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Lennaerts-Kats H, Daeter L, Forkink A, Hukema RK, Bloem BR, Vissers KCP, Meinders MJ, Groot MM. Implementing Advance Care Planning and Care Coordination in the Care for People With Parkinson Disease: A Feasibility Study. J Neurosci Nurs 2024:01376517-990000000-00104. [PMID: 39151066 DOI: 10.1097/jnn.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
ABSTRACT BACKGROUND: For people with a moderate stage of Parkinson disease (PD), dedicated care coordination combined with advance care planning (ACP) is highly needed. However, evidence is lacking. The objective of this study was to assess the feasibility and acceptability of the study processes to inform a larger randomized controlled trial, aiming the effectiveness of a combined intervention on ACP and care coordination for people with PD. METHODS: Two nurse practitioners with expertise in PD followed training on a combined intervention on ACP and care coordination. Patients were invited to participate in several sessions for a period of 12 months. Feasibility of the study was surveyed covering sample recruitment, attrition rate, eligibility, intervention delivery, number of ACP sessions, type of intervention administration, and satisfaction with the intervention. RESULTS: In total, 27 patients were invited to participate, and 20 (74%) enrolled into the study, together with 11 family caregivers; 7 patients (35%) dropped out. Most patients were men (n = 20), with a mean age of 73.4 (SD 8.2) years. In total, 71 ACP sessions were held (3.6 sessions per patient on average), of which 41% of the sessions were conducted face-to-face at home, 44% at the hospital, 11% over telephone, and 4% via a videoconference call. Patients perceived the intervention not only as supportive but also as confronting. CONCLUSION: The ACP aspect of the intervention was useful and feasible to stimulate patients to think about their current care situation as well as about future care. Care coordination was less profoundly provided and discussed.
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Claessens G, Gerritzen I, van Osch F, van den Bergh JP, Verberne D, Gach D, van Balen E, van Heugten CM. Prevalence and predictors of persistent cognitive and psychological symptoms in non-hospitalized post-COVID-19 patients seeking care at an outpatient post-COVID-19 clinic. Front Psychol 2024; 15:1396963. [PMID: 39193035 PMCID: PMC11347444 DOI: 10.3389/fpsyg.2024.1396963] [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: 03/06/2024] [Accepted: 07/15/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes. Methods This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses. Results A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels (β = 0.217, p < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms (β = -0.325, p < 0.001), PTSS (β = -0.290, p < 0.001), and cognitive symptoms (β = -0.220, p < 0.001). Discussion Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches.
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Affiliation(s)
- Gisela Claessens
- Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands
| | - Iris Gerritzen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Joop P. van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - Daan Verberne
- Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands
| | - Debbie Gach
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Eric van Balen
- Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands
| | - Caroline M. van Heugten
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, Netherlands
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Tian J, Wang HY, Peng SH, Tao YM, Cao J, Zhang XG. Experiences of older people with multimorbidity regarding self-management of diseases: A systematic review and qualitative meta-synthesis. Int J Nurs Pract 2024:e13289. [PMID: 39075877 DOI: 10.1111/ijn.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
AIM This qualitative systematic review aimed to consolidate existing evidence on the self-management experience of older patients with multimorbidity worldwide. METHODS Nine databases were searched, for papers published from database inception to April 2023. The systematic review was conducted according to the systematic review method of qualitative evidence by the Joanna Briggs Institute (JBI). RESULTS Seven studies were included. Finally, four themes and 12 subthemes were formed: (1) physical level: reduced physical function and lack of coordinated care; (2) psychological level: mental state of anxiety and positive attitude towards life; (3) social level: technical support, support from family, support from healthcare workers and support from others; and (4) practical level: economic burden, lifestyle changes, self-care in daily life and compliance was much lower than expected. CONCLUSIONS To improve self-management in older people with multimorbidity, nurses should provide more guidance to patients to improve their self-management skills, and clinicians should recommend effective self-management behaviours.
