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Bemme D, Béhague D. Theorising the social in mental health research and action: a call for more inclusivity and accountability. Soc Psychiatry Psychiatr Epidemiol 2024; 59:403-408. [PMID: 38407626 DOI: 10.1007/s00127-024-02632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
| | - Dominique Béhague
- King's College London, London, UK
- Vanderbilt University, Nashville, USA
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2
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Hasan S, Chevidikunnan MF, Khan F. Reliability and validity of the Arabic version of the modified falls efficacy scale. Disabil Rehabil 2024; 46:793-801. [PMID: 36727527 DOI: 10.1080/09638288.2023.2175045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. MATERIALS AND METHODS The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). RESULTS The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). CONCLUSION The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.
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Affiliation(s)
- Sami Hasan
- Department of occupational therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Fayaz Khan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
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Guerrero Z, Civišová D, Winkler P. Mental health and access to care among the Roma population in Europe: A scoping review. Transcult Psychiatry 2024; 61:118-130. [PMID: 37769608 DOI: 10.1177/13634615231200853] [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: 10/03/2023]
Abstract
The Roma are Europe's largest ethnic minority group, and often face discrimination and social exclusion. Social strife and lack of access to healthcare are associated with increased symptoms of psychopathology. We aimed to review evidence on mental health outcomes and on access to mental healthcare among the Roma population in Europe. We systematically searched five databases (PsycINFO, Global Health, Social Policy and Practice, Web of Science and PubMed) and conducted a grey literature search in August 2020. We identified 133 studies, 26 of which were included for final analysis. We present the results using a narrative synthesis. The available literature indicates a relatively high prevalence of anxiety, depression and substance abuse among Roma, and females seem to be more affected than males. Roma children exhibit more externalizing and internalizing disorders when compared with non-Roma children. Mental health and perceived well-being among the Roma population are strongly linked to social determinants of health such as housing or economic income. Access to mental healthcare is limited for Roma people because of several barriers pertaining to language, lack of information regarding available services, and the insurance and economic status of Roma people. Roma people report mainly negative experiences with mental health services, including a lack of understanding from healthcare providers, and instances of racism and discrimination. There is a need for more research on mental health and access to healthcare in Roma people. Future studies should be participatory in order to provide guidelines for mental healthcare that addresses the needs of the Roma population.
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Affiliation(s)
- Zoe Guerrero
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
| | - Dagmar Civišová
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
| | - Petr Winkler
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
- King's College London
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Creen J, Kennedy-Behr A, Donkin R, Verdonck M. Understanding parent engagement in advanced allied health single session therapy for children with developmental and behavioural disabilities. Child Care Health Dev 2024; 50:e13148. [PMID: 37369641 DOI: 10.1111/cch.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Increasingly, health services are adopting short-term consultative therapy models, such as single session therapy, to cope with increased service demands, finite budgets and changing consumer expectations. Within the paediatric sub-specialty of child development and behaviour, allied health clinicians are central to supporting families to understand their children, provide therapeutic interventions and help achieve optimal developmental and health outcomes. This study aimed to describe parents'/caregivers' engagement during advanced allied health consultations utilizing a single session therapy framework for managing neurodevelopmental and behavioural concerns in children. METHODS Between March to June 2021, 14 parents participated in a qualitative study involving focus groups. Reflexive thematic analysis was used to code and interpret the data to understand and explore families' engagement in single session therapy. RESULTS Three overarching themes relating to parents' engagement during consultations emerged from the data: connection with the clinician, parental attributes and organizational influences. Clinician connection was the prominent construct that enhanced parent attributes and the positive perception of the organization in an ongoing manner. There was a complex interplay between the behavioural and affective components of the clinician, parents and the organization to create mutual presence, valued time, understanding and action. CONCLUSIONS This study demonstrates the importance of clinician connection, parental attributes and organizational influences to enhance engagement in therapeutic consultations. These factors are interrelated and are a complex blend of behaviour and internal states and highly individualized for each family. Understanding how services can continue to engage families is integral to ongoing sustainability and overall health and well-being.
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Affiliation(s)
- Julie Creen
- Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- School of Health, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Ann Kennedy-Behr
- School of Health, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Rebecca Donkin
- School of Health, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Michele Verdonck
- School of Health, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
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van der Sterren AE, Nathan S, Rawstorne P, Yarbakhsh E, Gough C, Bowles D. Involvement of people who use alcohol and other drug services in the development of patient-reported measures of experience: A scoping review. Health Expect 2023; 26:2151-2163. [PMID: 37515528 PMCID: PMC10632652 DOI: 10.1111/hex.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/17/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Patient-reported measures that assess satisfaction and experience are increasingly utilised in healthcare sectors, including the alcohol and other drug (AOD) sector. This scoping review identifies how and to what extent people accessing AOD services have been involved in the development of satisfaction and experience measures to date. METHODS PubMed, EMBASE, CINAHL, Scopus, ProQuest, Google and Google Scholar were searched. Included papers described the development and/or implementation of a multiple-item measure of patient-reported experience or satisfaction specifically for people accessing AOD treatment and/or harm reduction programmes. If there was more than one paper, key papers were chosen that described each measure. The method of development, including service user involvement, was assessed against a framework generated for this review. Two reviewers were involved at each stage. RESULTS Thirty measures-23 satisfaction and 7 experience-were identified. Sixteen measures reported some level of involvement by people accessing AOD services in their development, although, for most measures, at a relatively low level. This involvement increased over the time span of the review becoming more frequent in later years. Only four measures were developed for use in harm reduction-specific settings, and fewer than half reported undertaking analysis of underlying scale structure and constructs. CONCLUSION Several gaps could be addressed to enhance the measurement of patient-centred care in the AOD sector, including: developing experience measures for use in harm reduction settings and across various AOD settings in a service system; improved reporting of psychometric properties of these measures and increasing commitment to the meaningful involvement of AOD service users in measure development. PATIENT OR PUBLIC CONTRIBUTION This scoping review is part of a broader codesign project that involves a partnership between the peak organisation for AOD services and the peer-based AOD consumer organisation in the Australian Capital Territory, Australia. These organisations are working closely together to engage with AOD service users, service providers and policy makers in this codesign project. As such, the Executive Director of the peer-based AOD consumer organisation is involved as a co-author of this scoping review.
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Affiliation(s)
- Anke E. van der Sterren
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Sally Nathan
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Patrick Rawstorne
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Elisabeth Yarbakhsh
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
| | - Chris Gough
- Canberra Alliance for Harm Minimisation and Advocacy (CAHMA)CanberraAustralian Capital TerritoryAustralia
| | - Devin Bowles
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
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6
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Stacy KE, Lambert J, Shatz R, Bakas T. Development and Validation of the Lewy Body Disease Caregiver Activities Scale. J Nurs Meas 2023; 31:606-614. [PMID: 37353322 DOI: 10.1891/jnm-2021-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Background and Purpose: Caring for someone with Lewy body disease (LBD) is difficult. This study describes the development and validity testing of the LBD Caregiver Activities Scale (LBD-CAS). Methods: Caregiver interviews informed the development of the LBD-CAS. Experts estimated the content validity of items (I-CVI) and provided feedback about the scale. Family caregivers evaluated items for face validity. Results: Expert I-CVI ratings yielded 49 items with scores of 0.83 or higher. Four items with I-CVI scores <.83 were retained due to conceptual significance. The overall scale CVI was 0.86. Items evaluated by caregivers for face validity showed excellent variability in responses, with no major ceiling or floor effects. Conclusions: LBD-CAS showed evidence of content and face validity for the assessment of activities performed by LBD caregivers. Further psychometric testing is recommended.
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Affiliation(s)
- Kelly E Stacy
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Joshua Lambert
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Rhonna Shatz
- University of Cincinnati Department of Neurology and Rehabilitation, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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Evans J, Tinch-Taylor R, Csipke E, Cella M, Pickles A, McCrone P, Stringer D, Oliver A, Reeder C, Birchwood M, Fowler D, Greenwood K, Johnson S, Perez J, Ritunnano R, Thompson A, Upthegrove R, Wilson J, Kenny A, Isok I, Joyce EM, Wykes T. Satisfaction with cognitive remediation therapy: its effects on implementation and outcomes using the cognitive remediation satisfaction scale. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:67. [PMID: 37777545 PMCID: PMC10542804 DOI: 10.1038/s41537-023-00390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 10/02/2023]
Abstract
Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach's alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design.
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Affiliation(s)
- Joanne Evans
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose Tinch-Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emese Csipke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- School of Health Sciences, University of Greenwich, London, UK
| | - Dominic Stringer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abigail Oliver
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Clare Reeder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Sonia Johnson
- Faculty of Brain Sciences, University College London, London, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Rosa Ritunnano
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alex Kenny
- Patient Advisory Board, King's College London, London, UK
| | - Iris Isok
- Patient Advisory Board, King's College London, London, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Okrant E, Reif S, Horgan CM. Development of an addiction recovery patient-reported outcome measure: Response to Addiction Recovery (R2AR). Subst Abuse Treat Prev Policy 2023; 18:52. [PMID: 37658373 PMCID: PMC10474628 DOI: 10.1186/s13011-023-00560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Recovery, a primary goal of addiction treatment, goes beyond abstinence. Incorporating broad domains with key elements that vary across individuals, recovery is a difficult concept to measure. Most addiction-related quality measurement has emphasized process measures, which limits evaluation of treatment quality and long-term outcomes, whereas patient-reported outcomes are richer and nuanced. To address these gaps, this study developed and tested a patient-reported outcome measure for addiction recovery, named Response to Addiction Recovery (R2AR). METHODS A multi-stage mixed methods approach followed the Patient-Reported Outcomes Measurement Information System (PROMIS) measure development standard. People with lived experience (PWLE) of addiction, treatment providers, and other experts contributed to item distillation and iterative measure refinement. From an item bank of 356 unique items, 57 items were tested via survey and interviews, followed by focus groups and cognitive interviews. RESULTS Face validity was demonstrated throughout. PWLE rated item importance higher and with greater variance than providers, yet both agreed that "There are more important things to me in my life than using substances" was the most important item. The final R2AR instrument has 19 items across 8 recovery domains, spanning early, active, and long-term recovery phases. Respondents assess agreement for each item as (1) a strength, and (2) importance to ongoing recovery. CONCLUSION R2AR allows PWLE to define what is important to their recovery. It is designed to support treatment planning as part of clinical workflows and to track recovery progress. Inclusion of PWLE and providers in the development process enhances its face validity. Including PWLE in the development of R2AR and using the tool to guide recovery planning emphasizes the importance of patient-centeredness in designing clinical tools and involving patients in their own care.
