Research Article

Knowledge and views about coordinated individual planning from the perspective of active older adults

Ingela Jobe, Asa Engstrom and Birgitta Lindberg*

Published: 06/05/2019 | Volume 3 - Issue 1 | Pages: 017-026


Background: Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed.

Aim: The aim of the study was to explore active older adult's knowledge and views regarding coordinated individual planning

Methods: The study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes.

Results: The four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individual's needs.

Conclusion: Older adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.

Read Full Article HTML DOI: 10.29328/journal.cjncp.1001012 Cite this Article


  1. von Bültzingslöwen I, Eliasson G, Sarvimäki A, Mattsson B, Hjortdahl P. Patients' views on interpersonal continuity in primary care: A sense of security based on four core foundations. Fam Pract. 2005; 23: 210–219. Ref.:
  2. Papastavrou E, Efstathiou G, Tsangari H, Karlou C4, Patiraki E. et al. Patients’ decisional control over care: A cross‐national comparison from both the patients’ and nurses’ points of view. Scand J Caring Sci. 2016; 30: 26–36. Ref.:
  3. Bernabeo E, Holmboe ES. Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Aff (Millwood). 2013; 32: 250–258. Ref.:
  4. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014; 94: 291–309. Ref.:
  5. Walker MT. Adopting year of care planning. Practice Nursing. 2009; 20: 571–574. Ref.:
  6. World Health Organization. World report on ageing and health. World Health Organization. 2015; Ref.:
  7. Dunér A, Nordström M. Intentions and strategies among elderly people: Coping in everyday life. Journal of Aging Studies, 2005, 19 437–451. Ref.:
  8. Swedish Association of Local Authorities and Regions. Coordinated individual plan, SIP. Swedish Association of Local Authorities and Regions. 2019. Ref.:
  9. SFS 2017:612 Law (2017: 612) on collaboration on discharge from closed health and medical care. The collaboration at discharge from hospital Act]. Stockholm, Sweden: Ministry of Health and Social Affairs, the Swedish Government; 2017. 2019; Ref.:
  10. Min plan [My Plan]. Region. Norrbotten [Norrbotten County Council]. 2017. 2019. Ref.:
  11. Thorne S. Kirkham SR, O'Flynn-Magee K. The analytic challenge in interpretive description. Int J Qual Methods. 2004; 3: 1–11. Ref.:
  12. Thorne S. Interpretive description: Qualitative research for applied practice. Taylor & Francis Group, New York, Routledge. 2016; Ref.:
  13. Hunt MR. Strengths and challenges in the use of interpretive description: Reflections arising from a study of the moral experience of health professionals in humanitarian work. Qual Health Res. 2009; 19: 1284–1292. Ref.:
  14. Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995; 311: 299-302.
  15. World Medical Association (WMA). The Declaration of Helsinki. 2018; Ref.:
  16. Meranius MS, Josefsson K. Health and social care management for older adults with multimorbidity: a multiperspective approach. Scand J Caring Sci. 2017; 31: 96-103. Ref.:
  17. Björkelund C, Maun A, Murante AM, Hoffman K, De Maeseneer J, et al. Impact of continuity on quality of primary care: From the perspective of citizens' preferences and multimorbidity-position paper of the European forum for primary care. Qual Prim Care. 2013; 21: 193–204. Ref.:
  18. Uijen AA, Schers HJ, Schellevis FG, van den Bosch WJ. How unique is continuity of care? A review of continuity and related concepts. Fam Pract. 2011; 29: 264–271. Ref.:
  19. Waibel S, Henao D, Aller MB, Vargas I, Vázquez ML. What do we know about patients' perceptions of continuity of care? A meta-synthesis of qualitative studies. Int J Qual Health Care. 2011; 24: 39–48. Ref.:
  20. Berglund H, Dunér A, Blomberg S, Kjellgren K. Care planning at home: a way to increase the influence of older people? Int J Integr Care. 2012; 12: 1-12. Ref.:
  21. Kajonius PJ, Kazemi A. Structure and process quality as predictors of satisfaction with elderly care. Health Soc Care Community. 2016; 24: 699–707. Ref.:
  22. Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centred participation in healthcare: A framework analysis. Nurs Ethics. 2014; 21: 129–147. Ref.:
  23. Vermunt NP, Westert GP, Olde Rikkert MG, Faber MJ. Assessment of goals and determinants across 11 countries. Scand J Prim Health Care. 2018; 36: 80-88. Ref.:
  24. Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, et al. Barriers and facilitators to the implementation of person‐centred care in different healthcare contexts. Scand J Caring Sci. 2017; 31: 662-673. Ref.:
  25. Themessl-Huber M, Hubbard G, Munro P. Frail older people's experiences and use of health and social care services. J Nurs Manag 2007; 15: 222-229. Ref.:
  26. de Carvalho A, Epping-Jordan J, Pot AM, Kelley E, Toro N, et al. Organizing integrated health-care services to meet older people’s needs. Bull World Health Organ. 2017; 95: 756-763. Ref.:
  27. Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C. et al. Healthy ageing and home: The perspectives of very old people in five European countries. Soc Sci Med. 2014; 106: 1–9. Ref.:
  28. Vamstad J. Exit, voice and indifference–older people as consumers of Swedish home care services. Ageing & Society. 2016; 36: 163–2181. Ref.:
  29. Wiles JL, Leibing A, Guberman N, Reeve J, Allen RE. The meaning of “aging in place” to older people. Gerontologist. 2012; 52: 357–366. Ref.:
  30. Esmaeili M, Cheraghi MA2, Salsali M. Cardiac patients' perception of patient‐centred care: a qualitative study. Nurs Crit Care. 2016; 21: 97-104. Ref.:
  31. Olsson T, Samuelsson U, Viscovi D. At risk of exclusion? Degrees of ICT access and literacy among senior citizens. Information, Communication & Society. 2019; 22: 55-72. Ref.:
  32. Levine DM, Lipsitz SR1, Linder JA. Trends in seniors’ use of digital health technology in the United States 2011-2014. JAMA. 2016; 316: 538–540. Ref.:
  33. Baxter K, Glendinning C. Making choices about support services: disabled adults’ and older people’s use of information. Health & Social Care in the Community. 2011; 19: 272-279. Ref.:
  34. Wahlstedt E, Ekman B. Patient choice, Internet-based information sources, and perceptions of health care: Evidence from Sweden using survey data from 2010 and 2013. BMC Health Serv Res. 2016; 16: 325. Ref.:
  35. Fjordside S, Morville A. Factors influencing older people′ s experiences of participation in autonomous decisions concerning their daily care in their own homes: A review of the literature. Int J Older People Nurs. 2016; 11: 284–297. Ref.:
  36. Ulin K, Olsson LE, Wolf A, Ekman I. Person-centred care–An approach that improves the discharge process. Eur J Cardiovasc Nurs. 2016; 15: e19-e26. Ref.:
  37. McCance T, McCormack B, Dewing J. An exploration of person-centredness in practice. Online J Issues Nurs. 2011; 16: 1. Ref.:
  38. Petersson P1, Springett J, Blomqvist K. Telling stories from everyday practice, an opportunity to see a bigger picture: A participatory action research project about developing discharge planning. Health Soc Care Community. 2009; 17: 548–556. Ref.:
  39. World Values Survey 2015. 2019; Ref.:
  40. Mair CA, Quiñones AR2, Pasha MA. Care preferences among middle-aged and older adults with chronic disease in Europe: Individual health care needs and national health care infrastructure. Gerontologist. 2015; 56: 687–701. Ref.: