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Nevard I, Brooks H, Gellatly J, Bee P. Modelling social networks for children of parents with severe and enduring mental illness: an evidence based modification to the network episode model. BMC Psychol 2024; 12:162. [PMID: 38500222 PMCID: PMC10949563 DOI: 10.1186/s40359-024-01647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
The Network Episode Model (NEM) is a well utilised model conceptualising how social networks, valuable resources which can positively impact wellbeing and functional outcomes, are responsive to the needs of people with physical and mental health difficulties. Children of parents with severe and enduring mental illness (COPMI) are impacted by these illnesses through the intersecting roles of kin relation, informal carer, and dependent. However, it is not clear that social networks effectively respond in kind to the child's episodic need.We draw upon qualitative data to propose a new multi-factorial conceptual model (COPMI-NEM), triangulating parental mental illness, child's developmental stage and social ties to theorise how social networks do respond and adapt to children's needs.The model illustrates how networks are typically flexible and responsive to visible age-related needs, but less reactive to more obscured needs. Successful network navigation and negotiation of support relies on multiple factors including the child's ability to successfully activate social ties and the availability of formal networks. We propose a new theoretically and empirically informed NEM model also available for testing, refinement and validation in other young carer populations exposed to episodic parental health needs. Findings from this study could be used to generate network informed interventions for this and comparable populations.
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Affiliation(s)
- Imogen Nevard
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, 6.333 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Helen Brooks
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, 6.333 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, 6.333 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Penny Bee
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, 6.333 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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Woodnutt S, Allen C, Snowden J, Flynn M, Hall S, Libberton P, Purvis F. Could artificial intelligence write mental health nursing care plans? J Psychiatr Ment Health Nurs 2024; 31:79-86. [PMID: 37538021 DOI: 10.1111/jpm.12965] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Artificial intelligence (AI) is freely available, responds to very basic text input (such as a question) and can now create a wide range of outputs, communicating in many languages or art forms. AI platforms like OpenAI's ChatGPT can now create passages of text that could be used to create plans of care for people with mental health needs. As such, AI output can be difficult to distinguish from human-output, and there is a risk that its use could go unnoticed. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Whilst it is known that AI can produce text or pass pre-registration health-profession exams, it is not known if AI can produce meaningful results for care delivery. We asked ChatGPT basic questions about a fictitious person who presents with self-harm and then evaluated the quality of the output. We found that the output could look reasonable to laypersons but there were significant errors and ethical issues. There are potential harms to people in care if AI is used without an expert correcting or removing these errors. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We suggest that there is a risk that AI use could cause harm if it was used in direct care delivery. There is a lack of policy and research to safeguard people receiving care - and this needs to be in place before AI should be used in this way. Key aspects of the role of a mental health nurse are relational and AI use may diminish mental health nurses' ability to provide safe care in its current form. Many aspects of mental health recovery are linked to relationships and social engagement, however AI is not able to provide this and may push the people who are in most need of help further away from services that assist recovery. ABSTRACT: Background Artificial intelligence (AI) is being increasingly used and discussed in care contexts. ChatGPT has gained significant attention in popular and scientific literature although how ChatGPT can be used in care-delivery is not yet known. Aims To use artificial intelligence (ChatGPT) to create a mental health nursing care plan and evaluate the quality of the output against the authors' clinical experience and existing guidance. Materials & Methods Basic text commands were input into ChatGPT about a fictitious person called 'Emily' who presents with self-injurious behaviour. The output from ChatGPT was then evaluated against the authors' clinical experience and current (national) care guidance. Results ChatGPT was able to provide a care plan that incorporated some principles of dialectical behaviour therapy, but the output had significant errors and limitations and thus there is a reasonable likelihood of harm if used in this way. Discussion AI use is increasing in direct-care contexts through the use of chatbots or other means. However, AI can inhibit clinician to care-recipient engagement, 'recycle' existing stigma, and introduce error, which may thus diminish the ability for care to uphold personhood and therefore lead to significant avoidable harms. Conclusion Use of AI in this context should be avoided until a point where policy and guidance can safeguard the wellbeing of care recipients and the sophistication of AI output has increased. Given ChatGPT's ability to provide superficially reasonable outputs there is a risk that errors may go unnoticed and thus increase the likelihood of patient harms. Further research evaluating AI output is needed to consider how AI may be used safely in care delivery.
