Date of Award


Document Type

Master Thesis

Degree Name

Masters of Science (Research)


School of Health & Social Science

First Advisor

Dr. Anna-Maire Greaney

Second Advisor

Dr. Dawn Farrell


Background: Ireland has recently enacted the Assisted Decision-Making (Capacity) Act 2015. The enactment of the legislation has allowed Ireland to ratify the United Nations Convention on the Rights of People with Disabilities (2008). The convention obliges all member states to assist people with disabilities to make their own decisions, with their will and preference taking precedence over what others deem to be in their best interests. Implementation of this legislation requires a change in working practice among health and social care providers to promote autonomy and decision-making among service users. To date, this topic has not been researched in Ireland.

Aim: To explore the readiness of health and social care providers to implement the Assisted Decision-Making (Capacity) Act 2015 for adults with intellectual disability, with the objective of ascertaining the state of readiness and identifying facilitators and barriers to implementation.

Method: An exploratory, qualitative study viewed through a focused ethnographic lens and with an appreciative approach to inquiry was employed. A total of four focus groups were conducted with a purposeful sample of 32 frontline and management staff working in a service provider for adults with intellectual disability. Data was analysed using Ritchie and Spencer’s (1994) framework method. The study was guided by Blackman, O Flynn and Uygel’s (2013) multi-level readiness model as the conceptual framework.

Findings: Four themes were identified. Evidence of readiness. Enablers to assisted decision making. Barriers to assisted decision making, and ‘Finding balance and taking a chance’. Overall a moderate level of readiness was identified in the organisation. Facilitators and barriers were identified at individual and organisational level. Facilitators included ‘Effective communicating’, ‘You have to care’ and ‘Senior leader support’. Families and hospital healthcare colleagues were identified as barriers and require significant training on the Assisted Decision-Making (Capacity) Act 2015 to reduce the barriers at both levels. The underlying culture was found to be a facilitator and a barrier.

Conclusions: A paradigm shift has occurred regarding the promotion of personal autonomy and decision-making by this service provider. The study identifies a series of facilitators and barriers to implementation of the 2015 Act within a service for adults with intellectual disability. The findings will contribute to the understanding and implications of the complexities of implementing the Assisted Decision Making (Capacity) Act 2015 in Ireland to ensure basic human rights are realised.

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