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Xavier SM, Malla A, Mohan G, Mustafa S, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese HC, Iyer SN. Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 2024; 59:813-825. [PMID: 37848572 DOI: 10.1007/s00127-023-02576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. METHODS Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. RESULTS The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. CONCLUSION This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.
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Affiliation(s)
- Salomé M Xavier
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
- University of Warwick, Coventry, CV4 7AL, UK
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- University of Tübingen, Geschwister-Scholl-Platz 72074, Tübingen, Germany
| | - Howard C Margolese
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Chevillotte E, Dondé C. Peer workers to address discrimination against women in psychiatry and mental health. L'ENCEPHALE 2024; 50:108-110. [PMID: 37400333 DOI: 10.1016/j.encep.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 07/05/2023]
Abstract
Compared to the general population and to males with mental health disorders, women with these disorders face more obstacles in psychiatric and mental health care settings. This strongly encourages mental health policies and psychiatric care to consider specific strategies that prevent gender bias in treatment among women with mental health issues. A growing body of research demonstrates the benefits of having peer workers-professionals with a lived experience of mental health issues who use their own experiences of mental distress to support others with comparable experiences-in mental health services. We postulate that peer support can become an important and integrated aspect of preventing and addressing discrimination against women in psychiatry and mental health care. First, women peer workers may combine their lived experiences as service users and as women to provide unique, experience- and gender-based support to women users who experience discrimination. Non-women or women peer workers who did not experience gender discrimination in psychiatric settings may nevertheless benefit from the integration of gender education in their curriculum and, in turn, bring a feminist lens to their work to achieve this mission. Second, using their experience as service users, peer workers have the credible ability to communicate and translate women patients' needs to the medical staff, and thus facilitate concrete, need-based adjustments of services. Third, peer workers' involvement as instructors in medical schools could provide early awareness of injustices experienced by women in psychiatry and mental health care. Further research is required to test the effectiveness of peer workers in addressing discrimination against women in real-world clinical settings. More broadly, from a diversity perspective, we believe that peer workers are one of the critical elements in the fight against discrimination in psychiatry and mental health.
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Affiliation(s)
- Elise Chevillotte
- Adult Psychiatry Department, CH Alpes-Isère, 38000 Saint-Egrève, France
| | - Clément Dondé
- Adult Psychiatry Department, CH Alpes-Isère, 38000 Saint-Egrève, France; University Grenoble Alpes, 38000 Grenoble, France; Adult Psychiatry Department, CHU de Grenoble-Alpes, 38000 Grenoble, France.
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Toy J, Gregory A, Rehmus W. Barriers to healthcare access in pediatric dermatology: A systematic review. Pediatr Dermatol 2021; 38 Suppl 2:13-19. [PMID: 34338358 DOI: 10.1111/pde.14748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Barriers to healthcare access are healthcare inequities that have been widely studied across different medical specialties. No studies have previously evaluated the state of barriers to healthcare access research in pediatric dermatology. A systematic review was conducted to examine the types of barriers identified within pediatric dermatology literature. Relevant information was extracted and categorized into the themes of systemic, sociocultural, or individual barriers. The systemic barriers we found include finances, wait times, and geography. The sociocultural barriers included culture beliefs and communication. Patient beliefs and health knowledge were found as individual barriers. The small number and limited scope of studies we identified suggest that barriers to healthcare access in pediatric dermatology remain an understudied topic. Additional research is needed to further characterize these barriers to dermatologic care, as well as the impact of any interventions designed to overcome them.
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Affiliation(s)
- Jeffrey Toy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allison Gregory
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Wingfield Rehmus
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Balogun-Katung A, Carswell C, Brown JVE, Coventry P, Ajjan R, Alderson S, Bellass S, Boehnke JR, Holt R, Jacobs R, Kellar I, Kitchen C, Lister J, Peckham E, Shiers D, Siddiqi N, Wright J, Young B, Taylor J. Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis. PLoS One 2021; 16:e0258937. [PMID: 34699536 PMCID: PMC8547651 DOI: 10.1371/journal.pone.0258937] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People living with severe mental illness (SMI) have a reduced life expectancy by around 15-20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. AIM To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. METHODS CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. RESULTS Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. CONCLUSIONS The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.
