Information versus experience: a comparison of an information leaflet on antidepressants with lay experience of treatment

Do anxiety websites have the answers people are looking for?

OBJECTIVES AND METHODS: A wealth of online anxiety information exists but much of it is not evidence-based or well-balanced. This study evaluated anxiety websites (N = 20) on readability, quality, usability, visual design, and content.

RESULTS

Overall, websites were of reasonable quality but only half were considered understandable according to the PEMAT usability scale (70% cutoff value). The average reading level across websites was 11.2 (SMOG), which is higher than NIH recommended grade 6-7 level. Websites had variable design features and a trending association suggested websites with better design come up earlier in search results. The number of topics covered varied across websites and most did not adequately cover all topics of interest. Most websites included information about psychological and self-help treatments, how treatment works, and what treatment entails. The Top 5 websites were: (1) Anxiety BC, (2) ADAA, (3) Mind, (4) Beyond Blue, and (5) Web MD.

CONCLUSIONS

This is the first study to evaluate existing anxiety information websites based on the dimensions described above and their relationship to Google search results.

PRACTICE IMPLICATIONS

This study highlights the importance of considering several dimensions in developing mental health resources and provides direction for strategies to improve existing websites and/or develop new resources.

Resisting psychotropic medicines: a synthesis of qualitative studies of medicine-taking

This article reports the results of a synthesis of qualitative research articles about lay perspectives on prescribed psychotropic medicines. It updates and elaborates on a model of medicine-taking developed by Pound and colleagues. In this model, the concept of resistance refers to the various ways in which people take prescribed medicines while trying to minimise their intake. The synthesis included 12 papers published since 1992. The findings are presented at the societal level, in terms of the social meanings of mental health problems and medication, and at the individual level; the latter covers active engagement and lay evaluation, as well as the outcomes of evaluation, including the doctor–patient relationship. Although it can be difficult to achieve in the current clinical environment, there is much scope for developing more concordant relationships with patients in relation to prescribing and using psychotropic medicines.

Playing With Antidepressants: Perspectives From Indian Australians and Anglo-Australians Living With Depression

Patient perspectives were explored on the meaning and experience of antidepressant use by applying Johan Huizinga's theory of play to interviews from Indian Australians and Anglo-Australians diagnosed with depression. Through the analysis, the centrality of Huizinga's "magic circle" emerged, that is, defining the boundaries within which one could safely play. Consumption of antidepressants involved learning, breaking, and modulating rules of the game of adherence, then forging a new "magic circle." In these games, there were playful elements including experimentation, improvisation, absorption, and experiential learning. This application of Huizinga's theory in relation to antidepressant use is a novel approach in the literature on medication non/adherence. This application not only opens a new theoretical line of inquiry but also shows that antidepressant non/adherence is not a static practice but dynamic and changing, revealing critical insights around participant's agency, capabilities, desires, and notions of selfhood with regard to managing their depression and conceptualizing their recovery.

A simple education tool for ventricular assist device patients and their caregivers

BACKGROUND

Ventricular assist devices (VADs) have become an important therapy in the management of patients with end-stage heart failure. Driveline infection is the most common late-onset complication in this group of patients. Patients and their caregivers require education regarding management of the driveline to reduce the risk of infection when they are discharged home with a VAD.

PURPOSE

The aim of this study was to develop an educational booklet on VAD driveline care for patients and their caregivers. A literature review was undertaken to explore the availability of patient education material pertaining to driveline management and to update evidence-informed knowledge that could potentially reduce infection rates in these patients. This information was evaluated by peers, patients, and caregivers to produce the final colored booklet.

CONCLUSIONS

Driveline care is not comprehensively discussed in the literature and lacks detail in the particulars of wound care, patient education, and the adaptation of driveline care to the patient's home environment. An educational booklet was designed to convey what is currently known about preventing driveline infections to those who are responsible for providing the required daily care. Evaluation of patient education material by those using the material is essential. As with all written material, the information will require updating as new evidence becomes available.

CLINICAL IMPLICATIONS

Managing driveline infection risk for patients at home with extended therapy is a critical nursing issue in improving morbidity and mortality. After VAD implantation, patients and caregivers must be educated about the ongoing care of the driveline exit site to minimize the risk of infection. A rigorously developed and patient-evaluated educational booklet on driveline exit site care can be a valuable reference tool for patients and caregivers after hospital discharge.

