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Al-Abdulmunem M, Kozelka EE, Acquilano SC, Drake RE, Carpenter-Song E, Elwyn G. Supporting the Individualized Use of Digital Tools in Community Mental Health: The Technology Specialist Pilot Study. Community Ment Health J 2025; 61:989-993. [PMID: 39779602 DOI: 10.1007/s10597-024-01439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025]
Abstract
This pilot study evaluated the feasibility of the technology specialist intervention, which assists clients in achieving mental health recovery and well-being goals via existing digital tools in a real-world community mental health setting. Thirteen adult clients with serious mental illness and their providers completed baseline, 3-, and 6-month assessments, including goal setting, self-efficacy, activation, and acceptability measures, along with weekly ecological momentary assessments. Clients selected goals and corresponding tools, used the tools steadily, and showed improvement in activation and self-efficacy. Most participating clients (82%, n = 9) and providers (80%, n = 8) found the intervention acceptable. These preliminary findings show that the technology specialist intervention is promising and warrants further testing.
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Affiliation(s)
| | - Ellen E Kozelka
- Department of Anthropology, University of Vermont, Burlington, VT, USA
| | - Stephanie C Acquilano
- Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Robert E Drake
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | | | - Glyn Elwyn
- Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Skliarova T, Lara-Cabrera ML, Brobakken MF, Heggelund J, Vedul-Kjelsås E, Güzey IC, Hafstad H, Reitan SK, Nygård M. The mental-health patient-activation measure: assessing validity, reliability, and responsiveness in outpatient settings. BMC Psychiatry 2025; 25:520. [PMID: 40405139 PMCID: PMC12096637 DOI: 10.1186/s12888-025-06939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 05/05/2025] [Indexed: 05/24/2025] Open
Abstract
INTRODUCTION The patient activation measure-mental health (PAM-MH) scale, adapted from the Patient Activation Measure-13 Items (PAM-13) developed in the United States, was designed to assess patient engagement and activation in mental health care. Despite initial validation of the PAM-MH in its original context, its applicability in other settings and its comparison to the gold standard PAM-13 remain unexplored. Furthermore, research addressing the face and construct validity of the PAM-MH is limited. This multi-phase study evaluated the face validity, construct validity, reliability and responsiveness of the PAM-MH in a Norwegian outpatient setting. METHODS A participatory approach was adopted to actively involve user representatives in validating the scale. The validation process consisted of four interconnected studies. In the first sub-study, user representatives were invited to contribute to establish face validity by providing quantitative feedback on the perceived value and burden of completing the PAM-MH. The second sub-study examined the construct validity. It was hypothesised that the PAM-MH measures the construct of patient activation and would therefore correlate with the PAM-13. This hypothesis was tested using Pearson's r in a sample of 55 outpatients. The third sub-study evaluated test-retest reliability (via ICC) and internal consistency (using Cronbach's α), in a sample of 27 outpatients who completed the PAM-MH on two separate occasions. The final sub-study explored the responsiveness of the scale to change, guided by predefined hypotheses, in a sample of 11 outpatients. RESULTS Adequate acceptability was established from users' views of the value and burden of the scale (overall mean "value" score was 59.7% and mean "burden" was 39.6%). All hypotheses, established a priori for construct validity, reliability, and responsiveness-to-change, were confirmed. CONCLUSION This multi-phase study employed a participatory approach to validate the PAM-MH in a Norwegian outpatient context. Preliminary results demonstrated satisfactory face validity and construct validity, along with good reliability and responsiveness-to-change. The findings suggest that the PAM-MH is both valid and reliable, making it a suitable questionnaire to measure patient activation in a Norwegian outpatient setting.
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Affiliation(s)
- Tatiana Skliarova
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway.
| | - Mariela L Lara-Cabrera
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Department of Mental Healthcare, St. Olavs Hospital, Nidelv Community Mental Health Center, Trondheim University Hospital, Trondheim, Norway
| | - Mathias Forsberg Brobakken
- Department of Psychosis and Rehabilitation, Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Jørn Heggelund
- Regional Center for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Einar Vedul-Kjelsås
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Department of Research, Innovation and Education, Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ismail Cüneyt Güzey
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Department of Research, Innovation and Education, Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hege Hafstad
- Vårres Regional User-Led Center Mid-Norway, Trondheim, Norway
| | - Solveig Klaebo Reitan
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Department of Mental Healthcare, St. Olavs Hospital, Nidelv Community Mental Health Center, Trondheim University Hospital, Trondheim, Norway
| | - Mona Nygård
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Department of Psychosis and Rehabilitation, Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Kafri M, Abu Taieh M, Duvdevani M, Schlesinger I, Nassar M, Erich I, Hadad R, Yogev-Seligmann G. Socio-Clinical factors associated with Parkinson's disease-related specific self-management behaviours. Chronic Illn 2024; 20:699-711. [PMID: 37671410 PMCID: PMC11622522 DOI: 10.1177/17423953231198893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/12/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To test associations between socio-clinical factors, self-management and patient activation among patients with Parkinson's disease (PD), and to explore the use of regression tree to find the cut-off levels of socio-clinical factors which associate with lower or higher self-management behaviours and patient's activation. METHODS A cross-sectional study of patients with PD (n = 62) who underwent assessment of their socio-clinical factors including age, gender, cognitive status, comorbidities, disease severity (motor and non-motor symptoms) and social support. The associations of these factors to specific aspects of self-management behaviours including utilization of rehabilitative treatments, physical activity and patient activation were tested. RESULTS Most patients did not utilize rehabilitative treatments. Non-motor symptoms and cognitive status were significantly associated with physical activity (R2 = 0.35, F(3, 58) = 10.50, p < 0.001). Non-motor symptoms were significantly associated with patient activation (R2 = 0.30, F(1, 30) = 25.88, p < 0.001). Patients with Mini-Mental State Exam score ≤24 performed less physical activity, relative to those with a higher score. Patients with ≤5 non-motor symptoms showed higher activation relative to those with >5. CONCLUSION In PD, disease-specific clinical characteristics overshadow other personal factors as determinants of self-management behaviours. The role of non-motor symptoms in reduced self-management behaviours and activation is highlighted.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Maram Abu Taieh
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Duvdevani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Ilana Schlesinger
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Maria Nassar
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Ilana Erich
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Rafi Hadad
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Martín-Ordiales N, Hidalgo MD, Martín-Chaparro MP, Ballester-Plané J, Barrios M. Assessing the Psychometric Properties of the Illness Management and Recovery Scale: A Systematic Review Using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN). Behav Sci (Basel) 2024; 14:340. [PMID: 38667137 PMCID: PMC11047639 DOI: 10.3390/bs14040340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
The Illness Management and Recovery Scale (IMR-S) is based on the IMR program, developed to assess the recovery process for people with severe mental disorders by considering the perceptions of clients and clinicians involved in it. The aim of this study was to analyze the psychometric properties of the IMR-S so as to determine the reliability and suitability of its scores for evaluating recovery. Two coders searched five databases for studies, published between January 2004 and May 2023, that describe the psychometric assessment of the IMR-S. Studies were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. Finally, 46 papers were included. Methodological quality was very good for most of the studies that provide information on internal validity, and limited for those that report on responsiveness. Measurement properties were positive for convergent validity and measurement error. The quality of evidence was high for structural validity studies. Although this study only includes research published in English and may have overlooked certain psychometric properties evaluated in studies published in other languages, our findings suggest that the IMR-S is a valid and reliable instrument, demonstrating its potential to offer guidance for clinical practice.
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Affiliation(s)
- Nuria Martín-Ordiales
- Department of Psychiatry and Social Psychology, University of Murcia, 30100 Murcia, Spain; (N.M.-O.); (M.P.M.-C.)
| | - María Dolores Hidalgo
- Department Basic Psychology and Methodology, University of Murcia, 30100 Murcia, Spain; (M.D.H.); (J.B.-P.)
| | - María Pilar Martín-Chaparro
- Department of Psychiatry and Social Psychology, University of Murcia, 30100 Murcia, Spain; (N.M.-O.); (M.P.M.-C.)
| | - Júlia Ballester-Plané
- Department Basic Psychology and Methodology, University of Murcia, 30100 Murcia, Spain; (M.D.H.); (J.B.-P.)
