combination of intuitive processes, such as brainstorming and analytical work (condensing and clustering data), was used. Access to the field was gained when a development manager from the participating PSS organization made a request to the research group to support their on-going work of realizing a more structured approach to user participation. A future workshop was considered suitable to use as method to support the request of implementation of new ways of working with user participation, as well as appropriate to gather data. An advantage with the chosen method is the possibility for staff to reason in groups and come closer to a collective understanding. It also allowed for the mere part of the staff to participate, which resulted in a rich material covering a multitude of perceived obstacles and solutions for user participation, as identified by social workers. Thus, even though this method did not provide an in-depth understanding of individual experiences, it did provide a broad picture of the diverse challenges and possible solutions for user participation in the everyday work of the PSS.

The workshops took place at the PSS section in a suburban area with approximately 42,000 inhabitants, outside a large city in Sweden. PSSs in Sweden consist of three core domains of social work practice: social assistance (SA), substance abuse treatment (SAT), and child welfare (CW) (Stranz, Wiklund, and Karlsson 2016). In the organization of municipal social services in Sweden, PSS is usually organized as one of three core domains; the others are elderly care and care of persons with disabilities (Grell, Ahmadi, and Blom 2016). In the municipality in this study, PSS was organized into seven different units; two were connected to SA, one to SAT, three to CW, and one had an overarching administrative function connected to all PSS (quality and development). Table 1 describes the participants in more detail.

Table 1. Participating units and practitioners.

Workshop	Total no. of practitioners*	No. of participants in workshop
WS 1: Support for young adults (SA) + Quality and development (all PSS domains) (Vägval Vuxen + kvalitetsenheten)	15 + 4	18
WS 2: Social assistance (SA) (ekonomiskt bistånd)	21	12
WS 3: Child and family prevention and treatment (CW) (Förebyggande och behandling)	22	20
WS 4: Substance abuse treatment (SAT) (Beroendeenheten)	16	16
WS 5: Child protection investigations (CW) (Utredningsenheten Barn och Unga)	24	21
WS 6: Foster care (CW) (Placeringsenheten Barn och Unga)	18	8
Total no. of practitioners	120	95

*In each workshop, both managerial staff and frontline workers participated in the workshop covering their unit.

The workshops were held separately with each unit, with the exception of two smaller units that were put together in one workshop. In total, six workshops were conducted, each lasting for 3 hours. No unit was new to the concept of user influence; they had discussed the issue in previous contexts and had also been offered a lecture by a user organization during the past year. Each unit also had a designated ‘user-influence coordinator’. Before each workshop, the researchers gave a brief introduction on the concept of user participation.

Each workshop was divided into three phases: a critique phase, a fantasy phase, and an implementation phase (Kensing and Greenbaum 2013). (1) In the critique phase, the aim was to acquire knowledge on two issues: (a) what practitioners in social services identify as challenging in implementing user participation, and (b) in what specific situations they experienced problems with user participation in their units. Initially, the participants were instructed to write down problems in a brainstorming fashion individually, and in silence, on a specific card. Then, each member in the group reported within their group on what they had written. In the next step, each group had a discussion on the problems and categorized the problems together. This was written down on a large worksheet. The analysis of the problems formed the basis of the fantasy phase. (2) In the fantasy phase, the purpose was to find solutions to the problems that were identified. First, the participants individually put down short solutions to the problems on post-its and paired them with a problem. The idea was to come up with numerous solutions to the problems, without any restrictions, such as budget or timely aspects. The participants got instructions to individually brainstorm and write down whatever ideas they came up with, and try to avoid self-critique of the ideas in that process. Subsequently, each participant described the solutions they had written within their group. The participants were prompted to continue to write down ideas as they listened to their teammates. (3) In the third part of the workshop, the implementation phase, the purpose was to create a selection of solutions and to continue defining those that the participants found appropriate to take further. Each group was then instructed to choose three relevant proposed solutions on how user participation can be implemented. This means that the participants in each group categorized all solutions and assessed which solutions were the most relevant to implement. These proposals were then reported to all participants in the workshop. The last step in the workshop was to give every participant one vote on each of the three solutions they considered most relevant to implement in their unit. During each workshop, participatory observation was conducted to record the activity in the room; all discussions and questions from the participants were written down. These written observations served as support in the analysis of the workshop material to contextualize and develop a deeper understanding of the written statements from the practitioners. At the end of the workshop, all the worksheets were collected, including cards and post-its, sorted by group and later transcribed verbatim.

