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Kaisler RE, Fede M, Diltsch U, Probst T, Schaffler Y. Common mental disorders in Gestalt therapy treatment: a multiple case study comparing patients with moderate and low integrated personality structures. Front Psychol 2023; 14:1304726. [PMID: 38173855 PMCID: PMC10761483 DOI: 10.3389/fpsyg.2023.1304726] [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: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Empowerment is central to self-development and growth in Gestalt therapy. The self evolves through interactions with others, forming self- and object-relations, and ego-functions. Underlying structural functions build the ability to regulate, differentiate, and integrate experiences, leading to self-, and emotion-regulation. Our study examined the self-development of seven clients with prevalent mental health issues and structural challenges, all of whom underwent 30 sessions of Gestalt therapy in a real-world individual therapy context. Methods Using a multiple case study approach, we contrasted two client groups: those with moderately integrated and those with low-integrated personality structures, as defined by the operationalised psychodynamic diagnostic manual. Our exploration centered on specific factors of empowerment, therapy processes, and interventions. The study's mixed-method design encompassed quantitative outcome measures (empowerment, wellbeing, psychosocial health, and severity of personality functioning), therapy diaries from both clients and therapists, and semi-structured client interviews about empowering factors in therapy. Results Both groups showed positive therapy outcomes on wellbeing, psychosocial health, and empowerment. Specific empowerment-related factors included promoting experiences, relationships, and self-efficacy in the low-integrated group. Support of self-regulation was reported to be essential for successful outcomes in the moderately integrated group. While the therapy processes proceeded similarly in both groups, we observed a strong focus on body awareness-oriented interventions and promotion of verbalisation in the low-integrated group and a relationship-oriented emphasis in the moderately integrated group. Emotional experience linked to positive experience was limited in the low-integrated group, suggesting an impairment of emotional processing, including bodily felt feelings. No change was reported in the level of personality functioning after 30 sessions in both groups. Discussion These results underscore the need for tailored therapeutic approaches based on the client's level of personality integration. Future research should probe the long-term effects of therapy and delve deeper into shifts in personality functioning, especially concerning emotional and bodily experiences. In practical terms, therapists should prioritize linking bodily sensations with emotions for clients with low-integrated personalities. For those with moderate integration, the emphasis should be on fostering exploration, awareness, and bolstering self-regulation.
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Affiliation(s)
- Raphaela E. Kaisler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
- Department Psychotherapy, Bertha von Suttner Private University St. Pölten, St. Pölten, Austria
| | - Manfred Fede
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Ulla Diltsch
- Integrative Gestalttherapie, Österreichischer Arbeitskreis für Gruppentherapie und Gruppendynamik, Vienna, Austria
| | - Thomas Probst
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
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Young MM, Byrd CT, Gabel R, White AZ. Self-Disclosure Experiences of Adults Who Stutter: An Interpretative Phenomenological Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2045-2060. [PMID: 35985338 DOI: 10.1044/2022_ajslp-22-00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Self-disclosure describes the act of revealing personal information to another person. To date, researchers in the area of stuttering have primarily demonstrated the utility of self-disclosure through analysis of listener perceptions. This study explores the utility of informative self-disclosure use from the perspectives of adults who stutter with experience using this strategy over time and across contexts. METHOD Twelve adults who stutter discussed their self-disclosure experiences in semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis to produce themes reflecting the most salient aspects of self-disclosure experiences. Credibility was achieved through bracketing, investigator triangulation, and member checking. RESULTS Four superordinate themes reflecting experiences shared by all 12 participants were generated. Each superordinate theme contained two to three corresponding subthemes. The superordinate themes included cognitive relief, self-empowerment, social connection, and personalization. These findings reflect the positive impact of informative self-disclosure use on communication and quality of life. CONCLUSIONS Adults who stutter perceive informative self-disclosure to be an effective strategy that provides various benefits to the speaker, in addition to facilitating positive listener perceptions. Clinicians should encourage clients to self-disclose in an informative and personalized manner, provide opportunities for practice, and support clients in determining when and where it is most beneficial for them to implement this strategy.
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Affiliation(s)
- Megan M Young
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Courtney T Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Rodney Gabel
- Division of Speech and Language Pathology, Binghamton University, NY
| | - Andrew Z White
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Hawgood J, Gibson M, McGrath M, Riley J, Mok K. Preliminary Evaluation of Lived Experience of Suicide Training: Short-, Medium- and Longer-Term Impacts of Our Voices in Action Training. Community Ment Health J 2022; 58:875-886. [PMID: 34561833 DOI: 10.1007/s10597-021-00894-7] [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: 06/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Despite increased participation and multiple workforce roles of those with lived experience in suicide prevention, there are no evaluated training programs to support this population. This study evaluated a training program aimed to prepare people for these important roles. Survey data at pre-, post- and at three- and 12-month follow-up were used measuring knowledge, attitudes, and self-efficacy, as well as psychological distress as a safety measure. Participants experienced significant gains in knowledge after training, although not all aspects of knowledge were maintained at follow-up. Self-efficacy was examined through confidence and empowerment. Confidence gains were significant at immediate and longer-term follow-up but gains in empowerment were not maintained over time. Participants' positive attitudes improved but this was not significant. There was no indication of increases in psychological distress in participants throughout the training and follow-up periods. Implications of these outcomes are discussed.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mt Gravatt Campus, Mount Gravatt, Brisbane, QLD, 4122, Australia.
| | - Mandy Gibson
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mt Gravatt Campus, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Martina McGrath
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mt Gravatt Campus, Mount Gravatt, Brisbane, QLD, 4122, Australia.,Roses in the Ocean, Brisbane, Australia
| | - Jo Riley
- Black Dog Institute, Sydney, Australia
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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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Tjaden CD, Mulder CL, Delespaul PA, Arntz AR, Kroon H. Attachment as a framework to facilitate empowerment for people with severe mental illness. Psychol Psychother 2021; 94:407-425. [PMID: 33124185 PMCID: PMC8451854 DOI: 10.1111/papt.12316] [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: 12/24/2019] [Revised: 08/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact. DESIGN We used a cross-sectional design. METHODS In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed. RESULTS Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not. CONCLUSIONS Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI. PRACTITIONER POINTS Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of 'standing alongside' and offering support may be important requisites for empowerment.
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Affiliation(s)
- Cathelijn D. Tjaden
- Department of Reintegration and Community CareTrimbos InstituteUtrechtThe Netherlands,Department of Social and Behavioral SciencesTranzo Scientific Center for Care and WelfareTilburg UniversityThe Netherlands
| | - Cornelis L. Mulder
- Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands,AntesParnassia Psychiatric InstituteRotterdamThe Netherlands
| | - Philippe A.E.G. Delespaul
- School of Mental Health and NeuroSciencesMaastricht UniversityThe Netherlands,Mondriaan Mental Health TrustMaastricht/HeerlenThe Netherlands
| | - Arnoud R. Arntz
- Department of Clinical PsychologyUniversity of AmsterdamThe Netherlands
| | - Hans Kroon
- Department of Reintegration and Community CareTrimbos InstituteUtrechtThe Netherlands,Department of Social and Behavioral SciencesTranzo Scientific Center for Care and WelfareTilburg UniversityThe Netherlands
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Langlois S, Pauselli L, Anderson S, Ashekun O, Ellis S, Graves J, Zern A, Gaffney E, Shim RS, Compton MT. Effects of perceived social status and discrimination on hope and empowerment among individuals with serious mental illnesses. Psychiatry Res 2020; 286:112855. [PMID: 32092596 PMCID: PMC7775621 DOI: 10.1016/j.psychres.2020.112855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Hope and empowerment are key elements of recovery in the context of serious mental illnesses (SMI). We examined predictors of hope among individuals with SMI and tested a hypothesized path model in which perceived social status and perceived discrimination adversely impact hope, directly and through their impacts on depressive symptoms. Data from 232 individuals with SMI receiving care in public-sector settings were used in both a multiple linear regression (predicting Herth Hope Scale scores), and in path analyses examining both direct and indirect effects of perceived social status (Social Status Ladder) and perceived discrimination (Everyday Discrimination Scale). Depressive symptoms, perceived social status, and perceived discrimination were predictive of hope. Path analyses revealed that perceived social status has a direct effect on hope and empowerment but also impacts hope through its effects on depression. Similarly, perceived everyday discrimination affects hope and empowerment, though this effect is mediated through its effects on depression. Two alternative models and a trimmed hypothesized model did not fit the data or improve fit. These social determinants of mental health should provoke program and policy change to improve mental health and enhance recovery among persons with SMI.