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Affiliation(s)
- Samuel Woodnutt
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Chris Allen
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jasmine Snowden
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Matt Flynn
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Simon Hall
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Paula Libberton
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Francesca Purvis
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Vassilev I, Lin SX, Calman L, Turner J, Frankland J, Wright D, Foster C. The role of social networks in the self-management support for young women recently diagnosed with breast cancer. PLoS One 2023; 18:e0282183. [PMID: 37053231 PMCID: PMC10101384 DOI: 10.1371/journal.pone.0282183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/09/2023] [Indexed: 04/14/2023] Open
Abstract
It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016-2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes.
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Affiliation(s)
- Ivaylo Vassilev
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sharon Xiaowen Lin
- ARC Wessex, University of Southampton, Southampton, United Kingdom
- Management School, Xian Polytechnic University, Xian, China
| | - Lynn Calman
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Josh Turner
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Frankland
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - David Wright
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Brooks H, Devereux-Fitzgerald A, Richmond L, Caton N, Newton A, Downs J, Lovell K, Bee P, Cherry MG, Young B, Vassilev I, Rotheram C, Rogers A. Adapting a social network intervention for use in secondary mental health services using a collaborative approach with service users, carers/supporters and health professionals in the United Kingdom. BMC Health Serv Res 2022; 22:1140. [PMID: 36085063 PMCID: PMC9461266 DOI: 10.1186/s12913-022-08521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Social integration, shared decision-making and personalised care are key elements of mental health and social care policy. Although these elements have been shown to improve service user and service-level outcomes, their translation into practice has been inconsistent and social isolation amongst service users persists. Aim To co-adapt, with service users, carers/supporters and health professionals, a web-based social network intervention, GENIE™, for use in secondary mental health services. The intervention is designed to support social activity and preference discussions between mental healthcare professionals and service users as a means of connecting individuals to local resources. Methods In Phase 1 (LEARN), we completed two systematic reviews to synthesise the existing evidence relating to the i) effectiveness and ii) the implementation of social network interventions for people with mental health difficulties. We undertook semi-structured interviews with a convenience sample of 15 stakeholders previously involved in the implementation of the intervention in physical healthcare settings. Interviews were also conducted with 5 national key stakeholders in mental health (e.g., policy makers, commissioners, third sector leads) to explore wider implementation issues. In Phase 2 (ADAPT), we worked iteratively with eight service users, nine carers, six professionals/volunteers and our patient and public advisory group. We drew on a framework for experience-based co-design, consisting of a series of stakeholder consultation events, to discuss the use of the social network intervention, in mental health services. Participants also considered factors that could serve as enablers, barriers, and challenges to local implementation. Results Across the stakeholder groups there was broad agreement that the social network intervention had potential to be useful within mental health services. In terms of appropriate and effective implementation, such an intervention was predicted to work best within the care planning process, on discharge from hospital and within early intervention services. There were indications that the social connection mapping and needs assessment components were of most value and feasible to implement which points to the potential utility of a simplified version compared to the one used in this study. The training provided to facilitators was considered to be more important than their profession and there were indications that service users should be offered the opportunity to invite a carer, friend, or family member to join them in the intervention. Conclusion The GENIE™ intervention has been co-adapted for use in mental health services and a plan for optimal implementation has been co-produced. The next phase of the programme of work is to design and implement a randomised controlled trial to evaluate clinical and cost effectiveness of a simplified version of the intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08521-1.
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"They're My Go-To People": A Qualitative Study of Support Networks for People Recently Diagnosed With HIV in Queensland, Australia. J Assoc Nurses AIDS Care 2022; 33:624-637. [PMID: 35878321 DOI: 10.1097/jnc.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Support networks promote care engagement and prevent social isolation for people living with HIV (PLWH). This study examined the personal support networks of recently diagnosed PLWH and explored how these networks change over time. We developed qualitative social network maps with 10 recently diagnosed PLWH in Queensland and identified unique and dynamic support networks. Network changes over time were influenced by changing support needs and experiences of stigma. Some support networks grew, whereas others remained small and close-knit or became sparse. The pivotal role of peers for information and emotional support was revealed. Socially isolated PLWH also described substantial reliance on long-term professional support. Others described reasons why health professionals were excluded from support networks, revealing the importance of nonjudgmental attitudes and HIV literacy among health professionals. Facilitating ongoing links with peers and professionals are crucial strategies to help PLWH foster effective and sustainable networks for comprehensive long-term support.