All material collected during the future workshops was analysed using content analysis (Hsieh and Shannon 2005). The individual brainstorming in the initial critique phase resulted in a total of 5712 written words on 190 worksheets (each participant had two worksheets representing the two issues a and b above), describing problems with user participation. In the following group discussions, they were narrowed down to 133 defined problems. In the fantasy phase the groups agreed upon 105 possible solutions. Further, in the implementation phase, the solutions were narrowed to 69 prioritized suggestions. In order to gain a sense of the content, the transcribed data were read inductively several times. The four researchers in the research group initially coded all transcribed text individually. These themes were then discussed in the research group and a preliminary grouping of the main themes and sub-themes was conducted. This open coding was extracted onto coding sheets to further organize and group the data. From this step, all data were handled in a joint document and sorted, based on their similarities and differences. The emerging themes were used to organize and group codes into clusters. The analysis was repeated, back and forth. After further discussions and abstractions between all the authors, the clusters were processed and grouped into main themes with underlying themes. On a number of occasions, the themes were recoded to ensure validity based on content. An additional analysis was conducted to look at whether the problems and solutions were dependent on the users, the practitioners themselves, the services, or on a structural level.

Results

The obstacles described by the practitioners could be categorized into three themes: organizational limitations, practitioners’ attitudes, and users’ attitudes and abilities. The solutions were also categorized into three themes: a supportive infrastructure, practitioners’ commitment, and availability (Table 2).

Table 2. Obstacles and solutions for user participation.

Obstacles	Solutions
Organizational limitations Laws and regulations Inaccessibility Resources (time, staff) Lack of routines Management (guidance)	A supportive infrastructure Structural suggestions (changing laws, economy) Organizational resources (work load, routines, cooperation) Leadership and clarification of responsibilities (guidance, systemization, expertise)
Practitioners attitudes Lack of consensus on user influence and participation User participation is not a part of regular work Collaboration within and between units	Practitioners commitment Discuss and develop common ground of user participation Practitioners need to focus on users Commitment and trust from users
Users attitudes and abilities Health condition, functional capacity, communication Motivational issues Users attitude that they themselves know best	Availability Flexible opening hours and establishment of citizen office Describe the organization of and processes within personal social services Clear and adaptive communication

Obstacles to user participation

Most of the participants talked about organizational limitations affecting their ability to work with user participation. Practitioners expressed frustration that the nature of their work was not attuned to user participation. They perceived that there was a fundamental contradiction between the authoritative nature of laws and regulations governing social services and the need for compliance with the users’ individual needs. Adherence to laws and local regulations restrains practitioners’ discretion and restricts their ability to meet the users’ individual needs, resulting in a discrepancy between their professional judgement and their formal decision mandate. One workshop participant summarized their lack of discretion in one sentence: ‘I can see a need and I can see possibilities [to meet that need], but I don’t have a mandate [to decide] or services tailored to the clients’ need.’

Laws and regulations were not the only organizational aspect that restrained the practitioners’ ability to adjust to the individual users’ needs and wishes. Different aspects of inaccessibility, such as inflexible opening hours, were posed as a risk that social services were unable to reach users who, for several reasons, did not want others to know about their visits and who could not take time off from school or work without notifying parents or managers.

Another obstacle to user participation that practitioners referred to was insufficient resources in terms of time and staffing, leading to a heavy workload that meant that they had to divide their time between numerous competing tasks and obligations. In this strained situation, they found it hard to set aside sufficient time to include users in decision-making. The difficulty of finding time was further accentuated by the lack of established routines for user participation, which meant that individual practitioners had to devote time to finding ways to involve users. As stated by one practitioner, this made user participation a time-consuming activity: ‘It takes time to make investigations, information and decisions understandable’.

