The Paradox of Help: User Participation in Rural Municipal Health and Care Services

The aim of the study was to investigate how users of municipal health and care services experience user participation in a small municipality in Norway. The study included ten qualitative interviews. Interpretative phenomenological analysis was used as the method of analysis, and two main findings were identified: (1) the paradox of receiving help and (2) the lack of individualization of the services. The paradox of receiving help highlights the complex emotions users can experience. Emotions such as gratitude and dependency can conflict with their desire for autonomy. This paradox emphasizes the need for service providers to balance support with respect for users’ autonomy. Furthermore, the study reveals a significant gap in service provision, with standardized approaches often failing to meet an individual’s unique needs. The lack of individualisation can lead to dissatisfaction and a feeling of not being heard. Drawing on family systems theory, the researchers argue in favour of autonomy as a relational phenomenon and promote a new system consisting of the user-next-of-kin-provider system. This approach suggests that such systems can better meet the diverse needs of users. The study concludes that it is important to re-evaluate current practices in rural health and care services and emphasizes the importance of tailoring and actively involving users in municipal health and care services.