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Affiliation(s)
- Jing Tian
- West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Yan Wang
- Southwest University, Chongqing, China
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Si Han Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Min Tao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jun Cao
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
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Lv Q, Zhang X, Wang Y, Xu X, Zang X. Cross-cultural adaptation and validation of the caregiver self-efficacy in contributing to patient self-care scale in China. BMC Public Health 2024; 24:1977. [PMID: 39049013 PMCID: PMC11267960 DOI: 10.1186/s12889-024-19534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Caregiver self-efficacy is crucial in improving patient outcomes and caregiver well-being, but there is a lack of suitable scales to assess this concept within the context of Chinese culture. This study aimed to cross-culturally translate the Caregiver Self-Efficacy in Contributing to Patient Self-Care (CSE-CSC) Scale and evaluate its psychometric properties using classical test theory and item response theory. METHODS The CSE-CSC scale was adapted using Brislin's translation model after obtaining authorization from the original author. A multicenter, cross-sectional study was conducted to assess the psychometric properties of this scale. Classical test theory was used to evaluate reliability (internal consistency, test-retest reliability), validity (content validity, structural validity, convergent validity), and floor and ceiling effects. Item response theory was employed to assess the fit of the rating scale model, reliability, item difficulties, and measurement invariance. RESULTS The translation and cultural adaptation process was completed. Classical test theory demonstrated good internal consistency (Cronbach's α = 0.935) and test-retest reliability (ICC from 0.784 to 0.829, p<0.001). The I-CVI and K* of each item ranged from 0.875 to 1.00 and 0.871 to 1.00. The first-order 2-factor model fit well (χ2/df = 3.71, RMSEA = 0.082, SRMR = 0.032, CFI = 0.973, TLI = 0.60). Convergent validity showed that the CSE-CSC scores had a strong positive correlation with three separate scales of the CC-SC-CII. There was no floor and ceiling effect in this scale. Rasch analysis showed that the CSE-CSC scale demonstrated a good fit to the rating scale model and exhibited excellent reliability (person/item separation index>2, person/item reliability coefficients>0.8). The Wright map showed that item difficulty matched the respondents' measured abilities. The analysis of differential item functioning (DIF) showed that all items were comparable in gender. CONCLUSIONS This study indicated that the CSE-CSC scale had good reliability, validity, difficulty degree, and measurement invariance. The CSE-CSC scale can be used to measure caregiver self-efficacy of Chinese patients with multiple chronic conditions.
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Affiliation(s)
- Qingyun Lv
- Tianjin Med Univ, Sch Nursing, 22 Qixiangtai Rd, Tianjin, 300070, P. R. China
| | - Xiaonan Zhang
- Tianjin Med Univ, Sch Nursing, 22 Qixiangtai Rd, Tianjin, 300070, P. R. China
| | - Yaqi Wang
- Tianjin Med Univ, Sch Nursing, 22 Qixiangtai Rd, Tianjin, 300070, P. R. China
| | - Xueying Xu
- Tianjin Med Univ, Sch Nursing, 22 Qixiangtai Rd, Tianjin, 300070, P. R. China
| | - Xiaoying Zang
- Tianjin Med Univ, Sch Nursing, 22 Qixiangtai Rd, Tianjin, 300070, P. R. China.
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Younas A, Zeb H, Inayat S, Aziz F. Coping among South Asian individuals living with chronic illnesses: A latent profile analysis. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2024. [PMID: 38890802 DOI: 10.1002/ijop.13157] [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: 07/08/2023] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
Individuals' coping differs based on sociocultural determinants and the nature of illness. This study developed a coping typology for South Asians with chronic illnesses and differentiated the coping profiles based on sociocultural determinants. Individuals (n = 384) with chronic illness were recruited. The Brief COPE scale was used for data collection and latent profile analysis for typology development. The class differences were examined in terms of age, gender, socioeconomic status, education, type of family, smoking, primary decision maker in the family, type of community, number of years living with chronic illness and type of health care services used. Latent profile analysis supported four class model: Avoider-Emotion (n = 34, 9%), Problem-Emotion (n = 128, 33.9%), Problem-Avoider (n = 55, 14.6%) and Emotion-Avoider (n = 161, 42.6%) copers. Comparison of classes across chronic illness showed that individuals with chronic respiratory disorders were Emotion-Avoider and Avoider-Emotion copers, those with cardiac problems were Problem-Emotional and Problem-Avoiders copers, those with renal problems were Emotional-Avoiders and Problem-Emotions copers, and individuals with mental health issues were mainly Problem-Emotional and Emotion-Avoider copers. These class differences were statistically different (χ2 = 134, df = 18, p < .001). The findings can be useful for developing coping programmes for South Asian populations in low- and middle-income countries and South Asian immigrants.
