Petra Svedberg

Mental health professionals' attitudes towards people with mental illness: do they differ from attitudes held by people with mental illness?

Aims: Studies investigating mental health professionals’ attitudes towards people with mental illness are scarce and there is a lack of comparative studies including both patients’ and mental health professionals’ attitudes. The aim of the present study was to investigate mental health staff’s attitudes towards people with mental illness and compare these with the attitudes of patients in contact with mental health services. A further aim was to relate staff attitudes to demographic and work characteristics. Methods: A cross-sectional study was performed including 140 staff and 141 patients. The study included a random sample of outpatients in contact with mental health services in the southern part of Sweden and staff working in these services. Attitudes were investigated using a questionnaire covering beliefs of devaluation and discrimination of people with a mental illness. Results: Negative attitudes were prevalent among staff. Most negative attitudes concerned whether an employer would accept an application for work, willingness to date a person who had been hospitalized, and hiring a patient to take care of children. Staff treating patients with a psychosis or working in inpatient settings had the most negative attitudes. Patient attitudes were overall similar to staff attitudes and there were significant differences in only three out of 12 dimensions. Patients’ most negative attitudes were in the same area as the staff’s. Conclusions: This study points to the suggestion that mental health care staff may hold negative attitudes and beliefs about people with mental illness with tentative implications for treatment of the patient and development and implementation of evidence-based services. Since patients and staff in most respects share these beliefs, it is essential to develop interventions that have an impact on both patients and staff, enabling a more recovery-oriented staff–patient relationship.

Co-constructing child personas for health-promoting services with vulnerable children

The availability of health-promoting resources for young children diagnosed with cancer who are transitioning from intensive care to everyday life is limited. In the context of designing digital peer support services for children who are considered vulnerable due to clinical and age-related aspects, there are several challenges that put critical requirements on a user-centered design process. This paper reports on a new method for co-constructing child-personas that are tailored for developing health-promoting services where empirical data is restricted due to practical and ethical reasons. In particular, we are proposing to focus children design workshop sessions on salutogenesis, and complement this with a pathogenic perspective by interviewing healthcare professionals and parents. We also introduce the use of proxy personas, and redemption scenarios in the form of comicboards, both collaboratively constructed by children and designers through storytelling. By applying four progressive steps of data collection and analysis we arrive at authentic child-personas that can be used to design and develop health-promoting services for children in vulnerable life stages.

Experiences of a Person-Centred Health Education Group Intervention–A Qualitative Study Among People with a Persistent Mental Illness

The main focus of psychoeducative interventions for people with persistent mental illnesses has been on providing information about symptoms of disease and its treatment. Supporting group contexts ...

Shared decision-making in mental health care—A user perspective on decisional needs in community-based services

Background Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. Objective The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. Methods Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.s model of SDM. Results The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. Conclusions and Implications for Practice The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

In what direction should we go to promote health in mental health care

There is a growing recognition of the need for health promotion interventions in all health care today. In spite of this, health promotion interventions among patients with mental illnesses have been scarce in research, practice, and policies. There is also an ambiguous interpretation of the definition of health promotion in the literature. The emphasis in this paper is thus to (1) discuss why we should pay attention to the interpretations of the concept of health promotion and (2) present a possible model for what nurses do when they intend to promote health in mental health care. This paper was presented at the Nordic Conference of Mental Health Nursing in Helsinki, Finland in 2010.

Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer

Background Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels.

Friendship Relations From the Perspective of Children With Experience of Cancer Treatment A Focus Group Study With a Salutogenic Approach

Friendships are significant to child development and health but diseases such as cancer can interrupt the contact with friends. The purpose of this study was to describe perceptions of friendship from the perspective of children undergoing cancer treatment, in order to build knowledge that can be used in a health promotion intervention for these children. Fifteen children between 8 and 12 years of age participated in focus groups, where a mixture of informative and creative techniques were used. The focus group discussions were analyzed using qualitative content analysis. The analysis resulted in three generic categories, “Common interests and experiences,” “Mutual empathic actions.” and “Mutual trust and understanding,” incorporating seven subcategories. Based on children’s descriptions from a salutogenic perspective, friendship emerged as An equal and mutual commitment that evolves over time and with interactions face-to-face and digitally, a child perspective on friendship should be central to the development of health promotion interventions designed to support friendship relations of children treated for cancer.

