Health and welfare services are facing major challenges, including impaired efficiency in meeting the complex needs of users. To face these challenges, there is a need to develop new ways of working, such as co-production. It is a challenge to enable and enhance inclusive co-productive processes, but trust and self-efficacy are key concepts for success. Trust and self-efficacy can be considered as both enablers and products of co-production and are thus important to acknowledge together with contextual factors and to act upon at all organizational levels, starting with individual patients and users.
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Health and welfare services are facing major challenges, such as demographic, financial, and organizational changes, together with increased digitalization of services (Roncarolo et al., 2017).The lack of collaboration between health and welfare providers in the system impair efficiency in meeting the complex needs of patients and users (Hultberg et al., 2005). To meet these challenges, providers of health and welfare services need to develop new innovative solutions and ways of working (Lehoux et al., 2019; Swedish Association of Local Authorities and Regions, 2019). One such innovation that has received increased empirical and theoretical interest is co-production (Kjellström et al., 2019).
Co-production can be defined as “the voluntary or involuntary involvement of public service users in any of the design, management, delivery and/or evaluation of public services” (Osborne et al., 2016). The co-productive relationship is a meeting of various experts; service providers providing their professional expertise and patients and users providing their experience of the situation, together with their attitudes, values, and personal preferences (Coulter, 2006; Palumbo & Manna, 2018). Everyone involved shares the responsibility to ensure their specialized knowledge is integrated to create optimal services. Thus, co-production requires high attention, focus, and commitment throughout the process (Lee et al., 2019; Vogus & McClelland, 2016).
There are elements of co-production in all health and welfare services, and care quality is positively associated with the relational aspect of co-production of care (Cramm & Nieboer, 2016). Staffs are able to recognize the need for service changes and improvement issues raised by patients as they share their experiences (Vennik et al., 2016). Co-production can also move the responsibility for health toward patients, compared with the dominant role of health care professionals as experts responsible for health-related decisions (Palumbo & Manna, 2018). The level of co-production in health and welfare services varies and is at its highest level when patients and users are engaged in assessments of needs and the choice of services to manage those needs (Adinolfi et al., 2016).
Earlier research has described how co-production is related to trust and self-efficacy (Fledderus, 2015a; Fledderus et al., 2014,; Thomsen, 2017). To enable and enhance inclusive co-productive processes is a challenge, but trust and self-efficacy are key concepts for success. For patients and users, trust involves how they perceive the intentions and behaviors of multiple constituencies of the organizations’ conduct and motives (Nelson et al., 2019). People who are motivated and have higher levels of trust are also more likely to be active in co-production (Fledderus & Honing, 2016). On the other hand, studies have showed that co-production activities can decrease trust in service providers (Fledderus, 2015a,b; Sudhipongpracha, 2018). Trust is a challenge if the system is experienced as incoherent and not in line with one’s values. To be involved, patients and users need to be respected, acknowledged, and have a trustworthy relationship with the professionals (Sagsveen et al., 2019). Furthermore, patients and users must perceive the services as legitimate to be persuaded to be involved in co-production (Gilson, 2003). The need for trust also includes trusting service providers with different professions in various health and welfare organizations. Trust is not only an issue for patients and users; staff’s trust in their organization concerns their confident and positive expectations of the organization. In systems of distrust, professionals can still promote trust (Gilbert, 2005), because there may be trusting relationships between professionals and individuals despite distrusting the organization.
Self-efficacy concerns individuals’ belief that they can manage to follow a set direction of action. Self-efficacy levels influence how individuals perceive problems, and individuals with high self-efficacy are more likely to understand problems as challenges or possibilities (Bandura, 1977). Scholars have described how self-efficacy perceptions are positively related to co-production (Fledderus, 2015a; Fledderus et al., 2014; Hattke, 2019; Thomsen, 2017).