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Serrano-Pérez P, Rivero-Santana A, Daigre-Blanco C, Palma-Álvarez RF, Nistal-Franco I, Ramos-Quiroga JA, Grau-López L. Correlates of Control Preferences, Participation in Decision-making and Activation in Patients with Substance Use Disorder. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:192-203. [PMID: 38863054 PMCID: PMC11188765 DOI: 10.62641/aep.v52i3.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Treatment of Substance Use Disorder (SUD) is complex and therefore including patients in the therapeutic process is needed. Patient-Centered Care (PCC) and Shared Decision-Making (SDM) have been associated with greater satisfaction, self-control, and less substance use. However, correlates of SDM have not been investigated in this population. METHOD A cross-sectional analysis was carried out in 214 SUD patients to identify sociodemographic, clinical and psychological correlates of preferences and perceptions about participation in SDM and degree of activation. The Control Preference Scale (CPS), the Shared Decision-Making Questionnaire (SDM-9-Q) and the Patient Activation Measure (PAM) were used to assess the PCC elements. Multinomial logistic regression was used to analyze the correlates of the CPS variables (preferred role, perceived role, and role matching). For SDM-9-Q and PAM, multilevel linear regression was used. RESULTS Preferring an active role, compared to a shared one, was significantly associated with higher educational level, lower neuroticism, absence of affective and alcohol use disorders, and higher quality of life. Perceiving greater participation was significantly associated with not being a new patient, having fewer legal problems, higher severity of alcohol consumption, not presenting polydrug use and main substance use different than opioids or sedatives. Activation was associated with higher scores in the personality trait activity, a preference for an active role and greater perception of being involved in the decision process. CONCLUSIONS Patients with milder clinical profiles prefer an active role compared to a shared one. Patients who prefer or perceive a shared or passive role did not show relevant differences. Greater activation was related to preference for an active role and the perception of having been involved in decisions.
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Affiliation(s)
- Pedro Serrano-Pérez
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, 36312 Vigo, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, 36312 Vigo, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), 35012 Las Palmas, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Constanza Daigre-Blanco
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), 08035 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Raúl Felipe Palma-Álvarez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), 08035 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Icía Nistal-Franco
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, 36312 Vigo, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), 08035 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Lara Grau-López
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), 08035 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
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Vall-Vargas A, Constans M, Torà N, Arnau A, Altés A, de Juan Pardo MÁ. Determinants associated with activation in patients with oral anticoagulant treatment: A cross-sectional study. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:148-160. [PMID: 38796107 DOI: 10.1016/j.enfcle.2024.05.002] [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: 12/01/2023] [Accepted: 04/16/2024] [Indexed: 05/28/2024]
Abstract
AIMS The terms "patient activation" and "patient empowerment" are used to describe the extent to which individuals are able to manage their own healthcare. Health outcomes and quality of life improve in patients who are more active in health care. The aim of this study was to identify sociodemographic, clinical, sociological and psychological determinants associated with activation in a group of chronically anticoagulated patients. METHODS Cross-sectional study of patients treated with oral antivitamin-k drugs attended at a specialized outpatient anticoagulant unit between November 2021 and June 2022. The main dependent variable was the level of patient activation according to the 13-item Patient Activation Measure (PAM-13). Simple and multiple linear regression models were conducted to identify the determinants associated with PAM-13 score. RESULTS A total of 137 patients who met all the inclusion criteria were recruited for the study. The mean age was 59.6 years (SD 13.8; range 22-86) and 60.6% were male. Sixty per cent presented a level IV of activation according to the PAM-13 scale. Mean patient activation score was 73.9 (SD 15.4). The factors independently associated with significantly lower activation were: emergency department visits in the past 12 months, intermediate social risk, anxiety symptoms, stress symptoms and low self-efficacy. CONCLUSIONS Five determinants were found to be associated with activation. Knowing the factors that modify the level of activation can help to identify subgroups of chronic anticoagulated patients who are less likely to engage in self-management and are therefore candidates for tailored educational interventions.
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Affiliation(s)
- Alba Vall-Vargas
- Department of Hematology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.
| | - Mireia Constans
- Department of Hematology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Núria Torà
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Anna Arnau
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain; Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Albert Altés
- Department of Hematology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - M Ángeles de Juan Pardo
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Coe A, Gunn J, Allnutt Z, Kaylor-Hughes C. Understanding Australian general practice patients' decisions to deprescribe antidepressants in the WiserAD trial: a realist informed approach. BMJ Open 2024; 14:e078179. [PMID: 38355180 PMCID: PMC10868251 DOI: 10.1136/bmjopen-2023-078179] [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: 07/26/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To evaluate how an approach to antidepressant deprescribing works, for whom, and in what contexts by (1) examining the experiences and perceptions of the approach for antidepressant users, (2) identifying the mechanisms of the approach and (3) describing what contexts are associated with antidepressant tapering. DESIGN This mixed methods study was informed by the principles of realist evaluation and was conducted in the first 3 months of participation in the WiserAD randomised control trial. SETTING General practice, Victoria, Australia. PARTICIPANTS 13 antidepressant users from general practice participating in the WiserAD trial for antidepressant deprescribing. INTERVENTION A patient-facing, web-based structured support tool that consists of a personalised tapering schedule, an action plan for managing withdrawal symptoms, a daily mood, sleep and activity tracker and mental health nurse support. PRIMARY/SECONDARY OUTCOME MEASURES The outcomes of the study were revealed on data analysis as per a realist evaluation approach which tests and refines an initial programme theory. RESULTS The contexts of learnt coping skills, knowledge and perceptions of antidepressants and feeling well were evident. Outcomes were intention to commence, initiation of deprescribing and successful completion of deprescribing. Key mechanisms for antidepressant deprescribing were (1) initiation of the deprescribing discussion; (2) patient self-efficacy; (3) provision of structured guidance; (4) coaching; (5) mood, sleep and activity tracking and (6) feelings of safety during the tapering period. CONCLUSIONS The WiserAD approach to antidepressant deprescribing supported participants to commence and/or complete tapering. The refined programme theory presents the WiserAD pragmatic framework for the application of antidepressant deprescribing in clinical practice. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05355025; ACTRN12622000567729; ISRCTN11562922; Pre-results.
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Affiliation(s)
- Amy Coe
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
| | - Jane Gunn
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
| | - Zoe Allnutt
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
| | - Catherine Kaylor-Hughes
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
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Serrano-Pérez P, Rivero-Santana A, Daigre-Blanco C, Palma-Álvarez RF, Nistal-Franco I, Antoni Ramos-Quiroga J, Grau-López L. Shared decision making in patients with substance use disorders: A one-year follow-up study. Psychiatry Res 2023; 329:115540. [PMID: 37857131 DOI: 10.1016/j.psychres.2023.115540] [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] [Received: 05/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Patient-centered care in therapeutic processes has been associated with better clinical outcomes, however, it remains a poorly studied aspect in Substance Use Disorder (SUD). The study aimed to evaluate patient's preferences, perceived participation in treatment decisions and activation level; and how they predict retention, pharmacological adherence and substance use during one-year follow-up. Logistic regression models were used to analyze the association between independent variables, along with a wide number of sociodemographic and clinical covariates, and outcomes. Most patients prefer a shared or passive role when making decisions about their treatment, and showed concordance between their preferred and perceived roles. In the univariate models, perceiving more involvement than desired showed a higher likelihood of treatment discontinuation at 12 months, and substance use at 6 and 12 months. No significant associations were found between the remaining decisional variables or the degree of activation with the assessed outcomes. A majority of SUD patients prefer and perceive to be involved in the decision-making process about their treatment. Patients perceiving more involvement than desired might experience an excess of responsibility that could negatively influence treatment continuation and substance use. Limitations of the study preclude any definitive conclusion, and more research is needed to confirm these results.
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Affiliation(s)
- Pedro Serrano-Pérez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain; Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain.
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC); Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) Spain
| | - Constanza Daigre-Blanco
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Raúl Felipe Palma-Álvarez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Icía Nistal-Franco
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Lara Grau-López
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
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Eliacin J, Burgess D, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Chinman M, Slaven JE, Matthias MS. Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability. Transl Behav Med 2023; 13:710-721. [PMID: 37130337 DOI: 10.1093/tbm/ibad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
This pilot study explored the feasibility and acceptability of PARTNER-MH, which aimed to engage racially diverse Veterans in mental health services, facilitate their active participation in care, and improve their communication with providers. Fifty participants were randomized to the intervention or a waitlist control group. For primary outcomes, we assessed the feasibility of the study design and PARTNER-MH's feasibility and acceptability. For secondary outcomes, we explored preliminary effects on patient engagement, patient activation, shared decision-making, and health-related outcomes. The study had a recruitment rate of 68%, enrollment rate of 91%, and a follow-up retention rate of 72%. For intervention feasibility and acceptability, fidelity scores were satisfactory and improved over time, session attendance was modest with 33% of participants completing ≥6 sessions, and 89% of participants were satisfied with the intervention. For secondary outcomes, patients in the intervention arm showed significant improvement on self-reported mental health and depression, compared with those in the control group at both 6- and 9-month follow-ups. However, there were no significant differences between study arms on the other measures. Pilot results provide support for future testing of PARTNER-MH in a larger trial, although modifications are needed to increase session attendance and follow-up retention rate. CLINICAL TRIAL INFORMATION The study was preregistered at Clinical Trials.gov. The study Trial registration number is ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Diana Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Scott Patterson
- Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Teresa Damush
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Bair
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, Pittsburg VA, Pittsburg, PA, USA
- RAND, Pittsburgh, PA, USA
| | - James E Slaven
- Deparmtent of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marianne S Matthias
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Zakeri MA, Esmaeili Nadimi A, Bazmandegan G, Zakeri M, Dehghan M. Psychometric Evaluation of Chronic Patients Using the Persian Version of Patient Activation Measure (PAM). Eval Health Prof 2023; 46:115-126. [PMID: 35506588 DOI: 10.1177/01632787221096904] [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: 12/14/2022]
Abstract
The Patient Activation Measure (PAM) is a 13-item questionnaire that assesses patients' knowledge, skills, and confidence in self-management. The current study aimed to translate the American version of the PAM-13 into Persian and test the psychometric properties of the Persian version among chronic patients. This cross-sectional study was conducted on 438 chronically ill patients in Rafsanjan, Iran from May to November 2019. The American version of the PAM-13 was translated into Persian using a standardized forward-backward translation method. Internal consistency, test-retest reliability, face and content validity, as well as construct validity (structural and convergent validity) were all assessed. The content validity index of the Patient Activation Measure-13 Persian (PAM-13-P) was 0.91. Exploratory and confirmatory factor analyses showed that the PAM-13-P had a meaningful structural validity. The PAM-13-P scores were negatively correlated with the Partner in Health Measure (PIH) (r = -0.29, p < 0.001). In addition, the PAM13-P scores were positively correlated with the Satisfaction with Life Scale (SWLS) (r = 0.31, p < 0.001). The internal consistency was 0.88, and the repeatability was excellent [Intraclass Correlation Coefficient (ICC):0.96 and confidence interval (CI): 0.94-0.98]. This study demonstrates that the PAM-13-P is a reliable and valid measure for assessing activation among chronically ill patients. The PAM-13-P scale assesses the level of self-management of chronic patients and identifies appropriate care strategies to meet their needs.
