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Sofouli E, Wiltsey-Stirman S, Groleau D, Perreault M, Piat M. Identifying and Exploring Sustainability Determinants of Mental Health Recovery-Oriented Interventions: A Mixed Methods Study Protocol. Glob Implement Res Appl 2022; 2:249-261. [PMID: 36035969 PMCID: PMC9395767 DOI: 10.1007/s43477-022-00052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
Mental health recovery is the new paradigm in the mental health service delivery system worldwide. Recovery-oriented services go beyond traditional clinical care that is centered on symptom remission, aiming to help people: restore social connections with other individuals and the community; develop hope and optimism for the future; reconstruct an identity beyond that of a “mental patient”; discover meaning in life; and feel empowered to gain control over treatment (CHIME framework). Over the last ten years, several efforts at implementation of recovery-oriented interventions have been documented in the scientific literature. However, little attention has been given to their sustainability, even though it is reported that not all health interventions can fully sustain their activities beyond the initial implementation phase. The aim of this mixed methods case study is to better understand the factors that determine the sustainability of two recovery-oriented interventions (peer support and recovery training) after their roll-out in four organizations in Canada that provide community housing for adults with mental health challenges. Qualitative and quantitative data will be collected from managers, service providers, and implementation team members that oversaw the implementation process along with organizational documents. Data collection and analysis will be guided by the Consolidated Framework for Sustainability Constructs in Healthcare, the Framework for Reporting Adaptations and Modifications, and the Program Sustainability Assessment Tool. Findings will expand our current evidence base on the intersection of sustainability and mental health recovery interventions that remains under-explored.
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Doucet MH, Delamou A, Manet H, Groleau D. Beyond the Sociocultural Rhetoric: Female Genital Mutilation, Cultural Values and the Symbolic Capital (Honor) of Women and Their Family in Conakry, Guinea-A Focused Ethnography Among "Positive Deviants". Sex Cult 2022; 26:1858-1884. [PMID: 36032217 PMCID: PMC9399019 DOI: 10.1007/s12119-022-09975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
Female genital mutilation (FGM) is justified by sociocultural arguments, including that it guarantees girls'/women's appropriate sexual behavior, thus preserving family honor. We explored the perspectives of Guineans who do not practice FGM ("positive deviants"), as well as of Guineans who still practice FGM but who are supportive of abandoning the practice ("reluctant adherents"). We conducted a "focused ethnographic" study in Conakry, Guinea with a sample of 58 people. Individual semi-structured interviews were undertaken to explore the views and experiences of 18 women and 12 men of different generations who abandoned the practice of FGM. Group interviews with an additional 16 women and 12 men (half of whom were "positive deviants" and the other half "reluctant adherents") validated and enriched the data. Participants consider that FGM has deleterious consequences as it: (1) does not prevent girls or married women from being sexually active outside of marriage; (2) may impair couples' sexual satisfaction, and thus lead to divorce, men's infidelity or polygamy; and (3) may reduce women's ability to have multiple children, because of the increased risk of infertility or obstetric complications. In addition, participants reported that many Guineans fear that the promotion of FGM abandonment is a Western plot to eradicate their culture. We conclude that Guineans who practice and do not practice FGM share the same cultural values about the importance of culturally appropriate sexual behavior, being married, and having many children, which are central sources of honor (symbolic capital) to women and their families. They, however, have opposing views on how to achieve these objectives. Based on our participants' perspectives, the harmful consequences of FGM can potentially sabotage these sources of honor. Recommendations for messages aimed at promoting FGM abandonment are discussed.
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Affiliation(s)
- Marie-Hélène Doucet
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC Canada
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Université Gamal Abdel Nasser de Conakry, Conakry, Republic of Guinea
| | - Hawa Manet
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Conakry, Republic of Guinea
| | - Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University, Jewish General Hospital, Lady Davis Institute, Montreal, QC Canada
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Omigbodun O, Bella-Awusah T, Emma-Echiegu N, Abdulmalik J, Omigbodun A, Doucet MH, Groleau D. Escaping social rejection, gaining total capital: the complex psychological experience of female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria. Reprod Health 2022; 19:41. [PMID: 35164773 PMCID: PMC8842570 DOI: 10.1186/s12978-022-01348-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background While the deleterious effects of FGM/C on physical health are well documented, the psychological experience of this harmful practice is a neglected area of research, which limits global mental health actions. As FGM/C was a traditional practice in some areas of Nigeria, the study aimed to understand the psychological experience of FGM/C in context. Methods This qualitative study was completed in urban and rural Izzi communities in Southeast Nigeria where FGM/C was widely practiced. In-depth interviews were completed with 38 women of the same ethnicity using the McGill Illness Narrative Interview (MINI) to explore the collective psychological experience of FGM/C before, during and after the procedure. The MINI was successfully adapted to explore the meaning and experience of FGM/C. We completed thematic content analysis and used the concepts of total capital and habitus by Bourdieu to interpret the data. Results During the period of adolescence, Izzi young women who had not yet undergone FGM/C reported retrospectively being subjected to intense stigma, humiliation and rejection by their cut peers. Alongside the social benefits from FGM/C the ongoing psychological suffering led many to accept or request to be cut, to end their psychological torture. Virtually all women reported symptoms of severe distress before, during and after the procedure. Some expressed the emotion of relief from knowing their psychological torture would end and that they would gain social acceptance and total capital from being cut. Newly cut young women also expressed that they looked forward to harassing and stigmatizing uncut ones, therein engaging in a complex habitus that underscores their severe trauma as well as their newly acquired enhanced social status. Conclusion FGM/C is profoundly embedded in the local culture, prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigma. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria. While the deleterious effects of FGM/C on physical health are well documented, we have little knowledge on the psychological experience of this harmful practice. This study aimed to understand the psychological experience of FGM/C in Izzi communities in Southeast Nigeria where FGM/C was widely practiced. In-depth interviews were completed with 38 women from the same ethnic group to explore the collective psychological experience of FGM/C before, during and after the procedure. Our results found that during adolescence, Izzi girls who had not yet undergone FGM/C reported being subjected to intense stigma, humiliation and rejection by their cut peers. This ongoing psychological suffering led many young women to accept or request to be cut, in order to end their psychological torture. Virtually all women reported experiencing severe distress before, during and after the procedure. Some expressed relief from knowing their psychological torture would end and that they would gain social acceptance and a rise in status from being cut. Newly cut young women also expressed that they looked forward to harassing and stigmatizing uncut ones, therein engaging in a complex behaviour that underscores their severe trauma as well as their newly acquired enhanced social status. Our results suggest that prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigmatizing behaviour towards the uncut. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria.
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Lonergan M, Brunet A, Rivest-Beauregard M, Groleau D. Is romantic partner betrayal a form of traumatic experience? A qualitative study. Stress Health 2021; 37:19-31. [PMID: 32533575 DOI: 10.1002/smi.2968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 01/13/2023]
Abstract
According to a growing body of research, betrayal by a romantic partner is increasingly considered as a form of interpersonal trauma. Between 30% and 60% of betrayed individuals experience symptoms of post-traumatic stress disorder (PTSD), depression and anxiety to clinically meaningful levels. From a clinical perspective, this constellation of symptoms can be conceptualized as a stressor-related adjustment disorder. Yet, no qualitative research has examined the association between romantic betrayal and traumatic stress from the perspective of betrayed individuals. Face-to-face semi-structured interviews were conducted with 13 participants who had completed a clinical trial for a new treatment for adjustment disorder stemming from betrayal. Data were analysed using thematic content analysis. Although betrayal was experienced as a shocking and destabilizing event, and participants used trauma or 'feeling traumatized' as a metaphor to describe their experience, few had constructed their reaction as traumatic stress. In fact, participants reported experiencing difficulties understanding the intensity of their experience. However, when exposed to external sources (e.g., books and interviews by psychologists and researchers) that used a trauma and PTSD framework to explain the effects of betrayal, participants reported feeling clarity, validation and relief. Findings are discussed in the light of theoretical and clinical implications.
