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Thomas E, Benjamin-Thomas TE, Sithambaram A, Shankar J, Chen SP. Participatory Action Research Among People With Serious Mental Illness: A Scoping Review. QUALITATIVE HEALTH RESEARCH 2024; 34:3-19. [PMID: 37929751 PMCID: PMC10714715 DOI: 10.1177/10497323231208111] [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: 11/07/2023]
Abstract
Participatory action research (PAR) is a research approach that creates spaces for marginalized individuals and communities to be co-researchers to guide relevant social change. While working toward social transformation, all members of the PAR team often experience personal transformation. Engaging people with serious mental illness (PSMI) in PAR helps them to develop skills and build relationships with stakeholders in their communities. It supports positive changes that persist after the completion of the formal research project. With the increasing recognition of PAR's value in PSMI, it is helpful to consider the challenges and advantages of this approach to research with this population. This review aimed at determining how PAR has been conducted with PSMI and at summarizing strategies used to empower PSMI as co-researchers by engaging them in research. This scoping review followed five steps Arkesy and O'Malley (2005) outlined. We charted, collated, and summarized relevant information from 87 studies that met the inclusion criteria. We identified five strategies to empower PSMI through PAR. These are to build capacity, balance power distribution, create collaborative environments, promote peer support, and enhance their engagement as co-researchers. In conclusion, PAR is an efficient research approach to engage PSMI. Further, PSMI who engage in PAR may benefit from strategies for empowerment that meet their unique needs as co-researchers.
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Affiliation(s)
- Elizabethmary Thomas
- Faculty of Rehabilitation Medicine, College of Health Sciences University of Alberta, Edmonton, AB, Canada
| | | | - Abirame Sithambaram
- Department of Occupational Therapy, Rocky Mountain University of Health Professions (Online program), Colombo, Sri Lanka
| | - Janki Shankar
- Faculty of Social Work, University of Calgary, Edmonton, AB, Canada
| | - Shu-Ping Chen
- Faculty of Rehabilitation Medicine, College of Health Sciences University of Alberta, Edmonton, AB, Canada
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Jakobsson CE, Genovesi E, Afolayan A, Bella-Awusah T, Omobowale O, Buyanga M, Kakuma R, Ryan GK. Co-producing research on psychosis: a scoping review on barriers, facilitators and outcomes. Int J Ment Health Syst 2023; 17:25. [PMID: 37644476 PMCID: PMC10466887 DOI: 10.1186/s13033-023-00594-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Co-production is a collaborative approach to service user involvement in which users and researchers share power and responsibility in the research process. Although previous reviews have investigated co-production in mental health research, these do not typically focus on psychosis or severe mental health conditions. Meanwhile, people with psychosis may be under-represented in co-production efforts. This scoping review aims to explore the peer-reviewed literature to better understand the processes and terminology employed, as well as the barriers, facilitators, and outcomes of co-production in psychosis research. METHODS Three databases were searched (MEDLINE, EMBASE, PsycINFO) using terms and headings related to psychosis and co-production. All titles, abstracts and full texts were independently double-screened. Disagreements were resolved by consensus. Original research articles reporting on processes and methods of co-production involving adults with psychosis as well as barriers, facilitators, and/or outcomes of co-production were included. Data was extracted using a standardised template and synthesised narratively. Joanna Briggs Institute and the AGREE Reporting Checklist were used for quality assessment. RESULTS The search returned 1243 references. Fifteen studies were included: five qualitative, two cross-sectional, and eight descriptive studies. Most studies took place in the UK, and all reported user involvement in the research process; however, the amount and methods of involvement varied greatly. Although all studies were required to satisfy INVOLVE (2018) principles of co-production to be included, seven were missing several of the key features of co-production and often used different terms to describe their collaborative approaches. Commonly reported outcomes included improvements in mutual engagement as well as depth of understanding and exploration. Key barriers were power differentials between researchers and service users and stigma. Key facilitators were stakeholder buy-in and effective communication. CONCLUSIONS The methodology, terminology and quality of the studies varied considerably; meanwhile, over-representation of UK studies suggests there may be even more heterogeneity in the global literature not captured by our review. This study makes recommendations for encouraging co-production and improving the reporting of co-produced research, while also identifying several limitations that could be improved upon for a more comprehensive review of the literature.