In addition to uncertainty of how to implement user participation, there was also uncertainty about whether or not user participation should be a priority, or if other aspects of the work were more important. The lack of clear directions from management sometimes meant that other obligations were given priority over user participation. To change this, practitioners wanted managers to promote user participation and lead the work towards that goal.

The second obstacle to user participation concerned practitioners’ attitudes to user participation. According to the workshop participants, there was no consensus on user participation, manifested through different opinions among practitioners. The differences concerned not only how and in what situations user participation should be implemented but also differing attitudes towards the significance of user participation.

The different opinions on how user participation should be implemented are related to the lack of routines for user participation, which makes practitioners feel uncertain on what to do and what to prioritize. However, some practitioners also communicated frustration over defensive attitudes among colleagues who viewed user participation as an extra service, and not a part of regular work. Some of these comments related colleagues’ negative attitudes to lack of knowledge on user participation. Others were more critical and argued that there are a number of methods available to promote user participation, but practitioners choose not to use them. In one of the workshops, a participant expressed a similar view when writing: ‘Our unit has been evaluated but the clients’ opinions and suggestions are not considered. There is unwillingness to change the current way of working.’ This quote also suggests that an obstacle to increased user participation is low confidence in users’ abilities to participate in and evaluate care and treatment decisions, and that professional knowledge is valued higher than users’ knowledge. This was supported by comments from other participants who stated that professionals’ lack of trust in the users was one of the major problems.

Different opinions and attitudes to user participation were also presented as an obstacle in interprofessional collaboration within and between units. Some participants claimed that there was no lack of user participation in their own unit; however, the problem of implementing user participation was present in other units. Some explained the low level of user participation in their own unit by referring to difficulties in collaboration with other authorities who had a different perception of user participation or ignored it.

The third area of obstacles to user participation was users’ attitudes and abilities. Practitioners identified cooperation and communication as essential to user participation but experienced difficulties in establishing a trustful and cooperative relationship with the users. Difficulties in establishing a working partnership with users was often related to the users’ poor health condition, their lack of functional capacity, or their lack of communication skills. Problems that arose from users’ lack of abilities were related to, for example, difficulties in informing and discussing alternatives with users suffering from alcohol or substance abuse, having cognitive disabilities, or having a different language or cultural affiliation. However, some of the practitioners emphasized the power imbalance between the professional and vulnerable users as the problem, rather than placing the problem with the users. One aspect of professional power that practitioners mentioned as an obstacle for user participation is bureaucratic jargon that is hard for users to understand. Immigrants were identified as a particularly vulnerable group, partly because of poor language skills and partly because of lack of knowledge of Swedish society. The workers felt that there were major shortcomings regarding information on when to use interpreters and regarding access to competent interpreters.

Practitioners listed users’ attitudes and insufficient motivation as a major obstacle to user participation. Many of them related lack of motivation to the fact that many of the users do not want to be involved with social services at all. Collaborating with users who did not participate voluntarily, for example, in coerced addiction treatment or foster care placements, was described as a major challenge. However, similar challenges existed in voluntary services as well, and there were many comments on the users’ attitudes and lack of motivation; for instance, ‘The user does not want to make an effort’ and ‘The user doesn’t show up [for meetings]’. The users’ reluctance towards social services was also related to a perceived distrust in the social worker, which meant that some users did not want or dare to express their views and opinions. In these cases, the practitioners thought it was difficult to increase their influence.

Another type of attitude that workers found problematic was users who placed too high demands on having an influence over their own treatment. Practitioners felt that it was a problem that users did not trust professional knowledge and sometimes were determined that they themselves knew best what services they needed and were thus unwilling to discuss practitioners’ suggestions. According to practitioners, some users also had unreasonable expectations of what kind of services they could receive.

Solutions to user participation

A number of solutions were proposed to solve the problems that were identified. One theme of solutions was a supportive infrastructure, which includes solutions pointing at an organizational change towards a structural support to achieve user participation. On a structural level, the practitioners suggested changes in the national laws as well as increased financial allocations to social work organizations.