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Affiliation(s)
- Elisabeth Okrant
- Institute for Behavioral Health, Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA, 02453, USA
| | - Sharon Reif
- Institute for Behavioral Health, Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA, 02453, USA.
| | - Constance M Horgan
- Institute for Behavioral Health, Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA, 02453, USA
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von Peter S, Jänchen P, Göppert L, Beeker T, Ziegenhagen J, Glück RK, Krispin H, Pfennig A, Heinze M, Schwarz J, Ignatyev Y. [Experience-based items of quality in psychiatric treatment: A first multivariate construct]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 176:51-60. [PMID: 36754717 DOI: 10.1016/j.zefq.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023]
Abstract
In the context of psychiatric care, user-generated measurement instruments may contribute to quality development and assurance. An explorative construct of experience-related quality components was developed in participative-collaborative cooperation that grasps the users' experiences of psychiatric care. After developing the components using a grounded theory methodology, they were quantified, and their interrelations were investigated using a multidimensional scaling method to explore their internal cohesion. The construct makes it possible to separate structural from interpersonal requirements of the quality components. It further indicated which components are more feasible for the home treatment setting, and which ones for an institutional setting. The components and the construct may be perceived as first steps towards the development of user-generated quality indicators; however, further validation steps are necessary.
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Affiliation(s)
- Sebastian von Peter
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland.
| | - Patrick Jänchen
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Lena Göppert
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Timo Beeker
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Jenny Ziegenhagen
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Rosa Kato Glück
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Helene Krispin
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Yuriy Ignatyev
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
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Bakolis I, Gupta P, Wykes T. Experience of Inpatient Mental Health Care Assessed With Service User-Developed and Conventional Patient-Reported Outcome Measures. Psychiatr Serv 2022; 73:1132-1139. [PMID: 35473362 DOI: 10.1176/appi.ps.202100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The goal of this study was to examine and compare the psychometric properties of a patient-reported outcome measure (PROM) generated with patients’ input (Views on Inpatient Care [VOICE]) and a PROM conventionally generated without patients’ input (Service Satisfaction Scale: Residential Services Evaluation [SSS-Res]) for assessing a patient’s perception of psychiatric ward care. METHODS In a stepped-wedge cluster-randomized trial conducted in the United Kingdom, 1,058 participants admitted to 16 wards reported on their perceptions of care via VOICE and SSS-Res before or up to 2 years after the staff training. Exploratory and confirmatory factor analyses were used to investigate the structure of the PROMs and to assess reliability and convergent validity as well as sensitivity to change; the analyses also considered whether study participants had been admitted voluntarily to the ward. RESULTS Two factors emerged from VOICE, labeled “trust” and “involvement,” and from SSS-Res, labeled “environment” and “care,” at baseline. All subscales had high internal consistency and good convergent validity. An ability to detect change in care due to the staff training was observed on the trust subscale of VOICE (N=1,058, mean difference=−0.25, 95% CI=−0.48 to −0.02), but no change was detected on any of the SSS-Res subscales. Patients admitted involuntarily benefited the most from the staff training. CONCLUSIONS VOICE captured patients’ perceptions of ward care better than SSS-Res and was sensitive to changes in aspects of trust, suggesting that participatory approaches for developing PROMs improve patients’ self-reports on the care they received.
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Affiliation(s)
- Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Bakolis, Gupta); Department of Biostatistics and Health Informatics (Bakolis) and Department of Psychology (Wykes), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; South London and Maudsley National Health Service (NHS) Foundation Trust (Wykes)
| | - Prashant Gupta
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Bakolis, Gupta); Department of Biostatistics and Health Informatics (Bakolis) and Department of Psychology (Wykes), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; South London and Maudsley National Health Service (NHS) Foundation Trust (Wykes)
| | - Til Wykes
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Bakolis, Gupta); Department of Biostatistics and Health Informatics (Bakolis) and Department of Psychology (Wykes), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; South London and Maudsley National Health Service (NHS) Foundation Trust (Wykes)
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11
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Sweeney A, White S, Kelly K, Faulkner A, Papoulias S, Gillard S. Survivor-led guidelines for conducting trauma-informed psychological therapy assessments: Development and modified Delphi study. Health Expect 2022; 25:2818-2827. [PMID: 36049032 DOI: 10.1111/hex.13585] [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: 03/23/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological therapy assessments are a key point at which a person is accepted into a service or referred on. There is evidence of service users experiencing harm, dropping out of services and potentially experiencing poor outcomes because of inadequate assessment practices. Approaches to assessment tend to be developed by individual services, with a lack of research identifying what makes a good assessment. METHODS This survivor-led study, based in England, aimed to generate guidelines for conducting trauma-informed psychological therapy assessments. The study was guided by a Service User Advisory Group and a Clinician Advisory Group. The study was conducted in three key stages: (i) identifying, modelling and drafting guideline content (ii) modified Delphi study and (iii) guideline finalization. Stage 1 was informed by literature reviews, qualitative research, data workshops with Advisory Groups and an expert consultation. Fifty-nine people with relevant experiences then participated in a single-stage modified Delphi (Stage 2). The guidelines were finalized through an analysis of Delphi open comments and a final expert consultation (Stage 3). RESULTS The guidelines evolved through each stage of the process, and all items were deemed important by >90% of Delphi participants. The final trauma-informed guidelines contain eight principles, including 'focus on relationships', 'from systems to people' and 'healing environments'. CONCLUSIONS Experiential knowledge was key in generating the guidelines and conceptualizing content, with a consequent focus on areas, such as recognizing power differentials, understanding oppression as trauma and the relational aspects of assessments. Future research should focus on guideline implementation and investigate whether this impacts service user dropout, engagement with therapy, and outcomes. PATIENT OR PUBLIC CONTRIBUTION This study is an example of survivor research, with several authors, including the study lead, identifying as survivors. We consider the ways in which our identities as survivor researchers impacted the study findings.
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Affiliation(s)
- Angela Sweeney
- Service User Research Enterprise, Population Health Research Institute, St George's University of London, London, UK
| | - Sarah White
- Population Health Research Institute, St George's University of London, London, UK
| | - Katie Kelly
- Little Bee Clinic, London and University College London, London, UK
| | | | - Stan Papoulias
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Steve Gillard
- School of Health & Psychological Sciences, Population Health Research Institute, St George's University of London, London, UK
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12
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Smith T, Wells L, Jones K, Jaouich A, Rush B. Assessing the Perception of Family and Caregivers' Experience with Mental Health and Substance Use Services. Int J Ment Health Addict 2022:1-16. [PMID: 35937612 PMCID: PMC9344803 DOI: 10.1007/s11469-022-00863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Standardized client feedback surveys encourage a culture of continuous quality improvement, allow for comparison of results over time and across similar types of service providers, and encourage use of evidence-based practices. Recognizing the importance of family and other caregivers in supporting people accessing services for mental health and substance use challenges, a standardized perception-of-care tool (the Ontario Perception of Care Tool for Mental Health and Addictions, OPOC-MHA) was adapted to collect feedback specific to the caregiver experience with these services. A collaborative process engaged a broad range of mental health and/or addiction providers, family advisory networks, and family members and caregivers to identify themes, specific items, and implementation approaches. The final version of the tool evolved through an iterative process of pilot testing and stakeholder feedback. Family member and caregiver perceptions of care will identify service areas in need of improvement, contribute to quality improvement initiatives, and facilitate the comparison of findings over time.
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Affiliation(s)
- Tayla Smith
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | - Leslie Wells
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | - Kelsey Jones
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | | | - Brian Rush
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
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The Lancet Psychiatry Commission on intimate partner violence and mental health: advancing mental health services, research, and policy. Lancet Psychiatry 2022; 9:487-524. [PMID: 35569504 DOI: 10.1016/s2215-0366(22)00008-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023]
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Carlton J, Peasgood T, Mukuria C, Johnson J, Ogden M, Tovey W. The role of patient and public involvement and engagement (PPIE) within the development of the EQ Health and Wellbeing (EQ-HWB). J Patient Rep Outcomes 2022; 6:35. [PMID: 35394269 PMCID: PMC8993969 DOI: 10.1186/s41687-022-00437-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives The value of patient and public involvement and engagement (PPIE) within the development and refinement of outcome measures is becoming increasingly recognized. The aim of this paper is to provide an overview of how PPIE was integrated within the development of a new measure designed for use in economic evaluations across health and social care, the EQ Health and Wellbeing (EQ-HWB™). Methods Four PPIE sessions were held at key stages. Discussions from each session and the outcome of any tasks were shared with the wider research team and used to help inform decision-making. Results and discussion PPIE covered several components of outcome measure development including; review of conceptual model; discussion on sub-domain inclusion; item refinement and reduction; pre-testing of items; selection of items for the measure; and design of the measure. Key learning points for future projects were highlighted including; consideration of practicalities, resources and logistics of PPIE activities; how sessions and activities are managed effectively; and how to managing expectations and communication from both researcher and PPIE perspectives. Conclusions The PPIE group provided invaluable insight into perspectives of future patients and carers. Their input was fed into a number of developmental stages. The formal involvement from the PPIE group meant that the voice of the general public was heard. This helped ensure the appropriateness of the design of the final measure.
