Bakgrund: Den personcentrerade vården är en strategi för att jämna ut patientens underläge som uppstår när hen besöker sjukvården. Vården ska vara individuellt anpassad och patienten ska respekteras för sina behov, och vården ska präglas av att patienten ska ses som människa och inte som den sjukdom hen bär. En personcentrerad miljö baseras på evidens, delaktighet och erfarenhet och patienten involveras genom sin livsberättelse avseende tidigare upplevelser och förväntningar på miljön. I denna miljö bedömer vårdgivaren vilka behov som finns hos personen. Det personcentrerade klimatet är den fysiska och psykosociala miljön där den personcentrerade vården bedrivs. Syfte: Syftet med denna studie var att undersöka personcentrerat klimat på en avdelning som bedriver högspecialiserad hjärtsjukvård.Metod: Kvantitativ design med enkätstudie. Patienterna tilldelades mätinstrumentet Person-centred Climate Questionaire – Patient version (PCQ-P). I studien ingick patienter vid Verksamhetsområde Thoraxkirurgi och Kärl vid Skånes Universitetssjukhus i Lund. De patienter som inkluderades hade genomgått hjärtkirurgi och vårdades postoperativt på Thoraxkirurgiavdelningen i Lund. Sammanlagt inkluderades 53 patienter i studien.Resultat: Det upplevda personcentrerade klimatet som helhet (maxpoäng för PCQ-P) visade ett resultat med medianvärdet 91,0 (maxpoäng 102).Medianvärdet för subdimensionen Climate of Safety var 58,0 (maxpoäng 60), för subdimensionen Climate of Everydayness 18,0 (maxpoäng 24), samt 16,0 för subdimensionen Climate of Hospitality (maxpoäng 18).Inga signifikanta skillnader kunde ses i upplevt personcentrerat klimat utifrån kön, vårdtid eller ålder.Slutsats: Personcentrerat klimat kan existera på en avdelning för högspecialiserad hjärtsjukvård och är en viktig förutsättning för att kunna ge en personcentrerad vård. Det är därmed också ett viktigt mått på patienternas nöjdhet med den vård de får. / Background: Person-centered care is directed towards the person with an illness and not the disease in the person. The care should be individually adapted, and the patient should be respected for his or her needs. A person-centered environment is based on evidence, participation and experience. The patient is involved through his or her life narrative, involving past experiences and expectations of the environment. In this environment, the healthcare provider performs an assessment of the needs of the person. The person-centered climate is the physical and psychosocial environment in which the person-centered care is conducted.Aim: The aim of this study was to investigate person-centered climate in a highly specialized toracic department.Design: A Cross-sectional study. Method: Quantitative design by a survey using the instrument Person-centred Climate Questionnaire – Patient version (PCQ-P). The patients were included after cardiac surgery and were hospitalized at the Transplant and Heart Department in Lund. A total of 53 patients were included in the study.Results: The perceived person-centered climate (total score for PCQ-P) showed a result of the median value of 91.0 (maximum score 102). The median value for the subdimension Climate of Safety was 58.0 (maximum score 60), for the subdimension Climate of Everydayness 16.0 (maximum score 24) and for subdimension Climate of Hospitality 16.0 (maximum score 18). No significant differences was found in perceived person-centered climate due to sex, hospital time or age.Conclusion: A person-centred climate is an important prerequisite for being able to provide a person-centred care, thus also an important measure of patient satisfaction with the care they receive.