- Departament of Psicology, University Abat Oliba CEU, CEU Universities, 08022 Barcelona, Spain
- Institute of Neurociencies, University of Barcelona, 08035 Barcelona, Spain
- Institute of Research Sant Joan de Déu, 08950 Barcelona, Spain
| | - Maite Barrios
- Institute of Neurociencies, University of Barcelona, 08035 Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, 08035 Barcelona, Spain
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Duvdevani M, Yogev-Seligmann G, Schlesinger I, Nassar M, Erich I, Hadad R, Kafri M. Association of health behaviors with function and health-related quality of life among patients with Parkinson's disease. Isr J Health Policy Res 2024; 13:2. [PMID: 38173041 PMCID: PMC10763356 DOI: 10.1186/s13584-023-00588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Current evidence on chronic conditions favors promotion of health behaviors as a mean to positively impact health outcomes. In Parkinson's disease, performing health behaviors is indicated as a means to fight the long-lasting burden of the disease. Understanding actual engagement in health behaviors and patient activation and their association to function and health-related quality of life is therefore important. Our objectives were, among people with Parkinson's disease: (1) to characterize health behaviors including utilization of rehabilitative treatments, physical activity, and patient activation levels, and (2) to test the associations between these health behaviors and health outcomes. METHODS A cross-sectional study of 88 people with Parkinson's disease (age 66.84 ± 8.8) was conducted. Participants answered questionnaires measuring health behaviors including utilization of health professions treatments, physical activity, patient activation, and health outcomes consisting of function and health-related quality of life. Linear regression models were conducted to test associations between measured health behaviors, function and health-related quality of life. RESULTS Participants rarely engage in rehabilitative treatments, but showed high levels of patient activation. Controlled by demographics and disease severity, physical activity and patient activation were associated with function (b = 0.41, p < .001; b = 0.2, p = .02, respectively) and physical activity but not patient activation, which was associated with health-related quality of life (b = 0.19, p = .03). There was also interaction effects of physical activity and non-motor symptoms, and physical activity and motor symptoms on health-related quality of life (b = 0.19, p = .02 and b = - 0.22, p = .01, respectively). CONCLUSIONS In respect to their potential health-related benefits for people with Parkinson's disease, health professionals' treatments are underutilized. Findings supported the importance of health behaviors for maintaining function and health-related quality of life among people with Parkinson's disease. They also show a differential contribution of motor and non-motor symptoms to the association between physical activity and quality of life. It is suggested that policy makers encourage opportunities for physical activity tailored for people with Parkinson's disease and adopt a proactive stance towards enhancing awareness and use of rehabilitation services. Trial registration NCT05211700, ClinicalTrials.gov ID: NCT05211700 first release 12/30/2021, https://classic. CLINICALTRIALS gov/ct2/show/NCT05211700.
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Affiliation(s)
- Michal Duvdevani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel.
| | - Ilana Schlesinger
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Maria Nassar
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Ilana Erich
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Rafi Hadad
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Naamneh-Abuelhija B, Yogev-Seligmann G, Kafri M. Does affiliation with a minority group affect patient activation? PATIENT EDUCATION AND COUNSELING 2024; 118:108011. [PMID: 37866072 DOI: 10.1016/j.pec.2023.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To systematically review published studies assessing associations between ethnicity and patient activation (PA) among people with chronic conditions. METHODS A systematic review (PROSPERO-CRD42022320793) was performed by searching in PubMed, CINAHL, Scopus, and Google Scholar. Studies were included according to the following criteria: age > 18, diagnosis of at least one chronic condition, assessment of PA, report of ethnic minority group, and statistical analyses of PA scores include between-group comparisons or correlation or regression with ethnic group affiliation. Two reviewers conducted independent screening of records and full-text articles published until July 2021. Quality was evaluated using the National Institutes of Health study quality assessment tool. RESULTS From 197 records identified, 12 studies were included. The majority of studies focused on participants of White, Black and Hispanic ethnicity. Seven studies establish a significant association between ethnicity and PA, while the remainder of the studies found no association or inconclusive results. CONCLUSIONS The findings indicate that ethnicity is related to PA although additional, multiple explanatory variables other than ethnicity to PA were identified. Practice implications Programs to promote PA should be adjusted to participants' ethnic affiliation but consider differences in the barriers to PA and their magnitude that may differ across different ethnicities.
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Affiliation(s)
- Badera Naamneh-Abuelhija
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
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Thongsalab J, Yunibhand J, Uthis P. Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review. BELITUNG NURSING JOURNAL 2023; 9:198-208. [PMID: 37492751 PMCID: PMC10363967 DOI: 10.33546/bnj.2632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 07/27/2023] Open
Abstract
Background The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. Objective This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. Design The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Data Sources Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Review Methods Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Results Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. Conclusion This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals' quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.
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Affiliation(s)
| | | | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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Ponce-Correa F, Caqueo-Urízar A, Berrios R, Escobar-Soler C. Defining recovery in schizophrenia: A review of outcome studies. Psychiatry Res 2023; 322:115134. [PMID: 36871410 DOI: 10.1016/j.psychres.2023.115134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
Schizophrenia is a chronic disorder with a heterogenous course and different ways in which recovery is measured or perceived. Recovery in schizophrenia is a complex process that it can be defined either from a clinical perspective focused on sustained symptom and functional remission, or from a patient-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Therefore, this meta-analysis aimed to examine the relationship of global measures of subjective recovery with each of the components of clinical recovery such as symptom severity and functioning, in patients with schizophrenia spectrum disorders. The results showed that the association between different indicators of personal recovery and remission are weak and inverse (dIG+ = -0.18, z = -2.71, p < 0.01), however, this finding is not substantial according to the sensitivity indicators. With respect to functionality and personal recovery, there was a moderate relationship (dIG+ = 0.26, z = 7.894, p < 0.01) with adequate sensitivity indices. In addition, a low consensus exists between subjective measures that are more related to the patient's perspective and clinical measures based on experts and clinician's viewpoint.
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Affiliation(s)
- Felipe Ponce-Correa
- Programa Doctorado en Psicología, Escuela de Psicología y Filosofía, Facultad de Ciencias Sociales y Jurídicas, Universidad de Tarapacá, Avenida 18 de Septiembre N 2222, Casilla 7-D, Arica, Chile
| | | | - Raúl Berrios
- Departamento de administración, Facultad de administración y economía, Universidad de Santiago de Chile, Chile
| | - Carolang Escobar-Soler
- Programa Doctorado en Psicología, Escuela de Psicología y Filosofía, Facultad de Ciencias Sociales y Jurídicas, Universidad de Tarapacá, Avenida 18 de Septiembre N 2222, Casilla 7-D, Arica, Chile
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Laranjeira C, Carvalho D, Valentim O, Moutinho L, Morgado T, Tomás C, Gomes J, Querido A. Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3869. [PMID: 36900879 PMCID: PMC10001153 DOI: 10.3390/ijerph20053869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Patient therapeutic adherence lies at the core of mental health care. Health Care professionals and organizations play a major role in promoting adherence among people with mental disorders. However, defining therapeutic adherence remains complex. We used Rodgers' evolutionary concept analysis to explore the concept of therapeutic adherence in the context of mental health. We conducted a systematic literature search on Medline/PubMed and CINAHL for works published between January 2012 and December 2022. The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors. Antecedents are those related to patients, such as their background, beliefs and attitudes, and acceptance of mental illness-and those related to patient-HCP therapeutic engagement. Lastly, three different consequences of the concept emerged: an improvement in clinical and social outcomes, commitment to treatment, and the quality of healthcare delivery. We discuss an operational definition that emerged from the concept analysis approach. However, considering the concept has undergone evolutionary changes, further research related to patient adherence experiences in an ecological stance is needed.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Daniel Carvalho
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Hospital Center of Leiria–Hospital de Santo André, R. de Santo André, 2410-197 Leiria, Portugal
| | - Olga Valentim
- Group Innovation & Development in Nursing (NursID), Center for Health Technology and Services Research (CINTESIS@RISE), 4200-450 Porto, Portugal
- Nursing School of Lisbon (ESEL), Av. Prof. Egas Moniz, 1600-096 Lisboa, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Av. Prof. Egas Moniz, 1600-096 Lisboa, Portugal
| | - Lídia Moutinho
- Group Innovation & Development in Nursing (NursID), Center for Health Technology and Services Research (CINTESIS@RISE), 4200-450 Porto, Portugal
- Nursing School of Lisbon (ESEL), Av. Prof. Egas Moniz, 1600-096 Lisboa, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Av. Prof. Egas Moniz, 1600-096 Lisboa, Portugal
| | - Tânia Morgado
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Group Innovation & Development in Nursing (NursID), Center for Health Technology and Services Research (CINTESIS@RISE), 4200-450 Porto, Portugal
- Pediatric Hospital, Coimbra Hospital and University Centre, R. Dr. Afonso Romão, 3000-602 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Catarina Tomás
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Group Innovation & Development in Nursing (NursID), Center for Health Technology and Services Research (CINTESIS@RISE), 4200-450 Porto, Portugal
| | - João Gomes
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Hospital Center of Leiria–Hospital de Santo André, R. de Santo André, 2410-197 Leiria, Portugal
| | - Ana Querido
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Group Innovation & Development in Nursing (NursID), Center for Health Technology and Services Research (CINTESIS@RISE), 4200-450 Porto, Portugal
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McNeely HE, Letts L, Martin ML, Strong S. Participants' Evaluation and Outcomes following Integration of Self-Management Support into Outpatient Schizophrenia Case Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3035. [PMID: 36833727 PMCID: PMC9964489 DOI: 10.3390/ijerph20043035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Self-management is advocated as a feasible, effective intervention to support individuals to actively manage the impact of illness and live healthier lives. We sought to evaluate a piloted self-management model, SET for Health, tailored for individuals living with schizophrenia embedded within ambulatory case management. (2) Methods: A mixed-methods design engaged 40 adults living with schizophrenia in the SET for Health protocol. Functional and symptomatic outcomes were measured by self-report and clinician ratings at baseline and completion of self-management plans, on average one year later. Semi-structured qualitative client interviews invited evaluations of personal experiences with the intervention. (3) Results: Significant improvements were found concerning client illness severity, social and occupational functioning, illness management and functional recovery with reductions in emergency visits and days in hospital. Clients endorsed the value of the intervention. Baseline clinical characteristics did not predict who benefited. Participation contributed to motivational gains and quality of life. (4) Conclusions: Results confirmed self-management support embedded within traditional case management improved clients' clinical and functional status, and contributed to quality of life. Clients engaged in their recovery and actively used self-management strategies. Self-management can be successfully adopted by clients with schizophrenia regardless of age, gender, education, illness severity or duration.
