Alyssa Milton

Consumer food safety education for the domestic environment: a systematic review

Purpose – Despite the recognised importance of food safety, a large number of consumers do not practice adequate food safety in the home. Many studies have recommended that education is a key step in preventing food‐borne illness in the domestic environment. However, few educational or psychosocial interventions have been designed and implemented to improve food safety knowledge, attitudes and behaviours. Even fewer of these studies have been subject to rigorous appraisal. The purpose of this paper is to conduct a systematic review of studies that described and evaluated a food safety intervention in a non‐clinical adult sample.Design/methodology/approach – A total of ten studies met the criteria for inclusion in the systematic review. Outcomes of interest included food safety behaviour, behavioural intention, attitudes, knowledge, microbial transfer and the use of social cognition models.Findings – The evidence regarding the effectiveness of the reviewed interventions on these food safety outcomes was so...

An Application of the Theory of Planned Behavior—A Randomized Controlled Food Safety Pilot Intervention for Young Adults

OBJECTIVE Approximately 48 million Americans are affected by foodborne illness each year. Evidence suggests that the application of health psychology theory to food safety interventions can increase behaviors that reduce the incidence of illness such as adequately keeping hands, surfaces and equipment clean. This aim of this pilot study was to be the first to explore the effectiveness of a food safety intervention based on the Theory of Planned Behavior (TPB). METHODS Young adult participants (N = 45) were randomly allocated to intervention, general control or mere measurement control conditions. Food safety observations and TPB measures were taken at baseline and at 4-week follow-up. Within and between group differences on target variables were considered and regression analyses were conducted to determine the relationship between condition, behavior and the TPB intention constructs; attitude, subjective norm, perceived behavioral control (PBC). RESULTS TPB variables at baseline predicted observed food safety behaviors. At follow-up, the intervention led to significant increases in PBC (p = .024) and observed behaviors (p = .001) compared to both control conditions. Furthermore, correlations were found between observed and self-reported behaviors (p = .008). CONCLUSIONS The pilot intervention supports the utility of the TPB as a method of improving food safety behavior. Changes in TPB cognitions appear to be best translated to behavior via behavioral intentions and PBC. Further research should be conducted to increase effectiveness of translating TPB variables to food safety behaviors. The additional finding of a correlation between self-reported and observed behavior also has implications for future research as it provides evidence toward the construct validity of self-reported behavioral measures.

Communication of a mental health diagnosis: a systematic synthesis and narrative review

Abstract Background: There is limited understanding of the mechanisms used to effectively communicate with service-users about their mental health diagnoses. Aims: To conduct a systematic synthesis of studies that present data on the communication of a psychiatric diagnosis. Methods: Comprehensive database and manual searches were conducted resulting in the inclusion of 30 quantitative and qualitative papers. Results: The majority of studies were descriptive. The rate of service-users being informed of their diagnosis has increased over the past decade. Consumer communication preferences were not always satisfactorily addressed in practice. Individual characteristics of service-users and clinicians influenced whether a diagnostic discussion took place. Results from intervention studies aimed at facilitating diagnostic communication reported significant improvements in service-user satisfaction and mood and clinician communication skills. Conclusions: This review highlights a gap in the system of communication between clinicians and service-users. To assist clinicians to talk effectively with individuals about their mental health, communication protocols and training need to be further developed and assessed. Such developments would benefit from well-designed randomised controlled trial protocols, should incorporate service-users’ preferences and address stigma-related concerns.

Diagnosis telling in people with psychosis

Purpose of review There are complexities in communicating diagnostic information relating to schizophrenia spectrum disorders. There is a current dearth of research in understanding how clinicians effectively communicate with service users about such diagnostic news. In this review, we aim to synthesize the latest research throughout 2012 and 2013 that presented data relating to the communication of a diagnosis of schizophrenia spectrum disorders, including individuals who had experienced first-episode psychosis or were in at-risk mental states. Comprehensive database and manual searches were conducted which obtained data from both service users and health professional groups. Recent findings Fourteen quantitative and qualitative studies were found. The majority of studies were descriptive and heterogeneous in content. Key themes included service user preferences towards disclosure and diagnostic terminology, health professional training, stigma-related issues and the use of diagnostic communication models. Summary Overall, communication models that foster therapeutic relationships and actively encourage the health professional to reduce stigma may be a key to initial diagnostic discussions in clinical practice. Such communication models and intervention require further more rigorous evaluation, as none have been tested through randomized controlled protocols in clinical settings.

Information giving challenges and support strategies at the time of a mental health diagnosis: qualitative views from Australian health professionals

PurposeCommunication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians’ perceptions of barriers and helpful strategies to discussing information about a mental health condition.MethodQualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically.ResultsAfter theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up.ConclusionsTalking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual’s needs. Strategies such as tailoring to the person’s situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia.