Bakgrund: Hjärtsvikt är en vanligt förekommande kronisk sjukdom, som ökar runt om i världen i takt med att befolkningen blir äldre. Personen som drabbas måste lära sig att leva med och hantera sjukdomen, då det dagliga livet kommer att påverkas. Syfte: Att beskriva personers upplevelser av att leva med hjärtsvikt. Metod: Litteraturöversikt baserad på 12 stycken kvalitativa vetenskapliga artiklar. Data samlades in via Medline och CINAHL samt sekundärsökning. Dataanalys utfördes enligt Fribergs metod.  Resultat: Analysen resulterade i fem kategorier som beskriver personers upplevelser av att leva med hjärtsvikt; ett förändrat liv, känna trygghet och stöd, begränsningar i vardagslivet, osäker framtid och att vara beroende av vård.  Slutsats: Personer som lever med hjärtsvikt får en förändrad livssituation som påverkar dem fysiskt, psykiskt, socialt och existentiellt. Att personerna känner trygghet i sin vardag krävs för hantering av sjukdomen.  Kliniska implikationer: Sjuksköterskan ska informera och vägleda personen i sin sjukdom, samt hjälpa personen att hitta resurser för att klara av vardagen och sin livssituation. / Background: Heart failure is a common chronic disease, increasing around the world as the population gets older. The person who is affected must learn to live with and manage the disease, since the daily life will be affected.  Aim: To describe persons’ experiences of living with heart failure. Method: A literature study based on 12 scientific qualitative articles. Medline, CINAHL and secondary search was used to collect data. Fribergs analyze method was used to analyze the data.  Results: The analysis resulted in five categories that describe persons’ experiences of living with heart failure; a changed life, feeling secure and supported, limitations in daily life, uncertain future and being dependent on care. Conclusion: People living with heart failure have a changed life situation that affects them physically, mentally, socially and existentially. For these people to feel secure in their daily life it is required of them to cope with the disease. Clinical implications: The nurse must inform and guide the person in their illness, help the person find resources to cope with everyday life and their life situation.

Background: Dementia impairs cognitive functions, such as memory and speech, changing a person’s life forever. Providing person-centred care to these persons intend to retain their identities, dignity and autonomy. Such care demands time, devotion and good knowledge of the caring nurse. Dementia is expected to increase in the future and therefore nurses will have to face new challenges. Aim: To describe nurses’ experience of providing person-centred care for people with dementia. Method: A literature review of 15 articles, published between 2009-2016, that have been read and analysed through content-analysis. Results: Nurses experience a positive change in their attitudes, when providing person-centred care to people with dementia, as they gained better understanding of their patients’ dignity and integrity. Education, training and support from management were seen as key factors for providing up-to-date care. Time was viewed as a hindrance for person-centred care, and often led to nurses prioritizing other routines. Two common outcomes of person-centred care were increased satisfaction as well as emotional burnout. Conclusion: Since dementia is increasing and nurses find person-centred care time-consuming, there is a risk of such care becoming poor. To prevent this nurses need good leadership and education. / Bakgrund: Demenssjukdomar försämrar den kognitiva funktionen, så som minne och tal, vilket förändrar en persons liv för alltid. Att ge personcentrerad vård till dessa personer ämnar behålla deras identitet, värdighet och autonomi. En sådan typ av vård kräver tid, hängivenhet och god kunskap av den behandlande sjuksköterskan. I framtiden förväntas alltfler att insjukna i demenssjukdom och sjuksköterskan kommer därför att behöva möta nya utmaningar. Syfte: Att beskriva sjuksköterskans upplevelse av att ge personcentrerad vård till personer med demenssjukdom. Metod: En litteraturstudie där 15 artiklar, publicerade mellan 2009-2016, har blivit lästa och analyserade genom innehållsanalys. Resultat: Sjuksköterskor upplevde en positiv förändring i sin inställning när de gav personcentrerad vård till personer med demenssjukdom. Framförallt då de fick ökad förståelse för deras patienters värdighet och integritet. Utbildning, övning och stöd från ledningen sågs som nyckelfaktorer för att kunna ge aktuell vård. Tiden sågs som ett hinder för personcentrerad vård och ledde ofta till att sjuksköterskorna prioriterade andra rutiner. Två vanliga följder av vårdandet rapporterades vara såväl ökad tillfredsställelse som emotionell utmattning. Konklusion: Eftersom demenssjukdomar ökar och sjuksköterskor finner personcentrerad vård som tidskrävande, finns det en risk att sådan vård fallerar. För att förhindra detta behöver sjuksköterskor gott ledarskap och utbildning.