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Affiliation(s)
- Heather E. McNeely
- Schizophrenia and Community Integration Service, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Mary-Lou Martin
- Forensic Service, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Susan Strong
- Schizophrenia and Community Integration Service, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
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11
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Fridén L, Hultsjö S, Lydell M, Jormfeldt H. Relatives' experiences of an equine-assisted intervention for people with psychotic disorders. Int J Qual Stud Health Well-being 2022; 17:2087276. [PMID: 35698741 PMCID: PMC9310814 DOI: 10.1080/17482631.2022.2087276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to describe relatives' experiences of an equine-assisted intervention for people with psychotic disorders. METHODS The study has a qualitative and descriptive design. Ten semi-structured interviews were performed with relatives of people with a psychotic disorder who had participated in an equine-assisted intervention. A conventional content analysis was used to analyse the data. RESULT The overall category "Being with the horses strengthens health capabilities" summarizes the four identified subcategories "The horses contribute to a context with a common focus", "Interaction with the horses enhances self-confidence and motivation", "The interplay with the horses nurtures positive emotions" and "Being with the horses encourages physical activity". CONCLUSIONS The result of this study contributes to the growing body of research about the potential outcomes of equine-assisted interventions. The result also indicates that equine-assisted interventions may improve health capabilities among people with psychotic disorders. The generated knowledge may be useful in mental health services when developing equine-assisted interventions.
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Affiliation(s)
- Linda Fridén
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Sally Hultsjö
- Department of Psychiatry, Region Jönköping County, Sweden and Department of Health, Medicine and Caring Sciences, Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | - Marie Lydell
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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12
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Üşenmez TY, Budak FK, Ayhan MO. The Effect of Psychological Resilience on Hope in Individuals With Schizophrenia. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220919-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Andersson P, Tistad M, Eriksson Å, Enebrink P, Sturidsson K. Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care – Study protocol for a multicenter cluster randomized trial. Contemp Clin Trials Commun 2022; 27:100907. [PMID: 35499065 PMCID: PMC9038540 DOI: 10.1016/j.conctc.2022.100907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/13/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants’ illness management skills and recovery. Objective To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual. Method This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory. Ethics and dissemination The study is approved by the Swedish Ethical Review Authority (Registration No. 2020–02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).
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Affiliation(s)
- Peter Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, Nissers väg 3, 791 82, Falun, Sweden
- Corresponding author. Nissers väg 3, 791 82, Falun, Sweden.
| | - Malin Tistad
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183, Huddinge, Sweden
| | - Åsa Eriksson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Knut Sturidsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
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Wang M, Wang J, Wang Y, Huang X, Huang Y, Huang J, Feng Y, Li X. Reliability and validity of the Mental Health Self-management Questionnaire among Chinese patients with mood and anxiety disorders. Front Psychiatry 2022; 13:952951. [PMID: 35966465 PMCID: PMC9372341 DOI: 10.3389/fpsyt.2022.952951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-management plays an important role in promoting and restoring mental health for individuals with mental health issues. However, there is no valid and reliable Chinese tool assessing the self-management behaviors of people with mood and anxiety disorders. This study aimed to develop a Chinese version of the Mental Health Self-management Questionnaire (MHSQ-C) and to verify its psychometric properties. METHODS A total of 440 potential participants were recruited by convenience sampling from June to August 2020. Item analysis and analyses of internal consistency, test-retest reliability, content validity, construct validity and criterion validity were performed. RESULTS Data from 326 participants were used. Three factors obtained via principal component analysis and varimax rotation explained 53.68% of the total variance. The average content validity index was 0.99. The Cronbach's α coefficient (total: 0.874, clinical: 0.706, empowerment: 0.818, vitality: 0.830) and test-retest reliability (ICC: total: 0.783, 95% confidence interval (CI) [0.616, 0.882], clinical: 0.525, 95% CI [0.240, 0.725], empowerment: 0.786, 95% CI [0.622, 0.884], vitality: 0.748, 95% CI [0.564, 0.862]) were good. The MHSQ-C was well correlated with the Partners in Health scale and showed no floor or ceiling effect. DISCUSSION The MHSQ-C is a reliable and valid tool to evaluate the self-management strategies of patients with mood and anxiety disorders.
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Affiliation(s)
- Mengmeng Wang
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
| | - Jingjun Wang
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
| | - Ya Wang
- Department of Nursing, West China Hospital and West China School of Nursing, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yalin Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Junqiang Huang
- Chengdu Dekang Hospital/Chengdu Psychiatric Hospital, Chengdu, China
| | - Yan Feng
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolin Li
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
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Ghaleb Dailah H. Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy. Front Public Health 2021; 9:736203. [PMID: 34900893 PMCID: PMC8661094 DOI: 10.3389/fpubh.2021.736203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.
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Golubinski V, Wild EM. Factors associated with patient activation in a socially deprived population: Evidence from Germany. PATIENT EDUCATION AND COUNSELING 2021; 104:2791-2802. [PMID: 33863586 DOI: 10.1016/j.pec.2021.03.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patient activation has been identified as a crucial determinant of health, but little is known about its own determinants, particularly in low socioeconomic status populations. To address this research gap, we analyzed factors that might explain variation in patient activation in such a population. METHODS We conducted a cross-sectional patient survey (n = 582) in a low socioeconomic status urban district in Germany in 2017. Using multivariate linear regressions, we examined the association between patient activation and a range of psychological, sociodemographic, and health-related factors. To assess the relative importance of these factors, we used dominance analysis. RESULTS Our results suggest that age, employment status, linguistic acculturation, health status, and self-efficacy were significantly associated with patient activation. Dominance analysis indicated that self-efficacy was the most important factor explaining variation in patient activation. CONCLUSIONS Age, employment status, linguistic acculturation, health status, and self-efficacy are important determinants of patient activation. PRACTICE IMPLICATIONS Our results can inform decision makers about approaches for more targeted and effective interventions to improve patient activation in low socioeconomic status populations. Much might be gained by investing in interventions that focus on age, employment status, linguistic acculturation, and health status. Interventions that improve self-efficacy may represent a particularly promising approach.
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Affiliation(s)
- Veronika Golubinski
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Eva-Maria Wild
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany.
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17
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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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Yogev-Seligmann G, Kafri M. COVID-19 social distancing: negative effects on people with Parkinson disease and their associations with confidence for self-management. BMC Neurol 2021; 21:284. [PMID: 34284733 PMCID: PMC8289714 DOI: 10.1186/s12883-021-02313-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the effects of COVID-19 social distancing on the function, health, and well-being of people with Parkinson disease (PD), and test the association of these effects with patients' activation levels, i.e., their skills and confidence in managing their health. METHODS Community-dwelling individuals with PD answered an anonymous web-based survey. Part 1 included 27 multiple-choice questions regarding changes in function, health, medical care, and well-being. Part 2 consisted of the Patient Activation Measure, which enquired about skills and confidence in managing one's health. RESULTS Respondents (N = 142) reported decreases in various function (24.8%-37.3%), health (33.8%-43%), and well-being (26.1%-47.1%) domains. Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 67.8% associated this with the cessation of rehabilitative treatments or decrease in physical activity. Patients' activation levels were inversely correlated with increased assistance for activities of daily living, increased tiredness, worsening symptoms, and lack of support from family and friends. CONCLUSIONS Social distancing had a major negative impact on the health and function of people with PD. PRACTICAL IMPLICATIONS Supporting people with PD skills and confidence in managing health may preserve their physical and mental health during this period of dramatic changes in life's circumstances.
