Strand Monica, Gammon Deede, Ruland Cornelia M
Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.O. Box 4950, Nydalen, Oslo, 0424, Norway.
Department of Psychiatry Blakstad, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Asker, Norway.
BMC Health Serv Res. 2017 Apr 7;17(1):257. doi: 10.1186/s12913-017-2176-5.
The Internet is transforming mental health care services by increasing access to, and potentially improving the quality of, care. Internet-based interventions in mental health can potentially play a role in transitions from biomedical to recovery-oriented research and practices, but an overview of what this may entail, current work, and issues that need addressing, is lacking. The objective of this study is to describe Internet-based recovery-oriented interventions (referred to as e-recovery) and current research, and to identify gaps and issues relevant to advancing recovery research and practices through opportunities provided by the Internet.
Five iterative stages of a scoping review framework were followed in searching and analyzing the literature. A recovery framework with four domains and 16 themes was used to deductively code intervention characteristics according to their support for recovery-oriented practices. Only Internet-based interventions used in conjunction with ongoing care were included.
Twenty studies describing six e-recovery interventions were identified and originated in Australia, Finland, the Netherlands, Norway and USA. The domain supporting personal recovery was most clearly reflected in interventions, whereas the last three domains, i.e., promoting citizenship, organizational commitment and working relationship were less evident. Support for the formulation and follow-up of personal goals and preferences, and in accessing peer-support, were the characteristics shared by most interventions. Three of the six studies that employed a comparison group used randomization, and none presented definitive findings. None used recovery-oriented frameworks or specific recovery outcome measures. Four of the interventions were specific to a diagnosis.
Research about how technologies might aid in illuminating and shaping recovery processes is in its formative stages. We recommend that future e-recovery research and innovation attend to four dimensions: evidence-supported interventions, new knowledge about personal recovery, values-based approaches and Internet as a facilitator for organizational transformation. The incremental changes facilitated by e-recovery may help propel a shift in mental health care toward recovery-oriented practices.
互联网正在通过增加医疗服务的可及性并有可能提高医疗质量来改变精神卫生保健服务。基于互联网的精神卫生干预措施有可能在从生物医学研究和实践向以康复为导向的研究和实践的转变中发挥作用，但目前缺乏对这可能涉及的内容、当前工作以及需要解决的问题的概述。本研究的目的是描述基于互联网的以康复为导向的干预措施（称为电子康复）和当前研究，并通过互联网提供的机会识别与推进康复研究和实践相关的差距和问题。
在搜索和分析文献时遵循了范围综述框架的五个迭代阶段。使用一个具有四个领域和16个主题的康复框架，根据干预措施对以康复为导向的实践的支持程度对干预特征进行演绎编码。仅纳入与持续护理相结合使用的基于互联网的干预措施。
共识别出20项描述六种电子康复干预措施的研究，这些研究来自澳大利亚、芬兰、荷兰、挪威和美国。支持个人康复的领域在干预措施中体现得最为明显，而最后三个领域，即促进公民身份、组织承诺和工作关系则不太明显。支持制定和跟进个人目标及偏好以及获得同伴支持是大多数干预措施共有的特征。六项采用对照组的研究中有三项使用了随机分组，且均未得出明确结果。没有一项研究使用以康复为导向的框架或特定的康复结局指标。其中四项干预措施针对特定诊断。
关于技术如何有助于阐明和塑造康复过程的研究尚处于形成阶段。我们建议未来的电子康复研究和创新关注四个方面：循证支持的干预措施、关于个人康复的新知识、基于价值观的方法以及互联网作为组织变革促进因素。电子康复带来的渐进性变化可能有助于推动精神卫生保健向以康复为导向的实践转变。
