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Fernandes S, Brousse Y, Zendjidjian X, Cano D, Riedberger J, Llorca PM, Samalin L, Dassa D, Trichard C, Laprevote V, Sauvaget A, Abbar M, Misdrahi D, Berna F, Lancon C, Coulon N, El-Hage W, Rozier PE, Benoit M, Giordana B, Caqueo-Urízar A, Yon DK, Tran B, Auquier P, Fond G, Boyer L. Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study. JMIR Ment Health 2024; 11:e49916. [PMID: 38753416 PMCID: PMC11140279 DOI: 10.2196/49916] [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: 06/13/2023] [Revised: 09/15/2023] [Accepted: 01/21/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. OBJECTIVE This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. METHODS We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. RESULTS In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. CONCLUSIONS The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. TRIAL REGISTRATION ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Yann Brousse
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Xavier Zendjidjian
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Delphine Cano
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Jérémie Riedberger
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, University of Clermont Auvergne, Centre national de la recherche scientifique, Institut national polytechnique de Clermont Auvergne, Institut Pascal UMR 6602, Clermont-Ferrand, France
| | - Ludovic Samalin
- Department of Psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, University of Clermont Auvergne, Centre national de la recherche scientifique, Institut national polytechnique de Clermont Auvergne, Institut Pascal UMR 6602, Clermont-Ferrand, France
| | - Daniel Dassa
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | | | - Vincent Laprevote
- Department of Addictology and Psychiatry, Centre Psychothérapique de Nancy, Laxou, France
- Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Institut national de la santé et de la recherche médicale U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Anne Sauvaget
- Nantes Université, Centre Hospitalier Régional Universitaire de Nantes, Movement - Interactions - Performance - MIP UR 4334, Nantes, France
| | - Mocrane Abbar
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, University of Montpellier, Nîmes, France
| | - David Misdrahi
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Fabrice Berna
- Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Institut national de la santé et de la recherche médicale U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Christophe Lancon
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Nathalie Coulon
- Centre Expert Schizophrénie, Centre Expert TSA-SDI et Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive - C3R, Centre Hospitalier Alpes Isère, Grenoble, France
| | - Wissam El-Hage
- Centre Hospitalier Régional Universitaire de Tours, Clinique Psychiatrique Universitaire, Tours, France
| | | | - Michel Benoit
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | | | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Bach Tran
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Pascal Auquier
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Guillaume Fond
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Laurent Boyer
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
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Rittenbacher D, Bosch SJ, Valipoor S, Lorusso L. Preliminary Development of Items for a Nurses' Physical Environmental Stress Scale. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241244468. [PMID: 38622874 DOI: 10.1177/19375867241244468] [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: 04/17/2024]
Abstract
RESEARCH PURPOSE This study aimed to develop a preliminary Nurses' Physical Environmental Stress Scale (NPESS) that explores the relationships between the physical environment in the intensive care unit (ICU) and work-related stress among ICU nurses. BACKGROUND Working within the healthcare field is stressful and comes with a high level of responsibility for nurses, especially ICU nurses. The ICU work environment is associated with risk factors such as excessive workload, increased expectations, and long working hours that can lead to burnout among nurses. There is some evidence that environmental design has the potential to prevent or mitigate work-related stress; however, an adequate assessment tool to identify physical environmental stressors or supports for moderating stress is lacking. METHODS To develop the preliminary environmental assessment tool, an exploratory sequential methodology was used. The approach consisted of three distinct phases, including (a) a qualitative content analysis of existing focus group data, (b) a qualitative content analysis of pertinent literature related to environmental assessment tools in a healthcare context, and (c) the development and refinement of the NPESS assessment tool. Tool refinement was based on interviews with ICU nurses. RESULTS The resulting NPESS tool was comprised of seven sections (sounds, lighting, smells, staff respite spaces, staff workspaces, patient rooms, and aesthetic qualities) containing a total of and 81 items that address factors that were identified as potential moderators of environmental stress in ICU settings. CONCLUSIONS The resulting NPESS assessment tool provides a feasible approach for evaluating ICU settings to identify possible improvements to reduce stress among nurses. Future research will be conducted to assess the validity and reliability of the final tool by distributing it to a larger sample of ICU nurses.
