Consumers' perspectives on their involvement in recognizing and responding to patient deterioration-Developing a model for consumer reporting.

BACKGROUND: Adverse events occur in health care. Detection and reporting of deterioration therefore have a critical role to play. Patient and family member (consumer) involvement in patient safety has gained powerful support amongst global policymakers. Few studies, with none taking a rigorous qualitative approach, have drawn upon consumers' experiences to establish their preferences in consumer reporting of patient deterioration programmes. OBJECTIVE: To explore consumers' experiences of previous reporting of patient deterioration; their preferred educational strategies on this role and recommended pathways in a consumer reporting of patient deterioration model. DESIGN, SETTING AND PARTICIPANTS: An interpretive, qualitative research design was utilized. Nine focus group interviews were undertaken across Adelaide, capital city of South Australia. Interviews were audio-taped, transcribed and analysed thematically. Twenty-six adults described, then reflected, on previous experiences of reporting patient deterioration. RESULTS: Overarching themes incorporated consumers' experiences and patient/family education. Three themes emerged in relation to consumers' experiences: feelings, thoughts and actions. Five themes arose on educating consumers: content, timing, format, information providers and information recipients. The consumers' deep reflections on their past reporting experiences led to the development of a new model for consumer reporting of patient deterioration. CONCLUSIONS: Consumers' views on ways to improve consumer reporting of patient deterioration processes emerged. These improvements include structured educational programmes for staff advocating open health-care professional/consumer communication, educational materials developed and tested with English-speaking and culturally and linguistically diverse consumers and a model with three consumer reporting pathways.

Analysis of social networks supporting the self-management of type 2 diabetes for people with mental illness.

BACKGROUND: People with mental illness have been identified as being more likely to experience type 2 diabetes and the complications arising from this, necessitating more complex chronic illness self-management. Social support has been identified as a significant factor in the successful adoption of lifestyle change for people with type 2 diabetes, however people with mental illness often have impoverished social networks leading to greater reliance upon professional care givers. This study maps the support provided by formal (paid and professional carers) and informal networks to people with mental illness and type 2 diabetes, comparing the experiences of people with a spouse with those without one. METHODS: Interviews were conducted with 29 clients of a community nursing service with mental health problems who receive professional support to self-manage type 2 diabetes. Participants were asked to complete an egocentric social network map which involved mapping the people and services who support them to manage their health. Demographic data was collected as was data about co-morbidities and service use within the last 6 months. Network maps were supplemented by a series of open-ended questions about self-management practices, who supports these practices and what support they provide. RESULTS: Participants identified small social networks with few friendship ties. These networks had diminished due to illness. For people with a spouse, this person provided significant support for chronic illness self-management performing a range of daily care and illness management tasks. People without a spouse were more reliant on professional and paid care givers for daily care and illness management. People without a spouse also demonstrated greater reliance upon weak social ties for emotional support and social connection and often developed friendships with formal caregivers. CONCLUSIONS: Spousal support reduces the need for professional services. In the absence of a spouse, participants were more reliant upon paid and professional carers and weaker social ties for chronic illness support and social connection leading to greater vulnerability of loss of support.

Social barriers to Type 2 diabetes self-management: the role of capital.

Approaches to self-management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self-management through exploring findings from 28 semi-structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self-management. While many participants described having sufficient cultural capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self-management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self-management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self-management.

Barriers to collaboration in mental health services for older people: external agency views.

The need for mental health services for older people living in rural areas is increasing in South Australia. Providing such care requires coordination between several types of services across government, hospital and non-government sectors. The purpose of this study was to identify barriers to collaboration from the perspective of external aged care agencies. A total of 42 responses from an online survey were qualitatively analysed. Four categories emerged, within which participants had identified barriers to collaboration: (1) awareness of services and certainty about responsibilities, in particular, a lack of awareness of which services are available; (2) referral criteria and processes, including the specific criteria needed to be eligible for these services; (3) opportunities to collaborate, with a perceived lack of formal opportunities for collaboration between individuals working across agencies; and (4) education of staff, with more joint education between agencies being recognised as having the potential to increase local knowledge and provide an opportunity for networking and relationship building, with greatest barriers experienced between mental health and social care services.

Helping and hindering: perceptions of enablers and barriers to collaboration within a rural South Australian mental health network.

OBJECTIVE: To evaluate clinicians' perceptions of what helps and hinders the delivery of mental health care across a service network in a rural setting. DESIGN: Qualitative, semistructured interviews were conducted with 10 individuals who work in one rural mental health care service network. SETTING: A regional centre in rural South Australia involving representatives of the mental health team, general practice, hospital, community health and nongovernment organisations. RESULTS: Clinicians' perceptions of barriers and enablers to working within their mental health care network were explored. Participants showed a strong shared commitment to effective mental health care delivery and a good understanding of the services that each offers. Interview data suggested that working relationships between local services could be perceived as stronger when a personal or historical element is recognisable. Similarly, the notion of familiarity and community involvement were perceived as facilitators in this network. A perceived barrier for participants was the failure to attract staff with mental health experience, leading to dependence upon the dedication and commitment of existing service providers. CONCLUSIONS: Collaboration is especially necessary in rural areas, where access to health care services is known to be difficult. The informality of relationships between service providers was shown to be the main facilitator in the network. This is both a strength as it promotes the communication between services and service providers that is essential for successful collaboration, yet is also a threat to the sustainability of the network based on the difficulties of staff recruitment and retention to rural settings.