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Ahmed A, Mutahar M, Daghrery AA, Albar NH, Alhadidi IQI, Asiri AM, Boreak N, Alshahrani AAS, Shariff M, Shubayr MA, Al Moaleem MM. A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic. Med Sci Monit 2024; 30:e943383. [PMID: 38341609 PMCID: PMC10868410 DOI: 10.12659/msm.943383] [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: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 02/12/2024] Open
Abstract
Telemedicine technologies allow distribution of health-related services and information and can include electronic and telecommunication technologies, remote patient and clinician contact, referral and prescribing, patient education, and monitoring. This systematic review aimed to evaluate publications on the perceptions and management of chronic medical conditions using telehealth remote consultations by primary healthcare professionals between April 2020 and December 2021 during the COVID-19 pandemic. Electronic databases, including Cinhal, PubMed, Science Direct, and ProQuest were searched to extract qualitative studies relevant to the topic. Inclusion criteria were developed based on the Population, Exposure, and Outcomes scoping framework. The target population was healthcare professionals working in primary care settings. Included studies encompassed various types of telemedicine, such as synchronous telemedicine, video conferencing, telephone conversations, and smart devices. Eight studies were included. Synchronous telemedicine was highly effective in ensuring the continuity of care and treatment, providing patients with convenience, improved access to treatment, and earlier disease management. Video conferencing and telephone consultations were the most common methods used. Challenges included concerns about patient privacy, technology literacy, and acceptance. Telemedicine was commended for its ability to provide access to immediate expert medical advice and eliminate the need for long-distance travel, contributing to increased patient compliance. Synchronous telemedicine is a promising solution for managing chronic conditions during and after the COVID-19 pandemic, offering benefits to patients and healthcare professionals. To maximize its potential, concerns regarding patient privacy, confidentiality, and technology literacy need to be addressed. Proper legislation and regulations are required for long-term success of telemedicine, making it a valuable component of healthcare systems.
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Affiliation(s)
- Arzaq Ahmed
- Faculty of Health, School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Mahdi Mutahar
- Dental Academy, University of Portsmouth, Portsmouth, UK
| | - Arwa A. Daghrery
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Nassreen H. Albar
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Ismail Qasem I. Alhadidi
- General Dentist, Dental Department, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Ali Mohammed Asiri
- Dental Department, Restorative Dental Science, Ministry of Health, Abha, Saudi Arabia
| | - Nezar Boreak
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | - Mansoor Shariff
- Prosthetic Department, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mosa A. Shubayr
- Division of Dental Public Health, Preventive Dentistry Department, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Qadir ZS, Kar N, Ball PA, Morrissey H. Antipsychotic Use: Cross-Sectional Opinion Survey of Psychiatrists in India and United Kingdom. PHARMACY 2023; 11:162. [PMID: 37888507 PMCID: PMC10609856 DOI: 10.3390/pharmacy11050162] [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: 09/10/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of this survey of psychiatrists from the UK and India was to compare their opinions on antipsychotic medication choice and their experiences of such medications' effectiveness and tolerability in patients who were newly diagnosed with acute schizophrenia. Following ethical approval, a cross-sectional online survey of psychiatrists from the UK and India was conducted. Ninety-five responses were received from each country. The most selected first-line APDs in both countries were olanzapine (47.5%), risperidone (42.8%) and aripiprazole (25.3%). A total of 60% of psychiatrists from India (60%) and 48% from the UK (48%) selected 'medication efficacy' as the main factor in their choice. Reassessment and consideration to switch most often took place within 4-6 weeks (53.7%) and 3-6 months (11.6%). The major reasons for switching antipsychotic medications were poor clinical efficacy (69%) and lack of tolerability (45%). Nonadherence was the most common reason for relapse (90% of UK psychiatrists and 70% of Indian psychiatrists), followed by illicit drug use (27.6%). The most commonly reported side effects that led to nonadherence were weight gain (10.8%), drowsiness (10.4%), erectile dysfunction and movement disorders (equally 8.7%). It was concluded that olanzapine, risperidone and aripiprazole are the most commonly selected as the initial treatment choice by psychiatrists from India and the UK. They are perceived as widely effective and well tolerated.