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Affiliation(s)
- Abisola Balogun-Katung
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Claire Carswell
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Peter Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ramzi Ajjan
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jan R. Boehnke
- Department of Health Sciences, University of York, York, United Kingdom
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Richard Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Charlotte Kitchen
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jennie Lister
- Department of Health Sciences, University of York, York, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Ben Young
- Department of Health Sciences, University of York, York, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jo Taylor
- Department of Health Sciences, University of York, York, United Kingdom
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Sarikhani Y, Bastani P, Rafiee M, Kavosi Z, Ravangard R. Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study. Community Ment Health J 2021; 57:836-852. [PMID: 32285371 DOI: 10.1007/s10597-020-00619-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/06/2020] [Indexed: 01/28/2023]
Abstract
Inadequate attention has been given to the provision of mental health (MH) services especially in low-and middle-income countries (LMICs). This study was aimed to identify key barriers to provide and utilize MH services in LMICs. A comprehensive search on7 important online databases was conducted for key barriers to the provision and utilization MH services in LMICs from Jan 2000 to Nov 2019. Five-step Arksey and O'Malley guideline was used for scope study. The extracted data were synthesized using a qualitative content analysis and thematic network. Three main themes identified as barriers to the provision of MH services in LMICs, namely resource and administrative barriers, information and knowledge barriers, as well as policy and legislation barriers. Also attitudinal barriers, structural barriers, knowledge barriers, and treatment-related barriers were four main themes emerged regarding the challenges of utilization of MH services. Equitable access to MH services in LMICs is influenced by many barriers in both provision and utilization sides. In order to alleviate these problems, health systems could adopt some strategies including integration of MH into the general health policy, improvement of public MH awareness, developing anti-stigma programs, reallocation of health resources toward high-priority MH needs, developing community-based insurance, as well as integration of MH services into all levels of health-care systems. The success of intervention strategies depends on the weight of these barriers in different socio-economic contexts.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- School of Management and Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Rafiee
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- School of Management and Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- School of Management and Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gedik MM, Partlak Günüşen N, Çelik Ince S. Experiences of individuals with severe mental illnesses about physical health services: A qualitative study. Arch Psychiatr Nurs 2020; 34:237-243. [PMID: 32828355 DOI: 10.1016/j.apnu.2020.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 01/17/2023]
Abstract
AIM This study aims to understand the ideas and experiences of individuals' with severe mental illnesses regarding their access to physical health care services. METHODS In this study, a qualitative descriptive approach and content analysis were used. The sample comprised 14 individuals with severe mental illnesses in a psychiatric clinic. RESULTS Three themes emerged: i) a barrier theme related to the patient and the illness, health care professionals, and the health system; ii) a theme that comprised facilitators, for example, health care system facilitators and family support; and iii) an expectations theme, comprising patients' and health care services. CONCLUSION Individuals with severe mental illnesses must overcome many barriers while receiving physical health care, and nursing interventions are critical for increasing these patients' access to physical health services.
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Affiliation(s)
- Mukaddes Müberra Gedik
- Health Sciences Institute, Psychiatric Nursing Program, Dokuz Eylul University, 35340 Izmir, Turkey
| | | | - Sevecen Çelik Ince
- Psychiatric Nursing Department, Zonguldak Bülent Ecevit University, 67600 Zonguldak, Turkey.
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Talley RM, Rolin SA, Trejo BN, Goldman ML, Alves-Bradford JME, Dixon LB. Perspectives of Individuals With Serious Mental Illness on a Reverse-Colocated Care Model: A Qualitative Study. Psychiatr Serv 2019; 70:793-800. [PMID: 31109264 PMCID: PMC6718316 DOI: 10.1176/appi.ps.201800480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with serious mental illness experience excess mortality related to general medical comorbidities. Reverse-integrated and reverse-colocated models of care have been proposed as a system-level solution. Such models integrate primary care services within behavioral health settings. Further understanding of consumer perspectives on these models is needed to ensure that models adequately engage consumers on the basis of their expressed needs. This qualitative study examined the perspectives of English- and Spanish-speaking individuals with serious mental illness on their current experience with the management of their medical care and on a hypothetical reverse-colocated care model. METHODS Semistructured interviews were conducted in a purposive sample of 30 individuals with serious mental illness recruited from two outpatient mental health clinics affiliated with a comprehensive community-based program. The interview assessed the participant's current experience with the management of their health care, followed by a vignette describing a reverse--colocated care model and questions to elicit the participant's reaction to the vignette. An inductive thematic analysis was employed. RESULTS Consumers expressed positive views of the potential for working with trusted staff, increased communication, and access to care through reverse colocation. Reflections on current health management experience were notable for an emphasis on self-efficacy and receipt of support for self-management strategies from mental health clinicians. CONCLUSIONS Study findings add to prior literature indicating support for assistance with management of general medical health in the mental health setting among individuals with serious mental illness. Key themes similar to those in previous studies generate hypotheses for further evaluation.
