Service user-professional interaction in health and care settings
Matthews, Paul (Clinical psychologist)
This thesis is comprised of three chapters written as articles for publication. The theme linking the chapters is the focus on interaction between service users and professionals working in health and care settings.\ud \ud Chapter one reviews discursive research on health and care professional interaction with people with a learning disability. The focus is on how professionals talk with and about people with a learning disability. Citations are explored which describe professional talk in research interviews, interactions with people with a learning disability in everyday settings, questionnaire-based interviews, therapeutic interactions and meetings. Certain practices have been found to work well in particular contexts and some not so well. There is potential to use practices across contexts, however there is no guarantee that a particular practice will perform the same action in a different interactional setting. Future research in the area could look at the effects of trying to increase the use of some of the more successful practices through staff training.\ud \ud Chapter two details an empirical study on how questions are used by participants in care programme approach (CPA) review meetings in the NHS. Questions were found to be asked by the professionals at the meeting in a manner that followed the format of a semi-structured interview. Six question types are described in the paper that perform a range of actions; switching topic, prompting the service user, avoiding overt disagreement, bringing the meeting back on topic, offering the service user the opportunity to ask questions and ensuring a particular structure is followed. The analysis suggests that government guidance on CPA regarding service user participation is not being realised in the way that the process is conducted on an interactional level.\ud \ud Chapter three contains a reflective piece about my experiences conducting discursive research in an NHS setting. It describes the challenges faced in doing research using this methodology and makes suggestions on how some of these potential issues might be tackled.
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