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Affiliation(s)
- Zina Sherzad Qadir
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
| | - Nilamadhab Kar
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
- Black Country Healthcare NHS Foundation Trust, Wolverhampton B71 4NH, UK
| | - Patrick Anthony Ball
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
- School of Dentistry & Medical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Hana Morrissey
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
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Lal S, Czesak A, Tibbo P, Joober R, Williams R, Chandrasena R, Otter N, Malla A. Young Adults' Perspectives on Factors Related to Relapse After First-Episode Psychosis: Qualitative Focus Group Study. Psychiatr Serv 2022; 73:1380-1388. [PMID: 35770426 DOI: 10.1176/appi.ps.202000641] [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] [Indexed: 12/01/2022]
Abstract
Relapse after first-episode psychosis (FEP) is a major clinical challenge for specialized early intervention services. Understanding patient perspectives on factors contributing to relapse can inform the development of risk assessments and preventive interventions. The objective of this study was to identify factors that may contribute to and prevent relapse from the perspectives of patients receiving services for FEP. Data from 25 participants across four focus groups in Canada were analyzed with a descriptive content analysis approach. Twelve factors were identified, of which four (social environment, technology use, medication, and lifestyle behaviors) had both contributory and preventive roles. In descending order of frequency, risk factors for relapse included substance use; unsupportive social environment; technology use; taking and not taking medication; lack of sleep; work, career, or school stress; significant life events; symptoms of depression or mania; generalized worry; and financial stress. Preventive factors consisted of having a supportive social environment, using technology, taking medication, using coping strategies, and engaging in healthy lifestyle behaviors and meaningful activities. These findings extend the literature on relapse vulnerability and protective factors. Importantly, the factors identified in this study are modifiable, and thereby provide insights for the development and optimization of relapse risk assessments and preventive interventions.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Anna Czesak
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Philip Tibbo
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Ridha Joober
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Richard Williams
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Ranjith Chandrasena
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Nicola Otter
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
| | - Ashok Malla
- School of Rehabilitation, University of Montreal, Montreal (Lal, Czesak); Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal (Lal); Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada (Tibbo); Douglas Mental Health University Institute, Montreal, and Department of Psychiatry, McGill University, Montreal (Joober, Malla); Victoria Mental Health Centre, Victoria, British Columbia, Canada (Williams); Schulich School of Medicine, University of Western Ontario, London, and Mental Health and Addictions Program, Chatham-Kent Health Alliance, Chatham, Ontario (Chandrasena); Canadian Consortium for Early Intervention in Psychosis (CCEIP), Hamilton, Ontario (Otter)
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Psychotic relapses from the perspective of patients and family members. Arch Psychiatr Nurs 2022; 41:300-305. [PMID: 36428064 DOI: 10.1016/j.apnu.2022.09.012] [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: 08/20/2021] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
This qualitative study was carried out with 10 dyads of patients-family members to explore their perception about psychotic relapses. Data were collected through a semi-structured interview from April to August 2019, in Brazil, and analyzed using the thematic analysis proposed by Braun & Clark. Four main themes emerged from the interviews: (1) defining and describing the psychotic relapses; (2) risk factors for psychotic relapse; (3) protective factors for psychotic relapse; and (4) early warning signs: identification of an episode of psychotic relapse. Exploring the perception of patients with psychotic disorders and their families about relapse is fundamental for the development of relapse risk assessment tools and to guide further research on this topic.
