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Reay M, Holliday J, Stewart J, Adams J. Creating a care pathway for patients with longstanding, complex eating disorders. J Eat Disord 2022; 10:128. [PMID: 36038898 PMCID: PMC9421634 DOI: 10.1186/s40337-022-00648-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery rates for people with eating disorders are low; fewer than half recover and approximately 20% develop a longstanding eating disorder. Patients with longstanding eating disorders are often referred to as "SEED" (severe and enduing eating disorders) although this remains controversial and is not acknowledged in the British treatment guidance. This project aimed to generate recommendations for a longstanding eating disorder care pathway by identifying what proportion of patients have longstanding eating disorders and how to best identify and support them. METHODS Initially, a literature review was completed, followed by interviews with service-users who consider themselves to have longstanding eating disorders, and focus groups with staff members. The results were combined to create a definition of a longstanding eating disorder which was used to establish how many service-users could benefit from the pathway. The qualitative data was used to produce recommendations for a tailored pathway for those with longstanding eating disorders. RESULTS The results highlighted that, although "SEED" is often used, participants preferred to be referred to as "longstanding" or having no label. Qualitative analysis identified four themes in relation to supporting this population group which described how to structure the service and individualise care, as well as patients' relationship to the service, and how to build a life after eating disorder services. CONCLUSIONS Recommendations included promoting a hopeful message, focusing on quality of life and introducing peer support. Crucially, accessing the pathway should not result in being labelled "SEED", nor should it prevent access to recovery focused interventions including weight restoration. The full list of recommendations are included as well as the implications of the project and limitations.
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Affiliation(s)
- Megan Reay
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | | | - Joanna Adams
- The Oxford Institute for Clinical Psychology Training and Research, Oxford, UK
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2
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Rizzo D, Mu T, Cotroneo S, Arunogiri S. Barriers to Accessing Addiction Treatment for Women at Risk of Homelessness. Front Glob Womens Health 2022; 3:795532. [PMID: 35252964 PMCID: PMC8893170 DOI: 10.3389/fgwh.2022.795532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
Women remain under-represented in addiction treatment, comprising less than a third of clients in treatment services. Shame, stigma, and fear of legal and social repercussions (e.g., child protection involvement) are major barriers impacting on treatment-seeking for women. This is compounded for women at risk of homelessness, with practical and logistical reasons for not engaging in treatment. We conducted a qualitative study with both clinicians and service-providers, and women with lived experience of addiction and at risk of homelessness, to identify barriers to access and help-seeking within this vulnerable population. Adult women with lived experience of homelessness and addiction were invited to participate in an online focus group. Interviews were transcribed and analyzed using framework analysis. Analysis resulted in the identification of barriers to access in three areas. These were system-related, socio-cultural, and emotional barriers. We also present findings from the focus group recorded in real-time, using the novel method of digital illustration. This study highlights key factors impacting on help-seeking and access to treatment for addiction faced by women at risk of homelessness. The findings of this study highlight important areas of consideration for clinicians and service-providers working with women who experience addiction, as well as informing future research directions for this priority population. Findings are discussed in the context of exigent literature.
