Barriers and facilitators during the implementation process of shared decision-making in the comorbidity field: staff perspectives

To enhance user participation in the complex setting of coordinating support, more knowledge is needed about strategies designed to improve user involvement. This study aimed to explore staff perceptions of barriers and facilitators during the implementation process of the innovation shared decision-making (SDM) in coordinated individual planning (CIP) within the comorbidity field of practice. A mixed methods approach was used, involving the collection and analysis of questionnaire data at two time points, followed by individual and focus group interviews. Data were collected from staff working in social services and healthcare. The data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), focusing on the domains of innovation, inner setting, and individuals involved. Barriers to implementation included among others, perceptions of high workloads, a lack of relational connections between staff from different units, and staff ambiguity regarding user participation. Facilitators included circumstances such as experience with the innovation, a focus on user participation, and the presence of functional collaboration between staff from different organizations prior to implementation. Overall, the findings highlight the importance of relational connections both between users and staff and among staff from different units during the implementation process of SDM in a collaborative setting like CIP.