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Affiliation(s)
- Mohammad Ali Zakeri
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Esmaeili Nadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Golamreza Bazmandegan
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Family Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Zakeri
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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McNeely HE, Letts L, Martin ML, Strong S. Participants' Evaluation and Outcomes following Integration of Self-Management Support into Outpatient Schizophrenia Case Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3035. [PMID: 36833727 PMCID: PMC9964489 DOI: 10.3390/ijerph20043035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Self-management is advocated as a feasible, effective intervention to support individuals to actively manage the impact of illness and live healthier lives. We sought to evaluate a piloted self-management model, SET for Health, tailored for individuals living with schizophrenia embedded within ambulatory case management. (2) Methods: A mixed-methods design engaged 40 adults living with schizophrenia in the SET for Health protocol. Functional and symptomatic outcomes were measured by self-report and clinician ratings at baseline and completion of self-management plans, on average one year later. Semi-structured qualitative client interviews invited evaluations of personal experiences with the intervention. (3) Results: Significant improvements were found concerning client illness severity, social and occupational functioning, illness management and functional recovery with reductions in emergency visits and days in hospital. Clients endorsed the value of the intervention. Baseline clinical characteristics did not predict who benefited. Participation contributed to motivational gains and quality of life. (4) Conclusions: Results confirmed self-management support embedded within traditional case management improved clients' clinical and functional status, and contributed to quality of life. Clients engaged in their recovery and actively used self-management strategies. Self-management can be successfully adopted by clients with schizophrenia regardless of age, gender, education, illness severity or duration.
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Affiliation(s)
- Heather E. McNeely
- Schizophrenia and Community Integration Service, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Mary-Lou Martin
- Forensic Service, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Susan Strong
- Schizophrenia and Community Integration Service, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
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Carleton-Eagleton K, Walker I, Gibson D, Freene N, Semple S. Testing the validation and reliability of the Caregiver-Patient Activation Measure (CG-PAM). PEC INNOVATION 2022; 1:100098. [PMID: 37213753 PMCID: PMC10194270 DOI: 10.1016/j.pecinn.2022.100098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 05/23/2023]
Abstract
Objective The objective of this study was to test the reliability and validity of the Caregiver-Patient Activation Measure (CG-PAM). Methods Based on the psychometric testing of the original Patient Activation Measure (PAM), three assessments of reliability and validity were completed on the CG-PAM. Test-retest reliability was assessed across two weeks (n = 23). Criterion validity was assessed by interviewing participants from the test-retest cohort (n = 10), with transcripts assessed by subject matter experts (n = 3) to classify activation levels of the interviewee. Construct validity was assessed through a survey (n = 179) consisting of demographic questions, the CG-PAM and concepts hypothesised to be related to caregiver activation. Results There was strong test-retest reliability (r = 0.893), but poor criterion validity. Assessment o;f construct validity demonstrated significant relationships found between caregiver activation and weekly hours of care provided (p < 0.001), relationship satisfaction (p < 0.001), and dyad typology (p < 0.001), but not with perceived levels of stress or social support. Conclusion The CG-PAM was found to have strong reliability, but there were inconsistent results across the validation tests conducted. Innovation Future research must consider the dynamic nature of caring and the importance of the relationship between the caregiver/recipient when defining activation levels within the CG-PAM.
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Affiliation(s)
| | - Iain Walker
- School of Psychological Sciences, University of Melbourne, Level 7, Redmond Barry Building, The University of Melbourne, Victoria, 3010, Australia
| | - Diane Gibson
- Health Research Institute, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Stuart Semple
- Health Research Institute and Research Institute for Sport & Exercise, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
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Bakker EM, Witkamp FE, Luu KLN, van Dongen SI, Raijmakers NJH, van Roij J, van der Heide A, Rietjens JAC. Caregiver activation of relatives of patients with advanced cancer. Eur J Cancer Care (Engl) 2022; 31:e13656. [PMID: 35841207 PMCID: PMC9788340 DOI: 10.1111/ecc.13656] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/03/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Relatives of patients with advanced cancer often have many caring responsibilities. Not everyone may have sufficient knowledge, skills, and confidence-also known as caregiver activation-to provide such care. We assessed caregiver activation in relatives and its association with their personal characteristics and their own well-being. METHODS A cross-sectional study among relatives of patients with advanced cancer. Measures included caregiver activation (C-PAM), resilience, personal self-care, caregiver burden, depressive symptoms, quality of life, and social well-being. The C-PAM distinguishes four levels of activation, ranging from poor (level 1) to adequate (level 4). Bivariate and multivariable regression analyses were performed. RESULTS Two hundred fifty-four relatives were included; 32% had level 1 activation, 30% level 2, 27% level 3 and 11% level 4. Higher levels of caregiver activation were found among partners, those who provided more hours of informal care, were more resilient, and scored higher on personal self-care. Higher caregiver activation was associated with lower caregiver burden, less depressive symptoms, and better social well-being. CONCLUSION In our study, the majority of relatives seem insufficiently prepared to provide care for their loved one. Supporting them in gaining knowledge, skills, and confidence to provide such care may improve their own well-being.
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Affiliation(s)
- Evi Marit Bakker
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Frederika Erica Witkamp
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands,Research Centre Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Khanh Linh Nancy Luu
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Sophie Irene van Dongen
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Natasja Johanna Helena Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands,Netherlands Association for Palliative Care (PZNL)UtrechtThe Netherlands
| | - Janneke van Roij
- Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands,Netherlands Association for Palliative Care (PZNL)UtrechtThe Netherlands,CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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10
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Leung T, Burgess DJ, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Slaven JE, O'Connor C, Walker K, Zou DS, Austin E, Akins J, Miller J, Chinman M, Matthias MS. Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study. JMIR Res Protoc 2022; 11:e37712. [PMID: 36066967 PMCID: PMC9490546 DOI: 10.2196/37712] [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: 03/04/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. OBJECTIVE The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. METHODS This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. RESULTS Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. CONCLUSIONS Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37712.
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Affiliation(s)
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Teresa Damush
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Matthew J Bair
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Caitlin O'Connor
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Kiara Walker
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Denise S Zou
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Emily Austin
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - John Akins
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - James Miller
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care, Pittsburgh, PA, United States.,RAND Corporation Pittsburgh Office, Pittsburgh, PA, United States
| | - Marianne S Matthias
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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11
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Blanchard BE, Mata-Greve F, Johnson M, Fortney JC. Knowledge about Treatment (KaT) in Mental Health Services. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022; 56:81-98. [PMID: 37378000 PMCID: PMC10292725 DOI: 10.1080/07481756.2022.2041439] [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] [Indexed: 12/22/2022]
Abstract
This study developed and psychometrically evaluated a brief measure of mental health treatment knowledge (N = 726). Scores from Knowledge about Treatment (KaT) demonstrated a unidimensional measure with good model fit, internal consistency reliability, convergent and predictive validity, test-retest reliability, and measurement invariance across gender, ethnicity, education, and poverty status.
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Affiliation(s)
- Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Felicia Mata-Greve
- Department of Veterans Affairs, Mental Health Service Line, Puget Sound VA Healthcare System, Seattle, WA, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C. Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound VA Healthcare System, Seattle, WA, USA
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12
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Mousa M, Mahmood M. Mental Illness of Management Educators: Does Holding Multiple Academic Jobs Play a Role? A Qualitative Study. PUBLIC ORGANIZATION REVIEW 2022. [PMCID: PMC8935113 DOI: 10.1007/s11115-022-00612-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Through addressing management educators in four public business schools in Egypt, the authors of this paper aim to uncover the impact of holding multiple academic jobs on the mental health of management educators. The paper asserts that management educators do not perceive the holding of multiple academic roles as a stimulant of any form of mental illness (e.g., anxiety, depression, stress) if it is accompanied by a sense of autonomy (proper teaching loads, rational time for supervising theses, reasonable requests for research production) a feeling of competence (relevant monthly salary, available training and learning opportunities) and a sense of relatedness (feeling of involvement, flexible work hours, option to work from home).
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Affiliation(s)
- Mohamed Mousa
- Department of Management Sciences, Pontifical Catholic University of Peru, Lima, Peru
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13
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Hussein WF, Bennett PN, Sun SJ, Reiterman M, Watson E, Farwell IM, Schiller B. Patient Activation Among Prevalent Hemodialysis Patients: An Observational Cross-Sectional Study. J Patient Exp 2022; 9:23743735221112220. [PMID: 35924026 PMCID: PMC9340399 DOI: 10.1177/23743735221112220] [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] [Indexed: 11/17/2022] Open
Abstract
Patient activation is the product of knowledge, skills, and confidence that
enables a person to manage their own healthcare. It is associated with healthy
behaviors and improved patient outcomes. We surveyed prevalent hemodialysis (HD)
patients at 10 centers using the Patient Activation Measure 13-item instrument
(PAM-13). Activation was reported as scores (0-100) and corresponding levels
(1-4). Of 1149 eligible patients, surveys were completed by 925 patients (92%
response rate). Mean age was 62 ± 14 years, 40% were female, median vintage was
41 (IQR 19-77) months, and 66% had diabetes. Mean PAM score was 56 ± 13, with
14%, 50%, 25%, and 10% in levels 1 to 4, respectively. In adjusted analysis,
older age and having diabetes were associated with lower activation, whereas
higher educational levels and female gender were associated with higher scores.