Moreover, the practitioners emphasized the need for organizational resources to achieve a functional and systematic working environment, with a reasonable workload and a stable organization to increase their ability to involve users. One participant expressed: ‘A reasonable amount of cases, which means that the supervisor has sufficient space to plan for user participation throughout the process. Otherwise, time consuming’. Also, aligning resources in accordance with users’ needs and not the other way around was described as a first step towards a user focus and flexibility in the service, giving space for user participation. Linked to the importance of ensuring a stable workforce, suggestions were made on how to make the working conditions better for the practitioners. It was suggested that the organization should strive to become an attractive workplace where practitioners could thrive and feel support and trust between colleagues. Suggestions on steps to achieve this ranged from investments in education and training for practitioners, to activities to get to know each other better within services and in between services, and to welcome new staff.

Another aspect of organizational resources involves cooperation with others as well as the clarification and delimitation of responsibilities for specific units or functions. Practitioners suggested increased collaboration between units in order to strengthen the overall competence around the service user. Specific suggestions concerned the formation of professional teams around the user in order to better utilize the diverse range of professional competences from which the user may benefit. Other suggestions include collaboration with professional groups from other organizations, for example, to gain more knowledge about children and youths at risk.

Although there was a clear emphasis on increased collaboration, there were also suggestions on the need to clarify and delimitate which responsibilities pertained to which specific units or organizations. Such clarification was necessary to avoid confusion and to allocate the workload between practitioners. For example, it was suggested that each unit needed knowledge about the capacity of other units to avoid ‘promising too much’ when informing the user about the support that other units may provide. Many suggestions also concerned the need for changes or the need for more knowledge within other units or organizations. Arguments were put forth that practitioners from other units need more training on how to understand the needs and challenges for a specific target group of service users. In one workshop, it was proposed: ‘That the entire social service could see the clients’ problem and offer the right efforts – to work together on issues in the social service.’

Another suggestion was to systematize the work on user participation more clearly. Practitioners pointed out the need for the leadership to provide guidance and to actively steer the work on user participation, for example, by putting user participation on the agenda for practitioners’ meetings, designing routines that ensure service user participation in case work, or through a systematic evaluation of user participation. Another suggestion on organizing guidance was to create an expert on user participation within each workplace by employing a specific person ‘who rocks at user involvement’ but also installing an expert team working strategically with user participation. In part, these suggestions could also be interpreted as another way to delimit responsibilities by allocating expert knowledge and the core work of user participation to expertise functions rather than having it as an integrated part of everyday work for all practitioners.

Practitioners’ commitment to user participation was also suggested as an aspect of the solutions. The practitioners emphasized that the infrastructure is not enough to increase user participation; social services and other actors also need to commit to user participation. A common ground needs to be created as a way to gain commitment. This includes the need to discuss and develop a shared understanding of what user participation means and the objectives of user participation at different organizational levels, among units in the social services, and among different authorities. For example, practitioners suggested creating forums where user participation is discussed and developed.

It was also suggested that practitioners need to focus on and adapt their work to each individual user and to follow the user through his/her own process of change. For example, it was argued that the social worker needs to be patient, listen to the user’s definition of his/her own situation, and involve the user in discussions about possible solutions. Furthermore, it was suggested that the social worker should have the courage to try the solutions proposed by the user. As one practitioner put it: ‘Show clients that we are there and help them, build client confidence’.

Apart from commitment from the practitioners, it was argued that service users also need to be committed to participating and cooperating with social services. It was argued that users need to have reasonable expectations and to understand the preconditions for the work of social services. Some of these suggestions refer to the responsibility of practitioners, for example, they have to explain the processes, rules and responsibilities in order to motivate the users. Other suggestions point more clearly to the responsibility of users, for example, that parents need to be engaged or that children must have a wish to express their opinions.

