Whether and how people reach care.
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1476 to 1500 of 2,047Challenging perceptions of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal community.
Aim: To identify factors that affect rheumatic fever prophylaxis for remote-living Aboriginal patients, and to determine the proportion who received adequate prophylaxis.
Design and setting: Interview (with analysis based on principles of grounded theory) of patients with a history of rheumatic fever or rheumatic heart disease and their relatives, and health service providers in a remote Aboriginal community; audit of benzathine penicillin coverage of patients with rheumatic heart disease.
Participants: 15 patients with rheumatic heart disease or a history of rheumatic fever, 18 relatives and 18 health care workers.
Results: Patients felt that the role of the clinic was not only to care for them physically, but that staff should also show nurturing holistic care to generate trust and treatment compliance. Differing expectations between patients and health care providers relating to the r…
matched on Health Services Accessibility (mesh)
Hospital-level racial disparities in acute myocardial infarction treatment and outcomes.
Background: Previous studies have documented racial disparities in treatment of acute myocardial infarction (AMI) among Medicare beneficiaries. However, the extent to which unobserved differences between hospitals explains some of these differences is unknown.
Objective: The objective of this study was to determine whether the observed racial treatment disparities for AMI narrow when analyses account for differences in where blacks and whites are hospitalized.
Research design: Retrospective observational cohort study using Medicare claims and medical record review.
Subjects: This study included 130,709 white and 8286 black Medicare patients treated in 4690 hospitals in 50 US states for confirmed AMI in 1994 and 1995.
Measures: Measures in this study were receipt of reperfusion, aspirin, and smoking cessation counseling during hospitalization; prescription of aspirin, angiotensin-converti…
matched on Health Services Accessibility (mesh)
The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS).
The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% report…
matched on Patient Acceptance of Health Care (mesh)
Low socioeconomic status as a risk factor for asthma, rhinitis and sensitization at 4 years in a birth cohort.
Background: The relation between socioeconomic status and allergic diseases in childhood is controversial. Some studies have proposed childhood asthma to be more common in families with low socioeconomic status, while sensitization to airborne allergens seems to be more frequent in individuals with higher socioeconomic status in childhood.
Objective: To assess the relation between socioeconomic status and asthma, rhinitis and sensitization in an unselected prospective birth cohort.
Methods: Four thousand and eighty-nine families with children born 1994-1996 in predefined areas of Stockholm answered questionnaires on environmental factors, socioeconomic status (parental occupation), and symptoms of allergic disease at birth, 1, 2 and 4 years of age. Blood samples taken at 4 years from 2614 children were analysed for specific IgE to common airborne and food allergens. Odds ratios (OR) and …
matched on Patient Acceptance of Health Care (mesh)
Predictors of diaphragm use as a potential sexually transmitted disease/HIV prevention method in Zimbabwe.
Background: Women who are the most vulnerable to sexually transmitted diseases/HIV are often unable to consistently use condoms. One potential alternative method currently under investigation is the diaphragm.
Goals: The goals of this study were to assess diaphragm uptake and use over time in Zimbabwe and to identify factors associated with self-reported consistent diaphragm use.
Study: Women attending family planning clinics who were inconsistent condom users received a diaphragm intervention and were followed for 6 months.
Results: Of the 186 participants, 99% ever reported using the diaphragm, and, at study exit, 96% had used it in the previous 2 months. Consistent diaphragm use since the previous visit was reported by 13% to 16% of the women, and in multivariate regression analysis, it was significantly associated with never using condoms (adjusted odds ratio, 24.08; 95% confidence i…
matched on Patient Acceptance of Health Care (mesh)
Patient delay in women presenting with advanced breast cancer: an Iranian study.
Introduction: Due to the lack of systematic screening programmes for early detection of breast cancer in Iran and the predominance of advanced cases, we aimed to study the extent and determinants of patient delay in women with advanced breast cancer.
Materials and methods: In this 1-year cross-sectional study, all consecutive women with advanced breast cancer (stages IIb, III or IV) who initially presented to a university hospital were studied.