Pakistani children's experiences of growing up with beta-thalassemia major

In this study, we explored the lived experiences of children with beta-thalassemia major (β-TM). We considered children as experts on their experiences in contrast to the prevalent approach of asking parents or other adults about children's perspectives. The sample consisted of 12 children aged 8 to12 years. There were two stages to data collection. In Stage 1 we employed two focus group discussions and two role plays and analyzed the data thematically. This directly informed Stage 2, consisting of 12 in-depth interviews subjected to interpretative phenomenological analysis. From our findings we show that living with β-TM involves a continuous struggle between feelings of being different and strategies to minimize these differences to strive for normalcy. We suggest that understanding the experiences of living with β-TM from children's perspectives can provide unique insights into their experiences, which can fill the gap in the existing, predominantly adult-oriented research on chronic illness.

Acceptability of a 'guidebook' for the management of Osteoarthritis: a qualitative study of patient and clinician's perspectives

BACKGROUND

Written information can be of benefit to both practitioners and patients and the provision of quality information is emphasised as a core intervention by United Kingdom National Institute of Clinical Excellence (NICE) OA guidelines. Researchers, patients and HCPs developed an 'OA guidebook' to provide; a) a balanced source of information for patients; b) a resource to aid practitioners when discussing self-management. This study aimed to evaluate the acceptability and usefulness of the OA guidebook as part of complex intervention to deliver NICE OA guidelines in General Practice.

METHODS

The intervention comprises a series of consultations with GPs and practice nurses in which supported self-management is offered to patients. Eight practices in the West Midlands and North West of England were recruited to take part: four control practices and four intervention practices. Semi-structured interviews were undertaken with patients (n = 29), GPs (n = 9) and practice nurses (n = 4) from the intervention practices to explore experiences of the intervention and use of the guidebook. Data were analysed using thematic analysis and constant comparison of data within and across interviews.

RESULTS

GPs thought the guidebook helped provide patients with information about OA aetiology, prognosis and self-management. Thus, it backed up key messages they provided patients during consultations. GPs also found the guidebook helped them 'close off' consultations. Nurses also thought the guidebook helped them describe OA disease processes in consultations. Patients valued the explanations of disease onset, process and prognosis. The use of 'real' people and 'real life' situations contained within the guidebook made self-management strategies seem more tangible. A sense of inclusion and comfort was obtained from knowing other people encountered similar problems and feelings.

CONCLUSION

An OA specific written information guidebook was deemed acceptable and useful to practitioners and patients alike as part of the MOSAICS study. Findings reinforce the utility of this model of patient information as a resource to support patients living with chronic illnesses. An OA guidebook featuring a mixture of lay and professional information developed by professionals and lay people is useful and could effectively be used more widely in usual care.

Cultural variations in interpretation of postnatal illness: Jinn possession amongst Muslim communities

Maternal experience of emotional and physical disturbance during the postnatal period is a worldwide occurrence but may be interpreted differently according to cultural background. Little is known about different expressions and treatment of cultural phenomena during the postnatal period such as the affliction of Jinn possession in Arabic cultures. Jinn are considered to be evil spirits, which cause emotional and physical distress at times of vulnerability such as the postnatal period. The aim of this paper was to explore maternal experience of Jinn possession and draw parallels with Western interpretations of postnatal illness. Ten women in an Arabian Gulf state who had recently given birth and identified themselves as having Jinn possession were interviewed as to their experiences of Jinn possession. Mothers described the Jinn as evil spirits who cause symptoms such as sadness, anxiety and physical malaise during the postnatal period. Numerous risk factors for possession emerged such as lack of familial support, poverty and a traumatic birth. Clear parallels emerged between Western concepts of postnatal illness and Jinn possession. Mothers in Muslim cultures may experience Jinn possession during the postnatal period, which reflects similar symptoms and aetiology to Western concepts of postnatal illness. With increasing multiculturalism in the UK, understanding the origins and perception of Jinn possession is important for health professionals working in Muslim communities here.

