86 research outputs found
A cross-national study of the stigmatization of severe psychiatric illness: historical review, methodological considerations and development of the questionnaire.
Despite their potential significance for public policy and health provision in different societies, popular conceptualizations of and social responses to severe psychiatric illness remain relatively unexamined. Two general research procedures may be identified: (1) the anthropological approach uses ethnographic methods to look at explicit categorizations, and (2) the sociological approach employs quantitative survey methods to examine the public 'stigma' of psychiatric illness. This article reviews methodological and conceptual approaches to the study of stigma and describes the development of an ethnographically grounded questionnaire to examine 'stigmatization' from data in different cultures. The difficulties of achieving cross-cultural comparability of meaning are discussed and the psychometric properties of the instrument are presented
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Psychiatric stigma across cultures: Local validation in Bangalore and London
Public responses to depression have a powerful effect on patientsâ personal experience of illness, the course and outcome of the illness, and their ability to obtain gainful employment. Mental illness-related stigma reduction has become a priority, and to be effective, it requires innovative and effective public mental health interventions informed by a clear understanding of what stigma means. Based on Goffmanâs formulation as spoiled identity, local concepts of stigma were validated and compared in clinical cultural epidemiological studies of depression in Bangalore, India, and London, England, using the EMIC, an instrument for studying illness-related experience, its meaning, and related behaviour. Similar indicators were validated in both centres, and the internal consistency was examined to identify those that contributed to a locally coherent concept and scale for stigma. Qualitative meaning of specific features of stigma at each site was clarified from patientsâ prose narrative accounts. Concerns about marriage figured prominently as a feature of illness experience in both centres, but it was consistent with other indicators of stigma only in Bangalore, not in London. Although stigma is a significant issue across societies, particular manifestations may vary, and the cultural validity of indicators should be examined locally. Analysis of cultural context in the narrative accounts of illness indicates the variation and complexity in the relationship between aspects of
illness experience and stigma. This report describes an approach following from the application of cultural epidemiological methods for identifying and measuring locally valid features of stigma in a scale for cultural study, cross-cultural comparisons, and for baseline and follow-up assessment to monitor stigma reduction programmes
A web-based self-management programme for people with type 2 diabetes : the HeLP-Diabetes research programme including RCT
Background: In the UK, 6% of the UK population have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Diabetes mellitus accounts for 10% of NHS expenditure (ÂŁ14B annually). Good self-management may improve health outcomes. NHS policy is to refer all people with T2DM to structured education, on diagnosis, to improve their self-management skills, with annual reinforcement thereafter. However, uptake remains low (5.6% in 2014â15). Almost all structured education is group based, which may not suit people who work, who have family or other caring commitments or who simply do not like group-based formats. Moreover, patient needs vary with time and a single education session at diagnosis is unlikely to meet these evolving needs. A web-based programme may increase uptake. / Objectives: Our aim was to develop, evaluate and implement a web-based self-management programme for people with T2DM at any stage of their illness journey, with the goal of improving access to, and uptake of, self-management support, thereby improving health outcomes in a cost-effective manner. Specific objectives were to (1) develop an evidence-based theoretically informed programme that was acceptable to patients and health-care professionals (HCPs) and that could be readily implemented within routine NHS care, (2) determine the clinical effectiveness and cost-effectiveness of the programme compared with usual care and (3) determine how best to integrate the programme into routine care. / Design: There were five linked work packages (WPs). WP A determined patient requirements and WP B determined HCP requirements for the self-management programme. WP C developed and user-tested the Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) programme. WP D was an individually randomised controlled trial in primary care with a health economic analysis. WP E used a mixed-methods and case-study design to study the potential for implementing the HeLP-Diabetes programme within routine NHS practice. / Setting: English primary care. / Participants: People with T2DM (WPs A, D and E) or HCPs caring for people with T2DM (WPs B, C and E). / Intervention: The HeLP-Diabetes programme; an evidence-based theoretically informed web-based self-management programme for people with T2DM at all stages of