Results: Sixty-eight percent (136/200) of cases had delayed their first visit by >1 month and 42.5% by >3 months. The median patient delay was 12 weeks. Delay was associated with: older age, being married, lower income, less education, place of residence (small cities), negative family history of breast cancer, belief in the fatality of breast cancer, lack of access to health care services, lack of knowledge of breast cancer symptoms, and denying …
matched on Patient Acceptance of Health Care (mesh)
Antisocial personality disorder is associated with increased severity of gambling, medical, drug and psychiatric problems among treatment-seeking pathological gamblers.
Aims: To evaluate systematically whether pathological gamblers with antisocial personality disorder (ASPD) experience increased severity of gambling, medical, psychiatric, substance use and psychosocial problems compared to pathological gamblers without ASPD. PARTICIPANTS, DESIGN AND MEASUREMENTS: Pathological gamblers (n = 237) entering an out-patient treatment study for pathological gambling completed the ASPD section of the Structured Clinical Interview for Diagnostic and Statistical Manual version IV (DSM-IV) Personality Disorders, California Psychological Inventory-Socialization Scale, Addiction Severity Index (ASI), Brief Symptom Inventory (BSI) and gambling questionnaires.
Setting: Pathological gambling research clinic.
Findings: Thirty-nine (16.5%) pathological gamblers met DSM-IV diagnostic criteria for ASPD. Compared to pathological gamblers without ASPD, pathological gamblers …
matched on Patient Acceptance of Health Care (mesh)
American Indian/Alaskan Native grandparents raising grandchildren: findings from the Census 2000 Supplementary Survey.
This article documents the prevalence and national profile of American Indian/Alaskan Native (AI/AN) grandparents who are raising their grandchildren, based on data from the American Community Survey/Census 2000 Supplementary Survey. In 2000 there were estimated to be nearly 53,000 AI/AN grandparent caregivers age 45 and older in the United States. Almost half of the caregiving grandparents had been raising a grandchild for five years or longer. The findings reveal a portrait of grandparents committed to raising their grandchildren despite the fact that many were living in extreme poverty, with ill health, and with limited resources and services. One-third of grandparent caregivers were living below the poverty line, and only one-quarter of these were receiving public assistance. Even when compared with their noncaregiving AI/AN peers, grandparents raising grandchildren were disproportio…
matched on Health Services Accessibility (mesh)
Smoking is associated with pessimistic and avoidant beliefs about cancer: results from the International Cancer Benchmarking Partnership.
Background: Smoking cessation is the key cancer prevention behaviour for smokers; nonetheless, smokers can still benefit from earlier diagnosis of cancer. However, fewer smokers participate in screening despite their increased risk, which may reflect different beliefs about cancer.
Methods: A UK population-representative sample of ⩾50 year-olds (n=6965) was surveyed using the Awareness and Beliefs about Cancer measure. These analyses examine six items on cancer beliefs (e.g., 'cancer can often be cured'), and four on help-seeking barriers (e.g., 'I would be too embarrassed').
Results: Smokers were more likely to hold pessimistic cancer beliefs than never-smokers or former-smokers on four of six items. For example, 34% agreed 'a cancer diagnosis is a death sentence', compared with 24% of non/former-smokers (P<0.001). More smokers (18%) than non/former-smokers (11%) would not want to know …
matched on Attitude to Health (mesh), help-seeking (text)
'Consumed by breathing' - a critical interpretive meta-synthesis of the qualitative literature.
Objective: To derive an improved understanding of how patients respond to, appraise, and understand the experience of an acute exacerbation of chronic obstructive pulmonary disease via a critical interpretive meta-synthesis.
Methods: Search terms - Exacerbate* OR hospital* AND 'Chronic obstructive' OR emphysema OR bronchitis AND interview* OR qualitative. Inclusion criteria - Primary research published in English of patients' experiences of an acute exacerbation of chronic obstructive pulmonary disease. Data extraction and synthesis - eight papers were identified. Data were extracted by three researchers and constructs elicited via reciprocal translational analysis.
Findings: Themes reflected two domains of understanding an acute exacerbation: (1) Acute effect - encompassing intense emotions, somatic awareness and patients need for rescue. (2) Sustained regulation - reflecting life as in…
matched on Attitude to Health (mesh), help-seeking (text)
What is a mental illness? Public views and their effects on attitudes and disclosure.