A third theme of solutions that emerged was availability, which includes concrete suggestions on how to make social services more accessible to users and suggestions on how to improve information and communication with the users. One suggestion was for practitioners to be available outside office hours when service users actually need them or offer flexible opening hours in relation to users’ life situations. A few practitioners also suggested establishment of a citizen office with flexible hours, providing information about social services and available support. Proposals on how to make social services more accessible included efforts to clarify the aim of different social work units and using an accessible language consistently in written and spoken communication. Practitioners suggested being clearer about their motivation for their decisions with the user, specifying the time allocated for meetings, and explaining the agenda beforehand. Describing how different units work, who makes decisions, and how the issues are handled in a case were also presented as important aspects of accessibility. Further, practitioners proposed using different ways of adapting their communication to make meetings and case work easier for the user to comprehend, regardless of disability or cognitive impairment. Related to this, the use of interpreters was suggested to facilitate communication when users had a different native language.

Discussion

In this study, social work practitioners’ experiences of the challenges and solutions in implementing user participation have been explored through future workshops. The study was conducted with all units in the PSS and included all staff and their managers, which might reduce the possibility of anyone being completely outspoken in their responses. A limitation is that staff may have been reluctant to expressing their opinions if they did not correspond to those of the group. Additional individual interviews could possibly have given a broader perspective. Another limitation of the study was that the future workshops were carried out on only one occasion and the output data consists of a large number of brainstorming notes, not necessarily providing in-depth reflections from participants. To further explore and develop the suggested solutions, a second set of workshops would have been appropriate (Muller 2007). However, although additional interviews and follow-up workshops may have contributed to more in-depth knowledge of the phenomenon under study, they would have required a delimitation of the setting (i.e. focusing on one unit instead of six), thus reducing the breadth of knowledge gained through the current design. Despite these limitations, the results identify several challenges in implementing user participation in the PSS, but also present solutions on how such implementation could be promoted.

The study contributes with experience-based knowledge of how user participation can be realized in PSS and the obstacles in this complex practice that need to be overcome. The results illustrate a perceived gap between the policy intentions of user participation and realization of these intentions in practice, which is in line with earlier studies (Bessant and Broadley 2014; Eriksson 2018; McLaughlin 2011; Vingare, Giertz, and Melin Emilsson 2020; Razon and Levin 2021). Despite a clear consensus on the concept of user participation in policy and guidelines (Beresford 2013; Levin, Gewirtz, and Cribb 2017; McLaughlin 2009), this study confirms that it is not as clear in practice. Working with user participation was not perceived as part of the practitioners’ day-to-day work. Previous research emphasizes that a consensus on the concept is not enough (Nykänen 2019). There has to be a supportive infrastructure in place to promote the actual implementation of the concept of user participation in practice (Björk 2019). This study shows that support and trust between staff to ensure a stable and grounded workforce, may be seen as important aspects of such supportive infrastructures. Cooperation and communication between practitioners and users were described by practitioners as essential to create openings for participation. To ease the collaboration between users and social workers, the practitioners proposed solutions that would make their practice more accessible for users, both through approachable information and through organizational changes such as different opening hours. These solutions also depend on previously mentioned support system, since the individual social worker often is conflicted with on the one hand involving users, and on the other hand meeting the organizational demands (Matscheck and Piuva 2021). Based on Shier’s model of participation, the realization of user participation in practice relates to both ‘openings’, ‘opportunities’, and ‘obligations’ (Shier 2001). Obligations are emphasized in terms of laws and regulations, clear leadership, and appropriate follow-up. Opportunities relate to the expressed need for methods and routines, as well as a common ground on the understanding of and objectives for user participation and on users’ abilities to function as active partners in a participatory service. In this sense, obligations and opportunities primarily address management and policy requirements outside of the practitioners’ control; the implementation of user participation was considered to be presupposed by a demand from management to systematically engage in the development and continuous upholding of such tasks. In line with previous studies (Bessant and Broadley 2014; Ebsen 2018; Herz and Lalander 2019), the results from this study confirm the challenge for practitioners of not having enough time to be flexible and to meet the various needs of the users, partly due to a perceived increased bureaucracy. Ebsen (2018) argues that national laws typically stipulate administrative rules of procedure and time limits regulating the social worker’s obligations. With the lack of stipulation of expected actions in situations more closely related to the quality and content of their daily work, the implementation of user participation is left in the hands of the individual social worker. Thus, a clear requirement and the go ahead (Herz and Lalander 2019) from management might be a way to ensure a joint prioritization between the administrative work and the development of user participation throughout the organization. The expressed need for clear requirements from management might also indicate that the practitioners experience a lack of power and influence themselves, having little authority to change the situation for the users towards a more profound user participation in the services, as illustrated also in other studies (Matscheck and Piuva 2021; Razon and Levin 2021).

