Mental illness research in the Gulf Cooperation Council: a scoping review

Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users’ experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services. This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users’ experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting. From this review, it is clear that the sociocultural context in the region is linked to service users’ experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region

Glaucoma, dementia and the 'precipice of care': transitions between states of medication adherence

Purpose: “She wouldn’t remember. Even when I go through, and she’s decided to go to bed, I’ll say I’ll come and do her drops. If I didn’t say that, they wouldn’t be done.” Dementia is widely considered a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia upon medication management strategies for glaucoma including how patient and carer needs impact adherence and long term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers and healthcare professionals. Patients and methods: 83 semi-structured interviews were conducted with 35 patients, 22 lay carers and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers and facilitators to drop administration, as well as attitudes towards glaucoma, dementia and other comorbidities. Results: Using Pandora Pound’s synthesis of adherence behaviour, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg heart disease, glaucoma and dementia) and socio-cultural influences (eg living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioural changes influenced their administration. Conclusion: Though dementia was associated with progression towards the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into pre-existing routines

Reciprocity Membership. A potential pathway towards recovery from mental illness in a Middle Eastern context

While recovery has become a popular framework for mental health services, there is limited understanding of its applicability outside of Western countries. In fact, recent studies in non-Anglophone populations suggest that recovery is contextually dependent and that implementation of mainstream recovery models risks imposing inappropriate values. We used classic grounded theory to explore the main concerns of mental health service users in a Middle Eastern context and the strategies they use to resolve those concerns. The theory of ‘reciprocity membership’, a process involving ongoing mutual exchange with a group or community, was developed. Reciprocity membership becomes balanced when an individual is satisfied with their ‘contribution to’ the group, the ‘acknowledgement from’ other group members, the ‘expectations of’ the group, and their ‘alignment with’ the values of the group. Balance among these conditions is appraised by a sub-process called ‘valuing’, and developed or maintained by two further sub-processes called ‘positioning’ and ‘managing relationships’. Balanced reciprocity membership seems to be associated with recovery. This study is the first in-depth exploration of people’s experience of mental illness in a Middle Eastern context; findings provide evidence for a novel potential pathway towards recovery

A feasibility study to prevent falls in older people who are sight impaired: the VIP2UK randomised controlled trial.

BACKGROUND: Published evaluations of successful interventions to prevent falls in people with sight impairment (SI) are limited. The aim of this feasibility study is to optimise the design and investigation of home safety (HS) and home exercise (HE) programmes to prevent falls in older people with SI. METHODS: A community-based feasibility study in north-west England comprising a three-arm randomised controlled trial (RCT) allocated participants to (1) a control group receiving usual care and social visits, (2) an experimental group receiving the HS programme and (3) an experimental group receiving the HS + HE programme. Participants were community-dwelling, aged 65 years and older and sight impaired. Primary outcome data on falls were collected continuously over 6 months. Secondary outcomes on physical activity (self-report and instrumented) and adherence were collected at baseline and 3 and 6 months for HE and at 6 months for the HS programme. Costs for the HS and HS + HE groups were calculated from logs of time spent on home visits, telephone calls and travel. The research assistant and statistician were blinded to group allocation. RESULTS: Altogether, 49 people were recruited over a 9-month period (randomised: 16 to control, 16 to HS, 17 to HS + HE). The interventions were implemented over 6 months by an occupational therapist at a cost per person (pounds sterling, 2011) of £249 (HS) and £674 (HS + HE). Eighty-eight percent (43/49) completed the trial and 6-month follow-up. At 6-month follow-up, 100 % reported partially or completely adhering to HS recommendations but evidence for adherence to HE was equivocal. Although self-reported physical activity increased, instrumented monitoring showed a decrease in walking activity. There were no statistically significant differences in falls between the groups; however, the study was not powered to detect a difference. CONCLUSION: It is feasible and acceptable for an occupational therapist to deliver HS and HE falls prevention programmes to people with SI living independently in the community. Future studies could access Local Authority Registers of people with SI to improve recruitment rates. Further research is required to identify how to improve adherence to HE and to measure changes in physical activity before conducting a definitive RCT. TRIAL REGISTRATION: ISRCTN53433311 , registered on 8 May 2014

Cultural diversity in childbirth practices in a rural community in Southern Nigeria