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Howard-Jones G, Vassilev I, Fenlon D, Ewings S, Richardson A. Influence of social networks on cancer survivors' self-management support: A mixed methods study. Eur J Cancer Care (Engl) 2022; 31:e13578. [PMID: 35416341 PMCID: PMC9286412 DOI: 10.1111/ecc.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Objective The role of social networks, especially weaker ties (e.g. casual acquaintances and hobby groups), in self‐management of long‐term consequences of cancer is unexplored. This study aimed to explore the structure of cancer survivors' social networks and their contribution to self‐management support and health‐related quality of life (HRQoL). Methods The study used a sequential, exploratory mixed methods design. Phase 1 surveyed 349 lymphoma, colorectal, breast and prostate cancer survivors. Phase 2 analysed 20 semi‐structured interviews with respondents recruited from Phase 1. Results Phase 1 results suggested participants' HRQoL increased if they participated in an exercise group, if their self‐management skills increased, and social distress and negative illness perception decreased (p < 0.0005 adj. R2 = 0.631). These findings were explored in Phase 2, identifying underlying mechanisms. Four themes were identified: disrupted networks after cancer treatment; navigating formal support and building individual capacity; peer networks and self‐management knowledge and linking networks to enable adaptation in recovery. Conclusions This study suggests engagement with community groups, particularly those not directly related to illness management and social interaction with weak ties, make a valuable contribution to self‐management support, increase HRQoL and enhance well‐being.
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Affiliation(s)
- Gilly Howard-Jones
- Department of Health Sciences, University of Southampton, Southampton, UK.,Maggie's Cancer Support Centre Southampton, University Hospital Southampton, Southampton, UK
| | - Ivaylo Vassilev
- Department of Health Sciences, University of Southampton, Southampton, UK
| | - Debora Fenlon
- Department of Health Sciences, University of Southampton, Southampton, UK
| | - Sean Ewings
- Department of Medical Statistics, University of Southampton, Southampton, UK
| | - Alison Richardson
- University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Chmielowska M, Zisman-Ilani Y, Saunders R, Pilling S. Social network interventions in mental healthcare: a protocol for an umbrella review. BMJ Open 2021; 11:e052831. [PMID: 34921079 PMCID: PMC8685933 DOI: 10.1136/bmjopen-2021-052831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Social networks (SNs) can play a crucial role in the process of recovery from mental illness. Yet there is no standard best practice for involving SNs to optimise patient recovery. It is therefore critical to explore the diversity of SN approaches in mental health, highlight gaps in the evidence and suggest future directions for research and practice. This protocol describes the methods for an umbrella review of SN interventions for the care and/or treatment of mental illness. METHODS AND ANALYSIS Nine electronic databases will be searched for the relevant journal articles: CINAHL, PubMed, Scopus, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Library, Web of Science, Scopus and Ovid PsycINFO. We will include reviews which extracted information about the quantity, structure and quality of patient's SNs as well as frequency of contact. The range of publication dates of the included articles will be from 2010 and 2021, as recommended by Joanna Briggs Institute guidelines. The Assessment of Multiple Systematic Reviews 2 tool and ratings of the quality of evidence will be used to assess the quality of the included reviews. The results will be presented in accordance with guidelines in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Findings will inform the development of an SN framework to guide the design and evaluation of psychosocial interventions. ETHICS AND DISSEMINATION This umbrella review will involve secondary data analysis and ethical approval is not required. The target audience includes clinicians, researchers and service users, who will be reached with tailored materials through journal publications, conference presentations and social media. The presentation of the results will provide a more complete picture of relevant evidence and explicit basis from which to improve psychosocial well-being for people diagnosed with a mental illness. PROSPERO REGISTRATION NUMBER This protocol was registered with the International Prospective Register of Systematic Reviews (http:/ /www.crd.york.ac.uk/PROSPERO), registration number CRD42020192873.
