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Wagner S, Addington KS, Varming A, Hempler NF. Caught between good intentions and rigid structures: A qualitative description of professionals' experiences with health promotion in mental health services. Scand J Caring Sci 2021; 36:663-672. [PMID: 34355422 DOI: 10.1111/scs.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Compared with the general population, people with mental illness are at higher risk of developing type 2 diabetes due to poor diet, medication and inactive lifestyle. People with mental illness and members of the general population are equally interested in health behaviour change, but those with mental illness experience communication barriers with professionals. The study aimed to explore philosophies that social care and healthcare professionals apply to health promotion activities targeting people with mental illness and challenges they face in applying these philosophies across multiple settings. METHODS Qualitative interviews were conducted with 18 social and healthcare professionals in a range of settings in 2016-2019. Descriptive qualitative analysis was applied to interview data. RESULTS Interviewees faced many structural challenges in the organisation of their work, which did not coincide with their philosophy or intentions in relation to health promotion. Three philosophical categories were identified: (a) health promotion approach, (b) elements of care and (c) social relations. Many interviewees intended to apply philosophies of broadly defined health, dialogue-based health education, and incremental approaches to health behaviour change. They wanted to provide holistic and flexible care and they valued peer-to-peer activities, family and friend involvement in care and a trusting relationship between the professional and the person with mental illness. However, rigid structures determining the organisation of health promotion challenged professionals' ability to follow their philosophical intentions. CONCLUSION Interviewees aspired to a collaborative, empowering and person-centred approach, but practical and structural factors made this difficult to achieve in practice. Major changes are required at the organisational level, implemented with the active involvement of professionals and people with mental illness.
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Affiliation(s)
- Sabina Wagner
- Steno Diabetes Center Copenhagen, Health Promotion Research, Gentofte, Denmark
| | | | - Annemarie Varming
- Steno Diabetes Center Copenhagen, Health Promotion Research, Gentofte, Denmark
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Stenov V, Joensen LE, Knudsen L, Lindqvist Hansen D, Willaing Tapager I. “Mental Health Professionals Have Never Mentioned My Diabetes, They Don’t Get Into That”: A Qualitative Study of Support Needs in Adults With Type 1 and Type 2 Diabetes and Severe Mental Illness. Can J Diabetes 2020; 44:494-500. [DOI: 10.1016/j.jcjd.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
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Hempler NF, Pals RAS, Pedersbæk L, DeCosta P. Barriers and facilitators of effective health education targeting people with mental illness: a theory-based ethnographic study. BMC Psychiatry 2018; 18:353. [PMID: 30376824 PMCID: PMC6208025 DOI: 10.1186/s12888-018-1924-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health education is particularly important for people with mental illness because they are at higher risk of becoming overweight or obese and developing type 2 diabetes than are members of the general population. However, little is known about how to provide health education activities that promote engagement and motivation among people with mental illness. METHODS This study used ethnographic methods to examine barriers and facilitators of effective health education targeting people with mental illness by applying the concept of flow as a theoretical framework. Flow refers to immersion in an activity and is related to motivation. Data were collected through participant observation during eight health-educating activities and were thematically analysed using the concept of flow. Fieldwork was carried out between May and July 2015 in Denmark. RESULTS Barriers to flow included: 1) information overload, particularly of biomedical rationales for behaviour change; 2) a one-size-fits-all approach that failed to address the needs and preferences of the target group; and 3) one-way communication allowing little time for reflection. Educators promoted a state of flow when they spoke less and acted outside of a traditional expert role, thus engaging participants in the activity. Flow was facilitated when educators were attentive and responsive to people with mental illness, and when they stimulated reflection about health and health behaviour through open-ended questions, communication tools and in small group exercises. CONCLUSIONS This study suggests that more focus should be paid to training of educators in terms of skills to involve and engage people with mental illness in health education activities.
