The purpose of the study was to explore aspects of implementing an SDM intervention which featured an interactive digital decision tool, designed for patients with severe mental illness using community mental health services in Sweden. A process evaluation design was selected in order to investigate actual obstacles and possibilities for a structured intervention to facilitate participation in decision making. The design utilized in the study (Moore et al. 2015) included collecting data focused on three identified evaluation components; Context, Implementation and Mechanism of impact.

The results illustrate both facilitating factors and barriers to implementing SDM. Facilitating factors included staff assertions that SDM was most appropriate for formal decisions such as care planning, assessments and planning at admission and discharge from services. Another facilitating factor was the use of the digital decision tool, which enabled interactive communication between staff and users, thereby supporting the user to be informed and prepared in decisions.

A contextual barrier was found to be the lack of a common agenda for concretely increasing user participation in the program. SDM was rather a voluntary activity shaped by each staff member in accordance with his or her judgment, experience and attitude. Another barrier concerned the decision making capacity of both staff and users. While staff sometimes felt that they did not have formal power regarding treatment planning decisions, they also expressed doubt as to the patient's willingness and ability to participate in decisions. Confidence in patients' decision-making capacity and their ability to integrate information was generally low.