Sambandet mellan patienters förväntningar inför axeloperation och i vilken utsträckning dessa påverkar den upplevda nöjdheten är inte entydigt. Positiva förväntningar är viktiga samtidigt som orealistiskt höga förväntningar kan ge lägre patientnöjdhet. Uppföljning utifrån individens upplevelse är viktig för att följa resultat och öka patientnöjdheten i en personcentrerad vård. Syftet med denna studie var att redogöra för en grupp axelopererade patienters mål inför operation, måluppfyllelse efter ett år och undersöka eventuella samband mellan olika förväntningar och grad av måluppfyllelse. Syftet var också att beskriva upplevd livskvalitet före och ett år efter operation, korrelera skattad livskvalitet och måluppfyllelse efter ett år samt undersöka eventuella skillnader i skattade värden beroende på bakgrundsfaktorer. Metoden var en  korrelerande prospektiv registerbaserad studie. Huvudresultatet visade hög grad av patientnöjdhet både för skattad livskvalitet och uppfyllelse av personligt mål, sambandet mellan dessa värden var starkt. Smärtfrihet var den vanligaste förhoppningen. Signifikant samband mellan olika förväntningar och uppnått mål sågs i grupperna ¨återgå till arbete¨ och ¨smärtfri nattetid¨. Kvinnor skattade signifikant lägre värden än män före operation men ingen signifikant skillnad kan ses vid ettårsuppföljningen. Slutsatsen var att undersökningsgruppen inför operation hade höga förväntningar och att dessa i stor utsträckning uppnåtts. Likaså sågs tydlig ökning i skattad livskvalitet. Minskad smärta/smärtfrihet var tydligt den viktigaste förväntan inför operation. Denna utvärdering av patientens upplevelse av måluppfyllelse och livskvalitet kan ge återkoppling i arbetet för att stärka och utveckla en personcentrerad vård. / The correlation between the expectations before shoulder surgery and to which extent they affect patient satisfaction is not unambiguous. Positive expectations are important whilst unrealistic expectations could lead to reduced patient satisfaction. Follow up based on the experiences of the individual is important to follow results and increase patient satisfaction in a person centred care. The aim of this study was to narrate the preoperative goals and the fulfilment of these goals after one year for a group of patients who had undergone shoulder surgery and to investigate the eventual relationship between different expectations and degree of goal fulfilment. The aim was also to describe the perceived life quality before and one year after surgery, to correlate perceived life quality and goal fulfilment after one year and to examine eventual differences in assessed values due to demographic factors. The method was a correlative prospective register based study. The main result showed high degree of patient satisfaction for both assessed life quality and fulfilment of personal expectations, the correlation between these values where strong. Relief of pain was the most common expectation. Significant correlation between expectations and goal assessment where seen in the groups ¨return to work¨ and ¨relief of nocturnal pain¨. Women assessed significant lower values than men before operation but no significant differences where seen at the follow-up after one year. The conclusion was that the study population had high preoperative expectations and that these where fulfilled to a great extent. An explicit increase in perceived life quality was also seen. Relief or reduction of pain was clearly the most important expectation before surgery. This evaluation of patients’ sense of goal fulfilment and perceived life quality might give feed back in the work to strengthen and generate a person centred approach.