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Affiliation(s)
- C E Jakobsson
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Eastbourne, England, UK.
| | - E Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - A Afolayan
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T Bella-Awusah
- Department of Psychiatry & Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O Omobowale
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M Buyanga
- SUCCEED Africa, University of Zimbabwe, Harare, Zimbabwe
| | - R Kakuma
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
| | - G K Ryan
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
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Boerkoel A, Brommels M. The processes involved in the establishment of user-provider partnerships in severe psychiatric illnesses: a scoping review. BMC Psychiatry 2022; 22:660. [PMID: 36289473 PMCID: PMC9608879 DOI: 10.1186/s12888-022-04303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE With the rising relevance of person-centred care, initiatives towards user-led decision making and designing of care services have become more frequent. This designing of care services can be done in partnership, but it is unclear how. The aim of this scoping review was to identify for mental health services, what user-provider partnerships are, how they arise in practice and what can facilitate or hinder them. METHODS A scoping review was conducted to obtain a broad overview of user provider partnerships in severe mental illness. Data was inductively analysed using a conventional content analysis approach, in which meaning was found in the texts. RESULTS In total, 1559 titles were screened for the eligibility criteria and the resulting 22 papers found relevant were analysed using conventional content analysis. The identified papers had broad and differing concepts for user-provider partnerships. Papers considered shared decision making and user-involvement as partnerships. Mechanisms such as open communication, organisational top-down support and active participation supported partnerships, but professional identity, power imbalances and stress hindered them. Users can be impeded by their illness, but how to deal with these situations should be formalised through contracts. CONCLUSION The field of research around user-provider partnerships is scattered and lacks consensus on terminology. A power imbalance between a user and a provider is characteristic of partnerships in mental healthcare, which hinders the necessary relationship building allowing partnerships to arise. This power imbalance seems to be closely linked to professional identity, which was found to be difficult to change.
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Affiliation(s)
- Aletta Boerkoel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. .,Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.
| | - Mats Brommels
- grid.465198.7Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
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Buse CG, Allison S, Cole DC, Fumerton R, Parkes MW, Woollard RF. Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis. Front Public Health 2022; 10:867397. [PMID: 35692331 PMCID: PMC9178183 DOI: 10.3389/fpubh.2022.867397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.
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Affiliation(s)
- Chris G. Buse
- Centre for Environmental Assessment Research, University of British Columbia (Okanagan Campus), Kelowna, BC, Canada
- *Correspondence: Chris G. Buse
| | | | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Margot Winifred Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Robert F. Woollard
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Turner E, Berry K, Aggarwal VR, Quinlivan L, Villanueva T, Palmier-Claus J. Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand 2022; 145:29-41. [PMID: 33862664 DOI: 10.1111/acps.13308] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
AIM To understand the relationship between serious mental illness and oral health self-care behaviours using meta-analytic methods and a narrative synthesis of available literature. METHOD The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines [PROSPERO reference: CRD42020176779]. Search terms pertaining to serious mental illness and oral health were entered into EMBASE, PsycINFO, Medline and CINAHL. Eligible studies included a sample of people with a serious mental illness and a quantitative measure of an oral health self-care behaviour (eg dental visits, toothbrushing). The Effective Public Health Practice Project tool was utilised to appraise the quality of the literature. Studies in the meta-analysis contained a non-clinical or general population comparator sample. RESULTS People with a serious mental illness were significantly less likely to visit the dentist (OR 0.46, 95% CI 0.32-0.065, p > 0.001) or brush their teeth (OR 0.19, 95% CI 0.08-0.42, p < 0.001) when compared to non-clinical comparator samples. Few studies explored other oral health self-care behaviours (eg flossing and mouth washing), but uptake was generally low in people with a serious mental illness. The study quality of included studies was variable. CONCLUSIONS The research showed a reduced uptake of oral health self-care behaviours in people with a serious mental illness. Suboptimal oral health can negatively impact on physical, social and psychological functioning. Further research is needed to understand the reasons for low rates of oral health self-care behaviours in this population.