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Affiliation(s)
- Ahtisham Younas
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Canada
| | - Hussan Zeb
- College of Nursing, Saidu Group of Teaching Hospitals & Saidu Medical College, Swat, Pakistan
| | - Shahzad Inayat
- Faculty of Nursing, Isra University, Islamabad, Pakistan, Calgary, Canada
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University Graz, Graz, Austria
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Varallo G, Franceschini C, Rapelli G, Zenesini C, Baldini V, Baccari F, Antelmi E, Pizza F, Vignatelli L, Biscarini F, Ingravallo F, Plazzi G. Navigating narcolepsy: exploring coping strategies and their association with quality of life in patients with narcolepsy type 1. Sci Rep 2024; 14:11837. [PMID: 38783152 PMCID: PMC11116444 DOI: 10.1038/s41598-024-62698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
Narcolepsy type 1 (NT1) is a chronic neurological disorder characterized by symptoms such as excessive daytime sleepiness, sudden sleep episodes, disrupted nocturnal sleep, cataplexy, sleep paralysis, and hypnagogic hallucinations, which significantly impact the overall well-being and quality of life of individuals. While psychological factors have gained attention, there is limited research on the coping strategies employed by patients with NT1 and their association with quality of life. This study aimed to compare coping strategies in patients with NT1 and controls, as well as assess the relationship between coping strategies and quality of life in patients with NT1. A total of 122 individuals diagnosed with NT1 and 138 controls were enrolled in this cross-sectional study. Participants completed questionnaires assessing coping strategies and health-related quality of life. A Mann-Whitney U test was conducted to compare the use of different coping strategies by patients with NT1 and controls. Spearman's rho correlation was performed to examine the association between coping strategies and quality of life in the NT1 group. Results showed that patients with NT1 exhibited differences in the use of coping strategies compared to controls. They reported lower use of active coping, planning, instrumental, and emotional social support, and higher use of behavioral and mental disengagement. Denial and behavioral disengagement were significantly and negatively associated with quality of life. Identifying coping strategies and their association with quality of life may aid in the development of tailored interventions aimed at improving the adoption of effective coping strategies and reducing the use of maladaptive coping strategies.
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Affiliation(s)
- Giorgia Varallo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giada Rapelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Corrado Zenesini
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Valentina Baldini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Flavia Baccari
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Fabio Pizza
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.
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Akbari Esfahani A, Pourshahbaz A, Dolatshahi B. Structural relations of illness perception, fatigue, locus of control, self-efficacy, and coping strategies in patients with multiple sclerosis: a cross-sectional study. BMC Public Health 2024; 24:1354. [PMID: 38769476 PMCID: PMC11103852 DOI: 10.1186/s12889-024-18807-0] [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: 12/31/2023] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Patients with multiple sclerosis (MS) experience extensive problems due to fatigue and illness perception. Reducing these problems may improve these patients' quality of life (QoL). Accordingly, the current study is aimed at investigating the mediating role of self-efficacy, locus of control, coping strategy, and outcome expectancy in the relationship between illness perception and fatigue severity in patients with MS. METHODS In a cross-sectional analytical study, data of 172 MS patients were collected by self-report questionnaires including illness perception questionnaires (IPQ-R), Multiple Sclerosis Self-Efficacy (MSSES) scale, health locus of control (MHLC), coping strategies in MS(CMSS), outcome expectancy, level of physical activity (IPAQ-SF), patient activation measure (PAM-13) and fatigue severity scale (FSS). The data were analyzed using linear and multiple regression analysis in SPSS software version 24 (SPSS Inc., Chicago, IL, USA). RESULTS The final model explained 62% of the fatigue variance. Illness perception both directly and indirectly (through self-efficacy, physical activity level, internal health locus of control, patient activation, and negative coping strategies) could predict the participants' fatigue severity. Among the mediating variables, internal health locus of control, self-efficacy, and negative coping strategies had the greatest impact, respectively. moreover, outcome expectancy variable did not a mediating role in the aforementioned relationship. CONCLUSIONS To enhance the well-being of MS patients and to improve the efficiency of treating MS related fatigue, a comprehensive treatment protocol is needed, encompassing psychological factors affecting fatigue severity.
