Women's strategies for coping with the impacts of domestic violence in Kyrgyzstan: A grounded theory study.

This paper provides an account of the adverse impacts of domestic violence on women in Kyrgyzstan and develops a grounded theory of coping among survivors of abuse. The results indicate that women adopt a range of strategies to prevent, avert, and minimize anticipated violence. Two key aspects of coping appeared in the narratives: 1) maintaining the status quo and 2) developing agency to resist the abuse. The results suggest that Government and nongovernmental organizations must take additional action to draw women to formal violence prevention services. Providing professional help at several levels (e.g., clinical, community, and societal) and promoting problem-focused strategies as part of therapeutic intervention are essential.

How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas.

OBJECTIVES: U.S. Latinas experience disproportionately high rates of unintended pregnancy and low rates of consistent contraception use. Not well known are Latinas' perspectives about how primary care physicians (PCPs) might facilitate or deter contraceptive decision making. The theory of planned behavior has been used previously to explain contraceptive behaviors. This study used the theory of planned behavior as a guide to help describe Latinas' perspectives regarding specific factors that influence their contraceptive decision making and to describe their perspectives about the role of PCPs in the decision making. STUDY DESIGN AND METHODS: We conducted focus groups (n = 3) and interviews (n = 8) of Latinas ages 15 to 24 years, recruited from urban primary care sites in Baltimore, Maryland. Concepts from the theory of planned behavior were used to develop a coding scheme and guide identification of themes. RESULTS: Sixteen Latinas participated; all were immigrants. THEMES: The desire to avoid unintended pregnancy is dominant and, not surprisingly, is the main driver of contraceptive intentions. The role of PCPs in contraceptive decision making is to build strong patient relationships through heightened communication and trust. PCPs should develop trust and foster communication by using a shared decision-making approach in contraceptive counseling. Religious norms rarely operate as barriers to contraceptive use, yet positive reinforcement from family, friends, and schools is viewed as supportive. CONCLUSIONS AND IMPLICATIONS: For this group of young, immigrant Latinas, there is a pervasive desire for effective communication and trusting relationships with PCPs. Findings suggest that providers can facilitate contraceptive decision making for this population by using a shared decision-making approach to contraceptive counseling.

Outcomes of a brief program, REORDER, to promote consumer recovery and family involvement in care.

OBJECTIVE: The Recovery-Oriented Decisions for Relatives' Support (REORDER) intervention is an innovative, manualized protocol utilizing shared decision-making principles with persons who have serious mental illnesses to promote recovery and encourage consideration of family involvement in care. This study compared REORDER to enhanced treatment as usual in a randomized design. METHODS: Participants included 226 veterans with serious mental illness whose relatives had low rates of contact with treatment staff. REORDER involved up to three consumer sessions followed by up to three relative educational sessions if the consumer and relative consented. Individuals were assessed at baseline and six months later. RESULTS: Eighty-five percent of the 111 randomly assigned REORDER participants attended at least one REORDER consumer session; of those, 59% had at least one family session. REORDER participants had significantly reduced paranoid ideation and increased recovery at follow-up. CONCLUSIONS: Participation in REORDER led to marked increases in family participation and improved consumer outcomes.

Adherence to medication regimens among low-income patients with multiple comorbid chronic conditions.

This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These factors included medication side effects, fear of harm from medication, fear of dependence on medication, complex instructions, suboptimal communications with doctor, suspicion about doctors' and pharmaceutical companies' motives in prescribing medication, and the high cost ofmedications. Participants also identified motivators, both internal (self-initiated) and external (initiated by family, doctor, support groups),to ensure adherence to multiple medications. These motivators included self-discipline, sense of personal responsibility, faith, support from family members and doctors, and focused health education and self-management support. Three themes emerged that enhanced understanding of the complexity of adherence to multiple medications: (1) reaching one's own threshold for medication adherence, (2) lack of shared information and decision making, and (3) taking less than the prescribed medication. Further analysis of the data revealed that the patients perceived a lack of shared decision making in the management of their comorbid chronic conditions and their medication regimen.

Understanding the ecological validity of neuropsychological testing using an ethnographic approach.

Neurocognitive impairment is a defining and disabling feature of schizophrenia and other physical disorders. Most of our understanding about neurocognitive deficits comes from laboratory-based testing in research protocols. There has been little research using direct behavioral community observation over a prolonged period to understand the association of daily functioning with cognitive performance.The purpose of this study was to develop an observational method that could be replicated by researchers interested in viewing cognitive deficits in vivo, and then comparing this data to laboratory measures to affirm the ecological validity of those measures.The eight-step method explained here was developed from the targeted ethnographic study of 10 persons with schizophrenia. Obtaining real world context with this method will help to increase the generalizability of effective cognitive treatments, create improved interventions for this population, and bring into greater relief the coping and compensatory strategies already used by individuals to complete daily tasks.

Neurocognition, ecological validity, and daily living in the community for individuals with schizophrenia: a mixed methods study.