Patient experiences of taking antidepressants for depression: a secondary qualitative analysis

BACKGROUND

Depression is one of the most commonly encountered mental health problems leading to significant morbidity and mortality and high medical and societal costs. Antidepressant prescribing in the UK has more than doubled in the last decade. There are a variety of factors that have been shown to affect a patient's experience of taking antidepressants The aim of this research was to explore patient narratives interviews about depression and its treatment in order to improve patient and health professional understanding of what it is like to use antidepressants.

METHODS

This study involved a supplementary secondary qualitative analysis of 80 in-depth narrative interviews from Healthtalkonline. Patients' experiences of using medicines for depression were explored in the context of their social, occupational and emotional impact, to identify any additional issues and to clarify what type of information people want to find after being prescribed a medicine. The interviews were conducted by the University of Oxford and had received ethical approval and been consented and copyrighted for this purpose. Data were analyzed thematically.

RESULTS

The most prominent theme was the coexistence of several conflicting issues around the use of medicines and participants were mostly influenced by the reality of their experiences, beliefs, attitudes and interaction with health care. Antidepressants appear to occupy a central place in many people' lives. Many people described how their medicines had helped them and how this served as a reinforcement to continue taking them in order to maintain a "normal life." Those who had stopped taking their antidepressants were likely to have experienced adverse reactions and had unsatisfactory interactions with health care professionals. A lack of information about antidepressants was a major cause of dissatisfaction often shaping attitudes to antidepressants'.

CONCLUSIONS

People's experiences with antidepressant use have a major impact on treatment continuation and hence treatment outcomes. Further studies are needed on depressed patients' beliefs about their depression and treatment and how they relate to different stages of illness, their interactions with health care and their adherence to antidepressants.

What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews

OBJECTIVE

To understand patients' perceptions of decision making and identify relationships among decision-making models.

METHODS

This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory.

RESULTS

Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making.

CONCLUSION AND PRACTICE IMPLICATIONS

In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices.

Developing written information on osteoarthritis for patients: facilitating user involvement by exposure to qualitative research

INTRODUCTION

In developing a guidebook on osteoarthritis (OA), we collaborated with people who have chronic joint pain (users). But to advise, users need to be aware of and sensitive about their own state of knowledge and educationalists argue that adults sometimes lack such awareness. This paper will report on our experience of providing users with findings from qualitative research to increase awareness of their level of knowledge.

METHOD

A summary of the results from qualitative research into people's experiences of living with chronic pain was sent to individual members of two groups of users. It was then used to structure group meetings held to help identify information needed for the guidebook.

FINDINGS

Some users found the summary difficult to read and suggested how to simplify it. Nevertheless, it helped most users to become aware of the experiences and views of others who have OA and thus become more sensitive to their own level of knowledge. It also helped them recall experiences that stimulated practical suggestions for managing joint pain in everyday life and provided a way of gently challenging the views of users when they appeared to assume that their views were widely held. The discussions brought to light gaps in the research literature.

CONCLUSION

We believe this way of involving users by exposing them to qualitative research findings about lay experiences of living with OA effectively facilitated the users' contributions to the needs of those who have to live with OA, and we believe it has wider applications.

Perceptions of and attitudes toward antidepressants: stigma attached to their use--a review

The aim of this study was to ascertain whether there is any evidence of stigma related to the use of antidepressants. Using the PubMed and MEDLINE databases, we searched for the terms stigma, antidepressants, and depression. A protocol was developed to extract information from the papers, which were identified and explored further. Thirty-two papers were identified. We found that the stigma against depression differs from stigma against the use of antidepressants. Stigma against depression does not impact on therapeutic adherence to antidepressant use. Stigma related to antidepressant use appears to be linked with perceived emotional weakness, severity of illness, an inability to deal with problems, and a lack of belief in the therapeutic efficacy of antidepressants. Stigma against medication can be a useful target for interventions, just like the stigma related to depression. However, clinicians must be careful in avoiding the medicalization of symptoms.

Psychoeducational methods for patients suffering from depression: the knowledge seeking instrument (KSI)

OBJECTIVE

To develop and psychometrically assess a short instrument that can be easily used in clinical practice to measure knowledge-seeking behavior in patients suffering from depression.

