A comprehensive overview of social network measures for older adults : a systematic review

Objectives: The size and type of older adults' social networks is associated with health, mental and social outcomes. Investigators within many disciplines are now measuring social networks, but it is not always clear what they are assessing, or which measures may best meet their objectives. To undertake a systematic review to identify (i) social network measures used for older adults, (ii) variety of social network dimensions and (iii) how measures have developed over time. Materials and Methods: The MEDLINE, EMBASE, CINAHL, PsycInfo and Cochrane Library databases were systematically searched to identify social network instruments, followed by categorization of the domains into quantitative, qualitative and alter domains. Results: A total of 229 studies and 21 social network measures were included, with 11 quantitative dimensions (e. g., size, frequency), 5 qualitative dimensions (e.g., support satisfaction, emotional bond) and 7 alter members (e. g., family, neighbours) of social networks identified. Measures commonly clustered on quantifiable network size (n = 19), availability of supportive networks (n = 14) and presence of family ties (n = 21). The period between 1985 and 1995 produced the greatest number of newly developed social network measures (n = 10) with a stronger focus on qualitative features. Discussion and Implications: This review provides researchers with an organized summary of measures and dimensions for consideration when appraising social connections in older adults. This can enable better study design through providing information that makes explicit inevitable trade-offs between survey length, comprehensiveness of dimension coverage, and utilization of the measure for researchers

The Reality of Uncertainty in Mental Health Care Settings Seeking Professional Integration: A Mixed-Methods Approach

Introduction: Uncertainty is a common experience in the complex adaptive health system, particularly amongst mental health professionals structured for the delivery of integrated care. Increased understanding of uncertainty will not necessarily make things more certain, but can act to sensitize professionals to the challenges they face. The aim of this study is to examine the types and situations of uncertainty experienced by professionals working in a mental health setting based on an integrated care model. The research assesses the impact of experience and professional group on reported uncertainties. Methods: First, semi-structured interviews were undertaken with clinical and non-clinical staff to examine uncertainties experienced by professionals working in 'headspace' centres in Australia. Second, an online survey was conducted to quantify the experiences of uncertainty and explore associations. Results: Findings revealed three overarching and largely interrelated aspects of uncertainty, namely: decision-making; professional role; and external factors. Most commonly, staff reported experiences of uncertainty pertaining to deciding to accept a client into the service and then deciding how to treat them. This is often due to arbitrary, or overly-restrictive criteria in integrated care. Findings also suggested that uncertainty does not necessarily decline with experience and there were no significant differences in levels of uncertainty between clinical and non-clinical staff. Conclusions: This study highlights the importance of acknowledging uncertainties and actively clarifying role ambiguities when working alongside diverse professionals in mental health care

Systems resilience in the implementation of a large-scale suicide prevention intervention: a qualitative study using a multilevel theoretical approach

Background Resilience, the capacity to adapt and respond to challenges and disturbances, is now considered fundamental to understanding how healthcare systems maintain required levels of performance across varying conditions. Limited research has examined healthcare resilience in the context of implementing healthcare improvement programs across multiple system levels, particularly within community-based mental health settings or systems. In this study, we explored resilient characteristics across varying system levels (individual, team, management) during the implementation of a large-scale community-based suicide prevention intervention. Methods Semi-structured interviews (n=53) were conducted with coordinating teams from the four intervention regions and the central implementation management team. Data were audio-recorded, transcribed, and imported into NVivo for analysis. A thematic analysis of eight transcripts involving thirteen key personnel was conducted using a deductive approach to identify characteristics of resilience across multiple system levels and an inductive approach to uncover both impediments to, and strategies that supported, resilient performance during the implementation of the suicide prevention intervention. Results Numerous impediments to resilient performance were identified (e.g., complexity of the intervention, and incompatible goals and priorities between system levels). Consistent with the adopted theoretical framework, indicators of resilient performance relating to anticipation, sensemaking, adaptation and tradeoffs were identified at multiple system levels. At each of the system levels, distinctive strategies were identified that promoted resilience. At the individual and team levels, several key strategies were used by the project coordinators to promote resilience, such as building relationships and networks and carefully prioritising available resources. At the management level, strategies included teambuilding, collaborative learning, building relationships with external stakeholders, monitoring progress and providing feedback. The results also suggested that resilience at one level can shape resilience at other levels in complex ways; most notably we identified that there can be a downside to resilience, with negative consequences including stress and burnout, among individuals enacting resilience. Conclusions The importance of considering resilience from a multilevel systems perspective, as well as implications for theory and future research, are discussed.publishedVersio