Significant variation in activation was observed among participants from
different centers even after adjustment for other variables. In conclusion, low
activation is common among prevalent HD patients.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, San Jose, CA, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Paul N Bennett
- Satellite Healthcare, San Jose, CA, USA
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | | | | | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, CA, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
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14
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Wang M, Wang J, Wang Y, Huang X, Huang Y, Huang J, Feng Y, Li X. Reliability and validity of the Mental Health Self-management Questionnaire among Chinese patients with mood and anxiety disorders. Front Psychiatry 2022; 13:952951. [PMID: 35966465 PMCID: PMC9372341 DOI: 10.3389/fpsyt.2022.952951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-management plays an important role in promoting and restoring mental health for individuals with mental health issues. However, there is no valid and reliable Chinese tool assessing the self-management behaviors of people with mood and anxiety disorders. This study aimed to develop a Chinese version of the Mental Health Self-management Questionnaire (MHSQ-C) and to verify its psychometric properties. METHODS A total of 440 potential participants were recruited by convenience sampling from June to August 2020. Item analysis and analyses of internal consistency, test-retest reliability, content validity, construct validity and criterion validity were performed. RESULTS Data from 326 participants were used. Three factors obtained via principal component analysis and varimax rotation explained 53.68% of the total variance. The average content validity index was 0.99. The Cronbach's α coefficient (total: 0.874, clinical: 0.706, empowerment: 0.818, vitality: 0.830) and test-retest reliability (ICC: total: 0.783, 95% confidence interval (CI) [0.616, 0.882], clinical: 0.525, 95% CI [0.240, 0.725], empowerment: 0.786, 95% CI [0.622, 0.884], vitality: 0.748, 95% CI [0.564, 0.862]) were good. The MHSQ-C was well correlated with the Partners in Health scale and showed no floor or ceiling effect. DISCUSSION The MHSQ-C is a reliable and valid tool to evaluate the self-management strategies of patients with mood and anxiety disorders.
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Affiliation(s)
- Mengmeng Wang
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
| | - Jingjun Wang
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
| | - Ya Wang
- Department of Nursing, West China Hospital and West China School of Nursing, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yalin Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Junqiang Huang
- Chengdu Dekang Hospital/Chengdu Psychiatric Hospital, Chengdu, China
| | - Yan Feng
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolin Li
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
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15
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Kemp E, Chen H, Childers C. Mental health engagement: Addressing a crisis in young adults. Health Mark Q 2021; 40:153-173. [PMID: 34825631 DOI: 10.1080/07359683.2021.2004339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This research examines the influence that emotional distress, socially demanding contexts, and the coronavirus pandemic have had on the mental health of young adults. It highlights how active engagement in one's mental health can help mitigate the negative influence of emotional distress on mental health. A research model outlines the importance of mental health engagement in combating and controlling mental health symptoms. Implications from findings underscore the significance of creating a culture that assigns parity to both mental and physical healthcare. Direction is offered for healthcare providers in fostering mental health engagement by promoting mental health literacy and increasing access.
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Affiliation(s)
- Elyria Kemp
- Department of Management and Marketing, University of New Orleans, New Orleans, LA, USA
| | - Han Chen
- Lester E. Kabacoff School of Hotel, Restaurant and Tourism Administration, University of New Orleans, New Orleans, LA, USA
| | - Carla Childers
- Rubel School of Business, Bellarmine University, Louisville, KY, USA
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16
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Keen A, Lu Y, Oruche UM, Mazurenko O, Draucker CB. Activation in persons with mental health disorders: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:873-899. [PMID: 34311508 DOI: 10.1111/jpm.12789] [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: 04/17/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Evidence indicates a strong relationship between patient activation (i.e. confidence, knowledge and skills to self-manage health) and positive health behaviours and outcomes in a variety of clinical populations. Because persons with mental health disorders experience significant disease burden but often underutilize mental health treatment or experience poor treatment outcomes, they would likely benefit from increases in activation. No systematic reviews have been conducted to summarize and synthesize research on patient activation in persons with mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, this is the first comprehensive review to identify factors associated with activation and interventions that have shown to be effective in persons with mental health disorders. This integrative review indicates that better health status, less depression, positive health attitudes and behaviours, and higher quality therapeutic relationships may be associated with higher levels of activation in persons with mental health disorders. This review also indicates that a variety of interventions, most notably educational programs, are effective in increasing levels of patient activation in persons with mental health disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric mental health nurses and other clinicians should consider routine assessment of patient activation to inform individualized treatment plans for their clients. Clinicians should aim to form high-quality therapeutic relationships with clients as a way to promote higher levels of activation. Interventions that have been found to be effective in improving activation could be offered in a variety of mental health settings. ABSTRACT: Introduction Patient activation is understanding one's role in the healthcare process and having confidence, knowledge, and skills to self-manage one's health and health care. Researchers have begun to investigate patient activation in persons with mental health disorders, but no systematic reviews have been conducted to summarize and synthesize this research. For psychiatric mental health nurses and other clinicians to develop strategies to increase patient activation in this population, more information is needed about factors associated with activation and interventions that increase activation. Review Questions (1) What factors are associated with levels of activation in persons diagnosed with mental health disorders? (2) What interventions have shown to be effective at increasing levels of activation in persons diagnosed with mental health disorders? Method A 5-stage integrative review as described by Whittemore & Knafl. Results Twenty-nine articles were included in the review. Ten provided correlations between activation and other factors, and 20 examined the effects of interventions on activation. Some studies revealed significant correlations between a variety of health and treatment-related factors, and others revealed that some interventions, most notably educational programs, were shown to increase activation. Discussion The findings of this comprehensive review can inform psychiatric mental health nurses and other clinicians in developing strategies to increase activation in the patients with whom they work. More research is needed to provide a deeper understanding of the role of activation in the recovery and treatment of persons with mental health disorders. Implications for Practice Psychiatric nurses and other clinicians should assess for patient activation and incorporate strategies to increase levels of activation in patients in their practice. Positive therapeutic relationships likely enhance activation in persons with mental health disorders.
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Affiliation(s)
- Alyson Keen
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Yvonne Lu
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Ukamaka M Oruche
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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17
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Chronic Patients' Activation and Its Association with Stress, Anxiety, Depression, and Quality of Life: A Survey in Southeast Iran. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6614566. [PMID: 33834068 PMCID: PMC8018869 DOI: 10.1155/2021/6614566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 12/31/2022]
Abstract
A better perception of the factors associated with patient activation, as a way to improve self-management, is the most important step in planning patient-centered education for chronic disease management. Therefore, the present study is aimed at investigating the relationship between activation, stress, anxiety, depression, and quality of life (QOL) in patients with chronic diseases. This correlational study was performed on 293 chronic patients admitted to coronary care units (CCUs) in one of the hospitals in Rafsanjan. The Patient Activation Measure (PAM), Quality of Life-BREF (WHOQOL-BREF), and Depression, Anxiety, and Stress Scale-21 Items (DASS-21) were used to collect data. The data were then analyzed using SPSS 22. A significant positive correlation was observed between general QOL and PAM (P < 0.001). In addition, a significant negative correlation was found between PAM, stress (P = 0.032), and depression (P = 0.025). The results of multivariate linear regression indicated that only physical and psychological subscales of QOL significantly predicted PAM (B = 0.24; 95% confidence interval; P value < 0.05). Owing to the fact that some subscales of QOL have a determinant role in the PAM of chronic patients, healthcare providers are recommended to plan and implement the necessary interventions to improve the QOL and the health outcomes of chronic patients.
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18
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Fowler JC, Cope N, Knights J, Fang H, Skubiak T, Shergill SS, Phiri P, Rathod S, Peters-Strickland T. Hummingbird Study: Results from an Exploratory Trial Assessing the Performance and Acceptance of a Digital Medicine System in Adults with Schizophrenia, Schizoaffective Disorder, or First-Episode Psychosis. Neuropsychiatr Dis Treat 2021; 17:483-492. [PMID: 33603385 PMCID: PMC7886232 DOI: 10.2147/ndt.s290793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Symptoms of psychotic disorders can complicate efforts to accurately evaluate patients' medication ingestion. The digital medicine system (DMS), composed of antipsychotic medication co-encapsulated with an ingestible sensor, wearable sensor patches, and a smartphone application, was developed to objectively measure medication ingestion. We assessed performance and acceptance of the DMS in subjects with psychotic disorders. METHODS This was an 8-week open-label, single-arm, multicenter, Phase 4 pragmatic study (NCT03568500; EudraCT #2017-004602-17). Eligible adults were diagnosed with schizophrenia, schizoaffective disorder, or first-episode psychosis; were receiving aripiprazole, quetiapine, olanzapine, or risperidone; and could use the DMS with the application downloaded on a personal smartphone. The primary endpoint was good patch coverage, defined as the proportion of days over the assessment period where ≥80.0% of patch data was available, or an ingestion was detected. Exploratory endpoints included a survey on user satisfaction, used to assess acceptance of the DMS. Safety analyses included the incidence of treatment-emergent adverse events (TEAEs). RESULTS From May 25, 2018 to March 22, 2019, 55 subjects were screened and 44 were enrolled. Good patch coverage was achieved on 63.4% of days assessed and the DMS generated an adherence metric of ≥80.0%, reflecting the percentage of ingestion events expected when good patch coverage was reported. Most subjects (53.5%) were satisfied with the DMS. Medical device skin irritations were the only TEAEs reported. CONCLUSION The DMS had sufficient performance in, and acceptance from, subjects with psychotic disorders and was generally well tolerated.