Objective: 'Mental illness' is a common label. However, the general public may or may not consider various conditions, ranging from major psychiatric disorders to stress, as mental illnesses. It is unclear how such public views affect attitudes towards people with mental illness and reactions to one's own potential mental illness, e.g. in terms of help-seeking or disclosure.
Methods: In representative English population surveys the classification of six conditions (schizophrenia, bipolar disorder, depression, drug addiction, stress, grief) as a mental illness was assessed as well as attitudes towards, and contact with, people with mental illness, intentions to disclose a mental illness and to seek treatment.
Results: A factor analysis of how strongly respondents perceived the six conditions as a mental illness yielded two factors: (i) major psychiatric disorders and (ii) stress- and beha…
matched on Attitude to Health (mesh), help-seeking (text)
The balance of give and take in caregiver-partner relationships: An examination of self-perceived burden, relationship equity, and quality of life from the perspective of care recipients following stroke.
Purpose: We examined the sense of being a burden to others or self-perceived burden (SPB) in people with stroke.
Method: A mail survey was completed by 57 former inpatients and their partner caregivers. The care recipient survey included measures of functional status, quality of life, marital satisfaction, equity in the relationship, and psychological distress, as well as SPB using the Self-Perceived Burden Scale (SPBS; Cousineau, McDowell, Hotz, & Hébert, 2003). The caregiver survey included similar measures in addition to a caregiver burden measure.
Results: SPB was found to be a prevalent and distressing concern. SPBS scores correlated with measures of functional status and mood; however, the correlations were highest for measures of family roles and work/productivity. Using equity theory as a basis to examine the SPB construct, care recipients who perceived themselves as overbenefiti…
matched on Attitude to Health (mesh), help-seeking (text)
Trajectory to a first episode of psychosis: a qualitative research study with families.
Aim: The trajectory in psychotic disorders which leads from a relatively normal premorbid state in young people to a first episode of psychosis is only partly understood. Qualitative research methods can be used to begin to elucidate the temporal unfolding of symptoms leading to a first episode of psychosis, and its impact on families.
Methods: We conducted open-ended interviews with family members of 13 patients with recent onset non-affective psychotic disorders, which focused on changes observed, effects on the family, explanatory models, help-seeking patterns and future expectations. Standard data analytic methods employed for qualitative research were used.
Results: Narratives by family members were remarkably similar. First, social withdrawal and mood symptoms developed in previously normal children; these changes were typically ascribed to drugs or stress, or to the 'storminess' o…
matched on Attitude to Health (mesh), help-seeking (text)
Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking Among African American Boys.
African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined …
matched on barriers to care (text), help-seeking (text)
Exploring the drivers of suicide among individuals served by a medical university in Southeastern Iran: a qualitative study.
BACKGROUND: Suicide remains a leading cause of death worldwide and a critical global public health concern. Although the majority of suicides occur in low- and middle-income countries (LMICs), prevention in these contexts is often hampered by limited mental health infrastructure, entrenched stigma, and systemic barriers. In Iran, although the national suicide mortality rate remains comparatively low, a growing trend in suicide attempts—especially among youth—has raised concern. However, little is known about the sociocultural and structural drivers of suicidal behavior in underserved regions such as southeastern Iran. This study aimed to explore the underlying causes of suicide attempts among individuals served by health services affiliated with Bam University of Medical Sciences. METHODS: This qualitative case study was conducted with 54 individuals who had previously attempted suicide.…
matched on help-seeking (text), Mental Health Services (keyword)
Identity negotiation processes among Black and Latinx sexual minority young adult mental health service users.
The transition to adulthood presents particular challenges for Black and Latinx sexual minorities in need of mental health services. Identity formation and marginalization during this developmental period can interfere with help-seeking and lead to health disparities. Identity-specific psychosocial supports are needed to assist young adults to successfully navigate these challenges, but research on identity processes, help-seeking, and service-utilization among sexual minority young people of color is very limited. To better understand how multiple minority young people navigate their identities in the context of using, or choosing not to use, mental health services, this study qualitatively explored the experiences of 31 emerging adults. Through in-depth interviews, analyses revealed that young adults negotiated social identity norms about mental health help-seeking by separating from u…
matched on help-seeking (text), Mental Health Services (keyword)
Exploring biomedical and traditional care pathways for people with psychosis in Karachi, Pakistan.
