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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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Meepring S, Gray R, Li X, Chien WT, Li Y, Ho GWK, Kritkitrat P, Bressington D. Evaluating the efficacy of the Thai Health Improvement Profile intervention for preventing weight gain in people with early stage psychosis: A randomized controlled trial. Int J Nurs Stud 2023; 146:104570. [PMID: 37597457 DOI: 10.1016/j.ijnurstu.2023.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES To investigate the efficacy of the Thai Health Improvement Profile intervention for preventing clinically significant weight gain in people with early stage psychosis. METHODS We undertook a randomised controlled trial from 10/2018 to 05/2021. Participants with early stage psychosis (<5 year duration) were recruited using convenience sampling from the caseloads of community psychiatric nurses in Thailand and randomly allocated to either the Thai Health Improvement Profile intervention or treatment as usual group following baseline assessment. Outcome assessors were blind to group allocation, whereas participants were not. Participants in the intervention group received three monthly (five in total) systematic health checks using the Thai Health Improvement Profile tool, which was used to develop a personal health plan in collaboration with a family member/carer. Nurses supported participants to implement the health plan using behaviour change techniques derived from motivational interviewing. The treatment as usual group consisted of medication and psychosocial support, and no additional intervention was provided. The primary outcome was weight gain (defined as a greater or equal to 7 % increase in weight against baseline) within 1 year. RESULTS Fifty-three participants were allocated to the intervention and an equal number to the treatment as usual group. Primary outcome data were available for 30 participants in each group at the 12 month follow-up. We undertook an intention to treat analysis with multiple imputation (to handle the missing data) for the primary outcome. The treatment as usual group was found to have higher odds than the Thai Health Improvement Profile intervention group of gaining ≥7 % of baseline body weight (OR = 6.52; 95 % CI: 1.88-22.65, p = 0.004). CONCLUSIONS The Thai Health Improvement Profile intervention was effective at preventing weight gain in people with early stage psychosis at one year, though attrition was relatively high. The results highlight the need for community mental health nurses to adopt a holistic approach, the potential benefits of conducting regular comprehensive health checks and the importance of involving family members when aiming to improve the physical health of people diagnosed with early stage psychosis. A large definitive multi-site randomised controlled trial of the Thai Health Improvement Profile with a longer follow-up is now justified. TRIAL REGISTRATION Prospectively registered with the Thai Clinical Trials Registry (reference: TCTR20180305002).
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Affiliation(s)
| | | | - Xia Li
- La Trobe University, Melbourne, Australia
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Preeyakamon Kritkitrat
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros road, SriPhum District, Chiang Mai 50200, Thailand
| | - Daniel Bressington
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros road, SriPhum District, Chiang Mai 50200, Thailand; Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin 0810, Australia.
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Bos D, Gray R, Meepring S, White J, Foland K, Bressington D. The Health Improvement Profile for people with severe mental illness: Feasibility of a secondary analysis to make international comparisons. J Psychiatr Ment Health Nurs 2022; 29:86-98. [PMID: 33655576 DOI: 10.1111/jpm.12748] [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] [Received: 06/28/2020] [Revised: 12/05/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates. No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: It appears feasible to use the HIP to profile and compare physical health-related risks in people with SMI across different international settings. The HIP tool identified significant differences in areas of risk across the four countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The HIP could be used to identify unique clusters of health promotion needs in different countries. Use of HIP health checks may support implementation of individualized interventions. ABSTRACT: Introduction To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi-national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources.
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Affiliation(s)
- Dawn Bos
- School of Nursing, Winona State University, Rochester, MN, USA
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
| | | | - Jacquie White
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Kay Foland
- School of Nursing, South Dakota State University, Brookings, SD, USA
| | - Daniel Bressington
- College of Nursing & Midwifery, Charles Darwin University, Darwin, NT, Australia
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Beks H, Walsh SM, Binder MJ, Jones M, Versace VL. Contribution of nurse leaders to rural and remote health research in Australia: A non-systematic scoping review. Collegian 2021. [DOI: 10.1016/j.colegn.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Brown T, May A, Beverley-Stone M. The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings. J Psychiatr Ment Health Nurs 2020; 27:628-639. [PMID: 32037667 DOI: 10.1111/jpm.12616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The Health Improvement Profile (HIP) is a one-page form developed in the United Kingdom as a tool for mental health nurses to assess service user's physical health needs. The HIP screens service users' physical health and provides recommendations that clinicians can provide service users with in order to improve their physical health. There was evidence supporting the effectiveness of the HIP; however, the majority of HIP studies to date involve the screening tool being completed by nurses. In Australia, a large proportion of mental health clinicians providing case management to service users in community settings are not nurses. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper shows that the HIP can be adjusted to suit the needs of Australian service users and can be utilized by clinicians from a variety of disciplines. It also shows that both clinicians and Australian service users find the HIP helpful and argues for it being made available for all service users. It has clearly shown a need to target flu vaccine programmes at service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The HIP has been shown to be a suitable and acceptable screening tool for different clinicians to assess multiple lifestyle risk factors at once, which can be used across different diagnoses and settings. This study, for example, demonstrated a need to focus on promoting the flu vaccine and smoking cessation, as well as encouraging service users to visit eye and dental health services. ABSTRACT: Introduction Health Improvement Profile (HIP) studies to date primarily focused on the screening tool being completed by nurses. This paper explores the HIP in two different settings, with an emphasis on expanding physical health roles for all mental health clinicians. Aim The aim of the present study was to adapt the HIP to Australian standards and implement it at a large mental health service. Method This is an evaluation of the implementation of the HIP over a two-month pilot period. Clinicians and service users were surveyed on their experience of the HIP. Results The community team completed the HIP with 34 (15%) service users. The inpatient unit completed the HIP with 137 (54%) service users. Results from the HIP clearly show priority areas for health interventions. Feedback from clinicians and service users was predominately positive. Discussion We found the HIP to be an acceptable screening tool that encompasses multiple lifestyle risk factors. Implications for practice This study clearly demonstrates the utility of the HIP as a workable and acceptable screening tool with real world applicability. In our pilot, for example, we identified the need for the promotion of influenza vaccinations amongst service users, as well as the ongoing need to target smoking cessation and substance use.
