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McMillan IF, Montanaro E, Langhinrichsen-Rohling J, Mennicke A. Queering the Conflict in Adolescent Dating Relationships Inventory: An Examination of the Conflict in Adolescent Relationships Inventory Perpetration Scale's Measurement Invariance Across Heterosexual and Sexual Minority Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2017-2040. [PMID: 38006239 DOI: 10.1177/08862605231213381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Teen dating violence (TDV) is a public health concern impacting more than half of U.S. adolescents aged 12 to 18. Sexual minority youth (i.e., adolescents who are not exclusively heterosexual) experience disproportionately high rates of TDV. Yet, measures of TDV such as the Conflict in Adolescent Dating Relationships Inventory (CADRI) have been developed without considering sexual identity with items and instructions frequently anchored in heterosexual romantic relationships. Examination of measurement equivalence across heterosexual and sexual minority youth has only begun recently with existing research examining the CADRI's victimization scale measurement invariance providing empirical support for invariance across heterosexual and sexual minority youth. However, no prior research has examined the measurement invariance of the CADRI perpetration scales across heterosexual and sexual minority youth. The current study fills this gap by examining the CADRI perpetration scale measurement invariance across heterosexual and sexual minority youth. Using multigroup confirmatory factor analysis responses from 1,143 adolescents (Mage = 15.88, SD = 2.49) to the CADRI perpetration items were examined across heterosexual (n = 922) and sexual minority youth (n = 218). Results confirmed the five-factor structure of the CADRI perpetration scales, providing empirical support for the appropriateness of the use of the CADRI perpetration scale's scores across heterosexual and sexual minority youth broadly. However, findings of partial scalar measurement invariance on the emotional/verbal abuse perpetration scale raise questions about the appropriateness of mean-score comparisons on this particular subscale. Areas of potential revisions of the emotional/verbal abuse perpetration scale are discussed to facilitate meaningful comparisons among heterosexual and sexual minority youth and to substantiate program evaluation results by groups.
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Affiliation(s)
- Iris F McMillan
- Health Psychology Program, The University of North Carolina at Charlotte, USA
| | - Erika Montanaro
- Health Psychology Program, The University of North Carolina at Charlotte, USA
- Department of Psychological Sciences, The University of North Carolina at Charlotte, USA
| | - Jennifer Langhinrichsen-Rohling
- Health Psychology Program, The University of North Carolina at Charlotte, USA
- Department of Psychological Sciences, The University of North Carolina at Charlotte, USA
| | - Annelise Mennicke
- School of Social Work, The University of North Carolina at Charlotte, USA
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McMillan IF, Langhinrichsen-Rohling J, Mennicke A, Montanaro E. Attitude Is Everything: Examining Acceptance of Violence Items for Differential Item Functioning Across Heterosexual and Sexual Minority Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241243338. [PMID: 38581249 DOI: 10.1177/08862605241243338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Acceptance of dating violence (ADV) is a cognitive risk factor for violence perpetration and a common target of prevention programs. However, frequently used items assessing ADV are characterized by heteronormative item wording, and limited research has evaluated the degree to which ADV items function equivalently for both heterosexual and sexual minority youth (SMY). The current study sought to determine if there are differences in the way heterosexual and SMY respond to ADV survey items. Secondary data from a total of 2,014 adolescents (Mage = 16.78) were used to examine differences in ADV. Results of differential item functioning analysis indicated nonuniform differential item functioning for two of eight ADV items, with heterosexual youth being more likely to express strong levels of agreements with (a) female-perpetrated physical violence in response to male-perpetrated violence and (b) female-perpetrated violence against males broadly, relative to SMY. Although these differences were of negligible magnitude and only resulted in minimal differences in overall expected average scores, heterosexual youth were more likely to strongly accept female-perpetrated dating violence compared to SMY. Findings highlight differences in ADV item response patterns across heterosexual and sexual minority identifying youth and provide preliminary evidence for group differences in acceptance of female-perpetrated dating violence. Implications for prevention programming based on current findings include greater focus on measure adaptation and development as well as more consensus on the necessity of preventing female-perpetrated violence.
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Ruphrect-Smith H, Davies S, Jacob J, Edbrooke-Childs J. Ethnic differences in treatment outcome for children and young people accessing mental health support. Eur Child Adolesc Psychiatry 2024; 33:1121-1131. [PMID: 37245162 PMCID: PMC11032270 DOI: 10.1007/s00787-023-02233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.
