Gammon Deede, Strand Monica, Eng Lillian Sofie, Børøsund Elin, Varsi Cecilie, Ruland Cornelia
Center for Shared Decision-Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway.
Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.
J Med Internet Res. 2017 May 2;19(5):e145. doi: 10.2196/jmir.7524.
Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery.
The aim was to illustrate uses and experiences with the secure e-recovery portal "ReConnect" as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery.
ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment.
Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users' control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs.
Regardless of providers' portal use, service users' control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users' autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans).
精神卫生保健正从主要关注症状减轻转向以个人康复为导向的护理，特别是对于有长期精神卫生保健需求的人群。基于网络的门户可能有助于这一转变，但对于此类工具的使用方式或它们在个人康复中可能发挥的作用知之甚少。
旨在阐述安全的电子康复门户“重新连接”作为社区精神卫生保健辅助工具的使用情况和体验，并探讨其在向康复实践转变中可能发挥的作用。
“重新连接”被引入挪威的两个精神卫生保健社区并使用了6个月。目的是支持个人康复以及服务使用者与医疗保健提供者之间的协作。参与的纳入标准包括长期护理需求以及至少一名愿意通过“重新连接”与服务使用者互动的提供者。该门户旨在支持每个服务使用者 - 提供者二元组/团队认为合适的持续协作，它由以下部分组成：（1）一个资源工具箱，用于阐明和处理康复过程，例如与生活领域（如就业、社交网络、健康）、药物治疗、网络图和练习（如睡眠卫生、正念）相关的状态/目标/活动；（2）与部分有权访问工具箱内容的提供者进行消息传递；（3）一个同伴支持论坛。使用描述性统计分析定量数据（即系统日志、问卷）。定性数据（如焦点小组、论坛帖子）是相对于四个以康复为导向的实践领域呈现的：个人定义的康复、促进公民身份、工作关系和组织承诺。
56名参与者（29名服务使用者和27名提供者）组成了29个服务使用者 - 提供者二元组。服务使用者报告有11种不同的精神卫生诊断，每人中位数为2种（范围为1 - 7种）。27名提供者代表了9种不同的专业背景。论坛是使用最频繁的模块，有1870次访问和542个帖子。服务使用者对工具箱资源的控制（如定义并朝着个人目标努力），再加上同伴支持，在个人康复过程和社区参与中激发了服务使用者的积极性。一些提供者（30%，8/27）没有通过“重新连接”与服务使用者互动。使用门户资源的二元组以高度多样化的方式进行操作，参与者报告需要超过6个月的时间来发现并根据他们的个人和协作需求调整最佳使用方式。
无论提供者对门户的使用情况如何，服务使用者对工具箱资源的控制，再加上同伴支持，提供了一个赋权的共同参考框架，代表了社区内朝着以康复为导向的实践的转变。虽然服务使用者对门户的自主使用最终可能会影响提供者朝着康复实践的方向发展，但如果没有与康复原则相一致的更广泛的组织承诺（如服务使用者参与护理计划的量化目标），根本性的转变不太可能发生。