Aims: Acquired Brain Injury (ABI) is often researched from a reductionist perspective, focusing on pathology and dysfunction (Olney & Kim, 2001). More recently there has been a call towards taking a person-centred, global approach; questioning old ‘assumptions’ about what is currently known, and incorporating the views of the patient (Hill, 1999). This qualitative research study aimed to make a further contribution to the evidence-base by investigating the experience of adjusting to life after ABI. Method: Six participants, (two female, four male) aged 26-49, who had experienced a severe ABI an average of 31 months previously, were interviewed using a semistructured schedule. Interpretative Phenomenological Analysis (IPA) was employed to analyse the transcripts. Results: Five master themes emerged from the participants’ accounts: Experiencing a loss of control; Observed changes as a threat to identity; Being displaced by the injury: Feeling unchanged in a changed world; Attempts at managing a threatened identity, and Enable me don’t disable me: The role of support in recovery. Implications: Clinical implications were considered within Bronfenbrenner’s (1979, 2004) Ecological Systems Theoretical Framework. Within the Microsystems (the individual’s immediate systems such as their body, home and work) participants described a struggle to make sense of their perceived loss of control of their body and brain. They described the importance of making sense of these changes. Clinically there is a potential role for professionals to facilitate how people make sense of their experiences, perhaps moving away from reductionist explanations, which appeared to prevent participants from having hope to influence change. From a Macrosystemic level (the individual’s social, cultural and political systems) the participants felt they were less valued and as a result, judged by society and by political systems. Participants’ accounts suggested that they wanted to continue to contribute and be valuable in society. An implication therefore is for professionals involved to take more a political stance in influencing how we currently conceptualise people after brain injury, focusing on enablement rather than disablement.

Bakgrund: Demens är en av de stora folksjukdomarna och vårdpersonal möter dessa personer med demens både inom akutsjukvård och kommunal vård. På slutet av sitt liv bor de flesta personer som drabbats av demens på institution. Personcentrerad vård beskrivs vara gynnsamt i vården av personer med demens och personalens erfarenhet av detta har stor betydelse. Syfte: Syftet var att studera sjuksköterskors, enhetschefers och undersköterskors erfarenhet av personcentrerad omvårdnad inom kommunal hälso och sjukvård. Metod: Designen var en deskriptiv studie med kvalitativ ansats som har analyserats med hjälp av en induktiv innehållsanalys. Deltagarna som inkluderades i intervjustudien kom från samma kommun. Det var tio personer och bestod av fyra sjuksköterskor, fyra undersköterskor och två enhetschefer. De valdes ut av verksamhetschefen där inklusionskriteriet var att ha arbetat med personer med demens i minst fem år. Resultat: I resultatet framkom fyra kategorier och 12 subkategorier. Personcentrerad omvårdnad ansågs relevant i samband med god omvårdnad av personer med demens. I arbetet med personcentrerad vård var fokus att; anpassa sig till personen med demens, att se till dennes identitet och personlighet. Vidare lades vikt vid anhörigas deltagande, bemötande och ett gemensamt arbetssätt, vilket bestod av att identifiera behov och se personen bakom sjukdomen. Slutsats: Resultatet visade att de flesta intervjupersonerna hade liknande erfarenheter i att arbeta med personer med demens. Det framkom i studien att bemötandet hade stor betydelse i omvårdnaden. Fokus i personcentrerad omvårdnad var de redovisade kategorierna och dess innehåll och ansågs betydelsefull och nödvändig för att personer med demens får ett så bra och värdigt liv som möjligt efter sjukdomsdebuten. / Background: Dementia is one of the major diseases and health professionals encounter these people with dementia both in emergency care and municipal care. At the end of life most people affected by dementia live in institutions. Personcentered care is described to be beneficial in the care of people with dementia and staff's experience of this is of great importance. Purpose: The aim was to study nurses, unit managers and staff nurses' experience of person-centered care in local health care. Method: The design was a descriptive study with qualitative approach which has been analyzed by means of an inductive content analysis. Participants enrolled in the interview study came from the same municipality. There were ten people and consisted of four registered nurses, four enrolled nurses and two managers for the organization. They were chosen by business manager and had worked with people with dementia in at least five years Results: The result showed four categories and 12 subcategories. Personcentered care was considered relevant in the context of good nursing care of people with dementia. In the process of person-centered care was the focus to; adapt to the person with dementia, to ensure the identity and personality. Furthermore, it was stressed relatives' participation, treatment and a common approach, which consisted of identifying the needs and sees the person Conclusion: The results showed that most interviewees had similar experiences in working with people with dementia. It emerged from the study that the patient specific approach had positive outcomes when caring for a person with dementia. Person-centered care was considered very important and necessary to ensure that people with dementia have good and dignified life after being diagnosed with the disease.

