Psychoeducation for adult ADHD: a scoping review about characteristics, patient involvement, and content.

BACKGROUND: Psychosocial interventions such as psychoeducation are increasingly being used to treat adult ADHD, both as an alternative and as a supplement to pharmacotherapy. A thorough overview of the literature on psychoeducation for adult ADHD is lacking. The objectives of this scoping review were therefore to identify the characteristics of psychoeducation interventions designed for adults with ADHD, examine how the patient experience or perspective is considered during the intervention's development and implementation, determine the typical themes covered, and explore how 'psychoeducation' is defined in these interventions. METHODS: A comprehensive search was performed to identify records in MEDLINE, Embase, PsycINFO, Web of Science, Cochrane CENTRAL, AMED, and ClinicalTrials.gov. Two or more reviewers were included in every step of the screening process and the final selection of included studies. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (Supplementary Material 1) was used to report the results, and the framework developed by Arksey and O'Malley was used as a guide throughout the scoping process. RESULTS: A total of 2121 records were identified through the literature search. After screening and full-text analysis, ten studies were included for final analysis. Most studies were conducted in Europe and followed a group format. Seven main themes were identified: Information about the diagnosis, treatment options, somatic health and ADHD, the insider perspective, ADHD and social life, coping and psychological skills, and ADHD and work. There was significant overlap in themes covered, but coverage of each theme varied. Themes deemed important by newer research, such as sexuality and gender-specific issues, were missing. Only one intervention involved patients in its development and implementation, and two interventions involved family members. There was variation in how psychoeducation was defined in the included studies, and the implications of this are discussed. CONCLUSION: The literature on psychoeducation for adult ADHD is not ready for any systematic effect estimation. Before such estimations are conducted, a shared understanding and definition of psychoeducation are needed. The involvement of end users in the development and delivery of interventions may aid reach this goal but results from this review indicate that such practices are rare.

Measuring patient satisfaction with four items: validity of the client satisfaction questionnaire 4 in an outpatient population.

INTRODUCTION: Patient satisfaction with mental health services has for several decades been considered an important component when evaluating service quality. It is often assessed in the context of monitoring quality of care, developing or evaluating newly implemented interventions or changes in practice. Because of this, patient satisfaction questionnaires are often added to longer questionnaire batteries, and shorter questionnaires are preferred to prevent respondent fatigue and non-compliance and to secure easy implementation. However, most studies use unvalidated patient satisfaction measures, making comparisons between studies difficult. Validation studies of short patient satisfaction measures are therefore warranted. METHODS: The primary aim was to examine the construct validity and internal reliability of the Client Satisfaction Questionnaire-4 (CSQ-4) in a Norwegian outpatient mental health setting. A total of 467 patients were recruited from an outpatient psychiatric care clinic in Central Norway. The secondary aim was to examine an earlier proposed cutoff for classifying dissatisfied patients in this new population. A principal component analysis was conducted to evaluate factor structure, correlation analyses were conducted to test for predicted relationships, and Cronbach's alpha was calculated to examine internal reliability. RESULTS: The CSQ-4 showed a clear unidimensional structure with one factor explaining 80% of its variance. Its internal reliability was very high, with a Cronbach's alpha of 0.92. As hypothesised this study found no statistically significant sex differences in satisfaction and no statistically significant association between age and satisfaction. Positive changes in symptoms during treatment and higher post-treatment functional impairment were associated with higher patient-reported treatment satisfaction scores, which indicates good construct validity. CONCLUSION: This is the first study to evaluate the CSQ-4 in a psychiatric population. The CSQ-4 demonstrated good structural validity and internal reliability and was correlated with outcome variables in terms of symptom change and post-treatment functioning. In sum, this indicates that the CSQ-4 is a good short alternative for evaluating patient satisfaction in routine outpatient mental health care.

Factor structure and internal consistency of the parent patient activation measure (P-PAM) in parents of children with ADHD in norwegian paediatric mental health.

BACKGROUND: This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. METHODS: In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach's alpha and McDonald's omega. A confirmatory factor analysis was used to estimate and test individual parameters. RESULTS: The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. CONCLUSIONS: Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related.

A digital Norwegian version of the client satisfaction questionnaire 8: factor validity and internal reliability in outpatient mental health care.

BACKGROUND: Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated. METHODS: We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated. RESULTS: The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach's alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed. CONCLUSION: Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects.

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE / Evaluación de la toma de decisiones compartidas en la atención comunitaria de salud mental: validación de CollaboRATE

BACKGROUND/OBJECTIVE: CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. METHOD: A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. RESULTS: Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (Alpha Cronbach = .95, Guttman's Lambda = .93, and Omega = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. CONCLUSIONS: This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM

ANTECEDENTES/OBJETIVO: CollaboRATE es un autoinforme de tres ítems que permite al paciente valorar su experiencia en la toma de decisiones compartidas (TDC) sobre su tratamiento. El objetivo de este estudio fue evaluar las propiedades psicométricas de CollaboRATE en la atención comunitaria de salud mental. MÉTODO: Se realizó un estudio transversal en una Unidad de Salud Mental del Servicio Canario de la Salud. Doscientos cincuenta pacientes psiquiátricos ambulatorios consecutivos fueron invitados a participar y 191 aceptaron (76,40%). Los pacientes completaron el CollaboRATE, la Escala de Preferencias de Control (EPC), y un formulario con variables sociodemográficas y clínicas. RESULTADOS: El análisis factorial exploratorio ratificó la unidimensionalidad de la medida. Se encontró una alta consistencia interna (alfa Cronbach = 0,95; Guttman's lambda = 0,93; y omega = 0,95). Se registraron significativas correlaciones positivas (p < 0,0001) entre CollaboRATE y el EPC. Solo el 39,80% de los encuestados dieron la mejor puntuación posible en CollaboRATE. CONCLUSIONES: La versión en español de CollaboRATE es una medida fiable y válida de TDC, rápida de completar y factible para su uso en Psiquiatría comunitaria. En la actualidad, pocos pacientes psiquiátricos son involucrados en TDC. CollaboRATE puede ser una herramienta clave para evaluar e implementar la TDC en la atención psiquiátrica ambulatoria

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE.

