Vulnerable users and family carers as actors in co-creation

Jim Broch Skarli problematizes the term co-creation in public services in his doctoral degree.

Jim Broch Skarli will defend his thesis on 10 June.

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The full title of the thesis is: "Sometimes there are conflicts". A public service logic perspective on vulnerable users and family carers as actors in co-creation

Co-creation has gained increasing popularity in connection with public service provision, where service users are understood as active and equal partners to the service providers.

Based on a study of vulnerable users and family carers, the dissertation problematizes this harmonious understanding and discusses how users and family carers' resources and attributes can influence co-creation processes and their outcomes. Vulnerable users are used in the sense of chronically and seriously ill users, where vulnerability refers to some degree of powerlessness in interaction with the public service system, indicating that users may have different prerequisites and opportunities to participate.

The dissertation shows that vulnerable users often lack resources and attributes that enable them to participate as active and equal partners in co-creation, and that family carers’ role as actors in this context must be understood as a result of users’ lack of resources and attributes. At the same time, it is substantiated that family carers’ ability to fulfil this role must also be understood in the context of their own resources and attributes, as well as the broader context in which they find themselves.

The main findings of the doctorate

Users' low health literacy illustrates a basic built-in asymmetry between the involved actors, with regard to operant resources. Service providers’ failure to reduce this asymmetry through adequate facilitation may result in value co- destruction.
It is not a given that vulnerable users are cognitively able to determine whether they come better or worse off in the end. Therefore, it may be necessary for service providers to play a greater role in assessing what are positive or negative value for users, when users are not able to do so themselves. The dissertation thus problematizes the service literature's understanding of the user as uniquely determining value, as well as the understanding of the users' and service providers' roles and the relationship between them, within Public Service Logic.
When responsibility is placed in the hands of family carers, it has a negative impact on their capacity, capability, and room for maneuver. This weakens their ability to integrate resources in co-creation, which in turn can result in co-destruction and conflictual value outcomes.
Strong emotional ties and loyalty between actors add to the pressure of the service providers’ expectations, and further reduce individuals’ perception of a realistic opportunity to opt out of participation. Therefore, the absence of choice is further reinforced in in this setting.
Value is not only negotiated across the actors in public services, but also between short- and long-term value for the individual actor. However, reduced room for maneuver resulting from responsibilization, reduces family carers' ability to negotiate between short- and long-term value outcomes. Therefore, increasing deterioration of the family carers’ ability to effectively integrate resources in co- creation is likely to have a significantly negative effect on their own, as well as the users’ well- being over time.
Responsibilization challenges Public Service Logic's understanding of the facilitating role of service providers, as the responsibility for successful resource integration and facilitation to a greater extent is transferred to the individuals.

About the public defence

The public defence for Jim Broch Skarlis’ doctoral thesis takes place at Inland Norway University of Applied Sciences, Lillehammer campus, Friday 10 June 2022. The defence will also be streamed.