Psychometric properties of the Providers Survey in the Brazilian context of mental health: a validation study

ABSTRACT BACKGROUND: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results. OBJECTIVES: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services. DESIGN AND SETTING: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil. METHODS: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability. RESULTS: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849. CONCLUSIONS: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

As vozes são muito mais que um sintoma / Las voces son mucho más que un síntoma (resumen: p. 15) / Voices are much more than a symptom

O Movimento Internacional de Ouvidores de Vozes, surgido nos anos 1980, entende o fenômeno de ouvir vozes não apenas como um sintoma, mas auxilia o desenvolvimento de estratégias para lidar com essas vozes. O objetivo deste estudo foi compreender como pessoas que participaram de grupos de ouvidores de vozes no SUS lidaram com tais experiências. Trata-se de uma pesquisa qualitativa, realizada em 2020, coletando dados de entrevistas em profundidade e diário de campo, examinados utilizando-se análise de conteúdo. Os participantes adultos (4) frequentaram o grupo por mais de um mês. Foi possível explorar as estratégias de enfrentamento individuais desenvolvidas pelas vivências de cada um com as suas vozes. O grupo também foi instrumento de socialização, por meio da normalização da experiência, de maior autoaceitação e de redução do estigma.(AU)

El Movimiento Internacional de Oidores de Voces, surgido en la década de 1980, entiende el fenómeno de oír voces no solo como un síntoma, sino que auxilia en el desarrollo de estrategias para enfrentarlas. El objetivo de este estudio fue comprender cómo personas que participaron en grupos de oidores de voces en el SUS enfrentaron tales experiencias. Se trata de una investigación cualitativa, realizada en 2020, con colecta de datos, a partir de entrevistas en profundidad y diario de campo, analizadas utilizándose análisis de contenido. Los participantes adultos (4) frecuentaron el grupo durante más de un mes. Fue posible explorar las estrategias de enfrentamiento individuales desarrolladas a partir de las vivencias de cada uno con sus voces. El grupo también fue un instrumento de socialización y, a partir de la normalización de la experiencia, de mayor autoaceptación y reducción del estigma.(AU)

Abstract The international Hearing Voices Movement, which emerged in the 1980s, understands the phenomenon of hearing voices not just as a symptom, but helps in the development of strategies to deal with these voices. The objective of this study was to understand how people who participated in groups of voice hearers in the Brazilian health system dealt with such experiences. This was a qualitative research study, carried out in 2020, with data collection from in-depth interviews and field diary, analyzed using content analysis. Adult participants (4) attended the group for more than a month. It was possible to explore the individual coping strategies developed from the experiences of each one with their voices. The group was also an instrument of socialization and, from the normalization of the experience, of greater self-acceptance and reduction of stigma.(AU)

The multidimensional model of hope as a recovery-focused practice in mental health nursing / O modelo multidimensional de esperança como uma prática focada no recovery em enfermagem de saúde mental / El modelo multidimensional de la esperanza mientras práctica dirigida por el recovery en enfermería de salud mental

ABSTRACT Objective: To analyze the theoretical dimensions of hope as a recovery-oriented practice in mental health nursing. Method: This is a reflective and discursive study based on theoretical and experiential aspects of hope in the recovery process of people facing mental health disorders. Results: Maintaining hope in adverse situations, especially while facing mental suffering, requires skills to manage the factors that promote and inhibit hope. This balance can be tricky to reach without the presence of high-skilled professionals. The study presents the concept of hope-inspiring competence and its main dimensions. The nurse's hope-inspiring competence is recognized as a crucial advanced practice that optimizes mental health by providing motivational resources. Final Considerations: Hope-inspiring competence should be a core principle for recovery-oriented mental health professionals. Despite this recognition, the promotion of hope in mental health nursing specialized practice lacks evidence and visibility.

RESUMO Objetivo: Analisar as dimensões teóricas da esperança enquanto prática orientada pelo recovery em enfermagem de saúde mental. Métodos: Estudo reflexivo e discursivo baseado nos aspectos teóricos e vivenciais da esperança no processo de recovery de pessoas que enfrentam transtornos mentais. Resultados: Manter a esperança em situações adversas, principalmente no sofrimento mental, requer habilidades para gerenciar os fatores que a promovem e a inibem. Esse equilíbrio pode ser difícil de alcançar sem a presença de profissionais qualificados. Apresentamos o conceito de competência inspiradora de esperança e suas principais dimensões. A competência do enfermeiro inspirador de esperança é uma prática avançada crucial que otimiza a saúde mental ao fornecer recursos motivacionais. Considerações finais: A competência inspiradora de esperança deve ser um princípio fundamental para profissionais de saúde mental orientados para o recovery. Apesar desse reconhecimento, a promoção da esperança na prática especializada de enfermagem em saúde mental carece de evidências e visibilidade.

