Steno Diabetes Center Copenhagen, Health Promotion Research, Gentofte, Denmark.
Scand J Caring Sci. 2022 Sep;36(3):663-672. doi: 10.1111/scs.13023. Epub 2021 Aug 5.
Compared with the general population, people with mental illness are at higher risk of developing type 2 diabetes due to poor diet, medication and inactive lifestyle. People with mental illness and members of the general population are equally interested in health behaviour change, but those with mental illness experience communication barriers with professionals. The study aimed to explore philosophies that social care and healthcare professionals apply to health promotion activities targeting people with mental illness and challenges they face in applying these philosophies across multiple settings.
Qualitative interviews were conducted with 18 social and healthcare professionals in a range of settings in 2016-2019. Descriptive qualitative analysis was applied to interview data.
Interviewees faced many structural challenges in the organisation of their work, which did not coincide with their philosophy or intentions in relation to health promotion. Three philosophical categories were identified: (a) health promotion approach, (b) elements of care and (c) social relations. Many interviewees intended to apply philosophies of broadly defined health, dialogue-based health education, and incremental approaches to health behaviour change. They wanted to provide holistic and flexible care and they valued peer-to-peer activities, family and friend involvement in care and a trusting relationship between the professional and the person with mental illness. However, rigid structures determining the organisation of health promotion challenged professionals' ability to follow their philosophical intentions.
Interviewees aspired to a collaborative, empowering and person-centred approach, but practical and structural factors made this difficult to achieve in practice. Major changes are required at the organisational level, implemented with the active involvement of professionals and people with mental illness.
与一般人群相比，由于饮食不良、用药不当和生活方式不活跃，精神疾病患者患 2 型糖尿病的风险更高。精神疾病患者和一般人群同样对健康行为改变感兴趣，但精神疾病患者与专业人员沟通存在障碍。本研究旨在探讨社会护理和医疗保健专业人员应用于针对精神疾病患者的健康促进活动的理念，以及他们在跨多个环境应用这些理念时面临的挑战。
2016 年至 2019 年期间，对来自不同环境的 18 名社会和医疗保健专业人员进行了定性访谈。对访谈数据进行了描述性定性分析。
受访者在工作组织方面面临许多结构性挑战，这些挑战与他们在健康促进方面的理念或意图并不相符。确定了三个哲学范畴：(a)健康促进方法，(b)护理要素和 (c)社会关系。许多受访者打算应用广义健康、基于对话的健康教育和逐步改变健康行为的方法。他们希望提供全面和灵活的护理，重视同伴活动、家庭和朋友参与护理以及专业人员与精神疾病患者之间的信任关系。然而，决定健康促进组织的僵化结构挑战了专业人员遵循其哲学意图的能力。
受访者渴望采取协作、赋权和以患者为中心的方法，但实际和结构性因素使得这在实践中难以实现。需要在组织层面进行重大变革，让专业人员和精神疾病患者积极参与实施。