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Affiliation(s)
- H Ruphrect-Smith
- Clinical, Educational, and Health Psychology, University College London, London, UK
| | - S Davies
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
| | - J Jacob
- Clinical, Educational, and Health Psychology, University College London, London, UK
- Child Outcomes Research Consortium, Anna Freud, London, UK
| | - J Edbrooke-Childs
- Clinical, Educational, and Health Psychology, University College London, London, UK.
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Child Outcomes Research Consortium, Anna Freud, London, UK.
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Yi Nam S, Yik Chun W, Tak Hing Michael W, Kit Wa Sherry C, Lai Ming Christy H, Ho Ming Edwin L, Yu Hai Eric C. Double stigma in mental health service use: Experience from ethnic minorities in Hong Kong. Int J Soc Psychiatry 2023; 69:1345-1353. [PMID: 36938981 DOI: 10.1177/00207640231161301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could help reduce their mental health disparities. AIMS This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong. METHODS Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use. RESULTS Among 31 adults (20 [64.5%] women, 11 [35.5%] men; 17 [54.8%] aged 25-39 years) who participated, most participants self-identified as Indian (13 [41.95]) or Pakistani (10 [32.3]). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools. CONCLUSION This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.
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Affiliation(s)
- Suen Yi Nam
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Wong Yik Chun
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | - Chan Kit Wa Sherry
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | | | - Lee Ho Ming Edwin
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Chen Yu Hai Eric
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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Clarke Y. 'Mixed white and Black Caribbean' millennials in Britain: An exploration of identity. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lovell K, Bee P, Bower P, Brooks H, Cahoon P, Callaghan P, Carter LA, Cree L, Davies L, Drake R, Fraser C, Gibbons C, Grundy A, Hinsliff-Smith K, Meade O, Roberts C, Rogers A, Rushton K, Sanders C, Shields G, Walker L. Training to enhance user and carer involvement in mental health-care planning: the EQUIP research programme including a cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Service users and carers using mental health services want more involvement in their care and the aim of this research programme was to enhance service user and carer involvement in care planning in mental health services.
Objectives
Co-develop and co-deliver a training intervention for health professionals in community mental health teams, which aimed to enhance service user and carer involvement in care planning. Develop a patient-reported outcome measure of service user involvement in care planning, design an audit tool and assess individual preferences for key aspects of care planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and carer-involved care planning. Disseminate resources to stakeholders.
Methods
A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the priorities underpinning involvement in care planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of care planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental health professionals from both the usual-care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention).
Results
The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of care planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for care are included in the care plan’. The training was delivered to 304 care co-ordinators working in community mental health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and carers, finding a failure of training to become embedded in routine care.
Limitations
Our pragmatic study was designed to improve service user and care involvement in care planning among routine community mental health services. We intervened in 18 sites with > 300 care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population.
Conclusions
We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and carer involvement in care planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results.
Future work
Research should focus on developing and evaluating new organisational initiatives in addition to training health-care professionals to address contextual barriers to service and carer involvement in care planning, and explore co-designing and delivering new ways of enhancing service users’ and carers’ capabilities to engage in care planning.
Trial registration
Current Controlled Trials ISRCTN16488358.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Patrick Cahoon
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Lesley-Anne Carter
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Claire Fraser
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chris Gibbons
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Oonagh Meade
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Chris Roberts
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Caroline Sanders
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lauren Walker
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Burroughs H, Bartlam B, Bullock P, Lovell K, Ogollah R, Ray M, Bower P, Waheed W, Gilbody S, Kingstone T, Nicholls E, Chew-Graham CA. Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAnxiety and depression often coexist in older people. These disorders are often underdiagnosed and undertreated, and are associated with increased use of health and social care services, and raised mortality. Barriers to diagnosis include the reluctance of older people to present to their general practitioner (GP) with mood symptoms because of the stigma they perceive about mental health problems, and because the treatments offered are not acceptable to them.ObjectivesTo refine a community-based psychosocial intervention for older people with anxiety and/or depression so that it can be delivered by non-traditional providers such, as support workers (SWs), in the third sector. To determine whether or not SWs can be trained to deliver this intervention to older people with anxiety and/or depression. To test procedures and determine if it is feasible to recruit and randomise patients, and to conduct a process evaluation to provide essential information to inform a randomised trial.DesignThree phases, all informed by a patient and public involvement and engagement group. Qualitative work with older people and third-sector providers, plus a consensus group to refine the intervention, training, SW manuals and patient participant materials (phase 1). Recruitment and