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Affiliation(s)
- Marta Chmielowska
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Yaara Zisman-Ilani
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Social and Behavioural Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Gillham J, Vassilev I, Band R. Rural influences on the social network dynamics of district nursing services: A qualitative meta-synthesis. Health Sci Rep 2021; 4:e336. [PMID: 34430710 PMCID: PMC8369946 DOI: 10.1002/hsr2.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS As demands on healthcare services grow, fiscal restrictions place increased emphasis on services outside of traditional healthcare settings. Previous research into long-term-conditions suggests that social network members (including weaker ties such as acquaintances, community groups, and healthcare professionals) play a key role in illness management. There is limited knowledge about the engagement of social networks in supporting people who are receiving medical interventions at home. This qualitative metasynthesis explores the work and the interactions between district nurses (DN) and informal network members supporting people who are receiving medical interventions at home and living in rural areas. METHODS A search was undertaken on CINAHL, Medline, and PsychINFO for qualitative research articles from 2009 to 2019. Studies that examined DN in rural locations and/or social network support in rural locations were eligible. Fourteen articles were selected. RESULTS Thematic analysis of results and discussion data from the studies resulted in four themes being developed: the development of both transactional and friend-like nurse-patient ties in rural localities, engagement of the wider network in the delivery of good care, blurring of professional boundaries in close community relationships, and issues accessing and navigating formal and informal support in the context of diminishing resources in rural areas.These findings suggest that DNs in rural localities work beyond professional specialties and experience to provide emotional support, help with daily tasks, and build links to communities. There was also evidence that nurses embedded within rural localities developed friend-like relationships with patients, and negotiated with existing support networks and communities to find support for the patient. CONCLUSIONS Findings indicated that developing strong links with patients and members of their networks does not automatically translate into positive outcomes for patients, and can be unsustainable, burdensome, and disruptive. DNs developing weak ties with patients and building awareness of the structure of individual networks and local sources of support offers avenues for sustainable and tailored community-based nursing support.
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Affiliation(s)
- Jack Gillham
- School of Health SciencesUniversity of SouthamptonSouthamptonEngland
| | - Ivaylo Vassilev
- School of Health SciencesUniversity of SouthamptonSouthamptonEngland
| | - Rebecca Band
- School of Health SciencesUniversity of SouthamptonSouthamptonEngland
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Tse J, LaStella D, Chow E, Kingman E, Pearlman S, Valeri L, Wang H, Dixon LB. Telehealth Acceptability and Feasibility Among People Served in a Community Behavioral Health System During the COVID-19 Pandemic. Psychiatr Serv 2021; 72:654-660. [PMID: 33957769 PMCID: PMC11184975 DOI: 10.1176/appi.ps.202000623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the acceptability and feasibility of telehealth services shortly after their rapid introduction into a community behavioral health agency as part of the response to the COVID-19 pandemic. METHODS Individuals receiving services during May 8-18, 2020, from behavioral health programs that had introduced telehealth in March 2020, were invited to participate in a survey regarding their perceptions of the telehealth services. Ordinal logistic regressions were used to test for differences in survey responses in three ways: between program types, between the 2020 sample and a 2018 sample, and between individuals reported by staff to be distressed or not distressed by the COVID-19 pandemic. RESULTS Of 1,482 survey respondents, >80% reported that their ability to connect to staff, receive support, and get an appointment was at least as great as before the pandemic. Among 80% of respondents indicating interest in continuing remote services after the pandemic ended, 83% preferred a mix of remote and face-to-face services. From February 2020 to April 2020, total service utilization remained stable for treatment, outreach, and housing programs. In addition, mental health-related hospital utilization did not increase. CONCLUSIONS The findings of this study suggest that telehealth, including telephone-based services, is an acceptable and even preferred service delivery mode for clients with severe mental illness. Continued investigation into the optimal dosing of face-to-face versus remote services in various settings is needed to inform service practice during and after the COVID-19 pandemic.