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Affiliation(s)
- Elizabeth Turner
- Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine and Health, The University of Leeds, Leeds, UK
| | - Leah Quinlivan
- Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Jasper Palmier-Claus
- The Spectrum Centre for Mental Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK.,Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
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Zibrowski E, Carr T, McDonald S, Thiessen H, van Dusen R, Goodridge D, Haver C, Marciniuk D, Stobart C, Verrall T, Groot G. A rapid realist review of patient engagement in patient-oriented research and health care system impacts: part one. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:72. [PMID: 34629118 PMCID: PMC8504114 DOI: 10.1186/s40900-021-00299-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patient-oriented research affords individuals with opportunities to genuinely contribute to health care research as members of research teams. While checklists and frameworks can support academic researchers' awareness of patient engagement methods, less guidance appears available to support their understanding of how to develop and maintain collaborative relationships with their patient partners. This knowledge is essential as patient partners report that the social atmospheres of research teams significantly impacts the quality of their experiences. This study sought to develop theory regarding how academic researchers support and sustain patient engagement in patient-oriented research. METHODS A six-step, rapid realist review was conducted: (1) research question development, (2) preliminary theory development, (3) search strategy development; (4) study selection and appraisal, (4) data extraction, analysis and synthesis (5) identification of relevant formal theories, and (6) theory refinement with stakeholders. Findings were additionally distilled by collective competence theory. RESULTS A program theory was developed from 62 international studies which illuminated mechanisms supporting academic researchers to engage patient partners, contexts supporting these mechanisms, and resources that enabled mechanism activation. Interaction between seven contexts (patient-oriented research belief, prior interaction with a healthcare system, prior interaction with a particular academic researcher, educational background of patient partner, prior experience with patient-oriented research, study type, and time lived in a rural-urban setting) and seven mechanisms (deciding to become involved in patient-oriented research, recognizing valuable experiential knowledge, cultural competence, reducing power differentials, respectful team environment, supporting patient partners to feel valued, and readiness to research) resulted in an intermediate outcome (sense of trust). Trust then acted as an eighth mechanism which triggered the final-level outcome (empowered patient-centred lens). CONCLUSIONS Our theory posits that if patient partners trust they are a member of a supportive team working alongside academic researchers who authentically want to incorporate their input, then they are empowered to draw upon their experiential knowledge of health care systems and contribute as researchers in patient-oriented research. Our theory extends conceptual thinking regarding the importance of trust on patient-oriented research teams, how patient partners' trust is shaped by team interactions, and the role that academic researchers have within those interactions.
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Affiliation(s)
- Elaine Zibrowski
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | | | | | | | - Donna Goodridge
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Charlene Haver
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Darcy Marciniuk
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Christine Stobart
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tanya Verrall
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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Wagner S, Addington KS, Varming A, Hempler NF. Caught between good intentions and rigid structures: A qualitative description of professionals' experiences with health promotion in mental health services. Scand J Caring Sci 2021; 36:663-672. [PMID: 34355422 DOI: 10.1111/scs.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Compared with the general population, people with mental illness are at higher risk of developing type 2 diabetes due to poor diet, medication and inactive lifestyle. People with mental illness and members of the general population are equally interested in health behaviour change, but those with mental illness experience communication barriers with professionals. The study aimed to explore philosophies that social care and healthcare professionals apply to health promotion activities targeting people with mental illness and challenges they face in applying these philosophies across multiple settings. METHODS Qualitative interviews were conducted with 18 social and healthcare professionals in a range of settings in 2016-2019. Descriptive qualitative analysis was applied to interview data. RESULTS Interviewees faced many structural challenges in the organisation of their work, which did not coincide with their philosophy or intentions in relation to health promotion. Three philosophical categories were identified: (a) health promotion approach, (b) elements of care and (c) social relations. Many interviewees intended to apply philosophies of broadly defined health, dialogue-based health education, and incremental approaches to health behaviour change. They wanted to provide holistic and flexible care and they valued peer-to-peer activities, family and friend involvement in care and a trusting relationship between the professional and the person with mental illness. However, rigid structures determining the organisation of health promotion challenged professionals' ability to follow their philosophical intentions. CONCLUSION Interviewees aspired to a collaborative, empowering and person-centred approach, but practical and structural factors made this difficult to achieve in practice. Major changes are required at the organisational level, implemented with the active involvement of professionals and people with mental illness.
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Affiliation(s)
- Sabina Wagner
- Steno Diabetes Center Copenhagen, Health Promotion Research, Gentofte, Denmark
| | | | - Annemarie Varming
- Steno Diabetes Center Copenhagen, Health Promotion Research, Gentofte, Denmark
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[The impact of territorial care in the treatment of people diagnosed with schizophrenia and delusional disorders in a Rio de Janeiro community]. Salud Colect 2021; 17:e3020. [PMID: 33822540 DOI: 10.18294/sc.2021.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
Care for people diagnosed with schizophrenia and delusional disorders involves many challenges, especially in territorial contexts of pronounced social vulnerability. In Rio de Janeiro, the two decades after the passing of Federal Law 10,216 on Psychiatric Reform in 2001 have been characterized by the transition from a hospital-centered model to one based on community services. Taking the case of a community in Rio de Janeiro, data was extracted from the medical records of 94 patients diagnosed with schizophrenia, schizotypal disorders, and delusional disorders (ICD-10 codes F20 to F29) in five public health services. Covering the period from 2003 to 2016, indicators of the quality of treatment provided were analyzed. As a result of this transition, psychiatric hospitals have all but emptied and a low number of currently untreated patients can be observed. In addition, crisis care and long-term hospitalizations have been replaced by territorial care, and clinical comorbidities are monitored and treated at Family Health Units.
