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Pouls KPM, Mastebroek M, Ligthart SJ, Assendelft WJJ, Leusink GL, Koks-Leensen MCJ. Primary mental healthcare for adults with mild intellectual disabilities: Patients' perspectives. Eur J Gen Pract 2024; 30:2354414. [PMID: 38757401 PMCID: PMC11104687 DOI: 10.1080/13814788.2024.2354414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research. OBJECTIVES To explore patients' experiences, needs, and suggestions for improvement regarding primary MH care for people with MID. METHODS Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically. RESULTS The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability - instigated by the MID and reinforced by MH problems - experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability. CONCLUSION People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients' needs, for which collaborative care with the patient, the patient's network, and other (care) professionals is of utmost importance.
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Affiliation(s)
- Katrien PM. Pouls
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzanne J. Ligthart
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem JJ. Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geraline L. Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique CJ. Koks-Leensen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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Caltabiano P, Bailie J, Laycock A, Shea B, Dykgraaf SH, Lennox N, Ekanayake K, Bailie R. Identifying barriers and facilitators to primary care practitioners implementing health assessments for people with intellectual disability: a Theoretical Domains Framework-informed scoping review. Implement Sci Commun 2024; 5:39. [PMID: 38627849 PMCID: PMC11020327 DOI: 10.1186/s43058-024-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. METHODS This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. RESULTS The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. CONCLUSION Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.
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Affiliation(s)
- Paul Caltabiano
- School of Rural Health, The University of Sydney, Dubbo, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, Australia.
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Bradley Shea
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, ACT, Canberra, Australia
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Kanchana Ekanayake
- University of Sydney Library, The University of Sydney, Camperdown, Australia
| | - Ross Bailie
- School of Public Health, The University of Sydney, Camperdown, Australia
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Mafuba K, Kiernan J, Chapman HM, Kupara D, Kudita C, Chester R. Understanding the contribution of intellectual disability nurses. Paper 2 of 4 - Survey. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231213434. [PMID: 37956695 DOI: 10.1177/17446295231213434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The objective was to identify ID nursing interventions and their impact on the health and healthcare of people with IDs. Data was collected using an online survey questionnaire from a voluntary response and snowball sample of 230 participants. Thematic, descriptive statistical, and inferential statistical analyses were undertaken. We identified 878 interventions that could be undertaken by ID nurses from 7 countries. We categorised the interventions into five themes: effectuating nursing procedures, enhancing impact of ID services, enhancing impact of mainstream services, enhancing quality of life, and enhancing ID nursing practice. Findings demonstrate that ID nurses play important roles in improving the health and healthcare experiences of people with IDs.
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Affiliation(s)
| | - Joann Kiernan
- Edge Hill University and Alder Hey Children's Hospital, UK
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Doherty AJ, O'Donoghue A, Harrison J. Developing an understanding of the risk factors for falls among adults with intellectual disabilities: a commentary. Br J Community Nurs 2023; 28:238-242. [PMID: 37130713 DOI: 10.12968/bjcn.2023.28.5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Commentary on: Pope J, Truesdale M, Brown M. Risk factors for falls among adults with intellectual disabilities: A narrative review. J Appl Res Intellect Disabil. 2021; 34: 274-285. 10.1111/jar.12805 Falls are a serious and common problem for people with intellectual disabilities (ID). Whilst there is available evidence on falls risk factors for the general population, there is a lack of awareness and understanding of the contributing risk factors for this population. This commentary critically appraises a recent narrative review which sought to identify the risk factors for falls among people with ID. Clinical practice implications: Community nurses may identify people with ID at risk of falls, and work alongside other healthcare professionals and carers to provide tailored multidisciplinary falls-prevention interventions for individuals with ID living in the community.
