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Richardson BT, Jackson J, Marable G, Barker J, Gardiner H, Igarabuza L, Leasy M, Matthews E, Zisman-Ilani Y. The Role of Black Churches in Promoting Mental Health for Communities of Socioeconomically Disadvantaged Black Americans. Psychiatr Serv 2024:appips20230263. [PMID: 38595118 DOI: 10.1176/appi.ps.20230263] [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: 04/11/2024]
Abstract
OBJECTIVE Churches in socioeconomically disadvantaged neighborhoods serve as safe havens in many Black communities. Churches provide faith and charitable services but often have limited resources to address the mental health needs of their communities. This article reports on a collaborative effort, driven by members of a Black church, to understand mental health needs, coping strategies, and resilience factors in a community of socioeconomically disadvantaged Black Americans. METHODS A community-based participatory research effort was established among a church, a community mental health organization, clinicians, and researchers to interview and survey individuals residing near the church. RESULTS The sample consisted of 59 adults, most of whom were ages 46-65 years, men (N=34, 58%), and unemployed (N=46, 78%). Mean scores on the Patient Health Questionnaire-9 (9.2±7.7) and Generalized Anxiety Disorder-7 scale (9.4±6.7) were almost three times higher than those reported by studies of other Black populations in the United States. Five themes emerged: prolonged poverty and daily exposure to violence trigger emotional distress, mental health stigma affects help seeking, spirituality promotes mental relief and personal recovery, spirituality helps in coping with poverty and unsafe neighborhoods, and church-based programs are needed. CONCLUSIONS Uptake of traditional mental health services was low, and reliance on faith and resource distribution by the church was high. Church-led interventions are needed to promote mental health at the individual and community levels. Mental health stigma, and negative attitudes toward mental health promotion in the community, may be addressed by integrating traditional mental health services in church-based recreational and leisure activities.
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Affiliation(s)
- Briana T Richardson
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Jacqueline Jackson
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Grace Marable
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Jessica Barker
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Heather Gardiner
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Laura Igarabuza
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Menachem Leasy
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Elizabeth Matthews
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Yaara Zisman-Ilani
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
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Moore T, Johnson S. Improving effective depression care in an outpatient psychiatric clinic. J Am Assoc Nurse Pract 2024; 36:187-193. [PMID: 37921617 DOI: 10.1097/jxx.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND With more than 20 million adults experiencing a major depressive episode in 2020, depression is one of the most widespread and costly illnesses in the United States. LOCAL PROBLEM An audit of medical records at an outpatient psychiatric clinic revealed that none of the patients (0/56) were receiving standardized depression screening at follow-up appointments. METHODS An 8-week rapid cycle Plan-Do-Study-Act model for change was used to spearhead a quality improvement (QI) project for effective depression care. The QI project comprised ongoing data collection through chart audit every 3 days, which drove tests of change (TOC). Team engagement surveys were also assessed for change in team engagement scores. INTERVENTIONS The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, and an effective care log (ECL) measured effective depression care. Every 2 weeks, a TOC was implemented, which guided further iterative changes throughout the project. RESULTS Effective depression care increased to 74% over the course of the project, surpassing the initial aim of 50%. Completion rates of the PHQ-9 (76%) and ECL (91%) increased. Team engagement (27.1) also increased over the course of the project. CONCLUSIONS This project improved effective depression care. The success was largely due to the iterative TOCs, ECL, and team engagement.