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Pals RAS, Drejer S, Laursen RH, Oest L, Levisen VDH, Krogh NR, Hempler NF. Implementing a collaborative model in health education practice: a process evaluation of a health education programme targeting users with mental health problems. BMC Health Serv Res 2020; 20:38. [PMID: 31937316 PMCID: PMC6961358 DOI: 10.1186/s12913-019-4819-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Users with mental health problems (users) have a substantially higher risk of developing type 2 diabetes than the general population. Recent studies show that traditional lifestyle interventions focusing solely on exercise and diet among users have limited effect. Studies suggest collaborative models as a starting point for health behaviour change are more beneficial, but implementation in practice is a challenge. Using the Medical Research Council’s guidance for process evaluation, we explored implementation of a collaborative model in health education activities targeting users. The collaborative model focused on involving users in agenda setting and reflection about readiness to change health behaviour and was supported by dialogue tools (e.g., quotes and games). Educators received 3 days of training in applying the model. Methods Collected data included questionnaires for users (n = 154) and professionals (n = 158), interviews with users (n = 14), and observations of health education activities (n = 37) and the professional development programme (n = 9). Data were analysed using descriptive statistics and systematic text condensation. Results Ninetysix percent (152) of professionals tested the model in practice and tried at least one tool. Users reported that the model supported them in expressing their thoughts about their health and focused on their needs rather than the agenda of the professional. Ninetythree percent (143) of users strongly agreed that professionals were open-minded and responsive. However, observations showed that some professionals overlooked cues from users about motivation for health behaviour change. Furthermore, professionals identified lack of involvement from their managers as a barrier to implementation. Conclusions Implementation of a collaborative model was feasible in practice. Training of professionals in active listening and involvement of managers prior to implementation is crucial.
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Affiliation(s)
| | - Sabina Drejer
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark
| | | | - Lone Oest
- University College South Denmark, Lembckesvej 3, 6100, Haderslev, Denmark
| | | | | | - Nana Folmann Hempler
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark
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Chou FC, Huang LL, Hsieh KY, Chen SW, Yu SF, Chang SM, Chen SY. The Impact of Sex Differences and Oral Health Behaviors on Oral Health-related Quality of Life among Patients with Schizophrenia in Taiwan: A Cross-sectional Study. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_35_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rat C, Peteuil A, Reynaud M, Millot I, Carpentier M, Soudry-Faure A, Denis F. [A caregiver-person with schizophrenia partnership to improve oral health education]. SANTE PUBLIQUE 2019; Vol. 31:405-415. [PMID: 31640328 DOI: 10.3917/spub.193.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Poor oral health in persons with schizophrenia is a major public health issue affecting 600,000 people in France. The aim of this article was to present the different stages in the development of a specific oral health educational program for persons with schizophrenia. It takes into account experimental knowledge of these persons and presents the results of the feasibility study. PATIENTS AND METHOD The focus group method was applied to a group of health professionals and users to highlight an exploratory corpus in order to develop an oral health educational program. An expert group including persons with schizophrenia among others validated the fields and tools of this program. A feasibility study was then conducted in a control group of 7 persons with schizophrenia. RESULTS Altogether, 26 persons participated in this feasibility study. The main fields investigated by the expert group aimed to promote personal responsibility for one’s health, to improve access to the healthcare system and to promote the global management of health. The feasibility study showed the ability of this program to change persons with schizophrenia representations and knowledge of this health problem. Most educational tools were considered relevant. CONCLUSION An oral health educational program was built as part of a caregiver-persons with schizophrenia partnership and showed its feasibility. A multicentric randomized trial is currently ongoing to assess the efficacy of this program with a high level of proof.