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Affiliation(s)
- Michelle Lonergan
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Mental Health and Society Research Division, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Alain Brunet
- Mental Health and Society Research Division, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marjolaine Rivest-Beauregard
- Mental Health and Society Research Division, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Danielle Groleau
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,The Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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Doucet MH, Delamou A, Manet H, Groleau D. Correction to: Au-delà de la volonté: les conditions d’empowerment nécessaires pour abandonner les mutilations génitales féminines à Conakry (Guinée), une ethnographie focalisée. Reprod Health 2020; 17:113. [PMID: 32703238 PMCID: PMC7379818 DOI: 10.1186/s12978-020-00951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Omigbodun O, Bella-Awusah T, Groleau D, Abdulmalik J, Emma-Echiegu N, Adedokun B, Omigbodun A. Perceptions of the psychological experiences surrounding female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria. Transcult Psychiatry 2020; 57:212-227. [PMID: 31870245 DOI: 10.1177/1363461519893141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence about psychological experiences surrounding female genital mutilation/cutting (FGM/C) remains weak and inconclusive. This article is the first of a series that deploys qualitative methods to ascertain the psychological experiences associated with FGM/C through the lifecycle of women. Using the free listing method, 103 girls and women, aged 12 to 68 years from rural and urban Izzi communities in Southeastern Nigeria, produced narratives to articulate their perceptions of FGM/C. Sixty-one of them had undergone FGM/C while 42 had not. Data was analysed using thematic analysis and the emerging themes were related to experiences and disabilities in the psychological, physical, and social health domains. While physical experiences were mostly negative, psychological experiences emerged as both positive and negative. Positive experiences such as happiness, hopefulness, and improved self-esteem were commonly described in response to a rise in social status following FGM/C and relief from the stigma of not having undergone FGM/C. Less commonly reported were negative psychological experiences, e.g., shame when not cut, anxiety in anticipation of the procedure, and regret, sadness, and anger when complications arose from FGM/C. Some participants listed disruption of daily activities, chronic pain, and sleep and sexual difficulties occurring in the aftermath of FGM/C. Most participants did not list FGM/C as having a significant effect on their daily living activities. In light of the association of FGM/C with both positive and negative psychological experiences in the Izzi community, more in-depth study is required to enable policy makers and those campaigning for its complete eradication to rethink strategies and improve interventions.
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Gureje O, Oladeji BD, Montgomery AA, Araya R, Bello T, Chisholm D, Groleau D, Kirmayer LJ, Kola L, Olley LB, Tan W, Zelkowitz P. High- versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial). Br J Psychiatry 2019; 215:528-535. [PMID: 30767826 DOI: 10.1192/bjp.2019.4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. AIM To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. METHOD Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme - Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). RESULTS There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 70% with HIT and 66% with LIT: risk difference 4% (95% CI -4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. CONCLUSIONS Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care. DECLARATION OF INTERESTS None.
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Affiliation(s)
- Oye Gureje
- Professor of Psychiatry, Director, World Health Organization Collaborating Center for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Bibilola D Oladeji
- Senior Lecturer, Consultant Psychiatrist, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Alan A Montgomery
- Professor of Medical Statistics and Clinical Trials, Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, UK
| | - Ricardo Araya
- Director, Centre for Global Mental Health, Department of Health Services and Population Research, King's College London, UK
| | - Toyin Bello
- Biostatistician, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Dan Chisholm
- Programme Manager, Division of Noncommunicable Diseases, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
| | - Danielle Groleau
- Associate Professor, Senior Investigator, Division of Social and Transcultural Psychiatry, McGill University; and Director, Department of Psychiatry, Jewish General Hospital, Canada
| | - Laurence J Kirmayer
- Professor, Director, Division of Social and Transcultural Psychiatry, McGill University; and Department of Psychiatry, Jewish General Hospital, Canada
| | - Lola Kola
- Medical Sociologist, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Lydia B Olley
- Project Coordinator, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Wei Tan
- Medical Statistician, Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, UK
| | - Phyllis Zelkowitz
- Associate Professor, Division of Social and Transcultural Psychiatry, McGill University; and Research Director, Department of Psychiatry, Jewish General Hospital, Canada
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Groleau D, Benady-Chorney J, Panaitoiu A, Jimenez V. Hyperemesis Gravidarum in the context of migration: when the absence of cultural meaning gives rise to "blaming the victim". BMC Pregnancy Childbirth 2019; 19:197. [PMID: 31182057 PMCID: PMC6558872 DOI: 10.1186/s12884-019-2344-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Hyperemesis gravidarum (HG) is a rare complication of pregnancy that involves persistent nausea and extreme vomiting to an intensity that differentiates HG from nausea and vomiting commonly experienced during pregnancy. Research has suggested potential biological and psychological etiological pathways for HG, but the augmented prevalence in immigrant populations, which is 4.5 times higher, remains unclear. Studies show that in order to better address the psychosocial needs of immigrant patients with HG, we must first improve our understanding of how they experience their illness. The objective of this study was to understand the meaning and experience of HG among immigrant women in Canada. Methods Our “qualitative comparative analysis design” involved a sample of 15 pregnant mothers following their hospitalization for HG, including 11 immigrant women and 4 Canadian-born women recruited for comparison purposes. We used the Edinburgh Perinatal Depression Scale to assess distress, and the McGill Illness Narrative Interview Schedule to explore how pregnant women understood and experienced their HG and the health services that they received. Results With the exception of a few women whose mothers suffered from HG, immigrant women and their loved ones did not have cultural knowledge to attribute meaning to HG symptoms. This left them vulnerable to criticism from family, as well as feelings of self-doubt, stress, and anxiety. We interpret this phenomenon as ‘victim blaming’. Immigrant women’s experience of HG was also characterised by high levels of depressive symptoms (40%) which they linked to the severity of their symptoms, high levels of stress associated with adapting to their new country, social isolation, and loss of female family members. Furthermore, in contrast to Canadian-born women, immigrant women frequently reported feeling that their symptoms were minimized by hospital emergency room medical staff, which led to delays in obtaining appropriate health care. However, once admitted to hospital, they perceived the care provided by dieticians and nurses as helpful in managing their symptoms. Conclusions Wider awareness of the impact of HG may improve the quality of family support for immigrant women. There is a need to improve the delays and appropriateness of clinical care.
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Affiliation(s)
- Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University; Culture and Mental Health Unit - Lady Davis Medical Institute, Jewish General Hospital- CIUSSS West-Central Montreal, 4333 Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada.
| | - Jessica Benady-Chorney
- Division of Social and Transcultural Psychiatry, McGill University; Culture and Mental Health Unit - Lady Davis Medical Institute, Jewish General Hospital- CIUSSS West-Central Montreal, 4333 Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Alexandra Panaitoiu
- Department of Psychiatry, University of Toronto, 500 University Avenue, Suite 602, Toronto, ON, M5G 1V7, Canada
| | - Vania Jimenez
- Department of Family Medicine, McGill University, CLSC de Côte-des-Neiges- CIUSSS West-Central Montreal, 5700 Chemin de la Cote-des-Neiges, Montreal, QC, H3T 2A8, Canada
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Boucher ME, Groleau D, Whitley R. Recovery from severe mental illness in Québec: The role of culture and place. Health Place 2019; 56:63-69. [PMID: 30710835 DOI: 10.1016/j.healthplace.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
This paper examines the role of culture and place in recovery from severe mental illness amongst a group of Québécois living in Montreal, Canada. Results indicate that dominant cultural characteristics of Québécois, such as a marked Roman Catholic heritage, use of the French language and a close affiliation with the natural territory of Québec can all play important roles in recovery from severe mental illness. The findings suggest that participants weave together places with cultural, familial and personal meaning to create their own healing landscapes. We propose ways to leverage place and dominant cultural traits to facilitate recovery.
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Affiliation(s)
- Marie-Eve Boucher
- Douglas Mental Health University Institute, 6875 boulevard LaSalle, Montréal, Quebec, Canada H4H 1R3; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1
| | - Danielle Groleau
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1; Lady Davis Institute, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, Quebec, Canada H3T 1E2
| | - Rob Whitley
- Douglas Mental Health University Institute, 6875 boulevard LaSalle, Montréal, Quebec, Canada H4H 1R3; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1.
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Doucet MH, Farella Guzzo M, Groleau D. Brief report: A qualitative evidence synthesis of the psychological processes of school-based expressive writing interventions with adolescents. J Adolesc 2018; 69:113-117. [PMID: 30286329 DOI: 10.1016/j.adolescence.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Expressive writing interventions consist of brief writing sessions on thoughts and emotions and are known to yield positive benefits on adolescents' mental health. However, the psychological mechanisms explaining these effects are not clear. METHOD This review explored the psychological processes underlying school-based expressive writing interventions with adolescents. A thematic synthesis of qualitative research consisted of identifying, appraising and summarizing the qualitative evidence of eligible studies. RESULTS Only six of the 510 identified studies met the inclusion criteria of this review. Results provide some validation for cognitive-processing, emotion-regulation, and disinhibition as psychological mechanisms underlying school-based expressive writing with adolescents. CONCLUSIONS However, these conclusions are still preliminary because of the paucity of the qualitative evidence found, both in quantity and quality. We recommend that more rigorous and in-depth qualitative research be undertaken to: 1) explore adolescents' subjective experience about the expressive writing intervention, using in-depth individual interviews; 2) thoroughly assess the content of students' texts written during the intervention; and 3) document the process of expressive writing interventions through observational methods. The results of such investigations would support the development and implementation of school-based expressive writing-type of interventions adapted to adolescents.