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Affiliation(s)
- Amir Akbari Esfahani
- Department of Clinical Psychology, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abbas Pourshahbaz
- Department of Clinical Psychology, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Onofrei LM, Puiu M, Chirita-Emandi A, Serban CL. A comprehensive analysis concerning eating behavior associated with chronic diseases among Romanian community nurses. Front Public Health 2024; 12:1368069. [PMID: 38577280 PMCID: PMC10991806 DOI: 10.3389/fpubh.2024.1368069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Lifestyle factors, including inadequate eating patterns, emerge as a critical determinant of chronic disease. Apart from caring for patients, nurses should also take an active role in monitoring and managing their own health. Understanding the intricate relationship between nurses' eating behavior and managing their own health is crucial for fostering a holistic approach to healthcare, therefore our study aimed to evaluate eating behavior and demographic factors influencing chronic disease prevalence in a sample of community nurses from Romania. Methods Between October-November 2023, 1920 community nurses were invited to answer an online survey, using an advertisement in their professional network. Of them, 788 responded. In the survey, which included a semi-quantitative food frequency questionnaire with 53 food items, the Intuitive Eating Survey 2 (IES-2), and demographic items were used. Results A multivariate model was built for the prediction of the association between eating behavior and other factors associated with chronic diseases. The majority of participants were females (95.1%), with the largest age group falling between 40 and 49.9 years (48.2%). Regarding the EFSA criteria for adequate carbohydrate and fat intake, 20.2% of the group have a high intake of carbohydrates, respectively, 43.4% of the group have a high intake of fat. Analysis of chronic diseases indicated that 24.9% of individuals reported at least one diagnosis by a physician. The presence of chronic disease was associated with a low level of perceived health status, with an OR = 3.388, 95%CI (1.684-6.814), compared to those reporting excellent or very good perceived health status. High stress had an OR = 1.483, 95%CI (1.033-2.129). BMI had an OR = 1.069, 95%CI (1.032-1.108), while low carbohydrate diet score had an OR = 0.956, 95%CI (0.920-0.992). Gender and IES-2 did not significantly contribute to the model, but their effect was controlled. Discussion By unraveling the intricate interplay between nutrition, lifestyle, and health outcomes in this healthcare cohort, our findings contribute valuable insights for the development of targeted interventions and support programs tailored to enhance the well-being of community nurses and, by extension, the patients they support.
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Affiliation(s)
- Lidia-Manuela Onofrei
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Maria Puiu
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, part of ERN ITHACA, Timisoara, Timis, Romania
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, part of ERN ITHACA, Timisoara, Timis, Romania
| | - Costela Lacrimioara Serban
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, part of ERN ITHACA, Timisoara, Timis, Romania
- Department of Functional Sciences, Discipline of Public Health, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Functional Sciences, Discipline of Public Health, Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Okanlawon Bankole A, Jiwani RB, Avorgbedor F, Wang J, Osokpo OH, Gill SL, Jo Braden C. Exploring illness perceptions of multimorbidity among community-dwelling older adults: a mixed methods study. AGING AND HEALTH RESEARCH 2023; 3:100158. [PMID: 38779434 PMCID: PMC11109937 DOI: 10.1016/j.ahr.2023.100158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. Although extensive research exists about illness perceptions, little is known about illness perceptions of multimorbidity. Methods The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n=17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n=116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics. Results Overall, participants were mostly female (71%), self-reported as Hispanic (35%), Black (33%), White (27%), or Asian (5%). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants' socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions. Conclusions Illness perception of multimorbidity may not differ by the number of chronic conditions the participants had. Rather, participants prioritized the impact of multimorbidity on their overall wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused interventions to address holistic needs of older adults with multimorbidity.