However, opportunities and obligations at an organizational level were not separated from staffs´ own perceived autonomy to act. Another main theme in the solutions concerned practitioners’ commitment to user participation, which directly corresponds to Shier’s ‘openings’ (Shier 2001), that is, the practitioners’ and the organizations’ attitudes and readiness to support user participation. The participants in this study suggested strengthened activities to reach a common ground with a clear focus on and a shared definition of user participation in order to gain the users’ trust and engagement. This can be related to McCormack, Dewing, and McCance (2011) who showed that a key consideration to reach this common ground was to move from person-centred moments to a person-centred culture within the services.

Related to the urge for a common ground is the fact that some participants also expressed a need to strengthen (other) practitioners’ attitudes to user participation. This discrepancy among participants perceptions of user participation was evident also in the diversity of their proposed obstacles and solutions. For example, while some pointed out users’ own insufficient abilities as an obstacle for user participation, others emphasized their co-workers lack of confidence in user’s abilities as an obstacle, and while some pointed out the power-imbalance between users and practitioners as an obstacle, others suggested that users’ high demands for influence was sometimes an obstacle in itself. In the light of Shier’s five levels of participation (Shier 2001), this points to a tension within participants view of which level of participation that is actually desirable. While there seemed to be a consensus on the endeavour to provide users with accessible information, to listen to users, to support them in expressing their needs, and to take their perspectives into account (which corresponds with level 1–3), the endeavour to involve users more actively in decisions (level 4) or to share power with users (level 5) was not as clearly a common standpoint.

Implications

Previous research has highlighted a gap between the intentions of user participation at a policy level and a lack of user participation in practice (Bessant and Broadley 2014; Eriksson 2018; Nykänen 2019). This study contributes important knowledge on how to overcome this gap. Realizing user participation in social work practice is a complex task. The participatory design conducted in this study has created a unique opportunity to explore, together with practitioners from different units within the PSS, a complex pattern of intertwined challenges and possible solutions reflected through the experience-based knowledge of social work practitioners.

The practitioners proposed challenges and solutions on an individual, an organizational, and a systemic level, promoting solutions for both openings, opportunities and obligations (Shier 2001). A strengthened commitment to user participation within the organization was emphasized, for example, through developing a shared understanding of what user participation entails and through increased cooperation and dialog with individual users (openings). Other solutions concerned extended access to knowledge and methods that enhance user participation, support from management, and increased resources to ensure continuous development and maintenance of user participation (opportunities). Finally, many solutions were linked to the need for clear requirements and leadership, both from management and from laws and regulations, to genuinely implement user participation in the everyday work (obligations).

For practitioners to be able to actively engage in user participation, actions need to be taken at all these levels. To overcome a complex and intertwined set of challenges, an intertwined set of solutions is required. Furthermore, these solutions need to be clearly structured, offering support and leadership from management as well as autonomy for social workers in their everyday interaction with users. The responsibility to realize user participation in the organization cannot be referred to individual social workers, or even to managers within the welfare services. Social workers need support in handling recurring dilemmas and challenges and managers need the tools to offer such support, in form of for example, organizational resources as well as laws and regulations that clearly address the expected content and quality of user participation. This study provides a broad picture of practitioners’ perceptions of obstacles and possible solutions for user participation. Further research is needed to gain a more in-depth understanding of how these obstacles and solutions are perceived and handled with in social work day-to-day practice. This requires a more in-depth exploration of both practitioners and users’ perspectives on and experiences of these matters.

Acknowledgments

We are deeply grateful to all the participating staff from the Personal Social Services section for their time and commitment during the workshop and the provision of indispensable knowledge and experience.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Swedish Council for Research on Health, Welfare and Working Life -FORTE- Forskningsrådet för halsa, arbetsliv och valfard, under grant no. 2018-01341.