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Affiliation(s)
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, St. Luke's/West Hospital Center, Department of Psychiatry, 1 Gustave L. Levy Place, New York, NY, USA
| | - Simone Anderson
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | | | - Samantha Ellis
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - JaShala Graves
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168(th) Street, New York, NY, USA
| | - Ebony Gaffney
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - Ruth S Shim
- University of California, Davis, Department of Psychiatry and Behavioral Sciences, 2230 Stockton Blvd, Sacramento, CA, USA
| | - Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168(th) Street, New York, NY, USA.
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Easter MM, Swanson JW, Robertson AG, Moser LL, Swartz MS. Impact of psychiatric advance directive facilitation on mental health consumers: empowerment, treatment attitudes and the role of peer support specialists. J Ment Health 2020; 30:585-593. [PMID: 32013647 DOI: 10.1080/09638237.2020.1714008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND A psychiatric advance directive (PAD) is designed to prevent involuntary mental health interventions by enabling people with serious mental illnesses to plan ahead for their own treatment during a future incapacitating crisis. This study implemented PAD facilitation in assertive community treatment (ACT) teams. AIMS We examined ACT clients' attitudes toward PAD facilitators, satisfaction with PAD facilitation, the short-term impact of PAD completion on subjective sense of empowerment and attitudes toward treatment, and whether the type of PAD facilitator made a difference. METHODS Participants were randomly assigned to be offered PAD facilitation by a peer support specialist or non-peer ACT team clinician, and interviewed at baseline (n = 145) and post-facilitation 1-2-month follow-up (n = 116), to assess perceived consumer-directedness of PAD facilitation, empowerment and various treatment attitudes. Mean scores before and after the intervention were compared for PAD-completers, non-completers, and those who completed a PAD with a peer vs. non-peer. The effect of PAD completion was assessed using logistic and linear regression analysis. RESULTS There was no evidence of bias against peer-facilitators. There was a modest positive impact of PAD facilitation on treatment attitudes and empowerment. CONCLUSIONS PAD facilitation by peer support specialists and others working in community mental health settings supports recovery.
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Affiliation(s)
- Michele M Easter
- Department of Psychiatry and Behavioral Sciences, Services Effectiveness Research Program, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey W Swanson
- Department of Psychiatry and Behavioral Sciences, Services Effectiveness Research Program, Duke University School of Medicine, Durham, NC, USA
| | - Allison G Robertson
- Department of Psychiatry and Behavioral Sciences, Services Effectiveness Research Program, Duke University School of Medicine, Durham, NC, USA
| | - Lorna L Moser
- Department of Psychiatry, Center for Excellence in Community Mental Health, UNC School of Medicine, Chapel Hill, NC, USA
| | - Marvin S Swartz
- Department of Psychiatry and Behavioral Sciences, Services Effectiveness Research Program, Duke University School of Medicine, Durham, NC, USA
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Boggian I, Lamonaca D, Ghisi M, Bottesi G, Svettini A, Basso L, Bernardelli K, Merlin S, Liberman RP. "The Italian Study on Recovery 2" Phase 1: Psychometric Properties of the Recovery Assessment Scale (RAS), Italian Validation of the Recovery Assessment Scale. Front Psychiatry 2020; 10:1000. [PMID: 32119004 PMCID: PMC7013090 DOI: 10.3389/fpsyt.2019.01000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The achievement of recovery is related to the notion of developing personal potential and restoring a legitimate social role, even against the backdrop of mental illness limitations. It is still difficult to fully understand this highly subjective and dynamic process. Therefore, in order to test the recovery process, specific tools, still only marginally used in our country, are needed. AIMS The Italian Study on Recovery is the first study aimed at confirming the validity of the Italian version of the Recovery Assessment Scale (RAS), an instrument developed with the goal of detecting recovery among patients. METHOD This multicentric research involved several Mental Health Services from various parts of Italy. The first phase of the study consisted in the administration of the Italian translation of RAS, previously used in a pilot study conducted in 2009. RAS was administered to 219 patients diagnosed with psychosis, whose mental disorder lasted for at least 5 years. RESULTS Findings supported the good psychometric properties of the Italian version of RAS, demonstrating its capability of identifying patients matching the "in recovery" operational criteria. CONCLUSIONS In consideration of the results highlighting the good psychometric properties of RAS, the present study may contribute to the diffusion of instruments to be included in Mental Health Service planning in the Italian context, in order to start a recovery-oriented transformation.
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Affiliation(s)
- Ileana Boggian
- Center for Mental Health, Psychiatry 3, AULSS 9 Scaligera, Verona, Italy
| | - Dario Lamonaca
- Center for Mental Health, Psychiatry 3, AULSS 9 Scaligera, Verona, Italy
| | - Marta Ghisi
- Department of Psychology, University of Padua, Padua, Italy
| | - Gioia Bottesi
- Department of Psychology, University of Padua, Padua, Italy
| | | | - Luigi Basso
- Psychiatric Service, Health Trust of Bolzano, Bolzano, Italy
| | - Katia Bernardelli
- Center for Mental Health, Psychiatry 3, AULSS 9 Scaligera, Verona, Italy
| | - Silvia Merlin
- Center for Mental Health, Psychiatry 3, AULSS 9 Scaligera, Verona, Italy
| | - Robert Paul Liberman
- UCLA Psych REHAB program, University of California, Los Angeles, Los Angeles, CA, United States
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Palmer VJ, Weavell W, Callander R, Piper D, Richard L, Maher L, Boyd H, Herrman H, Furler J, Gunn J, Iedema R, Robert G. The Participatory Zeitgeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. MEDICAL HUMANITIES 2019; 45:247-257. [PMID: 29954854 PMCID: PMC6818522 DOI: 10.1136/medhum-2017-011398] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 05/23/2023]
Abstract
Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist-the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an 'explanatory theoretical model of change' that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities-narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. TRIAL REGISTRATION NUMBER: The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results).
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Affiliation(s)
- Victoria Jane Palmer
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wayne Weavell
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosemary Callander
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Donella Piper
- Business School, University of New England, Armidale, New South Wales, Australia
| | - Lauralie Richard
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of General Practice and Rural Health, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Lynne Maher
- Ko Awatea, Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Hilary Boyd
- Strategy, Participation and Improvement Group, Auckland District Health Board, Auckland, New Zealand
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Gunn
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rick Iedema
- Centre for Team Based Practice and Learning in Health Care, Health Schools, King's College London, London, UK
| | - Glenn Robert
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Khenti A, Bobbili SJ, Sapag JC. Evaluation of a Pilot Intervention to Reduce Mental Health and Addiction Stigma in Primary Care Settings. J Community Health 2019; 44:1204-1213. [DOI: 10.1007/s10900-019-00706-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Shih M, Wilton LS, Does S, Goodale BM, Sanchez DT. Multiple racial identities as sources of psychological resilience. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Scholz B, Roper C, Juntanamalaga P, Happell B. Understanding the Role of Allies in Systemic Consumer Empowerment: A Literature Review. Issues Ment Health Nurs 2019; 40:354-361. [PMID: 30742549 DOI: 10.1080/01612840.2018.1553004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Contemporary mental health policies call for the inclusion of consumers in the development, implementation and evaluation of mental health services. Barriers to systemic consumer engagement have been related to unequal distributions of power. One of the goals of the consumer movement is to address imbalances of power, resources and knowledge. Empowerment through consumer leadership in the mental health sector has been identified as a fundamental goal of the consumer movement and has been considered the philosophical basis for alternative models of mental health care. However, currently such systemic empowerment is poorly understood, assuming diverse and at times contradictory definitions within mental health literature. The role of allies as facilitators of systemic empowerment opportunities has been recognised and valued within numerous social movements. Currently, there is a lack of research in regards to the potential role of allies in the consumer movement and more specifically in systemic consumer empowerment. Future research should seek to more clearly define systemic consumer empowerment. Additionally, future research collaborations between consumer and ally perspectives should specifically investigate the role of allies in systemic consumer empowerment, to highlight potential opportunities and limitations.