Background: Psychosis is known to have an adverse impact on an individual's quality of life, social and occupational functioning. A lack of treatment options for psychotic disorders such as schizophrenia contributes to adverse outcomes for individuals. A significant proportion of people with psychosis consult both formal and traditional routes of care. This warrants a need to explore perceptions around treatment options provided by diverse care providers, as the identification of avenues for support can improve psychiatric, alternative treatment and social outcomes.
Methods: Focus groups discussions (FGDs) and in-depth interviews (IDIs) were used. Interactive Research and Development (IRD) research staff conducted 20 IDIs and 2 FGDs to obtain information about the perspectives, treatment pathways and experiences of individuals with psychosis, their caregivers, and service providers. Ques…
matched on help-seeking (text), treatment gap (text)
Technology-Based Interventions to Improve Help-Seeking for Mental Health Concerns: A Systematic Review.
Background: Despite the high prevalence of mental health disorders worldwide, a significant proportion of distressed individuals do not seek professional help. Digital technology can be a potential bridge to reduce the treatment gap for mental disorders. A systematic review was undertaken to examine the technology-based interventions aimed at improving help-seeking attitude, intention, or behavior for mental health concerns.
Methods: The literature search was conducted in January-February 2020 through various e-databases using relevant keywords that targeted help-seeking interventions for mental health disorders via different technology modes.
Results: 21 studies (15 randomized controlled trials and six non-randomized studies) were reviewed. The included studies were published between April 2006 to February 2020. Majority of the interventions led to an increase in the help-seeking variab…
matched on help-seeking (text), treatment gap (text)
Anderson L, Dallinger VC, Krishnamoorthy G, du Plessis C, Pillai-Sasidharan A, Ayres A, Waters L, Groom Y, Rees B, Slade M, Gildersleeve J, Burton L, Ireland R (2026)MEDLINE-indexed journal, not yet read by usChild and adolescent mental health2 citations "All that I've been through has made me who I am": youth conceptualisations of personal recovery in mental health.
Background: Youth is a transitional period from 15 to 24 years involving developmental milestones that may be adversely affected by mental health (MH) concerns. Clinical interventions tend to focus on the reduction or cure of illness-based psychiatric symptoms. However, national and international mental policy focuses on promoting well-being and self-management through personal recovery. The leading framework of personal recovery in adults is CHIME, an acronym used to denote five key processes - Connectedness, Hope, Identity, Meaning and Empowerment. The extent to which CHIME reflects the experience of personal recovery in youth is under-researched, yet the framework often underpins youth mental health services.
Method: The present study uses a qualitative methodology to analyse interviews with 16 youth referred for treatment. Interviews focused on the lived experiences of youth recovery…
matched on Mental Health Services (mesh)
Using a short-term risk assessment and compassion focused staff support groups to reduce restrictive intervention use in a secure mental health service.
Objectives: The aim of the current study was to introduce two interventions to reduce restrictive practice use in a UK-based secure mental health service. The interventions were a short-term risk assessment called the Dynamic Appraisal of Situational Aggression (DASA), and staff support groups based on the Compassion Focused Therapy model (CFSS groups). Intervention selection was guided by a recently published, trauma-informed model of restrictive practice use, the Maintenance Model of Restrictive Practices.
Methods: Five secure mental health wards were included in the study and restrictive practices were compared pre and post intervention for each ward. Owing to limitations in the available data, we were limited in the research design and analyses that could be used. Descriptive statistics were used to compare restraint frequency and short-, medium- and long-duration seclusion episodes …
matched on Mental Health Services (mesh)
Hanlon C, Smartt C, Mutiso VN, Yaro P, Misganaw E, Read U, Mayston R, Birhanu R, Dako-Gyeke P, Ndetei DM, Asher L, Repper J, Eaton J, Chua KC, Fekadu A, Tsigebrhan R, Ashaley Fofo C, Kariuki K, Rai S, Abayneh S, Amissah CR, Boadu AM, Makau P, Tadesse A, Timms P, Prince M, Thornicroft G, Kohrt B, Alem A (2025)MEDLINE-indexed journal, not yet read by usEpidemiology and psychiatric sciences7 citations Improving outcomes for people who are homeless and have severe mental illness in Ethiopia, Ghana and Kenya: overview of the HOPE programme.