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Affiliation(s)
- Davinia Rizzo
- Faculty of Medicine, Nursing and Health Sciences, Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Richmond, VIC, Australia
- Turning Point, Eastern Health, Richmond, VIC, Australia
- *Correspondence: Davinia Rizzo
| | - Temika Mu
- Turning Point, Eastern Health, Richmond, VIC, Australia
| | | | - Shalini Arunogiri
- Faculty of Medicine, Nursing and Health Sciences, Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Richmond, VIC, Australia
- Turning Point, Eastern Health, Richmond, VIC, Australia
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3
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Bradley P, Lowell A, Daiyi C, Macklin K, Nagel T, Dunn S. It's a little bit like prison, but not that much: Aboriginal women's experiences of an acute mental health inpatient unit. Int J Ment Health Nurs 2021; 30:917-930. [PMID: 33630404 DOI: 10.1111/inm.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
This research aimed to gain an understanding of the acute mental health inpatient experience as described by Aboriginal women during admission. It recorded for the first time the words of Aboriginal women within the inpatient unit, including their perceptions of factors which may promote or impede a culturally safe environment. Eleven Aboriginal women inpatients gave interviews before discharge from the inpatient unit. Five Aboriginal Reference Group (ARG) members with experience of the inpatient unit also gave interviews, adding 'insider-outsider' perspectives. Interviews were recorded, transcribed, entered into NVivo software, and analysed inductively to raise codes and develop themes. Five interconnecting themes emerged: Social Context: life experience preceding, shaping, and following admission; Connection: with kin, community, and culture. Control: self-determination, legally and physically curtailed; Caring: actions promoting reconnection and self-determination; Communication: conveying caring and supporting agency, reconnection, and return to community. Findings reflected inpatient issues reported in previous studies, adding insights into the cultural concerns of Aboriginal women and offering practical clinical implications for culturally secure service delivery in an inpatient setting. Existing literature offered a basis for developing the model offered here for transcultural interaction for recovery in an inpatient setting. Attention to these findings can enhance Aboriginal women's inpatient experience and promote further research. The article complies with the COREQ-32 checklist for describing qualitative studies.
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Affiliation(s)
- Patricia Bradley
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Lowell
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cherise Daiyi
- Top End Mental Health & AOD Services, Darwin, Northern Territory, Australia
| | - Karen Macklin
- Top End Mental Health & AOD Services, Darwin, Northern Territory, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Sandra Dunn
- Charles Darwin University, Darwin, Northern Territory, Australia
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4
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Dickman NE, Chicas R. Nursing is never neutral: Political determinants of health and systemic marginalization. Nurs Inq 2021; 28:e12408. [PMID: 33651915 DOI: 10.1111/nin.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
The nursing community in the United States polarized in September 2020 between Dawn Wooten's whistleblowing about forced hysterectomies at an immigration center in Georgia and the American Nurses Association's refusal to endorse a presidential candidate despite the Trump administration's mounting failures to address the public health crisis posed by the COVID-19 pandemic. This reveals a need for more attention to political aspects of health outcome inequities. As advocates for health equity, nurses can join in recent scholarship and activism concerning the political determinants of health. In this paper, we examine recent work on the political determinants of health with an aim to add two things. First, we seek to build further on the notion of "political" determinants of health by distinguishing policy and governance structures from dynamics of politicization through appeal to critical disabilities studies. Second, we seek to apply this further nuanced approach to challenge rhetorical uses of "vulnerable populations," where this phrase serves to misrecognize systemic institutionalized forces that actively exploit and marginalize people and groups. By refocusing attention to political systems organized around and perpetuating inequitable health outcomes, nurses and other health care professionals-as well as those whom they serve-can concentrate their effort and power to act on political determinants of health in bringing about more equitable health outcomes.
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Affiliation(s)
- Nathan Eric Dickman
- Humanities and Fine Arts Division, University of the Ozarks, Clarksville, AR, USA
| | - Roxana Chicas
- Emory University School of Medicine, Atlanta, GA, USA
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Affiliation(s)
- Piyush Pushkar
- Department of Social Anthropology, University of Manchester, Manchester, UK
| | - Louise Tomkow
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
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6
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Women and Stigma: A Protocol for Understanding Intersections of Experience through Body Mapping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155432. [PMID: 32731565 PMCID: PMC7432432 DOI: 10.3390/ijerph17155432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/02/2022]
Abstract
This paper outlines a research and dissemination protocol to be undertaken with specific groups of marginalised women in Australia. Women impacted by significant mental distress, disability, or refugee status are among society’s most vulnerable and disenfranchised groups. They can experience significant social exclusion, marginalisation and stigma, associated with reduced help seeking, deprivation of dignity and human rights, and threats to health, well-being and quality of life. Previous research has assessed the experiences of discrete groups of women but has to date failed to consider mental health–refugee–disability intersections and overlaps in experience. Using body mapping, this research applies an intersectional approach to identify how women impacted by significant mental distress, disability, and refugee status negotiate stigma and marginalisation. Findings on strategies to cope with, negotiate and resist stigmatised identities will inform health policy and yield targeted interventions informed by much-needed insights on women’s embodied experience of stigma. The women’s body maps will be exhibited publicly as part of an integrated knowledge translation strategy. The aim is to promote and increase sensitivity and empathy among practitioners and policy makers, strengthening the basis for social policy deliberation.
