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Schön, U.-K., Grim, K. & Wallin, L. (2018). Psychiatric service staff perceptions of implementing a shared decision-making tool: A process evaluation study. International Journal of Qualitative Studies on Health and Well-being, 13(1)
Open this publication in new window or tab >>Psychiatric service staff perceptions of implementing a shared decision-making tool: A process evaluation study
2018 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden.

METHOD:

The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact.

RESULTS:

The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations.

CONCLUSION:

The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

Keywords
Shared decision making; decision support tool; implementation; process evaluation; psychiatric services
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26828 (URN)10.1080/17482631.2017.1421352 (DOI)000424831900001 ()29405889 (PubMedID)2-s2.0-85045243442 (Scopus ID)
Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2018-09-05Bibliographically approved
Grim, K., Rosenberg, D., Svedberg, P. & Schön, U.-K. (2017). Development and usability testing of a web-based decision support for users and health professionals in psychiatric services. Psychiatric rehabilitation journal, 40(3), 293-302
Open this publication in new window or tab >>Development and usability testing of a web-based decision support for users and health professionals in psychiatric services
2017 (English)In: Psychiatric rehabilitation journal, ISSN 1095-158X, E-ISSN 1559-3126, Vol. 40, no 3, p. 293-302Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported.

METHOD: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers.

RESULTS: Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This web-based decision aid has the potential to strengthen service users' experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives. (PsycINFO Database Record

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27766 (URN)10.1037/prj0000278 (DOI)28737415 (PubMedID)
Available from: 2018-06-05 Created: 2018-06-05 Last updated: 2018-06-05Bibliographically approved
Osman, F., Salari, R., Klingberg-Allvin, M., Schön, U.-K. & Flacking, R. (2017). Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial. BMJ Open, 7(12), Article ID e017600.
Open this publication in new window or tab >>Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.

DESIGN: Randomised controlled trial.

SETTING: A city in the middle of Sweden.

PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).

CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

CLINICAL TRIAL REGISTRATION: NCT02114593.

Keywords
child protection, community child health, mental health, public health
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26770 (URN)10.1136/bmjopen-2017-017600 (DOI)000423826700065 ()29222136 (PubMedID)
Note

Open Access APC beslut 26/2017

Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-02-22Bibliographically approved
Rosenberg, D., Schön, U.-K., Nyholm, M., Grim, K. & Svedberg, P. (2017). Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments.. Journal of Mental Health, 26(2), 142-149
Open this publication in new window or tab >>Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments.
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2017 (English)In: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 26, no 2, p. 142-149Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers.

AIM: The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context.

METHOD: The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity.

RESULTS: The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden.

CONCLUSIONS: The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.

National Category
Social Work
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-22660 (URN)10.1080/09638237.2016.1207223 (DOI)000399610500008 ()27452763 (PubMedID)
Available from: 2016-08-03 Created: 2016-08-03 Last updated: 2017-05-11Bibliographically approved
Osman, F., Flacking, R., Schön, U.-K. & Klingberg-Allvin, M. (2017). The impact of a culturally tailored parenting support for Somali-born parents’ and children’s mental health: A randomized controlled trial. In: : . Paper presented at 31st ICM Triennial Congress, Toronto, 18-22 June 2017.
Open this publication in new window or tab >>The impact of a culturally tailored parenting support for Somali-born parents’ and children’s mental health: A randomized controlled trial
2017 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23736 (URN)
Conference
31st ICM Triennial Congress, Toronto, 18-22 June 2017
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2016-12-26Bibliographically approved
Osman, F., Flacking, R., Schön, U.-K. & Klingberg-Allvin, M. (2016). Effectiveness of parenting support to Somali parents on children’s mental health: A randomized controlled trial. In: : . Paper presented at European Public Health Conference, Vienna, 9-12 November 2016.
Open this publication in new window or tab >>Effectiveness of parenting support to Somali parents on children’s mental health: A randomized controlled trial
2016 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23733 (URN)
Conference
European Public Health Conference, Vienna, 9-12 November 2016
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2016-12-27Bibliographically approved
Osman, F., Klingberg-Allvin, M., Flacking, R. & Schön, U.-K. (2016). Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes. BMC International Health and Human Rights, 16(1), Article ID 82.
Open this publication in new window or tab >>Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes
2016 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 16, no 1, article id 82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting.

METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied.

RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities.

CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Keywords
immigrant, mental health, migration, parenting, parenthood in transition, qualitative method, Somali parents
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21064 (URN)10.1186/s12914-016-0082-2 (DOI)000370315600001 ()26883321 (PubMedID)
Available from: 2016-02-18 Created: 2016-02-18 Last updated: 2017-12-19Bibliographically approved
Olsson, H. & Schön, U.-K. (2016). Reducing violence in forensic care: how does it resemble the domains of a recovery-oriented care?. Journal of Mental Health, 25(6), 506-511
Open this publication in new window or tab >>Reducing violence in forensic care: how does it resemble the domains of a recovery-oriented care?
2016 (English)In: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 25, no 6, p. 506-511Article in journal (Refereed) Published
Abstract [en]

Background: Forensic psychiatry is characterized by involuntary treatment and risk of violence. The concept of recovery is rarely in focus as the primary focus is on risk assessment, violence prevention and reducing coercion in care.

Aim: To determine what resources forensic staff use to avoid or prevent violent situations, and to explore how these practices resemble the domains of recovery-oriented care.

Method: Semi-structured interviews with staff who were identified by forensic patients as key workers in their recovery process. Interview texts were analyzed using interpretive content analysis.

Results: Staff prevent violent situations using tacit knowledge and experience, and through a shared collegial responsibility. Staff safeguard patients, encourage patient participation, and provide staff consistency.

Conclusions: The results have implications for forensic care as well as psychiatry regarding the process of making recovery a reality for patients in the forensic care setting.

Keywords
forensic care; interviews; recovery; reducing violence
National Category
Social Work Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-20962 (URN)10.3109/09638237.2016.1139075 (DOI)000390749400007 ()26854519 (PubMedID)
Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2017-11-30Bibliographically approved
Grim, K., Rosenberg, D., Svedberg, P. & Schön, U.-K. (2016). Shared decision-making in mental health care: a user perspective on decisional needs in community-based services. International Journal of Qualitative Studies on Health and Well-being, 11, Article ID 30563.
Open this publication in new window or tab >>Shared decision-making in mental health care: a user perspective on decisional needs in community-based services
2016 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30563Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Shared decision-making, information needs, mental health care, directed content analysis
National Category
Social Work
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21478 (URN)10.3402/qhw.v11.30563 (DOI)000396163500001 ()27167556 (PubMedID)
Available from: 2016-05-20 Created: 2016-05-20 Last updated: 2017-04-28Bibliographically approved
Schön, U.-K. (2016). User and carer involvement in social work education: reasons for participation. Scandinavian Journal of Disability Research, 18(2), 154-163
Open this publication in new window or tab >>User and carer involvement in social work education: reasons for participation
2016 (English)In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 2, p. 154-163Article in journal (Refereed) Published
Abstract [en]

In many countries, user involvement in social work (SW) education is common practice, while in other countries, initiatives for inclusion are currently expanding. No matter how far the progress of user involvement in education has come, issues on clarity, sustainability and accountability need to be addressed. In this paper, users’ reasons for wanting to participate in SW education and the way they define their potential contribution are explored. These experiences can provide important information contributing to sustainable, meaningful, and accountable collaborations between users, university staff and students. Participants (n = 33) answered a questionnaire including demographic data and four open-ended questions about their expectations of participation in a SW programme at the University of Dalarna in Sweden. The results from the open-ended questions were analysed using qualitative content analysis. Results show that users’ main reasons for wanting to get involved were to contribute through sharing their lived experience of SW education, to help improve services and also to obtain respect for their own personal knowledge and experience. The respondents described themselves both as carriers of valuable knowledge and as accountable experts on the subject.

Keywords
User involvement, carer involvement, SW education, social work, mental illness
National Category
Social Work
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19086 (URN)10.1080/15017419.2015.1063539 (DOI)
Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2017-12-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3866-5636

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