Coordinating care for people with serious mental illness: A qualitative study with service users and professionals
Doctoral thesis
Permanent lenke
https://hdl.handle.net/11250/3172847Utgivelsesdato
2025Metadata
Vis full innførselSamlinger
- PhD theses (HV) [59]
Originalversjon
Coordinating care for people with serious mental illness: A qualitative study with service users and professionals by Jorunn Nærland Skjærpe, Stavanger : University of Stavanger, 2024 (PhD thesis UiS, no. 829)Sammendrag
Background
Individuals with serious mental illness (SMI) encounter substantial physical health problems and have an increased risk of illness burden, poor clinical outcomes, higher mortality rates, and shorter life expectancy than the general population. These difficulties are linked to persistent symptoms of mental illness, inadequate treatment for chronic medical conditions, and a lack of coordinated care.
Mental, physical, and social determinants of health influence the prevalence and severity of SMI and the life expectancy of sufferers. Recognizing and addressing these determinants and ensuring coordinated care across settings can help meet the complex health needs of individuals with SMI.
Overall aim and research questions
The overall aim of this thesis was to qualitatively explore and describe how healthcare services are coordinated for individuals with SMI to prevent the deterioration of their health conditions and ensure their health and well-being. It also aimed to describe how insights from professionals and service users could be included in an innovation process to improve care coordination.
Three empirical studies presented as Papers I to III addressed the following research questions: (1) What care coordination measures are taken by professionals in municipal health and care services to meet the healthcare needs of individuals with SMI and address the deterioration of their health conditions? (2) What determinants of health do individuals with SMI perceive as important to their health, well-being, and ability to live a meaningful life? and (3) How can professionals and service users be included in an innovation process to improve the coordination of municipal health and care services for individuals with SMI?
Methods
The thesis employed qualitative methods throughout. Paper I reports an exploratory, descriptive study that presents the perspectives of 27 professionals from one urban and one rural municipality on care coordination and measures to ensure the health of individuals living with SMI. Interview data were analyzed using systematic text condensation.
Paper II reports an exploratory interview study that explored determinants of health using data from 13 individuals with lived experience of SMI. Interview data were analyzed using qualitative content analysis.
Paper III reports a participatory study that involved three café dialogues with 30 professionals and seven service users with SMI from one rural municipality. Qualitative written notes were thematically analyzed to describe an inclusive, responsible innovation process to improve the coordination of municipal health and care services for individuals with SMI.
Results
Paper I identified three categories and seven subcategories. In the first category, participants highlighted the importance of a stable and meaningful home life, which covered proper housing, access to services, and assistance in receiving healthcare. The second category reflected measures initiated by professionals to prevent the deterioration of service users’ health conditions, including symptom monitoring, emergency psychiatric care plans, and emergency room contact. The third category represented inpatient care when facing acute and severe symptoms, covering returning home after inpatient care and the need for shared responsibility for care.
Paper II revealed two themes and eight categories that focused on the experiences of individuals with SMI regarding care coordination and the mental, physical, and social determinants they perceived as influencing their health and well-being. The first theme pertained to mental and physical health management, with categories focused on personalized healthcare, measures to mitigate deterioration, psychotropic medication use, and lifestyle. The second theme highlighted the social determinants of health, with categories covering the importance of family and friends, engaging in meaningful activities, and the influence of employment on mental health.
In Paper III, two themes and five sub-themes emerged. The first theme reflected responsible coordination at the individual level, which focused on personalized healthcare, balancing healthcare provision with allowing service users responsibility for their lives and access to meaningful activities. The second theme addressed responsible coordination at the provider level, covering coordination routines, communication, and mutual familiarity among professionals. These themes and sub-themes provided insights into participants’ inclusion in responsible coordination, their anticipations of efficient care coordination, reflexivity on care coordination challenges, and responsiveness to improvement measures. The fusion of responsible innovation and care coordination in the café dialogues led to the coining of the term “responsible coordination.”
Conclusion
This thesis provides qualitative knowledge from the perspectives of multidisciplinary professionals and service users on coordinating healthcare services for individuals with SMI. It identifies measures to prevent the deterioration of health conditions and ensure the health of these individuals. Additionally, it highlights key determinants important to health and well-being and describes how professionals and service users can be included in an innovation process to improve care coordination.
These findings can inform efforts to improve care coordination, promoting the health and well-being of individuals with SMI. This knowledge is relevant to service users, researchers, practitioners, and policymakers. In the future, care coordination and integration should adopt a holistic approach that focuses on the mental, physical, and social determinants of health at individual, provider, and system levels.
Består av
Paper I: Skjærpe, J. N., Joa, I., Willumsen, E., Hegelstad, W. t. V., Iakovleva, T. A., & Storm, M. (2022). Perspectives on Coordinating Health Services for Individuals with Serious Mental Illness – A Qualitative Study. Journal of Multidisciplinary Healthcare, 15, 2735–2750. https://doi.org/10.2147/JMDH.S384072Paper II: Skjærpe, J. N., Hegelstad, W. t. V., Joa, I., & Storm, M. (2023). Exploring key determinants of health among individuals with serious mental illness: qualitative insights from a first episode psychosis cohort, 20 years postdiagnosis. BMC Psychiatry, 23, 784. https://doi.org/10.1186/s12888-023-05270-1
Paper III: Skjærpe, J. N., Iakovleva, T. A., & Storm, M. (2024). Responsible coordination of municipal health and care services for individuals with serious mental illness: a participatory qualitative study with service users and professionals. BMC Health Services Research, 24, 633. https://doi.org/10.1186/s12913-024-10999-w
Utgiver
University of Stavanger, NorwaySerie
PhD thesis UiS;;829