Physical health attitude scale among mental health nurses in Taiwan: Validation and a cross-sectional study.

The Physical Health Attitude Scale (PHASe) is an internationally valid and reliable scale for assessing mental health nurses' attitudes toward providing physical health care to people with serious mental illness. This study translated the PHASe into traditional Chinese and evaluated its psychometric properties in the context of Taiwan. A descriptive, cross-sectional study design was adopted, and convenience sampling was used to recruit 520 mental health nurses from 11 hospitals across Taiwan. Data were collected between August and December 2019. Brislin's translation model was used for the validation process. Exploratory factor analysis and confirmatory factor analysis were used to establish the construct validity of the scale, and Cronbach's alpha and composite reliability were used to determine its reliability. The factor analysis results revealed that the 4-factor 17-item traditional Chinese version of the PHASe accounted for 44.2% of the total variance. Each factor had adequate internal consistency (Cronbach's alpha = 0.70 to 0.80). We also noted significant differences between groups with different attitudes, demonstrating known-group validity. Our findings indicate that the traditional Chinese version of the PHASe is acceptable for evaluating nurses' attitudes toward providing physical health care in Taiwan.

A systematic review of barriers and enablers that health professionals experience to the delivery of type 2 diabetes care for adults with severe mental illness.

BACKGROUND: People with severe mental illness have a heightened risk for type 2 diabetes. They also experience poorer outcomes, including more diabetes complications, more emergency admissions, lower quality of life and excess mortality. AIMS: This systematic review aimed to identify health professionals' barriers to and enablers of delivering and organising type 2 diabetes care for people with severe mental illness. METHODS: Searches were conducted in Medline, EMBASE, PsycInfo, CINAHL, OVID Nursing, Cochrane Library, Google Scholar, OpenGrey, PsycExtra, Health Management Information Consortium and Ethos in March 2019, with updates in September 2019 and January 2023. There were no restrictions on study design, but studies were excluded if they did not include the perspective of health professionals or were not in English. Barriers and/or enablers of type 2 diabetes care for people with a severe mental illness were organised using the theoretical domains framework with additional inductive thematic coding. RESULTS: Twenty-eight studies were included in the review. Overall, eight domains were identified as important with barriers and enablers identified at individual, interpersonal and organisational levels. CONCLUSIONS: Focussing on providing a collaborative healthcare environment which actively supports type 2 diabetes care, fostering improved communication both between professionals and service users, ensuring clear boundaries around roles and responsibilities as well as individual skill and knowledge support alongside confidence building all offer opportunities to improve type 2 diabetes care.

Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial.

BACKGROUND: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. AIMS: This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. METHOD: The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3-5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT). RESULTS: In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI -1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact. CONCLUSIONS: Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.

Perceived barriers and enablers influencing physical activity in heart failure: A qualitative one-to-one interview study.

In heart failure (HF), increased physical activity is associated with improved quality of life, reduced hospitalisation, and increased longevity and is an important aim of treatment. However, physical activity levels in individuals living with HF are typically extremely low. This qualitative study with one-to-one interviews systematically explores perceived clinical, environmental, and psychosocial barriers and enablers in older adults (≥70 years old) living with HF. Semi-structured interviews (N = 16) based on the Theoretical Domains Framework elicited 39 belief statements describing the barriers and enablers to physical activity. Theoretical domains containing these beliefs and corresponding constructs that were both pervasive and common were deemed most relevant. These were: concerns about physical activity (Beliefs about Consequences), self-efficacy (Beliefs about Capabilities), social support (Social Influences), major health event (Environmental Context and Resources), goal behavioural (Goal), action planning (Behavioural Regulation). This work extends the limited research on the modifiable barriers and enablers for physical activity participation by individuals living with HF. The research findings provide insights for cardiologists, HF-specialist nurses, and physiotherapists to help co-design and deliver a physical activity intervention more likely to be effective for individuals living with HF.

Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager.