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8
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McGeechan GJ, James B, Burke S. 'Well that's the most ridiculous thing I have ever heard! No excuse'. A discourse analysis of social media users' othering of non-attenders for cervical screening. Psychol Health 2020; 36:290-306. [PMID: 32456477 DOI: 10.1080/08870446.2020.1772258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: For women cervical cancer is the fourth most commonly diagnosed cancer worldwide, incidences of which have increased by 20% in the UK in two decades. A growing number of people access health information online and as such health promotion campaigns are utilising social media to reach wider audiences.Design: This study adopts a discourse analysis approach to analysing online interactions in relation to cervical cancer screening campaigns. Data were collected from Facebook and Twitter between August 2017 and August 2018.Results: Three approaches in the discursive strategy of othering were identified: (1) Cervical cancer screening presented as an easy, and obvious choice; (2) Footing and the use of statistics to add credibility to posts; (3) Morality positioning and shaming of non-attenders. The findings suggest that in response to such campaigns there is an element of online 'othering' in terms of shaming non-attenders and attempting to delegitimise reasons for non-attendance.Conclusion: Whilst health promotion campaigns should be designed to empower individuals to make informed choices, at times they can lead to stigmatisation of those who do not conform. Future campaigns should focus more on understanding the reasons why women do not attend without dismissing them.
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Affiliation(s)
- Grant J McGeechan
- Centre for Applied Psychological Sciences, Teesside University, Middlesbrough, UK
| | | | - Shani Burke
- Centre for Applied Psychological Sciences, Teesside University, Middlesbrough, UK
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9
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Perry A, Lawrence V, Henderson C. Stigmatisation of those with mental health conditions in the acute general hospital setting. A qualitative framework synthesis. Soc Sci Med 2020; 255:112974. [PMID: 32388323 DOI: 10.1016/j.socscimed.2020.112974] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/26/2020] [Accepted: 03/29/2020] [Indexed: 01/22/2023]
Abstract
RATIONALE Patients with long-term mental health conditions often have complex physical, mental, and social needs. They are frequent users of the acute general healthcare system, but can experience stigmatising attitudes and behaviours, and structural discrimination. We wished to improve understanding of stigmatisation in the acute healthcare setting, to target areas for future intervention. OBJECTIVE A synthesis of qualitative literature was undertaken in order to understand how patients with long-term mental health conditions are stigmatised, or otherwise treated, within the acute healthcare system. METHOD A theory-driven framework approach was implemented. Existing stigma theory was used to outline a framework for categorizing stigmatising and non-stigmatising phenomena within the acute healthcare system. RESULTS A systematic literature search of qualitative studies identified a sample of 51 studies that would inform the framework. Using data in these studies, a final theoretical 'best fit' framework was developed. In this framework there is an overarching pattern of labelling and stereotyping, plus five ways in which patients with mental health conditions are stigmatised in the acute healthcare system: devaluation, social control, avoidance, rejection, and failure to act. In addition, the framework outlines positive attitudes and behaviours - valuing, adjustment, responding, legitimising, and positive action - which contrast with the stigmatisation patterns. CONCLUSIONS The study offers a framework for identifying stigmatisation and positive treatment of those with mental health conditions in an acute health setting. This framework is of potential value in targeting areas for improved quality of care and may have utility beyond this setting and stigmatised group.