RESUMEN Objetivo: Analizar dimensiones teóricas de esperanza mientras práctica dirigida por recovery en enfermería de salud mental. Métodos: Estudio reflexivo y discursivo basándose en aspectos teóricos y experiencias de la esperanza en el proceso de recovery de personas que enfrentan trastornos mentales. Resultados: Mantener la esperanza en situaciones adversas, principalmente en el enfrentamiento del sufrimiento mental, requerir habilidades para administrar factores que proveen e inhiben. Ese equilibrio puede ser difícil de alcanzar sin la presencia de profesionales altamente cualificados. Presentamos concepto de competencia inspiradora de esperanza y sus principales dimensiones. Competencia del enfermero inspirador de esperanza es reconocida como una práctica avanzada crucial que optimiza la salud mental al fornecer recursos motivacionales. Consideraciones finales: Competencia inspiradora de esperanza debe ser un principio fundamental para profesionales de salud mental dirigidos por recovery. Aunque ese reconocimiento, la promoción de esperanza en práctica especializada de enfermería en salud mental carece de evidencias y visibilidad.

Recovery, revisões e experiências: modos de envolvimento de usuários e usuárias de serviços de saúde mental em pesquisas / Recovery, reviews and experiences: forms of mental health service user involvement in research

Como envolver usuários/as de serviços de saúde mental em pesquisas? A partir da prática exercida com os grupos de ajuda e suporte mútuos em saúde mental no Rio de Janeiro-RJ, e da convivência a longo prazo com seus usuários/as, foi elaborado um projeto de pesquisa visando responder a essa questão. Fundamentado no conceito de recovery, relacionado ao protagonismo desses usuários/as, tornados co-pesquisadores, o projeto apresentou uma orientação metodológica guiada pelo pressuposto conceitual. Com a instauração de um coletivo de co-pesquisadores, reuniões foram realizadas para planejamento do conjunto da tese, incluindo seus objetivos e estratégias. A partir dessa iniciativa, um objetivo foi estipulado para compreender os processos de recovery de outros/as usuários/as da rede de saúde mental do referido município, por meio de entrevistas em dispositivos nos quais os/as co-pesquisadores se inseriam. Com a realização do doutorado sanduíche na Service User Research Enterprise da King's College London, buscou-se compreender como usuários/as de serviços de saúde mental são inseridos/as nas pesquisas daquele contexto, dada a relevância da tradição britânica para esta área de conhecimento. Devido à pandemia da COVID-19, as entrevistas deram lugar à realização de testemunho pessoal da autora sobre a experiência de pesquisa com o coletivo de co-pesquisadores, além de revisões da literatura mundial e brasileira sobre pesquisas com o envolvimento de usuários/as de serviços de saúde mental. Duas categorizações britânicas de modos de envolvimento de usuários/as em pesquisas foram adotadas nas revisões: consulta, contribuição, colaboração e controle; e princípios, propósito, presença, processo e impacto; tendo a segunda estruturado o testemunho da experiência da autora com o coletivo, considerando sua formação, modo de funcionamento e impacto, e questões referentes à ética, à autoria, às relações de poder, à contextualização grupal e à transparência. Debateu-se, ainda, o conceito de recovery de acordo com críticas apreendidas na realidade britânica de saúde mental e com a concepção produzida pelo coletivo. É expressivo o envolvimento de usuários/as de serviços de saúde mental em pesquisas na Inglaterra, no entanto, apesar das políticas públicas que favorecem a inclusão, denuncia-se a participação simbólica desses atores nesse âmbito. No Brasil, ainda é incipiente a realidade de pesquisas que incluem usuários/as de saúde mental de modo mais significativo. Diante disso, considera-se fundamental a reivindicação por incentivos a pesquisas colaborativas no país, além da defesa do protagonismo de usuários/as de saúde mental na produção de conhecimento em torno das políticas públicas que sustentam a reforma psiquiátrica brasileira, visando avanços e a manutenção dos fazeres democráticos, considerando os retrocessos e as graves ameaças ao Sistema Único de Saúde e às políticas sociais brasileiras