BACKGROUND: 'Engager' is an innovative 'through-the-gate' complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case study analysis part of the process evaluation, exploring how a sub-sample of prison-leavers engaged and responded to the intervention offer of one-to-one support during their re-integration into the community. METHODS: To understand intervention delivery and what response it elicited in individuals, we used a realist-informed qualitative multiple 'case' studies approach. We scrutinised how intervention component delivery lead to outcomes by examining underlying causal pathways or 'mechanisms' that promoted or hindered progress towards personal outcomes. 'Cases' (n = 24) were prison-leavers from the intervention arm of the trial. We collected practitioner activity logs and conducted semi-structured interviews with prison-leavers and Engager/other service practitioners. We mapped data for each case against the intervention logic model and then used Bhaskar's (2016) 'DREIC' analytic process to categorise cases according to extent of intervention delivery, outcomes evidenced, and contributing factors behind engagement or disengagement and progress achieved. RESULTS: There were variations in the dose and session focus of the intervention delivery, and how different participants responded. Participants sustaining long-term engagement and sustained change reached a state of 'crises but coping'. We found evidence that several components of the intervention were key to achieving this: trusting relationships, therapeutic work delivered well and over time; and an in-depth shared understanding of needs, concerns, and goals between the practitioner and participants. Those who disengaged were in one of the following states: 'Crises and chaos', 'Resigned acceptance', 'Honeymoon' or 'Wilful withdrawal'. CONCLUSIONS: We demonstrate that the 'implementability' of an intervention can be explained by examining the delivery of core intervention components in relation to the responses elicited in the participants. Core delivery mechanisms often had to be 'triggered' numerous times to produce sustained change. The improvements achieved, sustained, and valued by participants were not always reflected in the quantitative measures recorded in the RCT. The compatibility between the practitioner, participant and setting were continually at risk of being undermined by implementation failure as well as changing external circumstances and participants' own weaknesses. TRIAL REGISTRATION NUMBER: ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016-Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.

Investigating the feasibility of MePlusMe, an online intervention to support mental health, well-being, and study skills in higher education students.

INTRODUCTION: While there are several web-based mental health interventions, few target higher education (HE) students. Importantly, more research is needed to establish their effectiveness. Here, we provide a pragmatic evaluation of an online intervention (MePlusMe) specifically designed to improve the mental health, well-being, and study skills of HE students. METHODS: In accordance with the published protocol for a feasibility study, we recruited a convenience sample of 137 HE students to participate in an eight-week intervention, with 26 participants retained at week 8. Validated measures of mood (depression and anxiety), well-being, and self-efficacy were collected at baseline, 2, 4, and 8 weeks, alongside two feedback forms assessing design and functionality (baseline) and engagement (week 4 and 8). RESULTS: We observed significant reductions in levels of anxiety and depression as well as increases in well-being, but no changes in self-efficacy. Participants rated the system design and functionality positively and qualitative findings indicated high levels of satisfaction with MePlusMe. DISCUSSION: Findings support both the acceptability and the effectiveness of MePlusMe. Nonetheless, modest retention rates limit the precision and generalisability of these findings. Further investigation should ascertain optimal duration of engagement, most acceptable means of outcome assessment, and further detail about obstacles to utilisation.

Self-harm and suicide: occurrence, risk assessment and management for general nurses.

Suicide is a tragic event that has traumatic and far-reaching effects on families, friends and healthcare professionals, for whom feelings of guilt, blame and regret are common. Although there have been reductions in suicide rates globally and in the UK over past decades, it remains one of the leading causes of death. Assessing and supporting people who present with self-harm and risk of suicide are essential aspects of all nurses' clinical practice. This article explains the relationship between suicide, self-harm and other risk factors. It also provides guidance for general nurses on evidence-based approaches to managing self-harm and assessing suicide risk collaboratively with service users.

Economic evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: a cost-utility and cost-consequences analysis.

BACKGROUND: People in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention ("Engager") to address common mental health problems. METHODS: Two hundred and eighty people were recruited from prisons in England and randomised to Engager plus usual care or usual care. Participants were followed up for 12 months following release from prison. The primary analysis is the cost per quality-adjusted life year (QALY) gained of Engager compared to usual care from a National Health Service (NHS) perspective with QALYs calculated using the CORE 6 Dimension. A cost-consequences analysis evaluated cross-sectoral costs and a range of outcomes. RESULTS: From an NHS perspective, Engager cost an additional £2737 per participant (95% of iterations between £1029 and £4718) with a mean QALY difference of - 0.014 (95% of iterations between - 0.045 and 0.017). For the cost-consequences, there was evidence of improved access to substance misuse services 12 months post-release (odds ratio 2.244, 95% confidence Interval 1.304-3.861). CONCLUSION: Engager provides a rare example of a cost-utility analysis conducted in prisons and the community using patient-completed measures. Although the results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations. TRIAL REGISTRATION: (ISRCTN11707331).

Is an individually tailored programme of intense leg resistance and dynamic exercise acceptable to adults with an acute lateral patellar dislocation? A feasibility study.

