Implicit attitudes, emotions, and helping intentions of mental health workers toward their clients

Mental Health Nurses' Social Representations of People Who Experience Mental Illness: A Story of Paradoxes

Public representations of people who experience mental illness (PEMI) have been well documented within the stigma literature. However, studies about mental health nurses' representations of PEMI are still scarce and characterized by contradictions. Using the theoretical concept of social representation instead of stigma, the current study aims to explore and understand mental health nurses' social representations of PEMI. Qualitative research was conducted based on 13 semi-structured interviews with nurses from two psychiatric units in general hospitals. Data were analyzed using interpretative phenomenological analysis. Results showed that nurses' social representations were characterized by paradoxes. They explicitly displayed positive social representations, while nuancing them from an implicit point of view. The nurses wanted to work toward a destigmatizing voice for PEMI while nuancing their assertions to sound honest and accurate, which led them to a state of cognitive dissonance.

Sharing online clinical notes with patients: implications for nocebo effects and health equity

Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called 'open notes'). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes-the potential to increase 'nocebo effects'. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify 'closed notes', and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route.

Role of traditional beliefs in the knowledge and perceptions of mental health and illness amongst rural-dwelling women in western Nigeria

Background

Globally, the public health importance of mental health has gained significant attention in recent years. In Africa, many traditional belief systems impact the perceptions, attitude and management of mental illness. Women are usually the primary caregivers of mentally ill persons, but they have lower mental health literacy.

Aim

To assess rural women’s knowledge, perceptions and attitudes regarding mental illnesses and the role of traditional beliefs in their management.

Setting

Epe Local Government Area of Lagos State, Nigeria.

Methods

This was a cross-sectional study with a total of 295 rural women recruited through a multistage sampling method. A pretested interviewer-administered questionnaire was used to collect data. Summary and inferential statistics were measured using Epi Info version 7. The level of significance was predetermined at 5%.

Results

A total of 253 questionnaires were adequately filled and analysed. Overall, just over one-third (35%) of respondents had good knowledge and only 26% had positive attitudes towards mental health and illness. About 45% reported that mental illness should first be treated in ‘the traditional way’, whilst 47% felt that there was no need for collaboration between orthodox and unorthodox healthcare for mental illness. Sociodemographic variables were significantly associated with knowledge (educational level p = 0.001) and attitude (marital status p = 0.001 and ethnicity p = 0.001).

Conclusion

Respondents had poor knowledge of and attitude towards mental health, and traditional beliefs played a role in their perception and management of mental illness. We recommend community-based health education programmes to improve knowledge and help-seeking for mental illness amongst rural women.

Australian health and medical workers' concerns around providing care to people living with hepatitis B

There is established literature on health workers' attitudes towards working with people living with stigmatised health conditions and behaviours, such as HIV, hepatitis C and injecting drug use. Less is known about health workers' attitudes and concerns around providing care to people living with hepatitis B virus (HBV), which is concerning as research indicates that negative attitudes may impact on the quality of care provided to these populations, with adverse health outcomes for clients. The aim of this paper is to examine health and medical workers' concerns about providing care to people living with HBV, and the factors that may influence these concerns. Australian health and medical workers (n = 551) completed an online survey measuring their concerns about providing care to people living with HBV, stigmatising attitudes towards this group, perceived comfort of themselves and colleagues in providing care towards clients with HBV, and witnessing their colleagues behaviour in a discriminatory way towards clients with HBV. Multiple regression was used to ascertain factors predictive of health workers' concerns about working with clients with HBV. Results showed that older participants and those who had spent less time working in the health and medical field had greater concerns about caring for people living with HBV. Workers who did not know someone living with HBV, who were less comfortable around clients with HBV, who perceived their colleagues to be less comfortable working with clients with HBV, and who had more negative attitudes towards this group also had greater concerns around providing care to people living with HBV. Efforts should be made to improve health and medical workers' attitudes towards working with people with HBV. This may also improve workers' level of comfort with people with HBV and reduce the reported reticence they have towards working with this client group.

The effect of extended contact with community-dwelling older adults on the ageist and helping attitudes of home care students: A single-blind randomised controlled trial

BACKGROUND

Ageist and helping attitudes among undergraduate homecare students are a concern for educators, healthcare professionals and home care workers due to their potential to increase the marginalisation of older people and negatively impact quality of care.

OBJECTIVES

The current study evaluated the effect of extended contact with community-dwelling older adults on the ageist and helping attitudes of home care students.

METHODS

Fifty-five students attending a public university in Turkey were randomly assigned to the intervention group (n = 27) or control group (n = 28). The intervention group received positive theoretical education and had extended contact with community-dwelling older adults, while the control group only received positive theoretical education. Before and after the intervention, the students' ageist attitudes were evaluated with Kogan's Attitudes towards Old People scale (KAOP) and helping attitudes were evaluated with the Helping Attitude Scale (HAS).