Aim: HOPE (National Institute for Health and Care Research Global Health Research Group on Homelessness and Mental Health in Africa) aims to develop and evaluate interventions that address the unmet needs of people who are homeless and have severe mental illness (SMI) living in three African countries in ways that are rights-based, contextually grounded, scalable and sustainable.
Methods: We will work in the capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and the capital city (Nairobi) and a rural county (Makueni) in Kenya to understand different approaches to intervention needed across varied settings. We will be guided by the MRC/NIHR framework on complex interventions and implementation frameworks and emphasise co-production. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercis…
matched on Mental Health Services (mesh)
Temporal Patterns of Suicidality Among Adolescents Receiving Behavioral and Mental Health Services in the Community: A Survival Analysis.
Adolescent suicide is a major public health concern, particularly among adolescents who have endured Adverse Childhood Experiences (ACEs). Adolescents who have been exposed to multiple ACEs are as much as three times more likely to present with suicidality compared to the general adolescent population. Adolescents who have been exposed to multiple ACEs are also more likely to receive behavioral and mental health services in the community. It is therefore important to understand patterns of suicidality among this sub-population of adolescents in order to provide the best clinical care. The present study examined the temporal patterns of suicidality among adolescents who have been exposed to multiple ACEs and are receiving behavioral and mental health services in the community. Using Electronic Health Record (EHR) data from a community-based behavioral and mental health care organization, …
matched on Mental Health Services (mesh)
An exploration of the costs of family and group conferencing pathways in adult social care and mental health: A scenario-based cost analysis.
Context: Family and Group Conferencing (FGC) is a strengths-based approach to social work, originating from New Zealand and now used internationally. Previous research on FGC has focused largely on the context of children's services but, FGC also aligns with the principle of the Care Act in England to prevent, reduce or delay the need for long-term (and potentially costly) adult care services. Limited previous research has tended to explore potential cost savings associated with FGC, without accounting for the cost of the intervention itself, risking biased results.
Objective: This paper aims to identify resource use and associated monetary costs associated with FGC services in English adult social care and mental health settings.
Methods: Framework development was informed by previously published work establishing programme theory for FGC, extended by expert opinion and published source…
matched on Mental Health Services (mesh)
Gray divorce among migrants and non-migrants in Norway: trends and implications for mental healthcare use.
Objectives: The literature on gray divorce, that is, marital dissolution at age 50 or later, has hitherto had little consideration for differences between migrants and non-migrants. Differing family attitudes and socio-economic characteristics may, however, lead to differences between non-migrants and (specific groups of) migrants in gray divorce risks and in the mental health implications of gray divorce. We assess such differences by comparing native Norwegians and five groups of migrants (from Nordic countries; Western Europe; Eastern Europe; North Africa, Turkey, and Middle East; Asia) in Norway.
Methods: Drawing on administrative data covering Norway's full population, group-specific age-standardized divorce rates for the period 1990-2018 are calculated. Group-specific trajectories of mental healthcare use around gray divorce are estimated for the shorter period 2008-2018, using lin…
matched on Mental Health Services (mesh)
The patient journeys of children and adolescents with depression: a study of electronic health records.
In England, children and adolescents with depression can seek treatment from specialist mental health services. We know little about how they journey through these services, or whether healthcare providers collect sufficient data to accurately appraise this. We aimed to summarise the child and adolescent depression pathway for two healthcare providers. This cohort study used de-identified electronic health records extracted from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) and South London and Maudsley NHS Foundation Trust (SLaM). We identified referrals between 2015 and 2019 during which the referred patient received their first depression diagnosis aged < 18 years. We described patient demographic and clinical characteristics, and features of the referral. In total, n = 296 (CPFT) and n = 2502 (SLaM) patients had a referral which met eligibility criteria. In both sites, …
matched on Mental Health Services (mesh)