Univerzita Karlova v Praze 1. léka ská fakulta Studijní program: Specializace v léka ství Studijní obor: Adiktologie Bc. Kate ina Sklená ová Francová ístup zam ený na lov ka (PCA) v psychoterapii závislostí: teoretická východiska, aplika ní možnosti a kompatibilita se sou asným systémem ambulantní pé e a jeho praxí. Person centred approach in psychotherapy of addiction: theoretical background, application possibilities and compatibility with the current system of outpatient care and practice. Diplomová práce Vedoucí práce: PhDr. Monika Nevoralová Praha, 2013 Abstrakt diplomové práce: Východiska: Mezi základní charakteristiky p ístupu zam eného na lov ka (PCA) ve vztahu klient- terapeut pat í mimo jiné pojmy bezpodmíne né p ijetí, empatie a autenticita. V minulosti se tento psychoterapeutický sm r nazýval nedirektivním. Dnes je tento název p ekonán pro jeho redukující edur ení, nicmén pojem nedirektivita by se dal ozna it jako další z jeho p ízna ných rys . Sou asný systém lé by a rehabilitace závislých v psychiatrických lé ebnách, terapeutických komunitách i ambulantních typech lé by je založen na kontrole, režimu, vedení, tvorb terapeutického plánu a jiných, zejména kognitivn -behaviorálních metod, které jsou v sou asné adiktologii "dominantní". Nabízí se proto otázka, zda PCA m že najít v adiktologii...

Background Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory. RT is often associated with unfamiliar procedures where the technical environment, side effects and interaction with staff seem to play a major role in the patient’s treatment experience. These experiences could sometimes lead to disruption of the treatment which may have negative consequences for the outcome. The overall aim of this thesis was to gain further knowledge about how patients experience RT and the related processes. Such knowledge is of vital importance when developing and improving care within a high-tech RT environment. Aim The overall aim of this thesis was to gain further knowledge about how patients experience RT and the related processes. Such knowledge is of vital importance when developing and improving care within a high-tech RT environment. Methods To gain further knowledge and understanding about patients experience of RT both quantitative (I, II, III) and qualitative (III, IV) methodology were used. The data in the thesis focused on patients undergoing external RT at different RT units in Sweden. Study I and II, focused on two regions, the northern region of Sweden and the region of Stockholm and Gotland.  Study III and IV were performed at eight different RT units in Sweden. Results In Study I, two types of topical agents (Calendula Weleda cream vs. Essex cream) were compared regarding reducing the risk of severe acute radiation skin reactions (ARSR). No difference in severe ARSR was found between the groups and the patients reported low levels of ARSR. In Study II, the influence of an RT unit’s psychosocial climate and treatment environment on cancer patients’ anxiety during external RT was evaluated. Data was collected (questionnaire) from 892 patients. The results showed that both the treatment environment and the psychosocial climate of the RT unit significantly impacted cancer patient anxiety levels. In Study III & IV, a questionnaire to measure the patient´s experience during external RT was developed and tested. The results showed that the RT Experience Questionnaire (RTEQ), with 23 items, was a tentatively valid and reliable instrument to measure how patients experience the RT process and the environment in the treatment room. In Study IV, written comments from the open-ended question “Is there anything else you want us to know?” in the preliminary RTEQ was analysed with qualitative content analysis. This data was abstracted into the following four major categories reflecting the experience of the RT process:  Experiences in the high tech RT environment; Understanding the RT procedures and side effects; Dealing with daily life during RT and The nurses’ role and performance. Conclusion The RT environment and the RT related processes seem to impact cancer patients, both physically and psychologically. A person-centered care approach, as well as attention to the design, both of the treatment process and the physical environment could significantly improve the patient experience and patient involvement. The results also highlight the importance of taking patient experiences into account when introducing new RT methods and techniques.