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Affiliation(s)
- Marie-Hélène Doucet
- Division of Social and Transcultural Psychiatry, McGill University, 1033, Des Pins West, Montreal, QC H3A 1A1, Canada.
| | - Maria Farella Guzzo
- Division of Social and Transcultural Psychiatry, McGill University, 1033, Des Pins West, Montreal, QC H3A 1A1, Canada.
| | - Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University, 1033, Des Pins West, Montreal, QC H3A 1A1, Canada; Jewish General Hospital, Lady Davis Institute, 4333 Côte St-Catherine Road, Montreal, QC H3T 1E4, Canada.
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D’souza NA, Guzder J, Hickling F, Groleau D. The ethics of relationality in implementation and evaluation research in global health: reflections from the Dream-A-World program in Kingston, Jamaica. BMC Med Ethics 2018; 19:50. [PMID: 29945592 PMCID: PMC6020003 DOI: 10.1186/s12910-018-0282-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice. DISCUSSION In this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees' rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons. Global health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives.
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Affiliation(s)
- Nicole A. D’souza
- Department of Psychiatry, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
| | - Jaswant Guzder
- Department of Psychiatry, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
| | - Frederick Hickling
- CARIMENSA (Caribbean Institute of Mental Health and Substance Abuse), University of the West Indies, Kingston, Jamaica
| | - Danielle Groleau
- Department of Psychiatry, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
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Adeponle A, Groleau D, Kola L, Kirmayer LJ, Gureje O. Perinatal depression in Nigeria: perspectives of women, family caregivers and health care providers. Int J Ment Health Syst 2017; 11:27. [PMID: 28428813 PMCID: PMC5392941 DOI: 10.1186/s13033-017-0134-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Perinatal maternal depression is common and undertreated in many sub-Saharan African countries, including Nigeria. While culture shapes the social determinants and expression of depressive symptoms, there is a dearth of research investigating these processes in African contexts. Methods To address this gap, we conducted in-depth interviews with 14 women with perinatal depression, 14 of their family caregivers and 11 health providers, using the McGill Illness Narrative Interview as part of a larger trial of a stepped-care intervention. Interpretation of themes was guided by cultural constructivist and critical anthropological perspectives that situate perinatal depression in its complexity as a disorder that is embedded in webs of social relations and embodied practices. Results Study respondents used idioms of distress that identified perinatal conditions that consist of somatic, affective, cognitive and behavior symptoms found in depressive disorders. Respondents viewed mental health problems in the perinatal period as tied to sociomoral concerns over gender roles and women’s position within the household. Conflict between women’s effort to be assertive to address interpersonal problems, while needing to be seen as non-aggressive contributed to their distress. Causal explanations for depression included husband’s lack of care, family problems, “spiritual attack”, having a female child when a male child was desired, and not resting sufficiently after childbirth. Guilt about breaching social norms for women’s conduct contributed to self blame, and feelings of shame. Conclusions Clinical assessment and interventions as well as public health prevention strategies for perinatal depression in global mental health need to consider local social contexts and meanings of depression, which can be explored with narrative-based methods. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0134-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ademola Adeponle
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4 Canada
| | - Danielle Groleau
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4 Canada
| | - Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Laurence J Kirmayer
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4 Canada
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Doucet MH, Pallitto C, Groleau D. Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature. Reprod Health 2017; 14:46. [PMID: 28335771 PMCID: PMC5364567 DOI: 10.1186/s12978-017-0306-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/09/2017] [Indexed: 12/03/2022] Open
Abstract
Background Female genital mutilation (FGM) is a traditional harmful practice that can cause severe physical and psychological damages to girls and women. Increasingly, trained health-care providers carry out the practice at the request of families. It is important to understand the motivations of providers in order to reduce the medicalization of FGM. This integrative review identifies, appraises and summarizes qualitative and quantitative literature exploring the factors that are associated with the medicalization of FGM and/or re-infibulation. Methods Literature searches were conducted in PubMed, CINAHL and grey literature databases. Hand searches of identified studies were also examined. The “CASP Qualitative Research Checklist” and the “STROBE Statement” were used to assess the methodological quality of the qualitative and quantitative studies respectively. A total of 354 articles were reviewed for inclusion. Results Fourteen (14) studies, conducted in countries where FGM is largely practiced as well as in countries hosting migrants from these regions, were included. The main findings about the motivations of health-care providers to practice FGM were: (1) the belief that performing FGM would be less harmful for girls or women than the procedure being performed by a traditional practitioner (the so-called “harm reduction” perspective); (2) the belief that the practice was justified for cultural reasons; (3) the financial gains of performing the procedure; (4) responding to requests of the community or feeling pressured by the community to perform FGM. The main reasons given by health-care providers for not performing FGM were that they (1) are concerned about the risks that FGM can cause for girls’ and women’s health; (2) are preoccupied by the legal sanctions that might result from performing FGM; and (3) consider FGM to be a “bad practice”. Conclusion The findings of this review can inform public health program planners, policy makers and researchers to adapt or create strategies to end medicalization of FGM in countries with high prevalence of this practice, as well as in countries hosting immigrants from these regions. Given the methodological limitations in the included studies, it is clear that more robust in-depth qualitative studies are needed, in order to better tackle the complexity of this phenomenon and contribute to eradicating FGM throughout the world. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0306-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Hélène Doucet
- Division of Social and Transcultural Psychiatry, McGill University, 1033, Des Pins West, Montreal, QC, H3A 1A1, Canada.
| | - Christina Pallitto
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, 1201, Switzerland
| | - Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University, 1033, Des Pins West, Montreal, QC, H3A 1A1, Canada.,Jewish General Hospital, Lady Davis Institute, 4333 Côte St-Catherine Road, Montreal, QC, H3T 1E4, Canada
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14
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Groleau D, Pizarro KW, Molino L, Gray-Donald K, Semenic S. Empowering women to breastfeed: Does the Baby Friendly Initiative make a difference? Matern Child Nutr 2016; 13. [PMID: 27896940 DOI: 10.1111/mcn.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/01/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022]
Abstract
The Baby-Friendly Hospital Initiative (BFI) is currently presented worldwide as the gold standard model of care for promoting and supporting breastfeeding. However, there is a lack of understanding about the ways in which health services, including the BFI, address the cultural change from a disembodied practice (formula feeding) to an embodied one (breastfeeding) in contexts where formula feeding is the norm. We used a qualitative case study methodology to compare the embodied experience of breastfeeding and the maternal experience of breastfeeding promotion and support services between mothers receiving care from institutions with low and high levels of BFI implementation in Québec, Canada. A total of 11 focus groups were conducted with mothers from six institutions-three with high and three with low levels of BFI implementation. We found the flexible approach to breastfeeding duration, characteristic of BFI services in our study, helped to avoid maternal guilt and shame; the shift to focusing on potential barriers and strategies for overcoming them empowered women to negotiate changes in infant feeding with others and self by addressing the embodied experience of a practice that may not feel natural at the beginning. Findings have implications for the concept of habitus and the construction of the breastfeeding body; we suggest that habitus can change if agents are provided with discursive tools to negotiate this embodied change. Implications for BFI services include the need to implement the 10 steps in a flexible, family-centred way that focuses on empowering women rather than simply reaching outcomes.
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Affiliation(s)
- Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, Québec, Canada.,Culture and Mental Health Research Unit, Lady Davis Medical Institute, Jewish General Hospital, 4333 Chemin de la Côte-Ste-Catherine, Montréal, Québec, Canada
| | - Katherine W Pizarro
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, Québec, Canada.,Culture and Mental Health Research Unit, Lady Davis Medical Institute, Jewish General Hospital, 4333 Chemin de la Côte-Ste-Catherine, Montréal, Québec, Canada
| | - Luisa Molino
- Simone de Beauvoir Institute, Concordia University, 2170 Rue Bishop, Montréal, Québec, Canada
| | - Katherine Gray-Donald
- School of Dietetics and Human Nutrition, McGill University, 21111 Rue Lakeshore, Ste-Anne-de-Bellevue, Québec, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, 3506 Rue University, Montréal, Québec, Canada.,McGill University Health Center, 1001 Boulevard Décarie, Montréal, Québec, Canada
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15
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Bélanger E, Rodríguez C, Groleau D, Légaré F, MacDonald ME, Marchand R. Patient participation in palliative care decisions: An ethnographic discourse analysis. Int J Qual Stud Health Well-being 2016; 11:32438. [PMID: 27882864 PMCID: PMC5122231 DOI: 10.3402/qhw.v11.32438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022] Open
Abstract
The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team. This qualitative study combined ethnographic observations of a palliative care team with discourse analysis. Eighteen palliative care patients with cancer diagnoses, six family physicians, and two nurses were involved in the study. Multiple interactions were observed between each patient and health care providers over the course of 1 year, for a total of 101 consultations, 24 of which were audio-recorded. The analysis consisted in looking for the interpretive repertoires (i.e., familiar lines of argument used to justify actions) that were used to justify patient participation in decision-making during clinical interactions, as well as exploring their implications for decision roles and end-of-life care. Patients and their health care providers seldom addressed their decision-making roles explicitly. Rather, they constructed patient participation in palliative care decisions in a covert manner. Four interpretive repertoires were used to justify patient participation: (1) exposing uncertainty, (2) co-constructing patient preferences, (3) affirming patient autonomy, and finally (4) upholding the authority of health care providers. The results demonstrate how patients and health care providers used these arguments to negotiate their respective roles in decision-making. In conclusion, patients and health care providers used a variety of interpretive repertoires to covertly negotiate their roles in decision-making, and to legitimize decisions that shaped patients’ dying trajectories. Discourse analysis encourages awareness of the role of language in either promoting or hindering patient participation in decision-making.