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Affiliation(s)
- Rachel M Talley
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Barbara N Trejo
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew L Goldman
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Jean-Marie E Alves-Bradford
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Yarborough BJH, Stumbo SP, Cavese JA, Yarborough MT, Green CA. Patient perspectives on how living with a mental illness affects making and maintaining healthy lifestyle changes. PATIENT EDUCATION AND COUNSELING 2019; 102:346-351. [PMID: 30205919 PMCID: PMC6377329 DOI: 10.1016/j.pec.2018.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the ways that mental health symptoms interfere with achieving health goals. METHODS Individuals with mental illness diagnoses and varying levels of preventive service use were recruited from federally qualified health centers and an integrated health care delivery system and interviewed. Thematic analysis was used to characterize descriptions of how mental illness experiences influenced lifestyle change efforts. RESULTS Three themes described patients' (n = 163) perspectives on barriers to making healthy lifestyle changes: 1) Thinking about making lifestyle changes is overwhelming for individuals already managing the burdens of mental illnesses; 2) Depression makes it difficult to care about a healthy future; and 3) When mental illness symptoms are not adequately treated unhealthy behaviors that provide relief are unlikely to be discontinued. Participants also made suggestions for improving health care delivery to facilitate positive behavior change. CONCLUSION Patients with mental illnesses need their clinicians to be empathic, help them envision a healthier future, address unmet mental health needs, and provide resources. PRACTICE IMPLICATIONS Primary care clinicians should encourage their patients with mental illnesses to make healthy lifestyle changes within the context of a supportive relationship. Lifestyle change can be overwhelming; clinicians should acknowledge progress and provide ongoing tangible support.
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Affiliation(s)
- Bobbi Jo H Yarborough
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA.
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
| | - Julie A Cavese
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
| | - Micah T Yarborough
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
| | - Carla A Green
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
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Hauenstein EJ, Clark RS, Merwin EI. Modeling Health Disparities and Outcomes in Disenfranchised Populations. Community Ment Health J 2019; 55:9-23. [PMID: 30136013 PMCID: PMC8751484 DOI: 10.1007/s10597-018-0326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.
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Affiliation(s)
| | - Rachael S Clark
- University of Delaware, 25 N. College Avenue, Newark, DE, 19716, USA
| | - Elizabeth I Merwin
- School of Nursing, Duke University, 3027A Pearson Building, Durham, NC, 27710, USA
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Stumbo SP, Yarborough BJH, Yarborough MT, Green CA. Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses. Am J Health Promot 2018; 32:1730-1739. [PMID: 29658287 PMCID: PMC7220499 DOI: 10.1177/0890117118763233] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. DESIGN Cross-sectional; mixed methods. SETTING An integrated health system and a network of federally qualified health centers and safety net clinics. PARTICIPANTS Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. MEASURES Semi-structured interviews and surveys. ANALYSIS Thematic analysis for qualitative data; frequencies for quantitative data. RESULTS More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients' chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. CONCLUSIONS Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician-patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
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Affiliation(s)
- Scott P. Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Moravac CC. Reflections of Homeless Women and Women with Mental Health Challenges on Breast and Cervical Cancer Screening Decisions: Power, Trust, and Communication with Care Providers. Front Public Health 2018; 6:30. [PMID: 29600243 PMCID: PMC5863503 DOI: 10.3389/fpubh.2018.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
This study conducted in Toronto, Canada, explored the perceptions of women living in homeless shelters and women with severe mental health challenges about the factors influencing their decision-making processes regarding breast and cervical cancer screening. Twenty-six in-depth qualitative interviews were conducted. The objectives of this research were (i) to provide new insights about women's decision-making processes, (ii) to describe the barriers to and facilitators for breast and cervical cancer screening, and (iii) to offer recommendations for future outreach, education, and screening initiatives developed specifically for under/never-screened marginalized women living in urban centers. This exploratory study utilized thematic analysis to broaden our understanding about women's decision-making processes. A constructed ontology was used in an attempt to understand and describe participants' constructed realities. The epistemological framework was subjective and reflected co-created knowledge. The approach was hegemonic, values-based, and context-specific. The aim of the analysis was to focus on meanings and actions with a broader view to identify the interplay between participants' narratives and social structures, medical praxis, and policy implications. Results from 26 qualitative interviews conducted in 2013-2014 provided insights on both positive and negative prior cancer screening experiences, the role of power and trust in women's decision-making, and areas for improvement in health care provider/patient interactions. Outcomes of this investigation contribute to the future development of appropriately designed intervention programs for marginalized women, as well as for sensitivity training for health care providers. Tailored and effective health promotion strategies leading to life-long cancer screening behaviors among marginalized women may improve clinical outcomes, decrease treatment costs, and save lives.
