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User involvement is increasingly the focus reforms of the health care system in the Nordic countries, and may be expected to change the authority and knowledge hierarchies in the care work. User involvement, however, is a broad concept and may be based on ideas of democratization as well as efficiency, redistribution of tasks and user accountability. In this article, we explore how user involvement is practiced in two major areas, psychiatry and COPD, where very different ideas of user involvement are prevalent. Psychiatry is characterized by strong user movements aiming at democratization, while, in the field of COPD, logics of efficiency and accountability are dominant. The article is based on exploratory field studies carried out as part of a larger research project, focusing on methods based on co-production and integrating the users' own knowledge, assessment and perspectives. The article shows how relationships between professionals and users are transformed. It also underline how new forms of knowledge gain momentum, but in ways that raise dilemmas and challenges to the professionals. Finally, we discuss potentials for new spaces for care to emerge, spaces which in a different way are open to participation and everyday life perspectives, but also offer challenges.

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