RESULTS

There were statistically significant differences between pre- and post-test mean KAOP total, positive ageism and negative ageism subscale scores in the intervention group (p < 0.05) and in KAOP negative ageism score in the control group (p < 0.05). HAS scores showed no significant post-intervention change in helping attitudes in either group.

CONCLUSION

Extended contact with community-dwelling older adults had a favourable influence on undergraduate health students' ageism attitudes. These results suggest that contact with older adults may be an effective strategy to reduce ageism but may not increase helping behaviours.

IMPLICATIONS FOR PRACTICE

Positive contact experiences with community-dwelling older adults can be used to reduce ageism in home care students.

The value of doing philosophy in mental health contexts

People experiencing mental distress and illness are frequently on the receiving end of stigma, epistemic injustice, and social isolation. A range of strategies are required to alleviate the subsequent marginalisation. We ran a series 'philosophy of mind' workshops, in partnership with a third-sector mental health organisation with the aim of using philosophical techniques to challenge mental health stigma and build resources for self-understanding and advocacy. Participants were those with lived experience of mental distress, or unusual beliefs and experiences; mental health advocates; and mental health service providers (such as counsellors, psychologists and psychiatrists). We draw on a shared perspective as a participant and facilitator of the workshop series to assess their impact. We discuss the following benefits: (i) the opportunity for structured discussion of experiences and models; (ii) dialogue across different mental health backgrounds; (iii) the potential to reduce self-stigma and to increase self-understanding and advocacy; and (iv) the potential to alleviate (some) epistemic injustice. We invite researchers and mental health practitioners to consider further opportunities to investigate the potential benefits of philosophy groups in mental health settings to establish whether they generalise.

Stigmatising attitudes towards people who inject drugs, and people living with blood borne viruses or sexually transmissible infections in a representative sample of the Australian population

Stigma has significant detrimental health outcomes for those affected. This study examined socio-demographic characteristics that were associated with stigmatising attitudes among the general population towards people who inject drugs, and people living with blood borne viruses or sexually transmissible infections. Questions were included in the Australian Survey of Social Attitudes (total sample = 1,001). Attitudes towards each of the target populations were measured by 5-item stigma scales. Bivariate analyses and multiple regression analyses were conducted to identify socio-demographic characteristics associated with stigmatising attitudes. Knowing a person affected by a stigmatised attribute was associated with reduced stigmatising attitudes, while voting for a conservative political party was associated with increased stigmatising attitudes. Age, gender, education, income, and marital status were each related to some stigmatising attitudes. Results also highlight differences between attitudes towards a stigmatised behaviour (i.e., injecting drug use) and stigmatised conditions (i.e., blood borne viruses and sexually transmissible infections). Identifying socio-demographic characteristics that are associated with stigmatising attitudes may have global implications for informing stigma reduction interventions, in order to promote positive health outcomes for affected communities.

Age discrimination in osteoporosis screening--data from the Aalborg University Hospital Record for Osteoporosis Risk Assessment (AURORA)

BACKGROUND

Old age carries a markedly increased risk of osteoporotic fractures with subsequent disability, dependency and premature death. Timely detection and treatment reduces fracture risk and particular attention should be drawn to age.

OBJECTIVE

To assess the impact of age on referral for osteoporosis screening.

SETTING AND METHODS

Dual energy X-ray Absorptiometry (DXA) at the Osteoporosis Clinic in North Denmark was reorganised from 2010. Risk factors, anthropometry and bone mineral density were recorded and considered in the reply and recommendations to the referring doctor. We report data from the 8,131 consecutive evaluations in 7914 individuals at the Osteoporosis Clinic from January 1st 2010 through December 31st 2012.

RESULTS

Risk factor data were available in >96% and DXA in 98%. Population DXA frequency decreased markedly after the 7th decade and was performed yearly in 1.2% of the population aged >80 years in North Denmark. The >80 years group had more fragility fractures and lower T-scores (p<0.001) compared to those below 80 years of age, and age >80 years was a dominant risk factor for fragility fracture (OR 2.4, 95% CI 2.0-2.9; p<0.001) and for having diagnosed osteoporosis by DXA (OR 2.1, 95% CI 1.7, 2.5; p<0.001).

CONCLUSION

Referral for osteoporosis screening decreased after the 7th decade despite the finding that high age carried the highest risk of osteoporosis by DXA and by fragility fracture. Osteoporosis is a disease of aging, but it is apparently not recognised as such. This is likely to cause undertreatment among the old.