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Affiliation(s)
- Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Tessa Peasgood
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Clara Mukuria
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Julie Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Wade Tovey
- On Behalf of the EQ-HWB PPIE Group, Sheffield, UK
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von Peter S, Krispin H, Kato Glück R, Ziegenhagen J, Göppert L, Jänchen P, Schmid C, Neumann A, Baum F, Soltmann B, Heinze M, Schwarz J, Beeker T, Ignatyev Y. Needs and Experiences in Psychiatric Treatment (NEPT)- Piloting a Collaboratively Generated, Initial Research Tool to Evaluate Cross-Sectoral Mental Health Services. Front Psychiatry 2022; 13:781726. [PMID: 35153874 PMCID: PMC8829038 DOI: 10.3389/fpsyt.2022.781726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research tools to evaluate institutions or interventions in the field of mental health have rarely been constructed by researchers with personal experience of using the mental health system ("experiential expertise"). This paper presents a preliminary tool that has been developed within a participatory-collaborative process evaluation as part of a controlled, multi-center, prospective cohort study (PsychCare) to evaluate psychiatric flexible and integrative treatment, FIT for short, models in Germany. METHOD The collaborative research team consisting of researchers with and without experiential expertise developed 12 experiential program components of FIT models by an iterative research process based on the Grounded Theory Methodology. These components were transformed into a preliminary research tool that was evaluated by a participatory expert panel, and during a pilot and validation study, the latter using a random sample of 327 users from 14 mental health departments. Internal consistency of the tool was tested using Cronbach's alpha. Construct validity was evaluated using a Principal Components Analysis (PCA) and a Jonckheere Terpstra test in relation to different implementation levels of the FIT model. Concurrent validity was tested against a German version of the Client Satisfaction Questionnaire (ZUF-8) using correlation analysis and a linear regression model. RESULTS The evaluation of the expert panel reduced 29 initial items to 16 that were further reduced to 11 items during the pilot study, resulting into a research tool (Needs and Experiences in Psychiatric Treatment-NEPT) that demonstrated good internal consistency (Cronbach's alpha of 0.89). PCA yielded a 1-component structure, which accounted for 49% of the total variance supporting the unidimensional structure of the tool. The total NEPT score increased alongside the increasing implementation of the FIT model (p < 0.05). There was evidence (p < 0.001) for convergent validity assessed against the ZUF-8 as criterion measure. CONCLUSIONS The NEPT tool seems to be promising for further development to assess the experiences with and fulfillment of needs of psychiatric care models from the perspective of users. This paper demonstrates that it is possible to use a participatory-collaborative approach within the methodologically rigorous confines of a prospective, controlled research design.
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Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Helene Krispin
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Rosa Kato Glück
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Jenny Ziegenhagen
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,ExPEERienced- Experience With Mental Health Crises- Registered Non-profit Organization, Berlin, Germany
| | - Lena Göppert
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Patrick Jänchen
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Christine Schmid
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Anne Neumann
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Technische Universität Dresden, Dresden, Germany
| | - Fabian Baum
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Technische Universität Dresden, Dresden, Germany
| | - Bettina Soltmann
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Technische Universität Dresden, Dresden, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Timo Beeker
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
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A philosophical perspective on the development and application of patient-reported outcomes measures (PROMs). Qual Life Res 2021; 31:1703-1709. [PMID: 34657279 DOI: 10.1007/s11136-021-03016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Questionnaires are a common method in healthcare and clinical research to collect self-reported data on patients' behaviour and outcomes rather than the clinician's perspective. As a consequence there is a plethora of questionnaires and rating forms developed to measure a range of concepts such as health-related quality of life and health status. Given that these measures have been developed within a nomothetic paradigm to enhance our understanding of peoples self-perceived health status by translating complex personal feelings and experiences into a simple numeric score, the patient's illness narrative is lost along the way. This commentary discusses the limitations of the nomothetic approach as completion of a questionnaire is a social and contextually orientated activity and that their development is best viewed within the philosophical tradition of pragmatism, based on sound qualitative methods and rigorous psychometric testing. The commentary discusses the philosophical orientation underpinning PROM development and argues the case for a pragmatic epistemology based on a mixed methods research paradigm which goes beyond the current practice of informing the content validity of a PROM in the early phase of its development but to work towards developing a more composite and holistic picture through mixed methods in the interpretation of a patient's PROM score. Therefore, it is argued that the quality of data obtained will be enhanced but, also importantly and rightly places the participant at the centre of the research.
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Cocho Santalla C, Vera López I, Bardón Rivera B, Gómez Olmeda MD, Duque Domínguez R, Fadón Martín P, Blanco Prieto M, García Jorge S, Martínez Hernanz Á, Molina Serrano A, Mollejo Aparicio E, Nava García P, Salvador Robert M, Sánchez Morla EM, Sanz-Aranguez Ávila B, Vives Luengo A, Martínez Arias MR, Sanz Fuentenebro FJ. Satisfacción percibida con los ingresos en unidades de hospitalización breve psiquiátricas: diseño y validación del cuestionario PSYQUEST. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021. [DOI: 10.1016/j.rpsm.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Chua YC, Wong HH, Abdin E, Vaingankar J, Shahwan S, Cetty L, Yong YH, Hon C, Lee H, Tang C, Verma S, Subramaniam M. The Recovering Quality of Life 10-item (ReQoL-10) scale in a first-episode psychosis population: Validation and implications for patient-reported outcome measures (PROMs). Early Interv Psychiatry 2021; 15:1127-1135. [PMID: 33058560 DOI: 10.1111/eip.13050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/05/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to examine the psychometric performance of the Recovering Quality of Life scale 10-item version (ReQoL-10) using a sample from a Singapore first-episode psychosis intervention program, to explore its clinical and sociodemographic correlates, and to discuss its utility as a patient-reported outcome measure (PROM). METHODS Sociodemographic data, duration of untreated psychosis (DUP), and diagnosis were collected from 300 participants. Clinical data, which included baseline and current scores on the Patient Health Questionnaire 9-item version, EuroQoL-5 Dimension 3-level version, Positive and Negative Syndrome Scale, and Global Assessment of Functioning scale, were extracted. The ReQoL-10 was tested for structural validity, internal consistency, and construct validity, and a multiple linear regression determined if any of the baseline factors were statistically significant predictors of the total ReQoL-10 scores. RESULTS The mean (SD) total ReQoL-10 score of the sample was 27.8 (7.8). Confirmatory factor analysis confirmed the bifactor model structure of the ReQoL-10. The instrument demonstrated good internal consistency and adequate construct validity. Being older was associated with higher total ReQoL-10 scores, while being married, having a highest educational level of vocational/diploma, longer DUP, and a diagnosis of affective psychosis were associated with lower total ReQoL-10 scores. CONCLUSIONS This study has validated the ReQoL-10 as suitable for routine use to measure recovery-specific quality of life in a psychiatric setting among patients with first-episode psychosis, and is a potential tool to initiate recovery conversations. As a PROM, it can facilitate shared decision making, in line with efforts to evaluate and improve quality of care.
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Affiliation(s)
- Yi Chian Chua
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Horng Hien Wong
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | | | | | | | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore
| | - Yee Huei Yong
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Charlene Hon
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Helen Lee
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore.,Duke-NUS Medical School, Singapore
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Wong HH, Abdin E, Vaingankar J, Chua YC, Yong YH, Shahwan S, Cetty L, Hon C, Chan WQJ, Lee H, Verma S, Subramaniam M. Development, reliability, and validity of the case management quality of care scale (CMQS) among clients with first episode psychosis. Asian J Psychiatr 2020; 54:102271. [PMID: 32682297 DOI: 10.1016/j.ajp.2020.102271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
This paper describes the development and validation of the Case Management Quality Scale (CMQS) to measure the quality of care provided by case managers in an early intervention service for clients with first episode psychosis. A total of 300 client participants from the Singapore Early Psychosis Programme completed a self-administered survey comprising 52 items measuring case management, the Client Satisfaction Questionnaire 8-item version (CSQ-8), Recovery Self-Assessment - person in recovery version (RSA-R), and Working Alliance Inventory - long form client version (WAI-C), and Recovering Quality of Life 10-item version (ReQoL-10). Exploratory factor analysis was conducted on the 52-item scale and the items were reduced using criterion validity. Psychometric properties of the 25-item CMQS were tested using internal consistency and concurrent validity. A 2-factor structure of the CMQS was established comprising two subscales - Therapeutic alliance and Care and empowerment. The test of normality for CMQS and subscales was largely found to be within the acceptable range. The Cronbach's alpha for the CMQS scale was high (0.97) and in terms of convergent validity, the CMQS and the two subscales had a moderate correlation with the CSQ-8, RSA-R, and WAI-C (r ranging from 0.596-0.711) and a mild correlation with the ReQoL-10. In conclusion, the CMQS is a user-friendly, and psychometrically sound instrument that is potentially useful for measuring case manager-client therapeutic alliance, and the level of care and empowerment in a case management service.
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Affiliation(s)
- Horng Hien Wong
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore.
| | | | | | - Yi Chian Chua
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore.
| | - Yee Huei Yong
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore.
| | | | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore.
| | - Charlene Hon
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | | | - Helen Lee
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore.
| | - Swapna Verma
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore.