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Affiliation(s)
- Dagmar Rittenbacher
- Research & Insights, Gresham Smith, Orlando, FL, USA
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Sheila J Bosch
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Shabboo Valipoor
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Lesa Lorusso
- Research & Insights, Gresham Smith, Orlando, FL, USA
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Rodríguez-Labajos L, Kinloch J, Nicol L, Grant S, O'Brien G. Impact of the design of adult mental health inpatient facilities on healthcare staff: a mixed methods systematic review. BMJ Open 2024; 14:e074368. [PMID: 38448069 PMCID: PMC10916155 DOI: 10.1136/bmjopen-2023-074368] [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: 04/11/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff. DESIGN A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute's critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors. RESULTS In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors. CONCLUSION Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs. PROSPERO REGISTRATION NUMBER CRD42022368155.
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Affiliation(s)
| | - Joanne Kinloch
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
| | - Louise Nicol
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
| | - Susan Grant
- NHSScotland Assure, Procurement, Commissioning and Facilities, NHS National Services Scotland, Glasgow, UK
| | - Geraldine O'Brien
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
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Norouzi N, Martinez A, Rico Z. Architectural Design Qualities of an Adolescent Psychiatric Hospital to Benefit Patients and Staff. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:103-117. [PMID: 37365801 PMCID: PMC10621023 DOI: 10.1177/19375867231180907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES This study is focused on how architectural design of adolescent psychiatric hospitals could positively affect not only patients but also staff members working at the hospitals. BACKGROUND Adolescents between the ages of 12 and 18 are among the young population with the highest percentage of mental illness. However, there are limited number of intentionally designed psychiatric hospitals for adolescents. Staff who work in adolescent psychiatric hospitals may face workplace violence. Studies on environmental impacts suggest that the built environment affects patients' well-being and safety as well as staff's satisfaction, working condition, safety, and health. However, there are very few studies that focus on adolescent psychiatric hospitals and the impact of the built environment on both staff and patients. METHODS Data were collected through literature analysis and semi-structured interviews with staff of three psychiatric state hospitals with adolescent patient units. The triangulation of multiple data sources informed a set of environmental design conditions that captures the complexity and connectedness of architectural design and the occupants of an adolescent psychiatric hospital. RESULTS The results present architectural composition, atmosphere, lighting, natural environment, safety, and security as indispensable design conditions to create an enclosed and city-like campus that provides a serene, secure, and structured environment that benefit staff and adolescent patients. CONCLUSION The specific design strategies that need to be incorporated in the architectural design of a safe and secure adolescent psychiatric hospital include an open floor plan that respects patients' autonomy and offers privacy while always providing staff with full visibility of patients.
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Affiliation(s)
- Neda Norouzi
- Department of Architecture, University of Texas at San Antonio, TX, USA
| | - Antonio Martinez
- Department of Architecture, University of Texas at San Antonio, TX, USA
| | - Zayra Rico
- Department of Architecture, University of Texas at San Antonio, TX, USA
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McIntosh J, Marques B, Jenkin G. The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11414. [PMID: 36141687 PMCID: PMC9517498 DOI: 10.3390/ijerph191811414] [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: 07/28/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The role of courtyards and other outdoor spaces in the recovery of acute mental healthcare users has been gaining international appreciation and recognition. However, the physical properties and conditions necessary for therapeutic and rehabilitative engagement remain to be clearly established. This paper contributes to that knowledge by triangulating evidence from the literature, exemplar case studies of good practice and first-hand accounts of the experiences of staff and service users from four acute mental health facilities. The findings are then aligned with a well-established recovery framework (CHIMES) in light of existing landscape architecture knowledge. Within the complexity of varied mental health environments, this work establishes landscape architectural design requirements and qualities essential for recovery. Rather than adopting a prescriptive quantitative approach setting out areas, numbers of elements, etc., the proposed framework recommends a performance-based model and the creation of a cohesive network of microspaces that mesh into a design of outdoor areas. In this way, design details, materials, vegetation and the variety of spaces can be modified to suit service user population demographics and site-specific needs.