As relações interpessoais são discutidas em vários campos da enfermagem; na saúde mental e na psiquiátrica elas se desenvolvem como relações terapêuticas sendo abordadas como relação de ajuda ou relacionamento interpessoal. Na Abordagem Centrada na Pessoa as atitudes de consideração positiva incondicional, atitude empática e congruência são imprescindíveis para se desenvolver relações interpessoais terapêuticas promovendo nelas um clima de facilitação do crescimento e desenvolvimento do sujeito no cuidado. Na literatura brasileira de enfermagem não foram encontradas medidas de avaliação de tais atitudes embora se acredite que serão necessárias tanto no campo do cuidado quanto da educação. Através deste estudo, buscou-se desenvolver um instrumento de avaliação das relações interpessoais, abrangendo as três atitudes facilitadoras: consideração positiva incondicional, atitude empática e congruência e realizar a análise exploratória quanto à dimensionalidade e a fidedignidade do instrumento. O polo teórico envolveu a explicação dos construtos, a elaboração dos itens e as análises empíricas; o polo empírico relacionou-se a fase de experimentação do instrumento. Trata-se da escala de observação da interação enfermeiro-cliente constituída de itens positivos e reversos, tipo likert com cinco pontos. A consideração positiva incondicional ficou com 22 itens (15 reversos); a atitude empática compôs-se de 18 itens (2 reversos) e a congruência totalizou em 8 itens (2 reversos). Tais itens expressam o componente comportamental, verbal e motor de cada construto e foram indicados para o uso em situações de observação durante o cuidado. Optou-se pela filmagem das relações interpessoais desenvolvidas por 10 enfermeiros com 92 pessoas diagnosticadas com transtornos mentais durante consultas de enfermagem realizadas nas Estratégias de Saúde da Família de uma cidade do interior de Minas Gerais. No polo analítico, utilizou-se da análise fatorial (AF) e a consistência interna (coeficiente alfa de Cronbach) segundo referencial teórico-metodológico utilizado. O instrumento foi avaliado segundo modelo teórico apresentando alfa da escala global de 0,82, do atributo um (consideração positiva incondicional) 0,68, do atributo dois (atitude empática) 0,76 e do atributo três (congruência) 0,49. Devido à baixa consistência interna do atributo três em conformidade com os resultados das cargas fatoriais, analisou-se um modelo sugerido pela AF de 36 itens, o que se mostrou frágil em relação aos conceitos constitutivos e a operacionalização. Os melhores resultados apontaram para um instrumento composto de três subescalas. A escala global de consideração positiva incondicional apresentou alfa de 0,687, a escala de atitude empática teve escore global de 0,769 e a terceira de 0,517. Itens com cargas fatorais abaixo de 0,40 foram eliminados. Todos os coeficientes foram significativos com valor-p <0,01 e correlação significativa observada pelo coeficiente de Spearman. Consideram- se necessários ajustes no construto/atributo três, devido à fragilidade dos resultados, embora estejam dentro dos parâmetros considerados aceitáveis. O instrumento construído pode ser utilizado por profissionais que desejam avaliar as relações interpessoais no cuidado de enfermagem que tenha a finalidade de pesquisa ou didática. / The interpersonal relations are discussed in many nursing fields and in mental health or psychiatric nursing they develop themselves as therapeutic relations that are approached as help relations or interpersonal relationship. In the Person-Centred Approach, unconditional positive consideration attitudes, empathetic attitudes and congruence are indispensable to develop therapeutic interpersonal relations and to promote an environment of growing and development facilitation for the subject on care. In Brazilian nursing literature, evaluation measures for these attitudes were not found although one believes that they will be necessary so far as in care and education fields. Through this study, one had as an objective to develop an interpersonal relationship evaluation instrument that enfolds the three facilitating attitudes, unconditional positive consideration attitudes, empathetic attitudes and congruence, and to perform the exploratory analysis concerning the dimensionality and reliability of such an instrument. The theoretic pole involved the explanation of the constructs, elaboration of the items and empirical analysis; the empirical pole related to the experimentation phase of the instrument. It is a matter of nurse-customer interaction observation scale constituted of positive and reverse items like a Likert-scale with five points. The unconditional positive consideration stayed with 22 items (15 reverse); the empathetic attitude was composed of 18 items (2 reverse) and the congruence counted for 8 items (2 reverse). Such items express the behavioral, oral and motor component of each construct and were indicated for using in conditions of