METHOD

We developed the knowledge seeking instrument (KSI), a self-report scale of three items to assess the number of hours spent in knowledge seeking behavior such as reading written materials, surfing the internet, or watching audio-visual tools. Experts in mood disorders (n=12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to outpatients who were attending psychiatry clinic (n=63). All patients also completed a multiple choice question instrument to measure knowledge of depression, a Likert self report questionnaire to assess attitudes towards depression and its treatment, and an adherence to antidepressants scale.

RESULTS

In addition to the empirical evidence for validity, there was 68% agreement among experts that the items were highly relevant in measuring behavior of knowledge seeking, providing evidence for content validity. There were significant correlations (p<0.05) between knowledge of psychological and biological treatments of depression and knowledge seeking reading scores. The internal consistency reliability (Cronbach's alpha) was 0.67 for the instrument.

CONCLUSION AND SIGNIFICANCE

The KSI takes 2 min to complete. There is evidence for reliability, content, and criterion based concurrent validities. The KSI can be utilized to assess knowledge seeking behavior in patients with depression.

The decision to continue or discontinue treatment: experiences and beliefs of users of selective serotonin-reuptake inhibitors in the initial months--a qualitative study

BACKGROUND

Little is known about patients' views on taking selective serotonin-reuptake inhibitors (SSRIs) and their decision-making processes regarding either continuation or discontinuation within a few months of initiating therapy.

OBJECTIVE

To explore the experiences and beliefs of SSRI users in relation to initiation and execution of treatment, with the intention to identify patterns leading to discontinuation or continuation of treatment.

METHODS

Semistructured qualitative interview study. Eighteen patients, older than 18 years, were interviewed 3 months after starting SSRI treatment prescribed by a general practitioner (GP), 9 of whom had discontinued (discontinuers) and 9 of whom continued treatment (continuers).

RESULTS

Two main patterns lead to either discontinuation or continuation of use. Continuers were satisfied with the GP's role during initiation and execution of SSRI treatment and fully trusted their decision. Continuers' attitudes toward treatment were predominantly positive; they seemed to have little doubt about the necessity of using an SSRI and hardly considered discontinuing for fear of relapse. Discontinuers, on the other hand, seemed to be less involved in decision making and often appeared to have little confidence in their GPs. Most discontinuers felt that they lacked knowledge, and their attitude toward taking SSRIs was rather negative. Discontinuers often were unconvinced about the necessity of using an SSRI and appeared to have a strong desire to discontinue treatment.

CONCLUSION

Lack of shared decision making between patient and GP, limited counseling during treatment, lack of knowledge, and patients' negative attitudes toward SSRI use and the disease itself, hampered the acceptance of the SSRI and brought on the decisional conflict to discontinue treatment. Health care professionals could be more supportive during the initial months of SSRI treatment by eliciting patients' considerations for continuing or discontinuing treatment.

Women's accounts of their decision to quit taking antidepressants

Over the past 15 years, the rates at which antidepressants are prescribed have increased dramatically. Adherence, however, is often low and considered to be problematic. Using a discursive approach to analyzing interviews with six Canadian women who chose unilaterally to discontinue their use of antidepressants, we focus on three rhetorical strategies used to justify their actions: (a) referencing the actual or potential effects of antidepressants, (b) positioning lay knowledge as superior to expert medical knowledge, and (c) denigrating medical authorities. We argue that these women drew on the responsible-use-of-drugs framework as a way of positioning themselves against potential charges of having engaged in an irrational act.

"There are always two sides to these things": managing the dilemma of serious adverse effects from SSRIs

Over the past two decades, evidence and regulatory responses have surfaced regarding associations between selective serotonin reuptake inhibitors (SSRIs) and serious adverse effects, especially akathisia, aggression and suicidality. Given increasing concern about depression prevalence and harm, the dominance of biomedical approaches, and the normalisation of antidepressant use, reports about the potential for serious adverse effects from SSRIs present a dilemma for people working in depression intervention: the drugs are linked to "two conflicting claims" that they may either decrease or increase harm. We present data from in-depth semi-structured interviews with nine professionals in New Zealand working in fields relating to depression and supportive of SSRIs, to investigate the negotiation of this dilemma. We analysed participants' talk about akathisia, aggression and suicidality associated with SSRIs, and found the use of rhetorical strategies that minimised the significance of risks, countered risks with notions of benefit and/or questioned the validity of risks. These discursive resources provided ways of mitigating the dilemma otherwise posed by evidence of adverse drug effects. However in doing so they referenced notions of SSRI benefit that relied upon assumptions about the efficacy of the drugs, risks of untreated depression, and the impact of adverse effects. Overall, our analysis highlights ways in which evidence of serious adverse effects from SSRIs can be rhetorically contained and undermined.