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Affiliation(s)
- Jacqueline McIntosh
- Wellington School of Architecture, Victoria University of Wellington, P.O. Box 600, Wellington 6140, New Zealand
| | - Bruno Marques
- Wellington School of Architecture, Victoria University of Wellington, P.O. Box 600, Wellington 6140, New Zealand
| | - Gabrielle Jenkin
- Department of Psychological Medicine, University of Otago, Wellington 23a Mein St., Wellington 6021, New Zealand
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Engaging U.S. Adults with Serious Mental Illness in Participatory Design Research Exercises. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116743. [PMID: 35682321 PMCID: PMC9180822 DOI: 10.3390/ijerph19116743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Clubhouses are non-clinical, community-based centers for adult members with serious mental illness. The evidence-based model assists adults with identifying employment, housing, education, and social opportunities; wellness and health-promoting activities; reducing hospitalizations and criminal justice system involvement; and improving social relationships, satisfaction, and quality of life. The model enables member participation in all Clubhouse operations, yet offers little guidance concerning facility design and member engagement in the design process. This case study explored the use of participatory design research exercises to (1) document member needs, preferences, and priorities to inform the design of a new midwestern U.S. Clubhouse facility and (2) meaningfully engage members (n = 16) in the design process. Four participatory design research exercises were developed, administered, and analyzed. Results revealed aesthetics and ambience; safety and security; ease of use and maintenance; adaptability, flexibility, and accessibility; and transportation as future priorities. Space and furnishing needs and priorities were also identified. Informal observations and participant feedback suggested that the participatory exercises meaningfully engaged members in a manner aligned with Clubhouse Model principles by centering member dignity, strengths, and work-oriented expectations. Future directions for research on Clubhouse design and member engagement in the design process are also discussed.
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Sturge J, Starrenburg F. The Reorganization of a Psychiatric Unit During COVID-19: A Reflection for Psychiatric Hospital Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:354-368. [PMID: 35549742 PMCID: PMC9520130 DOI: 10.1177/19375867221098982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has impacted healthcare systems worldwide. Although this disease has primarily impacted general medicine intensive care units, other areas of healthcare including psychiatry were modified in response to corona measures to decrease the transmission of the disease. Reflecting on the modifications to the environment provides an opportunity to design psychiatric environments for future pandemics or other demands for healthcare. BACKGROUND The therapeutic environment of psychiatric wards was modified in Friesland, the Netherlands, in response to COVID-19. During this time, an interdisciplinary team met consistently to contribute to the preliminary design of a new psychiatric hospital. METHODS During the first 18 months of the pandemic, clinical reflections were made to describe the impact of COVID-19 on the psychiatric care environment. Architects have created a preliminary design of a new psychiatric hospital based on these reflections, monthly collaborative design discussions based on virtual mock-ups and evidence-based design based on theoretical concepts and research. RESULTS AND CONCLUSIONS This theoretical and reflective study describes how an inpatient psychiatric environment was restructured to manage infection during COVID-19. The therapeutic environment of the psychiatric ward and patient care changed drastically during COVID-19. The number of patients accessing care decreased, patient autonomy was restricted, and the function of designated behavioral support spaces changed to manage the risk of infection. However, these challenging times have provided an opportunity to reflect on theories and consider the design of new hospital environments that can be adapted in response to future pandemics or be restructured for different care functions.
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Affiliation(s)
- Jodi Sturge
- Adema Architecten, Groningen, the Netherlands.,Population Research Centre, University of Groningen, the Netherlands
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Oeljeklaus L, Schmid HL, Kornfeld Z, Hornberg C, Norra C, Zerbe S, McCall T. Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031490. [PMID: 35162518 PMCID: PMC8835684 DOI: 10.3390/ijerph19031490] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023]
Abstract
The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.
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Affiliation(s)
- Lydia Oeljeklaus
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Hannah-Lea Schmid
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
| | - Zachary Kornfeld
- LWL-Hospital Paderborn, Psychiatry Psychotherapy Psychosomatic, 33098 Paderborn, Germany; (Z.K.); (C.N.)
- Medical Faculty, Ruhr University Bochum, 44801 Bochum, Germany
| | - Claudia Hornberg
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
| | - Christine Norra
- LWL-Hospital Paderborn, Psychiatry Psychotherapy Psychosomatic, 33098 Paderborn, Germany; (Z.K.); (C.N.)
