User involvement in Finland: the hybrid of control and emancipation.
OBJECTIVE
The new "agenda of choice" in public services emphasises service users' needs and agency. The ideals of consumerism and user involvement have set new challenges for professionals. This paper aims to explore the effects of consumerism and user involvement at the level of day-to-day service delivery, looking at the encounters between professionals and service users.


METHODS
The paper applies an ethnographic approach. Observation data were collected at two Finnish drug treatment institutions: a needle exchange and health counselling service, and a specialised maternity clinic for pregnant women. Data from each institution consist of seven to 12 months of participant observation notes, which were subsequently systematically coded and analysed comparing the two institutions.


RESULTS
The promotion of new ideals does not automatically result in the empowerment of service users or the erosion of professional power. The two institutions differ greatly: institutional context and gender shape the everyday realisation of the new ideals. In both institutions, however, professionals have adopted new practices and rethought their role. The cultivation of service users' choice and agency can become valuable professional capital, a new kind of "know how" that can also be used by the professionals to justify the importance of their work.


CONCLUSIONS
The paper provides a nuanced and contextualised insight into "how" the ideals of consumerism and user involvement are translated into everyday encounters between service providers and users.
Leppo
Anna
A
Department of Sociology, University of Helsinki, Helsinki, Finland. anna.leppo@helsinki.fi
Perälä
Riikka
R
D003376:Counseling; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration; D018671:Needle-Exchange Programs / Q000458:organization & administration; D019982:Organizational Case Studies; D010358:Patient Participation; D026684:Personal Autonomy; D011247:Pregnancy; D011369:Professional-Patient Relations; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*