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Affiliation(s)
- Jeanie Tse
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Drew LaStella
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Elisa Chow
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Emily Kingman
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Shoshannah Pearlman
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Linda Valeri
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Hao Wang
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Lisa B Dixon
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
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Oh S, Chew-Graham CA, Silverwood V, Shaheen SA, Walsh-House J, Sumathipala A, Kingstone T. Exploring women's experiences of identifying, negotiating and managing perinatal anxiety: a qualitative study. BMJ Open 2020; 10:e040731. [PMID: 33380483 PMCID: PMC7780520 DOI: 10.1136/bmjopen-2020-040731] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Anxiety affects around 15% of women during the perinatal period and can adversely impact both mother and child, with potential implications for long-term health; few studies have examined women's experiences of perinatal anxiety (PNA). In the context of the National Institute for Health and Care Excellence prioritising PNA, this study aimed to explore women's experiences of the identification and management of PNA and their engagement with healthcare professionals. DESIGN Qualitative study with semi-structured interviews and applying thematic analysis. SETTING Recruitment materials were shared widely through maternal support groups, children's centres, libraries, National Health Service (NHS) providers (primary and secondary care) operating in the West Midlands or North West of England and through social media. PARTICIPANTS Seventeen women (aged 25-42 years) with self-reported anxiety during pregnancy and/or up to 12 months postpartum. Interviews digitally recorded and transcribed with consent. RESULTS Three main themes and corresponding sub-themes are described around a central concept of PNA as an individualised experience: barriers to disclosing PNA; help-seeking for PNA and establishing and engaging support networks. Disclosing, help-seeking and accessing systems of support were interconnected and contextualised by individualised experiences of PNA and pervaded by stigma. CONCLUSIONS This research provides new insights into PNA and calls for awareness to be improved to achieve parity alongside depression and avoid missed opportunities in the provision of care for women and families. Future research should seek to develop novel PNA-specific interventions aimed at prevention, management and/or combatting stigma to support more women to disclose mental health concerns and seek help early.
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Affiliation(s)
- Soo Oh
- School of Medicine, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Keele, UK
- St George's Hospital, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | | | | | - Athula Sumathipala
- School of Medicine, Keele University, Keele, UK
- St George's Hospital, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Tom Kingstone
- School of Medicine, Keele University, Keele, UK
- St George's Hospital, Midlands Partnership NHS Foundation Trust, Stafford, UK
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McKenna G, Rogers A, Walker S, Pope C. The influence of personal communities in understanding avoidable emergency department attendance: qualitative study. BMC Health Serv Res 2020; 20:887. [PMID: 32958065 PMCID: PMC7504825 DOI: 10.1186/s12913-020-05705-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Use of emergency department (ED) care globally seems to be increasing at a faster rate than population growth (Baker, House of Commons Library. Accident and Emergency Statistics, Demand, Performance, 2017). In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment (NHS Digital, Hospital Accident and Emergency Activity 2016-17, 2019) is cited as evidence that these patients did not require this level of care. The solution to not using the most appropriate point in the system has traditionally been seen as a knowledge problem, requiring, improved sign-posting and information to enable people to self-manage or use health care management for minor ailments. However research about help-seeking behaviour suggests that the problem may not be an informational one. A considerable literature points to help seeking as a social process influenced by a range of contingencies and contextual factors including the way in which lay people influence health care utilisation (Giebel et al. BMJ Open 9:1, 2019). Personal communities comprise a variety of active and significant social ties which have potential to influence individual capacity to seek help. Here we extend and unpack further influencing decisions about seeking formal health care with reference to how they are shaped and informed by and within personal social networks. METHODS We undertook a personal network mapping and qualitative interview-based study to look at, problematize and understand attendance for non-urgent problems. We used network analysis and methods to map and characterise the personal communities of people seeking help from ED for minor ailments and semi-structured interviews with 40 people attending a single ED and associated GP hub providing equivalent care. Interviews were built around an ego network mapping activity and a topic guide structured to explore attender's narratives about why they had visited the ED. This ego network activity uses a diagram consisting of three concentric circles (Fiori et al. J Gerontol B-Psychol 62: 322-30, 2007), representing closest social network members (in the centre) and those at further distance. Participants were initially presented with one of these diagrams and asked to write names of people or resources that had played a role in their attendance and the interviewer probed the interviewee to discuss the actions, input and value of the people and services that supported the visit to the ED. RESULTS We analysed number and type of network connections and undertook a thematic analysis to identify how imagined and actual network members and influences were implicated in ED attendance. The network maps created during the interviews were examined and a typology of networks was developed and used to distinguish different types of networks informed by our reading of the data, and a Network Typology Scoring Tool, a measure of frequency of contact and relationship type in networks. CONCLUSIONS Our study suggests that faced with acute minor illness or injury people's networks narrow: they do not (and perhaps cannot) mobilise their imagined care network because the resources or connections may not be there or are difficult to engage. In addition we identified important system drivers of behaviour, notably that these patients are often directed to the ED by 'professional influencers' including health services staff.