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Affiliation(s)
- Alison J Doherty
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire
| | | | - Joanna Harrison
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire
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Ratnayake I, Shooshtari S, Chateau D, Kristjanson M. Complete physical examinations in Manitoba adults with an intellectual or developmental disability: A retrospective cohort study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1582-1591. [PMID: 34196454 DOI: 10.1111/jar.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete physical examinations (CPE) can identify health disparities in persons with intellectual or developmental disabilities. The objective of this study was to determine and compare rates of CPE among Manitoba adults with and without intellectual or developmental disabilities over time and to identify factors that were associated with receiving a CPE. METHOD A retrospective cohort study using linked administrative health and non-health data from 1995 to 2015 was conducted. Poisson and logistic regression were used to calculate CPE rates and examine factors associated with CPE. RESULTS The rates of CPE are decreasing over time and are higher among Manitobans with an intellectual or developmental disability. Characteristics such as being male, living rurally, low socioeconomic status, and high continuity of care led to lower odds of receiving a CPE. CONCLUSIONS The current state of CPE provision to adults with intellectual or developmental disabilities in Manitoba is encouraging but needs improvement.
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Affiliation(s)
- Iresha Ratnayake
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark Kristjanson
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
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Bakker-van Gijssel EJ, Lucassen PLBJ, Olde Hartman TC, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ. "Constructing a health assessment questionnaire for people with intellectual disabilities: A cognitive interview study". JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:345-353. [PMID: 31602729 DOI: 10.1111/jar.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Health assessment instruments can help to raise awareness among general practitioners of specific health problems in people with intellectual disabilities (PID). The present authors developed a health assessment questionnaire using the cognitive interview technique (CI) to improve the comprehensibility. The utility of this approach to questionnaire development involving PID is assessed. METHOD A qualitative approach using the CI was employed. The study included PID and their caregivers. The present authors interviewed 14 participants in 5 subsequent rounds. After each round, the questionnaire was adjusted until saturation was reached. RESULTS Three hundred and sixty three identified problems led to 316 changes to the questionnaire. Most problems (102) concerned the comprehension of the question, followed by problems in the "missing answer categories" and "inaccurate instruction" section. CONCLUSION The comprehensible health assessment questionnaire can help PID to take an active role in communication with their GP. The use of CI helped to improve the questionnaire. CI is a usable and valuable procedure for PID.
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Affiliation(s)
- Esther J Bakker-van Gijssel
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Siza, residential care facility for people with disabilities, Arnhem, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Bakker-van Gijssel EJ, Lucassen PLBJ, Olde Hartman TC, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ. Development of a health assessment instrument for people with intellectual disabilities: a Delphi study. Fam Pract 2018; 35:599-606. [PMID: 29471438 DOI: 10.1093/fampra/cmy004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with intellectual disabilities (IDs) experience health inequalities. Applying health assessments is one way of diminishing these inequalities. A health assessment instrument can support general practitioners (GPs) in providing better medical care to people with ID. OBJECTIVES The aim of this study was to determine which items should be part of a health assessment instrument for people with ID to be used in primary care. METHODS This Delphi consensus study was conducted among 24 GP experts and 21 ID physicians. We performed three anonymous sequential online questionnaire rounds. We started with 82 'general' items and 14 items concerning physical and additional examinations derived from the international literature and a focus group study among Dutch GPs. We definitely included items if more than 75% of the GP experts agreed on their inclusion. RESULTS The participation rate in all rounds was above 88%. The expert groups proposed 10 new items. Consensus was reached on 64 'general' items related to highly prevalent diseases, public health and health promotion. Consensus was also reached on 18 physical and additional examination items. CONCLUSIONS For the first time, experts in a Delphi study were able to arrive at a selection of items for a health assessment instrument for people with ID. The overall agreement among the GPs and ID physicians was good. Because the experts prefer that patients complete the health assessment questionnaire at home, questions that cover these items must be formulated clearly.
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Affiliation(s)
- Esther J Bakker-van Gijssel
- Department of Primary and Community Care, Radboud University Medical Center, HB Nijmegen, The Netherlands.,Siza, Residential Care Facility for People with Disabilities, AM Arnhem, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, HB Nijmegen, The Netherlands
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