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Affiliation(s)
- J Corey Fowler
- Global Clinical Development, CNS and Digital Medicine, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Nathan Cope
- Program Management, Otsuka Pharmaceutical Europe Ltd., Wexham, SL3 6PJ, UK
| | - Jonathan Knights
- Data Insights and Analytics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Hui Fang
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Taisa Skubiak
- Clinical Management, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Moorgreen Hospital, Clinical Trials Facility, Research Department, Southampton, SO30 3JB, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Moorgreen Hospital, Clinical Trials Facility, Research Department, Southampton, SO30 3JB, UK
| | - Timothy Peters-Strickland
- Global Clinical Development, CNS and Digital Medicine, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
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19
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The Association between Patient Activation and Outcomes among Severely Mentally Ill Patients. J Behav Health Serv Res 2020; 48:382-399. [PMID: 33205314 PMCID: PMC8275543 DOI: 10.1007/s11414-020-09731-3] [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] [Indexed: 11/25/2022]
Abstract
Little is known about the association between patient activation, health, service utilization, and cost among mental health (MH) patients. Patients aged 18 to 64 with schizophrenia (Sz, n = 43), bipolar disorder (BD, n = 59), or major depressive disorder (MDD, n = 34) completed the Patient Activation Measure for Mental Health (PAM-MH), the Colorado Symptom Index, demographic, socioeconomic, treatment, and social support questionnaire items. Average PAM-MH score indicated BD patients the most activated (66.6 ± 17.5), Sz (57.4 ± 10.4) less activated, and MDD the least activated (55.4 ± 14.6). The MDD cohort had the highest ($27,616 ± 26,229) and the BD had the lowest total annual healthcare cost ($18,312 ± 25,091). PAM-MH score was inversely correlated with healthcare costs and regression analysis showed a PAM-MH score × gender interaction. The strongest negative relationship between PAM and cost was for males. These analyses support the inverse association between PAM-MH and healthcare service utilization and cost.
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20
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Bahrom NH, Ramli AS, Isa MR, Baharudin N, Badlishah-Sham SF, Mohamed-Yassin MS, Abdul-Hamid H. Validity and reliability of the Patient Activation Measure® (PAM®)-13 Malay version among patients with Metabolic Syndrome in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:22-34. [PMID: 33329860 PMCID: PMC7735884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic. METHODS This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. RESULTS The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser-Meyer-Olkin test was 0.767, and Bartlett's test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach's α was 0.79, and the intraclass correlation coefficient was 0.45. CONCLUSIONS The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.
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Affiliation(s)
- N H Bahrom
- MD (Calgary), Department of Primary Care, Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - A S Ramli
- MBBS (Newcastle, UK), MRCGP (UK), Deputy Director, Institute of Pathology Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia,
| | - M R Isa
- MBBS (UM), MPH (UM), Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Selangor Malaysia
| | - N Baharudin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - S F Badlishah-Sham
- MBBCh BAO (Cork, Ireland), MFamMed (UiTM), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - M S Mohamed-Yassin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - H Abdul-Hamid
- MB BCh (Cardiff), MRCGP (UK), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
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21
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Hamilton CB, Li LC. Measures of Patient Activation and Self-Efficacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:645-659. [PMID: 33091240 DOI: 10.1002/acr.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Clayon B Hamilton
- The University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Linda C Li
- The University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
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22
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Miller DM, Moss B, Rose S, Li H, Schindler D, Weber M, Planchon SM, Alberts J, Boissy A, Bermel R. Obtaining Patient Priorities in a Multiple Sclerosis Comprehensive Care Center: Beyond Patient-Reported Outcomes. J Patient Exp 2020; 7:541-548. [PMID: 33062876 PMCID: PMC7534123 DOI: 10.1177/2374373519864011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: In order to provide patient center care, our multiple sclerosis (MS) clinic assesses patient concerns before clinical encounters, first by asking the optional qualitative question “What is the most important thing you what your health-care provider to know today” (most important concern of the patient [MIPC]) and then completing quantitative patient-reported outcome measures (PROMs) including Quality of Life in Neurological Disorders (Neuro-QoL). Both sets of questions are designed to facilitate encounters that address patients’ values and preferences. Objective: Determine whether the qualitative MIPC responses provided unique information not included in PROMs or clinical assessments. Methods: We randomly selected 400 first-time MIPC responders and 400 first-time MIPC nonresponders from 2788 participants in our database. We categorized MIPC responses by content and number of unique concerns and appended them to the Neuro-QoL framework. Nonresponders were compared to those who provided 1 and 2 or more responses. Results: Several MIPCs MS symptoms categories were added to the Neuro-QoL Physical domain. Most important concern of the patients work and cost-of-care categories were added to the Social Domain. Domains regarding treatment satisfaction and disease management were added. Two hundred thirty (58%) MIPC respondents reported 1 concern, 140 (35%) expressed 2 to 6 concerns, and 30 (7%) reported MS-unrelated concerns and not analyzed. Physical symptoms were the most common MIPC (69.9%). Respondents with more concerns were more likely African American, lacked private insurance, and worse disability. Conclusions: Importantly, MIPC responders described idiosyncratic symptoms, disease management, and social concerns not included in the PROMS, suggesting the MIPC question offered patients a unique opportunity to share specific concerns with their providers.
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Affiliation(s)
- Deborah M Miller
- Mellen Center, Cleveland Clinic, OH, USA.,Lerner College of Medicine, Cleveland Clinic, OH, USA
| | | | - Susannah Rose
- Lerner College of Medicine, Cleveland Clinic, OH, USA.,Office of Patient Experience, Cleveland Clinic, OH, USA
| | - Hong Li
- Quantitative Health Science, Cleveland Clinic, OH, USA
| | | | | | - Sarah M Planchon
- Mellen Center, Cleveland Clinic, OH, USA.,Lerner College of Medicine, Cleveland Clinic, OH, USA
| | - Jay Alberts
- Biomedical Engineering, Cleveland Clinic, OH, USA
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23
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Eyles JP, Ferreira M, Mills K, Lucas BR, Robbins SR, Williams M, Lee H, Appleton S, Hunter DJ. Is the Patient Activation Measure a valid measure of osteoarthritis self-management attitudes and capabilities? Results of a Rasch analysis. Health Qual Life Outcomes 2020; 18:121. [PMID: 32370751 PMCID: PMC7201682 DOI: 10.1186/s12955-020-01364-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Patient Activation Measure (PAM-13) was developed using Rasch analysis to assess knowledge, skills and confidence in the management of one's health. Previous studies report positive relationships between PAM-13 scores, self-management behaviours and longitudinal health outcomes in adults with chronic disease. There is little extant measurement property evidence for the use of PAM-13 in specific osteoarthritis (OA) populations. This study tested measurement properties of the PAM-13 in people living with hip and knee OA. METHODS Item response frequency analysis was conducted. Rasch analysis evaluated the fit of the PAM-13 data to the Rasch model. Model-data fit was evaluated using infit and outfit statistics; person/item reliability and person separation indices were computed. Unidimensionality was evaluated using Principal Components Analysis of Rasch residuals and the data were assessed for item redundancy. Differential Item Functioning (DIF) examined bias in respondent subgroups and correlations tested relationships between PAM-13 and other patient-reported outcomes. RESULTS Two-hundred-and-seventeen PAM-13 surveys were completed; there were no missing responses, floor or ceiling effects. Person and item reliability were acceptable (0.98 and 0.87 respectively) with good separation (person separation index 2.58). Unidimensionality was evaluated, with 49.4% of the variance explained by the first eigenvector. There was evidence of potential local response-dependence. The Rasch fit statistics were acceptable (except for item-2). There were some issues identified with targeting of the PAM-13 items to people with higher ability and the item difficulty order was different to that proposed in original cohorts. Significant DIF was identified for sex and educational level for a small number of items. PAM-13 scores were moderately correlated with depressive symptoms on the Depression Anxiety Stress Scale and Assessment of Quality of Life-6D. There were small correlations between PAM-13 and Knee injury and Osteoarthritis Outcome Score pain and activities of daily living scores. CONCLUSIONS This study provides some evidence of adequate person and item reliability, unidimensionality, and construct validity to support the use of PAM-13 to measure patient activation in people living with hip and knee OA. Possible limitations regarding targeting, different item difficulty order, DIF and local response dependence should be investigated in future research.
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Affiliation(s)
- J P Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia. .,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - M Ferreira
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - B R Lucas
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - S R Robbins
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - M Williams
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - H Lee
- Rehabilitation Department, Hunters Hill Private Hospital, Sydney, Australia
| | - S Appleton
- Physiotherapy Department, Mount Wilga Private Hospital, Sydney, Australia
| | - D J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
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24
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Horwitz SM, Cervantes P, Kuppinger AD, Quintero PL, Burger S, Lane H, Bradbury D, Cleek AF, Hoagwood KE. Evaluation of a Web-Based Training Model for Family Peer Advocates in Children's Mental Health. Psychiatr Serv 2020; 71:502-505. [PMID: 31910753 PMCID: PMC8904137 DOI: 10.1176/appi.ps.201900365] [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: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to compare knowledge gains from a new online training program with gains from an existing in-person training program for family peer advocates. METHODS Data were used from a pre-post study of individuals who enrolled in the Web-based Parent Empowerment Program training; 144 participants completed the training and pre-post tests, and 140 were admitted to the analyses. Knowledge was assessed with 34 questions, 29 of which were common to the online and in-person trainings. Pre-post knowledge scores were available from the in-person training. RESULTS Statistically significant gains in knowledge were found with both the 34 questions and the 29 questions common to both trainings. Knowledge gains across the two training models did not differ. CONCLUSIONS Data on knowledge gains from this accessible, affordable online model show promise for training the growing and important workforce of family peer advocates.