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Cameron CM, Cumsille Nazar J, Ehrlich C, Kendall E, Crompton D, Liddy AM, Kisely S. General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial. AUST HEALTH REV 2019; 41:665-671. [PMID: 27977388 DOI: 10.1071/ah16151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to assess the effects of a community intervention aimed at general practitioners (GPs) by comparing Medicare claims data from patients with severe mental illness (SMI) of GPs exposed to the intervention and controls that were not. Methods A comparison was made of primary care consultation and pathology data of people with SMI from intervention and control areas. Negative binomial regression models were used to compare the frequency and length of GP consultations, as well as the number and type of pathology examinations. Results Records of 103 people from intervention area and 98 controls were obtained. Intervention and control areas were not different at baseline in terms of age and claims data, but females had higher consultation rates. After adjusting for gender, people from intervention areas had more GP consultations, especially long consultations (adjusted incidence rate ratio 1.56; 95% confidence interval 1.28-1.91). They also had more pathology screening for chronic diseases, in accordance with implemented guideline recommendations. These benefits persisted after the end of the intervention. Conclusion These findings suggest that the ACTIVATE program aimed at training GPs to screen and better manage chronic diseases in adults with SMI had a positive effect up to 6 months after the trial, with demonstrated desired changes in medical management practices by GPs in the intervention area during that time. What is known about the topic? People with an SMI have higher mortality and poorer physical health than the general population. What does this paper add? The community intervention had a significant and sustained effect, with demonstrated desired changes in screening and medical management by GPs for adults with SMI in the intervention area. What are the implications for practitioners? GPs are ideally placed to assist in the prevention and better management of health conditions, thereby reducing avoidable illness and deaths in vulnerable populations, such as adults with SMI. Ongoing professional training and dissemination of clinical guidelines are critical for raising awareness about the physical and oral health care needs of people with SMI.
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Affiliation(s)
- Cate M Cameron
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - Jose Cumsille Nazar
- School of Health Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Carolyn Ehrlich
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - David Crompton
- School of Health Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Ann Maree Liddy
- General Practice Queensland t/a CheckUP Australia, PO Box 3205, South Brisbane, Qld 4101, Australia. Email
| | - Steve Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia. Email
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Tuesley KM, Jordan SJ, Siskind DJ, Kendall BJ, Kisely S. Colorectal, cervical and prostate cancer screening in Australians with severe mental illness: Retrospective nation-wide cohort study. Aust N Z J Psychiatry 2019; 53:550-558. [PMID: 30501394 DOI: 10.1177/0004867418814945] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE People with severe mental illness have similar cancer incidence, but higher mortality than the general population. Participation in cancer screening may be a contributing factor but existing studies are conflicting. The aim of this study was to investigate the frequency of colorectal, prostate and cervical cancer screening among people with and without severe mental illness in Australia, who have access to universal health care. METHODS We followed three cohorts using de-identified data from a random 10% sample of people registered for Australia's universal health care system: those aged 50-69 years ( n = 760,058) for colorectal cancer screening; women aged 18-69 years ( n = 918,140) for cervical cancer screening and men aged 50-69 years ( n = 380,238) for prostate cancer screening. We used Poisson regression to estimate incidence rate ratios and 95% confidence intervals for the association between severe mental illness and rates of faecal occult blood testing, pap smears and prostate-specific antigen testing. RESULTS Having severe mental illness was associated with a 17% reduction in rates of pap smear (incidence rate ratio = 0.83, 95% confidence interval: 0.82-0.84) and prostate-specific antigen testing (incidence rate ratio = 0.83, 95% confidence interval: 0.81-0.85), compared to the general population. By contrast, incidence rates of faecal occult blood testing were only lower in people with severe mental illness among the participants who visited their general practitioner less than an average of five times per year (incidence rate ratio = 0.83, 95% confidence interval = [0.73, 0.94]). CONCLUSION Our results suggest that differences in screening frequency may explain some of the mismatch between cancer incidence and mortality in people with severe mental illness and indicate that action is required to improve preventive screening in this very disadvantaged group.