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Affiliation(s)
- Emmanuelle Bélanger
- Department of Social and Preventive Medicine, Public Health Research Institute (IRSPUM), Université de Montréal, Montréal, Canada;
| | - Charo Rodríguez
- Department of Family Medicine, McGill University, Montreal, Canada
| | | | - France Légaré
- Department of Emergency and Family Medicine, Université Laval, Quebec City, Canada
| | | | - Robert Marchand
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
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16
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Leal EM, Souza AND, Serpa ODD, Oliveira ICD, Dahl CM, Figueiredo AC, Salem S, Groleau D. The McGill Illness Narrative Interview - MINI: translation and cross-cultural adaptation into Portuguese. Cien Saude Colet 2016; 21:2393-402. [PMID: 27557013 DOI: 10.1590/1413-81232015218.08612015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/25/2015] [Indexed: 11/22/2022] Open
Abstract
This paper presents the process of translation and cultural adaptation into Portuguese of the McGill Illness Narrative Interview - MINI, an interview protocol that is used to research meanings and modes of narrating illness experiences, tested, in the Brazilian context, for psychiatric and cancer-related problems. Two translations and their respective back-translations were developed. In addition, semantic equivalence was evaluated, a synthesis version and a final version were prepared, and two pre-tests were administered to the target populations (people with auditory verbal hallucinations or breast cancer). A high degree of semantic equivalence was found between the original instrument and the translation/back-translation pairs, and also in the perspective of referential and general meanings. The semantic and operational equivalence of the proposed modifications was confirmed in the pre-tests. Therefore, the first adaptation of an interview protocol that elicits the production of narratives about illness experiences has been provided for the Brazilian context.
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Affiliation(s)
- Erotildes Maria Leal
- Departamento de Medicina de Família e Comunidade, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ). R. Laura de Araújo 36/2º, Cidade Nova. 20211-170 Rio de Janeiro RJ Brasil.
| | - Alicia Navarro de Souza
- Departamento de Psiquiatria e Medicina Legal, Faculdade de Medicina, UFRJ. Rio de Janeiro RJ Brasil
| | | | - Iraneide Castro de Oliveira
- Departamento de Medicina de Família e Comunidade, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ). R. Laura de Araújo 36/2º, Cidade Nova. 20211-170 Rio de Janeiro RJ Brasil.
| | - Catarina Magalhães Dahl
- Departamento de Medicina de Família e Comunidade, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ). R. Laura de Araújo 36/2º, Cidade Nova. 20211-170 Rio de Janeiro RJ Brasil.
| | - Ana Cristina Figueiredo
- Departamento de Medicina de Família e Comunidade, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ). R. Laura de Araújo 36/2º, Cidade Nova. 20211-170 Rio de Janeiro RJ Brasil.
| | - Samantha Salem
- Instituto de Psiquiatria, UFRJ. Rio de Janeiro RJ Brasil
| | - Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University. Montreal Canadá
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Abstract
OBJECTIVE The overall aim of this article is to examine the self-defined role of romantic relationships, intimacy and sexuality in recovery from severe mental illness. METHOD Semistructured interviews were conducted with 35 people with severe mental illness, accompanied by participant observation. Data were analyzed using thematic analysis. RESULTS The vast majority of participants considered a supportive relationship that was emotionally or sexually intimate to be a key facilitator and indicator of recovery. However, only a small minority of participants were actually in such a relationship. Participants reported numerous barriers to forming and maintaining such relationships such as financial strain and enduring stigma against people with mental illness. CONCLUSION AND IMPLICATIONS FOR PRACTICE Addressing relational and intimate needs have not been a focus of traditional psychiatric services. As such, some form of "supported dating" within the field of psychosocial rehabilitation may be an essential development to foster an oft-overlooked but important aspect of recovery. (PsycINFO Database Record
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Affiliation(s)
- Marie-Eve Boucher
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University
| | - Danielle Groleau
- Jewish General Hospital, Department of Psychiatry, McGill University
| | - Rob Whitley
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University
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18
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Gureje O, Oladeji BD, Araya R, Montgomery AA, Kola L, Kirmayer L, Zelkowitz P, Groleau D. Expanding care for perinatal women with depression (EXPONATE): study protocol for a randomized controlled trial of an intervention package for perinatal depression in primary care. BMC Psychiatry 2015; 15:136. [PMID: 26122982 PMCID: PMC4486135 DOI: 10.1186/s12888-015-0537-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is common among women during perinatal period and is associated with long-term adverse consequences for the mother and infant. In Nigeria, as in many other low- and-middle-income countries (LMIC), perinatal depression usually goes unrecognized and untreated. The aim of EXPONATE is to test the effectiveness and cost-effectiveness of an intervention package for perinatal depression delivered by community midwives in primary maternal care in which physician support and enhanced patient compliance are implemented using mobile phones. METHODS/STUDY DESIGN A pragmatic two-arm parallel cluster randomized controlled trial was designed. The units of allocation are the primary maternal care clinics. Thirty eligible and consenting clinics were randomized but, due to problems with logistics, 29 eventually participated. Consenting pregnant women with a gestational age between 16 and 28 weeks who screened positive on the Edinburgh Postnatal Depression Scale (EPDS score ≥12), absent psychosis or bipolar disorder, and not actively suicidal were recruited into the trial (N = 686). Midwives in the intervention arm were trained to deliver psychoeducation, problem solving treatment, and parenting skills. Eight weekly sessions were delivered following entry into the study. Further sessions during pregnancy and 6 weeks following childbirth were determined by level of depressive symptoms. Clinical support and supervision, delivered mainly by mobile phone, were provided by general physicians and psychiatrists. Automated text and voice messages, also delivered by mobile phones, were used to facilitate patient compliance with clinic appointments and 'homework' tasks. Patients in the control arm received care as usual enhanced by further training of the providers in that arm in the recognition and standard treatment of depression. Assessments are undertaken at baseline, 2 months following recruitment into the study and 3, 6, 9 and 12 months after childbirth. The primary outcome is recovery from depression (EPDS < 6) at 6 months. Secondary outcomes include measures of disability, parenting skills, maternal attitudes, health care utilization as well as infant physical and cognitive development comprehensively assessed using the Bayley's Scales. DISCUSSION To the best of our knowledge, this is the largest randomized controlled trial of an intervention package delivered by community midwives in sub-Saharan Africa. TRIAL REGISTRATION Trial is registered with the ISRTCN registry at isrtcn.com; Trial number ISRCTN60041127 . Date of registration is 15/05/2013.
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Affiliation(s)
- Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | | | - Ricardo Araya
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Alan A. Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Laurence Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University Culture and Mental Health research unit, Jewish General Hospital, Montréal, Canada.
| | - Phyllis Zelkowitz
- Division of Social and Transcultural Psychiatry, McGill University Culture and Mental Health research unit, Jewish General Hospital, Montréal, Canada.
| | - Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University Culture and Mental Health research unit, Jewish General Hospital, Montréal, Canada.
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19
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Abstract
We examined how the process of cultural formulation contributes to diagnostic assessment of patients with psychotic disorders at a specialized Cultural Consultation Service (CCS). Specifically, we investigated the reasoning process used to resolve uncertainty of psychotic disorder diagnosis in African immigrant patients referred to the CCS for assessment of possible psychotic disorder. Qualitative thematic analysis of 23 clinical case conference transcripts was used to identify clinicians' reasoning styles. Use of the CF appears to facilitate the emergence of a rule-governed reasoning process that involved three steps: (i) problematize the diagnosis of the intake 'psychosis' symptoms or behavior; (ii) elaborate explanations as to why the symptoms or behavior may or may not be psychosis; and (iii) confirm the diagnosis of psychosis or re-interpret as non-psychosis. Prototypes and exemplars drawn from previous experience in intercultural work featured prominently in clinicians' reasoning. Prototypes were crucial in diagnostic decision-making and appear to be important sources of both clinician expertise and bias, and may need to be targeted specifically in cultural competence training.