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Affiliation(s)
- N. F. Hempler
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
| | - R. A. S. Pals
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
| | - L. Pedersbæk
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
| | - P. DeCosta
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
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Axon RN, Gebregziabher M, Dismuke CE, Hunt KJ, Yeager D, Ana EJS, Egede LE. Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus. J Gen Intern Med 2016; 31:1331-1337. [PMID: 27418346 PMCID: PMC5071286 DOI: 10.1007/s11606-016-3786-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/21/2016] [Accepted: 06/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent. OBJECTIVE We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus. DESIGN Longitudinal analysis of a retrospective cohort. SUBJECTS A national cohort of 1,263,906 Veterans with type 2 diabetes. Subjects with evidence of homelessness were identified using a combination of diagnostic and administrative codes. MAIN MEASURES Odds for poor glycemic control using hemoglobin A1C (HbA1C) cutoff values of 8 % and 9 %. Homeless defined as a score based on the number of indicator variables for homelessness within a veterans chart. KEY RESULTS Veterans with evidence of homelessness had a significantly greater annual mean HbA1C ≥ 8 (32.6 % vs. 20.43 %) and HbA1C ≥ 9 (21.4 % vs. 9.9 %), tended to be younger (58 vs. 67 years), were more likely to be non-Hispanic black (39.1 %), divorced (43 %) or never married (34 %), to be urban dwelling (88.8 %), and to have comorbid substance abuse (46.7 %), depression (42.3 %), psychoses (39.7 %), liver disease (18.8 %), and fluid/electrolyte disorders (20.4 %), relative to non-homeless veterans (all p < 0.0001). Homelessness was modeled as an ordinal variable that scored the number of times a homelessness indicator was found in the Veterans medical record. We observed a significant interaction between homelessness and race/ethnicity on the odds of poor glycemic control. Homelessness, across all racial-ethnic groups, was associated with increased odds of uncontrolled diabetes at a cut-point of 8 % and 9 % for hemoglobin A1C ; however, the magnitude of the association was greater in non-Hispanic whites [8 %, OR 1.55 (1.47;1.63)] and Hispanics [8 %, OR 2.11 (1.78;2.51)] than in non-Hispanic blacks [8 %, OR 1.22 (1.15;1.28)]. CONCLUSIONS Homelessness is a significant risk factor for uncontrolled diabetes in Veterans, especially among non-Hispanic white and Hispanic patients. While efforts to engage homeless patients in primary care services have had some success in recent years, these data suggest that broader efforts targeting management of diabetes and other chronic medical conditions remain warranted.
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Affiliation(s)
- R Neal Axon
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Division of General Internal Medicine, Department of Medicine, The Medical University of South Carolina, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Public Health Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Clara E Dismuke
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Division of General Internal Medicine, Department of Medicine, The Medical University of South Carolina, Charleston, SC, USA
| | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Public Health Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Derik Yeager
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Elizabeth J Santa Ana
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry, The Medical University of South Carolina, Charleston, SC, USA
| | - Leonard E Egede
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
- Division of General Internal Medicine, Department of Medicine, The Medical University of South Carolina, Charleston, SC, USA.
- Center for Health Disparities Research Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC, 29425-0593, USA.
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Hemingway S, Stephenson J, Trotter F, Clifton A, Holdich P. Increasing the health literacy of learning disability and mental health nurses in physical care skills: a pre and post-test evaluation of a workshop on diabetes care. Nurse Educ Pract 2014; 15:30-7. [PMID: 25547647 DOI: 10.1016/j.nepr.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 06/17/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
This paper presents the pre- and post-test results of the outcomes of a workshop designed to increase learning disability and mental health nurses' knowledge and skill to undertake interventions for service users at risk of, or with a diagnosis of, type 2 diabetes. Health literacy is also discussed as a way of explaining why such nurses may lack expertise in physical health care. Findings from the workshop show that learning disability and mental health nurses have the motivation to increase their health literacy (skills and knowledge) in diabetes care. The potential of such workshops, and how organisations looking forward to the future can build health literacy, is discussed.
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Affiliation(s)
- Steve Hemingway
- School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
| | - John Stephenson
- School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - Fiona Trotter
- School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
| | - Andrew Clifton
- School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
| | - Phillip Holdich
- School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
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Egede LE, Gebregziabher M, Zhao Y, Dismuke CE, Walker RJ, Hunt KJ, Axon RN. Impact of mental health visits on healthcare cost in patients with diabetes and comorbid mental health disorders. PLoS One 2014; 9:e103804. [PMID: 25083903 PMCID: PMC4118960 DOI: 10.1371/journal.pone.0103804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/25/2014] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To assess the impact of mental health visits (MHV) on the cost of care for Veterans with diabetes and comorbid mental health conditions. METHODS A national cohort of 120,852 Veterans with diabetes and at least one mental health diagnosis (i.e., substance abuse, depression or psychoses) in 2002 was followed through 2006. Outcomes were pharmacy, inpatient and outpatient costs in 2012 dollars. RESULTS Least-square covariate adjusted estimates from the joint model of total VA costs of the number of MHV using December 31, 2012 value dollars indicate that relative to those with fewer MHV, those with 3+ MHV had the lowest mean inpatient cost ($21,406), but the highest mean outpatient and pharmacy cost ($9,727 and $2,015, respectively). If all Veterans who received zero MHV actually received 3+ MHV, we estimate through simulated scenarios that between $32,272,329 and $181,460,247 in inpatient costs would be saved. However, these savings would be offset by additional expenditures of between $1,166,017,547 and $1,166,224,787 in outpatient costs and between $151,604,683 and $161,439,632 in pharmacy costs. CONCLUSIONS Among Veterans with diabetes and comorbid mental disorders having three or more mental health visits is associated with marginally decreased inpatient cost, but these potential savings seem to be offset by increased outpatient and pharmacy costs.