Patients' perceptions of information received at the start of selective serotonin-reuptake inhibitor treatment: implications for community pharmacy

BACKGROUND

Pharmacists are increasingly acknowledging their responsibility to inform and counsel patients. However, it is unclear how these tasks are implemented and whether patients' needs are being fulfilled.

OBJECTIVE

To examine patients' perceptions of information received at the start of selective serotonin-reuptake inhibitor (SSRI) treatment, aiming to identify (1) information needs and (2) the potential role of the community pharmacist as information provider.

METHODS

A qualitative descriptive study comprising semi-structured telephone interviews was carried out with patients who had recently started a new course of SSRI treatment. Patients were recruited through 6 Dutch community pharmacies. The interviews were guided by the following topics: type of information obtained, unmet information needs, preferred information provider, and the role of the pharmacist.

RESULTS

Forty-one patients took part in an interview. Information needs varied widely among patients; overall, patients felt that they would benefit from information tailored to their needs. Many patients required more concrete and practical information on adverse effects and delayed onset of action than was provided. In addition, an explanation of the term dependency in the context of SSRI use and a discussion of the necessity for use and believed harms of long-term treatment were important to patients. Regardless of patients' needs, the role of the pharmacist was generally perceived as limited, and patients identified several pharmacy-related barriers to improved communication, including the timing of information (mainly restricted to first-time dispensing), lack of time and privacy, lack of empathy and a protocol-driven way of providing information, and inexperience of pharmacy technicians.

CONCLUSIONS

Patients starting treatment with antidepressants may benefit from information tailored to their personal needs. Along with the prescribing physician, community pharmacists could have an important role in informing and counseling patients.

"Medication career" or "moral career"? The two sides of managing antidepressants: a meta-ethnography of patients' experience of antidepressants

The UK National Institute for Clinical Excellence (NICE) Clinical Guidelines recommend routine prescription of antidepressants for moderate to severe depression. While many patients accept a prescription, one in three do not complete treatment. We carried out a meta-ethnography of published qualitative papers since 1990 whose focus is patients' experience of antidepressant use for depression, in order to understand barriers and facilitators to concordance and inform a larger qualitative study investigating antidepressant use over time. A systematic search of five databases was carried out, supported by hand searches of key journals, writing to first authors and examining reference lists. After piloting three critical appraisal tools, a modified version of the CASP (Critical Appraisal Skills Programme) checklist was used to appraise potentially relevant and qualitative papers. We carried out a synthesis using techniques of meta-ethnography involving translation and re-interpretation. Sixteen papers were included in the meta-ethnography. The papers fall into two related groups: (1) Papers whose focus is the decision-making relationship and the ways patients manage their use of antidepressants, and (2) Papers whose focus is antidepressants' effect on self-concept, ideas of stigma and its management. We found that patients' experience of antidepressants is characterised by the decision-making process and the meaning-making process, conceptualised here as the 'medication career' and 'moral career'. Our synthesis indicates ways in which general practitioners (GPs) can facilitate concordant relationships with patients regarding antidepressant use. First, GPs can enhance the potential for shared decision-making by reviewing patients' changing preferences for involvement in decision-making regularly throughout the patient's 'medication career'. Second, if GPs familiarise themselves with the competing demands that patients may experience at each decision-making juncture, they will be better placed to explore their patients' preferences and concerns--i.e. their 'moral career' of medication use. This may lead to valuable discussion of what taking antidepressants means for patients' sense of self and how their treatment decisions may be influenced by a felt sense of stigma.

The role and value of written information for patients about individual medicines: a systematic review

OBJECTIVE

To review research on the role and value of written medicines information for patients from the perspective of patients and health professionals.