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Affiliation(s)
- Brett Scholz
- a ANU Medical School , The Australian National University , Acton , Australia
| | - Cath Roper
- b Centre for Psychiatric Nursing , The University of Melbourne , Melbourne , Australia
| | | | - Brenda Happell
- d School of Nursing and Midwifery , The University of Newcastle , Newcastle , Australia
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Abstract
Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with operators. This research aims to analyze the effects of patient empowerment on patients’ value co-creation behaviors. An empirical survey was conducted on 250 patients with chronic diseases in Italy. The results, analyzed using the structural equation modeling, showed that their empowerment enhanced value co-creation behaviors. Patients apply their health competencies and resources in their co-creation of health service with operators. It is, therefore, important to empower patients in their transformation from passive to active stakeholders, working with providers for the most optimal health outcomes. This research provides practitioners with suggestions for patient involvement which utilizes their knowledge, capabilities and responsibility to improving healthcare services.
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Abstract
BACKGROUND While the neighborhood community literature well documents a link between participation in supportive and effective community groups or activities and empowerment, there is as yet little empirical evidence of this relationship in the context of community mental health programs. AIM The primary purpose of the study was to examine the relationship between sense of community belonging and empowerment among members of mental health clubhouses. METHODS A secondary analysis using a hierarchical regression model was conducted on cross-sectional structured interview data collected through a self-report questionnaire from 102 clubhouse members from six clubhouses in the United States and Finland. RESULTS The results indicated that members' sense of clubhouse community belonging positively contributes to their empowerment. CONCLUSION Fostering sense of community belonging appears to be a valid approach to catalyze empowerment. Study limitations and future research agendas were discussed.
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Affiliation(s)
- Kimiko Tanaka
- 1 Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- 1 Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, CT, USA
| | - Thomas J Craig
- 2 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Carrara BS, Ventura CAA. Self-stigma, mentally ill persons and health services: An integrative review of literature. Arch Psychiatr Nurs 2018; 32:317-324. [PMID: 29579531 DOI: 10.1016/j.apnu.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/26/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
Integrative review about self-stigma among people with mental illness and its relationship with health services. A total of 149 articles were found in four databases. After screening, 9 articles were selected for complete reading and data extraction. The studies identified that higher levels of self-stigma result in lower levels of adherence to treatment and that lower levels of self-stigma result in greater adherence to treatment. Active participation and engagement in the aspects of care facilitate the empowerment of people with mental illness for better adherence to treatment, reduction of self-stigma and increase of recovery possibilities.
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Affiliation(s)
- Bruna Sordi Carrara
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Brazil
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Sutton D, Bejerholm U, Eklund M. Empowerment, self and engagement in day center occupations: A longitudinal study among people with long-term mental illness. Scand J Occup Ther 2017; 26:69-78. [PMID: 29105535 DOI: 10.1080/11038128.2017.1397742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Day centers are a common form of mental health service internationally. They are aimed at enhancing occupational engagement and social relations, but there is a need to clarify the outcomes of day center programs, including the impact on important aspects of recovery such as empowerment. AIMS The aim of this study was to explore whether perceived empowerment changed over time among Swedish day center users and whether self-esteem, quality of life, socio-demographic data and self-reported diagnosis, type of program and level of engagement in day center occupations could predict future empowerment. METHOD The study involved a re-analysis of longitudinal data from 14 day centers, where measures of perceived empowerment and other individual factors were collected over a 15-month period. Non-parametric statistics were used, including Wilcoxon's signed-rank test and logistic regression analysis. RESULTS There were no significant changes in day center attendee empowerment scores. Self-esteem and level of engagement in day center occupations were found to be predictors of empowerment, together explaining 34% of the variation. CONCLUSIONS Developing empowerment in the day center context involves a complex interaction of individual, social and material factors. Potential barriers to empowerment are discussed along with considerations related to measuring empowerment as an outcome of day center programs.
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Affiliation(s)
- Daniel Sutton
- a Department of Occupational Science and Therapy , Auckland University of Technology , Auckland , New Zealand
| | - Ulrika Bejerholm
- b Department of Health Sciences/Work and Mental Health , Lund University , Lund , Sweden
| | - Mona Eklund
- c Department of Health Sciences/Occupational Science and Occupational Therapy , Lund University , Lund , Sweden
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17
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Zhu X, Smith RA, Parrott RL. Living with a Rare Health Condition: The Influence of a Support Community and Public Stigma on Communication, Stress, and Available Support. JOURNAL OF APPLIED COMMUNICATION RESEARCH : JACR 2017; 45:179-198. [PMID: 29398734 PMCID: PMC5793934 DOI: 10.1080/00909882.2017.1288292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
People affected by rare diseases often have limited coping resources and sometimes face stigma. They build communities with others who share their conditions, but not all members may benefit from these communities. This study investigated how adults with a rare genetic health condition (Alpha-1 antitrypsin deficiency; AATD) think about both the Alpha-1 community and public stigma about AATD, and how these cognitions were associated with their communication responses and well-being. The results showed that people with AATD encountered stigmatization from various sources, including family, employers, healthcare providers, and insurance companies. Stronger public stigma predicted more secrecy, more stress, and less available support. Stronger group identification with the Alpha-1 community predicted less secrecy; stronger group activism predicted more available support and more communication to challenge stigmatizers. Post-hoc analyses showed significant interactions between public stigma and group cognitions on communication to challenge stigmatizers. Practical implications for bolstering communities to improve the well-being of people with rare diseases were discussed.
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Affiliation(s)
- Xun Zhu
- Communication Arts & Sciences, Pennsylvania State University, 316 Sparks Building, University Park, PA 16802
| | - Rachel A Smith
- Communication Arts & Sciences, Pennsylvania State University, 216 Sparks Building, University Park, PA 16802, (814) 865-4201
| | - Roxanne L Parrott
- Communication Arts & Sciences and Health Policy & Administration, Pennsylvania State University
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18
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Boevink W, Kroon H, Delespaul P, Os JV. Empowerment according to Persons with Severe Mental Illness: Development of the Netherlands Empowerment List and Its Psychometric Properties. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojpsych.2017.71002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Sharma R, Wigginton B, Meurk C, Ford P, Gartner CE. Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:ijerph14010007. [PMID: 28025516 PMCID: PMC5295258 DOI: 10.3390/ijerph14010007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/27/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.
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Affiliation(s)
- Ratika Sharma
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Britta Wigginton
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Carla Meurk
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD 4018, Australia.
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia.