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Affiliation(s)
- Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, 3498838 Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Melby K, Nygård M, Brobakken MF, Gråwe RW, Güzey IC, Reitan SK, Vedul-Kjelsås E, Heggelund J, Tchounwou PB. Test-Retest Reliability of the Patient Activation Measure-13 in Adults with Substance Use Disorders and Schizophrenia Spectrum Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1185. [PMID: 33572717 PMCID: PMC7908201 DOI: 10.3390/ijerph18031185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Patient Activation Measure-13 (PAM-13) is a valid and widely used questionnaire that assess an individual's knowledge, confidence, and skills for self-management of their chronic illness. Although there is some evidence regarding its reliability, the test-retest reliability has not been investigated among patients with substance use disorders (SUDs) or schizophrenia spectrum disorders. We investigated the internal consistency and test-retest reliability of PAM-13 in these populations. Test-retest reliability was analysed using data from 29 patients with SUDs and 28 with schizophrenia spectrum disorders. Cronbach's α and Intraclass Correlation Coefficient (ICC) scores were used to examine internal consistency and test-retest reliability, respectively. Of the 60 collected test-retest questionnaires, 57 were included in the analyses. No mean differences between time one (T1) and time two (T2) were observed in either patient group, except for item 12 in schizophrenia spectrum disorders patients (p < 0.05). Internal consistency for T1 and T2 was 0.75 and 0.84 in SUDs patients and 0.87 and 0.81 in schizophrenia spectrum disorders patients, respectively. The ICC was r = 0.86 in patients with SUDs and r = 0.93 in patients with schizophrenia spectrum disorders. To conclude, PAM-13 showed good internal consistency and test-retest reliability in SUDs and schizophrenia spectrum disorders patients.
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Affiliation(s)
- Katrine Melby
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway;
- Blue Cross Lade Addiction Treatment Centre, 7041 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Mona Nygård
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Mathias Forsberg Brobakken
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Rolf W. Gråwe
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ismail Cüneyt Güzey
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Einar Vedul-Kjelsås
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Jørn Heggelund
- Regional Center for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Paul B. Tchounwou
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Tiller Community Mental Health Centre, Division of Psychiatry, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
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Leendertse JCP, Wierdsma AI, van den Berg D, Ruissen AM, Slade M, Castelein S, Mulder CL. Personal Recovery in People With a Psychotic Disorder: A Systematic Review and Meta-Analysis of Associated Factors. Front Psychiatry 2021; 12:622628. [PMID: 33708145 PMCID: PMC7940758 DOI: 10.3389/fpsyt.2021.622628] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = -0.44, 95%CI -0.50 to -0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48-0.63), meaning in life (r = 0.48, 95%CI 0.38-0.58) and empowerment (r = 0.53, 95%CI 0.42-0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43-0.65) and identity (r = 0.43, 95%CI 0.35-0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time.
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Affiliation(s)
- J C P Leendertse
- Emergis Institute for Mental Healthcare, Kloetinge, Netherlands.,Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A I Wierdsma
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - D van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - A M Ruissen
- Emergis Institute for Mental Healthcare, Kloetinge, Netherlands.,Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands.,Department of Psychiatry, Haaglanden Medical Centre, The Hague, Netherlands
| | - M Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - S Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, Netherlands.,Faculty of Behavioural and Social Sciences, Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - C L Mulder
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands.,Research and Innovation, Parnassia Psychiatric Institute, The Hague, Netherlands
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21
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Chiang YS, Chang YC, Liu YP, Tzeng WC. Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model. J Adv Nurs 2020; 77:1271-1283. [PMID: 33230880 DOI: 10.1111/jan.14663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases. DESIGN Descriptive, cross-sectional study design. METHODS In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables. RESULTS Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life. CONCLUSION The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population. IMPACT Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.
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Affiliation(s)
- Yu-Shuang Chiang
- Department of Nursing, Tri-Service General Hospital Beitou Branch, Taipei City, Taiwan.,School of Nursing, National Defense Medical Center, Taipei City, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Yia-Ping Liu
- Department of Psychiatry, Cheng-Hsin General Hospital, Taipei City, Taiwan.,Laboratory of Cognitive Neuroscience, Departments of Physiology and Psychiatry, National Defense Medical Center, Taipei City, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan
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22
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Budak FK, Yildirim T, Özdemir A. The effect of negative automatic thoughts on hope in patients with schizophrenia. Perspect Psychiatr Care 2020; 57:936-940. [PMID: 33090516 DOI: 10.1111/ppc.12637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The purpose of this study is to determine the effect of negative automatic thoughts on hope in patients with schizophrenia. DESIGN AND METHODS The sample size of the study was calculated to be 94 patients through the power analysis. The study was completed with 115 patients who met the inclusion criteria. "descriptive characteristics form," "automatic thoughts questionnaire-negative," and "dispositional hope scale" were used to collect the data. FINDINGS In the study, it was found that there was a negative strong correlation between negative automatic thoughts and hope levels. In addition, the negative automatic thoughts of the patients had a statistical significance in accounting for hope (p < .05) and the negative automatic thoughts predicted the hope by 66%. PRACTICE IMPLICATIONS In the study, it was found that the patients had high negative automatic thoughts and moderate level of hopes. As negative automatic thoughts increased, hope decreased.
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Affiliation(s)
- Funda Kavak Budak
- Department of Psychiatric Nursing, Inonu Unıversıty, Malatya, Turkey
| | - Tülay Yildirim
- Department of Psychiatric Nursing, Dıcle Unıversıty, Diyarbakır, Turkey
| | - Aysel Özdemir
- Department of Psychiatric Nursing, Fırat Unıversıty, Elazığ, Turkey
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23
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Zyto S, Jabben N, Schulte PFJ, Regeer EJ, Goossens PJJ, Kupka RW. A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers. Int J Bipolar Disord 2020; 8:26. [PMID: 32869118 PMCID: PMC7459037 DOI: 10.1186/s40345-020-00190-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
Background Psychoeducation (PE) for bipolar disorder (BD) has a first-line recommendation for the maintenance treatment phase of BD. Formats vary greatly in the number of sessions, whether offered individually or in a group, and with or without caregivers attending. Due to a large variation in formats in the Netherlands, a new program was developed and implemented in 17 outpatient clinics throughout the country. The current study investigated the feasibility of a newly developed 12-sessions PE group program for patients with BD and their caregivers in routine outpatient practice and additionally explored its effectiveness. Methods Participants in the study were 108 patients diagnosed with BD, 88 caregivers and 35 course leaders. Feasibility and acceptance of the program were investigated by measures of attendance, and evaluative questionnaires after session 12. Preliminary treatment effects were investigated by pre- and post-measures on mood symptoms, attitudes towards BD and its treatment, levels of self-management, and levels of expressed emotion. Results There was a high degree of satisfaction with the current program as reported by patients, caregivers, and course leaders. The average attendance was high and 83% of the patients and 75% of the caregivers completed the program. Analyses of treatment effects suggest positive effects on depressive symptoms and self-management in patients, and lower EE as experienced by caregivers. Conclusions This compact 12-sessions psychoeducation group program showed good feasibility and was well accepted by patients, caregivers, and course leaders. Preliminary effects on measures of self-management, expressed emotions, and depressive symptoms were promising. After its introduction it has been widely implemented in mental health institutions throughout the Netherlands.
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Affiliation(s)
- Susan Zyto
- Mental Health Service Organisation North Holland North, Center for Psychosomatic Medicine, Hoorn, The Netherlands. .,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Nienke Jabben
- Department of Psychiatry, Zuyderland Medical Center, Sittard, The Netherlands
| | - Peter F J Schulte
- Mental Health Service Organisation North Holland North, Alkmaar, The Netherlands
| | - Eline J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Peter J J Goossens
- Dimence Group Mental Health Care Center, Deventer, The Netherlands.,University Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ralph W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
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24
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Işık I, Ergün G. Hope and belonging in patients with schizophrenia: A phenomenological study. Perspect Psychiatr Care 2020; 56:235-242. [PMID: 31313318 DOI: 10.1111/ppc.12418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to examine in depth the senses of hope and belonging in patients with schizophrenia and factors which affect these. DESIGN AND METHODS The data were collected through the phenomenological interview method and interpreted using Strauss and Corbin's approach to qualitative data analysis. FINDINGS Patients with schizophrenia reported that having hope and feeling a sense of belonging were very important to them and patients with the same diagnosis, and that being accepted by society, being employed and being productive increased their senses of both hope and belonging. PRACTICE IMPLICATIONS For the rehabilitation of patients with schizophrenia, which is a chronic disease, psychiatric nurses should carry out activities which increase their senses of hope and belonging.
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Affiliation(s)
- Işıl Işık
- Department of Nursing, Faculty of Health Sciences, Yeditepe University, Istanbul, Turkey
| | - Gül Ergün
- Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
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25
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Zhang X, Zhang R, Lu X. Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance. Telemed J E Health 2020; 26:1373-1382. [PMID: 32017672 DOI: 10.1089/tmj.2019.0258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.