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Happell B, Ewart SB, Platania-Phung C, Bocking J, Scholz B, Stanton R. What Physical Health Means to Me: Perspectives of People with Mental Illness. Issues Ment Health Nurs 2016; 37:934-941. [PMID: 27786585 DOI: 10.1080/01612840.2016.1226999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are significant inequalities in physical health and life expectancy between people with and without a mental illness. Understanding perspectives of people with mental illness on personal meanings of physical health is essential to ensuring health services are aligned with consumer understandings, needs, and values. A qualitative exploratory study was undertaken involving focus groups with 31 consumers in The Australian Capital Territory, Australia. Participants were asked: "What does physical health mean to you?" Thematic analysis was applied to interview transcripts. Five themes are discussed, representing different emphases in the meaning of physical health: (1) physical and mental are interconnected, (2) absence of disease, (3) moving the body, (4) struggling for healthy diet, and (5) functioning and participation. Physical pain was a difficulty that arose across these themes. Mental health consumers see physical health as always connected with well-being. Nurses would benefit from been informed by consumer understandings of physical health. In addition, there should be more attention to quality of life measures of people with mental illness as these are more congruent with consumer perspectives on physical health than biomedical measures.
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Affiliation(s)
- Brenda Happell
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Stephanie B Ewart
- b SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health , Woden , Australia
| | - Chris Platania-Phung
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Julia Bocking
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Brett Scholz
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Robert Stanton
- c Central Queensland University, School of Medical and Applied Sciences, Queensland, Australia, SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
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13
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Bender AK. Ethics, Methods, and Measures in Intimate Partner Violence Research: The Current State of the Field. Violence Against Women 2016; 23:1382-1413. [DOI: 10.1177/1077801216658977] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although intimate partner violence (IPV) is a well-studied topic, surprisingly little consensus among researchers has been reached with regard to the definition and measurement of its major typologies and constructs. The rigorous development and testing of prevention and intervention strategies on a large scale are hampered by many of these methodological difficulties as well as ethical considerations that make conducting IPV research difficult. The author presents a review of the current state of IPV research in these three areas (ethics, methods, and measurement) with suggestions for innovative research possibilities building from this status quo. Moving the field of IPV research forward is necessary to establish a broader evidence base for the prevention and treatment of abuse and to improve outcomes for survivors of IPV.
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14
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Rogers ES, Maru M, Kash-MacDonald M, Archer-Williams M, Hashemi L, Boardman J. A Randomized Clinical Trial Investigating the Effect of a Healthcare Access Model for Individuals with Severe Psychiatric Disabilities. Community Ment Health J 2016; 52:667-74. [PMID: 27137507 DOI: 10.1007/s10597-016-0009-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
We conducted a randomized trial to examine a model for integrating primary care into a community mental health setting. Two hundred individuals were recruited and randomly assigned to receive primary care delivered by a nurse practitioner (n = 94) or services-as-usual (n = 106), assessed on health and mental health outcomes, and followed for 12 months. Intent-to-Treat and exposure analyses were conducted and suggest that participants who engaged with the nurse practitioner experienced gains in perceptions of primary care quality. Health benefits accrued for individuals having receiving nurse practitioner services in a mental health setting to address primary care needs.