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Affiliation(s)
- Ademola B Adeponle
- Division of Social & Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada,
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20
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Bélanger E, Rodríguez C, Groleau D, Légaré F, Macdonald ME, Marchand R. Initiating decision-making conversations in palliative care: an ethnographic discourse analysis. BMC Palliat Care 2014; 13:63. [PMID: 25859161 PMCID: PMC4391144 DOI: 10.1186/1472-684x-13-63] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
Background Conversations about end-of-life care remain challenging for health care providers. The tendency to delay conversations about care options represents a barrier that impedes the ability of terminally-ill patients to participate in decision-making. Family physicians with a palliative care practice are often responsible for discussing end-of-life care preferences with patients, yet there is a paucity of research directly observing these interactions. In this study, we sought to explore how patients and family physicians initiated decision-making conversations in the context of a community hospital-based palliative care service. Methods This qualitative study combined discourse analysis with ethnographic methods. The field research lasted one year, and data were generated through participant observation and audio-recordings of consultations. A total of 101 consultations were observed longitudinally between 18 patients, 6 family physicians and 2 pivot nurses. Data analysis consisted in exploring the different types of discourses initiating decision-making conversations and how these discourses were affected by the organizational context in which they took place. Results The organization of care had an impact on decision-making conversations. The timing and origin of referrals to palliative care shaped whether patients were still able to participate in decision-making, and the decisions that remained to be made. The type of decisions to be made also shaped how conversations were initiated. Family physicians introduced decision-making conversations about issues needing immediate attention, such as symptom management, by directly addressing or eliciting patients’ complaints. When decisions involved discussing impending death, decision-making conversations were initiated either indirectly, by prompting the patients to express their understanding of the disease and its progression, or directly, by providing a justification for broaching a difficult topic. Conclusions Decision-making conversations and the initiation thereof were framed by the organization of care and the referral process prior to initial encounters. While symptom management was taken for granted as part of health care professionals’ expected role, engaging in decisions regarding preparation for death implicitly remained under patients’ control. This work makes important clinical contributions by exposing the rhetorical function of family physicians’ discourse when introducing palliative care decisions.
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Affiliation(s)
- Emmanuelle Bélanger
- Department of Social and Preventive Medicine, Université de Montréal, 7101 Parc Avenue, Montreal, H3N 1X9 Quebec Canada ; Department of Family Medicine, McGill University, Montreal, Canada
| | - Charo Rodríguez
- Department of Family Medicine, McGill University, Montreal, Canada
| | | | - France Légaré
- Department of Emergency and Family Medicine, Université Laval, Quebec City, Canada
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Harris S, Mamdani M, Galbo-Jørgensen CB, Bøgelund M, Gundgaard J, Groleau D. The effect of hypoglycemia on health-related quality of life: Canadian results from a multinational time trade-off survey. Can J Diabetes 2014; 38:45-52. [PMID: 24485213 DOI: 10.1016/j.jcjd.2013.09.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of hypoglycemia according to severity and time of onset on health-related quality of life (HRQoL) in a Canadian population. METHODS Time trade-off (TTO) methodology was used to estimate health utilities associated with hypoglycemic events in a representative sample of the Canadian population. A global analysis conducted in the United Kingdom, Canada, Germany and Sweden has been published. The present Canadian analysis focuses on 3 populations: general, type 1 and type 2 diabetes. Using a web-based survey, participants (>18 years) assessed the utility of 13 different health states (severe, non-severe, daytime and nocturnal hypoglycemia at different frequencies) using a scale from 1 (perfect health) to 0 (death). The average disutility value for each type of event was calculated. RESULTS Of 2258 participants, 1696 completers were included in the analysis. A non-severe nocturnal hypoglycemic event was associated with a significantly greater disutility than a non-severe daytime event (-0.0076 vs. -0.0056, respectively; p=0.05), while there was no statistically significant difference between severe nocturnal and severe daytime events (-0.0616 vs. -0.0592; p=0.76). Severe hypoglycemia was associated with greater disutility than non-severe hypoglycemia (p<0.0001). Similar trends were reported in participants with diabetes. CONCLUSIONS The findings presented here show that any form of hypoglycemia had a negative impact on HRQoL in a Canadian population. Nocturnal and/or severe hypoglycemia had a greater negative impact on HRQoL compared with daytime and/or non-severe events. This highlights the importance of preventing the development and nocturnal manifestation of hypoglycemia in patients with diabetes.
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Affiliation(s)
- Stewart Harris
- Department of Family Medicine, Western University, London, Ontario, Canada.
| | - Muhammad Mamdani
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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22
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Navarro de Souza A, Groleau D, Loiselle CG, Foulkes WD, Wong N. Cultural aspects of healthy BRCA carriers from two ethnocultural groups. Qual Health Res 2014; 24:665-681. [PMID: 24692182 DOI: 10.1177/1049732314528756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We explored the experiences of Ashkenazi Jewish and French Canadian women and meanings attributed to their hereditary breast and ovarian cancer (HBOC) risk. We purposively sampled 40 BRCA1 or BRCA2 (BRCA) mutation carriers and conducted theoretically driven semistructured interviews. According to content analysis, participants from these two ethnocultural groups held divergent meanings associated with being a BRCA carrier and different views pertaining to the illness experience and risk awareness. All participants identified a genetic basis; however, the French Canadian women also expressed other causes. The French Canadian women reported not knowing other carriers in their social environment, whereas the Ashkenazi Jewish women emphasized a strong sense of community contributing to their ethnic risk awareness. Based on these findings, we suggest that French Canadian women could benefit from greater awareness of the HBOC genetic risk and that health care providers should consider ethnically related and individual-based experiences and meanings during counseling.
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Brod M, Wolden M, Groleau D, Bushnell DM. Understanding the economic, daily functioning, and diabetes management burden of non-severe nocturnal hypoglycemic events in Canada: differences between type 1 and type 2. J Med Econ 2014; 17:11-20. [PMID: 24199622 DOI: 10.3111/13696998.2013.857676] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the daily functioning, diabetes management, and economic burden of non-severe nocturnal hypoglycemic events (NSNHEs) in Canada and differences in impacts by diabetes type. RESEARCH DESIGN AND METHODS A 20-min web-based survey, with items derived from the literature, expert and patient interviews, assessing the impact of NSNHEs, was administered to patients with self-reported diabetes aged ≥18 having an NSNHE in the past month. RESULTS Two thousand, two hundred and seventy-nine Canadian persons with diabetes were screened with 200 respondents meeting criteria and included in the analysis sample. Out of 87 working respondents, 15 reported on average 3.5 h of lost work (absenteeism). The reduction in work productivity (presenteeism) reported was comparable to the impact of arthritis. Other functional impacts included sleep and daily activities. Additionally, respondents' increased their usual blood sugar monitoring practice, on average, 4.2 (SD = 7.5) extra tests were conducted in the week following the event and reduced their insulin over the following 4.8 days. Increased healthcare utilization was also reported. Increased costs as a result of NSNHE for lost work productivity, increased diabetes management, and resource utilization was CAD 70.67 per person per year in this sample. Limitations of the study include the biases which are associated with a web-based survey and self-reported data. CONCLUSIONS NSNHEs have serious consequences for patients and diabetes management practices. Greater attention to treatments which reduce NSNHEs can have a major impact on improving functioning while reducing the economic burden of diabetes.
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Yeaw J, Lee WC, Wolden ML, Christensen T, Groleau D. Cost of Self-Monitoring of Blood Glucose in Canada among Patients on an Insulin Regimen for Diabetes. Diabetes Ther 2012; 3:7. [PMID: 22736405 PMCID: PMC3508114 DOI: 10.1007/s13300-012-0007-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION People with diabetes are at a higher risk of developing a variety of medical conditions relative to those without diabetes, resulting in increased healthcare costs. Self-monitoring of blood glucose (SMBG) is accepted as a recommended element of effective diabetes self-management. However, little is known about the real-world frequency and actual expenditures associated with SMBG, as well as the impact of SMBG costs relative to the cost of diabetes treatments. The primary objective is to evaluate the real-world utilization and costs of SMBG tests in Canada among insulin-treated diabetes patients during a 12-month follow-up period. METHODS A retrospective cohort study was conducted using the IMS Brogan Inc. Drug Plan database from July 1, 2006 through June 30, 2010. Total costs during the 12-month follow-up period were assessed, focusing on blood glucose (BG) testing strip costs, insulin therapy costs, and costs associated with oral antidiabetics medications. All prevalent patients with two or more prescriptions for insulin between January 1, 2007 and December 31, 2009 were initially included in the analysis, the first prescription serving as their index date. Depending on the insulin type(s) used, patients were subcategorized into one of four insulin regimen groups (basal, bolus, premix, or basal-bolus). RESULTS Among an initial sample of patients with two or more claims for insulin between January 1, 2007 and December 31, 2009, 142,551 met the aforementioned inclusion and exclusion criteria. An overall mean utilization of pharmacy-based blood glucose testing of approximately 1,094 strips per person per year was observed, with an average cost per testing strip of Canadian $0.79. SMBG treatment costs for insulin users ($860), specifically those associated with prescription testing strips, totaled 41.6% of the average annual pharmacy costs of diabetes-related prescriptions ($2,068). CONCLUSION This study shows that SMBG accounts for approximately 40% of the total diabetes-related pharmacy costs for insulin users.