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Affiliation(s)
- Karen M Tuesley
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,2 School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Susan J Jordan
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,2 School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Dan J Siskind
- 3 School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,4 Metro South Addiction and Mental Health Service, Brisbane, Metro South Health, QLD, Australia
| | - Bradley J Kendall
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,3 School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,5 Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Steve Kisely
- 3 School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,4 Metro South Addiction and Mental Health Service, Brisbane, Metro South Health, QLD, Australia.,6 Departments of Psychiatry and Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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14
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Frederic D, Corinne R, Matthieu R, Francesca SP, Stephanie TJ, Nathalie R. The Schizophrenia Oral Health Profile: Development and Feasibility. Transl Neurosci 2018; 9:123-131. [PMID: 30263228 PMCID: PMC6153450 DOI: 10.1515/tnsci-2018-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 12/26/2022] Open
Abstract
Background The aim of this study was to present the different stages of development of the Schizophrenia Oral Health Profile (SOHP) questionnaire, aimed at assessing oral disorders and their impacts on functioning and psychosocial wellbeing for patients with schizophrenia (PWS) and to give the results of a feasibility study conducted in France Materials and methods The first step of this qualitative study was semi-structured interviews were conducted with 20 PWS and 6 health professionals (HP). A focus group integrating 4 PWS and 4 HP was also organised to identify the items of the SOHP. The data were analysed using a thematic analysis. Second, a feasibility study was conducted in a sample of 30 PWS who answered the SOHP questionnaire. The acceptability and understanding of the SOHP were evaluated, using a specific questionnaire. Results The semi-structured interviews and focus groups included 34 individuals in total. Items’ selection was done with several stages and led to a SOHP scale with 53 final items related to oral disorders and their impacts on functioning and psychosocial well-being. These items were classified in 13 preselected dimensions including one additional module related to the side effects of medications (11 items). The feasibility study showed good acceptability and understanding of the items of the SOHP scale. Conclusions The psychometric validation of the SOHP scale, involving a large sample of PWS, is currently in progress. The SOHP is important to evaluate PWS oral health needs and to offer appropriate strategies to improve oral health of this persons. Trial registration Clinical Trials Gov NCT02730832. Date registered: 21 March, 2016.
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Affiliation(s)
- Denis Frederic
- Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033 Dijon, France.,EA 75-05 Education, Ethique, Santé, Université François-Rabelais Tours, Faculté de Médecine, 37032 Tours, France
| | - Rat Corinne
- Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033 Dijon, France
| | - Reynaud Matthieu
- Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033 Dijon, France
| | - Siu-Paredes Francesca
- EA 481 Integrative and Clinical Neurosciences, University Hospital of Besançon, F-25000 Besançon, France.,Université Champagne Ardenne. Faculté d'Odontologie de Reims, 51100 Reims, France
| | - Tubert-Jeannin Stephanie
- Université Clermont Auvergne, EA4847 CROC Centre for Clinical Research in Dentistry, Clermont-Ferrand, France
| | - Rude Nathalie
- EA 481 Integrative and Clinical Neurosciences, University Hospital of Besançon, F-25000 Besançon, France
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15
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A Therapeutic Educational Program in Oral Health for Persons with Schizophrenia: A Qualitative Feasibility Study. Int J Dent 2018; 2018:6403063. [PMID: 30344607 PMCID: PMC6174768 DOI: 10.1155/2018/6403063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/07/2018] [Accepted: 08/15/2018] [Indexed: 11/17/2022] Open
Abstract
Objective The aim of this study was to test the feasibility of a therapeutic educational program in oral health (TEPOH) for persons with schizophrenia (PWS). Design In a qualitative study, we explored the representation of oral health before and after a TEPOH. Clinical Setting: PWS are at greater risk of decayed and missing teeth and periodontal diseases. In a previous publication, we described the different steps in building a TEPOH by taking into account the experiences of PWS concerning oral health quality of life. This TEPOH aimed at promoting a global health approach. Participants: Voluntary PWS and their caregivers were recruited during face-to-face interviews at "Les Boisseaux" (a psychiatric outpatient centre) in Auxerre (France) and were included in the study between November and December 2016. Intervention: We explored the experiences of participants and their perceptions of oral health before and after the TEPOH with focus group meetings. Results Four females and three males participated in the study, and the mean age was 29.4 ± 5. Before the TEPOH, the PWS produced 28 ideas about oral health perception and 37 after the TEPOH. After the TEPOH, elements relating to the determinants of oral health (smoking and poor diet) emerged. Conclusions These results show an evolution in oral health representation, and after some adjustments to the TEPOH, the second step will be to test this program in a large sample to generate a high level of evidence of the impact of TEPOH in the long term.
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16
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Oakley P, Kisely S, Baxter A, Harris M, Desoe J, Dziouba A, Siskind D. Increased mortality among people with schizophrenia and other non-affective psychotic disorders in the community: A systematic review and meta-analysis. J Psychiatr Res 2018; 102:245-253. [PMID: 29723811 DOI: 10.1016/j.jpsychires.2018.04.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is increasing evidence of excess mortality in schizophrenia but less information on other non-affective psychoses. We therefore generated standardised mortality ratios (SMRs) for community-dwelling people with schizophrenia and other non-affective psychoses, relative to the general population, and examined changes to the SMR over time. METHODS We conducted a systematic review in which Pubmed, CINAHL, EMBASE, Google Scholar and PsycINFO were searched for publications that reported SMRs for all-cause mortality among community-dwelling people with schizophrenia and psychotic disorders. Meta-analyses of SMRs were conducted, pooled across genders and then separately by gender. Sub-group analyses were conducted for diagnostic group, global region, decade and risk of study bias. RESULTS We were able to include 34 studies covering 1,724,906 participants. The gender pooled SMR for schizophrenia and psychotic disorders was 3.08 (95%CI 2.88-3.31). Schizophrenia and broader psychotic disorders had similar SMRs. Stratification by decade of observation suggests that the difference in SMR is not declining and may possibly be widening. Analyses showed high levels of heterogeneity. CONCLUSIONS The appearance of a static or widening mortality gap over time between people with schizophrenia and psychotic disorders and the general population is of concern. However, whether it is an increase over time is unclear, as there are insufficient studies to confirm this.
