Impact of the Guided Self-Determination Intervention among Adolescents with Co-Existing ADHD and Medical Disorder: A Mixed Methods Study

Usefulness of working with a person-centred intervention in a group: Perspectives from facilitators and persons with mental illness

BACKGROUND

When implementing new interventions into clinical practice, it is of great importance to investigate the implementation process to better understand factors promoting and impeding the implementation to stimulate engagement and sustainability of the intervention. It is essential to consider perspectives both from the health professionals delivering the intervention and those receiving the intervention to be open to their suggestions for enhancing the dissemination and implementation of the intervention. The aim of the study was to evaluate adoption, acceptability and appropriateness of a person-centred group intervention (PCGI) from the perspectives of facilitators and participants with mental illness in mental health outpatient services right after delivery.

METHODS

A qualitative interview study design was used. Interview data from three individual interviews, one group interview with facilitators and 16 individual interviews with participants were analyzed through content analysis.

RESULTS

As described in the following three categories, the facilitators and participants found the PCGI overall useful and meaningful to deliver and receive: (1) application of a PCGI in clinical practice, (2) balancing the facilitator role and (3) establishing and maintaining a safe relationship.

CONCLUSION

Facilitators and participants found the form and structure of the PCGI useful and meaningful. Some participants dropped out as they did not feel comfortable in a group setting. The components in the sessions, questions on cards and reflection sheets together with peer-to-peer interactions provided a safe environment. However, facilitation from facilitators requires appropriate skills and qualifications, which must be provided by the hospital together with supervision and the possibility for peer feedback and exchange of experiences.

'To loosen up and talk': Patients´ and facilitators´ experiences of discovery group sessions from the Tidal Model as an introduction before engaging in a person-centred group intervention

WHAT IS KNOWN ABOUT THE SUBJECT

Treatment groups in Mental Health Service is cost-effective, increases patients´ self-understanding and stimulate change Research shows that people with mental illness have different barriers to attend group sessions which often originates from a lack of trust in other people, but it is known that the possibility to build gradual trust among the participants encourages attendance.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

This study is based on the experience from outpatients and illuminates how discovery groups from the Tidal Model can be used as introductory sessions to build gradual trust among people with mental illness before engaging in a person-centred group intervention. The study fills a research gap in methods to create a safe and trusting environment in treatment groups for people with mental illness working with recovery-oriented person-centred interventions.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This study emphasizes the importance of meeting concerns about social interactions in persons with mental illness when joining treatment groups. It presents a recovery-oriented method which meets this requirement and is easy to implement in practice.

ABSTRACT

INTRODUCTION: Recovery-oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment.

AIM

The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person-centred group intervention.

METHOD

A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur's theory of interpretation.

RESULTS

The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators.

DISCUSSION

Feeling safe and sharing experiences and emotions contribute to the relational climate in a group.

IMPLICATION FOR PRACTICE

Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality.

Impact of the person-centred intervention guided self-determination across healthcare settings-An integrated review

AIM

To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings.

METHODS

An integrated five-stage review.

RESULTS

Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets-appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice-a decision from above, (2) A new role-unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach.

CONCLUSION

Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice.

Measures used to assess interventions for increasing patient involvement in Danish healthcare setting: a rapid review

OBJECTIVE

To identify measures used within Denmark evaluating any type of intervention designed to facilitate patient involvement in healthcare.

DESIGN

Environmental scan employing rapid review methods.

DATA SOURCES

MEDLINE, PsycInfo and CINAHL were searched from 6-9 April 2021 from database inception up to the date of the search.

ELIGIBILITY CRITERIA

Quantitative, observational and mixed methods studies with empirical data on outcomes used to assess any type of intervention aiming to increase patient involvement with their healthcare. Language limitations were Danish and English.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data from 10% of the included studies and, due to their agreement, the data from the rest were extracted by first author. Data were analysed with reference to existing categories of measuring person-centred care; findings were synthesised using narrative summaries. Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were used to guide reporting.

RESULTS

Among 3767 records, 43 studies met the inclusion criteria, including 74 different measures used to evaluate interventions aimed at increasing patient involvement within healthcare in Danish hospital and community settings. Generic measures assessed: patient engagement (n=3); supporting self-management (n=8); supporting shared decision-making (n=9); patient satisfaction and experiences of care (n=11); health-related patient-reported outcome (n=20).

CONCLUSIONS

Across Denmark, complex interventions designed to improve patient involvement with healthcare vary in their goals and content. Some targeting healthcare professionals, some patient health literacy and some service infrastructure. A plethora of measures assess the impact of these interventions on patient, professional and service delivery outcomes. Few measures assessed patient involvement directly, and it is unclear which proxy measures capture indicators of perceived involvement. Lack of conceptual clarity between intervention goals, the components of change and measures makes it difficult to see what types of intervention can best support change in services to ensure patients are more effectively involved in their healthcare.

The need for earlier recognition of attention deficit hyperactivity disorder in primary care: a qualitative meta-synthesis of the experience of receiving a diagnosis of ADHD in adulthood

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopment disorder that affects individuals across the lifespan. ADHD causes dysfunction when left untreated. Individuals receiving a diagnosis in adulthood have a unique life experience because of their delayed diagnosis.

OBJECTIVES

To identify and methodically review qualitative studies that explored the experiences of receiving a diagnosis of ADHD in adulthood, conduct an interpretive analysis of the identified studies, and produce a qualitative meta-synthesis to provide an understanding of these experiences.

METHODS

Studies with adults diagnosed with ADHD in adulthood, focussed on experiences of receiving a delayed ADHD diagnosis, used qualitative methods, and were cited in PubMed, OVID, and ProQuest databases. Out of 251 studies identified, 7 met inclusion criteria.

RESULTS

This qualitative meta-synthesis produced 2 main themes: ADHD as an identity and ADHD as a diagnosis, and 5 subthemes: identity before diagnosis, identity after diagnosis, the unnecessary struggle, the diagnosis as a revelation and a burden, and a functional life was finally possible.

CONCLUSION

Overall, this study showed that delayed diagnosis of ADHD causes suffering and dysfunction that could be mitigated through earlier diagnosis and treatment.

Mixed methods intervention studies in children and adolescents with emotional and behavioral disorders: A methodological review

BACKGROUND

Mixed methods intervention studies can improve the accuracy of interventional evaluations in the field of emotional and behavioral disorders by helping researchers gain a more nuanced understanding of how a particular intervention works. However, no studies to date have systematically examined the ways in which this type of studies have been carried out and reported.

AIM

To examine the methodological features and reporting practices found in mixed methods intervention studies in children and adolescents with emotional and behavioral disorders.

METHOD

Methodological review based on a systematic search from inception to July 2021 in Embase, Medline, PsycINFO, and SCOPUS, and a hand search in seven journals.

RESULTS

We found 30 studies, most of them published since 2019. These studies reported several patterns of mixed methods use which illustrated the unique insights that researchers can gain by using this approach. We identified several ways that authors could more clearly report the justification for using a mixed methods approach, the description of the design used, and the evidence of integration of the quantitative and qualitative components.

CONCLUSION

We make recommendations for improving the reporting quality of mixed methods intervention studies in the field of emotional and behavioral disorders.