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da Silva Filho JC, Ramos Vieira Santos IC, Valença MP, Mendes Morato JE, Ferreira Dos Santos Filho SR, Lessa de Andrade A. Assessment instruments for lower urinary tract dysfunction in children: Symptoms, characteristics and psychometric properties. J Pediatr Urol 2020; 16:636-644. [PMID: 32798106 DOI: 10.1016/j.jpurol.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The use of instruments to assess symptoms of the lower urinary tract has increased mainly when it comes to pediatric urology. The search for a validated and reliable one for use in clinical practice should be a concern of the professionals involved in the care of these children. OBJECTIVE The aim of this study was to analyze the assessment instruments for lower urinary tract dysfunction in children regarding: symptoms, characteristics and psychometric properties. STUDY DESIGN PubMed and Latin American and Caribbean Literature in Health Sciences databases were searched. The PICO strategy was used to construct the research question and bibliographic search. Keywords included voiding disorders, LUTS, Child, Surveys and Questionnaires. RESULTS Nine articles were identified. The construct observed by all instruments was bladder dysfunction and seven instruments also assessed bowel dysfunction. Thirty different events were addressed. In eight instruments the respondents are the parents. The age of the target population ranged from three to eighteen years and regarding the number of items, an average of 21.8 items was observed. Six instruments showed good results of reliability and four presented good results of accuracy. CONCLUSIONS The instruments included a wide range of symptoms related to dysfunction. Only two reported all validation and reliability tests, however six instruments showed good reliability results, making them eligible for the cross-cultural adaptation and validation process for use in countries other than those of the instrument's origin.
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Individualized and Standardized Outcome Measures: Further Arguments in Favor of Cohabitation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:339-343. [PMID: 31571093 DOI: 10.1007/s10488-019-00981-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ashworth et al. (Admin Policy Ment Health Ment Health Serv Res 46:425-428, 2019) recently published a paper in this journal making a cogent argument for the cohabitation of standardized and individualized outcome measures. In the present Point of View article, we consider additional arguments in favor of this cohabitation.
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Harper Shehadeh M, Van't Hof E, Schafer A, van Ommeren M, Farooq S, Hamdani SU, Koyiet P, Akhtar P, Masood A, Nazir H, Dawson K, Albanese E. Using a person-generated mental health outcome measure in large clinical trials in Kenya and Pakistan: Self-perceived problem responses in diverse communities. Transcult Psychiatry 2020; 57:108-123. [PMID: 31237805 DOI: 10.1177/1363461519854831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health care should be informed by the physical, socioeconomic, mental, and emotional well-being of the person, and account for social circumstances and culture. Patient-generated outcome measures can contribute positively to mental health research in culturally diverse populations. In this study, we analysed qualitative responses to the Psychological Outcome Profiles (PSYCHLOPS) Questionnaire-a patient-generated outcome measure based on open-ended questions, and compared the qualitative responses gathered to conventional, nomothetic measures used alongside the PSYCHLOPS in two studies. Data were collected as part of outcome research on a psychological intervention in Pakistan (N = 346) and Kenya (N = 521). Two researchers coded the qualitative responses to the PSYCHLOPS and identified overarching themes. We compared the overarching themes identified to the items in the conventional, nomothetic outcome measures to investigate conceptual equivalence. Using the PSYCHLOPS, the most frequently reported problems in Kenya were financial constraints, poor health, and unemployment. In Pakistan, the most frequent problems were poor health and emotional problems. Most of the person-generated problem concepts were covered also in nomothetic measures that were part of the same study. However, there was no item equivalence in the nomothetic measures for the most frequent PSYCHLOPS problem cited in both countries. Response bias and measurement bias may not be excluded. More research on the use of PSYCHLOPS alongside conventional outcome measures is needed to further explore the extent to which it may bring added value. Use of a PSYCHLOPS semistructured interview schedule and efforts to minimise response biases should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Aqsa Masood
- Human Development Research Foundation, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Pakistan
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Carlton J, Peasgood T, Khan S, Barber R, Bostock J, Keetharuth AD. An emerging framework for fully incorporating public involvement (PI) into patient-reported outcome measures (PROMs). J Patient Rep Outcomes 2020; 4:4. [PMID: 31933005 PMCID: PMC6957651 DOI: 10.1186/s41687-019-0172-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/23/2019] [Indexed: 01/28/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are widely used in the United Kingdom (UK) and internationally to report and monitor patients’ subjective assessments of their symptoms and functional status and also their quality of life. Whilst the importance of involving the public in PROM development to increase the quality of the developed PROM has been highlighted this practice is not widespread. There is a lack of guidance on how public involvement (PI) could be embedded in the development of PROMs, where the roles can be more complex than in other types of research. This paper provides a timely review and sets out an emerging framework for fully incorporating PI into PROM development.
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Affiliation(s)
- J Carlton
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - T Peasgood
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - S Khan
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - R Barber
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J Bostock
- University of Cambridge, Cambridge, UK.,University of Oxford, Oxford, UK.,Kings College London, London, UK
| | - A D Keetharuth
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Rand L, Dunn M, Slade I, Upadhyaya S, Sheehan M. Understanding and using patient experiences as evidence in healthcare priority setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:20. [PMID: 31572067 PMCID: PMC6757378 DOI: 10.1186/s12962-019-0188-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In many countries, committees make priority-setting decisions in order to control healthcare costs. These decisions take into account relevant criteria, including clinical effectiveness, cost-effectiveness, and need, and are supported by evidence usually drawn from clinical and economic studies. These sources of evidence do not include the specific perspective and information that patients can provide about the condition and treatment. METHODS Drawing on arguments from political philosophy and ethics that are the ethical basis for many priority-setting bodies, the authors argue that criteria like need and its effects on patients and caregivers are best supported by evidence generated from patients' experiences. Social sciences and mixed-methods research support the generation and collection of robust evidence. RESULTS Patient experience is required for a decision-making process that considers all relevant evidence. For fair priority-setting, decision-makers should consider relevant evidence and reasons, so patient experience evidence should not be ignored. Patient experience must be gathered in a way that generates high quality and methodologically rigorous evidence. Established quantitative and qualitative methods can assure that evidence is systematic, adherent to quality standards, and valid. Patient, like clinical, evidence should be subject to a transparent review process. DISCUSSION Considering all relevant evidence gives each person an equal opportunity at having their treatment funded. Patient experience gives context to the clinical evidence and also directly informs our understanding of the nature of the condition and its effects, including patients' needs, how to meet them, and the burden of illness. Such evidence also serves to contextualise reported effects of the treatment. The requirement to include patient experience as evidence has important policy implications for bodies that make priority-setting decisions since it proposes that new types of evidence reviews are commissioned and considered.
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Affiliation(s)
- Leah Rand
- Board on Health Sciences Policy, National Academies of Sciences, Engineering, and Medicine, 500 Fifth Street NW, Washington, DC 20009 USA
| | - Michael Dunn
- Ethox Centre, Nuffield Department of Population Health, Big Data Institute, La Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Ingrid Slade
- Ethox Centre, Nuffield Department of Population Health, Big Data Institute, La Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Sheela Upadhyaya
- Highly Specialised Technology Program, Centre for Health Technology Evaluation, National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | - Mark Sheehan
- Ethox Centre, Nuffield Department of Population Health, Big Data Institute, La Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
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Mugisha J, Hanlon C, Knizek BL, Ssebunnya J, Vancampfort D, Kinyanda E, Kigozi F. The experience of mental health service users in health system strengthening: lessons from Uganda. Int J Ment Health Syst 2019; 13:60. [PMID: 31516548 PMCID: PMC6728966 DOI: 10.1186/s13033-019-0316-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mental, neurological and substance use disorders are a public health burden in Uganda. Mental health service user involvement could be an important strategy for advocacy and improving service delivery, particularly as Uganda redoubles its efforts to integrate mental health into primary health care (PHC). However, little is known on the most effective way to involve service users in mental health system strengthening. METHODS This was a qualitative key informant interview study. At national level, 4 interviews were conducted with national level health workers and 3 service user organization representatives. At the district level, 2 interviews were conducted with district level health workers and 5 service user organization representatives. Data were analyzed using content thematic analysis. FINDINGS Overall, there was low mental service user participation in health system strengthening at both national and district levels. Health system strengthening activities included policy development, implementation of programs and research. Informants mentioned several barriers to service user involvement in mental health system strengthening. These were grouped into three categories: institutional, community and individual level factors. Institutional level barriers included: limited funding to form, train and develop mental health service user groups, institutional stigma and patronage by founder members of user organizations. Community level barriers included: abject poverty and community stigma. Individual level barriers included: low levels of awareness and presence of self-stigma. Informants also recommended some strategies to enhance service user involvement. CONCLUSION The Uganda Ministry of Health should develop a strategy to improve service user participation in mental health system strengthening. This requires an appreciation of the importance of service users in improving service delivery. To address the barriers to service user involvement identified in this study requires concerted efforts by the Uganda Ministry of Health and the district health services, specifically with regard to attitudes of health workers, dealing with stigma at all levels, raising awareness about the rights of service users to participate in health systems strengthening activities, building capacity and financial empowerment of service user organizations.
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Affiliation(s)
- James Mugisha
- Kyambogo University, Kampala, Uganda
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
- PO. Box 2958, Kampala, Uganda
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birthe Loa Knizek
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joshua Ssebunnya
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
| | - Eugene Kinyanda
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Fred Kigozi
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
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Madden A, Hopwood M, Neale J, Treloar C. Acceptability of Patient-Reported Outcome and Experience Measures for Hepatitis C Treatment Among People Who Use Drugs. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:259-265. [PMID: 30270403 DOI: 10.1007/s40271-018-0332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Growing international interest in mechanisms to capture and measure experiences and outcomes of health interventions from the patient perspective has led to the development of patient-reported measures (PRMs) across many areas of medicine. Although PRMs are now well utilised in some settings, the rapidly expanding area of direct-acting antiviral (DAA) treatments for hepatitis C has received remarkably little attention. In addition, questions are also being raised about the extent to which patients have been involved in the development of PRMs, which are primarily designed to reflect the patient perspective. In this context, the aim of this paper was to explore the possibility of developing a new PRM for use in hepatitis C DAA therapy that would also be acceptable to the patient group, in this case people who inject drugs (PWID). METHOD The study was based on a participatory design that included a peer researcher and foundational qualitative research including semi-structured interviews with 24 PWID with hepatitis C to inform the development of the PRMs. Stage 2 included four focus groups of six PWID with hepatitis C, who were asked to complete the draft measures and provide feedback. RESULTS Participants responded positively to the draft PRMs. The results indicate that participants' concerns during DAA treatment are often not sufficiently attended to in clinical settings. In the light of this finding, participants reported that PRMs have a positive role to play in the negotiation of patients' care during DAA treatment. CONCLUSIONS The findings show that utilising a participatory approach to the development of PRMs for DAA HCV treatment with PWID not only provides a way to measure experiences and outcomes of treatment from the patient perspective, but also provides a means for highly marginalised patient groups to have a say in and negotiate their care in ways that might not otherwise be possible.