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Affiliation(s)
- Amanda Perry
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vanessa Lawrence
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Claire Henderson
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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10
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Baah FO, Teitelman AM, Riegel B. Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An integrative review. Nurs Inq 2018; 26:e12268. [PMID: 30488635 DOI: 10.1111/nin.12268] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/29/2018] [Accepted: 09/15/2018] [Indexed: 11/29/2022]
Abstract
Scientific advances in health care have been disproportionately distributed across social strata. Disease burden is also disproportionately distributed, with marginalized groups having the highest risk of poor health outcomes. Social determinants are thought to influence health care delivery and the management of chronic diseases among marginalized groups, but the current conceptualization of social determinants lacks a critical focus on the experiences of people within their environment. The purpose of this article was to integrate the literature on marginalization and situate the concept in the framework of social determinants of health. We demonstrate that social position links marginalization and social determinants of health. This perspective provides a critical lens to assess the societal power dynamics that influence the construction of the socio-environmental factors affecting health. Linking marginalization with social determinants of health can improve our understanding of the inequities in health care delivery and the disparities in chronic disease burden among vulnerable groups.
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Affiliation(s)
- Foster Osei Baah
- NewCourtland Center for Transitions & Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Lavie-Ajayi M, Moran GS, Levav I, Porat R, Reches T, Goldfracht M, Gal G. Using the capabilities approach to understand inequality in primary health-care services for people with severe mental illness. Isr J Health Policy Res 2018; 7:49. [PMID: 30145980 PMCID: PMC6109982 DOI: 10.1186/s13584-018-0236-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological studies show disparities in the provision of physical health-care for people with severe mental illness. This observation includes countries with universal health insurance. However, there is limited in-depth data regarding the barriers preventing equality of physical health-care provision for this population. This study applied the capabilities approach to examine the interface between general practitioners and patients with severe mental illness. The capabilities approach provides a framework for health status which conceptualizes the internal and external factors relating to the available options (capabilities) and subsequent health outcomes (functioning). METHODS Semi-structured in-depth interviews were conducted with 10 general practitioners and 15 patients with severe mental illness, and then thematically analyzed. RESULTS We identified factors manifesting across three levels: personal, relational-societal, and organizational. At the personal level, the utilization of physical health services was impaired by the exacerbation of psychiatric symptoms. At the relational level, both patients and physicians described the importance of a long-term and trusting relationship, and provided examples demonstrating the implications of relational ruptures. Finally, two structural-level impediments were described by the physicians: the absence of continuous monitoring of patients with severe mental illness, and the shortfall in psychosocial interventions. CONCLUSION The capability approach facilitated the identification of barriers preventing equitable health-care provision for patients with severe mental illness. Based on our findings, we propose a number of practical suggestions to improve physical health-care for this population: 1. A proactive approach in monitoring patients' health status and utilization of services. 2. Acknowledgment of people with severe mental illness as a vulnerable population at risk, that need increased time for physician-patient consultations. 3. Training and support for general practitioners. 4. Increase collaboration between general practitioners and mental-health professionals. 5. Educational programs for health professionals to reduce prejudice against people with severe mental illness.
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Affiliation(s)
- Maya Lavie-Ajayi
- The Israeli Center for Qualitative Research of People and Societies, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel. .,The Spitzer Department of Social Work, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel.
| | - Galia S Moran
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | - Itzhak Levav
- Department of Community Mental Health, University of Haifa, 199 Aba Khoushy Ave, Haifa, Israel
| | - Rotem Porat
- The Israeli Center for Qualitative Research of People and Societies, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | - Tal Reches
- The Israeli Center for Qualitative Research of People and Societies, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | | | - Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
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12
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Kim Y, Dee V. Self-Care for Health in Rural Hispanic Women at Risk for Postpartum Depression. Matern Child Health J 2018; 21:77-84. [PMID: 27435729 DOI: 10.1007/s10995-016-2096-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine factors that affect self-care of rural Hispanic women at risk for postpartum depression (PPD). METHODS This study was a descriptive cross-sectional design based on the key concepts of Orem's Self-care Deficit Nursing theory. Data were collected from 223 Hispanic postpartum women residing in Mecca, North Shore, and Thermal in California by an interviewer-administered survey. Four instruments were utilized: Edinburgh Postnatal Depression Scale (EPDS) for PPD, Multidimensional Scale of Perceived Social Support for social support, Duke University Religion Index (DUREL) for spirituality, and Self Rated Abilities for Health Practices for self-care. RESULTS The prevalence of women at risk for PPD was about 43 %. Social support, spirituality, and self-care ability were significantly correlated in women with PPD. Social support was a strong factor in predicting self-care ability for 'Nutrition', 'Psychological well-being', 'Exercise', and 'Responsible Health Practices' in the rural Hispanic women at risk for PPD. CONCLUSIONS The study findings can enable nurses and healthcare professionals to develop effective tailored interventions to assist rural Hispanic women's abilities to perform self-care for health, and in particular, during the postpartum period.