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Affiliation(s)
- Leonard E. Egede
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Yumin Zhao
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Clara E. Dismuke
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Rebekah J. Walker
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Kelly J. Hunt
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - R. Neal Axon
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
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Hultsjö S, Syren S. Beliefs about health, health risks and health expectations from the perspective of people with a psychotic disorder. Open Nurs J 2013; 7:114-22. [PMID: 24039643 PMCID: PMC3771229 DOI: 10.2174/1874434601307010114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 06/11/2013] [Accepted: 06/29/2013] [Indexed: 12/01/2022] Open
Abstract
AIM To examine beliefs about health, health risks and health expectations from the perspective of people diagnosed with a psychotic disorder. BACKGROUND People with psychotic disorders have a threefold higher risk of developing physical health problems than the general population, and prevention of these problems is warranted. Examining patients´ health beliefs could help deepen our understanding of how to plan successful health interventions with this group. METHODS Qualitative semi-structured interviews were conducted from November 2010 to October 2011 with 17 people with psychotic disorders. Data were analyzed using a qualitative content analysis. RESULTS An overall positive picture of health was found despite the fact that physical health was found to be hard to verbalize and understand. Health was mainly associated with psychological wellbeing, while health risks were found to be related to uncertain bodily identity, troublesome thoughts and inner voices, and exclusion from society. Interest in learning, and visions and goals of health seemed to increase awareness of health risks and health expectations, while not worrying could be viewed as a hindrance for health expectations. CONCLUSION There is a lack of expressed awareness of physical health risks, but such awareness is fundamental to performing life-style changes [14]. Nurses thus have an important task to help patients understand and verbalize potential physical health risks, and to find out what motivates them to adopt health behaviors.
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Affiliation(s)
- Sally Hultsjö
- Psychiatric Clinic, County Hospital, Ryhov, S-551 85 Jönköping, Sweden
| | - Susanne Syren
- Linnaeus University, Department of Health and Science, S-351 95 Växjö, Sweden
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Abstract
Mental health service provision has traditionally been dominated by biomedical models of illness and disorder, a problem-based orientation, and the assessment and management of risk. While psychotherapeutic approaches are numerous and have been widely utilized, psychotropic medications, either as monotherapy or in conjunction with psychological therapies, remain the mainstay for the 'treatment' of mental health problems. This is despite growing uncertainty over the effectiveness of psychotropic medications (particularly antidepressants), as well as their potential for enduring and debilitating side-effects. This discussion paper outlines the emerging field of positive health, which eschews a psychiatric disorder and illness focus, and is instead oriented towards the identification of strengths, abilities, hopes, and the individual's preferred future. The shift in positive health, from illness towards wellness, aims to build health literacy and the capacity of individuals to make decisions conducive to health, and thereby make more effective the use of health-care services. A positioning of mental health nursing practice within a positive health paradigm is promoted. By illustration, a number of solution-focused mental health assessment questions are tabled to contrast the current format for mental health assessment, which rather than being 'comprehensive', is predominantly concerned only with problem and risk identification, and the search for pathology in the individual.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Hultsjö S, Hjelm K. Community health-care staff's experiences of support to prevent type 2 diabetes among people with psychosis: an interview study with health staff. Int J Ment Health Nurs 2012; 21:480-9. [PMID: 22616560 DOI: 10.1111/j.1447-0349.2012.00820.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the study was to describe mental health staff experiences of giving support to prevent type 2 diabetes mellitus (DM) among people with psychosis in community psychiatry. A qualitative interview study with a purposeful sample of 12 community health staff was conducted. Data were analysed using qualitative content analysis. The results show how staff reported continuously supporting people with psychosis to adapt to healthy lifestyles, but stated that support is not given until after a person becomes overweight or is diagnosed with type 2 DM. Support was described as a never-ending process of motivation facing many reverses. Individually-adapted support given in practical situations was perceived as most successful. Cooperation between health-care organizations was seen as essential, but inadequate. Limitations in income and social network, and easy access to fast food and alcohol, were seen as obstacles to support. The results indicate that community health staff are in a position to make a considerable impact in motivating and supporting healthy lifestyle changes in practical situations in daily life among people with psychosis. This study raises awareness of how community health staff's support can be useful when developing nursing skills and health-care plans for people with psychosis.
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Affiliation(s)
- Sally Hultsjö
- Psychiatric Clinic, County Hospital, Ryhov, Jonkoping, Sweden.
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