Beyond formalized plans: User involvement in support in daily living – users’ and support workers’ experiences

Background: User involvement, based on respect and carried out through dialogue, has been shown to lead to increased self-respect, self-confidence and positive identity. In Sweden, the Social Service Act requires that interventions be designed and implemented together with the individual concerned. The basic criterion for social support is prolonged severe mental illness (usually at least 6 months), with no criteria for specific diagnosis or institutional history. The most common form of social support is ‘support in daily living’, a community care intervention for people aged 18 years or older who have their own homes and living arrangements. Aim: This article aims to deepen our understanding of user involvement at the individual level in the provision of an ongoing social work intervention. What elements of user involvement can be found in users’ and support workers’ descriptions of helpful support in daily living? Method: Qualitative interviews were conducted with 18 users, who had experienced support in daily living as helpful, and 16 interviews with the users’ support workers. Results: Three major, interconnected themes emerged: Constant dialogue; Framing the flexibility, in relation to formalized intervention plans and regulations; The importance of ‘small things’, decisions concerning daily life. Conclusion: Both users and support workers described user involvement at the individual, micro-level to be an integral part of helpful support in daily living. It was possible to create a space for dialogue and co-creation in which users were involved in formulating and deciding the contents of their support at an informal level, to influence their own everyday lives. While a formal framework of rules, restrictions and plans surrounds meetings between users and professionals, a facilitating factor may be the absence of too detailed plans and regulations, leaving trust to users and professionals and their capacity to manage most of the choices they have to make.