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Affiliation(s)
- Thomas Moore
- Benson Health Clinic, Eugene, Oregon
- Frontier Nursing University, Hyden, Kentucky
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Alinaitwe R, Seggane M, Turiho A, Bird V, Priebe S, Sewankambo N. Family Psycho-Social Involvement Intervention for severe mental illness in Uganda. S Afr J Psychiatr 2024; 30:2138. [PMID: 38322180 PMCID: PMC10839168 DOI: 10.4102/sajpsychiatry.v30i0.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/29/2023] [Indexed: 02/08/2024] Open
Abstract
Background Treatment rates for severe mental illness (SMI) are low in low- and middle-income countries because of limited resources. Enlisting family support could be effective and low cost in improving patient outcomes. Aim The article assess the feasibility, acceptability and estimates of efficacy of Family Psychosocial Involvement Intervention (FAPII) for patients with SMI. Setting Masaka Regional Referral Hospital and Mityana District Hospital in Uganda. Methods This was a controlled pilot study with two sites randomly assigned as intervention and control. Thirty patients each with one or two family members and six mental health professionals were recruited at the intervention site. Five patients, their family members and two mental health professionals met monthly for 6 months to discuss pre-agreed mental health topics. Patient outcomes were assessed at baseline, 6- and 12-months and analysed using paired t-tests. The trial was prospectively registered (ISRCTN25146122). Results At 6 and 12 months, there was significant improvement in the QoL in the intervention group compared to the control (p = 0.001). There was significant symptom reduction in the intervention group at 6 and 12 months (p < 0.001). Family Psychosocial Involvement Intervention affected better treatment adherence at 6 and 12 months (p = 0.035 and p < 0.001, respectively) compared to the control arm. Conclusion Family Psychosocial Involvement Intervention improved QoL, medication adherence, reduced stigma and symptoms among patients with SMI. The authors recommend involving families in the care of patients with SMI in Uganda, with FAPII employing culturally sensitive psychotherapy. Contribution The results support involvement of family in the care of patients with SMI.
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Affiliation(s)
- Racheal Alinaitwe
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Musisi Seggane
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Turiho
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Bird
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Nelson Sewankambo
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [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: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Eliacin J, Matthias MS, Cameron KA, Burgess DJ. Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 114:107847. [PMID: 37331280 PMCID: PMC11184508 DOI: 10.1016/j.pec.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE In this study, we report on participants' experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention's implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians. METHODS This is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data. RESULTS Participants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers' schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants' views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy. CONCLUSIONS Participants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication. PRACTICE IMPLICATION Some patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- National Center for PTSD, VA Boston Healthcare System, Boston, USA; HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA.
| | - Marianne S Matthias
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine, Chicago, USA
| | - Diana J Burgess
- Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, USA; University of Minnesota, Department of Medicine, Minneapolis, USA
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Sedlakova J, Westermair AL, Biller-Andorno N, Meier CA, Trachsel M. Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review. Front Digit Health 2023; 5:1208889. [PMID: 37744684 PMCID: PMC10513051 DOI: 10.3389/fdgth.2023.1208889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development. Methods A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles. Results We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards. Discussion More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.
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Affiliation(s)
- Jana Sedlakova
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Anna Lisa Westermair
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Christoph A. Meier
- Department of Internal Medicine, University Hospital Zurich (USZ), Zürich, Switzerland
- Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Ho EY, Karliner LS, Leung G, Harb R, Aguayo Ramirez G, Garcia ME. "How's your mood": Recorded physician mental health conversations with Chinese and Latino patients in routine primary care visits. PATIENT EDUCATION AND COUNSELING 2023; 114:107850. [PMID: 37364381 PMCID: PMC10528172 DOI: 10.1016/j.pec.2023.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Patient-physician communication patterns may influence discussions around depressive symptoms and contribute to engagement in depression care among racial/ethnic minority adults. We examined patient-physician communication about depressive symptoms during routine primary care visits with Chinese and Latino patients with and without language barriers. METHODS We examined 17 audio-recorded conversations between primary care physicians and Chinese (N = 7) and Latino (N = 10) patients who discussed mental health during their visit and reported depressive symptoms on a post-visit survey. Conversations (in English, Cantonese, Mandarin, Hoisan-wa, Spanish) were transcribed and translated by bilingual/bicultural research assistants and analyzed using inductive and deductive thematic and discourse analysis. RESULTS Patients initiated mental health discussion in eleven visits. Physicians demonstrated care in word choice and sometimes avoided openly mentioning depression; this could contribute to miscommunication around symptoms and treatment goals. Interpreters had difficulty finding single words to convey terms used by either patients or physicians. CONCLUSION Patients and doctors appeared willing to discuss mental health; however, variability in terminology presented challenges in mental health discussions in this culturally and linguistically diverse sample. PRACTICE IMPLICATIONS Further understanding patient preferred terminology about mental health symptoms and interpreter training in these terms could improve patient-physician communication about depressive symptoms and treatment preferences.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, University of California, San Francisco, San Francisco, CA, USA.
