Barts Explanatory Model Inventory: The exploration of cross-cultural variations in perceptions of mental distress

PhDCultural variations in individuals' perceptions of mental distress are an important issue for health care. They can affect communication between health professionals and mentally distressed individuals and might be one explanation for problematic diagnosis, poor service uptake and negative outcome for individuals from ethnic minorities. This PhD a) explores how cultural variations in perceptions of mental distress have been assessed in the past b) reports the construction and development of a new instrument, the Barts Explanatory Model Inventory (BEMI) and c) uses the instrument to explore associations between illness perceptions and ethnic background, acculturation processes and psychiatric 'caseness' in three different ethnic groups. It was found that significant ethnic variations existed in perceptions about physical complaints, spiritual, physical and psychosocial causes, expected timeline, psychological consequences and helpful treatment. For example individuals from White British background found 'alternative or complementary' treatments helpful (,X 2=1 2.035, p<. 01); individuals from Bangladeshi and Caribbean background on the other hand preferred 'medical' (72 =6.597, p<. 05) or (spiritual' interventions (,X 2=1 7.916, p<. 001). The survey also found that perceptions contribute significantly to predicting psychiatric caseness (R 2= . 577, p<. 0001) and are in turn also helping to predict how long migrants have been in the UK (R 2= . 581 p<. 0001). The findings support the notion of assessing cultural variations in perceptions in health care as a feasible as well as necessary endeavour

Patient-reported physical activity questionnaires: A systematic review of content and format

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.status: publishe

Validity of instruments to measure physical activity may be questionable due to a lack of conceptual frameworks: a systematic review

BACKGROUND: Regulators' guidance documents for the development and validation of patient reported outcomes (PROs) advise the use of conceptual frameworks, which outline the structure of the concept that a PRO aims to measure. It is unknown if currently available PROs are based on conceptual frameworks. This study, limited to a specific case, aimed (i) to identify conceptual frameworks of physical activity in chronic respiratory patients or similar populations (chronic heart disease patients or the elderly), and (ii) to assess if the development and validation of PROs to measure physical activity in these populations were based on a conceptual framework of physical activity. METHODS: Two systematic reviews were conducted through search in Medline, Embase, Psychinfo, and Cinahl databases up to January 2010. RESULTS: In the first review only 2 references, identified from 581 references about physical activity in the defined populations, provided a conceptual framework of physical activity in COPD patients. In the second review, out of 103 studies developing PROs to measure physical activity or related constructs, none of them was based on a conceptual framework of physical activity. CONCLUSIONS: These findings raise concerns about how the large body of evidence from studies that use physical activity PRO instruments should be evaluated by health care providers, guideline developers, and regulatory bodies

Do 'alternative' help-seeking strategies affect primary care service use? A survey of help-seeking for mental distress

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Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature.

This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Public Health, following peer review. The version of record: Kristoffer Halvorsrud, Justyna Kucharska, Katherine Adlington, Katja Rüdell, Eva Brown Hajdukova, James Nazroo, Maria Haarmans, James Rhodes, Kamaldeep Bhui, Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature, Journal of Public Health, fdz126, https://doi.org/10.1093/pubmed/fdz126 is available online at: https://doi.org/10.1093/pubmed/fdz126.BACKGROUND: To investigate and address the evidence gap on the effectiveness of co-creation/production in international health research. METHODS: An initial systematic search of previous reviews published by 22 July 2017 in Medline, Embase, PsycINFO, Scopus and Web of Science. We extracted reported aims, elements and outcomes of co-creation/production from 50 reviews; however, reviews rarely tested effectiveness against intended outcomes. We therefore checked the reference lists in 13 included systematic reviews that cited quantitative studies involving the public/patients in the design and/or implementation of research projects to conduct meta-analyses on their effectiveness using standardized mean difference (SMD). RESULTS: Twenty-six primary studies were included, showing moderate positive effects for community functions (SMD = 0.56, 95%CI = 0.29-0.84, n = 11) and small positive effects for physical health (SMD = 0.25, 95%CI = 0.07-0.42, n = 9), health-promoting behaviour (SMD = 0.14, 95%CI = 0.03-0.26, n = 11), self-efficacy (SMD = 0.34, 95%CI = 0.01-0.67, n = 3) and health service access/receipt (SMD = 0.36, 95%CI = 0.21-0.52, n = 12). Non-academic stakeholders that co-created more than one research stage showed significantly favourable mental health outcomes. However, co-creation was rarely extended to later stages (evaluation/dissemination), with few studies specifically with ethnic minority groups. CONCLUSIONS: The co-creation of research may improve several health-related outcomes and public health more broadly, but research is lacking on its longer term effects

Preferences for Involvement in Medical Decision Making: Comparing British & German Views

Despite beneficial outcomes of patients' involvement in medical decision processes, it has been claimed that patients are generally not interested in medical decision making (MDM). Whereas current research focuses on actual MDM, this research explored the impact of nationality and perceptual processes of MDM. Preferences for involvement in decision making were examined in a sample of 204 German and 143 British university students. Hierarchical multiple regressions were employed to explore the link between socio-demographic information, individuals' perceived relationship with their GP, Health Locus of Control - Powerful Others, perceptions regarding the frequency and sufficiency of information provision and involvement in MDM, and individuals' preferred level of involvement and information. A significant amount of the variance in individuals preferences for involvement could be explained (Adjusted R2 = .59, p < .001). Independent t-test analyses showed that British and German perceptions of care differed significantly on a variety of different measures. Separate analyses for the German and British group highlighted cross-national differences in care and preferences for involvement. The study suggests that preferences to become involved might depend more on perceptual processes than actual involvement in decision making, and that communication and national health policy could play an important role

Assessing Explanatory Models for Common Mental Disorders

Objectives: This article addresses the clinical implications of 3 questions: (1) Can a simple checklist, suitable for use by practitioners, assess all components of explanatory models (EMs) for mental distress? (2) Are perceived causes of mental distress actually related to treatment preferences? (3) Are EMs influenced uniquely by ethnic group, or are they more closely associated with the presence of common mental disorders? Method: From February 2003 to January 2004, we investigated EMs for mental distress among 79 Bangladeshi, 85 black Caribbean, and 97 white British people who reported difficulties in the preceding month. EMs were assessed by a self-report checklist that inquired about the identity, causes, timeline, consequences, controllability, and preferred treatments for mental distress. Common mental disorders were assessed using the Clinical Interview Schedule (revised). Results: Independent of ethnic group, people with common mental disorders were more likely to give spiritual causal explanations (odds ratio [OR] = 3.1, 95% CI = 1.9 to 4.9), to report behavioral (OR = 2.2, 95% CI = 1.3 to 3.8) and financial consequences (OR = 3.3, 95% CI = 1.8 to 6), and to prefer complementary treatments (OR = 4.6, 95% CI = 2.3 to 9.1). Compared with black Caribbean and white British subjects, Bangladeshi subjects more often gave spiritual or physical causal explanations. Compared with white British subjects, Bangladeshi and black Caribbean subjects preferred medical and spiritual treatments, whereas white British subjects, as compared with the other 2 ethnic groups, preferred self-management and social treatments. Causal explanations did not always relate to the corresponding treatment preferences. Conclusions: EMs can be assessed by a simple checklist, show variations by ethnic group, and are associated with common mental disorders. Identifying EMs may strengthen the assessment of common mental disorders