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Trust in intersectoral integrated services: a qualitative investigation of stakeholder-perspectives in the establishment of trust between professionals and service users


Rie Mandrup Poulsen

Mental Health Center Copenhagen, DK
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Trust between stakeholders is a key value in integrated and inter-organizational service delivery, e.g. because of the lack of formal agreements and inter-organizational hierarchies, and the introduction of new professional roles. However, few empirical studies have described the development of trust between micro-level stakeholders. This study investigates the challenges and the strategies used in the establishment of trust between stakeholders in an inter-organizational intervention: service users on sick leave due to common mental disorders, professionals from mental health care (MHC) centers, and employment consultants from Jobcenters (public sickness benefit insurance organs) who were the public authorities managing the service users benefit cases.


The study is nested within a process evaluation study of an integrated intervention designed to enhance person-centered services and coherence between MHC and vocational rehabilitation services in Denmark. We reused observations of roundtable meetings between stakeholders (n=12), and semi-structured interviews with service users (n=17), MHC professionals (n=12), employment consultants (n=12), and supervisors from both organizations who described the contextual influence on the three stakeholders (n=8). Perceptions and displays of trust amongst the stakeholder-groups were investigated separately using content analysis. 


Service users and MHC professionals expressed that service user’s individual trust in the professionals was particularly important for the service user’s openness towards professionals about mental problems and personal wishes. Diverging interests of the service user and the Jobcenter, diverging professional practices regarding service user’s vulnerability, and a general distrust in the Jobcenter-organization challenged the development of trust between the stakeholders. Strategies to develop service users trust in professionals included: Time to establish relations, MHC professional’s systematic sensitivity towards service user’s vulnerability and both professional’s display of sharing interests with the service user. Strategies to develop trust between professionals included time to establish relations, employment consultants displays of genuine wish to support service users, and MHC professional’s accept of Jobcenter interests. However, some MHC professionals counteracted knowledge-sharing between professionals when nurturing trust-based relationships with service users.


This study supports previous research suggesting that trust between service users and professionals is critical for the delivery of person-centered, integrated services and adds that trust might be perceived and managed differently by different stakeholders. Service user’s perceived need for individual trust in professionals calls for reflection about the employment consultant’s possibility to meet this need whilst supporting the Jobcenters’ interests.


Trust between service users and professionals was often developed in the integrated intervention and supported the person-centered intervention according to service users.

Lessons learned

Trust is important, yet potentially difficult to establish, in inter-organizational integrated services where professionals have authority over the service user, and when sensitive information about the service user is created in dyadic relationships with one professional and shared across organizations.


The empirical material was reused from a process evaluation study that was originally designed to investigate inter-organizational roundtable meetings without a specific focus on trust.

Suggestions for future research

Quantitative studies illuminating the effect of trust between service users and professionals on health and work outcomes in integrated services may be valuable.

How to Cite: Poulsen RM. Trust in intersectoral integrated services: a qualitative investigation of stakeholder-perspectives in the establishment of trust between professionals and service users. International Journal of Integrated Care. 2021;21(S1):106. DOI:
Published on 01 Sep 2021.


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