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Affiliation(s)
- Annie Madden
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Joanne Neale
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
- National Addiction Centre, Kings College London, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
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Hinsley K, Kelly PJ, Davis E. Experiences of patient‐centred care in alcohol and other drug treatment settings: A qualitative study to inform design of a patient‐reported experience measure. Drug Alcohol Rev 2019; 38:664-673. [DOI: 10.1111/dar.12965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Kathryn Hinsley
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Peter J. Kelly
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Esther Davis
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
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Grundy A, Keetharuth AD, Barber R, Carlton J, Connell J, Taylor Buck E, Barkham M, Ricketts T, Robotham D, Rose D, Kay J, Hanlon R, Brazier J. Public involvement in health outcomes research: lessons learnt from the development of the recovering quality of life (ReQoL) measures. Health Qual Life Outcomes 2019; 17:60. [PMID: 30975153 PMCID: PMC6458599 DOI: 10.1186/s12955-019-1123-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background To provide a model for Public involvement (PI) in instrument development and other research based on lessons learnt in the co-production of a recently developed mental health patient reported outcome measure called Recovering Quality of Life (ReQoL). While service users contributed to the project as research participants, this paper focuses on the role of expert service users as research partners, hence referred to as expert service users or PI. Methods At every stage of the development, service users influenced the design, content and face validity of the measure, collaborating with other researchers, clinicians and stakeholders who were central to this research. Expert service users were integral to the Scientific Group which was the main decision-making body, and also provided advice through the Expert Service User Group. Results During the theme and item generation phase (stage 1) expert service users affirmed the appropriateness of the seven domains of the Patient Reported Outcome Measure (activity, hope, belonging and relationships, self-perception, wellbeing, autonomy, and physical health). Expert service users added an extra 58 items to the pool of 180 items and commented on the results from the face and content validity testing (stage 2) of a refined pool of 88. In the item reduction and scale generation phase (stage 3), expert service users contributed to discussions concerning the ordering and clustering of the themes and items and finalised the measures. Expert service users were also involved in the implementation and dissemination of ReQoL (stage 4). Expert service users contributed to the interpretation of findings, provided inputs at every stage of the project and were key decision-makers. The challenges include additional work to make the technical materials accessible, extra time to the project timescales, including time to achieve consensus from different opinions, sometimes strongly held, and extra costs. Conclusion This study demonstrates a successful example of how PI can be embedded in research, namely in instrument development. The rewards of doing so cannot be emphasised enough but there are challenges, albeit surmountable ones. Researchers should anticipate and address those challenges during the planning stage of the project.
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Affiliation(s)
- Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Rosemary Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Thomas Ricketts
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Diana Rose
- King's College London, Institute of Psychiatry, London, UK
| | - John Kay
- Sheffield Hallam University, Sheffield, UK
| | | | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Rose D, Kalathil J. Power, Privilege and Knowledge: the Untenable Promise of Co-production in Mental "Health". FRONTIERS IN SOCIOLOGY 2019; 4:57. [PMID: 33869380 PMCID: PMC8022626 DOI: 10.3389/fsoc.2019.00057] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 06/26/2019] [Indexed: 05/21/2023]
Abstract
This paper examines the concept and practice of coproduction in mental health. By analyzing personal experience as well as the historical antecedents of coproduction, we argue that the site of coproduction is defined by the legacy of the Enlightenment and its notions of "reason" and "the cognitive subject." We show the enduring impact of these notions in producing and perpetuating the power dynamics between professionals, researchers, policy makers and service users within privileged sites of knowledge production, whereby those deemed to lack reason-the mad and the racialized mad in particular-and their knowledge are radically inferiorised. Articulating problems in what is considered knowledge and methods of knowing, we argue that modern "psy" sciences instantiates the privilege of reason as well as of whiteness. We then examine how the survivor movement, and the emergent survivor/mad knowledge base, duplicates white privilege even as it interrogates privileges of reason and cognition. Describing how we grapple with these issues in an ongoing project-EURIKHA-which aims to map the knowledge produced by service users, survivors and persons with psychosocial disabilities globally, we offer some suggestions. Coproduction between researchers, policy makers and those of us positioned as mad, particularly as mad people of color, we argue, cannot happen in knowledge production environments continuing to operate within assumptions and philosophies that privilege reason as well as white, Eurocentric thinking. We seek not to coproduce but to challenge and change thinking and support for psychosocial suffering in contexts local to people's lives.
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Affiliation(s)
- Diana Rose
- Service User Research Enterprise, London, United Kingdom
- Health Services and Population Research (HSPR), King's College London, London, United Kingdom
- *Correspondence: Diana Rose
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Wykes T, Csipke E, Rose D, Craig T, McCrone P, Williams P, Koeser L, Nash S. Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Emese Csipke
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Thomas Craig
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Williams
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Leonardo Koeser
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Nash
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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McConnell T, Best P, Davidson G, McEneaney T, Cantrell C, Tully M. Coproduction for feasibility and pilot randomised controlled trials: learning outcomes for community partners, service users and the research team. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:32. [PMID: 30338129 PMCID: PMC6174568 DOI: 10.1186/s40900-018-0116-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/30/2018] [Indexed: 05/20/2023]
Abstract
PLAIN ENGLISH SUMMARY Co-producing research with members of the public is increasingly recognised as a valuable process. Yet, despite these good intentions, the literature on coproduction has struggled to keep pace with the coproduction 'movement'. There is a lack of clarity regarding acceptable levels of involvement and attempts at standardising approaches appear generic and lack detail. Moreover, relatively little research has captured the views of all the parties involved (academics, service providers and service users).We conducted interviews with all those involved in developing a new online service for depression in Northern Ireland. Our main questions related to how these three very different groups of people worked together over a two-year period to design, develop and deliver the service (e.g. what were the benefits? What would they do differently?)We found that early involvement was a key factor as this promoted equal ownership. There was also a need to be flexible and recognise other workload pressures. Interestingly, service providers and service users were keen to become more involved in data analysis - this is one of the most under-researched and reported areas within the coproduction literature. Finally, we considered how user involvement worked within complex research designs and how this could be improved. Based on this learning, the paper concludes with a simple 3-step framework that others may wish to follow in order to improve coproduction outcomes within interventions. ABSTRACT Background Co-production, involving members of the public in research, is increasingly encouraged by research funders. However, reports detailing involvement of the public in the entire research process from design, delivery, analysis and dissemination of findings are lacking. Furthermore, little is known about the lessons learnt from the perspective of the public and researchers; or more specifically lessons learnt when coproducing specific types of research projects, such as feasibility/pilot studies incorporating a randomised controlled trial (RCT) design. This paper aims to provide a more rounded picture of co-production based on the learning outcomes of researchers, their community partners and service users involved in a feasibility/pilot RCT study developing and evaluating an E-health Service for adults with depression. Methods Qualitative research incorporating 11 semi-structured interviews with academic team members (n = 4), community partners (n = 3) and service users with depression (n = 4) Data were analysed using thematic analysis. Results Key factors for successful coproduction include - (1) early involvement at the pre-development stage, including contributing to the scientific grant application; (2) early identification of team strengths and expertise from the outset; (3) regular team meetings and contact (formal or informal) among coproduction partners; (4) a flexible and pragmatic approach to research design (particularly within RCTs); (5) shared decision making and responsibility and (6) recognition of 'other' pressures and providing support to each other. Findings also suggested further scope for involving community partners in data analysis and dissemination through co-authored papers. Those seeking to coproduce interventions or utilise RCT designs should consider tensions between data quality and intervention implementation and ethical issues regarding control groups. Conclusion This paper confirms previous research confirming the benefits of coproduction. However, it also highlights a number of barriers, particularly when using complex research design, such as RCTs. Learning points are summarised in an implementation model for coproducing research. This model may provide a useful guide for considering activities associated with meaningful coproduction. We urge others to test this proposed model more widely in different areas of coproduced research.
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Affiliation(s)
- Tracey McConnell
- School of Social Science, Education and Social Work, Queen’s University Belfast, Belfast, Northern Ireland
| | - Paul Best
- School of Social Science, Education and Social Work, Queen’s University Belfast, Belfast, Northern Ireland
| | - Gavin Davidson
- School of Social Science, Education and Social Work, Queen’s University Belfast, Belfast, Northern Ireland
| | | | | | - Mark Tully
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
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Faerden A, Lyngstad SH, Simonsen C, Ringen PA, Papsuev O, Dieset I, Andreassen OA, Agartz I, Marder SR, Melle I. Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up. Psychiatry Res 2018; 267:140-147. [PMID: 29906681 DOI: 10.1016/j.psychres.2018.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 05/04/2018] [Accepted: 05/25/2018] [Indexed: 11/15/2022]
Abstract
Negative symptoms have traditionally been assessed based on clinicians' observations. The subjective experience of negative symptoms in people with psychosis may bring new insight. The Apathy Evaluation Scale (AES) is commonly used to study apathy in psychosis and has corresponding self-rated (AES-S) and clinician-rated (AES-C) versions. The aim of the present study was to determine the validity and reliability of the AES-S by investigating its concordance with the AES-C. Eighty-four first-episode (FEP) patients completed the shortened 12-item AES-S and AES-C at baseline (T1) and 12 months (T2). Concordance was studied by degree of correlation, comparison of mean scores, and change and difference between diagnostic groups. The Positive and Negative Symptom Scale (PANSS) was used to study convergent and discriminative properties. High concordance was found between AES-S and AES-C at both T1 and T2 regarding mean values, change from T1 to T2, and the proportion with high levels of apathy. Both versions indicated high levels of apathy in FEP, while associations with PANSS negative symptoms were weaker for AES-S than AES-C. Controlling for depression did not significantly alter results. We concluded that self-rated apathy in FEP patients is in concordance with clinician ratings, but in need of further study.