their illness journey, developed using participatory design principles. / Main outcome measures: WPs A and B provided data on user âwants and needsâ, including factors that would improve the uptake and accessibility of the HeLP-Diabetes programme. The outcome for WP C was the HeLP-Diabetes programme itself. The trial (WP D) had two outcomes measures: glycated haemoglobin (HbA1c) level and diabetes mellitus-related distress, as measured with the Problem Areas in Diabetes (PAID) scale. The implementation outcomes (WP E) were the adoption and uptake at clinical commissioning group, general practice and patient levels and the identification of key barriers and facilitators. / Results: Data from WPs A and B supported our holistic approach and addressed all areas of self-management (medical, emotional and role management). HCPs voiced concerns about linkage with the electronic medical records (EMRs) and supporting patients to use the programme. The HeLP-Diabetes programme was developed and user-tested in WP C. The trial (WP D) recruited to target (nâ=â374), achieved follow-up rates of over 80% and the intention-to-treat analysis showed that there was an additional improvement in HbA1c levels at 12 months in the intervention group [mean difference â0.24%, 95% confidence interval (CI) â0.44% to â0.049%]. There was no difference in overall PAID score levels (mean difference â1.5 points, 95% CI â3.9 to 0.9 points). The within-trial health economic analysis found that incremental costs were lower in the intervention group than in the control group (mean difference âÂŁ111, 95% CI âÂŁ384 to ÂŁ136) and the quality-adjusted life-years (QALYs) were higher (mean difference 0.02 QALYs, 95% CI 0.000 to 0.044 QALYs), meaning that the HeLP-Diabetes programme group dominated the control group. In WP E, we found that the HeLP-Diabetes programme could be successfully implemented in primary care. General practices that supported people in registering for the HeLP-Diabetes programme had better uptake and registered patients from a wider demographic than those relying on patient self-registration. Some HCPs were reluctant to do this, as they did not see it as part of their professional role. / Limitations: We were unable to link the HeLP-Diabetes programme with the EMRs or to determine the effects of the HeLP-Diabetes programme on users in the implementation study. / Conclusions: The HeLP-Diabetes programme is an effective self-management support programme that is implementable in primary care. / Future work: The HeLP-Diabetes research team will explore the following in future work: research to determine how to improve patient uptake of self-management support; develop and evaluate a structured digital educational pathway for newly diagnosed people; develop and evaluate a digital T2DM prevention programme; and the national implementation of the HeLP-Diabetes programme. / Trial registration: Research Ethics Committee reference number 10/H0722/86 for WPs AâC; Research Ethics Committee reference number 12/LO/1571 and UK Clinical Research Network/National Institute for Health Research (NIHR) Portfolio 13563 for WP D; and Research Ethics Committee 13/EM/0033 for WP E. In addition, for WP D, the study was registered with the International Standard Randomised Controlled Trial Register as reference number ISRCTN02123133. / Funding details: This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 5. See the NIHR Journals Library website for further project information
The PREDICTS database: a global database of how local terrestrial biodiversity responds to human impacts
Biodiversity continues to decline in the face of increasing anthropogenic pressures
such as habitat destruction, exploitation, pollution and introduction of
alien species. Existing global databases of speciesâ threat status or population
time series are dominated by charismatic species. The collation of datasets with
broad taxonomic and biogeographic extents, and that support computation of
a range of biodiversity indicators, is necessary to enable better understanding of
historical declines and to project â and avert â future declines. We describe and
assess a new database of more than 1.6 million samples from 78 countries representing
over 28,000 species, collated from existing spatial comparisons of
local-scale biodiversity exposed to different intensities and types of anthropogenic
pressures, from terrestrial sites around the world. The database contains
measurements taken in 208 (of 814) ecoregions, 13 (of 14) biomes, 25 (of 35)
biodiversity hotspots and 16 (of 17) megadiverse countries. The database contains
more than 1% of the total number of all species described, and more than
1% of the described species within many taxonomic groups â including flowering
plants, gymnosperms, birds, mammals, reptiles, amphibians, beetles, lepidopterans
and hymenopterans. The dataset, which is still being added to, is
therefore already considerably larger and more representative than those used
by previous quantitative models of biodiversity trends and responses. The database
is being assembled as part of the PREDICTS project (Projecting Responses
of Ecological Diversity In Changing Terrestrial Systems â www.predicts.org.uk).
We make site-level summary data available alongside this article. The full database
will be publicly available in 2015
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