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Affiliation(s)
- Gemma McKenna
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, B15 2RT UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, University of Southampton, Southampton, SO17 1BJ UK
| | - Sandra Walker
- NIHR CLAHRC Wessex, University of Southampton, Southampton, SO17 1BJ UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, OX2 6GG UK
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Welch L, Orlando R, Lin SX, Vassilev I, Rogers A. Findings from a pilot randomised trial of a social network self-management intervention in COPD. BMC Pulm Med 2020; 20:162. [PMID: 32513163 PMCID: PMC7278059 DOI: 10.1186/s12890-020-1130-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Self-Management Support (SMS), refers to the actions taken by individuals to recognise and manage their own health. It is increasingly recognised that individuals with chronic obstructive pulmonary disease (COPD) require additional support with their Self-management. Emerging evidence suggests that the use of a social network intervention can improve health outcomes and increase quality of life. In order to understand the potential benefits of SMS in COPD, the GENIE (Generating Engagement in Network Support) SMS tool was implemented and evaluated in a COPD primary care context. The GENIE intervention is a social networking tool that consists of 3 parts; a concentric circle modelling to map existing social networks; a questions sections to elicit preferences for activities; a map of selected resources is then produced, aligned with the user's interests and suggestions for connections to existing network members and to new resources. METHODS A pilot, parallel, single blind, block randomised controlled trial. Patients with COPD ranging from mild-very severe were recruited. Participants provided written consent and were then randomised to either the intervention or usual care. The primary aim was to understand the clinical benefit through the analysis of health status, symptom burden and quality of life. The secondary outcome measure was health utilisation. NHS cost differences were reported between groups using the GENIE intervention over usual care. RESULTS The GENIE pilot results demonstrate maintenance in health status and clinical symptoms with a decrease in anxiety. An overall increase in quality of life was observed, these findings did not reach significance. A cost reduction was demonstrated in inpatient stay with no difference in primary care costs. Overall a cost reduction in NHS service utilisation was indicated in the intervention group. CONCLUSION This pilot study indicated that using a social network intervention can encourage the development of new social connections and extend existing support networks for COPD patients. Increasing network support in this population is of benefit to both patients and NHS providers in terms of cost reductions and enhancing wellbeing. This broadens the understanding of possible new approaches to SMS in community COPD patients, which could now be investigated in a larger population over a longer period. TRIAL REGISTRATION Clinical Trials.gov PRS National Library of Medicine. Protocol ID number: 19175, Clinical Trial ID: NCT02935452.
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Affiliation(s)
- Lindsay Welch
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
- Solent University, School of Sport, Health and Social Sciences, RM 126, East Park Terrace, Southampton, SO14 0YN UK
| | - Rosanna Orlando
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| | - Sharon X. Lin
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| | - Ivaylo Vassilev
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| | - Anne Rogers
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
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13
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Brooks HL, Bee P, Lovell K, Rogers A. Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems. BMC Psychiatry 2020; 20:50. [PMID: 32028906 PMCID: PMC7006131 DOI: 10.1186/s12888-020-2458-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/23/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems. METHODS A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model. RESULTS The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks. CONCLUSIONS Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.