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Affiliation(s)
| | - Rozmin B Jiwani
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
| | | | - Jing Wang
- University of New Hampshire, Durham, New Hampshire, USA
| | - Onome H. Osokpo
- University of Pennsylvania, New Courtland Center for Transitions and Health, Philadelphia, PA
| | - Sara L. Gill
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
| | - Carrie Jo Braden
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
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de Monteynard S, Bihan H, Campagné L, Crozet C, Cailhol J. Perceptions of multiple chronic conditions and coping strategies among migrants from Sub-Saharan Africa living in France with diabetes mellitus and HIV: An interview-based qualitative study. PLoS One 2023; 18:e0284688. [PMID: 37267406 DOI: 10.1371/journal.pone.0284688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/05/2023] [Indexed: 06/04/2023] Open
Abstract
Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives.
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Affiliation(s)
- Soline de Monteynard
- Department of Infectious and Tropical Diseases, Avicenne University Hospital, Bobigny, France
| | - Hélène Bihan
- Endocrinology-Diabetology Department, Avicenne University Hospital, Bobigny, France
- LEPS UR 3412, Sorbonne Paris Nord University, Bobigny, France
| | - Lucie Campagné
- Department of General Medicine, Sorbonne Paris Nord University, Bobigny, France
| | - Cyril Crozet
- LEPS UR 3412, Sorbonne Paris Nord University, Bobigny, France
| | - Johann Cailhol
- Department of Infectious and Tropical Diseases, Avicenne University Hospital, Bobigny, France
- LEPS UR 3412, Sorbonne Paris Nord University, Bobigny, France
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Sheth MS, Castle DJ, Wang W, Lee A, Jenkins ZM, Hawke LD. Changes to coping and its relationship to improved wellbeing in the optimal health program for chronic disease. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Otrębski W, Mariańczyk K, Krzysztofik K. Selected Personality Traits and Employment as the Predictors of the Intensity of Psychosocial Problems Experienced by Chronically Ill Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:747. [PMID: 36613067 PMCID: PMC9819775 DOI: 10.3390/ijerph20010747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND This study sought to determine the effect of being employed or unemployed on the relationships between selected personal variables (acceptance of one's illness, self-efficacy, and self-actualization) and the intensity of psychosocial problems experienced by chronically ill persons (ChIP). PARTICIPANTS AND PROCEDURES The PCH-R Scale, the Generalized Self-Efficacy Scale, the Acceptance-of-Illness Scale, and the Self-Actualization Scale were used to collect information from 236 employed and unemployed ChIP. RESULTS Acceptance of illness and self-efficacy predicted the intensity of general psychosocial problems and problems in the personal, family, social, and occupational spheres in both employed and unemployed ChIP. CONCLUSIONS The results can significantly contribute to increasing the effectiveness of treatment and support offered to ChIP. Continued employment or reemployment after a period of intense therapy can protect them from a rapid degradation of their personal-and frequently, socio-economic-resources, which are necessary for them to be able to adapt to new challenges and maintain a good quality of life, despite experiencing a chronic illness.
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Sun L, Liu JE, Ji M, Wang Y, Chen S, Wang L. Coping with multiple chronic conditions among Chinese older couples: A community of shared destiny. Geriatr Nurs 2022; 48:214-223. [PMID: 36279804 DOI: 10.1016/j.gerinurse.2022.09.019] [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: 07/16/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
Multiple chronic conditions (MCCs) affect patients and their spouses. We explored the experience of Chinese older couples living with MCCs to gain deeper understanding of how they cope with MCCs as dyads. A qualitative research design using semi-structured in-depth interviews was conducted. Sixteen couples (≥60 years) were included and a thematic analysis was undertaken using NVivo software. Four themes under an overarching theme "A community of shared destiny" were identified: (i) various changes and impacts in normal life; (ii) perceived dynamic stress and dyadic challenges of MCCs; (iii) acceptance and reflection on MCCs influenced by aging and fatalism; (iv) mutual support and dyadic adjustment based on a shared destiny. Coping with MCCs was a dyadic and periodic journey for older couples. They perceived themselves as a community of shared destiny. Our findings are important for healthcare professionals to develop targeted interventions for older couples living with MCCs.
