1
|
Rushton K, Ardern K, Hopkin E, Welsh C, Gellatly J, Faija C, Armitage CJ, Lidbetter N, Lovell K, Bower P, Bee P. 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions. BMC Psychiatry 2020; 20:156. [PMID: 32264865 PMCID: PMC7137505 DOI: 10.1186/s12888-020-02564-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Remote delivery of psychological interventions to meet growing demand has been increasing worldwide. Telephone-delivered psychological treatment has been shown to be equally effective and as satisfactory to patients as face-to-face treatment. Despite robust research evidence, however, obstacles remain to the acceptance of telephone-delivered treatment in practice. This study aimed to explore those issues using a phenomenological approach from a patient perspective to identify areas for change in current provision through the use of theoretically based acceptability and behaviour change frameworks. METHODS Twenty-eight semi-structured interviews with patients experiencing symptoms of common mental health problems, waiting, receiving or having recently received telephone-delivered psychological treatment via the UK National Health Service's Improving Access to Psychological Therapies (IAPT) programme. Interviews were recorded, transcribed verbatim, and analysed using the Theoretical Domains Framework (TDF) and Theoretical Framework of Acceptability (TFA). RESULTS The majority of data clustered within five key domains of the TDF (knowledge, skills, cognitive and interpersonal, environmental context and resources, beliefs about capabilities, beliefs about consequences) and mapped to all constructs of the TFA (affective attitude, ethicality, intervention coherence, self-efficacy, burden, opportunity costs, and perceived effectiveness). Themes highlighted that early stages of treatment can be affected by lack of patient knowledge and understanding, reservations about treatment efficacy, and practical obstacles such as absent non-verbal communication, which is deemed important in the development of therapeutic alliance. Yet post-treatment, patients can reflect more positively, and report gaining benefit from treatment. However, despite this, many patients say that if they were to return for future treatment, they would choose to see a practitioner face-to-face. CONCLUSIONS Using a combination of theoretically underpinned models has allowed the identification of key targets for change. Addressing knowledge deficits to shift attitudes, highlighting the merits of telephone delivered treatment and addressing skills and practical issues may increase acceptability of, and engagement with, telephone-delivered treatment.
Collapse
Affiliation(s)
- Kelly Rushton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Kerry Ardern
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Sheffield, UK
| | - Elinor Hopkin
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Charlotte Welsh
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Gellatly
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Cintia Faija
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christopher J. Armitage
- grid.5379.80000000121662407Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Karina Lovell
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- grid.5379.80000000121662407NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Penny Bee
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
2
|
Bowmer G, Sowerby C, Duff A. Transition and transfer of young people with cystic fibrosis to adult care. Nurs Child Young People 2018; 30:34-39. [PMID: 30088702 DOI: 10.7748/ncyp.2018.e1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 11/09/2022]
Abstract
Treatment for cystic fibrosis (CF) remains arduous and time-consuming, with young people in particular struggling to balance these demands with living a 'normal' life. Transferring to adult services is an important milestone that should be preceded by a gradual process of empowerment. This service evaluation aimed to explore the views of young people with CF before their transfer to adult care and to co-produce revisions to the transition and transfer programme. A total of 37 participants, aged 11-17 years, completed questionnaires during routine clinic visits with 81% expressing good knowledge of CF and treatment, and 59% reporting that they undertook their own treatment. Only 40% had seen a doctor alone for part of their clinic visit, 64% supported recruitment of a youth worker and 48% viewed dedicated adolescent clinics as beneficial. Participants expressed overall satisfaction with their care, however, improvements were suggested. Based on these suggestions, funding was secured for a youth worker, 'transition' clinics were established with children's and adult CF team members, and doctors started seeing young people on their own for part of the clinic visit from age 13 years.
Collapse
Affiliation(s)
- Grace Bowmer
- Paediatric Psychology Service, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Carol Sowerby
- Regional Paediatric CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Alistair Duff
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, England
| |
Collapse
|
3
|
Nicolais CJ, Bernstein R, Riekert KA, Quittner AL. Parent knowledge of disease management in cystic fibrosis: Assessing behavioral treatment management. Pediatr Pulmonol 2018; 53:162-173. [PMID: 29193881 DOI: 10.1002/ppul.23916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 08/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-shortening, burdensome disease requiring complex knowledge to manage the disease. Significant gaps in knowledge have been documented for parents, which may lead to unintentionally poor adherence and insufficient transfer of treatment responsibility from parents to adolescents. There are no current, validated measures of parent knowledge for this population and there are no measures that assess the knowledge required for day-to-day behavioral management of CF. We assessed the psychometric properties of the parent version of the Knowledge of Disease Management-Cystic Fibrosis measure (KDM-CF-P) using data from iCARE (I Change Adherence and Raise Expectations), a randomized control adherence intervention trial. METHODS A total of 196 parents in the iCARE standard care/control arm completed 35 items assessing their knowledge of disease management at their 12-month study visit, prior to beginning the intervention. Items were eliminated from the measure if they met the threshold for ceiling effects, were deemed clinically irrelevant, or did not correlate well with their intended scale. Item-to-total correlations, confirmatory factor analysis, discriminant function, reliability, and convergent validity were calculated. RESULTS The KDM-CF-P (19 items) demonstrated internal consistency of KR20 = 0.60 on each scale and a two-scale structure. Convergent validity for knowledge scores was found with maternal education, family income, and type of medical insurance. Parents correctly answered approximately 85% of items on the KDM-CF-P. CONCLUSIONS The KDM-CF-P psychometrics support a two-scale measure with clinical utility. It is useful for assessing gaps in knowledge that can be remediated through individualized, tailored interventions.
Collapse
Affiliation(s)
| | - Ruth Bernstein
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alexandra L Quittner
- Miami Children's Research Institute, Nicklaus Children's Hospital, Miami, Florida
| |
Collapse
|
4
|
Askew K, Bamford J, Hudson N, Moratelli J, Miller R, Anderson A, Doe S, Bourke SJ. Current characteristics, challenges and coping strategies of young people with cystic fibrosis as they transition to adulthood. Clin Med (Lond) 2017; 17:121-125. [PMID: 28365620 PMCID: PMC6297616 DOI: 10.7861/clinmedicine.17-2-121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study provides detailed data on the current characteristics, perceptions and outcomes of 45 young people with cystic fibrosis (CF) as they transition into adulthood. Although many had severe disease, they generally coped well, found attendance at a transition clinic helpful and welcomed the increased independence of an adult healthcare environment. Levels of psychological distress were low with only 15.6% having anxiety and 6.7% depression. The main psychological coping strategy used was optimistic acceptance. Overall, most remained stable after transfer but 33% had some decline in lung function and 9% in nutritional status, requiring intensification of treatment. They had high levels of satisfaction with their relationships and life situations and 76% were in employment or education. These results are encouraging and as life expectancy improves, young adults with CF are coping well with transition into adulthood.
Collapse
Affiliation(s)
| | - Jade Bamford
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | | - Simon Doe
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | |
Collapse
|