SEQUenCE: a service user-centred quality of care instrument for mental health services.

OBJECTIVE: To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. DESIGN: The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. SETTING: All participants were attending an independent mental health service in Ireland. PARTICIPANTS: Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. INTERVENTIONS: Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. MAIN OUTCOME MEASURES: Test-retest reliability, internal consistency and convergent validity of the instrument. RESULTS: The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87). CONCLUSIONS: SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups.

Quality of care in psychosis and bipolar disorder from the service user perspective.

According to the recovery model of mental health care, service development should incorporate the expert knowledge of service users. To date, there has been limited research into conceptualizations of mental health care quality among services users diagnosed with bipolar disorder or psychosis. To investigate service user perspectives on quality of care, we conducted six focus groups (N = 29) with inpatients and outpatients of an independent Irish mental health service. We undertook an inductive thematic analysis of the data. Participants identified proactive staff, meaningful and warm staff-patient interactions, and safety and sociability in the inpatient environment as components of good quality mental health care. Participants also discussed how the implementation of best practice guidelines does not necessarily improve quality of care from the service user perspective. This and similar qualitative research should be used to inform service development and the creation of evaluation instruments compatible with the recovery model.

Psychological distress as a key component of psychosocial functioning in community-dwelling older people.

OBJECTIVES: To explore the key components representative of measures of psychosocial functioning with a focus on identifying the constituents of psychological distress in an Irish sample of community-dwelling older adults and to examine the relationship between these components and health outcomes such as frailty. METHOD: Cross-sectional observational study at the Technology Research for Independent Living (TRIL) Clinic, a comprehensive geriatric assessment facility in St. James's Hospital, Dublin. In this study, 579 participants were given eight primary assessments (Centre for Epidemiological Studies of Depression, Geriatric Adverse Life Events Scale, Pittsburgh Sleep Quality Index, De Jong-Gierveld Scale, Practitioner Assessment of Network Type, Eysenck Personality Inventory, Hospital Anxiety and Depression Scale, Lubben Social Network Scale) and a broad range of health and demographic secondary assessments. Principal factor analysis identified the core components relating to psychosocial functioning. Following this, the regression factors of these components were correlated with health outcomes. RESULTS: The first of three components identified accounted for 9.08% of the variance and related to a core internal component of psychological distress. The two other components related to external and physiological functioning, specifically social support networks and sleep. Spearman's Rho correlations indicated significant associations of walking speed, age, Berg Balance Scale and living alone with all three components. Additionally, the core component of psychological distress significantly correlated with the Fried Frailty Index, illness co-morbidity, ADL, IADL and nutrition. CONCLUSION: These results characterise the variation in psychosocial functioning in older adults and identifies psychological distress as a core facet of psychosocial functioning which has associations with frailty.

Factors associated with perceived health in older adult Irish population.

OBJECTIVES: Perceived health status or self-reported health declines with age and is associated with increased morbidity, mortality, poor mental health and functional outcomes and health care utilisation. The aim of this study was to investigate the relationship between a range of biopsychosocial measures and self-reported health in a sample of community-dwelling older people living in Dublin. METHOD: A total of 492 participants with a mean age of 72.5 (SD = 7.34) were assessed at the Technology Research for Independent Living (TRIL) clinic, a comprehensive geriatric assessment facility in St James's Hospital, Dublin, using standardised measures of medical morbidity, personality, functional status, depression, anxiety, perceived stress, cognition, loneliness and social support. The relationship between self-rated health and health measures was analysed using bivariate correlations and backward multiple regression. Indirect pathways of effects on perceived health were evaluated using bootstrapping mediation analysis. RESULTS: Self-rated health was best predicted by instrumental activities of daily living (IADL), Charlson Co-morbidity Index (CCI), extraversion and perceived stress. The effects of cognition and social support from friends on self-rated health were found to be mediated by elements of these identified factors. CONCLUSION: Self-rated health is not simply the absence of physical illness but is also strongly influenced by the degree of functional impairment, personality factors and the level of stress experienced by the older person.

Risk factors and mediating pathways of loneliness and social support in community-dwelling older adults.

OBJECTIVES: To develop biopsychosocial models of loneliness and social support thereby identifying their key risk factors in an Irish sample of community-dwelling older adults. Additionally, to investigate indirect effects of social support on loneliness through mediating risk factors. METHODS: A total of 579 participants (400 females; 179 males) were given a battery of biopsychosocial assessments with the primary measures being the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale along with a broad range of secondary measures. ANALYSIS: Bivariate correlation analyses identified items to be included in separate psychosocial, cognitive, biological and demographic multiple regression analyses. The resulting model items were then entered into further multiple regression analyses to obtain overall models. Following this, bootstrapping mediation analyses was conducted to examine indirect effects of social support on the subtypes (emotional and social) of loneliness. RESULTS: The overall model for (1) emotional loneliness included depression, neuroticism, perceived stress, living alone and accommodation type, (2) social loneliness included neuroticism, perceived stress, animal naming and number of grandchildren and (3) social support included extraversion, executive functioning (Trail Making Test B-time), history of falls, age and whether the participant drives or not. Social support influenced emotional loneliness predominantly through indirect means, while its effect on social loneliness was more direct. CONCLUSIONS: These results characterise the biopsychosocial risk factors of emotional loneliness, social loneliness and social support and identify key pathways by which social support influences emotional and social loneliness. These findings highlight issues with the potential for consideration in the development of targeted interventions.