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Affiliation(s)
- Liu Sun
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Jun-E Liu
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China.
| | - Meihua Ji
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Yanling Wang
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Shaohua Chen
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Lingyun Wang
- Desheng Community Health Service Center, Capital Medical University, 34(#), De Wai street, Beijing, China
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Kim S, Choi M, Lee J, Kim H, Song K, Park HJ. Type D personality, cognitive illness perception, depression, approach coping, and self-management among older adults in long-term care hospitals: Structural equation modeling. Geriatr Nurs 2022; 48:150-157. [PMID: 36219934 DOI: 10.1016/j.gerinurse.2022.09.011] [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: 07/22/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to construct a structural equation model to explore the relationship between Type D personality, cognitive illness perception, depression, approach-coping, and self-management. The study was conducted at two long-term care hospitals with 300 or more beds in Korea. Participants were 287 older patients from whom data were collected from February 17 to March 10, 2021, using a structured questionnaire comprising items on the following variables: Type D personality, cognitive illness perception, depression, approach coping, and self-management. Type D personality (β=-.601, p=.001), cognitive illness perception (β =.692, p <.001), depression (β =-.204, p =.011), and approach-coping (β =.326, p <.001) explained 78.8% of the total variance of self-management, highlighting their impact on how patients accept and manage a disease and their relevance to the self-management of older adults in long-term care hospitals.
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Affiliation(s)
- Sunki Kim
- College of Nursing, CHA University, 120 Haeryong-ro, Pocheon-si, Gyeonggi-do 11160, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Heejung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Kijun Song
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hye-Ja Park
- College of Nursing, CHA University, 120 Haeryong-ro, Pocheon-si, Gyeonggi-do 11160, Republic of Korea
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Prell T, Mendorf S, Axer H. Tolerance to Dizziness Intensity Increases With Age in People With Chronic Dizziness. Front Neurol 2022; 13:934627. [PMID: 35911923 PMCID: PMC9330066 DOI: 10.3389/fneur.2022.934627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Dizziness is a common complaint in older adults. To know which factors are instrumental in enabling patients with chronic dizziness to tolerate their symptoms to a certain degree in everyday life can help to develop tailored therapies. Methods Data from 358 patients with chronic dizziness and vertigo who had attended a multimodal daycare treatment program were recorded. Data included sociodemographic parameters, dizziness-related characteristics, the Vertigo Symptom Scale (VSS), and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics, elastic net regression, and mediation analysis were used. Results A higher tolerance of dizziness was associated with higher age, higher intensity of dizziness, lower burden of dizziness, higher HADS depression, structural reason for dizziness (type), permanent dizziness, absence of attacks, and longer disease duration. In contrast, younger persons with attack-like dizziness reported to tolerate less dizziness. Age had a significant direct effect on tolerance (72% of the total effect) and a significant indirect effect via intensity on tolerance (28% of the total effect) in the mediation analysis. Conclusion It can only be speculated that negative stereotypes about age-related complaints may play a role in this. Why older people tolerate more dizziness and to what extent this may contribute to lower healthcare utilization need to be investigated in further studies.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- *Correspondence: Tino Prell ; orcid.org/0000-0002-6423-3108