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Affiliation(s)
- Xijing Zhang
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Runtong Zhang
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Xinyi Lu
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, China
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26
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Fortuna KL, Brooks JM, Umucu E, Walker R, Chow PI. Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions. ACTA ACUST UNITED AC 2019; 4:152-161. [PMID: 34337145 DOI: 10.1007/s41347-019-00105-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability -meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live sucessfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.
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Affiliation(s)
- Karen L Fortuna
- The Geisel School of Medicine at Dartmouth, 2 Pillsbury Street, Suite 401, Concord, NH 03301, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH 03766, USA
| | - Jessica M Brooks
- James J. Peters VA Medical Center, Geriatric Research, Education and Clinical Center, 130 W Kingsbridge Rd, The Bronx, NY, USA
| | - Emre Umucu
- Department of Rehabilitation Sciences, University of Texas at El Paso, 500 W University Ave, El Paso, TX 79968, USA
| | - Robert Walker
- Massachusetts Department of Mental Health, Office of Recovery, 25 Staniford St, Boston, MA 02114, USA
| | - Phillip I Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
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27
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Van Eck RM, Burger TJ, Schenkelaars M, Vellinga A, de Koning MB, Schirmbeck F, Kikkert M, Dekker J, de Haan L. The impact of affective symptoms on personal recovery of patients with severe mental illness. Int J Soc Psychiatry 2018; 64:521-527. [PMID: 29992846 DOI: 10.1177/0020764018784610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical recovery is often defined as remission of symptoms. Personal recovery is described as growing beyond the catastrophic effects of mental illness, sometimes despite ongoing symptoms. AIMS To examine the relationship between the severity of clinical symptom domains and personal recovery in patients with severe mental illness (SMI). METHODS Symptom severity and personal recovery of 105 outpatients with SMI at Mentrum, part of Arkin Institute for Mental Health in Amsterdam, the Netherlands, were assessed using the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E) and the Mental Health Recovery Measure (MHRM). Correlation and regression analyses were used to investigate the associations. RESULTS The multiple regression analysis showed that only affective symptoms significantly predicted personal recovery, whereas neither positive nor negative symptom severity added to the explained variance in the model. CONCLUSION The association between affective symptoms and personal recovery in patients with SMI implies that treatment of affective symptoms may advance personal recovery, and/or support of personal recovery may improve mood, whereas focussing on treatment of psychotic symptoms might not be the key to personal recovery. More research is needed to elucidate causal interrelations.
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Affiliation(s)
- Robin Michael Van Eck
- 1 Mentrum, part of Arkin Institute for Mental Health, Amsterdam, The Netherlands.,2 Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Thijs Jan Burger
- 2 Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,3 Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | | | - Astrid Vellinga
- 1 Mentrum, part of Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | | | - Frederike Schirmbeck
- 2 Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,3 Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Martijn Kikkert
- 3 Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Jack Dekker
- 3 Arkin Institute for Mental Health, Amsterdam, The Netherlands.,5 Department of Clinical Psychology, Free University, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- 2 Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,3 Arkin Institute for Mental Health, Amsterdam, The Netherlands
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28
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Van Eck RM, Burger TJ, Vellinga A, Schirmbeck F, de Haan L. The Relationship Between Clinical and Personal Recovery in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis. Schizophr Bull 2018; 44:631-642. [PMID: 29036720 PMCID: PMC5890469 DOI: 10.1093/schbul/sbx088] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Patients describe experiencing personal recovery despite ongoing symptoms of psychosis. The aim of the current research was to perform a meta-analysis investigating the relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders. A comprehensive OvidSP database search was performed to identify relevant studies. Correlation coefficients of the relationship between clinical and personal recovery were retrieved from primary studies. Meta-analyses were performed, calculating mean weighted effect sizes for the association between clinical and personal recovery, hope, and empowerment. Additionally, associations between positive, negative, affective symptoms, general functioning, and personal recovery were investigated. The results show that heterogeneity across studies was substantial. Random effect meta-analysis of the relationship between symptom severity and personal recovery revealed a mean weighted correlation coefficient of r = -.21 (95% CI = -0.27 to -0.14, P < .001). We found the following mean weighted effect size for positive symptoms r = -.20 (95% CI = -0.27 to -0.12, P < .001), negative symptoms r = -.24 (95% CI = -0.33 to -0.15, P < .001), affective symptoms r = -.34 (95% CI = -0.44 to -0.24, P < .001) and functioning r = .21 (95% CI = -0.09 to 0.32, P < .001). The results indicate a significant small to medium association between clinical and personal recovery. Psychotic symptoms show a smaller correlation than affective symptoms with personal recovery. These findings suggest that clinical and personal recovery should both be considered in treatment and outcome monitoring of patients with schizophrenia spectrum disorders.
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Affiliation(s)
- Robin Michael Van Eck
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Thijs Jan Burger
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid Vellinga
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
- Mentrum, part of Arkin, Amsterdam, The Netherlands
| | - Frederike Schirmbeck
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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29
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Matthias MS, Fukui S, Salyers MP. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:133-140. [PMID: 26427999 DOI: 10.1007/s10488-015-0688-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.
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Affiliation(s)
- Marianne S Matthias
- Department of Veterans Affairs Health Services Research and Development Service, Center for Health Information and Communication, 1481 W 10th St (11H), Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Indianapolis, IN, USA. .,Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Sadaaki Fukui
- Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, Lawrence, KS, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
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30
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Kimerling R, Pavao J, Wong A. Patient Activation and Mental Health Care Experiences Among Women Veterans. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:506-13. [PMID: 25917224 DOI: 10.1007/s10488-015-0653-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose-response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, PTSD-324, Menlo Park, CA, 94025, USA. .,Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA.
| | - Joanne Pavao
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, PTSD-324, Menlo Park, CA, 94025, USA
| | - Ava Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA
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31
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White DA, McGuire AB, Luther L, Anderson AI, Phalen P, McGrew JH. Consumer factors predicting level of treatment response to illness management and recovery. Psychiatr Rehabil J 2017; 40:344-353. [PMID: 28910123 PMCID: PMC5739957 DOI: 10.1037/prj0000284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations. METHOD Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR. RESULTS Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p < .001, R2 = .248, R2 change = .05. Additionally, we found that higher levels of maladaptive coping at baseline were predictive of higher levels of adaptive coping at follow-up, F(2, 180) = 5.29, p < .02, R2 = .38, R2 change = .02. Evidence did not support additional predictors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Previously, consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record
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Affiliation(s)
- Dominique A White
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Alan B McGuire
- Health Services Research and Development, Richard L. Roudebush, Veterans Affairs Medical Center
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | | | - Peter Phalen
- School of Psychological Sciences, University of Indianapolis
| | - John H McGrew
- Department of Psychology, Indiana University-Purdue University Indianapolis
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32
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Bonfils KA, Luther L, Fukui S, Adams EL, Dreison KC, Firmin RL, Salyers MP. Correlates of observer-rated active involvement in psychiatric treatment visits. Psychiatry Res 2017; 256:384-390. [PMID: 28688351 PMCID: PMC5603392 DOI: 10.1016/j.psychres.2017.06.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
Among people with serious mental illness, increased patient activation has been linked to a range of key recovery outcomes. To date, patient activation has been measured largely through self-report. The present study investigated correlates of a new tool that assesses active involvement through rating audio-recordings of treatment visits. The key domains of patient activation assessed in visits included: patients asking questions, discussing with providers instances of being active in managing illness outside the session, talking about goals, bringing up concerns, making evaluative statements about treatment, setting the agenda for the visit, and making requests about the course of treatment. The new coding scheme proved to be a feasible and reliable method for identifying multi-faceted behavioral indicators of patient activation. Contrary to our hypotheses, in a sample of 166 people diagnosed with severe mental illnesses, self-reported activation and observer-rated indices of activation were often not correlated or correlated in unexpected directions with the new behavioral measure of patient activation. This suggests the nature of patient activation may be complex and work is needed to understand how observer-rated and self-rated activation may predict differential recovery outcomes.
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Affiliation(s)
- Kelsey A. Bonfils
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States,phone: 317-274-6767; fax: 317-274-6756;
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Sadaaki Fukui
- The University of Kansas School of Social Welfare Center for Mental Health Research and Innovation, Lawrence, KS, United States
| | - Erin L. Adams
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Kimberly C. Dreison
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Ruth L. Firmin
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN, United States
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33
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Sims-Gould J, Vazirian S, Li N, Remick R, Khan K. Jump step - a community based participatory approach to physical activity & mental wellness. BMC Psychiatry 2017; 17:319. [PMID: 28859610 PMCID: PMC5579937 DOI: 10.1186/s12888-017-1476-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/22/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is a physical inactivity pandemic around the world despite the known benefits of engaging in physical activity. This is true for individuals who would receive notable benefits from physical activity, in particular those with mood disorders. In this study, we explored the factors that facilitate and impede engagement in physical activity for individuals with a mood disorder. The intent was to understand the key features of a community based physical activity program for these individuals. METHODS We recruited and interviewed 24 participants older than 18 with Major Depressive Disorder or Bipolar II. The interviews were conducted by peer researchers. The interviews were transcribed and analyzed using NVivo 10™. Thematic analysis was used to analyze the data. RESULTS The facilitators to physical activity include being socially connected with family and friends, building a routine in daily life, and exposure to nature. The barriers to physical activity include the inability to build a routine owing to a mood disorder, and high cost. The ideal exercise program comprises a variety of light-to-moderate activities, offers the opportunity to connect with other participants with a mood disorder, and brings participants to nature. The average age of our participants was 52 which could have influenced the preferred level of intensity. CONCLUSION The individuals in this study felt that the key features of a physical activity program for individuals with a mood disorder must utilize a social network approach, take into account the preferences of potential participants, and incorporate nature (both green and blue spaces) as a health promotion resource.