How to involve mental health service users in research? From the practice with a mutual help and support group in mental health in Rio de Janeiro-RJ, and the long-term conviviality with its users, a research project was elaborated to answer to this question. Based on the concept of recovery, related to the protagonism of these users, who became co-researchers, the project presented a methodological orientation guided by the conceptual assumption. With the establishment of a co-researchers' collective, meetings were held to plan the whole thesis, including its objectives and strategies. Based on this initiative, an objective was set to understand the recovery processes of other users of the mental health network in the referred city, through interviews on devices in which the co-researchers were inserted. From the opportunity to do part of the PhD at the Service User Research Enterprise of King's College London, it was aimed to understand how the mental health service users are involved in research in that context, given the relevance of the British tradition for this area of knowledge. Due to the COVID-19 pandemic, the interviews were replaced by the author's personal testimony about the research experience with the co-researchers' collective, in addition to reviews of the world and Brazilian literature on research involving mental health service users. Two British categorizations of forms of service user involvement in research were adopted in the reviews: consultation, contribution, collaboration and control; and principles, purpose, presence, process and impact; the second structured the author's testimony of the experience with the co-researchers' collective, considering its formation, mode of operation and impact, besides issues related to ethics, authorship, power relations, group contextualization and transparency. Furthermore, the concept of recovery was debated according to criticisms apprehended in the British reality of mental health and to the conception produced by the collective. The service user involvement in mental health research in England is expressive, however, despite of the public policies that favor inclusion, the tokenistic participation in this area is denounced. In Brazil, the reality of research that includes mental health service users in a more significant way is still incipient. Therefore, the demand for incentives for collaborative research in the country is relevant, in addition to the defense of the role of mental health service users in the production of knowledge about public policies that support the Brazilian psychiatric reform, aiming at advances and the maintenance of democratic practices, considering the setbacks and serious threats to the public health system and social policies in Brazil.

Narrativas sobre el proceso de recuperación ante la adicción: la perspectiva de familiares que asisten a servicios de atención / Narratives about the process of recovering from addiction: the perspective of family members attending care services

RESUMEN Los servicios de tratamiento para las adicciones suelen priorizar la recuperación del usuario, a pesar de que el consumo problemático implica un malestar en las familias que requiere atención. El objetivo de este estudio es identificar los tipos de narrativas que construyen los familiares de personas con trastornos por dependencia a sustancias, acerca del padecimiento y el proceso de recuperación, así como comprender las condiciones que facilitan u obstaculizan el proceso de recuperación desde la perspectiva de los familiares. Se realizaron siete entrevistas en profundidad con orientación narrativa. Se encontraron narrativas progresivas, estables y regresivas en las que se identificaron diversas etapas en los procesos de adicción y recuperación, y revelaron diferentes formas de malestar, barreras para el tratamiento, y momentos críticos para asistir a los servicios de atención. Las familias representan un recurso valioso para la recuperación del usuario, por lo que deben ser incluidas en el tratamiento.

ABSTRACT Addiction treatment services usually prioritize the recovery of the user, despite the fact that problematic consumption often leads to distress among families that requires attention. The purpose of this study is to identify types of narratives constructed by relatives of people with substance dependence disorders regarding their condition and recovery process. Additionally, we seek to understand the conditions that facilitate or hinder the recovery process from the perspective of family members. Seven in-depth interviews were conducted with a narrative approach. Progressive, stable, and regressive narratives were identified, corresponding to various stages in the addiction and recovery processes. These narratives revealed different forms of distress, obstacles to treatment, and critical junctures with respect to attending care services. Families represent a valuable resource for user recovery, and therefore must be included in the treatment process.

Effects of Acceptance Commitment Therapy Based Recovery Enhancement Program on Psychological Flexibility, Recovery Attitude, and Quality of Life for Inpatients with Mental Illness / 정신간호학회지

PURPOSE: The purpose of this study was to (1) develop an acceptance commitment therapy (ACT) based recovery enhancement program for inpatients with mental illness and (2) test the effects of the program on patients' psychological flexibility, recovery attitude, and quality of life. METHODS: A mixed methods design was used: a combination of a repeated-measure design with a non-equivalent control group and qualitative data collection. The participants were 41 inpatients with mental illness (experimental group: 20, control group: 21). The ACT based recovery enhancement program was conducted over four sessions for a total of two weeks. Data were collected from December 2018 to January 2019. RESULTS: Study results revealed that the ACT based recovery enhancement program was effective for psychological flexibility (F=150.71, p<.001), recovery attitude (F=60.22, p<.001), and quality of life (F=31.59, p<.001) for inpatients with mental illness. CONCLUSION: The results of this study suggest that the ACT based recovery enhancement program can be used as an effective mental health nursing intervention for psychological flexibility, recovery attitude, and quality of life of inpatients with mental illness.