training of SWs (phase 2). Feasibility study to test recruitment procedures and assess fidelity of delivery of the intervention; and interviews with study participants, SWs and GPs to assess acceptability of the intervention and impact on routine care (phase 3).SettingNorth Staffordshire, in collaboration with Age UK North Staffordshire.InterventionA psychosocial intervention, comprising one-to-one contact between older people with anxiety and/or depression and a SW employed by Age UK North Staffordshire, based on the principles of behavioural activation (BA), with encouragement to participate in a group activity.ResultsInitial qualitative work contributed to refinement of the psychosocial intervention. Recruitment (and retention) of the SWs was possible; the training, support materials and manual were acceptable to them, and they delivered the intervention as intended. Recruitment of practices from which to recruit patients was possible, but the recruitment target (100 patients) was not achieved, with 38 older adults randomised. Retention at 4 months was 86%. The study was not powered to demonstrate differences in outcomes. Older people in the intervention arm found the sessions with SWs acceptable, although signposting to, and attending, groups was not valued by all participants. GPs recognised the need for additional care for older people with anxiety and depression, which they could not provide. Participation in the study did not have an impact on routine care, other than responding to the calls from the study team about risk of self-harm. GPs were not aware of the work done by SWs with patients.LimitationsTarget recruitment was not achieved.ConclusionsSupport workers recruited from Age UK employees can be recruited and trained to deliver an intervention, based on the principles of BA, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to SWs, and the intervention was acceptable to older people.Future workFurther development of recruitment strategies is needed before this intervention can be tested in a fully powered randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN16318986.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 7, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Mo Ray
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
| | - Tom Kingstone
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Elaine Nicholls
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
- Collaboration for Leadership in Applied Health Research and Care West Midlands, Warwick, UK
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Pollard N, Kantartzis S, Ismail MM, Fransen-Jaïbi H, Viana-Moldes I. The occupation of accessing healthcare and processes of (dis)citizenship in UK Somali migrants: Sheffield case study. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2019. [DOI: 10.1080/14473828.2018.1434989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nick Pollard
- Occupational Therapy and Vocational Rehabilitation, Sheffield Hallam University, Sheffield, UK
| | - Sarah Kantartzis
- Division of Occupational Therapy and Arts Therapies, Queen Margaret University, Edinburgh, UK
| | - Mubarak Musa Ismail
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Hetty Fransen-Jaïbi
- Head of Occupational Therapy Education, Ecole Supérieure des Sciences et Techniques de la Santé de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Ines Viana-Moldes
- Department of Health Sciences, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
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Understanding Mental Health: What Are the Issues for Black and Ethnic Minority Students at University? SOCIAL SCIENCES 2018. [DOI: 10.3390/socsci7100196] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Black and Minority Ethnic (BME) communities continue to experience inequalities within the United Kingdom (UK) mental health system despite major government policy initiatives. Access to higher education for many ethnic minorities remains problematic. Within higher education, BME students consistently face barriers in terms of accessing culturally appropriate services including a lack of cultural understanding, communication issues, and where and how to seek help. This paper attempts to address the problems facing ethnic minorities with regard to accessing mental health services at university. Importantly, this paper highlights that barriers to accessing mental health support for ethnic minorities directly impact upon attainment outcomes and psychological well-being. This study utilizes the narratives of 32 BME university students to examine the impact of negotiating racial inequality and discrimination at university and the impact upon mental health. Aspects examined considered the impact of belonging, isolation, and marginalization on mental health and how this consequently affects university participation for BME students. Utilizing a thematic analysis paradigm, the key findings presented point towards differential healthcare outcomes for ethnic minority university students experiencing mental illness. The empirical findings in this paper suggest that currently ethnic minority service users experience overt discrimination and a lack of access to culturally appropriate services that are cognizant of the racialized plights faced by BME individuals. These findings inform an overarching dialogue, which suggests that mental health service providers need to work more collegially with people from BME communities prior to service design and delivery. Furthermore, the findings suggest that, upon presenting mental health issues, information should be made available in appropriate languages for ethnic minorities to support understanding about their illnesses and how they can seek professional intervention and help. Conclusions and recommendations provided advocate greater diversification of mental health support systems for ethnic minority students within universities. Conclusions drawn will also consider how existing systems can function to dismantle racial inequality within the mental health profession.
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Memon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, de Visser R. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open 2016; 6:e012337. [PMID: 27852712 PMCID: PMC5128839 DOI: 10.1136/bmjopen-2016-012337] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare. DESIGN AND SETTING Qualitative study in Southeast England. PARTICIPANTS 26 adults from BME backgrounds (13 men, 13 women; aged >18 years) were recruited to 2 focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. RESULTS Participants identified 2 broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users and lack of awareness of different services among service users and providers. CONCLUSIONS People from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access.