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Affiliation(s)
- Helen Louise Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.
| | - Penny Bee
- grid.5379.80000000121662407Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- grid.5379.80000000121662407Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK ,grid.450837.d0000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anne Rogers
- grid.5491.90000 0004 1936 9297NIHR CLAHRC Wessex, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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14
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Bloom I, Welch L, Vassilev I, Rogers A, Jameson K, Cooper C, Robinson S, Baird J. Findings from an exploration of a social network intervention to promote diet quality and health behaviours in older adults with COPD: a feasibility study. Pilot Feasibility Stud 2020; 6:15. [PMID: 32042439 PMCID: PMC7003327 DOI: 10.1186/s40814-020-0553-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/22/2020] [Indexed: 02/01/2023] Open
Abstract
Background Diet quality in older people with chronic obstructive pulmonary disease (COPD) is associated with better health and lung function. Social factors, such as social support, social networks and participation in activities, have been linked with diet quality in older age. A social network tool—GENIE (Generating Engagement in Network Involvement)—was implemented in a COPD community care context. The study aimed to assess the feasibility of the GENIE intervention to promote diet quality and other health behaviours in COPD. Methods Twenty-two community-dwelling older adults with COPD were recruited from a local COPD service. Participants were offered usual care or the GENIE intervention. Process evaluation methods were used to assess intervention implementation, context and mechanisms of impact; these included observations of patient interactions with the intervention, documented in observational field notes and in films of a patient group discussion. Diet quality was assessed by food frequency questionnaire; ‘prudent’ diet scores were used to describe diet quality at baseline and at 3-month follow-up. Change in diet quality was expressed per month, from baseline to follow-up. Results Feasibility data showed that the GENIE intervention could be implemented in this sample of community-living older people. The intervention was acceptable to clinicians and older people with COPD, especially for those with less severe disease, when facilitated appropriately and considering the levels of literacy of participants. There was no significant change in diet quality in the intervention group over the follow-up period (median change in prudent diet score per month (interquartile range (IQR), 0.03 (− 0.24–0.07)), whereas an overall fall in diet quality was observed in the control group (− 0.15 (− 0.24–0.03)). Conclusion The process evaluation findings suggest that this intervention is feasible and acceptable to both patients and clinicians. Although the sample size achieved in this study was small, findings suggest that the intervention may have a protective effect against declines in diet quality, and other health behaviours, in an older COPD population. Findings from this feasibility study indicate that further evaluation of the GENIE intervention is warranted in a larger study, with a longer follow-up. Trial registration ClinicalTrials.gov, NCT02935452. NIH U.S. National Library of Medicine. Registered 17 October 2016.
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Affiliation(s)
- Ilse Bloom
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,2NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lindsay Welch
- 3Solent NHS Trust, Bitterne Health Centre, Commercial Road, Bitterne, Southampton, UK.,4Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, UK
| | - Ivaylo Vassilev
- 4Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, UK
| | - Anne Rogers
- 4Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, UK
| | - Karen Jameson
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,2NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,6NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Sian Robinson
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,7AGE Research Group, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Janis Baird
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,2NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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15
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Brooks H, Rushton K, Lovell K, McNaughton R, Rogers A. 'He's my mate you see': a critical discourse analysis of the therapeutic role of companion animals in the social networks of people with a diagnosis of severe mental illness. MEDICAL HUMANITIES 2019; 45:326-334. [PMID: 31340997 PMCID: PMC6818524 DOI: 10.1136/medhum-2018-011633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 05/27/2023]
Abstract
There is increasing recognition of the role pets play in the management of mental health conditions. Evidence suggests that pets promote social interaction and provide secure and intimate relationships which support the management of symptoms. This paper aimed to extend this evidence by exploring the phenomenological understanding of relationships and relationality with companion animals as therapeutic agents in the context of people's wider social networks.A qualitative study was undertaken incorporating 35 interviews with 12 participants with a diagnosis of severe mental illness who identified a pet as being important in the management of mental health. Participants took part in three in-depth interviews centred on ego network mapping over a 12-month period (baseline, 6 and 12 months). A critical discourse analysis examined therapeutic relationships with pets in relation to mental health and compared these to other types of support over time. Summative discourse analyses were combined with a cross-case thematic analysis to look for commonalities and differences across individuals.Compared with interactions with other therapeutic agents, relationships with pets were free from the obligations and complexities associated with other types of network members and provided an extension and reinforcement to an individual's sense of self which militated against the negative experiences associated with mental illness. Relationships with human network members were more variable in terms of consistency and capacity to manage demands (eg, network members requiring support themselves) and the emotions of others associated with fluctuations in mental health.This study adds weight to research supporting the inclusion of companion animals in the lexicon of mental health self-management through the therapeutic value attributed to them by participants within a wide personal network of support. The findings point to how consideration might usefully be given to how relationships with companion animals can be incorporated into healthcare planning and delivery.