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Affiliation(s)
- E Sally Rogers
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.
| | - Mihoko Maru
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Boston University School of Social Work, Boston, MA, USA
| | - Megan Kash-MacDonald
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Institute of Child Health, University College London (UCL), London, England
| | - Mariah Archer-Williams
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Sharp HealthCare, San Diego, CA, USA
| | - Lobat Hashemi
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Genzyme, Sanofi, Boston, MA, USA
| | - Judith Boardman
- Northeast Health Systems/Health and Education Services, Inc., Beverly, MA, USA.,Salem State University, Salem, MA, USA
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15
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Happell B, Ewart SB, Platania-Phung C, Bocking J, Griffiths K, Scholz B, Stanton R. Embedding a physical health nurse consultant within mental health services: Consumers' perspectives. Int J Ment Health Nurs 2016; 25:377-84. [PMID: 26748945 DOI: 10.1111/inm.12185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 01/10/2023]
Abstract
The life expectancy of people living with mental illness is significantly shorter than that of the rest of the population. Despite the profound impact of physical health issues on both quality of life and life expectancy, the perspectives of mental health consumers have yet to be thoroughly explored. Furthermore, research has focused far more on describing barriers than on identifying solutions. This paper reports on findings from a qualitative exploratory research study, with the aim to examine the potential role of a specialist nurse with advanced physical health-care skills. Focus groups were conducted with 31 consumers. Data were analysed thematically. The concept of a role like this was supported; however, participants stressed: (i) the importance of integration between health professionals and various components of the health-care system; and (ii) the need for culture change for nurses to work from a less medically-dominated approach. Previous research literature suggests that a nursing position dedicated to physical health care and coordination might produce positive outcomes for mental health consumers. The findings from the current research project emphasize the need for consumers to be identified as key stakeholders in a solution-focused approach to improved physical health care for mental health consumers.
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Affiliation(s)
- Brenda Happell
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Stephanie B Ewart
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Chris Platania-Phung
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Julia Bocking
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Kathleen Griffiths
- National Institute for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Woden, Australian Capital Territory, Australia
| | - Brett Scholz
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Robert Stanton
- Central Queensland University, School of Medical and Applied Sciences, Rockhampton, Queensland, Australia
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16
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Bellamy CD, H Flanagan E, Costa M, O'Connell-Bonarrigo M, Tana Le T, Guy K, Antunes K, Steiner JL. Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered Healthcare Is Necessary. Issues Ment Health Nurs 2016; 37:421-8. [PMID: 27104370 DOI: 10.3109/01612840.2016.1162882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Understanding barriers and facilitators of healthcare for people with mental illness is essential for healthcare and mental healthcare organizations moving towards patient centered care. This paper presents findings of a measure on barriers and facilitators of healthcare completed by 204 patients being served at a co-located wellness center (primary healthcare clinic) located in an urban mental health center. The top 10 results show important findings for planning healthcare services that are responsive to the needs of people with mental illness. Basic structural issues as a result of poverty are extremely important (transportation, housing, payment) as well as difficulty with public healthcare that often involves long wait-times for appointments and at the doctor's office and hours that might not be convenient. Healthcare services that want to meet the needs of people with mental illness need to address these issues. What facilitates healthcare is not just removing the barriers to receiving healthcare services but instead involves more interpersonal aspects of healthcare such as liking your provider, being able to talk with your provider, feeling your provider cares about you and listens to you. Structural supports such as also being in mental health services, having systems for remembering appointments, and/or having appointment times that are convenient also facilitate seeking healthcare. Facilitating healthcare seeking also seems to involve a sense of agency-looking forward to taking charge of your health and feeling capable of following healthcare provider instructions. Healthcare systems for people with mental illness need to support these facilitators to give care-seekers the support they need. Key points are provided on how organizations and staff can work more effectively in implementing patient centered care.