- Medical Faculty, Ruhr University Bochum, 44801 Bochum, Germany
| | - Stefan Zerbe
- Faculty of Science and Technology, Free University of Bozen-Bolzano, 39100 Bolzano, Italy;
| | - Timothy McCall
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
- Correspondence: ; Tel.: +49-521-106-67898
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Weber C, Monero Flores V, Wheele TP, Miedema E, White EV. Patients' Health & Well-Being in Inpatient Mental Health-Care Facilities: A Systematic Review. Front Psychiatry 2022; 12:758039. [PMID: 35046849 PMCID: PMC8761847 DOI: 10.3389/fpsyt.2021.758039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Previous research indicates that the physical environment of healthcare facilities plays an important role in the health, well-being, and recovery outcomes of patients. However, prior works on mental healthcare facilities have incorporated physical environment effects from general healthcare settings and patient groups, which cannot be readily transferred to mental healthcare settings or its patients. There appears to be a specific need for evidence synthesis of physical environmental effects in mental healthcare settings by psychopathology. Purpose: This review evaluates the state (in terms of extent, nature and quality) of the current empirical evidence of physical environmental on mental health, well-being, and recovery outcomes in mental healthcare inpatients by psychopathology. Method: A systematic review (PRISMA guidelines) was performed of studies published in English, German, Dutch, Swedish, and Spanish, of all available years until September 2020, searched in Cochrane, Ovid Index, PsycINFO, PubMed, and Web of Science and identified through extensive hand-picking. Inclusion criteria were: Adult patients being treated for mental ill-health (common mental health and mood disorders, Cochrane frame); inpatient mental health care facilities; specifications of the physical and socio-physical environment (e.g., design features, ambient conditions, privacy); all types of empirical study designs. Quality assessment and data synthesis were undertaken. Results: The search retrieved 1,068 titles of which 26 met the inclusion criteria. Findings suggest that there is only indicative evidence of the impact of the physical healthcare environment on patients' mental health, well-being, and recovery outcomes. There is significant lack of pathology-specific evidence. Methodological shortcomings and empirical scarcity account for the poor evidence. Conclusion: This review highlights the need for more research using advanced study designs.
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Affiliation(s)
- Clara Weber
- Institute of Facility Management, Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
- Environmental Psychology Department, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Virna Monero Flores
- Institute of Facility Management, Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Theresa Poppy Wheele
- Institute of Facility Management, Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Elke Miedema
- Architectural Theory and Methods, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Emma Victoria White
- Environmental Psychology Department, School of Psychology, University of Surrey, Guildford, United Kingdom
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Cutler NA, Halcomb E, Sim J, Stephens M, Moxham L. How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study. J Clin Nurs 2021; 30:765-772. [PMID: 33348440 DOI: 10.1111/jocn.15614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety. BACKGROUND Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting. DESIGN The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist. METHODS Fifteen people who had experienced admission to an acute mental health unit were individually interviewed. RESULTS Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe. CONCLUSIONS Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery. RELEVANCE TO CLINICAL PRACTICE Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.
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Affiliation(s)
- Natalie Ann Cutler
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Moira Stephens
- Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
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Liddicoat S, Badcock P, Killackey E. Principles for designing the built environment of mental health services. Lancet Psychiatry 2020; 7:915-920. [PMID: 32171432 DOI: 10.1016/s2215-0366(20)30038-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users' experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. In this Personal View, we argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels.
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Affiliation(s)
- Stephanie Liddicoat
- School of Design, Faculty of Health, Arts and Design, Swinburne University, Melbourne, VIC, Australia.
| | - Paul Badcock
- Centre of Youth Mental Health, The University of Melbourne, Orygen, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre of Youth Mental Health, The University of Melbourne, Orygen, Melbourne, VIC, Australia
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Physical environments that support the mental health of staff and families in the NICU. J Perinatol 2020; 40:16-21. [PMID: 32859960 DOI: 10.1038/s41372-020-0750-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The number of individuals suffering from mental and behavioral health disorders and the lack of access to treatment and appropriate facilities for these individuals are among the most pressing issues of our time. The purpose of this study is to describe the psychological challenges of staff and families in a neonatal intensive care unit (NICU), apply the outcomes of a study on mental health environments to the NICU setting, and make recommendations for the design of NICUs in support of mental health therapy and care. MATERIALS AND METHODS This study involved the translation of a previous study in mental and behavioral health facilities to the NICU setting. The original study involved interviews (N = 19) and online surveys (N = 134) investigating the importance and presence of particular environmental amenities intended to support mental and behavioral health settings. Data analyzed using Mann-Whitney U tests suggested that the "importance" scores of specific environmental qualities and features were significantly higher than the "effectiveness" scores. An analysis using the Dunn-Bonferroni correction revealed that some environmental qualities and features were rated as significantly more important or more effective than others. For the purposes of this paper, the variables were reexamined for applicability to NICU settings. RESULT Twenty of the original 26 design goals for mental health units were applicable to NICUs. These goals and how they might be implemented are summarized. DISCUSSION Guidelines identified as being important in therapeutic environments can be applied to NICU settings.