A Qualitative Exploration of Service Users’ Information Needs and Preferences When Receiving a Serious Mental Health Diagnosis

AbstractHelpful strategies for communicating news of a serious mental health diagnosis are poorly understood. This study explored service users’ preferences for how they would like clinicians to deliver such news when a diagnosis of mental illness is made. Qualitative interviews were conducted with forty-five individuals identifying with serious mental illness in eleven community based mental health facilities. Inductive thematic analysis resulted in eight primary themes. Five themes related to the structure and content of the discussion; including a focus on information exchange, using an individualized collaborative partnership paradigm, addressing stigma, balancing hope with realism, and recognizing the dynamic nature of diagnosis. The remaining themes related to the involvement of others; including the importance of clinicians’ communication and relationship skills, involvement and education of carers, and offering an opportunity for peer support. The product of the synthesis of themes is a step-wise model for communicating news of mental health diagnosis.

Views and experience of communication when receiving a serious mental health diagnosis: satisfaction levels, communication preferences, and acceptability of the SPIKES protocol

Abstract Background: There is limited research investigating how information about a mental health diagnosis is discussed and received. Aims: To measure community-based service users’ satisfaction and preferences toward receiving news of a serious mental health diagnosis and to assess the acceptability of a diagnostic communication protocol (SPIKES: Setting; Perception; Invitation; Knowledge; Empathy; Summarizing). Method: A survey was conducted with 101 participants. Results: Participants rated the methods clinicians use to facilitate diagnostic discussions are highly important; however, they were not wholly satisfied with their experience. Higher satisfaction was reported if participants were provided with information in a face-to-face meeting (p < 0.001), and if they received supplementary support at the time of diagnosis from additional health professionals rather than only a sole practitioner (p < 0.001). The SPIKES protocol was rated as highly acceptable, with Empathy being rated as the most important feature. Conclusions: This research indicates there were specific areas of communication practices which can be improved within mental health service provision, as a gap existed between participants’ desire for support and their experience. Strategies outlined in the SPIKES protocol, and others such as addressing stigma concerns, may prove useful in development of clinician training and service improvement.

Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial

Summary Background High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis. Methods We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104. Findings 221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43–0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group). Interpretation Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission. Funding National Institute for Health Research.

The clinical profile of employees with mental health problems working in social firms in the UK

Abstract Background: UK social firms are under-researched but are a potentially important vocational option for people with mental health problems. Aims: To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems. Method: Clinical, work and service use characteristics were collected from social firms’ employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively. Results: Predominantly, social firms’ employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations. Conclusions: The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.

Randomised controlled trial of the clinical and cost-effectiveness of a peer-delivered self-management intervention to prevent relapse in crisis resolution team users: study protocol

Introduction Crisis resolution teams (CRTs) provide assessment and intensive home treatment in a crisis, aiming to offer an alternative for people who would otherwise require a psychiatric inpatient admission. They are available in most areas in England. Despite some evidence for their clinical and cost-effectiveness, recurrent concerns are expressed regarding discontinuity with other services and lack of focus on preventing future relapse and readmission to acute care. Currently evidence on how to prevent readmissions to acute care is limited. Self-management interventions, involving supporting service users in recognising and managing signs of their own illness and in actively planning their recovery, have some supporting evidence, but have not been tested as a means of preventing readmission to acute care in people leaving community crisis care. We thus proposed the current study to test the effectiveness of such an intervention. We selected peer support workers as the preferred staff to deliver such an intervention, as they are well-placed to model and encourage active and autonomous recovery from mental health problems. Methods and analysis The CORE (CRT Optimisation and Relapse Prevention) self-management trial compares the effectiveness of a peer-provided self-management intervention for people leaving CRT care, with treatment as usual supplemented by a booklet on self-management. The planned sample is 440 participants, including 40 participants in an internal pilot. The primary outcome measure is whether participants are readmitted to acute care over 1 year of follow-up following entry to the trial. Secondary outcomes include self-rated recovery at 4 and at 18 months following trial entry, measured using the Questionnaire on the Process of Recovery. Analysis will follow an intention to treatment principle. Random effects logistic regression modelling with adjustment for clustering by peer support worker will be used to test the primary hypothesis. Ethics and dissemination The CORE self-management trial was approved by the London Camden and Islington Research Ethics Committee (REC ref: 12/LO/0988). A Trial Steering Committee and Data Monitoring Committee oversee the progress of the study. We will report on the results of the clinical trial, as well as on the characteristics of the participants and their associations with relapse. Trial registration number ISRCTN01027104; pre-results stage.