| | - Leah S Karliner
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, San Francisco, CA, USA
| | - Raneem Harb
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA
| | - Giselle Aguayo Ramirez
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria E Garcia
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Schladitz K, Weitzel EC, Löbner M, Soltmann B, Jessen F, Pfennig A, Riedel-Heller SG, Gühne U. Experiencing (Shared) Decision Making: Results from a Qualitative Study of People with Mental Illness and Their Family Members. Healthcare (Basel) 2023; 11:2237. [PMID: 37628436 PMCID: PMC10454232 DOI: 10.3390/healthcare11162237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: There is a fundamental shift in healthcare toward shared decision making (SDM). This study explores SDM from the perspective of individuals affected by mental illness and their family members and investigates factors which promote and hinder the process. (2) Methods: We conducted N = 15 telephone interviews (n = 4 adults affected by mental illness, n = 5 family members, n = 6 both applicable, the majority reporting experiences with affective and anxiety disorders). Data were recorded, transcribed, and analyzed according to procedures established by Mayring. (3) Results: Individuals affected by mental illness and their family members have a strong desire to be involved in treatment decisions and to participate in finding a diagnosis. Often these stakeholders are denied the opportunity to participate; sometimes enabling behaviors impede participation. The stigmatization of mental illnesses is a major barrier. There are also structural barriers to SDM within the healthcare system. Peer support, self-help associations, and psychosocial counseling services are important to empowering individuals and promoting SDM. (4) Conclusions: SDM has the potential to improve the quality of mental healthcare. Barriers can be mitigated and new approaches for interventions in the psychiatric sector have been identified. This study has also shown the importance of understanding SDM as a process that should begin at the diagnostic phase.
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Affiliation(s)
- Katja Schladitz
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Elena C. Weitzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Köln, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
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Romero SA, Rasmussen A, Raue PJ. Treatment Decision-Making Preferences of Older Depressed Minority Primary Care Patients. Community Ment Health J 2022; 59:719-727. [PMID: 36445539 DOI: 10.1007/s10597-022-01055-0] [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: 04/25/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022]
Abstract
Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study's aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression. Linear regressions examined the association of sociodemographic and clinical characteristics with decision-making preference for both decision types. Majority of patients preferred shared decision-making for general medical and depression treatments. Female gender was associated with a preference for active decision-making for depression treatment. For this sample older depressed patients preferred sharing the decision-making responsibilities with physicians. To improve communication and the initiation and adherence to mental health care, physicians must consider older, minority patients' preferences for involvement in the decision-making process.
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Affiliation(s)
- Sara A Romero
- Harvard Medical School, 641 Huntington Avenue, 02115, Boston, MA, USA.
| | | | - Patrick J Raue
- University of Washington Medical Center, Seattle, WA, USA
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Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients. J Gen Intern Med 2022; 37:3947-3955. [PMID: 35132548 PMCID: PMC8821856 DOI: 10.1007/s11606-022-07427-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment. OBJECTIVE The present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation. DESIGN Semi-structured qualitative interviews were conducted with 27 patients. PARTICIPANTS Respondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic. APPROACH A grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology. KEY RESULTS Respondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE. CONCLUSION(S) Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.
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Zisman-Ilani Y, Chmielowska M, Dixon LB, Ramon S. NICE shared decision making guidelines and mental health: challenges for research, practice and implementation. BJPsych Open 2021; 7:e154. [PMID: 34470688 PMCID: PMC8444056 DOI: 10.1192/bjo.2021.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, USA
| | - Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, USA
| | - Shulamit Ramon
- Department of Allied Health, Midwifery and Social Work, University of Hertfordshire, UK
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