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Affiliation(s)
- Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Paige Cervantes
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Anne D Kuppinger
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Patricia L Quintero
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Susan Burger
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Heather Lane
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Donna Bradbury
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Andrew F Cleek
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
| | - Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Cervantes, Kuppinger, Hoagwood); McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York (Quintero, Cleek); Families Together in New York State, Albany (Burger); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health, Albany (Lane, Bradbury)
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25
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Green AL, Lambert MC, Hurley KD. Measuring Activation in Parents of Youth with Emotional and Behavioral Disorders. J Behav Health Serv Res 2020; 46:306-318. [PMID: 29956072 DOI: 10.1007/s11414-018-9627-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
For parents of youth with emotional and behavioral disorders, activation, or having the knowledge, skills, and confidence to access and engage in appropriate services for their children, is important for managing their child's mental health care. The Parent Activation Measure (PAM) was modified to create the Parent Patient Activation Measure-Mental Health (P-PAM-MH) to measure activation as part of a randomized controlled trial of a peer parent support intervention for parents of youth with emotional and behavioral problems. Results from this study provide initial support for use of the P-PAM-MH as a measure of activation in this population and for the reliability and validity of the measure. Implications of the findings from this study for research and practice in behavioral health are discussed.
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Affiliation(s)
- Amy L Green
- University of South Florida - Tampa, 13301 Bruce B. Downs Blvd., Tampa, FL, 33612, USA.
| | - Matthew C Lambert
- University of Nebraska - Lincoln, 247E Barkley Memorial Center, Lincoln, NE, 68583-0732, USA
| | - Kristin Duppong Hurley
- University of Nebraska - Lincoln, 247E Barkley Memorial Center, Lincoln, NE, 68583-0732, USA
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26
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Salyers MP, Garabrant JM, Luther L, Henry N, Fukui S, Shimp D, Wu W, Gearhart T, Morse G, York MM, Rollins AL. A Comparative Effectiveness Trial to Reduce Burnout and Improve Quality of Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:238-254. [PMID: 30488144 DOI: 10.1007/s10488-018-0908-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clinician burnout is presumed to negatively impact healthcare quality; yet scant research has rigorously addressed this hypothesis. Using a mixed-methods, randomized, comparative effectiveness design, we tested two competing approaches to improve care-one addressing clinician burnout and the other addressing how clinicians interact with consumers-with 192 clinicians and 469 consumers at two community mental health centers. Although qualitative reports were promising, we found no comparative effectiveness for either intervention on burnout, patient-centered processes, or other outcomes. Discussion includes identifying ways to strengthen approaches to clinician burnout.
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Affiliation(s)
- Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA. .,ACT Center of Indiana, Indianapolis, IN, USA.
| | - Jennifer M Garabrant
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.,ACT Center of Indiana, Indianapolis, IN, USA
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.,ACT Center of Indiana, Indianapolis, IN, USA
| | - Nancy Henry
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.,ACT Center of Indiana, Indianapolis, IN, USA
| | - Sadaaki Fukui
- Department of Social Work, School of Social Work and Center for Social Health and Well-being, IU and ACT Center of Indiana, IUPUI, Indianapolis, IN, USA
| | - Dawn Shimp
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.,ACT Center of Indiana, Indianapolis, IN, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.,ACT Center of Indiana, Indianapolis, IN, USA
| | | | - Gary Morse
- Places for People, Inc., St. Louis, MO, USA.,Department of Psychology, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Mary M York
- Department of Psychology, Southern Illinois University-Carbondale, Carbondale, IL, USA
| | - Angela L Rollins
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.,ACT Center of Indiana, Indianapolis, IN, USA.,Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
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27
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Christiansen TL, Lipsitz S, Scanlan M, Yu SP, Lindros ME, Leung WY, Adelman J, Bates DW, Dykes PC. Patient Activation Related to Fall Prevention: A Multisite Study. Jt Comm J Qual Patient Saf 2020; 46:129-135. [DOI: 10.1016/j.jcjq.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
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28
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Johnson-Kwochka A, Wu W, Luther L, Fischer MW, Salyers MP, Rollins AL. The Relationship Between Clinician Turnover and Client Outcomes in Community Behavioral Health Settings. Psychiatr Serv 2020; 71:28-34. [PMID: 31522631 DOI: 10.1176/appi.ps.201900169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE High clinician turnover in community behavioral health settings can lead to increased costs and can have a negative impact on care quality. Few studies have examined the implications of clinician turnover for client outcomes. This study investigated changes in client outcomes associated with clinician turnover. METHODS The study used prospective observational data collected as part of a larger randomized controlled trial. Clients (N=328) from two community behavioral health centers identified the clinician (N=121) whom they saw most often. Clients completed measures of depression, anxiety, mental and physical health functioning, and patient activation at baseline, 6 months, and 12 months. Clinician turnover during the 12-month study was obtained from agency records. Latent growth curve modeling was used to analyze the data. RESULTS Of the 328 clients, 24% experienced clinician turnover. For all outcomes except depression, the association with turnover was moderated by baseline status on the outcome measure. Turnover tended to be associated with clinical decline for clients who at baseline had low to moderate anxiety, high patient activation, or high physical health functioning. Surprisingly, turnover was associated with increased mental health functioning for clients who at baseline had very low mental health functioning. For physical health functioning, the association with turnover was also moderated by age. Turnover was associated with a sharper decline in functioning for older clients. CONCLUSIONS Results suggest that clinician turnover was associated most strongly with decline for higher functioning or older clients, but it was not uniformly associated with worsening clinical outcomes.
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Affiliation(s)
- Annalee Johnson-Kwochka
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Wei Wu
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Lauren Luther
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Melanie W Fischer
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Michelle P Salyers
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Angela L Rollins
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
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29
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Hurley D, Swann C, Allen MS, Ferguson HL, Vella SA. A Systematic Review of Parent and Caregiver Mental Health Literacy. Community Ment Health J 2020; 56:2-21. [PMID: 31541315 DOI: 10.1007/s10597-019-00454-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 09/07/2019] [Indexed: 12/14/2022]
Abstract
This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.
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Affiliation(s)
- Diarmuid Hurley
- School of Psychology, University of Wollongong, Wollongong, Australia. .,Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia.
| | - Christian Swann
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia.,Centre for Athlete Development, Experience & Performance, Southern Cross University, Coffs Harbour, Australia
| | - Mark S Allen
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Helen L Ferguson
- School of Psychology, University of Wollongong, Wollongong, Australia.,English Institute of Sport, Manchester, England, UK
| | - Stewart A Vella
- School of Psychology, University of Wollongong, Wollongong, Australia.,Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia
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30
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Malins S, Moghaddam N, Morriss R, Schröder T, Brown P, Boycott N, Atha C. Patient activation in psychotherapy interactions: Developing and validating the consultation interactions coding scheme. J Clin Psychol 2019; 76:646-658. [PMID: 31825098 DOI: 10.1002/jclp.22910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We describe the development of an instrument aiming to offer interaction-level feedback based on "patient activation": client confidence and perceived ability to manage their health. METHOD Twenty-two session-transcripts from cognitive behavioral therapy with high-users of healthcare were analyzed thematically, producing themes describing in-session interactions. Themes were subcategorized using patient activation theory into high and low activation presentations. Two coders new to the process were trained to use this consultation interactions coding scheme (CICS). Inter-rater reliability (IRR), convergent validity, and clinical utility were assessed and illustrated with extreme cases. RESULTS Good-to-excellent IRR was achieved. The CICS, therapeutic alliance, and therapist competence were correlated. Client engagement in session-structuring interactions correlated with outcome. The highest CICS scorer showed multiple outcome-improvements, the lowest scorer reported deteriorations. CONCLUSIONS This study presents the CICS's psychometric properties and indicates the value of client engagement in session-structuring.
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Affiliation(s)
- Sam Malins
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | | | - Richard Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Thomas Schröder
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Paula Brown
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Naomi Boycott
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Chris Atha
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
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31
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Denneson LM, Pisciotta M, Hooker ER, Trevino A, Dobscha SK. Impacts of a web-based educational program for veterans who read their mental health notes online. J Am Med Inform Assoc 2019; 26:3-8. [PMID: 30445648 DOI: 10.1093/jamia/ocy134] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
Objective This study evaluates whether a web-based educational program for patients who read their mental health notes online improves patient-clinician communication and increases patient activation. Methods The web-based educational program, developed with end-user input, was designed to educate patients on the content of mental health notes, provide guidance on communicating with clinicians about notes, and facilitate patients' safe and purposeful use of their health information. Eligible patients were engaged in mental health treatment (≥1 visit in the prior 6 months) and had logged into the Veterans Health Administration (VHA) patient portal at least twice. Participants completed measures of patient activation, perceived efficacy in healthcare interactions, patient trust in their clinicians, and patient assessment of the therapeutic relationship before and after participating in the program. A total of 247 participants had complete data and engaged with the program for 5 minutes or more, comprising the analytic sample. Multivariate analysis using mixed effects models were used to examine pre-post changes in outcomes. Results In bivariate analyses, patient activation, perceived efficacy in healthcare interactions, and trust in clinicians increased significantly between pre- and post-training assessments. In fully adjusted models, changes in patient activation [b = 2.71 (1.41, 4.00), P < 0.01] and perceived efficacy in healthcare interactions [b = 1.27 (0.54, 2.01), P < 0.01)] remained significant. Conclusions Findings suggest that this educational program may help empower mental health patients who read their notes online to be active participants in their care, while also providing information and tools that may facilitate better relationships with their clinicians.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Amira Trevino
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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32
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Kanu C, Brown C, Barner J, Chapman C, Walker H. The Effect of a Tailored Patient Activation Intervention in Inflammatory Bowel Disease Patients. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2019. [DOI: 10.37901/jcphp18-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose
A pre-test, post-test, control group design was employed to investigate the impact of a tailored patient activation intervention (PAI) among inflammatory bowel disease (IBD) patients.
Methods
Patients who met the inclusion criteria were selected from medical records via convenience sampling, were consented, and completed a baseline survey. Based on responses to the baseline 13-item patient activation measure (PAM-13), they were categorized into one of four patient activation stages. During office visits, intervention patients (N=23) were given a tailored PAI based on their baseline stage, which consisted of an information booklet and focused discussion with the gastroenterologist, while the control group (N=27) received usual care. Baseline and 1-month post-intervention scores were compared between the intervention (N=20) and control (N=21) groups for changes in patient activation score, medication adherence, and satisfaction with care.
