Cited by 200Mental Health and Patient InvolvementHealth Services Management and PolicyPatient Satisfaction in Healthcare

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Assessing the promise of user involvement in health service development: ethnographic study

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Fudge, Nina, Wolfe, Charles D A, McKevitt, Christopher·2008·BMJ

DOI 10.1136/bmj.39456.552257.bePMC PMC2234509

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Abstract

OBJECTIVES: To understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice. DESIGN: Ethnographic study using participant observation, interviews, and collection of documentary evidence. SETTING: A multiagency modernisation programme to improve stroke services in two London boroughs. PARTICIPANTS: Service users, National Health Service managers, and clinicians. RESULTS: User involvement in the programme was initiated and led by professionals. Professionals determined the areas of service improvement service users could participate in. A wide range of activities were considered "user involvement," from patient satisfaction surveys to service users delivering peer support. Involvement tended to be most active in the least technical areas and areas with least input from clinicians. Factors that might explain this included organisational structure, the vagueness of the concept of user involvement, the value attributed to service users' experiential knowledge, and variations in professional and service user understandings of and commitment to involvement. The gains of involvement were harder to identify in terms of impact on services. More evident were the personal gains for those involved: satisfaction of feeling listened to by professionals, social opportunities of meeting others in a similar situation, and increased knowledge about stroke and services available. CONCLUSIONS: User involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.

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Authors: Fudge, N., Wolfe, C. D. A., & McKevitt, C.
Affiliations: King's College London (GB)
Corresponding author: Fudge, Nina
ORCID: Fudge, Nina
Wolfe, Charles D A
McKevitt, Christopher
Venue: BMJ
Publisher: BMJ
Published: 2008-01-29
Volume: 336
Issue: 7639
Pages: 313-317
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.39456.552257.be
PMC: PMC2234509
OpenAlex: W2023760594
Cited by: 200
References: 30
Citations by year: 2026: 2 · 2025: 1 · 2024: 6 · 2023: 8 · 2022: 4 · 2021: 8 · 2020: 15 · 2019: 7 · 2018: 11 · 2017: 18 · 2016: 18 · 2015: 13 · 2014: 17 · 2013: 20 · 2012: 11
FWCI: 26.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
Locations: BMJ (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
HighWire Press Open Archive (submittedVersion)
Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
Funders: NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
National Institute for Health and Care Research (RP-PG-0407-10184)
King's College London
Stanley Thomas Johnson Stiftung
Topics: Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
Keywords: user participation, service user involvement, health service development, stroke care, service modernization, service user experiences, peer support, organizational structure, service quality, health policy implementation
MeSH terms: Communication, Humans, Health Knowledge, Attitudes, Practice, London, Patient Participation, State Medicine, Stroke

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Assessing the promise of user involvement in health service development: ethnographic study

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