BACKGROUND: Lateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants' activity-related goals, has rationale, but has not been previously reported. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment. METHODS: A single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over a maximum of 3 months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics. RESULTS: Fifteen of 22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. Two of 15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they 'always' or 'often' completed the prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions. CONCLUSION: The intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible. This future pilot trial should estimate attrition with increased precision over a longer duration and assess participants' willingness to be randomised to different treatments across multiple centres. TRIAL REGISTRATION: ClinicalTrials.gov NCT03798483 , registered on January 10, 2019.

Assessing and managing mental health issues in people with chronic skin conditions.

Chronic skin conditions, such as atopic eczema and psoriasis, can have significant psychological effects on patients. For example, these conditions can affect an individual's functioning, and may lead to mental health issues such as depression or anxiety disorders. This article identifies the links between chronic skin conditions and mental health issues, and discusses the nurse's role in assessing, managing and supporting patients with these comorbidities. It also emphasises the importance of using validated tools and a holistic approach to care, and discusses how to address challenges that patients may experience.

Objectively quantified lower limb strength recovery in people treated surgically or non-surgically after patellar dislocation: A systematic review.

OBJECTIVE: Synthesize evidence on objectively quantified lower limb strength recovery in people treated surgically or non-surgically after patellar dislocation. METHODS: MEDLINE, EMBASE, Cochrane Library, SPORTDiscus, PEDro, AMED and CINAHL databases were last searched on July 30th, 2020 for randomized controlled trials and observational studies that objectively quantified lower limb strength in people (any age or sex) treated surgically or non-surgically after patellar dislocation. RESULTS: 24 studies were included (877 participants, median age 20.7). All assessed knee extension strength, 11 knee flexion strength, three hip abduction strength, two hip external rotation strength, and one hip flexion, extension, adduction, and internal rotation strength. One randomized controlled trial judged at high risk of bias and two cohort studies with methodological limitations compared lower limb strength recovery between surgically and non-surgically treated people, with conflicting findings. After surgery, median long-term (>8 months) knee extension strength was 82.5% (IQR 78.5-88.2; 13 studies) of the unaffected leg and knee flexion strength was 91.5% (IQR 90.7-96.9; five studies). After non-surgical treatment, median long-term knee extension strength was 86% (IQR 79.3-87.4; four studies) and mean flexion strength ranged from 95.2 to 96.7% (two studies). Mean hip strength was always >90% (two studies). Two redislocations during eccentric isokinetic knee testing and knee pain during isokinetic knee extension testing were reported as adverse events. CONCLUSIONS: Available evidence indicates that after patellar dislocation, knee extension strength deficits in the affected limb are frequently observed and can persist long term, but this remains uncertain due to the limitations of relevant included studies. Whether lower limb strength recovery differs between people treated surgically and those treated non-surgically after patellar dislocation also remains uncertain. TRIAL REGISTRATION: (PROSPERO CRD42019139533).

Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis.

OBJECTIVES: This meta-analysis aims to (1) evaluate the efficacy of physical activity interventions in heart failure and (2) to identify intervention characteristics significantly associated with the interventions' efficacy. METHODS: Randomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (eg, cardiac rehabilitation), strategies used (eg, action planning), setting (eg, centre based), mode of delivery (eg, face to face or online), facilitator (eg, nurse), contact time and behavioural change theory use as predictors in the random-effect model. RESULTS: Interventions (n=21) had a significant overall effect (SMD=0.54, 95% CI (0.13 to 0.95), p<0.0005). Combining an exercise programme with behavioural change intervention was found efficacious (SMD=1.26, 95% CI (0.26 to 2.26), p<0.05). Centre-based (SMD=0.98, 95% CI (0.35 to 1.62), and group-based (SMD=0.89, 95% CI (0.29 to 1.50),) delivery by a physiotherapist (SMD=0.84, 95% CI (0.03 to 1.65),) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD=3.29, 95% CI (1.97 to 4.62)), credible source (standardised mean difference, SMD=2.08, 95% CI (0.95;3.22)), adding objects to the environment (SMD=1.47, 95% CI (0.41 to 2.53)), generalisation of the target behaviour SMD=1.32, 95% CI (0.22 to 2.41)), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI (0.05 to 1.98)), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI (0.06 to 1.52), graded tasks (SMD=0.73, 95% CI (0.22 to 1.24)), behavioural practice/rehearsal (SMD=0.72, 95% CI (0.26 to 1.18)), action planning (SMD=0.62, 95% CI (0.03 to 1.21)) and goal setting (behaviour) (SMD=0.56, 95% CI (0.03 to 1.08)). CONCLUSION: The meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behavioural change intervention delivered by a physiotherapist in a group-based and centre-based settings. PROSPERO REGISTERATION: CRD42015015280.