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Affiliation(s)
- Younglee Kim
- California State University San Bernardino, 5500 University Pkwy, San Bernardino, CA, 92407, USA.
| | - Vivien Dee
- Nursing Program, Azusa Pacific University, 901 E Alosta Ave, Azusa, CA, 91702, USA
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13
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McEvoy P, Williamson T, Kada R, Frazer D, Dhliwayo C, Gask L. Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness. BMC Health Serv Res 2017; 17:557. [PMID: 28806946 PMCID: PMC5557521 DOI: 10.1186/s12913-017-2509-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 08/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England. Methods A combination of qualitative and quantitative data were drawn upon including naturally occurring data, observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as well as written feedback and recorded discussions with 12 key informants. Results Improvements in access to mental health care for some people from the Orthodox Jewish community were achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding, power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process of dialogic engagement the team was able to work with the community to develop a bespoke service that accommodated its wish to maintain a distinct sense of cultural otherness. Conclusions This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy, concordance and recursivity that are associated with improvements in access to care in under-served sections of the population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of community engagement. However, the full alignment of the goals of differing constituencies may not always be possible, due the complex interaction between the multiple positions and understandings of stakeholders that are involved and the need to respect the other’-s’ autonomy. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2509-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Phil McEvoy
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom.
| | - Tracey Williamson
- University of Salford, School of Nursing, Midwifery, Social Work & Social Sciences, Mary Seacole Building, Frederick Road Campus, Salford, M6 6PU, United Kingdom
| | - Raphael Kada
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Debra Frazer
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Chardworth Dhliwayo
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Linda Gask
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
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14
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Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice. Br J Gen Pract 2016; 65:e813-21. [PMID: 26622034 DOI: 10.3399/bjgp15x687853] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. AIM To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK. DESIGN AND SETTING Realist review in general practice. METHOD A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. RESULTS Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship. CONCLUSION Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction.
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15
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Rogers ES, Maru M, Kash-MacDonald M, Archer-Williams M, Hashemi L, Boardman J. A Randomized Clinical Trial Investigating the Effect of a Healthcare Access Model for Individuals with Severe Psychiatric Disabilities. Community Ment Health J 2016; 52:667-74. [PMID: 27137507 DOI: 10.1007/s10597-016-0009-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
We conducted a randomized trial to examine a model for integrating primary care into a community mental health setting. Two hundred individuals were recruited and randomly assigned to receive primary care delivered by a nurse practitioner (n = 94) or services-as-usual (n = 106), assessed on health and mental health outcomes, and followed for 12 months. Intent-to-Treat and exposure analyses were conducted and suggest that participants who engaged with the nurse practitioner experienced gains in perceptions of primary care quality. Health benefits accrued for individuals having receiving nurse practitioner services in a mental health setting to address primary care needs.
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Affiliation(s)
- E Sally Rogers
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.