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
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Chiauzzi E, DasMahapatra P, Cochin E, Bunce M, Khoury R, Dave P. Factors in Patient Empowerment: A Survey of an Online Patient Research Network. THE PATIENT 2016; 9:511-523. [PMID: 27155887 PMCID: PMC5107186 DOI: 10.1007/s40271-016-0171-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Providers and healthcare organizations have begun recognizing the importance of patient empowerment as a driver of patient-centered care. Unfortunately, most studies have investigated empowerment with single diseases. Identifying factors of empowerment across conditions and populations would enable a greater understanding of this construct. OBJECTIVE The purpose of this study was to understand empowerment in relation to health information-seeking, interactions with providers and peers, and healthcare access in chronic disease patients. This study also sought to identify key empowerment factors and their association with patient characteristics. METHODS Participants were recruited through PatientsLikeMe, an online research platform where patients share their personal and medical history data. Patients completed an online survey that assessed self-reported health behavior (e.g. knowledge-seeking, experiences with healthcare providers, and peer interactions) and healthcare access. An exploratory factor analysis identified key empowerment domains. Domain level sum scores and sum of all domains (total score) were compared across patient characteristics and diseases. RESULTS Overall, 3988 participants were included in the study, with the majority actively involved in their healthcare, but many cited difficulties with matching their treatment goals with those of their physician (34 %) and spending sufficient time with the physician (36 %). Factor analysis identified two domains-Positive Patient-Provider Interaction, and Knowledge and Personal Control-that explained >60 % of the overall variance in the observed variables. Mean total empowerment scores for patients with a primary complaint of Parkinson's disease (61.8) and multiple sclerosis (60.3) were significantly greater than fibromyalgia (55.3) and chronic fatigue syndrome (54.8). Patients who were older, male, more educated, and insured also reported significantly greater levels of empowerment. CONCLUSIONS The two domains of empowerment identified in this study are consistent with previous studies, but the differences in empowerment levels across diseases suggest a need for further studies on disease-related attributes of empowerment. Future research should examine the pathways for empowerment, as well as the relationship between empowerment domains and clinical outcomes.
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Affiliation(s)
- Emil Chiauzzi
- PatientsLikeMe, Inc., 160 Second Street, Cambridge, MA 02142 USA
| | | | - Elisenda Cochin
- PatientsLikeMe, Inc., 160 Second Street, Cambridge, MA 02142 USA
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21
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Jorge-Monteiro MF, Ornelas JH. "What's Wrong with the Seed?" A Comparative Examination of an Empowering Community-Centered Approach to Recovery in Community Mental Health. Community Ment Health J 2016; 52:821-33. [PMID: 27072950 DOI: 10.1007/s10597-016-0004-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
Abstract
This cross-sectional group comparison aimed to examine whether personal empowerment, recovery and community integration were associated with the individual's participation in an empowering community-centered model of intervention. Ninety-three participants from an empowering community-centered community mental health organization were compared with a matched group of individuals from standard interventions of four equivalent organizations. Results showed that participants taking advantage of the empowering community-centered approach were more involved in high recovery-oriented programs; and attained higher levels of personal goals and hope, empowerment, and of community integration. An involvement in high recovery-oriented programs (supported employment or independent housing) revealed improved outcomes for the individual. In conclusion, the findings suggested a transformative impact of the empowering community-centered model both at the individual and the program level by altering the resource accessibility and social conditions for people who experience mental illness. The implications of findings for transforming community mental health practice are discussed in detail.
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Affiliation(s)
- Maria F Jorge-Monteiro
- ISPA - Instituto Universitário, Rua Jardim do Tabaco, No. 34, 1149-041, Lisbon, Portugal.
| | - José H Ornelas
- Department of Clinical and Health Psychology, ISPA - Instituto Universitário, Lisbon, Portugal
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Tanabe Y, Hayashi K, Ideno Y. The Internalized Stigma of Mental Illness (ISMI) scale: validation of the Japanese version. BMC Psychiatry 2016; 16:116. [PMID: 27129370 PMCID: PMC4850681 DOI: 10.1186/s12888-016-0825-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/22/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The present study investigated the reliability and validity of a Japanese version of the Internalized Stigma of Mental Illness (ISMI) scale, designed to assess internalized stigma experienced by people with mental illness. METHODS A survey was conducted with 173 outpatients with mental illness who attended psychiatric clinics on a regular basis. A retest was conducted with 51 participants to evaluate the scale's psychometric properties. RESULTS The alpha coefficient for the overall internal consistency was 0.91, and the coefficients of the individual ISMI subscales ranged from 0.57 to 0.81. The test-retest reliability was r = 0.85 (n = 51, P < 0.01). In terms of criterion-related validity, the Japanese version of the ISMI scale was significantly correlated with the Beck Depression Inventory (r = 0.61, P < 0.01), the Rosenberg Self-Esteem Scale (r = -0.53, P < 0.01), and the Empowerment Scale (r = -0.52, P < 0.01). In addition, factor analyses of the ISMI items demonstrated a four-factor solution for the alienation, stereotype endorsement, discrimination experience, and social withdrawal subscales, with the stigma resistance items excluded. CONCLUSIONS The Japanese version of the ISMI scale demonstrated similar reliability and validity to the original English version. Therefore, the Japanese version of the ISMI scale may be an effective and valid tool to measure internalized stigma among Japanese people who have a mental illness.
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Affiliation(s)
- Yosuke Tanabe
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, 371-8514, Japan. .,Department of Nursing, Takasaki University of Health and Welfare, Takasaki, Gunma, 370-0033, Japan.
| | - Kunihiko Hayashi
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma 371-8514 Japan
| | - Yuki Ideno
- Center for Medical Education, Gunma University, Maebashi, Gunma 371-8511 Japan
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23
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A Qualitative Study of the Integration of Arab Muslim Israelis Suffering from Mental Disorders into the Normative Community. J Immigr Minor Health 2016; 19:686-696. [PMID: 26972458 DOI: 10.1007/s10903-016-0389-z] [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: 10/22/2022]
Abstract
This study focuses on the process of the integration of Arab Muslim Israelis suffering from mental disorders into the normative community, addressing perspectives of both people with mental disorders and the community. This qualitative-constructivist study seeks to understand the dynamics of face-to-face meetings by highlighting the participants' points of view. The main themes of the findings included stereotypes and prejudices, gender discrimination, and the effect of face-to-face meetings on integration of people with mental disorders (PMD) into the community. The findings support former studies about the integration of PMD into the normative community, but add a unique finding that females suffer from double discrimination: both as women in a conservative society and as PMD. The study findings indicate a perception of lack of self-efficacy of PMD as a key barrier preventing integration into the community, which also prevents community members and counselors from accepting them or treating them as equals. We recommend on a social marketing campaign to be undertaken with the Arab Muslim community to refute stigmas and prejudices, particulary with double gender discrimination suffered by women with mental disorders in the Muslim community and training of community center counselors who have contact with the PMD population.
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Omer S, Golden E, Priebe S. Exploring the Mechanisms of a Patient-Centred Assessment with a Solution Focused Approach (DIALOG+) in the Community Treatment of Patients with Psychosis: A Process Evaluation within a Cluster-Randomised Controlled Trial. PLoS One 2016; 11:e0148415. [PMID: 26859388 PMCID: PMC4747516 DOI: 10.1371/journal.pone.0148415] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background DIALOG+ is a new intervention to make routine community mental health meetings therapeutically effective. It involves a structured assessment of patient concerns and a solution-focused approach to address them. In a randomised controlled trial, DIALOG+ was associated with better subjective quality of life and other outcomes in patients with psychosis, but it was not clear how this was achieved. This study explored the possible mechanisms. Methods This was a mixed-methods process evaluation within a cluster-randomised controlled trial. Focus groups and interviews were conducted with patients and clinicians who experienced DIALOG+ and were analysed using thematic analysis. The content of DIALOG+ sessions was recorded and analysed according to (i) the type of actions agreed during sessions and (ii) the domains discussed. The subjective quality of life measure was analysed with mixed-effects models to explore whether the effect of DIALOG+ was limited to life domains that had been addressed in sessions or consistent across all domains. Results Four qualitative themes emerged regarding the mechanisms of DIALOG+: (1) a comprehensive structure; (2) self-reflection; (3) therapeutic self-expression; and (4) empowerment. Patients took responsibility for the majority of actions agreed during sessions (65%). The treatment effect on subjective quality of life was largest for living situation (accommodation and people that the patient lives with) and mental health. Two of these domains were among the three most commonly discussed in DIALOG+ sessions (accommodation, mental health, and physical health). Conclusion DIALOG+ initiates positive, domain-specific change in the areas that are addressed in sessions. It provides a comprehensive and solution-focused structure to routine meetings, encourages self-reflection and expression, and empowers patients. Future research should strengthen and monitor these factors. Trial Registration ISRCTN Registry ISRCTN34757603.
