User involvement in efforts to improve the quality of drug misuse services in England: A national survey

Aim: To examine the extent of user involvement (UI) in efforts to improve the quality of drug misuse services in England, to identify outcomes of involvement, and explore factors that promote and hinder this process. Methods: Cross-sectional survey of service commissioners, providers and members of user groups in a representative sample of 50 of the 149 English Drug Action Teams (DATs) in England. Findings: We found wide variation in the degree to which systems for involving users had been implemented. Thirty-nine (84.7%) of the 46 DATs that responded reported working with service users, but only 22 (47.8%) involved them directly in commissioning services. User groups had generally been set up with the support of service providers, and had been running for an average of three years. Most stakeholders were able to identify changes to the organization and delivery of services resulting from user involvement, but the impact of these changes on engagement and retention in services has not been examined. Stakeholders reported that cultural, organizational, and individual variables hindered UI, including staff resistance and limited numbers of users willing to be involved. Conclusions: Our findings suggest that most commissioners and providers of drug services in England involve users in efforts to improve service quality. Direct payments to users, effective systems for delivering feedback, and a better understanding of the impact of the outcomes of involvement may help to sustain this process.