Connecting local support: A qualitative study exploring the role of voluntary organisations in long-term condition management

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

BACKGROUND

Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems.

METHODS

A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model.

RESULTS

The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks.

CONCLUSIONS

Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.

Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges

BACKGROUND

Social prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health.

AIM

To investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals.

DESIGN AND SETTING

Qualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas.

METHOD

Audiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically.

RESULTS

Participants identified some benefits of collaborative working, particularly the CLPs' ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management.

CONCLUSION

Although the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as 'magic bullets'. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care.

General practice and patients’ views of the social networks of patients with multimorbidity

ABSTRACT INTRODUCTION For patients with multimorbidity to live well, they need the support of not only health professionals but family, friends and organisations. These social networks provide support, potentially enabling the formation of a Community of Clinical Practice approach to multimorbidity care. AIM This study aimed to explore general practice knowledge of the social networks of patients with multimorbidity. METHODS Social network maps were completed by both patients and general practice. The social network maps of 22 patients with multimorbidity were compared with corresponding social network maps completed by general practice staff. RESULTS In 60% (13/22) of the patients, general practice staff held a high or moderate knowledge of individual patients’ social networks. Information on social networks was recalled from staff memory and not systematically recorded in patients’ electronic health records. DISCUSSION Social network information is not routinely collected, recorded or used by general practice to understand the support available to patients with multimorbidity. General practice could take an active role in coordinating social network supporters for certain patient groups with complex multimorbidity. For these groups, there is value in systematically recording and regularly updating their social network information for general practice to use as part of a coordinated Community of Clinical Practice.

Local networks of community and healthcare organisations: a mixed methods study

BACKGROUND

Local collaboration of community organisations and healthcare organisations is seen as relevant for the efficiency and efficacy of health and social care because of their potential role in providing social involvement which may reduce the need for the utilisation of formal services. Care organisations connect to each other in different ways, thus comprising an organisational network. This study aimed to describe and explore organisational networks with respect to their activities for people with diabetes mellitus type 2 and potential mechanisms of effective collaboration. Collaboration could include, for example, referring to each other and organising activities together. Potential mechanisms are navigation, negotiation and contagion.

METHODS

A mixed methods study was conducted in an urban and a rural area in the Netherlands. The participating organisations were mentioned by a sample of diabetes patients in these regions and by organisations' representatives in a snowballing procedure. Next a quantitative survey and a semi-structured interview were conducted, including 35 representatives of these local organisations. The social network analysis methods was used to map and characterise the organisational networks based on results from the survey. A thematic analysis of interviews was undertaken to identify how three mechanisms (navigation, negotiation and contagion) were used in the collaboration.

RESULTS

Both interviews and network structures showed evidence of navigation-related mechanisms. Organisations referred patients with diabetes to services within their organisation or to relevant services provided by other organisations. Hardly any negotiation or contagion-related mechanisms were identified. If negotiation between organisations was found, it seemed externally enforced. The density, centrality, and reciprocity in the networks seemed low to facilitate contagion of practices. Some organisations reported actions that could have impacted on contagion. Representatives emphasized the need of network collaboration with local or regional community and healthcare organisations.

CONCLUSION

The study suggests that navigation to resources is a relevant theme in organisational networks, which could be targeted by interventions. More research is needed to explore the relevance of other network-related mechanisms.

Why do people with chronic disease not contact consumer health organisations? A survey of general practice patients

Aim Consumer health organisations (CHOs) are non-profit or voluntary sector organisations that promote and represent the interests of patients and carers affected by particular conditions. The purpose of this study was to examine, among patients with chronic disease, what differentiates those who contact CHOs from those who do not and what stops people from making contact.

BACKGROUND

CHOs can enhance people's capacity to manage chronic disease by providing information, education and psychosocial support, but are under-utilised. Little is known about barriers to access.

METHODS

Data were from a baseline telephone survey conducted as part of a randomised trial of an intervention to improve access to CHOs. Participants constituted a consecutive sample of 276 adults with diagnosed chronic disease recruited via 18 general practitioners in Brisbane, Australia. Quantitative survey items examined participants' use and perceptions of CHOs and a single open-ended question explored barriers to CHO use. Multiple logistic regression and thematic analysis were used. Findings Overall, 39% of participants had ever contacted a CHO for their health and 28% had contacted a CHO specifically focussed on their diagnosed chronic condition. Diabetes, poorer self-reported physical health and greater health system contact were significantly associated with CHO contact. The view that 'my doctor does it all' was prevalent and, together with a belief that their health problems were 'not serious enough', was the primary reason patients did not make contact.

CONCLUSION

Attitudinal and system-related barriers limit use of CHOs by those for whom they are designed. Developing referral pathways to CHOs and promoting awareness about what they offer is needed to improve access.