| | - Mihoko Maru
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Boston University School of Social Work, Boston, MA, USA
| | - Megan Kash-MacDonald
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Institute of Child Health, University College London (UCL), London, England
| | - Mariah Archer-Williams
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Sharp HealthCare, San Diego, CA, USA
| | - Lobat Hashemi
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave, West, Boston, MA, USA.,Genzyme, Sanofi, Boston, MA, USA
| | - Judith Boardman
- Northeast Health Systems/Health and Education Services, Inc., Beverly, MA, USA.,Salem State University, Salem, MA, USA
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16
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Vergunst R, Swartz L, Mji G, MacLachlan M, Mannan H. 'You must carry your wheelchair'--barriers to accessing healthcare in a South African rural area. Glob Health Action 2015; 8:29003. [PMID: 26434691 PMCID: PMC4592846 DOI: 10.3402/gha.v8.29003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/22/2015] [Accepted: 09/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background There is international evidence that people with disabilities face barriers when accessing primary healthcare services and that there is inadequate information about effective interventions that work to improve the lives of people with disabilities, especially in low-income and middle-income countries. Poor rural residents generally experience barriers to accessing primary healthcare, and these problems are further exacerbated for people with disabilities. Objective In this study, we explore the challenges faced by people with disabilities in accessing healthcare in Madwaleni, a poor rural Xhosa community in South Africa. Design Purposive sampling was done with 26 participants, using semi-structured interviews and content analysis to identify major themes. Results This study showed a number of barriers to healthcare for people with disabilities. These included practical barriers, including geographical and staffing issues, and attitudinal barriers. Conclusions It is suggested that although there are practical barriers that need to be addressed, attitudinal barriers could potentially be addressed more easily and cost effectively.
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Affiliation(s)
- Richard Vergunst
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa;
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Malcolm MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa.,Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Poreddi V, Thimmaiah R, Math SB. Attitudes toward people with mental illness among medical students. J Neurosci Rural Pract 2015; 6:349-54. [PMID: 26167018 PMCID: PMC4481789 DOI: 10.4103/0976-3147.154564] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Globally, people with mental illness frequently encounter stigma, prejudice, and discrimination by public and health care professionals. Research related to medical students’ attitudes toward people with mental illness is limited from India. Aim: The aim was to assess and compare the attitudes toward people with mental illness among medical students’. Materials and Methods: A cross-sectional descriptive study design was carried out among medical students, who were exposed (n = 115) and not exposed (n = 61) to psychiatry training using self-reporting questionnaire. Results: Our findings showed improvement in students’ attitudes after exposure to psychiatry in benevolent (t = 2.510, P < 0.013) and stigmatization (t = 2.656, P < 0.009) domains. Further, gender, residence, and contact with mental illness were the factors that found to be influencing students’ attitudes toward mental illness. Conclusion: The findings of the present study suggest that psychiatric education proved to be effective in changing the attitudes of medical students toward mental illness to a certain extent. However, there is an urgent need to review the current curriculum to prepare undergraduate medical students to provide holistic care to the people with mental health problems.
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Affiliation(s)
| | - Rohini Thimmaiah
- Department of Psychiatry, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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18
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Ion A, Elston D. Examining the Health Care Experiences of Women Living with Human Immunodeficiency Virus (HIV) and Perceived HIV-Related Stigma. Womens Health Issues 2015; 25:410-9. [PMID: 26025423 DOI: 10.1016/j.whi.2015.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 03/17/2015] [Accepted: 03/23/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The increased incidence of human immunodeficiency virus (HIV) in women, particularly marginalized women, prompted research to examine women's health service experiences at a local outpatient clinic. METHODS A qualitative case study using semistructured interviews examined facilitators and barriers to health care services. Seventeen women living with HIV who accessed care at an outpatient HIV clinic in central west Ontario were interviewed. Thematic analysis was used to code health care experiences perceived as HIV-related stigma. RESULTS Women perceived HIV-related stigma when health care providers lacked basic HIV knowledge and failed to uphold the ethical principles of patient-provider relationships, resulting in women's disengagement from health care. CONCLUSIONS We propose a community-based participatory research framework to reform health care educational curriculum toward a culture of health care safety that is inclusive of people living with HIV.
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Affiliation(s)
- Allyson Ion
- McMaster University, School of Social Work, Hamilton, Ontario, Canada.
| | - Dawn Elston
- McMaster University, School of Nursing, Hamilton, Ontario, Canada.
