User-focused monitoring (UFM) is a method for fostering user involvement at organizational levels in the evaluation and quality development of mental health service and support programs. To enhance understanding of factors that promote or hinder the implementation of UFM, we have purposely sampled and followed five Swedish UFM projects through a case study approach, paying specific attention to key components for its sustainable implementation. We collected empirical data through interviews with involved actors during a start-up phase and shortly after the UFM projects ended, and examination of UFM reports. The acquired data were subjected to directed content analysis, guided by normalization process theory. The results highlight the importance of coherence in the goals and methodological procedures for promoting implementation of UFM projects, as well as activation of the engagement of both service users and staff in initial stages.