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Affiliation(s)
- Serif Omer
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Eoin Golden
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
- * E-mail:
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Lang FU, Gühne U, Riedel-Heller SG, Becker T. [Innovative patient-centered care systems: International perspectives]. DER NERVENARZT 2015; 86:1313-9. [PMID: 26440520 DOI: 10.1007/s00115-015-4331-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The "Psychiatrie-Enquete" (German Report on the State of Psychiatry) is 40 years old this year. It has always been inspirational; also internationally. OBJECTIVE Which innovative elements of community mental health services can be found in an international perspective? MATERIALS AND METHODS Narrative review. RESULTS Community mental health care is a lively field with much research and innovative practice. With assertive community treatment (ACT) and home treatment (HT), internationally well-evaluated forms of community mental health care are available. CONCLUSION Recovery-based and peer-to-peer approaches hold promise for the future. In terms of mid- and long-term perspectives, an increase in patient-centering via individualization of mental health care and a better implementation of community mental health interventions would be desirable in Germany.
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Affiliation(s)
- F U Lang
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland.
| | - U Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - T Becker
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland
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Govender M, Bowen RC, German ML, Bulaj G, Bruggers CS. Clinical and Neurobiological Perspectives of Empowering Pediatric Cancer Patients Using Videogames. Games Health J 2015; 4:362-74. [PMID: 26287927 PMCID: PMC4545566 DOI: 10.1089/g4h.2015.0014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Pediatric oncology patients often experience fatigue and physical and mental deconditioning during and following chemotherapy treatments, contributing to diminished quality of life. Patient empowerment is a core principle of patient-centered care and reflects one's ability to positively affect his or her own health behavior and health status. Empowerment interventions may enhance patients' internal locus of control, resilience, coping skills, and self-management of symptoms related to disease and therapy. Clinical and technological advancements in therapeutic videogames and mobile medical applications (mobile health) can facilitate delivery of the empowerment interventions for medical purposes. This review summarizes clinical strategies for empowering pediatric cancer patients, as well as their relationship with developing a “fighting spirit” in physical and mental health. To better understand physiological aspects of empowerment and to elucidate videogame-based intervention strategies, brain neuronal circuits and neurotransmitters during stress, fear, and resilience are also discussed. Neuroimaging studies point to the role of the reward system pathways in resilience and empowerment in patients. Taken together, videogames and mobile health applications open translational research opportunities to develop and deliver empowerment interventions to pediatric cancer patients and also to those with other chronic diseases.
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Affiliation(s)
- Meveshni Govender
- 1 Division of Hematology-Oncology, University of Utah School of Medicine , Salt Lake City, Utah
| | - Randy C Bowen
- 2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Massiell L German
- 2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Grzegorz Bulaj
- 3 Department of Medicinal Chemistry, College of Pharmacy, University of Utah , Salt Lake City, Utah
| | - Carol S Bruggers
- 1 Division of Hematology-Oncology, University of Utah School of Medicine , Salt Lake City, Utah.,2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.,4 Huntsman Cancer Institute, University of Utah School of Medicine , Salt Lake City, Utah.,5 Primary Children's Hospital , Salt Lake City, Utah
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27
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Martin L, Perlman C, Bieling P. Using the RAI-MH to support shared decision-making in mental healthcare. Healthc Manage Forum 2015; 28:163-6. [PMID: 26015490 DOI: 10.1177/0840470415581231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persons with mental illness often struggle to meaningfully participate in decisions about their services. This study engaged persons with mental illness to understand how health information could empower them. Participants reported wanting information on diagnoses, medications, symptoms, and strengths as well as clinician notes and rationale. The Resident Assessment Instrument for Mental Health contains this information and is mandated in in-patient psychiatry. Its findings could be summarized and shared with individuals to promote and facilitate shared decision-making.
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Affiliation(s)
- Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada.
| | - Christopher Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Bieling
- Mood Disorders Service, Centre for Mountain Health Services, St. Joseph's Hospital, Hamilton, Ontario, Canada. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Assessment of patient empowerment--a systematic review of measures. PLoS One 2015; 10:e0126553. [PMID: 25970618 PMCID: PMC4430483 DOI: 10.1371/journal.pone.0126553] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 04/03/2015] [Indexed: 12/03/2022] Open
Abstract
Background Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified. Methods Electronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee’s 2007 criteria. Findings 30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures. Discussion Findings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for further work to develop a (set of) appropriately validated measure(s) to capture this. The methodological quality of psychometric studies could be improved by adhering to published quality criteria.
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Jahnke S, Imhoff R, Hoyer J. Stigmatization of people with pedophilia: two comparative surveys. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:21-34. [PMID: 24948422 DOI: 10.1007/s10508-014-0312-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 02/13/2014] [Accepted: 02/25/2014] [Indexed: 05/28/2023]
Abstract
Despite productive research on stigma and its impact on people's lives in the past 20 years, stigmatization of people with pedophilia has received little attention. We conducted two surveys estimating public stigma and determining predictors of social distance from this group. In both studies, pedophilia was defined as a "dominant sexual interest in children." The survey was comprised of items measuring agreement with stereotypes, emotions, and social distance (among others). Responses were compared with identical items referring to either people who abuse alcohol (Study 1), sexual sadists or people with antisocial tendencies (Study 2). Study 1 was conducted in two German cities (N = 854) and Study 2 sampled 201 English-speaking online participants. Both studies revealed that nearly all reactions to people with pedophilia were more negative than those to the other groups, including social distance. Fourteen percent (Study 1) and 28 % (Study 2) of the participants agreed that people with pedophilia should better be dead, even if they never had committed criminal acts. The strongest predictors of social distance towards people with pedophilia were affective reactions to this group (anger and, inversely, associated, pity) and the political attitude of right-wing authoritarianism (Study 1). Results strongly indicate that people with pedophilia are a stigmatized group who risk being the target of fierce discrimination. We discuss this particular form of stigmatization with respect to social isolation of persons with pedophilia and indirect negative consequences for child abuse prevention.
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Affiliation(s)
- Sara Jahnke
- Clinical Psychology and Psychotherapy, Technische Universität Dresden, Hohe Straße 53, 01187, Dresden, Germany,
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30
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Morris SB, Huang J, Zhao L, Sergent JD, Neuhengen J. Measurement Equivalence of the Empowerment Scale for White and Black Persons with Severe Mental Illness. Psychiatr Rehabil J 2014; 37:277-283. [PMID: 24884300 PMCID: PMC4254373 DOI: 10.1037/prj0000069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study examined the measurement equivalence on a measure of personal empowerment for Black and White consumers of mental health services. METHOD Confirmatory factor analysis was used to assess measurement equivalence of the 28-item Empowerment Scale (Rogers, Chamberlin, Ellison, & Crean, 1997), using data from 1,035 White and 301 Black persons with severe mental illness. RESULTS Metric invariance of the Empowerment Scale was supported, in that the factor structure and loadings were equivalent across groups. Scalar invariance was violated on 3 items; however, the impact of these items on scale scores was quite small. Finally, subscales of empowerment tended to be more highly intercorrelated for Black than for White respondents. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE RESULTS generally support the use of Empowerment Scale for ethnic group comparisons. However, subtle differences in the psychometric properties of this measure suggest that Black and White individuals may conceptualize the construct of empowerment in different ways. Specifically, Black respondents had a lower threshold for endorsing some items on the self-esteem and powerlessness dimensions. Further, White respondents viewed the 3 dimensions of empowerment (self-esteem, powerlessness, and activism) as more distinct, whereas these 3 traits were more strongly interrelated for Blacks.