Results
Most participants were Caucasian (88%), female (64%), college graduates (56%), and had Crohn's disease (59.2%). Overall, females had a significantly higher (p=0.04) mean activation score (mean=70.9±15.4) than males (mean=60.9±10.7) at baseline. This trend was the same post-intervention (75.6 females vs 64.4 males; p=0.03). The difference in mean activation scores pre- vs post-intervention was not statistically significant between the intervention and control groups (mean=4.9±12.3, p=0.21). However, this difference could be considered to be clinically significant based on results from previous studies. There were no significant differences in medication adherence or satisfaction scores pre- vs post-intervention for either group.
Conclusion
Tailored PAIs have the potential to increase activation level of patients with inflammatory bowel disease. This customized medical interaction increased patient involvement in disease management and could potentially lead to improved health outcomes.
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Possemato K, Johnson EM, Emery JB, Wade M, Acosta MC, Marsch LA, Rosenblum A, Maisto SA. A pilot study comparing peer supported web-based CBT to self-managed web CBT for primary care veterans with PTSD and hazardous alcohol use. Psychiatr Rehabil J 2019; 42:305-313. [PMID: 30489140 PMCID: PMC6541543 DOI: 10.1037/prj0000334] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive behavior therapy (CBT) targeting PTSD symptoms and hazardous drinking, called Thinking Forward. METHOD Thirty primary care patients with PTSD and hazardous alcohol use were randomized to receive Thinking Forward with or without peer support. Participants were assessed at pretreatment, posttreatment, and 24-week follow-up. Feasibility was analyzed with descriptive statistics. Preliminary outcomes were analyzed with multilevel modeling and effect sizes are presented. RESULTS Peer support specialists can be feasibly trained to support the Thinking Forward intervention with good fidelity. Both participants and peers reported good satisfaction with the protocol; although peers discussed a mismatch between the philosophies of peer support and diagnostically focused CBT. All participants experienced significant improvements in PTSD, quality of life, resiliency, and coping from pre- to posttreatment, with no differences between conditions. Pretreatment patient activation predicted outcomes regardless of whether participants received peer support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Peer support interventions to facilitate eHealth programs should strive to be consistent with the person-centered, recovery orientation of peer support, explicitly focus on patient activation, and consider characteristics of the patients, such as their level of problem recognition and willingness to engage in traditional behavioral health modalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Michael Wade
- Veterans Affairs Center for Integrated Healthcare
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Chiang M, Chang J, Nakash O, Cruz-Gonzalez M, Fillbrunn MK, Alegría M. Change in Patient Activation and Mental Illness Symptoms After Communication Training: A Multisite Study With a Diverse Patient Sample. Psychiatr Serv 2019; 70:696-702. [PMID: 31084292 PMCID: PMC6675648 DOI: 10.1176/appi.ps.201800216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patient activation involves patients' ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample. METHODS Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients' symptoms, and patient activation. RESULTS Clinicians' greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients' decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients' anxiety symptoms appeared to increase patient activation. CONCLUSIONS Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients' anxiety and may ultimately improve patient activation.
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Affiliation(s)
- Mengchun Chiang
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Janet Chang
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Ora Nakash
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Mario Cruz-Gonzalez
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Mirko K Fillbrunn
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Margarita Alegría
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
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Williams A, Rushton A, Lewis JJ, Phillips C. Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial. PLoS One 2019; 14:e0220110. [PMID: 31365565 PMCID: PMC6668791 DOI: 10.1371/journal.pone.0220110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes. METHODS In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 physiotherapists were randomised by cluster to receive the intervention-150 hours of mentored clinical practice-at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of physiotherapist performance was collected by an independent assessor observing the physiotherapists practice. RESULTS 80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes. CONCLUSION This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.
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Affiliation(s)
- Aled Williams
- University Hospital of Wales Physiotherapy Department, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - James J. Lewis
- Y Lab (Public Services Innovation Lab for Wales), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ceri Phillips
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Masterson Creber RM, Grossman LV, Ryan B, Qian M, Polubriaginof FCG, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal. J Am Med Inform Assoc 2019; 26:115-123. [PMID: 30534990 PMCID: PMC6339515 DOI: 10.1093/jamia/ocy146] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the effects of an inpatient portal intervention on patient activation, patient satisfaction, patient engagement with health information, and 30-day hospital readmissions. Methods and Materials From March 2014 to May 2017, we enrolled 426 English- or Spanish-speaking patients from 2 cardiac medical-surgical units at an urban academic medical center. Patients were randomized to 1 of 3 groups: 1) usual care, 2) tablet with general Internet access (tablet-only), and 3) tablet with an inpatient portal. The primary study outcome was patient activation (Patient Activation Measure-13). Secondary outcomes included all-cause readmission within 30 days, patient satisfaction, and patient engagement with health information. Results There was no evidence of a difference in patient activation among patients assigned to the inpatient portal intervention compared to usual care or the tablet-only group. Patients in the inpatient portal group had lower 30-day hospital readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P = 0.044). There was evidence of a difference in patient engagement with health information between the inpatient portal and tablet-only group, including looking up health information online (89.6% vs. 51.8%; P < 0.001). Healthcare providers reported that patients found the portal useful and that the portal did not negatively impact healthcare delivery. Conclusions Access to an inpatient portal did not significantly improve patient activation, but it was associated with looking up health information online and with a lower 30-day hospital readmission rate. These results illustrate benefit of providing hospitalized patients with real-time access to their electronic health record data while in the hospital. Trial Registration ClinicalTrials.gov Identifier: NCT01970852.
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Affiliation(s)
- Ruth M Masterson Creber
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Beatriz Ryan
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Fernanda C G Polubriaginof
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Restaino
- Columbia University Medical Center, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Data Science Institute, Columbia University, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
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Beentjes TAA, Goossens PJJ, Vermeulen H, Teerenstra S, Nijhuis-van der Sanden MWG, van Gaal BGI. E-IMR: e-health added to face-to-face delivery of Illness Management & Recovery programme for people with severe mental illness, an exploratory clustered randomized controlled trial. BMC Health Serv Res 2018; 18:962. [PMID: 30541536 PMCID: PMC6292084 DOI: 10.1186/s12913-018-3767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-mental health holds promise for people with severe mental illness, but has a limited evidence base. This study explored the effect of e-health added to face-to-face delivery of the Illness Management and Recovery Programme (e-IMR). METHOD In this multi-centre exploratory cluster randomized controlled trial, seven clusters (n = 60; 41 in intervention group and 19 in control group) were randomly assigned to e-IMR + IMR or IMR only. Outcomes of illness management, self-management, recovery, symptoms, quality of life, and general health were measured at baseline (T0), halfway (T1), and at twelve months (T2). The data were analysed using mixed model for repeated measurements in four models: in 1) we included fixed main effects for time trend and group, in 2) we controlled for confounding effects, in 3) we controlled for interaction effects, and in 4) we performed sub-group analyses within the intervention group. RESULTS Notwithstanding low activity on e-IMR, significant effects were present in model 1 analyses for self-management (p = .01) and recovery (p = .02) at T1, and for general health perception (p = .02) at T2, all in favour of the intervention group. In model 2, the confounding covariate gender explained the effects at T1 and T2, except for self-management. In model 3, the interacting covariate non-completer explained the effects for self-management (p = .03) at T1. In model 4, the sub-group analyses of e-IMR-users versus non-users showed no differences in effect. CONCLUSION Because of confounding and interaction modifications, effectiveness of e-IMR cannot be concluded. Low use of e-health precludes definite conclusions on its potential efficacy. Low use of e-IMR calls for a thorough process evaluation of the intervention. TRIAL REGISTRATION The Dutch Trial Register ( NTR4772 ).
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Affiliation(s)
- Titus A A Beentjes
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Center for Nursing Research, Saxion University of Applied Science, Deventer/Enschede, the Netherlands. .,Dimence Group Mental Health Care Centre, Deventer, the Netherlands.
| | - Peter J J Goossens
- Dimence Group Mental Health Care Centre, Deventer, the Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Hester Vermeulen
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Group Biostatistics, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Betsie G I van Gaal
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
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The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions. Qual Life Res 2018; 28:545-556. [PMID: 30390217 DOI: 10.1007/s11136-018-2036-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Self-management ability is commonly assessed in chronic disease research and clinical practice. The purpose of this study was to assess the structural and convergent validity of three commonly used self-management outcome measures in a sample of persons with neurological conditions. METHODS We used data from a Canadian survey of persons with neurological conditions, which included three commonly used self-management measures: the Partners in Health Scale (PIH), the Patient Activation Measure (PAM), and the Self-Efficacy for Managing a Chronic Disease Scale (SEMCD). Confirmatory factor analysis was used to assess the structural and convergent validity of the three measures. RESULTS When treated as single-factor constructs, none of the measurement models provided a good fit to the data. A four-domain version of the PIH was the best fitting model. Confirmatory factor analysis suggests that the three tools measure different, but correlated constructs. CONCLUSIONS While the PAM, PIH and SEMCD scales are all used as measures of patient self-management, our study indicates that they measure different, but correlated latent variables. None, when treated as single, uni-dimensional construct, provides an acceptable fit to our data. This is probably because self-management is multi-dimensional, as is consistently shown by qualitative evidence. While these measures may provide reliable summative measures, multi-dimensional scales are needed for clinical use and more detailed research on self-management.
