Suchergebnisse

The tension between providing adequate information and achieving sufficiently high participation in population-based screening programmes, such as mammography, represents an ongoing challenge for health authorities. The theory of nudge illuminates how individuals may be nudged towards healthy behaviours without restricting individual freedom of choice. We analyse information provided on health authority webpages and uncover the subject positions available to healthy women deciding whether to participate in screening. We do so by comparing different policy contexts where women must opt in to screening (Australia) or opt out (Scandinavia).We conclude that information is used to nudge women towards screening. Alongside focus on the ease of being screened, tensions exist in simultaneously portraying women as being at risk of breast cancer and providing reassurance of their healthy state. We identify persuasive devices that emphasise responsibility to participate in screening and conclude that webpages play a dynamic role in authorities' attempts to, on one hand, achieve high participation in screening, and on the other, promote mammography screening as an individual choice.

Background: Few studies have investigated user involvement initiatives in whole organizations. The aim was to explore the experiences of professionals and user representatives taking part in the implementation of a user involvement plan. Materials: A qualitative study in a mental health hospital included interviews and observational data. Discussion: Three different stories emerged. The first described the implementation as a success. The second described the implementation as a success, but after overcoming several obstacles. The third described that the development plan had limited impact. Conclusions: Close attention should be made to decision-making and resource allocation when implementing user involvement.

Background: In western countries, patient participation is requested in policies on mental health services. Participation is built on ideas of democracy and individual responsibility. Mental illness has, however, been characterized by its irrational features. Aim: To investigate mental health service users' and providers' views on patient participation during episodes of mental illness. Methods: Qualitative interview study with 20 users and 25 staff from a mental health hospital in central Norway. Results: Both users and professionals saw poor illness phases as an obstacle to patient participation. Lack of insight, lack of verbal ability and difficulty cooperating made participation difficult. During such phases, patient participation was redefined. There was a shift in responsibility where professionals took charge through strategies of providing information, motivating patients and reducing choices. Respect and dignity were maintained and not redefined. Conclusions: In poor phases of mental illness, patient participation was redefined and weighed against what was perceived to be the patient's best interest.

Abstract Background Governments in several countries attempt to strengthen user participation through instructing health care organisations to plan and implement activities such as user representation in administrational boards, improved information to users, and more individual user participation in clinical work. The professionals are central in implementing initiatives to enhance user participation in organisations, but no controlled studies have been conducted on the effect on professionals from implementing institutional development plans. The objective was to investigate whether implementing a development plan intending to enhance user participation in a mental health hospital had any effect on the professionals' knowledge, practice, or attitudes towards user participation. Methods This was a non-randomized controlled study including professionals from three mental health hospitals in Central Norway. A development plan intended to enhance user participation was implemented in one of the hospitals as a part of a larger re-organizational process. The plan included i.e. establishing a patient education centre and a user office, purchasing of user expertise, appointing contact professionals for next of kin, and improving of the centre's information and the professional culture. The professionals at the intervention hospital thus constituted the intervention group, while the professionals at two other hospitals participated as control group. All professionals were invited to answer the Consumer Participation Questionnaire (CPQ) and additional questions, focusing on knowledge, practice, and attitudes towards user participation, two times with a 16 months interval. Results A total of 438 professionals participated (55% response rate). Comparing the changes in the intervention group with the changes in the control group revealed no statistically significant differences at a 0.05 level. The implementation of the development plan thus had no measurable effect on the professionals' knowledge, practice, or attitudes at the intervention hospital, compared to the control hospitals. Conclusion This is the first controlled study on the effect on professionals from implementing a development plan to enhance user participation in a mental health hospital. The plan had no effect on professionals' knowledge, practice, or attitudes. This can be due to the quality of the development plan, the implementation process, and/or the suitability of the outcome measures.

AbstractArtificial intelligence (AI) is increasingly used in health care to improve diagnostics and treatment. Decision‐making tools intended to help professionals in diagnostic processes are developed in a variety of medical fields. Despite the imagined benefits, AI in health care is contested. Scholars point to ethical and social issues related to the development, implementation, and use of AI in diagnostics. Here, we investigate how three relevant groups construct ethical challenges with AI decision‐making tools in prostate cancer (PCa) diagnostics: scientists developing AI decision support tools for interpreting MRI scans for PCa, medical doctors working with PCa and PCa patients. This qualitative study is based on participant observation and interviews with the abovementioned actors. The analysis focuses on how each group draws on their understanding of 'good health care' when discussing ethical challenges, and how they mobilise different registers of valuing in this process. Our theoretical approach is inspired by scholarship on evaluation and justification. We demonstrate how ethical challenges in this area are conceptualised, weighted and negotiated among these participants as processes of valuing good health care and compare their perspectives.