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Affiliation(s)
- Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Katie Taylor
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Lisa M Mohebati
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Josefin Sundin
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Max Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Thomas Scanlon
- Public Health Directorate, Brighton and Hove City Council, Brighton and Hove, UK
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Dowrick C, Bower P, Chew-Graham C, Lovell K, Edwards S, Lamb J, Bristow K, Gabbay M, Burroughs H, Beatty S, Waheed W, Hann M, Gask L. Evaluating a complex model designed to increase access to high quality primary mental health care for under-served groups: a multi-method study. BMC Health Serv Res 2016; 16:58. [PMID: 26883118 PMCID: PMC4756439 DOI: 10.1186/s12913-016-1298-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/09/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many people with mental distress are disadvantaged because care is not available or does not address their needs. In order to increase access to high quality primary mental health care for under-served groups, we created a model of care with three discrete elements: community engagement, primary care training and tailored wellbeing interventions. We have previously demonstrated the individual impact of each element of the model. Here we assess the effectiveness of the combined model in increasing access to and improving the quality of primary mental health care. We test the assumptions that access to the wellbeing interventions is increased by the presence of community engagement and primary care training; and that quality of primary mental health care is increased by the presence of community engagement and the wellbeing interventions. METHODS We implemented the model in four under-served localities in North-West England, focusing on older people and minority ethnic populations. Using a quasi-experimental design with no-intervention comparators, we gathered a combination of quantitative and qualitative information. Quantitative information, including referral and recruitment rates for the wellbeing interventions, and practice referrals to mental health services, was analysed descriptively. Qualitative information derived from interview and focus group responses to topic guides from more than 110 participants. Framework analysis was used to generate findings from the qualitative data. RESULTS Access to the wellbeing interventions was associated with the presence of the community engagement and the primary care training elements. Referrals to the wellbeing interventions were associated with community engagement, while recruitment was associated with primary care training. Qualitative data suggested that the mechanisms underlying these associations were increased awareness and sense of agency. The quality of primary mental health care was enhanced by information gained from our community mapping activities, and by the offer of access to the wellbeing interventions. There were variable benefits from health practitioner participation in community consultative groups. We also found that participation in the wellbeing interventions led to increased community engagement. CONCLUSIONS We explored the interactions between elements of a multilevel intervention and identified important associations and underlying mechanisms. Further research is needed to test the generalisability of the model. TRIAL REGISTRATION Current Controlled Trials, reference ISRCTN68572159 . Registered 25 February 2013.
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Affiliation(s)
- Christopher Dowrick
- />Institute of Psychology, Health and Society, Waterhouse Building, University of Liverpool, Liverpool, L69 3GL UK
| | - Peter Bower
- />NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Carolyn Chew-Graham
- />Primary Care and Health Sciences Research Institute, Keele University, Keele, Staffordshire ST5 5BG UK
- />West Midlands Collaboration for Leadership in Applied Health Research & Care, Birmingham, UK
| | - Karina Lovell
- />School of Nursing, Midwifery and Social Work, Jean MacFarlane Building, University of Manchester, Manchester, M13 9PL UK
| | - Suzanne Edwards
- />College of Medicine, Grove Building, Swansea University, Swansea, SA2 8PP UK
| | - Jonathan Lamb
- />NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Katie Bristow
- />Institute of Psychology, Health and Society, Waterhouse Building, University of Liverpool, Liverpool, L69 3GL UK
| | - Mark Gabbay
- />Institute of Psychology, Health and Society, Waterhouse Building, University of Liverpool, Liverpool, L69 3GL UK
| | - Heather Burroughs
- />Primary Care and Health Sciences Research Institute, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Susan Beatty
- />School of Nursing, Midwifery and Social Work, Jean MacFarlane Building, University of Manchester, Manchester, M13 9PL UK
| | - Waquas Waheed
- />NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Mark Hann
- />NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Linda Gask
- />NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
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Masood Y, Lovell K, Lunat F, Atif N, Waheed W, Rahman A, Mossabir R, Chaudhry N, Husain N. Group psychological intervention for postnatal depression: a nested qualitative study with British South Asian women. BMC WOMENS HEALTH 2015; 15:109. [PMID: 26603604 PMCID: PMC4659205 DOI: 10.1186/s12905-015-0263-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 11/17/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postnatal depression affects 10-15 % of all mothers in Western societies and remains a major public health concern for women from diverse cultures. British Pakistani and Indian women have a higher prevalence of depression in comparison to their white counterparts. Research has shown that culturally adapted interventions using Cognitive Behavioural Therapy (CBT) may be acceptable and may help to address the needs of this population. The aim of this study was to assess the acceptability and overall experience of the Positive Health Programme by British South Asian mothers. METHODS This was a nested qualitative study, part of an exploratory randomized controlled trial (RCT) conducted to test the feasibility and acceptability of a culturally-adapted intervention (Positive Health Programme or PHP) for postnatal depression in British South Asian women. In-depth interviews (N = 17) were conducted to determine the views of the participants on the feasibility and acceptability of the intervention. RESULTS The participants found the intervention acceptable and experienced an overall positive change in their attitudes, behaviour, and increased self-confidence. CONCLUSIONS The findings suggest that the culturally adapted Positive Health Programme is acceptable to British South Asian women. These results support that culturally sensitive interventions may lead to better health outcomes and overall satisfaction. TRIAL REGISTRATION Protocol registered on Clinicaltrials.gov NCT01838889.