CONTEXT

Providing written information to patients about their medicines is acknowledged as a priority but there is poor understanding of how best to meet patients' needs.

METHOD

A sensitive search strategy was developed to maximize the identification of relevant studies. We used a data extraction form designed to appraise qualitative research. Findings were synthesized into a narrative account.

MAIN RESULTS

There were three broad categories of study: those which related to policy initiatives; those where the aim was to increase compliance; and those concerned with using information to support decision-making ('informed patient' studies). While the policy initiative and compliance studies reported that, mostly, patients were positive about written information, the 'informed patient' studies showed a more complex picture. Patients valued medicines information tailored to their condition. They did not want it to be a substitute for spoken information from their doctor. Not everyone wanted written information but those who did wanted sufficient detail to meet their need. Need varied over time and between patients. The small number of studies relating to health professionals showed widespread ambivalence towards using written information. Some thought it should be brief and simple, only partially disclose side-effects and saw its main role as being to increase compliance.

CONCLUSION

The different perspectives of patients and health professionals, and the diverse and changing information needs of patients pose a challenge to providers of written medicines information.

Guided self-help in primary care mental health: meta-synthesis of qualitative studies of patient experience

BACKGROUND

There is a gap between the supply of trained cognitive-behavioural therapists to treat depression and demand for care in the community. There is interest in the potential of self-help interventions, which require less input from a therapist. However, the design of effective self-help interventions is complex. Qualitative research can help to explore some of this complexity.

AIMS

The study aimed to identify qualitative studies of patient experience of depression management in primary care, synthesise these studies to develop an explanatory framework, and then apply this framework to the development of a guided self-help intervention for depression.

METHOD

A meta-synthesis was conducted of published qualitative research.

RESULTS

The synthesis revealed a number of themes, including the nature of personal experience in depression; help-seeking in primary care; control and helplessness in engagement with treatment; stigma associated with treatment; and patients' understandings of self-help interventions.

CONCLUSIONS

This meta-synthesis of qualitative studies provided a useful explanatory framework for the development of effective and acceptable guided self-help interventions for depression.

Agency and dependency within treatment: Drug treatment clients negotiating methadone and antidepressants

This paper explores how drug treatment clients exercise agency while finding their ability to act curtailed by the strictures of treatment itself. Drawing on qualitative interviews with 77 male and female drug treatment clients collected in an Australian study of drug treatment and mental health, the experience of methadone maintenance treatment (MMT) and that of commonly prescribed medications for depression (antidepressants) are examined. The ways that clients engage with MMT and antidepressants are detailed, illustrating how both types of treatment can make clients feel dependent, but can also motivate clients to modify their treatment regimens. These modifications are "tactical" responses generated within the constraints of treatment regulations and can also be against clinical recommendations e.g. stopping treatment. Rather than seeing this as "non-compliance", it is suggested that the negotiation of treatment is an inevitable response of clients trying to adapt to imperfect treatment conditions, who may have understandable anxieties about taking medication. The ways in which treatment providers might better acknowledge the capacities of MMT clients to engage with or modify treatment are discussed, as is the need to acknowledge drug treatment clients' anxieties about dependency and pharmaceutical drugs.

Attributing recovery from depression. Perceptions of people cared for in primary care

AIMS AND OBJECTIVES

The aim of the study was to understand how people treated for depression in primary care perceived the care they received. The focus was specifically on ascertaining their perceptions of what had helped during their treatment, their understanding of the factors to which they attributed their recovery, and their reflections on their experience of depression.

BACKGROUND

Although knowledge of the factors that promote recovery from depression is growing, personal accounts of attributions of recovery are largely absent from the literature. Identifying and understanding people's accounts of their recovery is particularly important for practitioners involved in medication management and prescribing.

METHOD

A purposeful sample of 60 people who had accessed primary care and been prescribed medication because of depressive symptoms was interviewed using a semistructured approach. Interviews explored people's experiences of accessing and using primary care, their assessments of care offered, experiences of medication management and their attributions of recovery.