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Jørring NT, Gjessing Jensen K. Treatment efficacy of narrative family therapy for children and adolescents with diverse psychiatric symptomatology. Scand J Child Adolesc Psychiatr Psychol 2018; 6:107-114. [PMID: 33520758 PMCID: PMC7703837 DOI: 10.21307/sjcapp-2018-012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Little research has been undertaken on children and adolescents with psychiatric co-morbidity and this group is seldom subject to evidence-based treatment. Equally, there has been little research on creating an evidence base for Narrative Therapy, which means that narrative family therapy (NFT) is seldom available to children and adolescents with a psychiatric disorder. Objective: A single group clinical design was used to examine the efficacy of NFT for children and adolescents with different diagnoses. Method: Families receiving NFT from the Family Therapy Team (FTT) at the Child and Adolescent Mental Health Services (CAMHS) of the Capital Region of Denmark filled out psychometric measurements before and after treatment. Patients evaluated the burden of symptoms using Beck’s Youth Inventory (BYI), and parents evaluated their personal agency in relationship to their child’s psychiatric disorder using Parent Activation Measurement (PAM). Results: We analyzed data from 48 patients and found a significant increase in median BYI measures of Self-Concept (40.5 to 46.0, p = 0.002) with an effect size of 0.60, decreases in BYI Depression Index (58.0 to 54.0, p = 0.030) with an effect size of –0.41, decreases in BYI Disruptive Behaviour Index (48.0 to 43.0, p = 0.030) with an effect size of –0.38, and a significant increase in PAM from 56.4 to 68.5, p = 0.001 with an effect size of 0.61. Conclusion: Results from this study suggest that NFT has a direct positive effect on patients’ own evaluation of the burden of symptoms, and parents’ perceived personal agency regarding their child’s distress.
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Affiliation(s)
- Nina Tejs Jørring
- Unit for Psychotherapy, Child and Adolescent Mental Health Services, Capital Region of Denmark, Glostrup, Denmark
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Sturt J, Dliwayo TR, Forjaz V, Hamilton K, Bryce C, Fraser J, Griffiths F. Eliciting the Impact of Digital Consulting for Young People Living With Long-Term Conditions (LYNC Study): Cognitive Interviews to Assess the Face and Content Validity of Two Patient-Reported Outcome Measures. J Med Internet Res 2018; 20:e268. [PMID: 30309832 PMCID: PMC6231804 DOI: 10.2196/jmir.9786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Digital consulting, using email, text, and Skype, is increasingly offered to young people accessing specialist care for long-term conditions. No patient-reported outcome measures (PROMs) have been evaluated for assessing outcomes of digital consulting. Systematic and scoping reviews, alongside patient involvement, revealed 2 candidate PROMs for this purpose: the patient activation measure (PAM) and the physician's humanistic behaviors questionnaire (PHBQ). PAM measures knowledge, beliefs, and skills that enable people to manage their long-term conditions. PHBQ assesses the presence of behaviors that are important to patients in their physician-patient interactions. OBJECTIVE This study aimed to assess the face and content validity of PAM and PHBQ to explore whether they elicit important outcomes of digital consulting and whether the PROMs can isolate the digital consultation component of care. METHODS Participants were drawn from 5 clinics providing specialist National Health Service care to 16- to 24-year-olds with long-term health conditions participating in the wider LYNC (Long-Term Conditions, Young People, Networked Communications) study. Overall, 14 people undertook a cognitive interview in this substudy. Of these, 7 participants were young people with either inflammatory bowel disease, cystic fibrosis, or cancer. The remaining 7 participants were clinicians who were convenience sampled. These included a clinical psychologist, 2 nurses, 3 consultant physicians, and a community youth worker practicing in cancer, diabetes, cystic fibrosis, and liver disease. Cognitive interviews were transcribed and analyzed, and a spreadsheet recorded the participants' PROM item appraisals. Illustrative quotes were extracted verbatim from the interviews for all participants. RESULTS Young people found 11 of the PAM 13 items and 7 of the additional 8 PAM 22 items to be relevant to digital consulting. They were only able to provide spontaneous examples of digital consulting for 50% (11/22) of the items. Of the 7 clinicians, 4 appraised all PAM 13 items and 20 of the PAM 22 items to be relevant to evaluating digital consulting and articulated operationalization of the items with reference to their own digital consulting practice with greater ease than the young people. Appraising the PHBQ, in 14 of the 25 items, two-thirds of the young people's appraisals offered digital consulting examples with ease, suggesting that young people can detect and discern humanistic clinician behaviors via digital as well as face-to-face communication channels. Moreover, 17 of the 25 items were appraised as relevant by the young people. This finding was mirrored in the clinician appraisals. Both young people and the clinicians found the research task complex. Young participants required considerably more researcher prompting to elicit examples related to digital consulting rather than their face-to-face care. CONCLUSIONS PAM and PHBQ have satisfactory face and content validity for evaluating digital consulting to warrant proceeding to psychometric evaluation. Completion instructions require revision to differentiate between digital and face-to-face consultations.
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Affiliation(s)
- Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | | | - Vera Forjaz
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Kathryn Hamilton
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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Schneeberger D, Golubíc M, Moore HCF, Weiss K, Abraham J, Montero A, Doyle J, Sumego M, Roizen M. Lifestyle Medicine-Focused Shared Medical Appointments to Improve Risk Factors for Chronic Diseases and Quality of Life in Breast Cancer Survivors. J Altern Complement Med 2018; 25:40-47. [PMID: 30256657 DOI: 10.1089/acm.2018.0154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Poor lifestyle choices play a significant role in the development and progression of preventable chronic diseases, including cancer. In this study, we evaluate the effectiveness of a comprehensive lifestyle medicine intervention on chronic disease risk factors and quality of life in breast cancer survivors. DESIGN This is a retrospective review of a clinical program from January 2016 to July 2017. SETTINGS/LOCATION It includes seven 2-h group medical visits held every other week at an outpatient wellness facility. SUBJECTS Eligible participants are breast cancer survivors who have completed treatment, including those who remain on hormonal therapy. INTERVENTION Patients receive education and experience in nutrition, culinary medicine, physical activity, and stress relief practices. OUTCOME MEASURES Participants' weight, body mass index (BMI), body fat mass, lean body mass, and percent body fat were measured at visit 1 and visit 7. Standard validated questionnaires were used to measure perceived stress, depression, patient activation, physical and mental quality of life, dietary fat consumption, and dietary fruit, vegetable, and fiber consumption. RESULTS A total of 31 patients participated in the group visits. Pre-post comparison data were not available for 10 patients. More than three-quarters of the 21 breast cancer survivors who attended 5 or more of the 7 group visits and provided data at the first and the last group visit decreased their body weight. On average, patients lost 4.9 pounds (-2.6%, p < 0.01), and their BMI decreased by 0.8 kg/m2 (-2.5%, p < 0.01). Changes in psychosocial variables of perceived stress, depression, patient activation, and quality of life trended in a positive direction, but did not reach statistical significance. Patients reported a significant decrease in average weekly fat consumption (-31.5%, p < 0.01). Most patients found the program educational and enjoyable, and nearly half of them described it as life changing. CONCLUSIONS Breast cancer survivors could employ the prescribed lifestyle modifications to produce clinically relevant health benefits. Interdisciplinary teams of health care professionals may help breast cancer survivors with chronic diseases implement evidence-based, individualized, and effective lifestyle prescription through group medical visits.
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Affiliation(s)
- Dana Schneeberger
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| | - Mladen Golubíc
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| | | | - Kenneth Weiss
- 3 Regional Oncology, Cleveland Clinic, Twinsburg, OH
| | - Jame Abraham
- 2 Hematology & Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Jonathan Doyle
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| | | | - Michael Roizen
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
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Cunha CM, Nepomuceno E, Manzato RDO, Cunha DCPTD, Silva DD, Dantas RAS. Cultural adaptation and validation of the Brazilian Version of the Patient Activation Measure-22 items. Rev Bras Enferm 2018; 71:1891-1898. [PMID: 30156674 DOI: 10.1590/0034-7167-2016-0470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To adapt and validate the Patient Activation Measure (PAM22) in a sample of Brazilians with chronic diseases under outpatient monitoring. METHOD Adaptation process comprises translation, back translation, analysis by a committee of judges, semantic analysis, and pre-test. Psychometric validation was performed with 513 individuals. Construct validity was analyzed through Pearson's correlation, Student's t-test and Structural Equation Modeling; reliability was assessed by the intraclass correlation coefficient and Cronbach's Alpha. RESULTS The internal consistency was adequate and test-retest reliability was low to moderate (p < 0.05). Validity evidence was found on the convergent construct, with statistically significant correlations between measures of activation, self-esteem, anxiety, depression, and health status. The one-dimensionality of the theoretical model was not confirmed in the adapted version. CONCLUSION Results have shown that the adapted version is reliable and valid, although the theoretical model cannot be explained in a single dimension.
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Affiliation(s)
- Cristiane Martins Cunha
- Universidade de São Paulo, School of Nursing of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | - Eliane Nepomuceno
- Universidade de São Paulo, School of Nursing of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | | | | | - Dirceu da Silva
- Universidade de Campinas, Faculty of Education. Campinas, São Paulo, Brazil
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Teo AR, Marsh HE, Forsberg CW, Nicolaidis C, Chen JI, Newsom J, Saha S, Dobscha SK. Loneliness is closely associated with depression outcomes and suicidal ideation among military veterans in primary care. J Affect Disord 2018; 230:42-49. [PMID: 29407537 DOI: 10.1016/j.jad.2018.01.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the substantial influence of social relationships on health is well-known, studies that concurrently examine the influence of varying dimensions of social connectedness on major depression are more limited. This study's aim was to determine to what degree several facets of social connectedness (number of confidants, social support, interpersonal conflict, social norms, and loneliness) are correlated with depression-related outcomes. METHODS Participants were primary care patients (n = 301) with probable major depression at a Veterans Health Administration hospital and its satellite clinics. Social connectedness was primarily measured using multi-item instruments from the NIH Toolbox of Adult Social Relationship Scales. Primary outcomes were clinical symptoms (depression and suicidal ideation) and secondary outcomes were self-reported health-related behaviors (medication adherence, patient activation, and help-seeking intentions). RESULTS In multivariate models adjusting for potential confounders and other facets of connectedness, loneliness was associated with higher levels of depression and suicidal ideation, as well as lower patient activation and help-seeking intentions. Social support and social norms about depression treatment were each associated with higher patient activation and help-seeking intentions. Social connectedness was not associated with medication adherence. LIMITATIONS The limitations of this study are primarily related to its cross-sectional survey design and study population. CONCLUSIONS Multiple aspects of social connectedness are associated with depression outcomes among military veterans with depression. Loneliness may represent the most important component of connectedness, as it is associated with depression severity, suicidality, and health-related behaviors.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, United States; Oregon Health & Science University and Portland State University, School of Public Health, 506 SW Mill St, Suite 450 (OMPH-SCH), Portland, OR 97201-5404, United States.
| | - Heather E Marsh
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Christopher W Forsberg
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Christina Nicolaidis
- Oregon Health & Science University and Portland State University, School of Public Health, 506 SW Mill St, Suite 450 (OMPH-SCH), Portland, OR 97201-5404, United States; Oregon Health & Science University, Department of Internal Medicine, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, United States; Portland State University, School of Social Work, 1600 SW 4th Ave, Portland, OR 97201-5522, United States
| | - Jason I Chen
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Jason Newsom
- Portland State University, School of Community Health: Institute on Aging, P.O. Box 751 - IOA, Portland, OR 97207-0751, United States
| | - Somnath Saha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Internal Medicine, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, United States; Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, 3181 SW Sam Jackson Park Rd (5th Floor, Biomedical Information Communication Center), Portland, OR 97239-3098, United States
| | - Steven K Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, United States
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Matthias MS, Fukui S, Salyers MP. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:133-140. [PMID: 26427999 DOI: 10.1007/s10488-015-0688-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.
