Experiential expertise in the co-development of social and health-care services: Self-promotion and self-dismissal as interactional strategies

Abstract

Increasing client involvement in the development of social and health-care services has resulted in clients being invited to present their experiential knowledge in service co-development groups. Nevertheless, research has shown that their opportunities to really contribute to actual decision-making are limited. This article investigates how client representatives initiate turns-at-talk in the decision-making context and the way in which professionals respond to them. Using conversation analysis, we analyzed 15 h of recorded interactions in five co-development workshops. Our data exhibited a systematic pattern that linked client representatives' self-promoting and self-dismissive turns-at-talk to specific types of responses from professionals. When the client representatives highlighted the relevance of their experiential knowledge for making decisions, the professionals disregarded their contributions. However, if instead, the client representatives cast their experiential knowledge as irrelevant to the decision-making activity at hand, the professionals subsequently appreciated this knowledge. Thus, paradoxically, in order to establish the relevance of their views, client representatives diminished their positions as experiential experts.

Keywords: client involvement; co-development; decision-making; experience knowledge; expertise; social and health care.