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Affiliation(s)
- Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, 793-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Sara Vazirian
- 0000 0001 2288 9830grid.17091.3eUniversity of British Columbia, Center for Hip Health and Mobility, 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Neville Li
- 0000 0001 2288 9830grid.17091.3eUniversity of British Columbia, Center for Hip Health and Mobility, 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Ronald Remick
- grid.477581.8Mood Disorders Association of BC, 1450 - 605 Robson Street, Vancouver, BC V6B 5J3 Canada
| | - Karim Khan
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, 5950 University Blvd, Vancouver, BC V6T 1Z3 Canada
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Zimbudzi E, Lo C, Ranasinha S, Kerr PG, Polkinghorne KR, Teede H, Usherwood T, Walker RG, Johnson G, Fulcher G, Zoungas S. The association between patient activation and self-care practices: A cross-sectional study of an Australian population with comorbid diabetes and chronic kidney disease. Health Expect 2017; 20:1375-1384. [PMID: 28675539 PMCID: PMC5689227 DOI: 10.1111/hex.12577] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/28/2022] Open
Abstract
Objective This study aimed to examine the association between performance of self‐care activities and patient or disease factors as well as patient activation levels in patients with diabetes and chronic kidney disease (CKD) in Australia. Methods A cross‐sectional study was conducted among adults with diabetes and CKD (eGFR <60 mL/min/1.73m2) who were recruited from renal and diabetes clinics of four tertiary hospitals in Australia. Demographic and clinical data were collected, as well as responses to the Patient Activation Measure (PAM) and the Summary of Diabetes Self‐Care Activities (SDSCA) scale. Regression analyses were performed to determine the relationship between activation and performance of self‐care activities. Results A total of 317 patients (70% men) with a mean age of 66.9 (SD=11.0) years participated. The mean (SD) PAM and composite SDSCA scores were 57.6 (15.5) % (range 0‐100) and 37.3 (11.2) (range 0‐70), respectively. Younger age, being male, advanced stages of CKD and shorter duration of diabetes were associated with lower scores in one or more self‐care components. Patient activation was positively associated with the composite SDSCA score, and in particular the domains of general diet and blood sugar checking (P<.05), but not specific diet, exercising and foot checking. Conclusion In people with diabetes and CKD, a high level of patient activation was positively associated with a higher overall level of self‐care. Our results identify subgroups of people who may benefit from tailored interventions to further improve their health outcomes. Further prospective studies are warranted to confirm present findings.
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Affiliation(s)
- Edward Zimbudzi
- Department of Nephrology, Monash Health, Clayton, Vic, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia
| | - Clement Lo
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Vic, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Vic, Australia
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Vic, Australia
| | - Timothy Usherwood
- Department of General Practice, Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, Camperdown, NSW, Australia
| | - Rowan G Walker
- Department of Renal Medicine, Alfred Health, Prahran, Vic, Australia
| | | | - Greg Fulcher
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Vic, Australia.,The George Institute for Global Health, Camperdown, NSW, Australia
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Case K, Guo Y, Nixon SJ, Muller K, Huo T, Prather R, Morris H, Stoner D, Shenkman E. Exploring the Role of Executive Functioning Capacity in Patient Activation and Health Outcomes Among Medicaid Members With Multiple Comorbidities. Med Care Res Rev 2017; 76:444-461. [DOI: 10.1177/1077558717709419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient activation, the perceived capacity to manage one’s health, is positively associated with better health outcomes and lower costs. Underlying characteristics influencing patient activation are not completely understood leading to gaps in intervention strategies designed to improve patient activation. We suggest that variability in executive functioning influences patient activation and ultimately has an impact on health outcomes. To examine this hypothesis, 440 chronically ill Medicaid enrollees completed measures of executive functioning, patient activation, and health-related quality of life. Mediation analyses revealed that executive functioning: (a) directly affected patient activation and mental health-related quality of life, (b) indirectly affected mental health-related quality of life through patient activation, and (c) was unrelated to physical health-related quality of life. These data indicate that further study of the relationships among neurocognitive processes, patient activation, and health-related quality of life is needed and reinforces previous work demonstrating the association between patient activation and self-reported outcomes.
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Affiliation(s)
| | - Yi Guo
- University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | - Dena Stoner
- Department of State Health Services, Austin, TX, USA
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36
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Language and hope in schizophrenia-spectrum disorders. Psychiatry Res 2016; 245:8-14. [PMID: 27526311 DOI: 10.1016/j.psychres.2016.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 07/17/2016] [Accepted: 08/04/2016] [Indexed: 11/21/2022]
Abstract
Hope is integral to recovery for those with schizophrenia. Considering recent advancements in the examination of clients' lexical qualities, we were interested in how clients' words reflect hope. Using computerized lexical analysis, we examined social, emotion, and future words' relations to hope and its pathways and agency components. Forty-five clients provided detailed narratives about their life and mental illness. Transcripts were analyzed using the Linguistic Inquiry and Word Count program (LIWC), which assigns words to categories (e.g., "anxiety") based on a pre-existing dictionary. Correlations and linear multiple regression were used to examine relationships between lexical qualities and hope. Hope and its subcomponents had significant or trending bivariate correlations in expected directions with several emotion-related word categories (anger and sadness) but were not associated with expected categories such as social words, positive emotions, optimism, achievement, and future words. In linear multiple regressions, no LIWC variable significantly predicted hope agency, but anger words significantly predicted both total hope and hope pathways. Our findings indicate lexical analysis tools can be used to investigate recovery-oriented concepts such as hope, and results may inform clinical practice. Future research should aim to replicate our findings in larger samples.
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37
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Kipping S, Stuckey MI, Hernandez A, Nguyen T, Riahi S. A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation. J Med Internet Res 2016; 18:e294. [PMID: 27852556 PMCID: PMC5131190 DOI: 10.2196/jmir.6483] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/06/2016] [Accepted: 10/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Treatment for mental illness has shifted from focusing purely on treatment of symptoms to focusing on personal recovery. Patient activation is an important component of the recovery journey. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown. Objective To conduct a benefits evaluation of a Web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on (1) patient activation, (2) recovery, (3) productivity, and (4) administrative efficiencies. Methods All registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal and those who did not were designated as “users” and “nonusers,” respectively. All patients received usual treatment. Users had Web-based access to view parts of their electronic medical record, view upcoming appointments, and communicate with their health care provider. Users could attend portal training or support sessions led by either the engagement coordinator or peer support specialists. A subset of patients who created and utilized their portal account completed 2 Web-based surveys at baseline (just after enrollment; n=91) and at follow-up (6 and 10 months; n=65). The total score of the Mental Health Recovery Measure (MHRM) was a proxy for patient activation and the individual domains measured recovery. The System and Use Survey Tool (SUS) examined the use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and nonusers missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation. Results A total of 461 patients (44.0% male, n=203) registered for the portal, which was used 4761 times over the 1-year follow-up period. The majority of uses (95.34%, 4539/4761) were for e-views. The overall MHRM score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at combined follow-up (P=.01). Of the 8 recovery domains, 7 were increased at follow-up (all P<.05). The odds of a portal user attending an appointment were 67% (CI 56%-79%) greater than that of nonusers over the follow-up period. Compared with 2014, over 2015 there was an 86% and 57% decrease in requests for information in users and nonusers, respectively. The SUS revealed that users felt an increased sense of autonomy and found the portal to be user-friendly, helpful, and efficient but felt that more information should be accessible. Conclusions The benefits evaluation suggested that access to personal health records via patient portals may improve patient activation, recovery scores, and organizational efficiencies in a tertiary level mental health care facility.