BACKGROUND/OBJECTIVE: CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. METHOD: A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. RESULTS: Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. CONCLUSIONS: This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.

ANTECEDENTES/OBJETIVO: CollaboRATE es un autoinforme de tres ítems que permite al paciente valorar su experiencia en la toma de decisiones compartidas (TDC) sobre su tratamiento. El objetivo de este estudio fue evaluar las propiedades psicométricas de CollaboRATE en la atención comunitaria de salud mental. MÉTODO: Se realizó un estudio transversal en una Unidad de Salud Mental del Servicio Canario de la Salud. Doscientos cincuenta pacientes psiquiátricos ambulatorios consecutivos fueron invitados a participar y 191 aceptaron (76,40%). Los pacientes completaron el CollaboRATE, la Escala de Preferencias de Control (EPC), y un formulario con variables sociodemográficas y clínicas. RESULTADOS: El análisis factorial exploratorio ratificó la unidimensionalidad de la medida. Se encontró una alta consistencia interna (α Cronbach = 0,95; Guttman's λ = 0,93; y ω = 0,95). Se registraron significativas correlaciones positivas (p < 0,0001) entre CollaboRATE y el EPC. Solo el 39,80% de los encuestados dieron la mejor puntuación posible en CollaboRATE. CONCLUSIONES: La versión en español de CollaboRATE es una medida fiable y válida de TDC, rápida de completar y factible para su uso en Psiquiatría comunitaria. En la actualidad, pocos pacientes psiquiátricos son involucrados en TDC. CollaboRATE puede ser una herramienta clave para evaluar e implementar la TDC en la atención psiquiátrica ambulatoria.

Patient-reported well-being: psychometric properties of the world health organization well-being index in specialised community mental health settings.

The Five-item World Health Organization Well-being Index (WHO-5) is an increasingly used measure of generic well-being, but there is no evidence to support whether outpatients consider the questionnaire valuable. As the WHO-5 has not yet been psychometrically evaluated in specialised community mental health settings, an evaluation of its validity seems warranted. The aim of this cross-sectional study was to examine the psychometric properties of the WHO-5 in this type of setting. Data was collected from an outpatient center (N = 191 adults). Results indicate that the questionnaire was feasible to administer (n = 57 patients), it reported low mean Burden-scores and high Positive-Value scores, and had excellent internal consistency. No evidence of floor or ceiling effects was found. Results supported the unidimensional structure of the questionnaire. Significant differences were found concerning patients' diagnoses, with patients with schizophrenia diagnoses reporting higher scores and patients with depression and personality disorders reporting lower ones. When comparing the WHO-5 total score and patients' attitudes toward medication, negative correlations were observed with psychological reactance, as well as positive aspects of psychiatric medication. The present study demonstrates that the WHO-5 is feasible to administer and has robust psychometric properties in specialised community mental health centres.

Psychometric properties of the Five-item World Health Organization Well-being Index used in mental health services: Protocol for a systematic review.

AIMS: To synthesize evidence of the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and critically appraise the methodologies of the included studies. DESIGN: Protocol for a systematic psychometric review. METHODS: The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus-based Standards for the Selection of Health Measurements Instruments. DISCUSSION: The results of our psychometric review will synthesize the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change. IMPACT: The evaluation of patient well-being is important, and the Five-item World Health Organization Well-being Index is an increasingly used patient-reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well-being.

The effect of a brief educational programme added to mental health treatment to improve patient activation: A randomized controlled trial in community mental health centres.

OBJECTIVE: While there is growing interest in improving patient activation in general medical health services, there are too few randomized controlled trials in mental health settings which show how improvement can be achieved. Using the Patient Activation Measure-13 (PAM-13), we aimed to assess the effect of pre-treatment, peer co-led educational intervention on patient activation. Secondary outcomes included measures of patient satisfaction, well-being, mental health symptoms, motivation, and treatment participation. METHODS: Patients from two community mental health centres were randomized to a control group (CG, n=26) receiving treatment as usual, or an intervention group (IG, n=26) consisting of a four-hour group educational seminar (aiming to encourage patients to adopt an active role in their treatment) followed by treatment as usual. RESULTS: Only the IG improved on PAM-13, at one- and four-month follow-ups. The intervention had significant effects on patient satisfaction and treatment participation, compared to CG. CONCLUSION: Providing pre-treatment, peer co-led education improves patient activation in community mental health care settings. PRACTICE IMPLICATIONS: The use of peers as co-educators may contribute to a different mental health care delivery, ensuring patient activation and participation in treatment. Further studies should examine peers' needs for supervision, challenges for the services, long-term and cost-benefit effects. CLINICALTRIALS. GOV IDENTIFIER: NCT01601587.

Psychometric properties of the Patient Activation Measure-13 among out-patients waiting for mental health treatment: A validation study in Norway.

OBJECTIVE: The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined. METHODS: A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51). RESULTS: The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85). CONCLUSION: PAM has appropriate and acceptable psychometric properties in mental health settings. PRACTICE IMPLICATIONS: Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health.