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Affiliation(s)
- Yumna Masood
- Cumbria Partnership Foundation Trust, Garburn House, Westmoreland General Hospital, Burton Road, Kendal, LA97RG, UK.
| | - Karina Lovell
- The School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK.
| | - Farah Lunat
- Lancashire Care NHS Foundation Trust, Whalley Road, Accrington, BB5 5AD, UK.
| | - Najia Atif
- The School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- Centre for Primary Care, Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Atif Rahman
- Institute of Psychology, Health & Society, University of Liverpool, The Waterhouse Building, Dover Street, Liverpool, Merseyside, L3 5DA, UK. .,Child Mental Health Unit, Alder Hey Children's NHS Foundation Trust, Mulberry House, Eaton Road, Liverpool, L12 2AP, UK.
| | - Rahena Mossabir
- Centre for Primary Care, Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Nasim Chaudhry
- Institute of Brain, Behaviour, and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Nusrat Husain
- Lancashire Care NHS Foundation Trust, Whalley Road, Accrington, BB5 5AD, UK. .,Institute of Brain, Behaviour, and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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Ford JA, Jones AP, Wong G, Clark AB, Porter T, Shakespeare T, Swart AM, Steel N. Improving access to high-quality primary care for socioeconomically disadvantaged older people in rural areas: a mixed method study protocol. BMJ Open 2015; 5:e009104. [PMID: 26384728 PMCID: PMC4577946 DOI: 10.1136/bmjopen-2015-009104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The UK has an ageing population, especially in rural areas, where deprivation is high among older people. Previous research has identified this group as at high risk of poor access to healthcare. The aim of this study is to generate a theory of how socioeconomically disadvantaged older people from rural areas access primary care, to develop an intervention based on this theory and test it in a feasibility trial. METHODS AND ANALYSIS On the basis of the MRC Framework for Developing and Evaluating Complex Interventions, three methods will be used to generate the theory. First, a realist review will elucidate the patient pathway based on existing literature. Second, an analysis of the English Longitudinal Study of Ageing will be completed using structural equation modelling. Third, 15 semistructured interviews will be undertaken with patients and four focus groups with health professionals. A triangulation protocol will be used to allow each of these methods to inform and be informed by each other, and to integrate data into one overall realist theory. Based on this theory, an intervention will be developed in discussion with stakeholders to ensure that the intervention is feasible and practical. The intervention will be tested within a feasibility trial, the design of which will depend on the intervention. Lessons from the feasibility trial will be used to refine the intervention and gather the information needed for a definitive trial. ETHICS AND DISSEMINATION Ethics approval from the regional ethics committee has been granted for the focus groups with health professionals and interviews with patients. Ethics approval will be sought for the feasibility trial after the intervention has been designed. Findings will be disseminated to the key stakeholders involved in intervention development, to researchers, clinicians and health planners through peer-reviewed journal articles and conference publications, and locally through a dissemination event.
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Affiliation(s)
- John A Ford
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew P Jones
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, London, UK
| | - Allan B Clark
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tom Porter
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tom Shakespeare
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ann Marie Swart
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
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Lamb J, Dowrick C, Burroughs H, Beatty S, Edwards S, Bristow K, Clarke P, Hammond J, Waheed W, Gabbay M, Gask L. Community Engagement in a complex intervention to improve access to primary mental health care for hard-to-reach groups. Health Expect 2014; 18:2865-79. [PMID: 25263536 DOI: 10.1111/hex.12272] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite the availability of effective evidence-based treatments for depression and anxiety, many 'harder-to-reach' social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. OBJECTIVES To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model. DESIGN Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered. SETTING & PARTICIPANTS A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom. KEY FINDINGS Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open-ended investment are a barrier. The time-limited nature of a CE intervention provides an impetus to 'do it now', allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement. CONCLUSIONS CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology.