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Schrank B, Riches S, Coggins T, Rashid T, Tylee A, Slade M. WELLFOCUS PPT - modified positive psychotherapy to improve well-being in psychosis: study protocol for a pilot randomised controlled trial. Trials 2014; 15:203. [PMID: 24888479 PMCID: PMC4057564 DOI: 10.1186/1745-6215-15-203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 05/20/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The promotion of well-being is an important goal of recovery oriented mental health services. No structured, evidence-based intervention exists that aims to increase the well-being in people with severe mental illness such as psychosis. Positive psychotherapy (PPT) is a promising intervention for this goal. Standard PPT was adapted for use with people with psychosis in the UK following the Medical Research Council framework for developing and testing complex interventions, resulting in the WELLFOCUS Model describing the intended impact of WELLFOCUS PPT. This study aims to test the WELLFOCUS Model, by piloting the intervention, trial processes, and evaluation strategy. METHODS/DESIGN This study is a non-blinded pragmatic pilot RCT comparing WELLFOCUS PPT provided as an 11-session group therapy in addition to treatment as usual to treatment as usual alone. Inclusion criteria are adults (aged 18-65 years) with a main diagnosis of psychosis who use mental health services. A target sample of 80 service users with psychosis are recruited from mental health services across the South London and Maudsley NHS Foundation Trust. Participants are randomised in blocks to the intervention and control group. WELLFOCUS PPT is provided to groups by specifically trained and supervised local therapists and members of the research team. Assessments are conducted before randomisation and after the group intervention. The primary outcome measure is well-being assessed by the Warwick-Edinburgh Mental Well-being Scale. Secondary outcomes include good feelings, symptom relief, connectedness, hope, self-worth, empowerment, and meaning. Process evaluation using data collected during the group intervention, post-intervention individual interviews and focus groups with participants, and interviews with trial therapists will complement quantitative outcome data. DISCUSSION This study will provide data on the feasibility of the intervention and identify necessary adaptations. It will allow optimisation of trial processes and inform the evaluation strategy, including sample size calculation, for a future definitive RCT. TRIAL REGISTRATION Current Controlled Trials ISRCTN04199273 - WELLFOCUS study: an intervention to improve well-being in people with psychosis, Date registered: 27 March 2013, first participant randomised on 26 April 2013.
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Affiliation(s)
- Beate Schrank
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Simon Riches
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
| | - Tony Coggins
- South London and Maudsley NHS Foundation Trust, Mental Health Promotion, London, United Kingdom
| | - Tayyab Rashid
- Health & Wellness Centre, University of Toronto, Toronto, Canada
| | - Andre Tylee
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
| | - Mike Slade
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
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Wciórka J, Świtaj P, Anczewska M. The sense of empowerment in the early stage of recovery from psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2014. [DOI: 10.1080/17522439.2014.910253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Berry K, Allott R, Emsley R, Ennion S, Barrowclough C. Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse. Soc Psychiatry Psychiatr Epidemiol 2014; 49:377-84. [PMID: 24141697 DOI: 10.1007/s00127-013-0776-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/04/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. METHOD Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12- and 24-month follow-ups. RESULTS A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. CONCLUSIONS Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.
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Affiliation(s)
- Katherine Berry
- School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK,
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Brief battery for measurement of stigmatizing versus affirming attitudes about mental illness. Psychiatry Res 2014; 215:466-70. [PMID: 24388505 DOI: 10.1016/j.psychres.2013.12.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 09/22/2013] [Accepted: 12/04/2013] [Indexed: 11/22/2022]
Abstract
Decreasing the stigma of mental illness is not sufficient. Rather promoting important ideas, such as recovery, empowerment, and self-determination, is important to increase social inclusion, or more broadly, affirming attitudes. The goal of this article is to evaluate the psychometrics of a battery of measures that assess both stigmatizing and affirming attitudes toward people with mental illnesses. The aforementioned battery was used in four separate RCTs on stigma change with different samples: college students, adults, health care providers, and mental health service providers. Test-retest indices were satisfactory for all samples except for the Empowerment Scale score for the mental health providers. Attribution Questionnaire-9 (AQ-9) scores were significantly and inversely associated with the three affirming attitude scale scores for eight of twelve correlations, with five of these meeting the Bonferroni Criterion. Research on social attitudes and structures needs to incorporate assessment of affirming perspectives about a group and effective anti-stigma programs need to promote social inclusion and affirming attitudes.
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Jorge-Monteiro MF, Ornelas JH. Properties of the Portuguese version of the empowerment scale with mental health organization users. Int J Ment Health Syst 2014; 8:48. [PMID: 25926873 PMCID: PMC4414465 DOI: 10.1186/1752-4458-8-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background This study examines the reliability and validity of the Portuguese version of the Empowerment Scale (ES) to be used in the community/psychosocial mental health field. Authors also reviewed the properties of the development and cross-cultural adaptation of the ES. Because mental health services are required to encourage empowerment and recovery-oriented interventions, adequate empowerment-oriented outcome measures are needed to evaluate services and study interventions across countries. Methods The current research was part of a larger research project with 213 participants. A confirmatory factor analysis (CFA) was conducted to observe the ES’s construct-related validity, and a reliability analysis for internal consistency. The ES concurrent validity with the recovery and psychiatric symptoms measures was also assessed using the Pearson’s correlation coefficient. Results The CFA supported the five-factor configuration for the refined model of measure as satisfactory. The Portuguese version of the ES presented an overall satisfactory reliability (α = .79) and was positively correlated with personal recovery (r = .71) and inversely with psychiatric symptoms (r = -.22). Conclusions The overall scale was considered reliable and valid to be used by Portuguese researchers and practitioners to evaluate empowering interventions in mental health services. Furthermore, in the effort to increase ES construct-related validity, this article suggests further improvements to enhance the empowerment measure.
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Krajewski C, Burazeri G, Brand H. Self-stigma, perceived discrimination and empowerment among people with a mental illness in six countries: Pan European stigma study. Psychiatry Res 2013; 210:1136-46. [PMID: 23998361 DOI: 10.1016/j.psychres.2013.08.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 07/29/2013] [Accepted: 08/08/2013] [Indexed: 01/24/2023]
Abstract
A cross-sectional study including 796 individuals with a psychiatric disorder was conducted in Croatia, Israel, Lithuania, Malta, Romania and Sweden in 2010 aiming to assess correlates of self-stigma. The Internalized Stigma of Mental Illness (ISMI) was used to measure self-stigma, whereas the Boston University Empowerment Scale was used to measure the self-efficacy/self-esteem (SESE) and sense of power/powerlessness (PP). Perceived discrimination and devaluation was measured with the Perceived Devaluation and Discrimination (PDD) Scale. Thirty three percent of participants had moderate-to-high ISMI scores. In multivariable-adjusted analysis, significant 'predictors' of high ISMI scores were: age-group of 50-59 years, current employment, lower social contacts, and minimal-to-low SESE and PP scores. Remarkably, no significant association between ISMI and PDD was evident. Furthermore, there was evidence of a significant interaction between SESE and country. Study participants might not be representative to all individuals with mental disorders in countries included in this survey. Our findings indicate that people with psychiatric diseases suffer both self-stigma and perceived discrimination and devaluation. This is one of the very few reports highlighting country differences and diagnosis disparities of self-stigma among individuals with mental illnesses. Between-country differences should be considered and carefully addressed in the process of policy formulation and interventional programs against stigma.
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Affiliation(s)
- Christin Krajewski
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands.
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Ryhänen AM, Rankinen S, Siekkinen M, Saarinen M, Korvenranta H, Leino-Kilpi H. The impact of an empowering Internet-based Breast Cancer Patient Pathway program on breast cancer patients' clinical outcomes: a randomised controlled trial. J Clin Nurs 2013; 22:1016-25. [PMID: 23480498 DOI: 10.1111/jocn.12007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effect of the Breast Cancer Patient Pathway program on breast cancer patient's empowerment process. BACKGROUND The results of earlier studies indicate that the use of tailored Internet-based patient education programs increased patient's knowledge level; however, other outcome measures differed. DESIGN This randomised control trial studied the effect of the Internet-based patient educational program on breast cancer patients' empowerment. In this study, we measured the quality of life, anxiety and managing with treatment-related side effects as the outcomes of breast cancer patients' empowering process. METHODS Breast cancer patients who were Internet users in one Finnish university hospital during 2008-2010 were randomised to the control group (n=43) and the intervention group (n=47). Baseline data were collected first in the hospital and the following data seven times during the treatment process, the last time one year after breast cancer diagnosis. RESULTS There were no statistically significant differences in the quality of life, anxiety or side effects of treatment between the groups. The amount of treatment-related side effects was connected to both physical and psychological well-being. CONCLUSIONS In this study, the Breast Cancer Patient Pathway program did not decrease anxiety level or treatment-related side effects among breast cancer patients or improve subscales of quality of life when compared with controls. RELEVANCE TO CLINICAL PRACTICE There is a need to relieve the side effects caused by patients' care with the help of patient education. Internet-based patient education programs need more focus when developing new patient education methods.