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Affiliation(s)
- Ann Faerden
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway.
| | - Siv Hege Lyngstad
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Carmen Simonsen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Petter Andreas Ringen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Oleg Papsuev
- Outpatient Psychiatry and Organization of Psychiatric Care Department, Moscow Research Institute of Psychiatry, Russia
| | - Ingrid Dieset
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Ole A Andreassen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| | - Ingrid Agartz
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway; Diakonhjemmet Hospital, Oslo 0319, Norway
| | - Stephen R Marder
- Semel Institute for Neuroscience, University of California in Los Angeles, USA
| | - Ingrid Melle
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
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Abstract
BACKGROUND Participatory research has as a central tenet that power relations between researcher and researched be reduced. In the last 20 years, a substantial literature has demonstrated the difficulties inherent in this as well as the troublesome nature of certain central concepts. AIMS (1) To describe and illustrate a new form of participatory research where the researchers share at least something with the participants in the research. That is, all are users of mental health services. (2) To reflect on the novel form of participatory research in terms of whether it shares, mitigates or avoids some of the difficulties of more traditional forms and to pose the question: what is a mental health community? RESULTS The model described is new in that the researchers have a different status than in conventional participatory research. But it is illuminated by and itself illuminates issues of power relations in research and difficulties in reducing that; gatekeepers and the exclusion of crucial groups of service users; the confusion of demographic representativeness with the silencing of marginalized perspectives; coming out of the academic space and the shifting issue of what counts as 'communities' in mental health. CONCLUSION The examples given are moderate in scale and relevant to social psychiatry. Yet they may change methods and the definition of participatory research and at the same time be vitiated by but also illuminate dilemmas already identified in the literature albeit in different formations.
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Affiliation(s)
- Diana Rose
- PO34 Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Developing a patient-reported experience questionnaire with and for people who use drugs: A community engagement process in Vancouver's Downtown Eastside. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:16-23. [PMID: 29966804 DOI: 10.1016/j.drugpo.2018.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022]
Abstract
People who use drugs (PWUD) frequently have complex health care needs, yet face multiple barriers to accessing services. Involving PWUD in health service design and evaluation can enhance the quality of data collected and ensure policy and practice improvements reflect the expressed needs of the population. However, PWUD remain largely excluded from the evaluation of health services that directly affect their lives, including development of patient-reported experience measures (PREMS) that have gained prominence in health services research and clinical practice. Detailed descriptions of PWUD participation in survey design are notably absent in the literature. In this commentary, we present a case that demonstrates how PWUD can contribute meaningfully to the development of questionnaires that assess patient-reported health care experiences. We describe the development, implementation and outcomes of a process to engage local drug user organizations in the evaluation of a redesign and reorientation of health service delivery in the Downtown Eastside (DTES) neighborhood of Vancouver, Canada. Through this process, participants contributed critical elements to the design of a patient-reported experience measure, including: (1) identifying unmet service needs in the neighborhood; (2) identifying local barriers and facilitators to care; (3) formulating questions on cultural safety; and (4) improving structure, language and clarity of the questionnaire. We highlight lessons learned from the process, reflecting on the strengths, challenges and ethical considerations associated with community-based approaches to questionnaire development. The workshop model presented here illustrates one flexible and promising approach to enabling meaningful participation of PWUD in questionnaire development.
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Papoulias C. Showing the Unsayable: Participatory Visual Approaches and the Constitution of 'Patient Experience' in Healthcare Quality Improvement. HEALTH CARE ANALYSIS 2018; 26:171-188. [PMID: 29038985 PMCID: PMC5899993 DOI: 10.1007/s10728-017-0349-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This article considers the strengths and potential contributions of participatory visual methods for healthcare quality improvement research. It argues that such approaches may enable us to expand our understanding of 'patient experience' and of its potential for generating new knowledge for health systems. In particular, they may open up dimensions of people's engagement with services and treatments which exceed both the declarative nature of responses to questionnaires and the narrative sequencing of self reports gathered through qualitative interviewing. I will suggest that working with such methods may necessitate a more reflexive approach to the constitution of evidence in quality improvement work. To this end, the article will first consider the emerging rationale for the use of visual participatory methods in improvement before outlining the implications of two related approaches-photo-elicitation and PhotoVoice-for the constitution of 'experience'. It will then move to a participatory model for healthcare improvement work, Experience Based Co-Design (EBCD). It will argue that EBCD exemplifies both the strengths and the limitations of adequating visual participatory approaches to quality improvement ends. The article will conclude with a critical reflection on a small photographic study, in which the author participated, and which sought to harness service user perspectives for the design of psychiatric facilities, as a way of considering the potential contribution of visual participatory methods for quality improvement.
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Affiliation(s)
- Constantina Papoulias
- Service User Research Enterprise, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Connell J, Carlton J, Grundy A, Taylor Buck E, Keetharuth AD, Ricketts T, Barkham M, Robotham D, Rose D, Brazier J. The importance of content and face validity in instrument development: lessons learnt from service users when developing the Recovering Quality of Life measure (ReQoL). Qual Life Res 2018; 27:1893-1902. [PMID: 29675691 PMCID: PMC5997715 DOI: 10.1007/s11136-018-1847-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Service user involvement in instrument development is increasingly recognised as important, but is often not done and seldom reported. This has adverse implications for the content validity of a measure. The aim of this paper is to identify the types of items that service users felt were important to be included or excluded from a new Recovering Quality of Life measure for people with mental health difficulties. METHODS Potential items were presented to service users in face-to-face structured individual interviews and focus groups. The items were primarily taken or adapted from current measures and covered themes identified from earlier qualitative work as being important to quality of life. Content and thematic analysis was undertaken to identify the types of items which were either important or unacceptable to service users. RESULTS We identified five key themes of the types of items that service users found acceptable or unacceptable; the items should be relevant and meaningful, unambiguous, easy to answer particularly when distressed, do not cause further upset, and be non-judgemental. Importantly, this was from the perspective of the service user. CONCLUSIONS This research has underlined the importance of service users' views on the acceptability and validity of items for use in developing a new measure. Whether or not service users favoured an item was associated with their ability or intention to respond accurately and honestly to the item which will impact on the validity and sensitivity of the measure.
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Affiliation(s)
- Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Grundy
- School of Health Sciences, Medical School, University of Nottingham, Nottingham, UK
| | | | | | - Thomas Ricketts
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dan Robotham
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The McPin Foundation, London, UK
| | - Diana Rose
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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McDermott TJ, Kirlic N, Aupperle RL. Roadmap for optimizing the clinical utility of emotional stress paradigms in human neuroimaging research. Neurobiol Stress 2018; 8:134-146. [PMID: 29888309 PMCID: PMC5991342 DOI: 10.1016/j.ynstr.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 01/24/2023] Open
Abstract
The emotional stress response is relevant to a number of psychiatric disorders, including posttraumatic stress disorder (PTSD) in particular. Research using neuroimaging methods such as functional magnetic resonance imaging (fMRI) to probe stress-related neural processing have provided some insights into psychiatric disorders. Treatment providers and individual patients would benefit from clinically useful fMRI paradigms that provide information about patients' current brain state and responses to stress in order to inform the treatment selection process. However, neuroimaging has not yet made a meaningful impact on real-world clinical practice. This lack of clinical utility may be related to a number of basic psychometric properties that are often overlooked during fMRI task development. The goals of the current review are to discuss important methodological considerations for current human fMRI stress-related paradigms and to provide a roadmap for developing methodologically sound and clinically useful paradigms. This would include establishing various aspects of reliability, including internal consistency, test-retest and multi-site, as well as validity, including face, content, construct, and criterion. In addition, the establishment of standardized normative data from a large sample of participants would support our understanding of how any one individual compares to the general population. Addressing these methodological gaps will likely have a powerful effect on improving the replicability of findings and optimize our chances for improving real-world clinical outcomes.
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Affiliation(s)
- Timothy J. McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
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Abstract
Patient-reported outcome measures (PROMs) are self-rated, but may not take in other aspects of the patient's perspective, such as the inclusion of domains that reflect service-user priorities. The clinician's view still has priority, although this situation has shifted in recent years. The Recovering Quality of Life (ReQoL) offers an advance in this area. Declaration of interest None.
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Affiliation(s)
- Jed Boardman
- King's College London Institute of Psychiatry,Psychology & Neuroscience,De Crespigny Park,London SE5 8AF,UK.
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Keetharuth AD, Brazier J, Connell J, Bjorner JB, Carlton J, Taylor Buck E, Ricketts T, McKendrick K, Browne J, Croudace T, Barkham M. Recovering Quality of Life (ReQoL): a new generic self-reported outcome measure for use with people experiencing mental health difficulties. Br J Psychiatry 2018; 212:42-49. [PMID: 29433611 PMCID: PMC6457165 DOI: 10.1192/bjp.2017.10] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Outcome measures for mental health services need to adopt a service-user recovery focus. Aims To develop and validate a 10- and 20-item self-report recovery-focused quality of life outcome measure named Recovering Quality of Life (ReQoL). METHOD Qualitative methods for item development and initial testing, and quantitative methods for item reduction and scale construction were used. Data from >6500 service users were factor analysed and item response theory models employed to inform item selection. The measures were tested for reliability, validity and responsiveness. RESULTS ReQoL-10 and ReQoL-20 contain positively and negatively worded items covering seven themes: activity, hope, belonging and relationships, self-perception, well-being, autonomy, and physical health. Both versions achieved acceptable internal consistency, test-retest reliability (>0.85), known-group differences, convergence with related measures, and were responsive over time (standardised response mean (SRM) > 0.4). They performed marginally better than the Short Warwick-Edinburgh Mental Well-being Scale and markedly better than the EQ-5D. CONCLUSIONS Both versions are appropriate for measuring service-user recovery-focused quality of life outcomes. Declaration of interest M.B. and J.Co. were members of the research group that developed the Clinical Outcomes in Routine Evaluation (CORE) outcome measures.