observation during care. One chose for recording the interpersonal relations developed by 10 nurses involving 92 subjects with mental-impaired patients during nursing inquiries performed in Family Health Strategies in an inland city of Minas Gerais. In the analytical pole one made use of the factorial analysis (FA) and the internal consistency (Cronbach\'s alpha-coefficient) according the used theoretic-methodological referential. The instrument evaluated concerning to the theoretical model presented an alpha-scale global outcome of 0.82, being 0.68 for attribute one (unconditional positive consideration), 0.76 for attribute two (empathetic attitude) and 0.49 for attribute three (congruence). Due to the low internal consistency of attribute three in relation to the factorial load results, one analyzed a model of 36 items suggested by FA that showed itself fragile in relation to constitutive concepts and operationalization. The best outcomes indicate a three-subscale instrument. The unconditional positive consideration global scale presented an alpha of 0.687, the empathetic attitude scale got a global score of 0.769, and congruence featured 0.517. Items with factorial load below 0.40 were eliminated. All coefficients were significant for p<0.01 and significant correlation confirmed by Spearman coefficient. Some adjustments are necessary for the third construct/item due to the fragility of the results, although they are within acceptable parameters. The instrument so developed can be used by professionals who wish to evaluate the interpersonal relations in nursing care with research or didactic purpose.

Aims. The aim of this study was to explore the effects of the health consultation experience for people with learning disabilities, particularly in terms of their self-concept Background. Annual health checks have been introduced as a reasonable adjustment for health providers to make in meeting the needs of people with learning disabilities, who experience significantly poorer health outcomes than the general population. Evaluation of the health consultation from the service user perspective can inform this service provision. Design. A constructivist grounded theory approach, based on symbolic interactionism, was used to explore the meaning of the health consultation experience for the person with learning disabilities, and its effects on their sense of self. Methods. Purposive and snowballing sampling was used to recruit 25 participants with learning disabilities through a GP practice, self-advocacy groups and a health facilitator. Nine individual interviews, three interviews with two participants, three focus groups (n=7, n=5 and n=3), and an audio-recorded health check consultation were carried out (with two participants interviewed twice and four attending two focus groups), as well as a member check used to assess the resonance of the findings. Data collection was undertaken in different primary care trusts across the north west of England. Data were subjected to constant comparative analysis, using a symbolic interactionist approach, to explore all aspects of the health consultation experience and its effects on the self. Findings. Current expectations, attitudes and feelings about health consultations were strongly influenced by previous experience. Participants negotiated their own reality within the consultation, which affected their self-concept and engagement with their health care. Respectful and secure health professional – service user relationships, developed over time, were central to an effective consultation. Perspectives on the consultation, and engagement within it, were co-constructed with a companion, who could help to promote the personhood of the service user with support from the health professional. Anxiety, embarrassment and felt stigma were identified as significant barriers to communication and engagement within the consultation. Conclusions. People with learning disabilities have similar health consultation needs and expectations to other people, but may have more difficulties in engaging with the process and building trusting relationships with the health professional, due to previous negative experiences, anticipated stigma and loss of self within health settings leading to a fear of disclosure. This, combined with difficulties in communication and cognitive processing, results in less satisfactory outcomes persisting over time. The effects of triadic consultations are generally positive, particularly where relatives or health facilitators are involved. However, continuity of companion as well as health professional is needed, and more service user engagement should be supported. Fundamental attitude change by health professionals, supported by specific educational initiatives to enhance their understanding of the service user perspective, is needed to reduce health inequalities. Participatory research by people with learning disabilities should inform future health care practice.