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Affiliation(s)
- Padraig Oakley
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Amanda Baxter
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Meredith Harris
- Queensland Centre for Mental Health Research, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jocelyne Desoe
- University of Queensland School of Medicine, Brisbane, Australia
| | - Alyona Dziouba
- University of Queensland School of Medicine, Brisbane, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Brisbane, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia.
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17
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Siu-Paredes F, Rude N, Rat C, Reynaud M, Hamad M, Moussa-Badran S, Denis F. The Schizophrenia Coping Oral Health Profile. Development and Feasibility. Transl Neurosci 2018; 9:78-87. [PMID: 29967693 PMCID: PMC6024692 DOI: 10.1515/tnsci-2018-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this work was to present the creation of appropriate tools to evaluate the coping strategies in Oral-Health-related Quality of Life (OHrQOL) implemented by persons with schizophrenia (PWS), the Schizophrenia Coping Oral Health Profile (SCOOHP), and the results of a feasibility study. METHODS A qualitative investigation was conducted between June 2016 and May 2017.The first step included 26 semi-structured individual interviews, 20 with PWS and 6 with health professionals (HPs), and 2 focus groups (PWS and HPs) to explore the experiences of the participants and how they felt about coping strategies in OHrQOL. The second step was a feasibility study involving a statistical analysis to test the acceptability and internal consistency (Cronbach's α) of the SCOOHP. RESULTS The analysis of these interviews allowed for us to obtain 277 items from 3545 verbatim transcriptions related to various dimensions of OHrQOL. We presented the items selected in coping concepts in this study. After selecting items in several stages, we drew up the SCOOHP scale with 23 items (15 items for positive coping and 8 items for negative coping). The feasibility study showed good acceptability, good understanding of the items and good consistency reliability (α = 0.59). CONCLUSIONS This is the first study that has enabled us to draw up a specific tool to assess coping strategies in OHrQOL of PWS. A multicentre study involving a larger sample of PWS is underway in order to perform the psychometric validation of the SCOOHP. TRIAL REGISTRATION Clinical Trials Gov NCT02730832. Date registered: 21 March 2016.
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Affiliation(s)
- Francesca Siu-Paredes
- Université Champagne Ardenne, Faculté d’Odontologie de Reims, 2 rue du Général Koenig 51100, Reims, France
- EA 481 Integrative Neurosciences and Clinical, University Hospital of Besançon, F-25000Besançon, France
| | - Nathalie Rude
- EA 481 Integrative Neurosciences and Clinical, University Hospital of Besançon, F-25000Besançon, France
| | - Corinne Rat
- Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033Dijon, France
| | - Matthieu Reynaud
- Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033Dijon, France
| | - Mohamad Hamad
- EA 481 Integrative Neurosciences and Clinical, University Hospital of Besançon, F-25000Besançon, France
| | - Sahar Moussa-Badran
- Université Champagne Ardenne, Faculté d’Odontologie de Reims, 2 rue du Général Koenig 51100, Reims, France
| | - Frederic Denis
- Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033Dijon, France
- EA 75-05 Education, Ethique, Santé, Université François-Rabelais Tours, Faculté de Médecine, 37032Tours, France
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18
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Pals RAS, Hempler NF. How to achieve a collaborative approach in health promotion: preferences and ideas of users of mental health services. Scand J Caring Sci 2018; 32:1188-1196. [DOI: 10.1111/scs.12564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/10/2018] [Indexed: 01/15/2023]
Affiliation(s)
| | - Nana Folmann Hempler
- Diabetes Management Research; Steno Diabetes Center Copenhagen; Gentofte Denmark
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19
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Denis F, Millot I, Abello N, Carpentier M, Peteuil A, Soudry-Faure A. Study protocol: a cluster randomized controlled trial to assess the effectiveness of a therapeutic educational program in oral health for persons with schizophrenia. Int J Ment Health Syst 2016; 10:65. [PMID: 27757142 PMCID: PMC5053217 DOI: 10.1186/s13033-016-0096-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schizophrenia is a severe mental disorder that affects 1 % of the world's population, including 600,000 people in France. Persons with schizophrenia (PWS) have excess mortality (their life expectancy is reduced by 20 %) and excess morbidity. In addition, such persons may have a large number of missing or decayed teeth. Dental caries and periodontal measurement indexes are often twice as high as the level found in the general