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Affiliation(s)
- Anne M Ryhänen
- Department of Nursing Science, Turku Social and Health Services, Turku City Hospital, University of Turku, Turku, Finland.
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Small N, Bower P, Chew-Graham CA, Whalley D, Protheroe J. Patient empowerment in long-term conditions: development and preliminary testing of a new measure. BMC Health Serv Res 2013; 13:263. [PMID: 23835131 PMCID: PMC3725177 DOI: 10.1186/1472-6963-13-263] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 06/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background Patient empowerment is viewed by policy makers and health care practitioners as a mechanism to help patients with long-term conditions better manage their health and achieve better outcomes. However, assessing the role of empowerment is dependent on effective measures of empowerment. Although many measures of empowerment exist, no measure has been developed specifically for patients with long-term conditions in the primary care setting. This study presents preliminary data on the development and validation of such a measure. Methods We conducted two empirical studies. Study one was an interview study to understand empowerment from the perspective of patients living with long-term conditions. Qualitative analysis identified dimensions of empowerment, and the qualitative data were used to generate items relating to these dimensions. Study two was a cross-sectional postal study involving patients with different types of long-term conditions recruited from general practices. The survey was conducted to test and validate our new measure of empowerment. Factor analysis and regression were performed to test scale structure, internal consistency and construct validity. Results Sixteen predominately elderly patients with different types of long-term conditions described empowerment in terms of 5 dimensions (identity, knowledge and understanding, personal control, personal decision-making, and enabling other patients). One hundred and ninety seven survey responses were received from mainly older white females, with relatively low levels of formal education, with the majority retired from paid work. Almost half of the sample reported cardiovascular, joint or diabetes long-term conditions. Factor analysis identified a three factor solution (positive attitude and sense of control, knowledge and confidence in decision making and enabling others), although the structure lacked clarity. A total empowerment score across all items showed acceptable levels of internal consistency and relationships with other measures were generally supportive of its construct validity. Conclusion Initial analyses suggest that the new empowerment measure meets basic psychometric criteria. Reasons concerning the failure to confirm the hypothesized factor structure are discussed alongside further developments of the scale.
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Affiliation(s)
- Nicola Small
- Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road Williamson Building, Manchester, UK.
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Levels of patient activation among adults with schizophrenia: associations with hope, symptoms, medication adherence, and recovery attitudes. J Nerv Ment Dis 2013; 201:339-44. [PMID: 23538980 DOI: 10.1097/nmd.0b013e318288e253] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient activation, defined as one's attitudes and confidence toward managing illness, has been not been thoroughly studied in consumers with schizophrenia. The current study sought to understand the relationship between patient activation and symptoms, medication adherence, recovery attitudes, and hope in a sample of 119 adults with schizophrenia. The participants were enrolled in an 18-month randomized controlled study of the Illness Management and Recovery program. Data were collected at baseline; correlations and stepwise multiple regressions were used to examine the relationships and determine the unique contribution of variables. Higher patient activation was most strongly associated with positive recovery attitudes, higher levels of hope, and fewer emotional discomfort symptoms. Patient activation was significantly related to a broad measure of illness self-management, providing evidence for the construct validity of the patient activation measure. Our findings emphasize the importance of recovery-based mental health services that recognize level of patient activation as a potential factor in consumer outcomes.
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Tambuyzer E, Van Audenhove C. Is perceived patient involvement in mental health care associated with satisfaction and empowerment? Health Expect 2013; 18:516-26. [PMID: 23425015 DOI: 10.1111/hex.12052] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients increasingly assume active roles in their mental health care. While there is a growing interest in patient involvement and patient-reported outcomes, there is insufficient research on the outcomes of patient involvement. OBJECTIVE The research questions in this study are as follows: 'To what extent is perceived patient involvement associated with satisfaction and empowerment?'; 'What is the nature of the relationship between satisfaction and empowerment?'; and 'To what extent are background variables associated with satisfaction and empowerment?'. We assumed that a higher degree of patient involvement is associated with higher satisfaction and empowerment scores and that satisfaction and empowerment are positively associated. DESIGN, SETTING AND PARTICIPANTS Data were gathered using surveys of 111 patients of 36 multidisciplinary care networks for persons with serious and persistent mental illness. MAIN VARIABLES STUDIED AND MAIN OUTCOME MEASURES Demographic characteristics, patient involvement and satisfaction were measured using a new questionnaire. Empowerment was assessed using the Dutch Empowerment Scale. Descriptive, univariate (Pearson's r and independent-samples t-tests), multivariate (hierarchical forced entry regression) and mixed-model analyses were conducted. RESULTS The hypotheses of positive associations between patient involvement, satisfaction and empowerment are confirmed. The demographics are not significantly related to satisfaction or empowerment, except for gender. Men reported higher empowerment scores than did women. DISCUSSION AND CONCLUSIONS Making patient involvement a reality is more than just an ethical imperative. It provides an opportunity to enhance patient-reported outcomes such as satisfaction and empowerment. Future research should focus on the nature of the association between satisfaction and empowerment.
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Affiliation(s)
- Else Tambuyzer
- LUCAS, Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
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Corrigan PW, Sokol KA, Rüsch N. The impact of self-stigma and mutual help programs on the quality of life of people with serious mental illnesses. Community Ment Health J 2013; 49:1-6. [PMID: 22038373 PMCID: PMC3320674 DOI: 10.1007/s10597-011-9445-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 10/04/2011] [Indexed: 11/28/2022]
Abstract
Mutual help programs (MHPs) are informal services developed and operated by people with serious mental illnesses for peers with these illnesses. We expect MHPs to have positive effects on quality of life and inverse associations with self-stigma. We hypothesize group identification and social support to be key ingredients that lead to MHPs benefits and hence to also be significant correlates. Eighty-five people with serious mental illness reported current and past MHP experience and completed self-report measures of quality of life, self-stigma, group identification, and social support. Self-stigma was shown to be a significant and large correlate of quality of life. Satisfaction with current and past MHP participation was also associated with quality of life. Group identification and satisfaction with one's support network were significantly and largely associated with MHP satisfaction. MHPs are a specific example of the broader category of consumer operated services which also include drop-in centers and education-for-advocacy programs. Findings about group identification will inform ongoing development of MHPs and consumer operated services, as well as evaluation of these programs.
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Nour K, Hébert M, Lavoie JP, Dallaire B, Wallach I, Moscovizt N, Regenstreif A, Billette V. [Specialized mental health services for the elderly: a pilot study of the evaluation process]. SANTE MENTALE AU QUEBEC 2013; 38:81-102. [PMID: 24336991 DOI: 10.7202/1019187ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In Quebec, the Centre de santé et services sociaux (CSSS) Cavendish offers specialized services for the elderly with mental health problems (SSSM 60+) (Nour et al., 2011a). This article describes a targeted segment of the population reached (considering the exclusion criteria, only 50% of the elderly receiving services from the SSSM 60+ were followed). The article presents the model of individual changes relating to services, and explores the psychosocial mediators that influence the efficiency of services. This population experiences various psychosocial problems, the most important being mild to moderate symptoms of depression. Services and interventions by the SSSM 60+ team appear to increase significantly the therapeutic alliance and the feeling of empowerment in this clientele. Prioritizing these two concepts during service delivery appears to be an avenue to consider.