RESULTS

Recovery from depression was characterized by its multifactorial nature, and two-thirds of the participants felt that medication had contributed to their recovery. Factors in recovery changed with the passage of time and many perceived personal strengths as important to recovery. Practitioners who acknowledged and encouraged people's roles in recovery and supported multifaceted care were perceived by users as caring and offering holistic, individualized care.

CONCLUSION

People with depression are keen to regard their recovery as multifactorial and to have their own roles in recovery acknowledged. Preferences for a 'portfolio' of care, the components of which change as recovery progresses, were evident.

RELEVANCE TO CLINICAL PRACTICE

Practitioners involved in prescribing and medication management for depression must aim to explore patients' beliefs about appropriate treatments and recovery. Addressing these can potentially promote treatment concordance and enhance recovery from depression by establishing and sustaining therapeutic relationships.

How should we inform patients about antidepressants? A study comparing verbal and written information

Objective. To compare the efficacy of verbal, written and, combined verbal and written information about selective serotonin reuptake inhibitors in patients with depression. Method. Patients with a diagnosis of major depression who were prescribed selective serotonin reuptake inhibitors (n=104) were randomly allocated to verbal (n=34, 18F 16M), written (n=38, 19F 19 M) and verbal and written information (n=32, 18F 14M) groups, the content of the verbal and written information being exactly the same. Beck depression inventory was used to evaluate the depressive symptoms. Patients were called back after 10-14 days and their retention of the knowledge was measured. Results. The total retention scores of the verbal group, written group and the combined written and verbal group were 12.85±2.19, 7.39±2.85, and 13.19±2.12, respectively. The total scores of the verbal and the combined verbal and written information groups were significantly higher than those of the written group. The information scores had a significant positive correlation with education level. Conclusion. The retention of verbal information given to patients with low levels of depression concerning the effects and side effects of serotonin reuptake inhibitors is higher than written information. Further studies with more severely depressed patients, comparing the basal information level and the information level after the intervention and the effect of information on compliance are needed.

Patient and professional perspectives on prescribed therapeutic footwear for people with diabetes: a vignette study

OBJECTIVE

This article draws on a qualitative study to identify and discuss patient and health professional views of the use of therapeutic footwear for people with diabetes-related foot complications.

METHODS

Semi-structured interviews were conducted with 15 patients and 15 health professionals using a 'vignette' technique. The interviews were audio-taped, and framework analysis was used to identify main themes and categories.

RESULTS

The prescription of therapeutic footwear was an important issue for patients, and health professionals were aware of this. The main issues were the differing perspectives between patients and professionals in terms of the expectations and reality of preventive behaviour, and difficulties in fitting shoes when feet are constantly changing shape.

CONCLUSIONS

Patients often have difficulty changing their shoe-wearing behaviour in line with guidelines, particularly within the limits of available therapeutic shoes. The choice of available shoes may not meet the varied and specific needs of patients. Patient perspectives therefore need to be taken into account in shoe provision.

PRACTICE IMPLICATIONS

The concept of concordance would appear to be useful in allowing patient needs to be identified before designing and prescribing therapeutic shoes. More choice in styles, and involving patients in footwear design and selection, might encourage the use of appropriate footwear.

Do themes in consumer medicines information literature reviews reflect those important to stakeholders?

OBJECTIVE

To compare the themes emerging from a stakeholder workshop on consumers' medicines information with themes in relevant published reviews.

METHODS

A stakeholder workshop was held to permit consumer orientation of a systematic review of consumer medicines information. Analysis of the workshop outputs was compared to a content analysis of the identified published reviews.

RESULTS

The workshop generated a range of responses inductively grouped into 12 over-arching themes. No reviews tackled all of these themes, nor addressed 'informed choice and autonomy'. More recent reviews reflected more workshop themes than older ones, suggesting a temporal trend towards a greater sensitivity to consumer issues. The most common workshop themes were covered by all reviews. Six themes in the reviews were related to traditional professional concerns including compliance, which did not arise in the workshop.

CONCLUSION

The results highlight a mismatch between the themes in previous published reviews and the themes emerging from the workshop. The most commonly reflected themes in reviews conform to the 'patient education' model of discourse, while workshop themes less often echoed in reviews reflect the discourse of 'patient empowerment'.

PRACTICE IMPLICATIONS

The findings suggest the importance of involving patients in the development of patient literature from the outset.