population. Poor oral health can also affect quality of life and oral health is inseparable from general health. The management of oral health problems needs a multidisciplinary approach. According to the World Health Organization, the aim of therapeutic education (TE) is to help patients take care of themselves and to improve empowerment and recovery. In this educational approach, it is important to take into account the patient's personal experience. Though rarely investigated, the personal experience of PWS in oral health quality of life (OHRQoL) must be used to build a therapeutic educational programme in oral health (TEPOH) in a multidisciplinary approach, and the effectiveness of this program must be evaluated. METHODS/DESIGN We report the protocol of a randomized controlled cluster study. This study will be conducted in twelve hospitals in France. We hypothesized that a decrease of 20 % in the proportion of patients with CPI ≥ 3 would establish the effectiveness of TEPOH. Therefore, 12 hospitals will be randomly allocated to either TEPOH or no TEPOH. Altogether, they will have to recruit 230 PWS, who will be randomly allocated with a ratio of 1:1 to one of two conditions: control without intervention versus the group benefitting from TEPOH. DISCUSSION If successful, the study will generate methodologically sound results that provide knowledge on the effectiveness of a TEP in oral health for PWS. The results can be used to promote OHRQoL in a global health approach and develop appropriate strategies to encourage and facilitate financial support for healthcare, the multidisciplinary treatment of dental disorders, and the development of training in oral and mental health for caregivers. Trial registration Clinical Trials Gov NCT02512367. Date registered 19 July, 2015.
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Affiliation(s)
- Frederic Denis
- La Chartreuse Psychiatric Centre, 1, boulevard Chanoine Kir, BP 23314, 21033 Dijon Cedex, France
| | - Isabelle Millot
- Instance Régionale d’éducation et de promotion de la santé, 21000 Dijon Cedex, France
| | - Nicolas Abello
- Direction de la Recherche Clinique, University Hospital of Dijon, 21079 Dijon Cedex, France
| | - Maud Carpentier
- Direction de la Recherche Clinique, University Hospital of Dijon, 21079 Dijon Cedex, France
| | - Audrey Peteuil
- Instance Régionale d’éducation et de promotion de la santé, 21000 Dijon Cedex, France
| | - Agnès Soudry-Faure
- USMR-Réseau d’aide Méthodologiste, University Hospital of Dijon, 21079 Dijon Cedex, France
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20
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Happell B, Ewart SB, Platania-Phung C, Stanton R. Participative mental health consumer research for improving physical health care: An integrative review. Int J Ment Health Nurs 2016; 25:399-408. [PMID: 27159221 DOI: 10.1111/inm.12226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 02/04/2023]
Abstract
People with mental illness have a significantly lower life expectancy and higher rates of chronic physical illnesses than the general population. Health care system reform to improve access and quality is greatly needed to address this inequity. The inclusion of consumers of mental health services as co-investigators in research is likely to enhance service reform. In light of this, the current paper reviews mental health consumer focussed research conducted to date, addressing the neglect of physical health in mental health care and initiatives with the aim of improving physical health care. The international literature on physical healthcare in the context of mental health services was searched for articles, including mental health consumers in research roles, via Medline, CINAHL and Google Scholar, in October 2015. Four studies where mental health consumers participated as researchers were identified. Three studies involved qualitative research on barriers and facilitators to physical health care access, and a fourth study on developing technologies for more effective communication between GPs and patients. This review found that participatory mental health consumer research in physical health care reform has only become visible in the academic literature in 2015. Heightened consideration of mental health consumer participation in research is required by health care providers and researchers. Mental health nurses can provide leadership in increasing mental health consumer research on integrated care directed towards reducing the health gap between people with and without mental illness.
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Affiliation(s)
- Brenda Happell
- Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Australian Capital Territory, Australia.
| | - Stephanie B Ewart
- Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Australian Capital Territory, Australia
| | - Robert Stanton
- Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Australian Capital Territory, Australia.,Central Queensland University, School of Medical and Applied Sciences, Queensland, Australia
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