How do professionals collaborate in the face of uncertainty?: An investigation into the complexities of mental health care

Theoretical thesis.Bibliography: pages 86-94.Chapter 1. Introduction -- Chapter 2. Uncertain about uncertainty: a scoping review -- Chapter 3. Methods: study one -- Chapter 4. Uncertainties reported and explored -- Chapter 5. How do mental health care professionals collaborate when they are uncertain? a systematic review -- Chapter 6. Methods: study 2 - a social network approach -- Chapter 7. Findings: social network analysis -- Chapter 8. Conclusions and reflections: collaboration, uncertainty and mental health care.Professional uncertainty is ubiquitous across health care settings, yet it may be managed by the sharing of information through effective interprofessional collaboration. Professional uncertainty is particularly prominent in mental health care; however, the literature lacks a consistent categorisation of the types of uncertainty in this context.The aim of this thesis was to identify the types of uncertainty experienced by professionals working in mental health, and evaluate how professionals collaborate in these situations. The research was conducted in two youth mental health 'headspace' centres in Australia. Two literature reviews and an exploratory two-stage mixed-methods design were employed. Study 1 used semi-structured interviews and Study 2, a social network survey. Statistical, thematic and social network analyses were employed to analyse the data. Findings revealed distinct types of professional uncertainty in mental health care related to: decisions, professional role, and external factors. In the face of these uncertainties, health care professionals collaborated across professional bounds, however, the degree of connectedness and who colleagues sought for support varied depending on the type of uncertainty. Specifically, collaboration during professional role uncertainty was sparse, indicating that the mere co-location of professionals may not always lead to cohesive interprofessional working. This suggests the need to do more to engender professional collaboration (rather than just co-location). Research must continue to identify situations of sparse collaborative patterns, such as role uncertainty, in order to develop interventions to improve interprofessional teams in navigating these complex situations. The findings of this research are directly applicable to headspace centres, and can be extrapolated to other services that aim for integrated, collaborative care.1 online resource (xiii, 132 pages

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis

BackgroundThe COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” ObjectiveThe aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. MethodsWe conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. ResultsA total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. ConclusionsCOVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care

Changes in public perceptions and experiences of the Australian health?care system: A decade of change

BACKGROUND: The views and experiences of the Australian public are an important barometer of the health system. This study provides key findings about the changing views held by Australians over time regarding their individual experiences and perceptions of the overall performance of the health system. METHODS: A population-based online survey was conducted in 2018 (N = 1024). Participants were recruited through market research panels. The results were compared with previous Australian population survey data sets from 2008 (N = 1146), 2010 (N = 1201) and 2012 (N = 1200), each of which used different population samples. The survey included questions consistent with previous surveys regarding self-reported health status, and questions about use, opinions and experiences of the health system. RESULTS: Overall, there has been a shift in views from 2008 to 2018, with a higher proportion of respondents now viewing the Australian health-care system more positively (X2 (2, N = 4543) = 96.5

Innovative models of healthcare delivery: an umbrella review of reviews

Objective To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.Design Umbrella review.Setting Interventions delivered inside and outside of acute care settings.Participants Children and adults with one or more identified acute or chronic health conditions.Data sources PsycINFO, Ovid MEDLINE and CINAHL.Primary and secondary outcome measures Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge.Results A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care.Conclusions A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems.Trial registration number 10.17605/OSF.IO/PS6ZU