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Affiliation(s)
- Jonathan Lamb
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Heather Burroughs
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Susan Beatty
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Suzanne Edwards
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Kate Bristow
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Pam Clarke
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jonathan Hammond
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Waquas Waheed
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Mark Gabbay
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Linda Gask
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
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Lovell K, Lamb J, Gask L, Bower P, Waheed W, Chew-Graham C, Lamb J, Aseem S, Beatty S, Burroughs H, Clarke P, Dowrick A, Edwards S, Gabbay M, Lloyd-Williams M, Dowrick C. Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care. BMC Psychiatry 2014; 14:217. [PMID: 25085447 PMCID: PMC4149271 DOI: 10.1186/s12888-014-0217-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 07/18/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Psychological therapy is effective for symptoms of mental distress, but many groups with high levels of mental distress face significant barriers in terms of access to care, as current interventions may not be sensitive to their needs or their understanding of mental health. There is a need to develop forms of psychological therapy that are acceptable to these groups, feasible to deliver in routine settings, and clinically and cost effective. METHODS We developed a culturally sensitive wellbeing intervention with individual, group and sign-posting elements, and tested its feasibility and acceptability for patients from ethnic minorities and older people in an exploratory randomised trial. RESULTS We recruited 57 patients (57% of our target) from 4 disadvantaged localities in the NW of England. The results of the exploratory trial suggest that the group receiving the wellbeing interventions improved compared to the group receiving usual care. For elders, the largest effects were on CORE-OM and PHQ-9. For ethnic minority patients, the largest effect was on PHQ-9. Qualitative data suggested that patients found the intervention acceptable, both in terms of content and delivery. CONCLUSIONS This exploratory trial provides some evidence of the efficacy and acceptability of a wellbeing intervention for older and ethnic minority groups experiencing anxiety and depression, although challenges in recruitment and engagement remain. Evidence from our exploratory study of wellbeing interventions should inform new substantive trial designs. TRIAL REGISTRATION Current controlled trials ISRCTN68572159.
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Affiliation(s)
- Karina Lovell
- School of Nursing Midwifery and Social Work, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
| | - Jonathan Lamb
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Linda Gask
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Pete Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Carolyn Chew-Graham
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Jon Lamb
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Saadia Aseem
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Susan Beatty
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Heather Burroughs
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Pam Clarke
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Anna Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Suzanne Edwards
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Mark Gabbay
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Mari Lloyd-Williams
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Chris Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
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Chew-Graham C, Burroughs H, Hibbert D, Gask L, Beatty S, Gravenhorst K, Waheed W, Kovandžić M, Gabbay M, Dowrick C. Aiming to improve the quality of primary mental health care: developing an intervention for underserved communities. BMC FAMILY PRACTICE 2014; 15:68. [PMID: 24741996 PMCID: PMC4004464 DOI: 10.1186/1471-2296-15-68] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background The purpose of the study was to improve the quality of primary mental healthcare in underserved communities through involvement with the wider primary care team members and local community agencies. Methods We developed training intended for all GP practice staff which included elements of knowledge transfer, systems review and active linking. Seven GP Practices in four localities (North West England, UK) took part in the training. Qualitative evaluation was conducted using thirteen semi-structured interviews and two focus groups in six of the participating practices; analysis used principles of Framework Analysis. Results Staff who had engaged with the training programme reported increased awareness, recognition and respect for the needs of patients from under-served communities. We received reports of changes in style and content of interactions, particularly amongst receptionists, and evidence of system change. In addition, the training program increased awareness of – and encouraged signposting to - community agencies within the practice locality. Conclusions This study demonstrates how engaging with practices and delivering training in a changing health care system might best be attempted. The importance of engaging with community agencies is clear, as is the use of the AMP model as a template for further research.
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Affiliation(s)
| | - Heather Burroughs
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
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Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, Brozek I, Hughes C. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol 2014; 14:42. [PMID: 24669751 PMCID: PMC3974746 DOI: 10.1186/1471-2288-14-42] [Citation(s) in RCA: 700] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups. Methods A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition. Results In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials. Conclusions To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.
