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Lawn S, Shelby-James T, Manger S, Byrne L, Fuss B, Isaac V, Kaambwa B, Ullah S, Rattray M, Gye B, Kaine C, Phegan C, Harris G, Worley P. Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): study protocol for a stepped-wedge cluster randomised controlled trial. Trials 2024; 25:319. [PMID: 38745299 PMCID: PMC11094922 DOI: 10.1186/s13063-024-08165-y] [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: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. METHODS This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3-4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. DISCUSSION This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715.
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Affiliation(s)
- Sharon Lawn
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Tania Shelby-James
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Sam Manger
- Lifestyle Medicine, James Cook University, James Cook University LPO, 150 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - Louise Byrne
- School of Management, RMIT, GPO Box 2476, Melbourne, VIC, 3001, Australia
| | - Belinda Fuss
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Vivian Isaac
- Faculty of Science and Health, Charles Sturt University, Albury, NSW, 2640, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Megan Rattray
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Bill Gye
- Community Mental Health Australia, PO Box 668, Rozelle, NSW, 2039, Australia
| | - Christine Kaine
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Caroline Phegan
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Geoff Harris
- Mental Health Coalition of South Australia, Suite 2/195 North Terrace, Adelaide, SA, 5000, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Volcevska S, Luck L, Elmir R, Dickens G, Murphy G. Nurses' experiences when conducting the mental state examination (MSE): A scoping review. Int J Ment Health Nurs 2024; 33:224-240. [PMID: 37817424 DOI: 10.1111/inm.13237] [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: 03/16/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023]
Abstract
The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in-patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in-patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in-patient mental health nurses. This review identified the need for evidence-based research related to the MSE and its application in nursing practice. Evidence-based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer-nurse therapeutic alliance in acute in-patient mental health settings.
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Affiliation(s)
- Spasija Volcevska
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Lauretta Luck
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
- Nepean Blue Mountain Local Health District, Sydney, New South Wales, Australia
| | - Rakime Elmir
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Geoffrey Dickens
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Gillian Murphy
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
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Welke S, Duncanson E, Bollen C, Britton A, Donnelly F, Faull R, Kellie A, Le Leu R, Manski-Nankervis JA, McDonald S, Richards K, Whittington T, Yeoh J, Jesudason S. The impact on patients of the tertiary-primary healthcare interface in kidney failure: a qualitative study. J Nephrol 2023; 36:2023-2035. [PMID: 37632667 DOI: 10.1007/s40620-023-01742-5] [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: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Clinicians and patients have reported fragmentation in the primary and tertiary healthcare interface. However, perspectives of service navigation and the impacts of fragmentation are not well defined, particularly for patients transitioning to dialysis. This study aimed to define patient perspectives of the functioning of the health service interface and impacts on healthcare experiences and engagement, informing patient-centred and outcomes-focused service models. METHODS A qualitative study was conducted through semi-structured interviews with 25 dialysis patients (16 males) aged 34-78 receiving dialysis across a multi-site tertiary service. Transcripts were analysed thematically. RESULTS Three main themes were identified: (1) The Changing Nature of General Practitioner (GP) Patient Relationships; (2) Ownership and Leadership in Kidney Care; and (3) The Importance of Nephrologist-GP Communications. Patients perceived an unreliable primary-tertiary service interface which lacked coordinated care and created challenges for primary care continuity. These impacted perceptions of healthcare provider expertise and confidence in healthcare systems. Patients subsequently increased the healthcare sought from tertiary kidney clinicians. The fractured interface led some to coordinate communication between health sectors, to support care quality, but this caused additional stress. CONCLUSIONS A fragmented primary-tertiary healthcare interface creates challenges for patient service navigation and can negatively impact patient experiences, leading to primary care disengagement, reduced confidence in health care quality and increased stress. Future studies are imperative for assessing initiatives facilitating health system integration, including communication technologies, healthcare provider training, patient empowerment, and specific outcomes in health, economic and patient experience measures, for patients transitioning to dialysis.
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Affiliation(s)
- Samantha Welke
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Emily Duncanson
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Chris Bollen
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne Britton
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Fiona Donnelly
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Randall Faull
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Kellie
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Richard Le Leu
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Stephen McDonald
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Katherine Richards
- Faculty of Health and Medical Sciences, University of Otago, Christchurch, New Zealand
| | - Tiffany Whittington
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jackie Yeoh
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Bijkerk LE, Oenema A, Geschwind N, Spigt M. Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments. Int J Behav Med 2023; 30:155-166. [PMID: 35578099 PMCID: PMC10036274 DOI: 10.1007/s12529-022-10086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Engagement is a complex construct consisting of behavioral, cognitive, and affective dimensions, making engagement a difficult construct to measure. This integrative review aims to (1) present a multidisciplinary overview of measurement methods that are currently used to measure engagement with adult mental health and behavior change interventions, delivered in-person, blended, or digitally, and (2) provide a set of recommendations and considerations for researchers wishing to study engagement. METHODS We used an integrative approach and identified original studies and reviews on engagement with mental health or behavior change interventions that were delivered in-person, digitally, or blended. RESULTS Forty articles were analyzed in this review. Common methods to assess engagement were through objective usage data, questionnaire-based data, and qualitative data, with objective usage data being used most frequently. Based on the synthesis of engagement measures, we advise researchers to (1) predefine the operationalization of engagement for their specific research context, (2) measure behavioral, cognitive, and affective dimensions of engagement in all cases, and (3) measure engagement over time. CONCLUSIONS Current literature shows a bias towards behavioral measures of engagement in research, as most studies measured engagement exclusively through objective usage data, without including cognitive and affective measures of engagement. We hope that our recommendations will help to reduce this bias and to steer engagement research towards an integrated approach.
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Affiliation(s)
- Laura Esther Bijkerk
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Anke Oenema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicole Geschwind
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Heard, known and safe in general practice? An interview study with patients with severe and persistent mental illness. BJGP Open 2021; 6:BJGPO.2021.0201. [PMID: 34916224 PMCID: PMC9447307 DOI: 10.3399/bjgpo.2021.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues. Aim To explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice. Design & setting Patient participants were recruited from community mental health clinics in Brisbane, Australia. Method Individual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity. Results Sixteen interviews were conducted by one author (RW), with an average duration of 29 minutes. Three overarching themes were identified: being heard, being known, and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known, and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect GPs who predominantly engage with their physical health to have negative attitudes to mental illness. Conclusion Some GPs play central roles in patients’ mental health care. Barriers for others need further exploration, and may include time, confidence, and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in their general practice consultations.
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