The experiences of carers looking after people with Parkinson's disease who exhibit impulsive and compulsive behaviours: An exploratory qualitative study.

AIM: To understand the experiences of carers who were confronted by the development of impulsive and compulsive behaviours. BACKGROUND: Impulsive and compulsive behaviours (ICBs) are a serious complication in Parkinson's disease (PD) strongly associated with dopamine replacement therapy used to treat patients. These behaviours comprise abnormal activities such as pathological gambling, binge eating, compulsive shopping and hypersexuality. These behaviours place a considerable burden on patients and on their carers and families. DESIGN: An exploratory qualitative study. METHODS: Using a convenience sampling approach, 13 carers were recruited to participate in semi-structured interviews. Interviews were conducted over the telephone. Verbatim transcripts were analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. RESULTS: Five main themes were identified: (a) realisation-developing awareness of ICB symptoms and their causes; (b) reacting-confronting and attempts to manage ICBs; (c) reaching out-help-seeking and selective disclosure; (d) reframing-shifting perspectives on ICBs over time; and (e) resignation-impact on relationships and facing the future. CONCLUSIONS: The profound impact of ICBs on quality of life, relationships and economic stability was clear in the carers' accounts. Possible avenues for future clinical research are suggested. RELEVANCE TO CLINICAL PRACTICE: The potentially devastating effects of ICBs provide a strong imperative for nurses and other health professionals to ensure that close monitoring for symptom development together with patient education is always part of practice.

Initial psychometric evaluation of the physical health attitude scale and a survey of mental health nurses.

WHAT IS KNOWN ON THE SUBJECT?: A clear association exists between serious mental illness (SMI) and poor physical health. Individuals with SMI have markedly higher risks for mortality and morbidity. Mental health nurses play an important role in enhancing service users' mental and physical well-being. The attitudes of mental health nurses towards physical health care have been explored in the western part of the world. However, cross-country differences should be determined to reveal the importance of this global issue. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds new data to the literature on the Physical Health Attitude Scale's (PHASe) validity and nurses' attitudes when working in acute mental health services in different cultures. Nurses in acute mental health wards mostly focus on the basic physiological indicators of patients' existing physical health problems, so health promotion practices such as sexual health and eye/dental examinations are neglected for individuals with SMI. Nurses' higher level of confidence about their delivery of physical health care is due to their familiarity with basic nursing practices (e.g. monitoring blood pressure and checking blood glucose levels). Differences that exist between countries in relation to smoking habits are probably due to different regulations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To improve patients' physical healthcare outcomes, nurses should be provided with additional training and supervision to strengthen their skills and confidence. Nurses' perceived need for additional training reflects the importance of physical health care in mental health settings, in which training could substantially improve patient outcomes. Authors believe that standard protocols must be established in acute psychiatric care to eliminate obstacles to holistic patient care. Training needs of mental health nurses on health promotion practices should be considered by administrators of mental health settings. Abstract Introduction Nurses play an important role in improving the physical health of individuals with serious mental illnesses. The literature on the attitudes of mental health nurses towards physical health care provides a small amount of data. Assessing trends in nurses' attitudes through suitable surveys is important to ensure holistic care. Aim/Question This study sought to examine the Turkish version of the Physical Health Attitude Scale's (PHASe) validity and reliability and to survey Turkish mental health nurses' attitudes towards physical health care. Method The sample consisted of 174 nurses working in acute psychiatric wards. Firstly, the psychometric properties of the scale were analysed using factor analysis and measures of internal consistency and reliability. Then, the survey results of the attitudes of mental health nurses towards the physical health of patients with serious mental illnesses were determined using the Physical Health Attitude Scale (PHASe). Results The translated PHASe functioned best as a 24-item version and 4-factor solution that explains 51.3% of the variance. The internal consistency value was 0.83. The respondents' attitudes were generally positive about their role. There was less agreement for the involvement of nurses in practices of health promotion, such as sexual health, eye and/or dental examinations. The nurses surveyed also tended to use smoking for therapeutic purposes. Implications for practice Mental health nurses' knowledge and attitudes should be enhanced by additional training in the ways of meeting patients' biopsychosocial needs. Obstacles to physical health care can be removed by implementing standard protocols nationwide.