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Affiliation(s)
- Jason Yeaw
- IMS Consulting Group, 3 Lagoon Drive, Suite 230, Redwood City, CA, 94065, USA,
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Harris S, Mamdani M, Bogelund M, Galbo-Jorgensen CB, Groleau D, Gundgaard J. Health-related Quality of Life Associated with Daytime and Nocturnal Hypoglycemic Events: a Canadian Time Trade-off Survey. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wolden ML, Brod M, Groleau D, Christensen TE, Mamdani M. Patient-related and Socio-economic Implications of Non-Severe Nocturnal Hypoglycaemia among Canadian Type 1 and Type 2 Diabetes Patients. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Emotional distress is common among patients with chronic medical illnesses, but the nature of the distress is not well understood. Our objective was to understand patients' experiences of emotional distress by conducting in-depth interviews using the McGill Illness Narrative Interview with women affected by scleroderma (N = 16). We sought to determine how participants described their distress, what they believed caused it, and how they coped. We analyzed interview transcripts using thematic analysis. Many participants described distress associated with scleroderma, but the term depression was reserved for extraordinary, severe experiences. Instead, participants preferred more normal mood descriptors and often viewed their distress in keeping with the definition of "demoralization." Participants listed concrete symptoms and experiences that caused distress, and some added that stress could exacerbate scleroderma. Participants dealt with distress by not dwelling on their circumstances and working to maintain autonomy. Most preferred to not rely on psychologists and support groups.
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Semenic S, Childerhose JE, Lauzière J, Groleau D. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review. J Hum Lact 2012; 28:317-34. [PMID: 22628290 DOI: 10.1177/0890334412445195] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.
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Affiliation(s)
- Sonia Semenic
- School of Nursing, McGill University, Montreal, Canada.
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Macías YF, Marquis GS, Groleau D, Penny ME. Decline of exclusive breastfeeding: Practical advice and stronger policy compliance are needed in government health services in Lima, Peru. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.806.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yvette Fautsch Macías
- School of Dietetics and Human NutritionMcGill UniversitySte-Anne-de-BellevueQCCanada
| | - Grace S. Marquis
- School of Dietetics and Human NutritionMcGill UniversitySte-Anne-de-BellevueQCCanada
| | - Danielle Groleau
- Division of Social and Transcultural PsychiatryJewish General HospitalMcGill UniversityMontrealQCCanada
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Dinh NM, Groleau D, Kirmayer LJ, Rodriguez C, Bibeau G. Influence of the DSM‐IV Outline for Cultural Formulation on multidisciplinary case conferences in mental health. Anthropol Med 2012; 19:261-76. [DOI: 10.1080/13648470.2011.646944] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nathalie M.H. Dinh
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Danielle Groleau
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Laurence J. Kirmayer
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Charo Rodriguez
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Gilles Bibeau
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
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Adeponle AB, Thombs BD, Groleau D, Jarvis E, Kirmayer LJ. Using the cultural formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients. Psychiatr Serv 2012; 63:147-53. [PMID: 22302332 DOI: 10.1176/appi.ps.201100280] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the study was to assess the impact of systematic use of the DSM-IV-TR cultural formulation on diagnoses of psychotic disorders among patients of ethnic minority and immigrant backgrounds referred to a cultural consultation service (CCS) in Canada. METHODS The study entailed a review of medical records and case conference transcripts of 323 patients seen in a ten-year period at the CCS to determine factors associated with change in the diagnosis of psychotic disorders by the CCS. Logistic regression analysis was used to identify variables associated with changes in diagnosis. RESULTS A total of 34 (49%) of the 70 cases with an intake (referral) diagnosis of a psychotic disorder were rediagnosed as nonpsychotic disorders, whereas only 12 (5%) of the 253 cases with an intake diagnosis of a nonpsychotic disorder were rediagnosed as a psychotic disorder (p<.001). Major depression, posttraumatic stress disorder (PTSD), adjustment disorder, and bipolar affective disorder were the common disorders diagnosed with use of the cultural formulation. Rediagnosis of a psychotic disorder as a nonpsychotic disorder was significantly associated with being a recent arrival in Canada (odds ratio [OR]=6.05, 95% confidence interval [CI]=1.56-23.46, p=.009), being nonblack (OR=3.72, CI=1.03-13.41, p=.045), and being referred to the CCS by nonmedical routes (such as social work or occupational therapy) (OR=3.23, CI=1.03-10.13, p=.044). CONCLUSIONS Misdiagnosis of psychotic disorders occurred with patients of all ethnocultural backgrounds. PTSD and adjustment disorder were misidentified as psychosis among immigrants and refugees from South Asia. Studies are needed that compare clinical outcomes of use of cultural consultation with outcomes from use of other cultural competence models.
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Affiliation(s)
- Ademola B Adeponle
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
This paper wishes to contribute to the debate around citizen participation in health system decision-making that has been present internationally for the last 30 years. I argue that if we aim to change health inequalities, health professionals and planners need to understand the illness and health service experience of citizens. The concept of 'health citizenship' introduced here refers to health knowledge that integrates the lay knowledge of patients and that this integration is translated into health actions such as clinical communication and the planning of health care, programs, and policy. We illustrate our argument with the two cases: health literacy and the promotion of breastfeeding in a Canadian population living in context of poverty. This paper then concludes by addressing the leadership role, Brazilian graduate nursing schools can play in promoting 'health citizenship' and by doing so, contribute to fight health inequalities.
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Abstract
The aim of this study is to synthesize knowledge about the process of shared decision-making (SDM) in palliative care. Medline, EMBASE, CINAHL, PsychInfo, Web of Science were searched with core concepts: shared decisions, patient participation in decision-making, and palliative care. Titles and abstracts were screened according to inclusion criteria (original research, adult patients, Western contexts, decision-making, palliative treatment or setting), yielding 37 articles for analysis. A narrative synthesis was created using the methods of thematic analysis, conceptual mapping, and critical reflection on the synthesis process. Results demonstrate that while a majority of patients want to participate in treatment decisions to some extent, most do not achieve their preferred levels of involvement because decisions are delayed and alternative treatment options are seldom discussed. The literature regarding the process of SDM itself remains scarce in palliative care. Further research is needed in order to better understand the longitudinal, interactive, and interdisciplinary process of decision-making in palliative care.
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Affiliation(s)
- Emmanuelle Bélanger
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.
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Dickinson P, Looper KJ, Groleau D. Patients diagnosed with nonepileptic seizures: their perspectives and experiences. Epilepsy Behav 2011; 20:454-61. [PMID: 21316310 DOI: 10.1016/j.yebeh.2010.12.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/20/2010] [Accepted: 12/21/2010] [Indexed: 11/26/2022]
Abstract
The objective of this qualitative study was to examine how patients with nonepileptic seizures (NES) make sense of their illness experience in light of the many obstacles they may face when seeking treatment. We conducted semistructured interviews with five patients with NES to explore their illness perspectives and different modes of reasoning in regard to their illness and treatment experiences. The data were examined using thematic content analysis. The participants who implicitly incorporated epilepsy as an illness prototype demonstrated less effective treatment expectations and imposed greater life constraints on themselves than the participant who used anxiety attacks. The participants who defined an explanatory model with a psychosocial basis for illness onset were receptive and demanding of psychotherapeutic intervention. Emergent themes included accounts of adverse and positively perceived life events coinciding with illness onset, head injury, presence of caregivers during events, comorbid illness, and previously witnessing epilepsy in others.