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Affiliation(s)
- Billie Bonevski
- School of Medicine & Public Health, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia.
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Slaying the dragon myth: an ethnographic study of receptionists in UK general practice. Br J Gen Pract 2013; 63:e177-84. [PMID: 23561784 DOI: 10.3399/bjgp13x664225] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND General practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful 'gatekeepers'. Existing literature and management initiatives advocate more training to improve their performance and, consequently, the patient experience. AIM To explore the complexity of the role of general practice receptionists by considering the wider practice context in which they work. DESIGN AND SETTING Ethnographic observation in seven urban general practices in the north-west of England. METHOD Seven researchers conducted 200 hours of ethnographic observation, predominantly in the reception areas of each practice. Forty-five receptionists were involved in the study and were asked about their work as they carried out their activities. Observational notes were taken. Analysis involved ascribing codes to incidents considered relevant to the role and organising these into related clusters. RESULTS Receptionists were faced with the difficult task of prioritising patients, despite having little time, information, and training. They felt responsible for protecting those patients who were most vulnerable, however this was sometimes made difficult by protocols set by the GPs and by patients trying to 'play' the system. CONCLUSION Framing the receptionist-patient encounter as one between the 'powerful' and the 'vulnerable' gets in the way of fully understanding the complex tasks receptionists perform and the contradictions that are inherent in their role. Calls for more training, without reflective attention to practice dynamics, risk failing to address systemic problems, portraying them instead as individual failings.
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Dowrick C, Chew-Graham C, Lovell K, Lamb J, Aseem S, Beatty S, Bower P, Burroughs H, Clarke P, Edwards S, Gabbay M, Gravenhorst K, Hammond J, Hibbert D, Kovandžić M, Lloyd-Williams M, Waheed W, Gask L. Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- C Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - C Chew-Graham
- Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - K Lovell
- Institute of Population Health, University of Manchester, Manchester, UK
| | - J Lamb
- Institute of Population Health, University of Manchester, Manchester, UK
| | - S Aseem
- Institute of Population Health, University of Manchester, Manchester, UK
| | - S Beatty
- Institute of Population Health, University of Manchester, Manchester, UK
| | - P Bower
- Institute of Population Health, University of Manchester, Manchester, UK
| | - H Burroughs
- Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - P Clarke
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - S Edwards
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
- College of Medicine, Swansea University, Swansea, UK
| | - M Gabbay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - K Gravenhorst
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - J Hammond
- Institute of Population Health, University of Manchester, Manchester, UK
| | - D Hibbert
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - M Kovandžić
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - M Lloyd-Williams
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - W Waheed
- Institute of Population Health, University of Manchester, Manchester, UK
| | - L Gask
- Institute of Population Health, University of Manchester, Manchester, UK
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Diagnosis and management of chronic fatigue syndrome/myalgic encephalitis in black and minority ethnic people: a qualitative study. Prim Health Care Res Dev 2013; 15:143-55. [DOI: 10.1017/s1463423613000145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Allmark P, Baxter S, Goyder E, Guillaume L, Crofton-Martin G. Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:59-68. [PMID: 23039788 PMCID: PMC3557712 DOI: 10.1111/j.1365-2524.2012.01087.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 06/01/2023]
Abstract
Poverty is positively associated with poor health; thus, some healthcare commissioners in the UK have pioneered the introduction of advice services in health service locations. Previous systematic reviews have found little direct evidence for a causal relationship between the provision of advice and physical health and limited evidence for mental health improvement. This paper reports a study using a broader range of types of research evidence to construct a conceptual (logic) model of the wider evidence underpinning potential (rather than only proven) causal pathways between the provision of advice services and improvements in health. Data and discussion from 87 documents were used to construct a model describing interventions, primary outcomes, secondary and tertiary outcomes following advice interventions. The model portrays complex causal pathways between the intervention and various health outcomes; it also indicates the level of evidence for each pathway. It can be used to inform the development of research designed to evaluate the pathways between interventions and health outcomes, which will determine the impact on health outcomes and may explain inconsistencies in previous research findings. It may also be useful to commissioners and practitioners in making decisions regarding development and commissioning of advice services.
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Affiliation(s)
- Peter Allmark
- Health and Social Care Research Centre, Sheffield Hallam University, UK.
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Gask L, Bower P, Lamb J, Burroughs H, Chew-Graham C, Edwards S, Hibbert D, Kovandžić M, Lovell K, Rogers A, Waheed W, Dowrick C, Group AMPR. Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions. BMC Health Serv Res 2012; 12:249. [PMID: 22889290 PMCID: PMC3515797 DOI: 10.1186/1472-6963-12-249] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. METHODS Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. RESULTS The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions. CONCLUSIONS The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.