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Affiliation(s)
- Sarah Kipping
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Melanie I Stuckey
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | | | - Tan Nguyen
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Sanaz Riahi
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Degli Stefani M, Biasutti M. Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study. Front Psychol 2016; 7:1518. [PMID: 27774073 PMCID: PMC5054002 DOI: 10.3389/fpsyg.2016.01518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/20/2016] [Indexed: 12/30/2022] Open
Abstract
Objective: Framed in the patients’ engagement perspective, the current study aims to determine the effects of group music therapy in addition to drug care in comparison with drug care in addition to other non-expressive group activities in the treatment of psychiatric outpatients. Method: Participants (n = 27) with ICD-10 diagnoses of F20 (schizophrenia), F25 (schizoaffective disorders), F31 (bipolar affective disorder), F32 (depressive episode), and F60 (specific personality disorders) were randomized to receive group music therapy plus standard care (48 weekly sessions of 2 h) or standard care only. The clinical measures included dosages of neuroleptics, benzodiazepines, mood stabilizers, and antidepressants. Results: The participants who received group music therapy demonstrated greater improvement in drug dosage with respect to neuroleptics than those who did not receive group music therapy. Antidepressants had an increment for both groups that was significant only for the control group. Benzodiazepines and mood stabilizers did not show any significant change in either group. Conclusion: Group music therapy combined with standard drug care was effective for controlling neuroleptic drug dosages in adult psychiatric outpatients who received group music therapy. We discussed the likely applications of group music therapy in psychiatry and the possible contribution of music therapy in improving the psychopathological condition of adult outpatients. In addition, the implications for the patient-centered perspective were also discussed.
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Affiliation(s)
- Mario Degli Stefani
- Department of Mental Health, 2° Servizio Psichiatrico Ulss 16 Padova, Padova Italy
| | - Michele Biasutti
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova Italy
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Moljord IEO, Helland-Hansen KA, Salvesen Ø, Olsø TM, Gudde CB, Rise MB, Steinsbekk A, Eriksen L. Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial. BMC Health Serv Res 2016; 16:513. [PMID: 27659102 PMCID: PMC5034559 DOI: 10.1186/s12913-016-1712-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Service user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders. METHODS A randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences. RESULTS During the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = -5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = -0.3 to 0.3, p = 0.92). CONCLUSIONS Giving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further. TRIAL REGISTRATION NCT01133587 , clinicaltrials.gov.
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Affiliation(s)
- Inger Elise Opheim Moljord
- Division of Psychiatry, Nidaros Community Mental Health Center, St. Olav's University Hospital, Østmarkveien 21, Post box 1893 Lade, N-7440, Trondheim, Norway. .,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,Division of Psychiatry, Department of Research and Development, St. Olav's University Hospital, Trondheim, Norway.
| | - Kristel Antine Helland-Hansen
- Division of Psychiatry, Nidaros Community Mental Health Center, St. Olav's University Hospital, Østmarkveien 21, Post box 1893 Lade, N-7440, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Møller Olsø
- Norwegian Resource Center for Community Mental Health, Norwegian University of Science and Technology Social Research AS, Trondheim, Norway
| | - Camilla Buch Gudde
- Forensic Department Brøset, Center for Research and Education in Forensic Psychiatry, St. Olav's University Hospital, Trondheim, Norway.,Department of Social Work and Health Science, Faculty of Social Science and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit By Rise
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Eriksen
- Division of Psychiatry, Nidaros Community Mental Health Center, St. Olav's University Hospital, Østmarkveien 21, Post box 1893 Lade, N-7440, Trondheim, Norway.,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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40
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Tarutani S, Kikuyama H, Ohta M, Kanazawa T, Okamura T, Yoneda H. Association between Medication Adherence and Duration of Outpatient Treatment in Patients with Schizophrenia. Psychiatry Investig 2016; 13:413-9. [PMID: 27482242 PMCID: PMC4965651 DOI: 10.4306/pi.2016.13.4.413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Medication adherence is important in the treatment of schizophrenia, and critical periods during treatment may be associated with relapse. However, the relationship between adherence and duration of outpatient treatment (DOT) remains unclear. The authors aimed to clarify the relationship between adherence and DOT at a psychiatric hospital in Japan. METHODS For outpatients with schizophrenia who regularly visit Shin-Abuyama hospital, the authors conducted a single questionnaire survey (five questions covering gender, age, DOT, medication shortages, and residual medication) over one month period. Participants were divided into two groups whether DOT were from more than one year to within five years or not. Mantel-Haenszel analysis and logistic regression analysis were performed on the data regarding the medication adherence. RESULTS Effective answers were received for 328 patients. The residual medication rate was significantly higher among those receiving outpatient treatment from more than one year to within five years than five years than those receiving outpatient treatment for more than five years or less than one year (p=0.016). CONCLUSION This survey suggests that there are critical periods during which patients are most prone to poor adherence. Because poor adherence increases the risk of relapse, specific measures must be taken to improve adherence during these periods.
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Affiliation(s)
- Seiichiro Tarutani
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Hiroki Kikuyama
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Munehiro Ohta
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
| | - Tetsufumi Kanazawa
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Takehiko Okamura
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
| | - Hiroshi Yoneda
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
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41
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van Schie D, Castelein S, van der Bijl J, Meijburg R, Stringer B, van Meijel B. Systematic review of self-management in patients with schizophrenia: psychometric assessment of tools, levels of self-management and associated factors. J Adv Nurs 2016; 72:2598-2611. [DOI: 10.1111/jan.13023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Dayenne van Schie
- Parnassia Psychiatric Institute; Bavo Europoort; Rotterdam The Netherlands
| | | | | | - Robert Meijburg
- Parnassia Psychiatric Institute; Parnassia Academy; The Hague The Netherlands
| | - Barbara Stringer
- GGZ inGeest; Research Group Recovery and Rehabilitation; Amsterdam The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences; Amsterdam The Netherlands
- Parnassia Psychiatric Institute; Parnassia Academy; The Hague The Netherlands
- VU University Medical Center; Amsterdam The Netherlands
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42
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Schmaderer MS, Zimmerman L, Hertzog M, Pozehl B, Paulman A. Correlates of Patient Activation and Acute Care Utilization Among Multimorbid Patients. West J Nurs Res 2016; 38:1335-53. [PMID: 27245080 DOI: 10.1177/0193945916651264] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient activation and self-management have been associated with improved patient outcomes, including decreased re-hospitalization; however, little research has identified factors that predict patient activation in the multimorbid hospitalized patient. This descriptive correlational study included 200 patients with three or more chronic diseases discharged to home post-hospitalization. Standard multiple regression was used to identify correlates of patient activation. Multimorbid patients with lower activation scores had more acute care utilization (re-hospitalization and emergency department visits) 30 days post-discharge than patients with higher activation scores. Predictors of patient activation were health literacy (p = .013), satisfaction with social role (p = .014), and involvement in chronic illness care (p = .001). Care transition programs focusing on health literacy, role satisfaction, and promoting patient-centered care may improve patient outcomes for multimorbid patients.
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Affiliation(s)
| | | | | | - Bunny Pozehl
- University of Nebraska Medical Center, Lincoln, USA
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Müllerová H, Landis SH, Aisanov Z, Davis KJ, Ichinose M, Mannino DM, Maskell J, Menezes AM, van der Molen T, Oh YM, Tabberer M, Han MK. Health behaviors and their correlates among participants in the Continuing to Confront COPD International Patient Survey. Int J Chron Obstruct Pulmon Dis 2016; 11:881-90. [PMID: 27217741 PMCID: PMC4853156 DOI: 10.2147/copd.s102280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS We used data from the Continuing to Confront COPD International Patient Survey to test the hypothesis that patients with COPD who report less engagement with their disease management are also more likely to report greater impact of the disease. METHODS This was a population-based, cross-sectional survey of 4,343 subjects aged ≥40 years from 12 countries, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. The impact of COPD was measured with COPD Assessment Test, modified Medical Research Council Dyspnea Scale, and hospital admissions and emergency department visits for COPD in the prior year. The 13-item Patient Activation Measure (PAM-13) instrument and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used to measure patient disease engagement and medication adherence, respectively. RESULTS Twenty-eight percent of subjects reported being either disengaged or struggling with their disease (low engagement: PAM-13 levels 1 and 2), and 35% reported poor adherence (MMAS-8 <6). In univariate analyses, lower PAM-13 and MMAS-8 scores were significantly associated with poorer COPD-specific health status, greater breathlessness and lower BMI (PAM-13 only), less satisfaction with their doctor's management of COPD, and more emergency department visits. In multivariate regression models, poor satisfaction with their doctor's management of COPD was significantly associated with both low PAM-13 and MMAS-8 scores; low PAM-13 scores were additionally independently associated with higher COPD Assessment Test and modified Medical Research Council scores and low BMI (underweight). CONCLUSION Poor patient engagement and medication adherence are frequent and associated with worse COPD-specific health status, higher health care utilization, and lower satisfaction with health care providers. More research will be needed to better understand what factors can be modified to improve medication adherence and patient engagement.
