Factors shaping user involvement in social and health services in Poland: the perspective of persons with disabilities.

backgroundThe idea of involving citizens in shaping social and health services is not new. Many authors have stated the lack of citizens’ input in the development of these sectors. Different theoretical frameworks on the user perspective exist, but they are often broad and difficult to connect with the presented topic clearly.

objectiveThis paper aims to examine factors influencing the involvement of service users in health and social services in Poland, particularly from the perspective of individuals with disabilities and with chronic mental health conditions.

methodsThe findings presented here are part of a project funded by the European Union’s Horizon Europe programme, called RESPONSIVE. The empirical data used in this paper are based on qualitative research conducted in Poland, including 20 in-depth interviews and 2 focus groups with service users carried out between September 2023 and February 2024.

resultsThis article discusses the challenges and opportunities related to service user involvement in the Polish social and health care system, as perceived by people with disabilities. According to the collected data, three major factors are identified as supportive to their engagement: (1) multidimensional accessibility of services, (2) the need for basic information about available services, and (3) changes in the relationship between service users and service providers. While the empirical results are mixed, the overall picture of service user involvement is not very optimistic. Interviews reveal significant limitations to the users’ participation in Poland’s social and health services, resulting in relatively low engagement. Furthermore, for the groups analysed (people with disabilities and individuals with chronic mental health conditions experiencing psychosocial disabilities), the challenges in implementing effective service user involvement are more pronounced. The key barriers include: limited service accessibility, lack of information about health and social services, and the low agency of service users. Additionally, the power imbalance between service users and service providers hinders meaningful participation in decision-making processes on service changes.

conclusionsThe evolution of support systems for people with disabilities and chronic mental health conditions does not follow the direction toward greater sensitivity to the voices of citizens. It continues to overlook the importance of active listening and direct communication with service users to better address their needs and adapt services accordingly. Most often, current consultations remain limited and typically occur within political circles, which are often less accessible to the voices of those who use the services.