Exploring the feasibility and acceptability of the contents, design, and functionalities of an online intervention promoting mental health, wellbeing, and study skills in Higher Education students.

BACKGROUND: Substantial numbers of students in Higher Education (HE) are reporting mental health difficulties, such as mild to moderate symptoms of depression and anxiety. Coupled with academic skills challenges, these difficulties can lead to decreased academic performance, low levels of study satisfaction, and eventually drop out. Student support services are facing budget cuts and can only attend to limited numbers of students, usually the ones who present with more severe mental health problems. Moreover, face-to-face contact may not appeal to those students who feel embarrassed by their problems or are afraid of being stigmatised. To address this important problem, an online psychological wellbeing and study skills support system called MePlusMe, has been developed to provide personalised support to its users. In the present study we investigated the feasibility and acceptability of the contents, design, and functionalities of the system. METHODS: An offline version of the system was introduced to 13 postgraduate and undergraduate students (mean age = 31.3 years, SD = 10.25 years; 4 males) in a UK HE Institution, who presented with mild or moderate mental health difficulties. The participants evaluated the design of the system, its functionalities, and contents at Baseline and at Weeks 2, 4, and 8. RESULTS: Participants found the system easy to use, professional, and efficient and its contents non-judgemental and informative. Participants stated that engaging with and practicing the techniques targeted at mental health difficulties led to improvements in positive thinking and self-confidence, while the study skills techniques were practical. Suggestions for further improvement included the development of an app and an option for direct engagement with professionals. CONCLUSIONS: The findings confirmed the acceptability of the contents, design and functionalities of the system, while providing useful information to inform its further development. Next steps include a feasibility study, which will test and quantify the effects on everyday functioning, mood, mental wellbeing, and academic self-efficacy after using the system, and subsequently a randomized controlled trial, which will evaluate its effectiveness.

Spanish Validation Of The Revised Depression Attitude Questionnaire (R-DAQ).

PURPOSE: The aim of the study was to develop and validate a Spanish version of the Revised Depression Attitude Questionnaire (R-DAQ). METHODS: The R-DAQ was used as a baseline for the study. It was translated and tested to ensure the instrument was appropriate for the target population. 537 Ecuadorian healthcare professionals completed the revised Spanish version of the R-DAQ (SR-DAQ). Statistical and exploratory factor analyses were performed to examine construct validity, internal consistency, readability and floor and ceiling effects. RESULTS: Three factors were obtained: "Professional confidence in depression care"; "Therapeutic optimism about depression"; and "Generalist perspective about depression occurrence, recognition, and management". The internal consistency of the SR-DAQ was determined by means of Cronbach's α coefficient, with values ranging between 0.61-0.8. The correlations with the English version reflected adequate validity. The model explained 39% of the variance. Subsequent analysis with a sample restricted to those who had received training in depression produced a model that explained 42% of the variance. CONCLUSION: The SR-DAQ meets the psychometric requirements for measuring depression attitude in a Spanish-speaking population and shows adequate internal consistency and validity.

Barriers to effective diabetes management - a survey of people with severe mental illness.

BACKGROUND: People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. To maintain good diabetes control, people with diabetes are advised to engage in several self-management behaviours. The aim of this study was to identify barriers or enablers of diabetes self-management experienced by people with SMI. METHODS: Adults with type 2 diabetes and SMI were recruited through UK National Health Service organisations and mental health and diabetes charities. Participants completed an anonymous survey consisting of: Summary of Diabetes Self-Care Activities (SDSCA); CORE-10 measure of psychological distress; a measure of barriers and enablers of diabetes self-management based on the Theoretical Domains Framework; Diabetes UK care survey on receipt of 14 essential aspects of diabetes healthcare. To identify the strongest explanatory variables of SDSCA outcomes, significant variables (p < .05) identified from univariate analyses were entered into multiple regressions. RESULTS: Most of the 77 participants had bipolar disorder (42%) or schizophrenia (36%). They received a mean of 7.6 (SD 3.0) diabetes healthcare essentials. Only 28.6% had developed a diabetes care plan with their health professional and only 40% reported receiving specialist psychological support. Engagement in self-management activities was variable. Participants reported taking medication on 6.1 (SD 2.0) days in the previous week but other behaviours were less frequent: general diet 4.1 (2.3) days; specific diet 3.6 (1.8) days, taking exercise 2.4 (2.1) days and checking feet on 1.7 (1.8) days. Smoking prevalence was 44%. Participants reported finding regular exercise and following a healthy diet particularly difficult. Factors associated with diabetes self-management included: the level of diabetes healthcare and support received; emotional wellbeing; priority given to diabetes; perceived ability to manage diabetes or establish a routine to do so; and perceived consequences of diabetes self-management. CONCLUSIONS: Several aspects of diabetes healthcare and self-management are suboptimal in people with SMI. There is a need to improve diabetes self-management support for this population by integrating diabetes action plans into care planning and providing adequate psychological support to help people with SMI manage their diabetes.