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Liddicoat S. The Therapeutic Waiting Room: Therapist and Service User Perspectives on the Psychologically Supportive Dimensions of Architectural Space. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:103-118. [PMID: 32054326 DOI: 10.1177/1937586720904805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Waiting areas in healthcare settings play an important role in reassuring or potentially further distressing service users. The effects of the designed environment on mental health service users specifically are regarded by health professionals as having a considerable influence on treatment outcomes, experiences, and perceptions of care. PURPOSE The purpose of this article is to explore service user and practicing therapist perspectives of waiting areas in mental health service settings and how the design of these spaces affects anxiety levels, comfort, therapeutic relationships, outcomes, and perceptions of care. METHODS The methodology for this exploratory phenomenological study was developed in order to preserve the integrity of participant voices in the essences of experiences, during explorations of their encounters with therapeutic waiting areas. Fieldwork undertaken by the author involved a series of focused in-depth interviews with service users of mental health services and practicing therapists, counselors, and psychologists. RESULTS Key themes identified through data analysis include (1) space acting as symbolism, (2) interpersonal relations which are threatening, and (3) sensory modulation. Design implications in relation to each theme are presented. CONCLUSIONS This study uncovered a set of findings in relation to symbolic content inferred by spatial design aspects and the ways in which design can afford, or mitigate, development of interpersonal agencies, psychological safety, and negative stigmas. Future transdisciplinary research directions are suggested, including (1) examination of other relationships, beyond the service user-therapist dyad, which may influence waiting area experiences and (2) examination of the applicability of design suggestions to different contexts.
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Affiliation(s)
- Stephanie Liddicoat
- Faculty of Architecture, Building and Planning, The University of Melbourne, Victoria, Australia
- School of Design, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Victoria, Australia
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Sachs NA, Shepley MM, Peditto K, Hankinson MT, Smith K, Giebink B, Thompson T. Evaluation of a Mental and Behavioral Health Patient Room Mockup at a VA Facility. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 13:46-67. [PMID: 31304785 DOI: 10.1177/1937586719856349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The primary goal of this research was to evaluate a physical full-scale, high-fidelity mockup of a mental and behavioral health (MBH) inpatient room and bathroom. BACKGROUND There is minimal research on design for MBH and no published research using mockups to evaluate a MBH design proposal. To address this gap, an interdisciplinary team developed an ideal Patient-Centered MBH Patient Room, which was built as a mockup at a Veterans Administration (VA) facility and evaluated by patients and staff in situ. METHOD The mock-up was evaluated using a structured mixed methods process that incorporates feedback using Feedback Forms and facilitated Listening Sessions. Our two primary hypotheses were that the design, as represented by the mock-up, would be positively evaluated and that there would be a difference between staff and patient perceptions, with patients rating the design higher than staff. RESULTS Quantitative analysis confirmed our hypotheses, revealing an overall positive response, with a difference between patients and staff. Contrary to hypothesis, staff consistently rated the design higher than patients. Qualitative analysis found mixed reception of the design and three primary themes: safety, homeyness/deinstitutionalization, and positive distraction/nature. CONCLUSIONS Physical mock-ups may be an effective tool for evaluation of a proposed design; however, staff perceptions of the environment may differ from those of patients. One drawback of using a physical high-fidelity mock-up is the expectation that the mock-up perfectly represents the proposed design. With this project, even small unfinished details were distracting to the participants and may have negatively affected the evaluation.
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Affiliation(s)
- Naomi A Sachs
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA.,Department of Plant Science and Landscape Architecture, University of Maryland, College Park, MD, USA
| | - Mardelle M Shepley
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Kati Peditto
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Mary Therese Hankinson
- Office of Patient Centered Care & Veteran Experience, VA New Jersey Health Care System, Lyons, NJ, USA
| | | | | | - Tammy Thompson
- Institute for Patient-Centered Design, Inc., Mt. Pleasant, SC, USA
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Liddicoat S. Designing a supportive emergency department environment for people with self harm and suicidal ideation: A scoping review. Australas Emerg Care 2019; 22:139-148. [PMID: 31129061 DOI: 10.1016/j.auec.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with self harm and suicidal ideation are increasingly presenting emergency departments, resulting in significant economic impacts, increasing pressure on triage processes, and often poor outcomes and experiences. The emerging field of evidence-based design seeks to improve healthcare outcomes through considered design of the built environments delivering healthcare services. METHODS This scoping review aimed to (1) identify the current body of literature which examined the design of emergency departments for people with self harm and suicidal ideation, and (2) identify the ways in which the built environment could increase the efficacy of therapeutic efforts through improving service user outcomes and experiences. RESULTS Design strategies from the literature are collated and discussed. This review also developed a thematic network of key themes in the literature, to guide future evidence-based design researchers addressing the design of the built environment with the provision of care for people with self harm and suicidal ideation specifically in emergency departments. CONCLUSIONS Future research directions, limitations of the field and potential methodologies to address these limitations are presented, including clear definition of participant groups and settings, co-design processes engaging the service user voice alongside other stakeholders, and collaborative interdisciplinary research partnerships.