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Affiliation(s)
- Marianne S Matthias
- Department of Veterans Affairs Health Services Research and Development Service, Center for Health Information and Communication, 1481 W 10th St (11H), Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Indianapolis, IN, USA. .,Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Sadaaki Fukui
- Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, Lawrence, KS, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
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Kimerling R, Pavao J, Wong A. Patient Activation and Mental Health Care Experiences Among Women Veterans. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:506-13. [PMID: 25917224 DOI: 10.1007/s10488-015-0653-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose-response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, PTSD-324, Menlo Park, CA, 94025, USA. .,Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA.
| | - Joanne Pavao
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, PTSD-324, Menlo Park, CA, 94025, USA
| | - Ava Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA
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Key attributes of patient centered medical homes associated with patient activation of diabetes patients. BMC FAMILY PRACTICE 2018; 19:4. [PMID: 29304742 PMCID: PMC5755130 DOI: 10.1186/s12875-017-0704-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/20/2017] [Indexed: 12/04/2022]
Abstract
Background Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study’s objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes. Methods This study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model. Results Using the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31–1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13–1.85). Conclusions Many practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes. Trial registration Study was not a clinical trial; therefore it was not registered.
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Nguyen VT, Edmonds SW, Lou Y, Roblin DW, Saag KG, Cram P, Wolinsky FD. Validity, reliability, and responsiveness to change of the "Osteoporosis and You" knowledge scale. Osteoporos Int 2017; 28:3379-3388. [PMID: 28879445 PMCID: PMC5685910 DOI: 10.1007/s00198-017-4204-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
We studied the Osteoporosis and You knowledge scale in 7749 participants enrolled in a clinical trial. Results confirmed its psychometric properties in a diverse audience. Baseline scores were associated with better recall of bone mineral density test results at follow-up; however, the scale was not responsive to knowledge change. INTRODUCTION The goal of this study was to confirm the measurement properties of the Osteoporosis and You (O&Y) knowledge scale using classic test theory methods in the 7749 men and women participating in the Patient Activation After DXA Result Notification (PAADRN) randomized controlled trial. We hypothesized a simple factor structure that would reflect the four-factor model previously published. METHODS We conducted psychometric analyses which included item analysis, internal consistency reliability, construct validity using exploratory and confirmatory factor analysis (EFA and CFA), comparing knowledge levels across pre-specified groups, and responsiveness to change. RESULTS PAADRN participants were predominantly college educated, White females with low bone density, and a moderate level of 10-year fracture risk. EFA revealed four domains closely matching those in two previous reports. While overall scale reliability was minimally acceptable at 0.68, the reliabilities of the domain subscales were unacceptably low (0.59, 0.64, 0.45, and 0.36 for the Biological, Lifestyle, Consequences, and Prevention and Treatment subscales). CFA revealed the data fit the hypothesized model reasonably well with the items loading on their expected latent variable. The scale was not responsive to change, but although not significant, improved knowledge indicated better DXA result recall at 12 and 52 weeks. CONCLUSIONS In the PAADRN population, the O&Y knowledge scale had psychometric properties similar to those previously reported. Over 12 and 52 weeks, participants did not demonstrate significant changes in knowledge, but those with higher knowledge at baseline were more likely to accurately recall their baseline DXA result.
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Affiliation(s)
- V T Nguyen
- College of Public Health, University of Iowa, 5233 Westlawn, Iowa City, IA, 52242, USA.
| | - S W Edmonds
- College of Nursing, University of Iowa, Iowa City, IA, USA
- CADRE, Iowa City VA Health System, Iowa City, IA, USA
| | - Y Lou
- College of Public Health, University of Iowa, 5233 Westlawn, Iowa City, IA, 52242, USA
| | - D W Roblin
- Kaiser Permanente of Atlanta, Atlanta, GA, USA
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - K G Saag
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - P Cram
- Faculty of Medicine, University of Toronto, Toronto, ONT, Canada
- University Health Network and Mount Sinai Hospital, Toronto, ONT, Canada
| | - F D Wolinsky
- College of Public Health, University of Iowa, 5233 Westlawn, Iowa City, IA, 52242, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
- College of Medicine, University of Iowa, Iowa City, IA, USA
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Hoagwood KE, Olin SS, Storfer-Isser A, Kuppinger A, Shorter P, Wang NM, Pollock M, Peth-Pierce R, Horwitz S. Evaluation of a Train-The-Trainers Model for Family Peer Advocates in Children's Mental Health. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 27:1130-1136. [PMID: 29576726 PMCID: PMC5854741 DOI: 10.1007/s10826-017-0961-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - S. Serene Olin
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Amy Storfer-Isser
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Anne Kuppinger
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Priscilla Shorter
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Nicole M. Wang
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Michele Pollock
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | | | - Sarah Horwitz
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
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Chapman L, Edbrooke-Childs J, Martin K, Webber H, Craven MP, Hollis C, Deighton J, Law R, Fonagy P, Wolpert M. A Mobile Phone App to Support Young People in Making Shared Decisions in Therapy (Power Up): Study Protocol. JMIR Res Protoc 2017; 6:e206. [PMID: 29084708 PMCID: PMC5684513 DOI: 10.2196/resprot.7694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Evidence suggests that young people want to be active participants in their care and involved in decisions about their treatment. However, there is a lack of digital shared decision-making tools available to support young people in child and adolescent mental health services (CAMHS). OBJECTIVE The primary aim of this paper is to present the protocol of a feasibility trial for Power Up, a mobile phone app to empower young people in CAMHS to make their voices heard and participate in decisions around their care. METHODS In the development phase, 30 young people, parents, and clinicians will take part in interviews and focus groups to elicit opinions on an early version of the app. In the feasibility testing phase, 60 young people from across 7 to 10 London CAMHS sites will take part in a trial looking at the feasibility and acceptability of measuring the impact of Power Up on shared decision making. RESULTS Data collection for the development phase ended in December 2016. Data collection for the feasibility testing phase will end in December 2017. CONCLUSIONS Findings will inform the planning of a cluster controlled trial and contribute to the development and implementation of a shared decision-making app to be integrated into CAMHS. TRIAL REGISTRATION ISRCTN77194423; http://www.isrctn.com/ISRCTN77194423 (Archived by WebCite at http://www.webcitation.org/6td6MINP0). ClinicalTrials.gov NCT02987608; https://clinicaltrials.gov/ct2/show/NCT02987608 (Archived by WebCite at http://www.webcitation.org/6td6PNBZM).
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Affiliation(s)
- Louise Chapman
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and Familes, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and Familes, London, United Kingdom
| | - Kate Martin
- Common Room Consulting Ltd, London, United Kingdom
| | | | - Michael P Craven
- NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United Kingdom
- Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United Kingdom
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Jessica Deighton
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and Familes, London, United Kingdom
| | - Roslyn Law
- University College London and the Anna Freud National Centre for Children and Familes, London, United Kingdom
| | - Peter Fonagy
- University College London and the Anna Freud National Centre for Children and Familes, London, United Kingdom
| | - Miranda Wolpert
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and Familes, London, United Kingdom
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Bonfils KA, Luther L, Fukui S, Adams EL, Dreison KC, Firmin RL, Salyers MP. Correlates of observer-rated active involvement in psychiatric treatment visits. Psychiatry Res 2017; 256:384-390. [PMID: 28688351 PMCID: PMC5603392 DOI: 10.1016/j.psychres.2017.06.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
Among people with serious mental illness, increased patient activation has been linked to a range of key recovery outcomes. To date, patient activation has been measured largely through self-report. The present study investigated correlates of a new tool that assesses active involvement through rating audio-recordings of treatment visits. The key domains of patient activation assessed in visits included: patients asking questions, discussing with providers instances of being active in managing illness outside the session, talking about goals, bringing up concerns, making evaluative statements about treatment, setting the agenda for the visit, and making requests about the course of treatment. The new coding scheme proved to be a feasible and reliable method for identifying multi-faceted behavioral indicators of patient activation. Contrary to our hypotheses, in a sample of 166 people diagnosed with severe mental illnesses, self-reported activation and observer-rated indices of activation were often not correlated or correlated in unexpected directions with the new behavioral measure of patient activation. This suggests the nature of patient activation may be complex and work is needed to understand how observer-rated and self-rated activation may predict differential recovery outcomes.
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Affiliation(s)
- Kelsey A. Bonfils
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States,phone: 317-274-6767; fax: 317-274-6756;
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Sadaaki Fukui
- The University of Kansas School of Social Welfare Center for Mental Health Research and Innovation, Lawrence, KS, United States
| | - Erin L. Adams
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Kimberly C. Dreison
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Ruth L. Firmin
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
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