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Affiliation(s)
- Philip Dickinson
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Groleau D, Whitley R, Lespérance F, Kirmayer LJ. Spiritual reconfigurations of self after a myocardial infarction: Influence of culture and place. Health Place 2010; 16:853-60. [PMID: 20471300 DOI: 10.1016/j.healthplace.2010.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/13/2010] [Accepted: 04/19/2010] [Indexed: 11/29/2022]
Abstract
This study explored illness narratives following a myocardial infarction (MI) in French Canadians. Qualitative interviews were completed using the McGill Illness Narrative Interview with 51 patients following a first MI. Content analysis of interviews suggested that the heart was perceived as a receptacle that contained an accumulation of life's ordeals, negative emotions and family traumas. This resulted in perceived heart strain, which was considered a direct cause of the MI. References to spirituality were central to the patients' narratives and were identified as instrumental in post-MI recovery. Results illustrate how place and culture interact to shape illness experience and recovery trajectories after a life-threatening health event.
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Affiliation(s)
- Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, Qué., Canada.
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Abstract
This study focuses on the therapeutic process and perceived helpfulness of dang-ki, a form of Chinese shamanistic healing, in Singapore. It aims to understand the healing symbols employed in dang-ki, whether or not patients find them helpful and whether their perceived helpfulness can be explained by the symbolic healing model (Dow, Am Anthropol 88(1):56-69, 1986; Levi-Strauss, Structural anthropology. Basic Books, New York, 1963). Although many researchers have applied this model to explain the efficacy of shamanistic healings, they did not directly provide empirical support. Furthermore, the therapeutic process of a shared clinical reality as proposed by the model may be achievable in small-scale traditional societies that are culturally more homogeneous than in contemporary societies that are culturally more diversified due to globalization and immigration. Patients may hold multidimensional health belief systems, as biomedicine and alternative healing systems coexist. Thus, it would be interesting to see the relevance and applicability of the symbolic healing model to shamanistic healing in contemporary societies. In this study, ethnographic interviews were conducted with 21 patients over three stages: immediately before and after the healing and approximately 1 month later. The dang-ki healing symbols were identified by observing the healing sessions with video recording. Results show that dang-kis normally applied more than one method to treat a given problem. These methods included words, talismans and physical manipulations. Overall, 11 patients perceived their consultations as helpful, 4 perceived their consultations as helpful but were unable to follow all recommendations, 5 were not sure of the outcome because they had yet to see any concrete results and only 1 patient considered his consultation unhelpful. Although the symbolic healing model provides a useful framework to understand perceived helpfulness, processes such as enactment of a common meaning system and symbolic transformation are complex and dynamic, and may be carried over several healing sessions.
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Affiliation(s)
- Boon-Ooi Lee
- National Institute of Education, Nanyang Technological University, No. 1, Nanyang Walk, Singapore 637616, Singapore.
| | | | - Danielle Groleau
- McGill University, 845 Sherbrooke Street, West Montreal, QC H3A 2T5, Canada
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Cabral IE, Groleau D. Breastfeeding practices after Kangaroo Mother Method in Rio de Janeiro: the necessity for he alth education and nursing intervention at homea. Esc Anna Nery 2009. [DOI: 10.1590/s1414-81452009000400011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IThe "teaching-leaning" is part of the Brazilian Kangaroo Mother Method with the objective of increasing skills of mother's breastfeeding infants with special health needs. Nevertheless, we do not know if this knowledge was embodied in the family inner circle, so we aimed at identifying and analyzing how this medical knowledge was incorporated in the context of infants' homes. Participatory research was developed at home with eleven groups of mother, family members and neighbors. Local knowledge of neighbors' and family members' replaced the medical knowledge and changed infant feeding practices. Health education should be implemented beyond hospital and include family members.
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Groleau D, Pluye P, Nadeau L. A mix-method approach to the cultural understanding of distress and the non-use of mental health services. J Ment Health 2009. [DOI: 10.1080/09638230701496386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tunis SL, Minshall ME, Conner C, McCormick JI, Kapor J, Yale JF, Groleau D. Cost-effectiveness of insulin detemir compared to NPH insulin for type 1 and type 2 diabetes mellitus in the Canadian payer setting: modeling analysis. Curr Med Res Opin 2009; 25:1273-84. [PMID: 19366302 DOI: 10.1185/03007990902869169] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was conducted to quantify the long-term cost-effectiveness of insulin detemir (Levemir) versus intermediate-acting neutral protamine Hagedorn (NPH) insulin for the treatment of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in Canada, and to assess the sensitivity of results to dis-utilities for hypoglycemic events. dagger Levemir is a trade name of Novo Nordisk, Princeton, NJ, USA RESEARCH DESIGN AND METHODS: The web-based IMS-CORE diabetes model has a menu-driven interface programmed in hypertext markup language (HTML). It was used to project lifetime (60 years for T1DM and 35 years for T2DM) clinical and economic outcomes for patients on detemir vs. NPH. Cohort characteristics, utilities, and costs were derived from published literature. For T1DM, clinical trial data for HbA(1c) improvement (detemir -0.94% +/- 1.07; NPH -0.82% +/- 1.01) from baseline, and rates of hypoglycemic events (major events: 0.20 vs. 0.80 per patient-year for detemir vs. NPH, respectively) were modeled. For T2DM, observational study data for HbA(1c) improvement (detemir -0.18%) from baseline, and reductions in hypoglycemic events (major events: 0.0995 vs. 1.33 per patient-year for detemir vs. NPH, respectively) were modeled. Base-case hypoglycemia dis-utilities were -0.0118 for major and -0.0035 for minor events. Sensitivity analyses were conducted on discount rate and hypoglycemia dis-utility. OUTCOME MEASURES Outcomes included costs of treatment/management and costs (and incidence) of diabetes-related complications. Incremental cost-effectiveness ratios (ICERs) were calculated from differences in total costs and quality-adjusted life-years (QALYs). RESULTS Average total costs for T1DM were $CAN 83 622 +/- 4585 for detemir and $CAN 72 016 +/- 4593 for NPH. QALYs increased by 0.475 years with detemir, with an ICER of $CAN 24 389/QALY. Average direct costs for T2DM were $CAN 74 919 +/- 6391 (detemir) and $CAN 69 230 +/- 6840 (NPH). QALYs increased by 0.305 years. The ICER was $CAN 18 677. Although detemir was associated with slightly lower costs for most complications, results were driven by the differences in rates and costs for hypoglycemic events, and their assumed dis-utility. Study limitations include the use of single trials for clinical assumptions and the lack of analyses for patient risk sub-groups. CONCLUSIONS Findings provide evidence for the cost-effectiveness of detemir vs. NPH in treating T1 and T2DM in Canada, and support the key role of assumptions regarding the impact of hypoglycemic events. Additional work is needed to determine the extent to which results are robust for different sub-groups of patients and for variation in assumptions around HbA(1c) improvements and hypoglycemic event rates.
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MESH Headings
- Adult
- Canada
- Cost-Benefit Analysis
- Diabetes Complications/economics
- Diabetes Complications/epidemiology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/epidemiology
- Female
- Humans
- Incidence
- Insulin/analogs & derivatives
- Insulin/economics
- Insulin/therapeutic use
- Insulin Detemir
- Insulin, Isophane/economics
- Insulin, Isophane/therapeutic use
- Insulin, Long-Acting
- Life Expectancy
- Male
- Middle Aged
- Models, Econometric
- Quality of Life
- Single-Payer System/economics
- Single-Payer System/statistics & numerical data
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Groleau D, Cabral IE. Reconfiguring insufficient breast milk as a sociosomatic problem: mothers of premature babies using the kangaroo method in Brazil. Matern Child Nutr 2009; 5:10-24. [PMID: 19161541 DOI: 10.1111/j.1740-8709.2008.00151.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study focuses on Brazilian mothers who gave birth to premature babies who were discharged from hospital using the Kangaroo Mother Care Method. While mothers left the hospital breastfeeding exclusively, once back at home, they abandoned exclusive breastfeeding because of insufficient breast milk (IBM). In this project we explored how IBM was interpreted by mothers within their social context. Participatory research using the Creative Sensitive Method was done in the homes of mothers with family members and neighbours. We described the conflicting social discourse that influenced the mothers' perception of IBM and explored their sources of distress. At the hospital and Kangaroo ward, mothers considered that clinicians recognized they were experiencing IBM and thus supported them to overcome this problem. Back at home and in their community, other sources of stress generated anxiety such as: the lack of outpatient clinical support, and conflicting local norms to care and feed premature babies. These difficulties combined with economic constraints and discontinuity in models of health care led mothers to lose confidence in their breastfeeding capacity. Mothers, thus, rapidly replaced exclusive breastfeeding by mixed feeding or formula feeding. Our analysis suggests that IBM in our sample was the result of a socio-somatic process. Recommendations are proposed to help overcome IBM and corresponding contextual barriers to exclusive breastfeeding.
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Affiliation(s)
- Danielle Groleau
- Culture & Mental Health Research Unit, Sir Mortimer B. Davis - Jewish General Hospital & Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.