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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Sexual Function, Anxiety, Depression and Coping After Myocardial Infarction: An Exploratory Study. SEXUALITY AND DISABILITY 2022; 40:77-89. [PMID: 36712231 PMCID: PMC9881546 DOI: 10.1007/s11195-021-09715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Myocardial infarction (MI) may decrease sexual function and satisfaction in men and can be influenced by anxiety, depression, and sexual fear. However, few studies have examined short-term changes in sexual function over time in a post-MI population. This study aimed to longitudinally describe changes in sexual function and satisfaction in a sample of men post-MI. Methods Eighteen patients were recruited from a Midwestern hospital. Surveys were mailed two weeks and three months post discharge. Sexual function was measured with the Male Sexual Function Index. Other variables collected included sexual fear (Multidimensional Sexuality Questionnaire), anxiety and depressive symptoms (Patient-Reported Outcomes Measurement Information System Anxiety and Depression 4a), and use of coping strategies (Coping Strategy Indicator). Results Sexual function scores increased in the entire sample from 8.9 (SD 7.3) at two weeks to 14.6 (SD 8.9) at three months (18.8% improvement, p=0.04). Men who were sexually active improved their scores by 27.3% (p=0.01), while those who were not sexually active decreased their scores by 2.3% (p=0.5). Depressive symptoms and anxiety scores were low and largely stable across timepoints, though there were some improvements among men who were sexually active compared to those who were not. Decreased utilization of avoidance coping strategies was reported in sexually active versus inactive men. Conclusion While sexual function improved within a short-time period post discharge among sexually active men post-MI, further research is needed with a larger sample to understand these changes across a longer period. Additional research is also warranted to examine any potential influence of psychosocial predictors.
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Alanazi MO, Given CW, Deka P, Lehto R, Wyatt G. OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 22:236-244. [PMID: 35950340 DOI: 10.1093/eurjcn/zvac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/14/2022]
Abstract
AIMS To identify and provide clarity on factors that influence coping and the type of coping strategies used by patients with heart failure (HF) to improve health-related quality of life (HRQoL). METHODS AND RESULTS The Arksey and O'Malley template framed this scoping review guided by the stress and coping model. Five databases were explored: PubMed, Web of Science, Cochrane, CINAHL, and PsycINFO. Keywords included HF, quality of life, coping, and influencing factors. Eligibility criteria involved patients with HF, reported on coping strategies and HRQoL, and published in English. Thirty-five studies were included (4 randomized controlled trials, 27 cross-sectional, and 4 qualitative/mixed methods). Active emotional coping (e.g. acceptance) and problem-focused (e.g. seeking social support) coping strategies were linked to better HRQoL, while avoidant emotional coping (e.g. denial) was linked to worse HRQoL. In the presence of the stressor of HF severity, key factors that influenced the types of the coping strategy included sex, age, social support, income, education, spiritual beliefs, and illness duration. However, the evidence on the effectiveness of the type of coping on HRQoL remains inadequate due to the majority of studies being cross-sectional. CONCLUSION Problem-focused and active emotional coping strategies are associated with improved HRQoL. However, their effect is inconclusive due to the lack of experimental studies. Additional predictive studies will enhance the understanding of coping among HF patients.
