Section of Mental Health, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
BMC Health Serv Res. 2012 Jul 7;12:189. doi: 10.1186/1472-6963-12-189.
Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems.
A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together.
Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health.
Service delivery components - e.g. peer support groups, personal planning - advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.
在老龄化人口和经济限制的背景下，支持自我护理已在国际医疗保健系统中得到探索，作为改善长期疾病护理的一种方法。英国卫生政策提倡采用一系列支持自我护理的方法，包括在各种情况下应用通用自我管理型计划。在心理健康领域，自我护理的范围仍然没有得到很好的概念化，支持自我护理的现有证据基础也相应地不一致。本文旨在通过考虑通用自我护理政策指导如何在支持严重、长期心理健康问题的服务背景下实施，为心理健康领域的自我护理支持的发展提供信息。
进行了一项混合方法研究，包括标准化心理社会措施、关于卫生服务使用的问卷和对 120 名新转诊到三个支持严重、长期心理健康问题自我护理的社区基础干预措施的定性访谈，九个月后重复进行。采用框架方法进行定性分析，探索性统计分析旨在确定一系列自变量与自我护理结果之间的可能关联，并通过叙述性综合将这些分析结合在一起。
参与者报告自我护理结果有所改善（例如，增强了自主权；减少了对急症服务的使用）。这些变化与自我护理支持的参与程度无关。参与程度与与支持人员的积极合作有关。定性数据描述了支持自我护理的不同模式的价值，并考虑了挑战。综合分析表明，在支持心理健康中的自我护理时，支持自我护理的时机、给予服务用户控制他们何时以及如何获得支持的能力、服务用户-工作人员关系的质量以及围绕药物的决策都是重要问题。
在心理健康背景下实施通用自我护理政策中提倡的服务提供组件，例如同伴支持小组、个人计划，具有价值。心理健康中的自我护理支持应侧重于核心、心理健康特定的质量问题；控制、使工作人员-服务用户关系和共同决策的问题。我们研究的广泛实证基础表明，我们的研究结果在整个心理健康环境中具有更广泛的相关性。