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Abstract
Weak external validity of qualitative data has been a subject of debate outside and within the field of qualitative health research. Though some narratives have the power to reveal universal existential issues and inform theoretical development, each story remains unique and cannot be generalized. If the goal of qualitative researchers is to have narrative knowledge effect social change, we are faced with a pervasive problem. Our main objective with this article is methodological; that is, to argue and illustrate that a sequential-consensual qualitative design can yield data with adequate external validity to influence clinicians and public health programming. We seek to contribute to the debate on the generalizability of qualitative research in the health field and provide a methodological template for this type of qualitative design so researchers can apply it to future projects to transfer and translate popular knowledge in a way that can influence social change.
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Affiliation(s)
- Danielle Groleau
- McGill University and Sir Mortimer B. Davis Jewish General Hospital, Montreal, Québec, Canada
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Hagedorn A, Levadoux W, Groleau D, Tartakovsky B. Evaluation of Multiwavelength Culture Fluorescence for Monitoring the Aroma Compound 4-Hydroxy-2(or 5)-ethyl-5(or 2)-methyl-3(2H)-furanone (HEMF) Production. Biotechnol Prog 2008; 20:361-7. [PMID: 14763864 DOI: 10.1021/bp0300321] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fluorescence spectra of a 4-hydroxy-2(or 5)-ethyl-5(or 2)-methyl-3(2H)-furanone (HEMF) fermentation culture broth were combined with measurable process variables for off-line and on-line process monitoring. Culture broth fluorescence in UV and visible ranges was acquired by a fiber optic LCD array spectrometer. Process dynamics was followed on-line using a fiber optic probe attached to an external recirculation loop of the bioreactor. Partial least squares and stepwise regression methods were used to correlate measurable process parameters with the components of the fluorescence spectra. Both methods provided adequate approximation of yeast density, HEMF, glucose, and ethanol concentrations from fluorescence spectra. HEMF production was observed during the oxido-reductive growth phase when there was a lack of measurable oxygen in the culture broth and an excess of glucose. The addition of glucose resulted in the rapid production of HEMF and other metabolite intermediates such as ethanol, acetate, and glycerol.
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Affiliation(s)
- A Hagedorn
- Biotechnology Research Institute, NRC, 6100 Royalmount Ave., Montreal, Quebec, Canada H4P 2A2
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Abstract
Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation ("Kwam khem keuang") as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient's perspective offers a reflexive stance on the clinician-patient interaction that allows for better patient care.
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Affiliation(s)
- Nathalie M H Dinh
- Department of Psychology, University of Montreal, Montreal, QC, Canada.
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Kirmayer LJ, Rousseau C, Corin E, Groleau D. Training researchers in cultural psychiatry: the McGill-CIHR Strategic Training Program. Acad Psychiatry 2008; 32:320-326. [PMID: 18695034 DOI: 10.1176/appi.ap.32.4.320] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The authors aim to summarize the pedagogical approaches and curriculum used in the training of researchers in cultural psychiatry at the Division of Social and Transcultural Psychiatry at McGill University. METHOD We reviewed available published and unpublished reports on the history and development of the McGill cultural psychiatry programs to identify the main orientations (conceptual and methodological), teaching methods, curriculum and course content. Student evaluations of teaching were reviewed. Follow-up data on research and other academic activities and employment of trainees who graduated from the program was obtained by e-mail questionnaire. RESULTS The McGill program includes a Master of Science program, an intensive summer school, annual Advanced Study Institutes, and the McGill-CIHR Strategic Training Program in Culture and Mental Health Services Research. The interdisciplinary training setting emphasizes the cultural history and embedding of psychiatric knowledge and practice; the social construction of ethnicity, race, and cultural identity; the impact of globalization, migration, and ideologies of citizenship on individual identity and the configuration of cultural communities; and the integration of quantitative and qualitative ethnographic methods in basic and evaluative research. CONCLUSION This critical transdisciplinary approach provides researchers with conceptual tools to address the impact of the changing meanings of culture and ethnicity difference in the contemporary world on mental health services.
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Whitley R, Kirmayer LJ, Groleau D. Public Pressure, Private Protest: Illness Narratives of West Indian Immigrants in Montreal with Medically Unexplained Symptoms. Anthropol Med 2007; 13:193-205. [DOI: 10.1080/13648470600863548] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Groleau D, Young A, Kirmayer LJ. The McGill Illness Narrative Interview (MINI): an interview schedule to elicit meanings and modes of reasoning related to illness experience. Transcult Psychiatry 2006; 43:671-91. [PMID: 17166953 DOI: 10.1177/1363461506070796] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article summarizes the rationale, development and application of the McGill Illness Narrative Interview (MINI), a theoretically driven, semistructured, qualitative interview protocol designed to elicit illness narratives in health research. The MINI is sequentially structured with three main sections that obtain: (1) A basic temporal narrative of symptom and illness experience, organized in terms of the contiguity of events; (2) salient prototypes related to current health problems, based on previous experience of the interviewee, family members or friends, and mass media or other popular representations; and (3) any explanatory models, including labels, causal attributions, expectations for treatment, course and outcome. Supplementary sections of the MINI explore help seeking and pathways to care, treatment experience, adherence and impact of the illness on identity, self-perception and relationships with others. Narratives produced by the MINI can be used with a wide variety of interpretive strategies drawn from medical anthropology, sociology and discursive psychology.
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Lindblom B, Nordmann JP, Sellem E, Chen E, Gold R, Polland W, Williamson W, Buchholz P, Walt JG, Groleau D, Curry A, Evans SJ. A multicentre, retrospective study of resource utilization and costs associated with glaucoma management in France and Sweden. ACTA ACUST UNITED AC 2006; 84:74-83. [PMID: 16445443 DOI: 10.1111/j.1600-0420.2005.00560.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess resource utilization and costs associated with glaucoma management in France and Sweden. METHODS A total of 267 patient records (121 in France, 146 in Sweden) with diagnoses of primary open-angle glaucoma (POAG) and ocular hypertension (OH), treated medically, were reviewed for a 2-year period (beginning during 1997-99) for relevant clinical and resource utilization data. Economic data were applied to estimate treatment costs. RESULTS The annual cost of treating glaucoma was estimated at SEK5305 (531 euro )/patient in Sweden and 390 euro/patient in France. In both countries, medication costs comprised about half of the total costs. Surgical procedures and hospitalizations represented greater proportions of total cost in France (7.0% and 9.6%, respectively) than in Sweden (3.7% and 0.6%, respectively). CONCLUSION Medication costs represent a high proportion of total treatment costs. These findings highlight the relative importance of medical therapy and of assessing the cost-effectiveness of medications in glaucoma.
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Whitley R, Kirmayer LJ, Groleau D. Understanding immigrants' reluctance to use mental health services: a qualitative study from Montreal. Can J Psychiatry 2006; 51:205-9. [PMID: 16629344 DOI: 10.1177/070674370605100401] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms. METHOD Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services. RESULTS Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine. CONCLUSION The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore.
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Affiliation(s)
- Rob Whitley
- New Hampshire-Dartmouth Psychiatric Research Center, Lebanon 03766, USA.
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Abstract
This study aimed to identify cultural factors involved in the abandonment of breastfeeding amongst Vietnamese immigrant women in Canada. Qualitative interviews were conducted with 19 mothers, exploring their perinatal experience from Vietnam to Canada. The results suggest that the decision to bottle-feed was not related to acculturation to local practices as has been claimed in previous studies but to conflicts between Vietnamese cultural practices and the configuration of the new social space in Canada. Living in Canada did not allow specific family members to conduct postnatal traditional rituals thus jeopardizing mothers' perceived health and the quality of their milk. Culturally appropriate strategies to promote breastfeeding among migrants must consider the social and spatial organization of cultural practices.
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Affiliation(s)
- Danielle Groleau
- Culture & Mental Health Research Unit, Sir Mortimer B. Davis-Jewish General Hospital & Division of Social & Transcultural Psychiatry, McGill University.
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Abstract
Patients with medically unexplained symptoms comprise from 15% to 30% of all primary care consultations. Physicians often assume that psychological factors account for these symptoms, but current theories of psychogenic causation, somatization, and somatic amplification cannot fully account for common unexplained symptoms. Psychophysiological and sociophysiological models provide plausible medical explanations for most common somatic symptoms. Psychological explanations are often not communicated effectively, do not address patient concerns, and may lead patients to reject treatment or referral because of potential stigma. Across cultures, many systems of medicine provide sociosomatic explanations linking problems in family and community with bodily distress. Most patients, therefore, have culturally based explanations available for their symptoms. When the bodily nature and cultural meaning of their suffering is validated, most patients will acknowledge that stress, social conditions, and emotions have an effect on their physical condition. This provides an entree to applying the symptom-focused strategies of behavioural medicine to address the psychosocial factors that contribute to chronicity and disability.
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Affiliation(s)
- Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec.
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