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Affiliation(s)
- Trudy Brown
- Northern Area Mental Health Service, The Northern Hospital, Epping, Vic., Australia.,NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Alexis May
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Mid West Area Mental Health Service, Sunshine, Vic., Australia
| | - Matthew Beverley-Stone
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Mid West Area Mental Health Service, Sunshine, Vic., Australia
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Muyambi K, Leach M, Martinez L, Cronin K, McPhail R, Dennis S, Walsh S, Gray R, Jones M. Rural and metropolitan South Australian mental health workers' views about nurse prescribing: A thematic analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:356-365. [PMID: 30198070 DOI: 10.1111/hsc.12653] [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] [Received: 11/07/2017] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Almost one third of the South Australian population reside in regional locations, which are serviced by just 8% of the State's total psychiatrist workforce. Consequently, access to psychotropic medications in regional South Australia (SA) can be challenging. Granting prescribing rights to mental health nurses (MHNs) located in regional settings presents an opportunity to increase consumer access to psychotropic medications. The aim of the study was to understand the perspectives of mental health workers (MHWs) practising in regional and metropolitan settings towards MHN prescribing. The study adopted a qualitative approach. Seventeen MHWs participated in three focus groups, including two in regional SA and one in a metropolitan site within the State of SA. Participants reported difficulties in accessing medicines in regional areas. The regional focus groups indicated that MHN prescribing may help to release psychiatrists' time and provide quicker assessment and diagnosis. By contrast, the metropolitan focus group expressed reservations about MHN prescribing. Participants indicated that suitable governance structures supported by appropriate education programmes were a necessary prerequisite for MHN prescribing of psychotropic medications. MHN prescribing may help to mitigate the impact of psychiatrist shortages in regional South Australia and possibly in other areas of the world where recruitment is a challenge. The provision of adequate education and the establishment of a suitable governance and support framework are considered necessary steps to progress MHN prescribing.
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Affiliation(s)
- Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA, Australia
| | - Matthew Leach
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA, Australia
| | - Lee Martinez
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA, Australia
| | - Kathryn Cronin
- Country Health SA Local Health Network for Mental Health, Adelaide, SA, Australia
| | - Ruth McPhail
- Country Health SA Local Health Network for Mental Health, Adelaide, SA, Australia
| | - Shaun Dennis
- Country Health SA Local Health Network for Mental Health, Adelaide, SA, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA, Australia
| | - Richard Gray
- La Trobe University and Healthscope, Melbourne, Vic., Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA, Australia
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Debyser B, Duprez V, Beeckman D, Vandewalle J, Van Hecke A, Deproost E, Verhaeghe S. Mental health nurses and mental health peer workers: Self-perceptions of role-related clinical competences. Int J Ment Health Nurs 2018; 27:987-1001. [PMID: 29194905 DOI: 10.1111/inm.12406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
Abstract
In a mental healthcare that embraces a recovery-oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role-related competences in clinical practice. The aim of this study was to clarify and understand these self-perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role-related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role-related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self-assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training.
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Affiliation(s)
- Bart Debyser
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Centre for Psychiatry and Psychotherapy Clinic St Joseph, Psychiatric Hospital, Pittem, Belgium
| | - Veerle Duprez
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Joeri Vandewalle
- Department of Public Health, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy Clinic St Joseph, Psychiatric Hospital, Pittem, Belgium
| | - Ann Van Hecke
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Nursing, Ghent University Hospital, Ghent, Belgium
| | - Eddy Deproost
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Centre for Psychiatry and Psychotherapy Clinic St Joseph, Psychiatric Hospital, Pittem, Belgium
| | - Sofie Verhaeghe
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
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Jones M, Ferguson M, Walsh S, Martinez L, Marsh M, Cronin K, Procter N. Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:356-363. [PMID: 29316000 DOI: 10.1111/hsc.12532] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
There are well-established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta-theme was "Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide." This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery.
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Affiliation(s)
- Martin Jones
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Monika Ferguson
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Lee Martinez
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | | | | | - Nicolas Procter
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
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Gray R, Hughes E, Bressington D. Multimorbidity in people with mental illness: translating evidence to practice. J Psychiatr Ment Health Nurs 2016; 23:245-6. [PMID: 27307260 DOI: 10.1111/jpm.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- R Gray
- Health Services and Population Research Centre, Hamad Medical Corporation, Doha, Qatar.
| | - E Hughes
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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