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Affiliation(s)
- Anju Devianee Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK,Correspondence: Anju Keetharuth, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK.
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jakob Bue Bjorner
- Optum Patient Insights, Rhode Island, USA and University of Copenhagen, Copenhagen, Denmark
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Thomas Ricketts
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty McKendrick
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Browne
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Tim Croudace
- Dundee Centre for Health And Related Research, University of Dundee, Dundee, UK
| | - Michael Barkham
- Centre for Psychological Services Research and Department of Psychology, University of Sheffield, UK
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Wykes T, Evans J, Paton C, Barnes TRE, Taylor D, Bentall R, Dalton B, Ruffell T, Rose D, Vitoratou S. What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication. Psychol Med 2017; 47:2369-2378. [PMID: 28420450 PMCID: PMC5820531 DOI: 10.1017/s0033291717000903] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Capturing service users' perspectives can highlight additional and different concerns to those of clinicians, but there are no up to date, self-report psychometrically sound measures of side effects of antipsychotic medications. Aim To develop a psychometrically sound measure to identify antipsychotic side effects important to service users, the Maudsley Side Effects (MSE) measure. METHOD An initial item bank was subjected to a Delphi exercise (n = 9) with psychiatrists and pharmacists, followed by service user focus groups and expert panels (n = 15) to determine item relevance and language. Feasibility and comprehensive psychometric properties were established in two samples (N43 and N50). We investigated whether we could predict the three most important side effects for individuals from their frequency, severity and life impact. RESULTS MSE is a 53-item measure with good reliability and validity. Poorer mental and physical health, but not psychotic symptoms, was related to side-effect burden. Seventy-nine percent of items were chosen as one of the three most important effects. Severity, impact and distress only predicted 'putting on weight' which was more distressing, more severe and had more life impact in those for whom it was most important. CONCLUSIONS MSE is a self-report questionnaire that identifies reliably the side-effect burden as experienced by patients. Identifying key side effects important to patients can act as a starting point for joint decision making on the type and the dose of medication.
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Affiliation(s)
- T. Wykes
- Psychology Department,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London UK
| | - J. Evans
- NIHR Biomedical Research Centre, South London and
Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience,
King's College London, London, UK
| | - C. Paton
- Chief Pharmacist, Oxleas NHS
Foundation Trust, Dartford, UK
| | | | - D. Taylor
- Pharmacy and Pathology, South
London and Maudsley NHS Foundation Trust, London,
UK
- Institute of Pharmaceutical Science, King's
College London, London, UK
| | - R. Bentall
- Department of Psychological Sciences,
University of Liverpool, UK
| | - B. Dalton
- Department for Psychological Medicine,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - T. Ruffell
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - D. Rose
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - S. Vitoratou
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- Psychometrics and Measurement Lab,
Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology, and Neuroscience, King's College London,
London, UK
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van Kessel P, de Boer D, Hendriks M, Plass AM. Measuring patient outcomes in chronic heart failure: psychometric properties of the Care-Related Quality of Life survey for Chronic Heart Failure (CaReQoL CHF). BMC Health Serv Res 2017; 17:536. [PMID: 28784137 PMCID: PMC5547511 DOI: 10.1186/s12913-017-2452-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background The Care-Related Quality of Life survey for Chronic Heart Failure (CaReQoL CHF) is a newly developed patient-reported outcome measure (PROM) that measures care-related quality of life in patients diagnosed with chronic heart failure. This study describes the psychometric properties of the questionnaire and its relationship with disease severity and global rating of quality of care. Method Insurance companies selected patients with a recorded diagnosis of chronic heart failure and for whom the hospital submitted a billing statement in the last year. Exploratory factor analysis, Cronbach’s alpha and item-rest correlation were used to construct the CaReQoL CHF. Construct validity was assessed by examining the mean values of the CaReQoL CHF scales for the categories of the widely-used New York Heart Association (NYHA) functional classification and by correlating the global rating of quality of care with the CaReQoL CHF scales. Results One thousand eighteen patients with chronic heart failure filled out the CaReQoL CHF (RR: 35.7%). The CaReQoL CHF consists of 20 items and three scales: social and emotional problems, physical limitations, and being in safe hands. The mean scores of the three scales differed significantly for the NYHA categories, particularly for the social-emotional problems and physical limitation scales. The ‘being in safe hands’ scale showed a moderate positive correlation with the global rating of quality of care. Conclusions The CaReQoL CHF is a concise and valid PROM that matches patients’ priorities in healthcare. It adds a new element to existing quality of life questionnaires for patients with chronic heart failure, that is ‘being in safe hands’ scale. This scale is relevant for patients because they experience anxiety and tension about their condition. Future research should determine whether the CaReQoL CHF can help healthcare providers in daily practice to focus treatment on outcomes of care that are relevant to individual patients.
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Affiliation(s)
- Paul van Kessel
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Dolf de Boer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Michelle Hendriks
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.
| | - Anne Marie Plass
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,University Medical Center Göttingen (UMG)/ Georg-August-University, Institute of Medical Psychology and Medical Sociology, Göttingen, Germany
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Mayston R, Habtamu K, Medhin G, Alem A, Fekadu A, Habtamu A, Prince M, Hanlon C. Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study. BMC Health Serv Res 2017; 17:183. [PMID: 28274231 PMCID: PMC5343366 DOI: 10.1186/s12913-017-2126-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Service satisfaction is integral to quality of care and measures are therefore considered important indicators of quality. Patient’s responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Our aim was to use mixed methods to develop a new measure of satisfaction for use among consumers of the new models of mental healthcare which are currently being scaled-up. Methods We used qualitative methods to explore the concept of service satisfaction. On the basis of these findings, we developed a new ‘Mental health service satisfaction scale’ (MHSSS v0.0) by adapting existing measures of service satisfaction. We evaluated psychometric properties of the new measure, among a sample of service users with severe mental disorder (SMD) (n = 200) and caregivers (n = 200). Following expert review, a modified version of the measure was developed (MHSSS v1.0) and psychometric properties were examined with data from a second independent sample (n = 150 service users with SMD and n = 150 caregivers). Results Factors identified in analysis of the first quantitative sample coincide with core concepts of service satisfaction as reported in the literature and were reflected in the key themes which emerged from our qualitative study: interpersonal factors, efficacy, communication, technical competency and adequacy of facilities. There was generally consensus among caregivers and service users regarding dimensions of satisfaction. However there was evidence of some differences in prioritization. Revisions made to version 0.0 of the Mental Health Service Satisfaction Scale (MHSSS) led to an improved instrument, with excellent internal consistency, convergent validity and factor loadings indicative of a uni-dimensional construct. Conclusions Our findings suggest that conceptions of service satisfaction among people accessing a service for SMD are broadly similar with those established in the literature. Our findings indicate that the MHSSS might be a useful candidate for inclusion in the new toolkit of measures needed to facilitate monitoring of service satisfaction which will be crucial to quality improvement. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2126-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosie Mayston
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia.,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, PO 9086, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, PO 9086, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, PO 9086, Addis Ababa, Ethiopia.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Alehegn Habtamu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, PO 9086, Addis Ababa, Ethiopia
| | - Martin Prince
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK. .,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, PO 9086, Addis Ababa, Ethiopia.
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Staley K, Abbey-Vital I, Nolan C. The impact of involvement on researchers: a learning experience. RESEARCH INVOLVEMENT AND ENGAGEMENT 2017; 3:20. [PMID: 29062545 PMCID: PMC5611580 DOI: 10.1186/s40900-017-0071-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/04/2017] [Indexed: 05/11/2023]
Abstract
PLAIN ENGLISH SUMMARY The impacts of involvement in research are often described in terms of the difference made to the research, the people involved and less frequently the researchers. This paper focuses on the researchers' experiences of involvement, based on an evaluation of a pilot project supporting patient/carer involvement in research at Parkinson's UK. Telephone interviews were conducted with researchers from eight different research projects with involvement. The researchers reported gaining new knowledge from patients and carers. They used this knowledge to change their project designs, interventions and new devices. They also gained new skills in communicating with the public. Meeting patients for the first time had a profound impact on some researchers, causing a change in their professional values. Face-to-face contact seemed particularly important to gain a sense of the 'people behind the data', which suggests such meetings may result in impacts beyond those typically achieved through an exchange of documents. Involvement also influenced one researcher's choices and preferences, in terms of who to ask to take part in their study In summary, researchers often learn something new from talking to patients and carers. Facilitating this conversation seems important to maximise the impact of this learning. In future, it might be helpful for evaluations of involvement to ask researchers in more detail about what they learnt from patients/carers and how they applied their new skills and knowledge. This may help to understand how involvement can influence researchers' thinking to have an impact on research. ABSTRACT Background The impacts of patient/public involvement are often described in terms of the difference made to the research, the researchers and the people involved. Involvement often impacts on research by influencing the design, delivery and dissemination. Patients/the public report gaining new skills and knowledge, increased self-confidence, and satisfaction from making a difference. There are fewer reports of the impacts on researchers. This paper discusses the findings from an evaluation of a pilot project supporting patient/carer involvement in research at Parkinson's UK, focusing on the researchers' experiences. Methods Semi-structured telephone interviews were conducted with one researcher from each of the eight research projects which involved patients/carers in the pilot. The findings were analysed using theoretical thematic analysis. Results and discussion Learning can be described as acquiring new knowledge, behaviours, skills, values, or preferences. The researchers' reports reflected these different types of learning. They reported gaining new knowledge from patients and carers, which they recognised as distinct from their textbook knowledge of the condition. They used this learning to change their project designs and their new interventions and devices. They also gained new skills in communicating with patients and carers about the aims and significance of their research. Meeting patients for the first time had a profound impact on some researchers causing them to change their professional values. Face-to-face contact seemed particularly important to gain a sense of the 'people behind the data', which suggests such meetings may result in impacts beyond those typically achieved through an exchange of documents. The involvement also influenced one researchers' priorities and preferences, in terms of what questions to ask and of whom, in their project. Conclusions Researchers learn from an exchange of knowledge with patients/ carers, which influences their plans and actions. This seems to be one way that involvement subsequently has an impact on research. Facilitating this exchange seems important to support mutual learning and to enhance the impact on researchers. Future evaluations of involvement might benefit from exploring what researchers learnt from patients/carers and how they applied their new skills and knowledge.