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Affiliation(s)
- Linda Gask
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Peter Bower
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Jonathan Lamb
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Heather Burroughs
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Carolyn Chew-Graham
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Suzanne Edwards
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Derek Hibbert
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Marija Kovandžić
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Karina Lovell
- Manchester Academic Health Science Centre, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Anne Rogers
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Waquas Waheed
- Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - Christopher Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - AMP Research Group
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Richards DA, Bower P, Pagel C, Weaver A, Utley M, Cape J, Pilling S, Lovell K, Gilbody S, Leibowitz J, Owens L, Paxton R, Hennessy S, Simpson A, Gallivan S, Tomson D, Vasilakis C. Delivering stepped care: an analysis of implementation in routine practice. Implement Sci 2012; 7:3. [PMID: 22248385 PMCID: PMC3283464 DOI: 10.1186/1748-5908-7-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 01/16/2012] [Indexed: 11/23/2022] Open
Abstract
Background In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type) increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management. Methods We recorded service design features of four National Health Service sites implementing stepped care (e.g., the types of treatments available and their links with other treatments), together with the actual treatments received by individual patients and their transitions between different treatment steps. We computed the proportions of patients accessing, receiving, and transiting between the various steps and mapped these proportions visually to illustrate patient movement. Results We collected throughput data on 7,698 patients referred. Patient pathways were highly complex and very variable within and between sites. The ratio of low (e.g., self-help) to high-intensity (e.g., cognitive behaviour therapy) treatments delivered varied between sites from 22:1, through 2.1:1, 1.4:1 to 0.5:1. The numbers of patients allocated directly to high-intensity treatment varied from 3% to 45%. Rates of stepping up from low-intensity treatment to high-intensity treatment were less than 10%. Conclusions When services attempt to implement the recommendation for stepped care in the National Institute for Health and Clinical Excellence guidelines, there were significant differences in implementation and consequent high levels of variation in patient pathways. Evaluations driven by the principles of implementation science (such as targeted planning, defined implementation strategies, and clear activity specification around service organisation) are required to improve evidence on the most effective, efficient, and acceptable stepped care systems.
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Affiliation(s)
- David A Richards
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QG, UK.
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Chew-Graham C, Kovandžić M, Gask L, Burroughs H, Clarke P, Sanderson H, Dowrick C. Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:52-60. [PMID: 21749528 DOI: 10.1111/j.1365-2524.2011.01015.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Depression in older people is common, under-recognised and often undertreated. This study aimed to explore the reasons why older people with depression may not present to primary care. Secondary analysis was carried out, of qualitative data collected in two previous studies in North-West England. Older people are reluctant to recognise and name 'depression' as a set of symptoms that legitimises attending their general practitioner (GP). They do not consider themselves candidates for help for their distress. This is partly due to perceptions of the role of the GP but also to previous negative experiences of help seeking. In addition, treatments offered, which are predominantly biomedical, may not be acceptable to older people. Interventions offered to older people need to encourage social engagement, such as befriending, and enhancement of creative, physical and social activity.
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Affiliation(s)
- Carolyn Chew-Graham
- Health Sciences Research Group - Primary Care, School of Community-Based Medicine, University of Manchester, UK.
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Bristow K, Edwards S, Funnel E, Fisher L, Gask L, Dowrick C, Chew Graham C. Help Seeking and Access to Primary Care for People from "Hard-to-Reach" Groups with Common Mental Health Problems. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2011; 2011:490634. [PMID: 22312546 PMCID: PMC3268206 DOI: 10.1155/2011/490634] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/15/2011] [Accepted: 04/13/2011] [Indexed: 05/31/2023]
Abstract
Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from "hard-to-reach" groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from "hard-to-reach" groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from "hard-to-reach" groups including the need to offer a flexible, non-biomedical response to distress.
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Affiliation(s)
- K. Bristow
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - S. Edwards
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - E. Funnel
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - L. Fisher
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - L. Gask
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - C. Dowrick
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - C. Chew Graham
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
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Kovandžić M, Chew-Graham C, Reeve J, Edwards S, Peters S, Edge D, Aseem S, Gask L, Dowrick C. Access to primary mental health care for hard-to-reach groups: From ‘silent suffering’ to ‘making it work’. Soc Sci Med 2011; 72:763-72. [DOI: 10.1016/j.socscimed.2010.11.027] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 11/16/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
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