Self-rated mental health and socio-economic background: a study of adolescents in Sweden

BackgroundAdolescents’ mental health is a major public health issue. Previous research has shown that socio-economic factors contribute to the health status of adolescents. The present study explores the association between socio-economic status and self-rated mental health among adolescents.MethodsCross sectional data from the Halmstad Youth Quality of Life cohort was collected in a town in Sweden. In all, 948 adolescents (11–13 younger age group and 14–16 older age group) participated. Information on self-rated mental health was collected from the subscale Psychological functioning in the Minneapolis Manchester Quality of Life instrument. The items were summarized into a total score and dichotomized by the mean. Indicators measuring socio-economic status (SES) were collected in a questionnaire using the Family Affluence Scale (FAS) and additional factors regarding parents’ marital status and migration were added. Logistic models were used to analyze the data.ResultsGirls were more likely to rate their mental health below the mean compared to boys. With regard to FAS (high, medium, low), there was a significantly increased risk of self-rated mental health below the mean among younger boys in the medium FAS score OR; 2.68 (95% CI 1.35;5.33) and among older boys in the low FAS score OR; 2.37 (1.02;5.52) compared to boys in the high FAS score. No such trend was seen among girls. For younger girls there was a significant protective association between having parents born abroad and self-rated mental health below mean OR: 0.47 (0.24;0.91).ConclusionsA complex pattern of associations between SES and self-rated mental health, divergent between age and gender groups, was shown. The total FAS score was only associated with boys’ self-rated mental health in both age groups, whereas parents’ migratory status influenced only the girls’ self-rated mental health. Because of the different association for girls’ and boys’ self-rated mental health and SES, other factors than SES should also be considered when investigating and exploring the mental health of adolescents in affluent communities.

Sexual Knowledge in Patients With a Myocardial Infarction and Their Partners

Background:Sexual health and sexual activity are important elements of an individual’s well-being. For couples, this topic is often affected after a myocardial infarction (MI). It has become increasingly clear that, after an MI, patients are insufficiently educated on how to resume normal sexual activity. However, sufficient data on the general knowledge that patients and partners have about sexual activity and MI are lacking. Objective:The aims of this study were to explore and compare patients’ and partners’ sexual knowledge 1 month after a first MI and 1 year after the event and to compare whether the individual knowledge had changed over time. A second aim was to investigate whether patients and their partners report receiving information about sexual health and sexual activity from healthcare professionals during the first year after the event and how this information was perceived. Subjects and Methods:This descriptive, comparative survey study enrolled participants from 13 Swedish hospitals in 2007–2009. A total of 115 patients with a first MI and their partners answered the Sex After MI Knowledge Test questionnaire 1 month after the MI and 1 year after the event. Correct responses generated a maximum score of 75. Results:Only 41% of patients and 31% of partners stated that they had received information on sex and relationships at the 1 year follow-up. The patients scored 51 ± 10 on the Sex After MI Knowledge Test at inclusion into the study, compared with the 52 ± 10 score for the partners. At the 1-year follow-up, the patients’ knowledge had significantly increased to a score of 55 ± 7, but the partners’ knowledge did not significantly change (53 ± 10). Conclusions:First MI patients and their partners reported receiving limited information about sexual issues during the cardiac rehabilitation and had limited knowledge about sexual health and sexual activity.

Psychometric evaluation of a Swedish version of Minneapolis-Manchester quality of life-youth form and adolescent form

BackgroundIt has become important to measure long-term effects and quality of life in survivors of childhood cancer. The Minneapolis- Manchester Quality of Life (MMQL) instrument has been proven to better capture the quality of life (QoL) perspective of health than other instruments. The instrument has age appropriate versions and is therefore favourable for longitudinal studies of QoL of children surviving from cancer. The aim of this study was to evaluate the psychometric properties of the Swedish version of MMQL-Youth Form and the Adolescent Form focusing on: 1) face and content validity 2) the internal consistency and 3) the test-retest reliability.MethodsThe sample consisted of 950 pupils (11–16 years old) from 7 schools in the western Sweden who completed the questionnaire. For the test-retest evaluation 230 respondents completed the questionnaire two weeks later.ResultsFace and content validity was supported and internal consistency was found to be acceptable for the total scale for both the MMQL-Youth Form (8–12 years of age) and the Adolescent Form (13–20 years of age). Test-retest reliability for the MMQL-Youth Form was moderate for 50% of the items and good for the remaining. For the MMQL-Adolescent Form the test-retest showed moderate or good agreement for 80% of the items and fair for 20%.ConclusionsThe result indicated that the Swedish version of the MMQLYouth Form and Adolescent Form was valid and reliable in a sample of healthy children in a Swedish context. It is recommended to test the instrument among diverse samples of children such as survivors of childhood cancer in order to validate its usefulness in research and clinical settings.