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Affiliation(s)
- S Liddicoat
- School of Design, Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, Melbourne, Victoria 3122, Australia.
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Friesinger JG, Topor A, Bøe TD, Larsen IB. Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review. Health Place 2019; 57:44-53. [PMID: 30959400 DOI: 10.1016/j.healthplace.2019.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.
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Affiliation(s)
| | - Alain Topor
- University of Agder, Department of Psychosocial Health, Grimstad, Norway; Stockholm University, Department of Social Work, Stockholm, Sweden
| | - Tore Dag Bøe
- University of Agder, Department of Psychosocial Health, Grimstad, Norway
| | - Inger Beate Larsen
- University of Agder, Department of Psychosocial Health, Grimstad, Norway
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True G, Frasso R, Cullen SW, Hermann RC, Marcus SC. Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors. Gen Hosp Psychiatry 2017; 48:65-71. [PMID: 28843113 PMCID: PMC5605148 DOI: 10.1016/j.genhosppsych.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness. METHODS Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts. RESULTS Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur included: promoting a culture of safety; advocating for patient-centeredness; and engaging administrators and organizational leadership to champion these changes. CONCLUSIONS Findings highlight the impact of systems-level policies and procedures on safety in inpatient mental health care. Engaging all stakeholders, including patients, in patient safety efforts and establishing a culture of safety will help improve the quality of inpatient psychiatric care. Successful implementation of changes require the knowledge of local experts most closely involved in patient care, as well as support and buy-in from organizational leadership.
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Affiliation(s)
- Gala True
- Department of Veterans Affairs, South Central Mental Illness Research Education and Clinical Center, New Orleans, LA, United States.
| | - Rosemary Frasso
- School of Population Health, Jefferson University, Philadelphia, PA, United States
| | - Sara W Cullen
- School of Social Practice & Policy, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Steven C Marcus
- School of Social Practice & Policy, University of Pennsylvania, Philadelphia, PA, United States
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Haines A, Brown A, McCabe R, Rogerson M, Whittington R. Factors impacting perceived safety among staff working on mental health wards. BJPsych Open 2017; 3:204-211. [PMID: 28904814 PMCID: PMC5584653 DOI: 10.1192/bjpo.bp.117.005280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/06/2017] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Safety at work is a core issue for mental health staff working on in-patient units. At present, there is a limited theoretical base regarding which factors may affect staff perceptions of safety. AIMS This study attempted to identify which factors affect perceived staff safety working on in-patient mental health wards. METHOD A cross-sectional design was employed across 101 forensic and non-forensic mental health wards, over seven National Health Service trusts nationally. Measures included an online staff survey, Ward Features Checklist and recorded incident data. Data were analysed using categorical principal components analysis and ordinal regression. RESULTS Perceptions of staff safety were increased by ward brightness, higher number of patient beds, lower staff to patient ratios, less dayroom space and more urban views. CONCLUSIONS The findings from this study do not represent common-sense assumptions. Results are discussed in the context of the literature and may have implications for current initiatives aimed at managing in-patient violence and aggression. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license.
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Affiliation(s)
- Alina Haines
- , PhD, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Andrew Brown
- , MSc, Forensic Personality and Autism Spectrum Disorder Assessment and Liaison Team, Mersey Care NHS Foundation Trust, Rainhill, UK
| | - Rhiannah McCabe
- , MSc, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Michelle Rogerson
- , PhD, Applied Criminology Centre, University of Huddersfield, Huddersfield, UK
| | - Richard Whittington
- , PhD, Department of Health Services Research, University of Liverpool, Liverpool, UK
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