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Affiliation(s)
- Chyrell D Bellamy
- a Program for Recovery and Community Health of the Yale School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
| | - Elizabeth H Flanagan
- a Program for Recovery and Community Health of the Yale School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
| | - Mark Costa
- a Program for Recovery and Community Health of the Yale School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
| | - Maria O'Connell-Bonarrigo
- a Program for Recovery and Community Health of the Yale School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
| | - Thanh Tana Le
- b Cornell Scott Hill Health Center-CMHC Wellness Center , New Haven , Connecticut , USA
| | - Kimberly Guy
- a Program for Recovery and Community Health of the Yale School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
| | - Kimberly Antunes
- a Program for Recovery and Community Health of the Yale School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
| | - Jeanne L Steiner
- c Yale University School of Medicine , Department of Psychiatry , New Haven , Connecticut , USA
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17
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Ewart SB, Bocking J, Happell B, Platania-Phung C, Stanton R. Mental Health Consumer Experiences and Strategies When Seeking Physical Health Care: A Focus Group Study. Glob Qual Nurs Res 2016; 3:2333393616631679. [PMID: 28462330 PMCID: PMC5342294 DOI: 10.1177/2333393616631679] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 12/16/2015] [Accepted: 12/28/2015] [Indexed: 01/24/2023] Open
Abstract
People with mental illness have higher rates of physical health problems and consequently live significantly shorter lives. This issue is not yet viewed as a national health priority and research about mental health consumer views on accessing physical health care is lacking. The aim of this study is to explore the experience of mental health consumers in utilizing health services for physical health needs. Qualitative exploratory design was utilized. Semistructured focus groups were held with 31 consumer participants. Thematic analysis revealed that three main themes emerged: scarcity of physical health care, with problems accessing diagnosis, advice or treatment for physical health problems; disempowerment due to scarcity of physical health care; and tenuous empowerment describing survival resistance strategies utilized. Mental health consumers were concerned about physical health and the nonresponsive health system. A specialist physical health nurse consultant within mental health services should potentially redress this gap in health care provision.
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Affiliation(s)
- Stephanie B Ewart
- Synergy: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australia
| | - Julia Bocking
- Synergy: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australia
| | - Brenda Happell
- Synergy: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australia
| | - Chris Platania-Phung
- Synergy: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australia
| | - Robert Stanton
- Central Queensland University, Rockhampton, Queensland, Australia
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18
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Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, Alvarez J, Nicasio A, Druss B, Lewis-Fernández R. Primary health care experiences of hispanics with serious mental illness: a mixed-methods study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:724-36. [PMID: 24162079 PMCID: PMC4000574 DOI: 10.1007/s10488-013-0524-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants' primary care experiences.
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Affiliation(s)
- Leopoldo J. Cabassa
- School of Social Work, Columbia University and the New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | - Richard Younge
- Columbia Center for Family and Community Medicine, Columbia University, New York, NY, USA
| | - Dianna Dragatsi
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Juana Alvarez
- New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
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19
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Butler H, Hare D, Walker S, Wieck A, Wittkowski A. The acceptability and feasibility of the Baby Triple P Positive Parenting Programme on a mother and baby unit: Q-methodology with mothers with severe mental illness. Arch Womens Ment Health 2014; 17:455-63. [PMID: 24827076 DOI: 10.1007/s00737-014-0429-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 04/14/2014] [Indexed: 11/28/2022]
Abstract
New mothers with severe mental illness (SMI) frequently experience significant difficulties in caring for their babies. There are no structured, evidence-based interventions that guide health professionals to help these women improve early parenting. The extensively researched and effective Triple P Positive Parenting Programme has recently been expanded to families with children less than 1 year old, which provides an opportunity to develop the intervention for women with severe postnatal mental illness. This study explored the views of mothers with SMI about the acceptability and feasibility of Baby Triple P (Baby TP) in the setting of a psychiatric Mother and Baby Unit (MBU). An 88-item Q-sort was conducted with a purposive sample of 15 mothers using Q-methodology. Three main factors were identified: 'what we need', 'what we want' and 'we can do it'. A consensus was noted with general agreement about the benefits of Baby TP, and suitability of the MBU environment to accommodate Baby TP. Baby TP was viewed as an acceptable and feasible parenting intervention and deemed positive and non-stigmatising. Mothers requested more staff awareness and knowledge about the programme so that they were supported in learning and generalising skills.