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Affiliation(s)
- Kareen Nour
- Direction de santé publique de la Montérégie
| | - Marijo Hébert
- Centre de recherche et d'expertise en gérontologie sociale, CSSS Cavendish
| | - Jean-Pierre Lavoie
- Centre de recherche et d'expertise en gérontologie sociale, CSSS Cavendish
| | | | | | | | | | - Véronique Billette
- Centre de recherche et d'expertise en gérontologie sociale, CSSS Cavendish
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Corrigan PW, Rao D. On the self-stigma of mental illness: stages, disclosure, and strategies for change. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:464-9. [PMID: 22854028 PMCID: PMC3610943 DOI: 10.1177/070674371205700804] [Citation(s) in RCA: 438] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
People with mental illness have long experienced prejudice and discrimination. Researchers have been able to study this phenomenon as stigma and have begun to examine ways of reducing this stigma. Public stigma is the most prominent form observed and studied, as it represents the prejudice and discrimination directed at a group by the larger population. Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. In our article, we more fully define the concept of self-stigma and describe the negative consequences of self-stigma for people with mental illness. We also examine the advantages and disadvantages of disclosure in reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma is to promote personal empowerment. Lastly, we discuss individual- and societal-level methods for reducing self-stigma, programs led by peers as well as those led by social service providers.
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Affiliation(s)
- Patrick W Corrigan
- College of Psychology, Illinois Institute of Technology, Chicago, Illinois 60616, USA.
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Chou KR, Shih YW, Chang C, Chou YY, Hu WH, Cheng JS, Yang CY, Hsieh CJ. Psychosocial rehabilitation activities, empowerment, and quality of community-based life for people with schizophrenia. Arch Psychiatr Nurs 2012; 26:285-94. [PMID: 22835748 DOI: 10.1016/j.apnu.2012.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 03/08/2012] [Accepted: 04/01/2012] [Indexed: 10/28/2022]
Abstract
Many variables influencing quality of life (QOL) for outpatients with schizophrenia have been identified from prior studies. Symptom severity, psychosocial rehabilitation activities, and empowerment have all been clearly identified as key variables. However, which variables are the most influential and important factors remains unknown; factors influencing QOL, either directly or indirectly and to what degree, need to be examined. The aim of this study was to test the hypothesis that empowerment is a possible mediator of how (a) psychiatric symptoms and (b) psychosocial rehabilitation activities affect QOL for outpatients with schizophrenia in the community. We used the probability proportional to size random sampling for 190 outpatients with schizophrenia at 10 community rehabilitation centers in Taipei, such that samples consisted of adults who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The instruments included the questionnaire to gather demographic and disease information, the Empowerment Scale, the Psychiatric Symptoms Scale, the psychosocial rehabilitation activity (PRA), and the Quality of Life Scale for Psychiatric Patients. Beyond descriptive statistics, correlation and structural equation models were computed. Findings showed that empowerment in outpatients with schizophrenia mediates QOL, whereas psychosocial rehabilitation activities seem to increase empowerment, which may in turn increase QOL. Psychotic symptoms seem to have a direct effect of decreasing QOL that could not be mediated by empowerment. Empowerment had a significant effect on QOL for outpatients with schizophrenia. The findings of this study support the importance of empowerment and rehabilitation activities for promoting QOL among community outpatients. We suggest that various rehabilitation programs and empowerment health education are needed to enhance QOL for schizophrenia outpatients in the community.
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Affiliation(s)
- Kuei-Ru Chou
- Graduate Institute of Nursing, Taipei Medical University, Taipei, Taiwan, RO China.
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Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education. Community Ment Health J 2012; 48:420-30. [PMID: 22460927 DOI: 10.1007/s10597-012-9507-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering mental health consumers to become better advocates for their own care. A total of 428 adults with mental illness were randomly assigned to BRIDGES (intervention condition) or a services as usual wait list (control condition). Interviews were conducted at enrollment, at the end of the intervention, and 6-months post-intervention. Random regression results indicate that, compared to controls, BRIDGES participants experienced significant increases in overall empowerment, empowerment-self-esteem, and self-advocacy-assertiveness, and maintained these improved outcomes over time. Peer-led education interventions may provide participants with the information, skills and support they need to become more actively involved in the treatment decision-making process.
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Pitschel-Walz G, Rummel-Kluge C, Froböse T, Beitinger R, Stiegler M, Bäuml J, Kissling W. Steigerung des „empowerment“ bei Angehörigen von schizophren Erkrankten. PSYCHOTHERAPEUT 2012. [DOI: 10.1007/s00278-012-0924-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gavriilidis G, Östergren PO. Evaluating a traditional medicine policy in South Africa: phase 1 development of a policy assessment tool. Glob Health Action 2012; 5:17271. [PMID: 22666185 PMCID: PMC3365441 DOI: 10.3402/gha.v5i0.17271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/01/2012] [Accepted: 04/25/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Policies that empower individuals and communities may be appropriate for public health, and more broadly. Simple, transparent and acceptable tools are therefore required to evaluate policies from an empowerment perspective. In 2008, the South African Department of Health (DOHSA) drafted a policy to endorse the integration of African Traditional Medicine (ATM) into the public health sector, following the World Health Organization's (WHO) long-standing directives. OBJECTIVE The purpose of this study is to critically analyze this policy using a novel evaluation tool. DESIGN A 12-point 'Policy Empowerment Index' (PEI) is introduced, and used to classify and score the policy according to five theoretical policy types. The evaluation was based on a stepwise review and associated publications: policy drafts, policy statements and news announcements. RESULTS According to the assessment tool, the ATM policy was marginally 'supportive' of constituent empowerment, although several 'directive' features were also observed. The importance of ATM to SA's communities and the promotion of education, employment, entrepreneurship and peripheral resource mobilization were the main empowering elements. Centralised conception, planning and implementation, the absence of provisions for local adaptations and the authoritative legislation context were sub-optimal features. CONCLUSIONS South Africa's ATM legislation may need to further involve communities in policy design and implementation to capitalise upon the broader benefits of community empowerment. However, the iterative nature of method and evaluation is important. Indeed, they are proposed as points to initiate participatory development, and improve policy evaluation. Such instruments can empower constituents in the political process.
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Affiliation(s)
- Georgios Gavriilidis
- Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Sweden.
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Arvidsson S, Bergman S, Arvidsson B, Fridlund B, Tingström P. Psychometric properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23. Musculoskeletal Care 2012; 10:101-109. [PMID: 22315205 DOI: 10.1002/msc.1005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Empowerment is a central concept in both rheumatology and diabetes care. A Swedish empowerment instrument for patients with rheumatic diseases has not been created before now. The aim of the present study was to determine the psychometric properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23, such as construct validity, internal consistency reliability, inter-item correlations and discriminant validity. METHODS The already existing instrument, the Swedish Diabetes Empowerment Scale (SWE-DES-23), was adapted for use in patients with rheumatic diseases. The adapted instrument was called the SWE-RES-23. In 2009, 260 patients with rheumatic diseases from a rheumatology unit in Sweden completed the instrument. Construct validity was tested by using exploratory factor analysis. Internal consistency reliability was tested by the use of Cronbach's α-coefficient. In order to determine unidimensionality of the empowerment subscales, inter-item correlations were calculated. To establish discriminant validity, an item about self-perceived health from the Short Form (SF) 36 was used in addition to the SWE-RES-23. RESULTS The exploratory factor analysis resulted in five factors (empowerment subscales) with eigenvalues >1, explaining 64.1% of the total variance: Goal achievement and overcoming barriers to goal achievement; Self-knowledge; Managing stress; Assessing dissatisfaction and readiness to change; and Support for caring. Cronbach's α values ranged from 0.59 to 0.91, and the value for the total score was 0.92. CONCLUSION The results support the possibility of adapting the SWE-DES-23 for use in patients with rheumatic diseases. The SWE-RES-23 shows acceptable psychometric properties, in terms of construct validity and internal consistency reliability. To validate the SWE-RES-23 fully, further studies are needed, with a focus on test-retest correlations.
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Affiliation(s)
- Susann Arvidsson
- Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
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Klepp OM, Sørensen T, Kleiner R. Empowerment: Additive, Overlapping and Interactive Relation to Sense of Coherence, with Regard to Mental Health and its Promotion. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2007.9721839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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