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19
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Happell B, Platania-Phung C, Scott D. What determines whether nurses provide physical health care to consumers with serious mental illness? Arch Psychiatr Nurs 2014; 28:87-93. [PMID: 24673781 DOI: 10.1016/j.apnu.2013.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
People with serious mental illness (SMI) have heightened rates of chronic physical disease. This study aimed to identify what nurse and organisational factors predict physical health care provided by nurses in contact with consumers with SMI, through a survey in Australia (N=643). Statistical analyses revealed that physical health care could be accounted for in terms of nurse views on consumer health, rights and nurse role ideal ('nurses should be involved in physical health care'), and organisational factors. However, organisational factors may be more important in determining physical health care than views and perceptions about consumers, roles and ideals.
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Affiliation(s)
- Brenda Happell
- Central Queensland University, Centre for Mental Health Nursing Innovation, Institute for Health and Social Science Research, Bruce Hwy, Rockhampton, Queensland, 4702, Australia.
| | - Chris Platania-Phung
- Central Queensland University, Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation.
| | - David Scott
- Central Queensland University, Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, and School of Nursing and Midwifery.
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20
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Roscigno CI. Challenging nurses' cultural competence of disability to improve interpersonal interactions. J Neurosci Nurs 2013; 45:21-37. [PMID: 23291869 PMCID: PMC3609418 DOI: 10.1097/jnn.0b013e318275b23b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Worldwide, at least 6.9 billion people have an impairment-producing health condition. Insensitive encounters with healthcare providers (HCPs) can result in negative appraisals, fear, and avoidance, but little is known about what things are commonly perceived as insensitive. A review of published narratives describing negative encounters with HCPs was conducted. Narrative analysis was used to compare, contrast, and synthesize six themes describing the common negative encounters: (a) ignoring or minimizing their knowledge, (b) detached interpersonal interactions, (c) placing a negative skew on their life quality, (d) lack of HCP knowledge related to their complete needs, (e) assuming they should be asexual and childless, and (f) an inherent power differential. The medical model of disability is perceived by individuals with impairment-producing health conditions to inform negative encounters perceived as insensitive. This preliminary knowledge is important so we can address educational needs, plan future research questions, and establish clinical practice improvements.
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Affiliation(s)
- Cecelia I Roscigno
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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21
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A qualitative study: barriers and facilitators to health care access for individuals with psychiatric disabilities. Psychiatr Rehabil J 2011; 34:285-294. [PMID: 21459744 DOI: 10.2975/34.4.2011.285.294] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This qualitative study was conducted as part of a larger randomized trial to examine barriers and facilitators to accessing and providing comprehensive primary health care for individuals with serious mental illnesses. We examined the perspectives of administrators and providers in a behavioral health organization surrounding the use of a nurse practitioner model of delivering primary healthcare. METHODS Ten key informant interviews were conducted and analyzed using qualitative data analysis software. Concepts and themes regarding access to and delivery of primary healthcare were inductively derived from the data. RESULTS Results confirmed significant issues related to chronic physical health problems among individuals with psychiatric disabilities and detailed a host of barriers to receiving health care as well as the perceived benefits of the nurse practitioner intervention. Financial challenges played a significant role in the organization's ability to make primary and mental health care integration a sustainable endeavor. In addition, staff faced increased burdens on their time due to adding a focus on physical health to their existing job duties. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE A nurse practitioner stationed in a behavioral healthcare setting is viewed by administrators and providers as extremely beneficial in addressing issues of access to comprehensive and integrated primary healthcare for individuals with severe psychiatric disabilities but sustaining such a model of care is not without organizational challenges.
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Abstract
Stigmatising attitudes are not uncommon among mental health professionals who may be less than optimistic about outcomes for people with long-term mental health problems. These perceptions are probably related to the professionals' experiences, such as those working in the public sector dealing with clients in the most disturbed phases of mental illness. We provide an overview of stigma and some contemporary stigma conceptualisations and then explore some stigma-reducing strategies for mental health professionals. The way that mental health professionals work with patients can have an important effect on their recovery.
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Affiliation(s)
- Jan Horsfall
- Sydney South West Area Mental Health Service, Concord Hospital, Sydney, Australia
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