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Affiliation(s)
| | | | | | | | | | - David M Mannino
- University of Kentucky College of Public Health, Lexington, KY, USA
| | | | | | - Thys van der Molen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Yeon-Mok Oh
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
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Coulombe S, Radziszewski S, Meunier S, Provencher H, Hudon C, Roberge P, Provencher MD, Houle J. Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management. Front Psychol 2016; 7:584. [PMID: 27199819 PMCID: PMC4844930 DOI: 10.3389/fpsyg.2016.00584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/08/2016] [Indexed: 12/21/2022] Open
Abstract
Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators. Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables. Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping). Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity. Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.
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Affiliation(s)
- Simon Coulombe
- Department of Psychology, Université du Québec à Montréal, Montréal QC, Canada
| | | | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montréal QC, Canada
| | | | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke Sherbrooke, QC, Canada
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke Sherbrooke, QC, Canada
| | | | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, MontréalQC, Canada; Research Centre, Institut universitaire en santé mentale de Montréal, MontréalQC, Canada
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45
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Barut JK, Dietrich MS, Zanoni PA, Ridner SH. Sense of Belonging and Hope in the Lives of Persons with Schizophrenia. Arch Psychiatr Nurs 2016; 30:178-84. [PMID: 26992868 PMCID: PMC4799831 DOI: 10.1016/j.apnu.2015.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/05/2015] [Indexed: 11/17/2022]
Abstract
This qualitative study used semi-structured interviews to explore the meaning of sense of belonging and hope in the lived experiences of 20 persons with chronic schizophrenia-spectrum disorders receiving acute inpatient treatment. Experience of treatment was also explored. Sense of belonging and hope were both identified as valuable or even vital, yet the experiences of not belonging and/or feeling hopeless was more prevalent. Participants frequently felt like an outsider and experienced loneliness and isolation, suggesting a need for further exploration of the impact of sense of belonging and hope on recovery and even treatment adherence in persons with schizophrenia.
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Affiliation(s)
- Jennifer K Barut
- Vanderbilt University School of Nursing, Nashville, TN; Vanderbilt Psychiatric Hospital, Nashville, TN.
| | - Mary S Dietrich
- Biostatistics & Psychiatry, Vanderbilt University Schools of Medicine & Nursing, Nashville, TN
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Moljord IEO, Lara-Cabrera ML, Perestelo-Pérez L, Rivero-Santana A, Eriksen L, Linaker OM. Psychometric properties of the Patient Activation Measure-13 among out-patients waiting for mental health treatment: A validation study in Norway. PATIENT EDUCATION AND COUNSELING 2015; 98:1410-7. [PMID: 26146239 DOI: 10.1016/j.pec.2015.06.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/20/2015] [Accepted: 06/13/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined. METHODS A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51). RESULTS The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85). CONCLUSION PAM has appropriate and acceptable psychometric properties in mental health settings. PRACTICE IMPLICATIONS Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health.
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Affiliation(s)
- Inger Elise O Moljord
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Nidaros Community Mental Health Center, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway.
| | - Mariela L Lara-Cabrera
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Tiller Community Mental Health Center, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway.
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Amado Rivero-Santana
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain; Canarian Foundation of Health Research (FUNCANIS), Tenerife, Spain
| | - Lasse Eriksen
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway
| | - Olav M Linaker
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway
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47
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Oles SK, Fukui S, Rand KL, Salyers MP. The relationship between hope and patient activation in consumers with schizophrenia: Results from longitudinal analyses. Psychiatry Res 2015; 228:272-6. [PMID: 26165962 DOI: 10.1016/j.psychres.2015.05.100] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 02/21/2015] [Accepted: 05/24/2015] [Indexed: 11/29/2022]
Abstract
Hope (goal-directed thinking) and patient activation (knowledge and skills to manage one's illness) are both important in managing chronic conditions like schizophrenia. The relationship between hope and patient activation has not been clearly defined. However, hope may be viewed as a foundational, motivating factor that can lead to greater involvement in care and feelings of efficacy. The purpose of the present study was to understand the prospective relationship between hope and patient activation in a sample of adults with schizophrenia (N=118). This study was a secondary data analysis from a study on Illness Management and Recovery (IMR) - a curriculum-based approach to schizophrenia self-management. Data were collected at baseline (prior to any intervention), and at 9 and 18-month follow-up. As predicted, hope and patient activation were significantly related with each other, showing large positive concurrent correlations. Demographics and background characteristics were not significantly related to patient activation or hope. Longitudinal analyses found no specific directional effect, yet suggested that hope and patient activation mutually influence each other over time. Our findings add flexibility in designing recovery-based interventions - fostering hope may not be a pre-requisite for activating consumers to be more involved in their own care.
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Affiliation(s)
- Sylwia K Oles
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA.
| | - Sadaaki Fukui
- School of Social Welfare Center for Mental Health Research and Innovation, University of Kansas, Lawrence, KS, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, US
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, US
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Khan KM, Windt A, Davis JC, Dawes M, Liu-Ambrose T, Madden K, Marra CA, Housden L, Hoppmann C, Adams DJ. Group Medical Visits (GMVs) in primary care: an RCT of group-based versus individual appointments to reduce HbA1c in older people. BMJ Open 2015; 5:e007441. [PMID: 26169803 PMCID: PMC4513482 DOI: 10.1136/bmjopen-2014-007441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/05/2015] [Accepted: 06/13/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) affects more than 1.1 million Canadians aged ≥65 years. Group Medical Visits are an emerging health service delivery method. Recent systematic reviews show that they can significantly reduce glycated haemoglobin (HbA1c) levels, but Group Visits have not been evaluated within primary care. We intend to determine the clinical effectiveness, quality of life and economic implications of Group Medical Visits within a primary care setting for older people with T2DM. METHODS AND ANALYSIS A 2-year proof-of-concept, single-blinded (measurement team) randomised control trial to test the efficacy of Group Medical Visits in an urban Canadian primary care setting. Participants ≥65 years old with T2DM (N=128) will be equally randomised to either eight groups of eight patients each (Group Medical Visits; Intervention) or to Individual visits (Standard Care; Controls). Those administering cointerventions are not blinded to group assignment. Our sample size is based on estimates of variance (±1.4% for HbA1c) and effect size (0.9/1.4=0.6) from the literature and from our own preliminary data. Forty participants per group will provide a β likelihood of 0.80, assuming an α of 0.05. A conservative estimation of an effect size of 0.7/1.4 changes the N in the power calculation to 59 per group. Hence, we aim to enrol 64 participants in each study arm. We will use intention-to-treat analysis and compare mean HbA1c (% glycosylated HbA1c) (primary outcome) of Intervention/Control participants at 12 months, 24 months and 1 year postintervention on selected clinical, patient-rated and economic measures. TRIAL REGISTRATION NUMBER NCT02002143.
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Affiliation(s)
- Karim M Khan
- Centre for Mobility and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriaan Windt
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Department of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Dawes
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ken Madden
- Department of Medicine (Geriatric Medicine), University of British Columbia, Vancouver, British Columbia, Canada
| | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Housden
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christiane Hoppmann
- Psychology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Adams
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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49
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Scioli A, Scioli-Salter ER, Sykes K, Anderson C, Fedele M. The positive contributions of hope to maintaining and restoring health: An integrative, mixed-method approach. THE JOURNAL OF POSITIVE PSYCHOLOGY 2015. [DOI: 10.1080/17439760.2015.1037858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Bonfils KA, Fukui S, Adams EL, Hedrick HM, Salyers MP. Why are you here again? Concordance between consumers and providers about the primary concern in recurring psychiatric visits. Psychiatry Res 2014; 220:541-8. [PMID: 25130783 PMCID: PMC4254049 DOI: 10.1016/j.psychres.2014.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/07/2014] [Accepted: 07/24/2014] [Indexed: 11/25/2022]
Abstract
Patient-centered care has become increasingly important over the last decade, both in physical and mental health care. In support of patient-centered care, providers need to understand consumers׳ primary concerns during treatment visits. The current study explored what primary concerns were brought to recurring psychiatric visits for a sample of adults with severe mental illness (N=164), whether these concerns were concordant with those recognized by providers, and which factors predicted concordance. We identified 17 types of primary concerns, most commonly medications and symptoms, with only 50% of visits showing evidence of at least partial agreement between consumers and providers. Contrary to expectations, consumer demographics, activation, trust, and perceptions of patient-centeredness were not predictive, while greater preferences for autonomy predicted poorer agreement. Our findings highlight the need for interventions to promote a shared understanding of primary concerns in recurring psychiatric visits. Further attention is needed to ensure the provision of patient-centered care such that consumer concerns are acknowledged and addressed within recurring psychiatric visits.
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Affiliation(s)
- Kelsey A. Bonfils
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Sadaaki Fukui
- The University of Kansas School of Social Welfare Center for Mental Health Research and Innovation, Lawrence, Kansas, USA
| | - Erin L. Adams
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Heidi M. Hedrick
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Michelle P. Salyers
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA,ACT Center of Indiana, Indianapolis, Indiana, USA
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