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Affiliation(s)
- Mohammed Owayrif Alanazi
- College of Nursing, Michigan State University, 1355 Bogue Street East Lansing, MI 48824, USA
- Department of Nursing, University of Bisha, Al Nakhil St, Bisha 61922, Saudi Arabia
| | - Charles W Given
- College of Nursing, Michigan State University, 1355 Bogue Street East Lansing, MI 48824, USA
| | - Pallav Deka
- College of Nursing, Michigan State University, 1355 Bogue Street East Lansing, MI 48824, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, 1355 Bogue Street East Lansing, MI 48824, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, 1355 Bogue Street East Lansing, MI 48824, USA
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Cheng C, Bai J. Coping with Multiple Chronic Conditions in the Family Context: A Meta-Synthesis. West J Nurs Res 2021; 44:972-984. [PMID: 34433327 DOI: 10.1177/01939459211041171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was to collect, synthesize, and interpret the current qualitative evidence from studies that investigated family coping among people with multiple chronic conditions (MCCs). A meta-synthesis approach was used to report this study. A systematic search was performed in five electronic databases, including CINAHL, EMBASE, PsycINFO, Web of Science, and PubMed from January 2000 to December 2020. The PRISMA flow chart and Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist are integrated into the meta-synthesis. A total of ten eligible studies including data from 381 participants were identified. Three meta-themes were identified in the synthesis: (1) family role maintenance in MCCs management, (2) coping as a family, and (3) be frustrated with family interactions. This meta-synthesis indicated the importance of maintaining social roles and family support within family interactions for coping with MCCs. It also demonstrated the frustrations in the family coping process experienced by people with MCCs. Health care professionals should understand the interactions between people with MCCs and their family members that may impact people's coping. Such an understanding may contribute to the development of supportive programs such as family-based interventions for people with MCCs.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Bai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Leecharoen P, Pothiban L, Chintanawat R, Khampolsiri T. Factors predicting coping in older people with dementia: A cross-sectional study. Nurs Health Sci 2021; 23:733-741. [PMID: 34117701 DOI: 10.1111/nhs.12860] [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: 03/15/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
Coping can buffer the effect of stress on well-being. Information about factors predicting coping is essential knowledge for developing programs to promote effective coping among older people with dementia and serves as basic knowledge for further study. A cross-sectional study design was employed to investigate the associated and predictive factors of coping. The factors were derived from the Stress Process Model for people with dementia. A group of 364 participants was determined by power analysis and purposively selected from out-patient dementia clinics of hospitals in Thailand. Data were collected from interviews using questionnaires and were analyzed using Spearman's rank correlation coefficient and the enter method of multiple regression analysis. With reference to the conceptual framework of the Stress Process Model, the results revealed that three background and context factors (gender, personal income, and relationships with family members), two stressor factors (cognitive ability, and self-esteem), and four mediator factors (optimism, hope, hardiness, and perceived social support) were significantly related to coping. Of the variation in coping scores, 47% could be explained by hope, perceived social support, cognitive ability, and gender.
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Ranieri V, Kennedy E, Walmsley M, Thorburn D, McKay K. The Primary Sclerosing Cholangitis (PSC) Wellbeing Study: Understanding psychological distress in those living with PSC and those who support them. PLoS One 2020; 15:e0234624. [PMID: 32628685 PMCID: PMC7337345 DOI: 10.1371/journal.pone.0234624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 05/31/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The impact of living with Primary Sclerosing Cholangitis (PSC) on psychological wellbeing is not well-known. A recent scoping review by the authors found that both depression and anxiety frequently featured in the accounts of those living with the illness. However, less clear were the factors that led to such psychological distress, the impact that the illness had on families and how to best support those living or supporting someone living with the illness. In light of this, the aim of this study was to explore how the illness impacted the lives of both those diagnosed with the illness and those supporting them. METHOD AND RESULTS This study adopted a phenomenological approach to understand the subjective experiences of individual participants. A total of 30 individuals took part in Asynchronous Virtual Focus Groups hosted on a Virtual Learning Environment for a four-week period. Chronological narratives of individuals' lived experiences from diagnosis to post-transplant are presented below. These narratives centred upon individuals' and families' experiences of receiving a diagnosis, and adjusting to life post-diagnosis, particularly in regard to their relationships with health professionals and other family members, and in preparing for the possibility of transplant. DISCUSSION The present article provides an in-depth look at how PSC can impact psychological wellbeing, how psychological distress arises and includes advice tailored to individuals, families and health professionals on how to best support each other.
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Affiliation(s)
- Veronica Ranieri
- Research & Development Unit, Tavistock Centre, Tavistock & Portman NHS Foundation Trust, London, United Kingdom
- Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
- * E-mail:
| | - Eilis Kennedy
- Research & Development Unit, Tavistock Centre, Tavistock & Portman NHS Foundation Trust, London, United Kingdom
- Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | | | - Douglas Thorburn
- Sheila Sherlock Liver Centre & UCL Institute of Liver and Digestive Health, Royal Free Hospital, London, United Kingdom
| | - Kathy McKay
- Research & Development Unit, Tavistock Centre, Tavistock & Portman NHS Foundation Trust, London, United Kingdom
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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