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Affiliation(s)
- Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Kelly Rushton
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Karina Lovell
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Anne Rogers
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
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16
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Brooks H, Lovell K, Bee P, Fraser C, Molloy C, Rogers A. Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation. Soc Psychiatry Psychiatr Epidemiol 2019; 54:221-233. [PMID: 30267112 DOI: 10.1007/s00127-018-1603-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels. METHODS A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. RESULTS The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. CONCLUSIONS Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.
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Affiliation(s)
- Helen Brooks
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Liverpool, UK.
| | - Karina Lovell
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Penny Bee
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Claire Fraser
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christine Molloy
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
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17
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Brooks HL, Rushton K, Lovell K, Bee P, Walker L, Grant L, Rogers A. The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. BMC Psychiatry 2018; 18:31. [PMID: 29402247 PMCID: PMC5800290 DOI: 10.1186/s12888-018-1613-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/18/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There is increasing recognition of the therapeutic function pets can play in relation to mental health. However, there has been no systematic review of the evidence related to the comprehensive role of companion animals and how pets might contribute to the work associated with managing a long-term mental health condition. The aim of this study was to explore the extent, nature and quality of the evidence implicating the role and utility of pet ownership for people living with a mental health condition. METHODS A systematic search for studies exploring the role of companion animals in the management of mental health conditions was undertaken by searching 9 databases and undertaking a scoping review of grey literature from the earliest record until March 2017. To be eligible for inclusion, studies had to be published in English and report on primary data related to the relationship between domestic animal ownership and the management of diagnosable mental health conditions. Synthesis of qualitative and quantitative data was undertaken in parallel using a narrative synthesis informed by an illness work theoretical framework. RESULTS A total of 17 studies were included in the review. Quantitative evidence relating to the benefits of pet ownership was mixed with included studies demonstrating positive, negative and neutral impacts of pet ownership. Qualitative studies illuminated the intensiveness of connectivity people with companion animals reported, and the multi-faceted ways in which pets contributed to the work associated with managing a mental health condition, particularly in times of crisis. The negative aspects of pet ownership were also highlighted, including the practical and emotional burden of pet ownership and the psychological impact that losing a pet has. CONCLUSION This review suggests that pets provide benefits to those with mental health conditions. Further research is required to test the nature and extent of this relationship, incorporating outcomes that cover the range of roles and types of support pets confer in relation to mental health and the means by which these can be incorporated into the mainstay of support for people experiencing a mental health problem.
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Affiliation(s)
- Helen Louise Brooks
- Psychology of Healthcare Research Group, Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Kelly Rushton
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Penny Bee
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Lauren Walker
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Walker S, Kennedy A, Vassilev I, Rogers A. How do people with long-term mental health problems negotiate relationships with network members at times of crisis? Health Expect 2017; 21:336-346. [PMID: 29024284 PMCID: PMC5750694 DOI: 10.1111/hex.12620] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/28/2022] Open
Abstract
Background Social network processes impact on the genesis and management of mental health problems. There is currently less understanding of the way people negotiate networked relationships in times of crisis compared to how they manage at other times. Objective This paper explores the patterns and nature of personal network involvement at times of crises and how these may differ from day‐to‐day networks of recovery and maintenance. Method Semi‐structured interviews with 25 participants with a diagnosis of long‐term mental health (MH) problems drawn from recovery settings in the south of England. Interviews centred on personal network mapping of members and resources providing support. The mapping interviews explored the work of network members and changes in times of crisis. Interviews were recorded, transcribed and analysed using a framework analysis. Results Three key themes were identified: the fluidity of network relationality between crisis and recovery; isolation as a means of crises management; leaning towards peer support. Personal network input retreated at times of crisis often as result of “ejection” from the network by participants who used self‐isolation as a personal management strategy in an attempt to deal with crises. Peer support is considered useful during a crisis, whilst the role of services was viewed with some ambiguity. Conclusions Social networks membership, and type and depth of involvement, is subject to change between times of crisis and everyday support. This has implications for managing mental health in terms of engaging with network support differently in times of crises versus recovery and everyday living.
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Affiliation(s)
- Sandra Walker
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ivaylo Vassilev
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
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