Session presented on Tuesday, November 10, 2015: Cultural diversity refers to the differences between people based on shared ideology and valued set of beliefs, norms, customs and meanings evidenced in a way of life. Knowledge of cultural diversity is important at all levels of nursing and midwifery care as this addresses ethnic and racial differences where applicable. Additionally, such knowledge can strengthen and broaden the healthcare delivery system through conceptualization of illness and development of treatment models. It is acknowledged that in a typical nurse/midwife-patient/client encounter, there is interplay of three cultural systems namely, the culture of the nurse/the profession, culture of the patient/client and culture of the setting. Therefore, nurses and midwives have to be culturally competent to facilitate the delivery of good quality healthcare in settings with diverse health values and practices. Nigeria is marked by people with diverse cultures which consequently create a challenge to the healthcare providers. These cultural variations also are thought to influence birth practices. Diversity in birth practices is also globally acknowledged in literature. The overarching aim of this study is to acquaint nurses/midwives and other healthcare providers with the cultural birth practices of community members in Bakassi Local Government Area in Southern Nigeria and their diversity from the nursing/midwifery culture. Reported in this presentation, are the findings from the fact-finding phase of an action research project on the prevention of maternal mortality in that rural community. Ethnography design was utilised. Data were generated through in-depth individual interviews of twenty-nine women of childbearing age to gain understanding of their cultural beliefs and practices on childbirth. Four focus group discussions were held with some other women of childbearing age, menopausal women/mothers-in-law and traditional birth attendants. Observations of five traditional birth attendants and one midwife in their places of practice were also undertaken. Participants were selected through purposive and snowball sampling. Thematic data analysis was undertaken and diversity in birth practices between the traditional indigenous culture and nursing/midwifery culture depicted in the following themes emerged: child pregnancy; nutritional taboos; imposition of decision on care; preference for traditional birth attendants; prayer as source of safety in childbirth; position for delivery; utilisation of traditional sanitary towels; care in delivery emergencies; midwives ethnocentrism and culture imposition. The findings were inputted into the planning phase of the action research project for critical reflection and action. It is concluded that cultural diversity explicitly exists in the nurse/midwife and client interaction in this setting. Therefore, to create a positive impact on maternal care, nurses, midwives and other healthcare providers should deliberately seek to understand the culture of the people and adopt the harmless ones. This would require flexibility in professional practice. Where the culture is inimical to health, the health providers should democratically and collaboratively motivate the clients to critique their practices with the hope of possible repudiation. This study has implication for the provision of culturally competent care for women of childbearing age

VeRSE: Vertical Reading Strategy Efficacy for Homonymous Hemianopia after Stroke: A Feasibility Study.

AimTo conduct a feasibility study using vertical reading for stroke survivors with homonymous hemianopia. Feasibility objectives included assessing the appropriateness of testing methods, outcomes and amount of recruitment possible. Vertical reading has yet no empirical evidence for its use in homonymous hemianopia.MethodA cross-over design was used involving stroke survivors with homonymous hemianopia. Three reading directions (horizontal; 90° clockwise rotation; 90° anti-clockwise rotation) were assessed in a randomised order whilst measuring reading speed.ResultsSeven participants with stroke-induced homonymous hemianopia were recruited (25.9% recruitment rate). The mean horizontal reading speed was 120.3 (SD 33.9) words per minute. When reading vertically (downwards) at 90° clockwise rotation the mean reading speed was 62.7 (SD 43.4) words per minute. When reading vertically (upwards) at 90° anti-clockwise rotation the mean reading speed was 74.6 (SD 53.5) words per minute.ConclusionsThis feasibility study has informed and provided vital information for planning and developing future studies for vertical reading. The primary outcome measure for future studies should be reading acuity, taking account of both speed and errors. Further preliminary studies are required which incorporate a practice element to assess for any improvement over time

Adherence to ocular hypotensive therapy: Patient health education needs and views on group education

BACKGROUND: In this study the authors sought both to understand the health education needs of patients with glaucoma, with particular regard to adherence to glaucoma treatment, and to examine these patients’ views of group education. METHODS: Using a health promotion approach to health education, 27 qualitative interviews with new and established patients receiving glaucoma treatment were conducted. Health promotion is defined as a way of strengthening people’s capacities to control and optimize their own health. The interviews were transcribed and were then analyzed thematically RESULTS: Nine categories of health education needs were identified from the transcripts: (1) to understand glaucoma; (2) to understand their diagnosis or understand the difficulties in giving a diagnosis; (3) to understand the implications of eye drops, their side effects, and how to renew the eye drops; (4) to feel confident to put in eye drops; (5) to put the condition into perspective - to know how to manage their risk; (6) to be able to ask questions of clinicians; (7) to be able to navigate the health care system; (8) to understand and be able to manage own adherence behavior; and (9) to know where to access other sources of information. The majority of patients had something positive to say about group education, and about half of the patients said they would attend group education if they were offered the opportunity. CONCLUSION: A health promotion approach identified a wide range of patient-centered health education needs regarding adherence to glaucoma treatment. Group education will be attractive to some patients. Clinicians could use the health education needs identified in this study to guide the development of either individual or group-based educational intervention to improve adherence to glaucoma treatment. However, clinicians need to be aware that when developing a group intervention, attention will need to be given to making the education relevant to the circumstances of each patient