Abstract
We report on a case study that examines client-service engagement at an agency providing social and health support to Pacific people with mental health conditions. The study is part of a wider research programme to improve uptake of services by those deemed 'hard to reach'. We take a service ecology approach to discover perspectives on engagement from clients, agency staff, agency management and funder.
The underlying hypothesis of the project is, that the uptake of service by a client (individual, family, aiga or whānau) is a process of collaboration between the client-system and the provider-system to create 'service-value'.
The method involved in-depth interviews, focus groups, and review of agency documents. Thematic analysis was primarily deductive, identifying latent themes driven by an underlying hypothesis, however, some inductive coding was also used. Data from individuals were used as windows into systemic relationships rather than as direct evidence of what is important in understanding client-service engagement.
We present our findings in terms of co-creation of service engagement whereby clients, others in the client's world, frontline support workers, and others in the world of the service provider all contribute to the quality of engagement between clients and the service, and thereby to outcomes. We draw on a pasifika metaphor - the Kakala, service-dominant logic, and a model of service co-creation - to interpret findings.
Findings are presented in terms of necessary capabilities and capacities of the client and the service agency, and processes of adaptation by clients and the service agency that enable sufficient fit between client and service agency, and thereby enable engagement and utilisation of service.
The findings of the case study have become part of a cross-case analysis to develop a general model for improving service uptake by populations deemed hard to reach. A provisional model from that analysis is offered to show how the case study findings might be generalised.