The ecological validity of neurocognitive measures concerns translating laboratory-based neuropsychological (NP) findings into relevant predictions about how people will perform in varied real world settings. There have been no studies of the ecological validity of psychosocial or neurocognitive measures in schizophrenia that incorporated direct observation of naturally occurring community behavior. The research questions for this mixed method study were: (1) Are there differences in the daily community functioning of persons with schizophrenia who have high or low cognitive functioning as determined by lab-based assessments? and (2) Can ethnographic methods be used to create descriptions of functioning that are useful for assessing ecological validity? Ten individuals from a larger longitudinal study were randomly selected from two strata that reflected low or high neurocognitive functioning. Individuals completed quantitative measures of psychosocial functioning and were also observed ethnographically for three days by an observer who was blind to their neurocognitive status. A new method developed in this study for characterizing the predominant behavioral living strategies of individuals with schizophrenia found notable differences between high and low NP groups in their community functioning. This study found evidence to support the ecological validity of NP measures and yielded an ethnographically based observational protocol to reliably characterize the predominant individual daily behavioral strategies.

Needs and preferences for receiving mental health information in an African American focus group sample.

The purpose of this study is to better understand the mental health/illness information and service delivery preferences among African American residents of Baltimore. We conducted four focus groups (n = 42) among African American adults currently unconnected with the mental health system. Participants expressed fear of stigma and perceptions of racism as major barriers to seeking information and/or services and discussed some normalizing strategies to address these barriers. African Americans harbor cultural and traditional beliefs regarding mental illness which could also act as barriers. Findings have implications for imparting acceptable and culturally sensitive mental health education and service delivery programs in community settings.

Adoption of evidence-based practices in community mental health: a mixed-method study of practitioner experience.

This mixed method study examined practitioners as they adopted four evidence-based practices (EBPs) in a community mental health center. In-depth semi-structured interviews; a measure of EBPs attitudes; and a final focus-group were used over a 2-year study period to assess 14 mental health practitioners on one immersion team. The framework for data collection was adapted from organizational theories that view culture and climate as mediating factors. Analysis of practitioner themes demonstrated that there were facilitating and impeding factors in the adoption process. Practitioners reported positive changes in their individual competency but two years was inadequate for training on four EBPs. Involvement of agency administration and consistent supervision were regarded by practitioners as crucial to successful adoption of EBPs.

A contextual study of daily living strategies in neurocognitively impaired adults with schizophrenia.

Schizophrenia is a severe mental illness often recognized as a degenerative neurocognitive condition. For some with the disorder, the impairment is fairly mild, but for others, neurocognitive abilities can be severely compromised. In this study, 5 individuals with schizophrenia had been assessed through a laboratory-based neurocognitive battery as having severe impairment. Their neurocognitive status was unknown to the author, and she was able to observe daily tasks and ask questions about strategies they employed while completing tasks, and analyze the data without preconceptions about their status. This study was guided by notions of ecological validity, which is the comparison between lab tests and real-world functioning. Despite their cognitive deficits, these individuals had remarkable strengths, which included drawing supportive people into their worlds to fulfill their daily tasks. These data contribute to the rehabilitation literature and propose remedies for struggles of daily living when one has schizophrenia.

Career development in schizophrenia: a heuristic framework.

Adults with schizophrenia continue to have poor rates of competitive employment. We have learned how to support individuals in the workplace with supported employment (SE); but have paid limited attention to early vocational identity development, work antecedents, illness characteristics, and career preferences. Vocational identity development is an important and natural condition of human growth for all persons and is well-researched in career counseling. For young adults with schizophrenia, the predictor of positive work outcome with the most evidence has been that working competitively prior to illness leads to better chances for work post-diagnosis. A heuristic framework is proposed to conceptualize how pre-illness vocational development (paid and unpaid) plus life cycle supports can provide direction to the individual in their work recovery.

Knowledge and use of workplace accommodations and protections by young adults with schizophrenia: a mixed method study.

Employment is an important outcome for individuals with schizophrenia and the Americans with Disabilities Act (ADA) is a key structural variable designed to favorably influence work. Little is known about how individuals understand and utilize ADA rights. The purpose of this mixed method study was to elicit understanding of the knowledge and use of ADA provisions from 20 persons with schizophrenia who returned to work. Three distinct groups emerged. Group differences suggest that use of ADA provisions may be dependent on individual need and comfort with ADA opportunity.

Rehab rounds: use of the Americans with Disabilities Act by young adults with schizophrenia.

Introduction by the column editors: People with mental illness have consistently identified employment as a strong unmet need, yet only one in five people with schizophrenia has been able to work in full-time competitive employment and less than 50 percent work at all, despite the advent of evidence-based services, such as supported employment (1,2). However, there are compelling developmental, clinical, and economic reasons for people with mental illnesses to pursue competitive employment as they attempt to normalize and reconstruct their lives (3). Even with a mainstreaming ideology that encourages everyone who wants work to seek it, the real challenges are to organize supportive employment services, match people to jobs, and sustain clients in a continuum of work rehabilitation (4). Several Rehab Rounds columns have focused on programs aimed at enhancing the work functioning of people with serious mental disorders by using supported employment (5), increasing work readiness (6), and teaching fundamental workplace skills (7). In this month's column, Deborah Gioia and John S. Brekke describe the impact of the Americans With Disabilities Act on the work experience of young adults with schizophrenia.