Mediating Effects of Hope and Therapeutic Relationship in the Relation between General Social Functions and Mental Health Recovery of Community People with Mental Illness

PURPOSE: This study tries to test mediating effects of hope and therapeutic relationship in the relation between general social functions and mental health recovery of community people with mental illness. METHODS: This study was carried out in a cross-sectional research design. The participants included 217 people with mental illnesses who were enrolled at eight Mental Health Welfare Centers in the Gyeonggi Province. Data were collected from February to May, 2018. The collected data were analyzed using a regression analysis, and SPSS PROCESS macro was used to test the mediating effects. RESULTS: This study analyzed the direct effects of general social functions on the hope, therapeutic relationship and mental health recovery. And general social functions had indirect effects on their mental health recovery via hope and therapeutic relationship. Both hope and therapeutic relationship had dual mediating effects in the influence of general social functions on mental health recovery. CONCLUSION: The role of hope and therapeutic relationship in the mental health recovery of community people with mental illness is important, and it is confirmed that hope is a powerful factor influencing mental health recovery.

Recovery in schizophrenia: Perspectives from psychiatrists in the Philippines

BACKGROUND@#A reliable and socially validated definition of recovery in schizophrenia is essential to decrease stigma associated with the illness. This study aimed to define recovery in schizophrenia in the Philippine context, determine its specific elements, and describe methods of assessment in clinical practice.@*METHODS@#We invited a group of purposively selected Filipino psychiatrists to participate in six simultaneous roundtable discussions to gather their opinions and perspectives on recovery in schizophrenia. Transcripts of the discussions were then subjected to framework analysis.@*RESULTS AND CONCLUSION@#Most Filipino psychiatrists were of the considered opinion that recovery in schizophrenia is possible, and their vision of a recovered patient resembles a combination of psychological and medical models. The mini-FROGS tool was deemed generally applicable in the Philippine setting except for self-esteem and sense of independence primarily because it is difficult to evaluate. The SWN was received with mixed reactions among the psychiatrists. Spirituality as an element of recovery and the family-oriented culture of the Filipinos were emphasized as important considerations in assessing patients. Other suggestions were given to tailor-fit these tools to the Philippine context.

Association of Basic Psychological Needs with Recovery Attitude in Inpatients with Alcohol Use Disorders based on the Self-Determination Theory / 정신간호학회지

PURPOSE: The purpose of this study was to examine the impact of autonomy, competence, and relationship on the recovery attitude of inpatients with alcohol use disorder.METHODS: This descriptive correlational study was based on the basic psychological needs theory, which is a sub-theory of self-determination theory (SDT). Study participants were 158 inpatients with alcohol use disorder from four mental hospitals in two areas. Data were collected from self-report questionnaires administered in September and October 2019. Data were analyzed using the t-test, one-way ANOVA, Pearson's correlation coefficients, and the multiple linear regression with IBM SPSS 22.0.RESULTS: Recovery attitude showed a positive correlation with autonomy (r=.62, p < .001), competence (r=.40, p < .001), and relationship (r=.33, p < .001). The results of the regression indicate the autonomy and competence explained 39% of the recovery attitude (R2=.40, F=51.04, p < .001).CONCLUSION: The results suggest that autonomy and competence play integral roles in the recovery attitude of inpatients with alcohol use disorders. Thus, mental health practitioners should develop psychological need-based interventions to improve the autonomy, competence, and recovery attitude of inpatients' with alcohol use disorder.

Validation Study of the Mental Health Recovery Measure / 신경정신의학

OBJECTIVES: This study was conducted to verify the reliability and validity of the Mental Health Recovery Measure (MHRM), which was designed to provide a comprehensive assessment of the recovery process. METHODS: A sample of 253 psychiatric patients were assessed using a package of measures, which comprised the MHRM, the Quality of Life Scale, the Empowerment Scale, the Ego-Resilience Scale, the Clinical Global Impression Scale and the General Assessment of Functioning. The reliability of the MHRM was evaluated in terms of its internal consistency and item-total correlations, and its validity was explored by factor analysis. A multiple regression analysis was conducted to examine the discriminant validity of the recovery factors. RESULTS: The MHRM was found to be highly reliable in terms of internal consistency, and corrected item-total correlations r ranged from 0.49 to 0.75. The exploratory factor analysis revealed six factors, and the regression analysis indicated that the factors are measuring distinct features. In addition, various estimates of validity of MHRM were established with the criterion measures in conceptually expected ways. CONCLUSION: These results offer the reliability and validity of the MHRM. The implications and limitations of this study were discussed, and future directions of study were suggested.