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Abu Sabra MA, Hamaideh SH, Hamdan-Mansour AM. Testing Efficacy of Relapse Prevention Intervention among Patients Diagnosed with Schizophrenia in Jordan. Issues Ment Health Nurs 2022; 43:670-682. [PMID: 35119343 DOI: 10.1080/01612840.2022.2025634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Relapse prevention is an essential component in sustaining positive treatment outcomes. The purpose of this study was to test the efficacy of a relapse prevention intervention on the ability of patients and their primary caregivers to self-detect and manage early warning signs of relapse, and its impact on relapse rate among patients diagnosed with schizophrenia. Quasi-experimental design; one group posttest only, repeated measure time-series design was employed. A total of 40 patients and their primary caregivers represented the sample in this study. The statistical analysis revealed that the effect of relapse prevention intervention on patients and their primary caregivers' ability to self-detect severity and manage early warning signs of relapse has sustainable and positive effect on patients and their primary caregivers from T1 to T3 (patients, M = 9.0-9.3; caregivers, M = 9.7-9.9). Also, positive effect of intervention detected on abilities of patients and primary caregivers to manage EWS from T1 to T3 (patients, M = 35-36.0; caregivers, M = 39.7-38.1). The analysis also showed a low relapse rate (14.9%). The study showed that relapse prevention interventions is effective and applicable approach that psychiatric nurses can use to ensure sustainable positive outcomes of psychiatric healthcare among patients with schizophrenia.
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Affiliation(s)
- Mohammad A Abu Sabra
- Psychiatric Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan (ZUJ), Amman, Jordan
| | - Shaher H Hamaideh
- Community and Mental Health Nursing Department Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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Allan S, Bradstreet S, Mcleod H, Farhall J, Lambrou M, Gleeson J, Clark A, Gumley A. Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study. J Med Internet Res 2019; 21:e14366. [PMID: 31651400 PMCID: PMC6838692 DOI: 10.2196/14366] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262
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Affiliation(s)
- Stephanie Allan
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Maria Lambrou
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrea Clark
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Gumley
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Chatzidamianos G, Lobban F, Jones S. A qualitative analysis of relatives', health professionals' and service users' views on the involvement in care of relatives in Bipolar Disorder. BMC Psychiatry 2015; 15:228. [PMID: 26403843 PMCID: PMC4582817 DOI: 10.1186/s12888-015-0611-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/17/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Relatives of people with bipolar disorder report that services do not meet their own needs, despite clinical recommendations for the development of care plans for relatives, provision of information regarding their statutory entitlements, and formal involvement in decision making meetings. Further, there is now conclusive evidence highlighting the benefits of relatives' involvement in improving outcomes for service users, relatives, and the health system as a whole. This qualitative study explored the views of relatives of people with bipolar disorder, service users and healthcare professionals regarding the barriers and the facilitators to relatives' involvement in care. METHODS Thirty five people were interviewed (12 relatives, 11 service users and 12 healthcare professionals). Audio recordings were transcribed verbatim and common themes in participants' narratives emerged using framework analysis. RESULTS Participants' accounts confirmed the existence of opportunities for relatives to be involved. These, however, were limited and not always accessible. There were three factors identified that influenced accessibility namely: pre-existing worldviews, the quality of relationships and of communication between those involved, and specific structural impediments. DISCUSSION These themes are understood as intertwined and dependent on one another. People's thoughts, beliefs, attitudes, cultural identifications and worldviews often underlie the ways by which they communicate and the quality of their relationship. These, however, need to be conceptualised within operational frameworks and policy agendas in health settings that often limit bipolar relatives' accessibility to opportunities for being more formally involved. CONCLUSIONS Involving relatives leads to clear benefits for relatives, service users, healthcare professionals, and the health system as a whole. Successful involvement of relatives, however, depends on a complex network of processes and interactions among all those involved and requires strategic planning from policy makers, operational plans and allocation of resources.
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Affiliation(s)
- Gerasimos Chatzidamianos
- Doctorate in Clinical Psychology, Division of Health Research, Faculty of Health and Medicine, Lancaster University, C38, Furness Building, Lancaster, LA1 4YG, UK.
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
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