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Affiliation(s)
- Kristina Staley
- TwoCan Associates, Montague House, 4 St. Mary’s Street, Ross on Wye, HR9 5HT UK
| | | | - Claire Nolan
- Parkinson’s UK, 215 Vauxhall Bridge Road, London, SW1V 1EJ UK
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Barkham M. Patient‐centered assessment in psychotherapy: Toward a greater bandwidth of evidence. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alves PCG, Sales CMD, Ashworth M. "It is not just about the alcohol": service users' views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:25. [PMID: 27430578 PMCID: PMC4949765 DOI: 10.1186/s13011-016-0070-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/11/2016] [Indexed: 01/24/2023]
Abstract
Background The involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised. Methods A focus group was conducted and data were analysed using a framework synthesis approach. Results Service users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0–20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments. Conclusions Patients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.
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Affiliation(s)
- Paula Cristina Gomes Alves
- Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Avenida das Forças Armadas, Edifício I, 2w17, 1649-026, Lisboa, Portugal. .,Centro de Psicologia da Universidade do Porto, Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL; Faculdade de Psicologia e de Ciências da Educação, Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - Célia Maria Dias Sales
- Centro de Psicologia da Universidade do Porto, Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL; Faculdade de Psicologia e de Ciências da Educação, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Mark Ashworth
- Division of Health and Social Care Research; Faculty of Life Sciences & Medicine, King's College London, 3rd Floor Addison House, Guy's Campus, SE1 1UL, London, UK
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Semrau M, Lempp H, Keynejad R, Evans-Lacko S, Mugisha J, Raja S, Lamichhane J, Alem A, Thornicroft G, Hanlon C. Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: systematic review. BMC Health Serv Res 2016; 16:79. [PMID: 26931580 PMCID: PMC4774091 DOI: 10.1186/s12913-016-1323-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 02/17/2016] [Indexed: 11/15/2022] Open
Abstract
Background The involvement of mental health service users and their caregivers in health system policy and planning, service monitoring and research can contribute to mental health system strengthening, but as yet there have been very few efforts to do so in low- and middle-income countries (LMICs). Methods This systematic review examined the evidence and experience of service user and caregiver involvement in mental health system strengthening, as well as models of best practice for evaluation of capacity-building activities that facilitate their greater participation. Both the peer-reviewed and the grey literature were included in the review, which were identified through database searches (MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, SciELO, Google Scholar and Cochrane), as well as hand-searching of reference lists and the internet, and a snowballing process of contacting experts active in the area. This review included any kind of study design that described or evaluated service user, family or caregiver (though not community) involvement in LMICs (including service users with intellectual disabilities, dementia, or child and adolescent mental health problems) and that were relevant to mental health system strengthening across five categories. Data were extracted and summarised as a narrative review. Results Twenty papers matched the inclusion criteria. Overall, the review found that although there were examples of service user and caregiver involvement in mental health system strengthening in numerous countries, there was a lack of high-quality research and a weak evidence base for the work that was being conducted across countries. However, there was some emerging research on the development of policies and strategies, including advocacy work, and to a lesser extent the development of services, service monitoring and evaluation, with most service user involvement having taken place within advocacy and service delivery. Research was scarce within the other health system strengthening areas. Conclusions Further research on service user and caregiver involvement in mental health system strengthening in LMICs is recommended, in particular research that includes more rigorous evaluation. A series of specific recommendations are provided based on the review. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1323-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maya Semrau
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Heidi Lempp
- King's College London, Faculty of Life Sciences and Medicine, Academic Rheumatology, Clinical Trials Group, Weston Education Centre, 10, Cutcombe Rd., London, SE5 9RJ, UK
| | - Roxanne Keynejad
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sara Evans-Lacko
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - James Mugisha
- Butabika National Referral and Teaching Hospital, Kampala, Uganda
| | - Shoba Raja
- Special Advisor, BasicNeeds, 158A Parade, Leamington Spa, Warwickshire, CV32 4AE, UK
| | | | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK. .,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.
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Wiering B, de Boer D, Delnoij D. Patient involvement in the development of patient-reported outcome measures: a scoping review. Health Expect 2016; 20:11-23. [PMID: 26889874 PMCID: PMC5217930 DOI: 10.1111/hex.12442] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 02/06/2023] Open
Abstract
Background Patient‐reported outcome measures (PROMs) measure patients’ perspectives on health outcomes and are increasingly used in health care. To capture the patient's perspective, it is essential that patients are involved in PROM development Objective This article reviews in what ways and to what extent patients are involved in PROM development and whether patient involvement has increased over time. Search strategy Literature was searched in PubMed, EMBASE, MEDLINE and the Cochrane Methodology Register. Inclusion criteria Studies were included if they described a new PROM development. Data extraction Basic information and information regarding patient involvement in development phases was recorded. Main results A total of 189 studies, describing the development of 193 PROMs, were included. Most PROMs were meant for chronic disease patients (n = 59) and measured quality of life (n = 28). In 25.9% of the PROM development studies, no patients were involved. Patients were mostly involved during item development (58.5%), closely followed by testing for comprehensibility (50.8%), while patient involvement in determining which outcome to measure was minimal (10.9%). Some patient involvement took place in the development of most PROMs, but in only 6.7% patients were involved in all aspects of the development. Patient involvement did not increase with time. Conclusions Although patient involvement in PROM development is essential to develop valid patient‐centred PROMs, patients are not always involved. When patients are involved, their level of involvement varies considerably. These variations suggest that further attention to building and/or disseminating consensus on requirements for patient involvement in PROM development is necessary.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
| | - Dolf de Boer
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
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Csipke E, Papoulias C, Vitoratou S, Williams P, Rose D, Wykes T. Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods. J Ment Health 2016; 25:114-21. [PMID: 26886239 PMCID: PMC4819846 DOI: 10.3109/09638237.2016.1139061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/04/2015] [Accepted: 12/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. METHOD User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. RESULTS Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. CONCLUSIONS Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.
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Affiliation(s)
| | | | | | | | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience, King’s College London,
London,
UK
| | - Til Wykes
- Department of Psychology
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience, King’s College London,
London,
UK
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Neale J, Strang J. Philosophical ruminations on measurement: methodological orientations of patient reported outcome measures (PROMS). J Ment Health 2016; 24:123-5. [PMID: 25989489 DOI: 10.3109/09638237.2015.1036978] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
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Staley K, Doherty C. It's not evidence, it's insight: bringing patients' perspectives into health technology appraisal at NICE. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:4. [PMID: 29062505 PMCID: PMC5611625 DOI: 10.1186/s40900-016-0018-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/06/2016] [Indexed: 05/23/2023]
Abstract
PLAIN ENGLISH SUMMARY Health technology appraisal involves reviewing the findings from clinical trials and economic data to produce guidance on how health technology should be used. This task is carried out by appraisal committees in NICE. One of the several ways in which patients can feed their views into these committees is via a written patient statement. We asked nine committee members about what difference the information from patients makes to their decision-making. The Committee members reported that written patient statements offer a different perspective when reviewing the clinical and economic data. This can have a profound impact when a committee draws conclusions based solely on the data, which may not reflect the reality of patients' lives. The patients' and carers' input provides meaning to the data, 'bringing the numbers to life'. It identifies if the technology has any wider impacts than what's been reported in the clinical trial, and also if the trial has measured what's important to patients. We conclude that the written patient statement adds value to the decision-making process by helping Committee members to make sense of the clinical and economic data-it makes them look at the evidence 'in a different light'. Patients' stories are very effective in this context, because they have the power to communicate and to challenge Committee members' assumptions. Understanding this difference between analysing research evidence and drawing on patients' insights is important in thinking about what's needed in a written patient statement and the best way to obtain it. ABSTRACT Background Health technology appraisal involves reviewing clinical and economic data to inform guidance on the use of technology. In England this task is carried out by appraisal committees within the National Institute for Health and Care Excellence (NICE). Patients are not committee members as they have a vested interest in the outcome, but one of the several ways they are involved is through submitting a written patient statement, which is considered by the committee during its deliberations. We aimed to find out how the written patient statement adds value to the decision-making process by exploring how it is used in practice. Methods Semi-structured interviews were conducted with nine members of NICE appraisal committees. The interviews were transcribed and analysed thematically. We drew on published evidence of the impact of patient involvement on clinical research and our experience of supporting organisations to produce written patient statements to analyse the findings. Results Committee members reported that written patient statements offer a different perspective when evaluating clinical and economic data. This can have a profound impact when a committee draws conclusions based on data that may not reflect the reality of the patient experience. Information from patients and carers also provides context and meaning to the data, by explaining its real-life implications. It identifies wider impacts of a technology that may not have been assessed in a clinical trial, as well as commenting on whether what has been measured in a trial is relevant to patients. The main barrier to using the written patient statement is the misperception that it is a form of research 'evidence', when in fact it takes the form of experiential knowledge - or insight. Conclusions The written patient statement adds value by aiding Committee members in their interpretation of existing evidence - it enables them to consider this evidence 'in a different light'. In this context, patients' experiential knowledge is effective because it is subjective, emotional and anecdotal. It then has the power to communicate and to challenge assumptions based on the data alone. Understanding this difference between using evidence and insights has implications for the content of a written patient statement and the approaches used to obtain it.
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