The effect of a training programme on school nurses' knowledge, attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial.

BACKGROUND: Mental health problems in children and young people are a vital public health issue. Only 25% of British school children with diagnosed mental health problems have specialist mental health services contact; front-line staff such as school nurses play a vital role in identifying and managing these problems, and accessing additional services for children, but there appears limited specific training and support for this aspect of their role. OBJECTIVES: To evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources. Hypothesized outcomes were improvements in school nurses' knowledge, attitudes, and recognition skills for depression. DESIGN: A cluster-randomised controlled trial. PARTICIPANTS AND SETTING: 146 school nurses from 13 Primary Care Trusts (PCTs) in London were randomly allocated to receive the training programme. METHODS: School nurses from 7 PCTs (n = 81) were randomly allocated to receive the training intervention and from 6 PCTs (n = 65) for waiting list control. Depression detection was measured by response to vignettes, attitudes measured with the Depression Attitude Questionnaire, and knowledge by the QUEST knowledge measure. These outcomes were measured at baseline and (following training) 3 months and nine months later, after which nurses in the control group received the training programme. RESULTS: At 3 months, 115 nurses completed outcome measures. Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses' knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased. There was also a significant change in optimism about depression outcomes, but no change in tendency to defer depression management to specialists. At 9-month follow-up, improved specificity in depression identification and improved knowledge were maintained. CONCLUSIONS: This school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.

Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals.

OBJECTIVES: To establish healthcare professionals' (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI). DESIGN: Cross-sectional, postal and online survey. SETTING: Trusts within the National Health Service, mental health and diabetes charities, and professional bodies. PARTICIPANTS: HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK. PRIMARY AND SECONDARY OUTCOME MEASURES: The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework. RESULTS: Respondents were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Univariate analysis found that mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (P<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the multiple regression analyses were a lack of knowledge (P=0.003); a need for training in communication and negotiation skills (P=0.04); a lack of optimism about the health of their clients (P=0.04) and their ability to manage T2DM in people with SMI (P=0.003); the threat of being disciplined (P=0.02); fear of working with people with a mental health condition (P=0.01); a lack of service user engagement (P=0.006); and a need for incentives (P=0.04). The significant enablers were an understanding of the need to tailor treatments (P=0.04) and goals (P=0.02) for people with SMI. CONCLUSIONS: This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of an HCP's role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced.

Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial.

INTRODUCTION: The 'Engager' programme is a 'through-the-gate' intervention designed to support prisoners with common mental health problems as they transition from prison back into the community. The trial will evaluate the clinical and cost-effectiveness of the Engager intervention. METHODS AND ANALYSIS: The study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either: (a) the Engager intervention plus standard care (intervention group) or (b) standard care alone (control group) across two investigation centres (South West and North West of England). Two hundred and eighty prisoners meeting eligibility criteria will take part. Engager is a person-centred complex intervention delivered by practitioners and aimed at addressing offenders' mental health and social care needs. It comprises one-to-one support for participants prior to release from prison and for up to 20 weeks postrelease. The primary outcome is change in psychological distress measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure at 6 months postrelease. Secondary outcomes include: assessment of subjective met/unmet need, drug and alcohol use, health-related quality of life and well-being-related quality of life measured at 3, 6 and 12 months postrelease; change in objective social domains, drug and alcohol dependence, service utilisation and perceived helpfulness of services and change in psychological constructs related to desistence at 6 and 12 months postrelease; and recidivism at 12 months postrelease. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action and look for unintended consequences. An economic evaluation will estimate the cost-effectiveness. ETHICS AND DISSEMINATION: This study has been approved by the Wales Research Ethics Committee 3 (ref: 15/WA/0314) and the National Offender Management Service (ref: 2015-283). Findings will be disseminated to commissioners, clinicians and service users via papers and presentations. TRIAL REGISTRATION NUMBER: ISRCTN11707331; Pre-results.