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Affiliation(s)
- Hannah Butler
- School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
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20
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Cabassa LJ, Siantz E, Nicasio A, Guarnaccia P, Lewis-Fernández R. Contextual Factors in the Health of People With Serious Mental Illness. QUALITATIVE HEALTH RESEARCH 2014; 24:1126-1137. [PMID: 24966198 PMCID: PMC4276729 DOI: 10.1177/1049732314541681] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
People living with serious mental illness (SMI) have shorter life expectancies than the general population. We examined how contextual factors influence the physical health of this population. We conducted interviews, focus groups, and participant observations with stakeholders from six behavioral health organizations. We found that consumers' avoidance of overt disagreement during medical visits, their mistrust of medical institutions, and cultural variations in body image influenced the clinical encounter. Mental health providers' ambivalence about intervening in consumers' physical health, primary care providers' misattribution of physical symptoms to mental disorders, and providers' stigmatization of consumers shaped clinical encounters. Consumers' diets were shaped by food environments and social norms associated with traditional diets. Internal and external factors impacted consumers' physical activity. In this article, we illustrate the importance of considering contextual factors in the development and implementation of interventions aimed at improving the physical health of people with SMI.
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Affiliation(s)
| | | | - Andel Nicasio
- New York State Psychiatric Institute, New York, New York, USA
| | - Peter Guarnaccia
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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21
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Siu JYM. The Illness Experiences of Women with Overactive Bladder in Hong Kong. QUALITATIVE HEALTH RESEARCH 2014; 24:801-810. [PMID: 24732998 DOI: 10.1177/1049732314530811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Overactive bladder (OAB) is a common chronic bladder dysfunction worldwide. However, the illness experiences of women with OAB in Asian countries have not been well documented. In this article, I investigate the illness experiences of women with OAB in Hong Kong. I adopted a qualitative study design by conducting 30 in-depth, semistructured interviews with women who were diagnosed as having OAB and were aged between 28 and 55 years. Negative illness experiences were noted among the participants, including embarrassment, shame, frustration, helplessness, resignation, uselessness, and self-seclusion. These negative experiences were not only the result of the physical symptoms and limitations brought on by the bladder condition, but were also caused by social difficulties such as the flippant attitudes of primary care providers, the tortuous journey of seeking and receiving treatment, and a lack of understanding from social members such as family members and colleagues in the workplace.
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22
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Gaebel W, Muijen M, Baumann A, Bhugra D, Wasserman D, van der Gaag R, Heun R, Zielasek J. EPA Guidance on Building Trust in Mental Health Services. Eur Psychiatry 2014; 29:83-100. [DOI: 10.1016/j.eurpsy.2014.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 01/26/2023] Open
Abstract
AbstractPurposeTo advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system.MethodsWe performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process.ResultsWe developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization.DiscussionTrust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust.ConclusionEvidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization.
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Happell B, Scott D, Platania-Phung C. Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia. Int J Ment Health Nurs 2013; 22:418-29. [PMID: 23211091 DOI: 10.1111/j.1447-0349.2012.00892.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse-based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health-care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health-care settings in Australia.
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Affiliation(s)
- Brenda Happell
- Central Queensland University, Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, QLD 4702, Australia.
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24
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Barriers and Enablers to Integrating Mental Health into Primary Care: A Policy Analysis. J Behav Health Serv Res 2013; 43:127-39. [DOI: 10.1007/s11414-013-9359-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Happell B, Scott D, Platania-Phung C. Perceptions of barriers to physical health care for people with serious mental illness: a review of the international literature. Issues Ment Health Nurs 2012; 33:752-61. [PMID: 23146009 DOI: 10.3109/01612840.2012.708099] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Premature death and poorer access to quality care for physical health concerns is common for people diagnosed with serious mental illness (SMI). However, there is lack of clarity regarding the nature of barriers encountered at different points in the physical health care process, and the level of consistency of these barriers both among countries, and between consumers with SMI and health care staff. The current narrative review integrates views of consumers and health care staff on barriers to physical health care. It involved a search of CINAHL, Proquest, and Web of Science, for peer-reviewed papers published between 2005 and June 2012, for studies of perceptions of barriers to physical health care, published in English. Despite variations in health care systems among countries, there is agreement between consumers and health care staff that division between physical and mental health care and stigma of mental illness act as barriers to all phases of the physical health care process. This uniformity is grounds for international policy development (in general public health and within mental health nursing) for reforms that improve the physical health care, quality of life, and longevity of people with serious mental illness.
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Affiliation(s)
- Brenda Happell
- Central Queensland University, School of Nursing and Midwifery, Rockhampton 4701, Australia.
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