Publications by authors named "Michelle Banfield"

52 Publications

Contemporary treatment of anxiety in primary care: a systematic review and meta-analysis of outcomes in countries with universal healthcare.

BMC Fam Pract 2021 May 15;22(1):92. Epub 2021 May 15.

College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.

Background: Anxiety disorders are highly prevalent mental health conditions and are managed predominantly in primary care. We conducted a systematic review and meta-analysis of psychological and pharmacological treatments in countries with universal healthcare, and investigated the influence of treatment provider on the efficacy of psychological treatment.

Method: PubMed, Cochrane, PsycINFO, CINAHL, and Scopus were searched in April 2017 for controlled studies of evidence-based anxiety treatment in adults in primary care, published in English since 1997. Searches were repeated in April 2020. We synthesised results using a combination of meta-analysis and narrative methods. Meta-analysis was conducted using a random-effects multi-level model to account for intercorrelation between effects contributed different treatment arms of the same study. Moderator variables were explored using meta-regression analyses.

Results: In total, 19 articles (from an initial 2,247) reporting 18 studies were included. Meta-analysis including ten studies (n = 1,308) found a pooled effect size of g = 1.16 (95%CI = 0.63 - 1.69) for psychological treatment compared to waitlist control, and no significant effect compared to care as usual (p = .225). Substantial heterogeneity was present (I = 81.25). Specialist treatment produced large effects compared to both waitlist control (g = 1.46, 95%CI = 0.96 - 1.96) and care as usual (g = 0.76, 95%CI = 0.27 - 1.25). Treatment provided by non-specialists was only superior to waitlist control (g = 0.80, 95%CI = 0.31 - 1.28). We identified relatively few studies (n = 4) of medications, which reported small to moderate effects for SSRI/SNRI medications and hydroxyzine. The quality of included studies was variable and most studies had at least "unclear" risk of bias in one or more key domains.

Conclusions: Psychological treatments for anxiety are effective in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (GP, nurse, trainee). However, non-specialists provide effective treatment compared with no care at all. Limited research into the efficacy of pharmacological treatments in primary care needs to be considered carefully by prescribers TRIAL REGISTRATION: PROSPERO registration number CRD42018050659.
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http://dx.doi.org/10.1186/s12875-021-01445-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126070PMC
May 2021

Trajectories of depression and anxiety symptoms during the COVID-19 pandemic in a representative Australian adult cohort.

Med J Aust 2021 06 26;214(10):462-468. Epub 2021 Apr 26.

Australian National University, Canberra, ACT.

Objectives: To estimate initial levels of symptoms of depression and anxiety, and their changes during the early months of the COVID-19 pandemic in Australia; to identify trajectories of symptoms of depression and anxiety; to identify factors associated with these trajectories.

Design, Setting, Participants: Longitudinal cohort study; seven fortnightly online surveys of a representative sample of 1296 Australian adults from the beginning of COVID-19-related restrictions in late March 2020 to mid-June 2020.

Main Outcome Measures: Symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ-9) depression and Generalised Anxiety Disorder (GAD-7) scales; trajectories of symptom change.

Results: Younger age, being female, greater COVID-19-related work and social impairment, COVID-19-related financial distress, having a neurological or mental illness diagnosis, and recent adversity were each significantly associated with higher baseline depression and anxiety scores. Growth mixture models identified three latent trajectories for depression symptoms (low throughout the study, 81% of participants; moderate throughout the study, 10%; initially severe then declining, 9%) and four for anxiety symptoms (low throughout the study, 77%; initially moderate then increasing, 10%; initially moderate then declining, 5%; initially mild then increasing before again declining, 8%). Factors statistically associated with not having a low symptom trajectory included mental disorder diagnoses, COVID-19-related financial distress and social and work impairment, and bushfire exposure.

Conclusion: Our longitudinal data enabled identification of distinct symptom trajectories during the first three months of the COVID-19 pandemic in Australia. Early intervention to ensure that vulnerable people are clinically and socially supported during a pandemic should be a priority.
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http://dx.doi.org/10.5694/mja2.51043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207103PMC
June 2021

Trajectories of depression and anxiety symptoms during the COVID-19 pandemic in a representative Australian adult cohort.

Med J Aust 2021 06 26;214(10):462-468. Epub 2021 Apr 26.

Australian National University, Canberra, ACT.

Objectives: To estimate initial levels of symptoms of depression and anxiety, and their changes during the early months of the COVID-19 pandemic in Australia; to identify trajectories of symptoms of depression and anxiety; to identify factors associated with these trajectories.

Design, Setting, Participants: Longitudinal cohort study; seven fortnightly online surveys of a representative sample of 1296 Australian adults from the beginning of COVID-19-related restrictions in late March 2020 to mid-June 2020.

Main Outcome Measures: Symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ-9) depression and Generalised Anxiety Disorder (GAD-7) scales; trajectories of symptom change.

Results: Younger age, being female, greater COVID-19-related work and social impairment, COVID-19-related financial distress, having a neurological or mental illness diagnosis, and recent adversity were each significantly associated with higher baseline depression and anxiety scores. Growth mixture models identified three latent trajectories for depression symptoms (low throughout the study, 81% of participants; moderate throughout the study, 10%; initially severe then declining, 9%) and four for anxiety symptoms (low throughout the study, 77%; initially moderate then increasing, 10%; initially moderate then declining, 5%; initially mild then increasing before again declining, 8%). Factors statistically associated with not having a low symptom trajectory included mental disorder diagnoses, COVID-19-related financial distress and social and work impairment, and bushfire exposure.

Conclusion: Our longitudinal data enabled identification of distinct symptom trajectories during the first three months of the COVID-19 pandemic in Australia. Early intervention to ensure that vulnerable people are clinically and socially supported during a pandemic should be a priority.
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http://dx.doi.org/10.5694/mja2.51043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207103PMC
June 2021

The Music Engagement Program for people with Alzheimer's disease and dementia: Pilot feasibility trial outcomes.

Eval Program Plann 2021 Aug 3;87:101930. Epub 2021 Mar 3.

School of Education / School of Theology, Charles Sturt University, 15 Blackall Street, Barton, Canberra, ACT, 2600, Australia.

Alzheimer's disease and dementia are common, highly disabling conditions frequently requiring residential care. This exploratory proof-of-concept study aimed to determine if the specialised Music Engagement Program (MEP) was sustainable, acceptable, and effective in improving quality of life, emotional wellbeing, and depression symptoms in this population. Sixteen residents, six staff members, and three family and community members took part in the evaluation of the MEP for people living with dementia in a residential aged-care nursing home in Canberra, Australia. Multiple methods were used. Quantitative evaluation assessed residents' depression symptoms (Cornell scale) at pre- and post-intervention, and emotional wellbeing pre- and post-session. Qualitative interviews with staff, and family and community members addressed the MEP's acceptability and potential sustainability. Results showed residents' mean depression scores were reduced from pre- to post-intervention (p = .039; d = 0.72). Interviews established multiple benefits for residents including improved mood, calmness, and reduced aggression. However, staff did not believe it was feasible to continue the MEP sessions beyond the trial period without an external facilitator, citing potential difficulties in adhering to internal activities due to time constraints. This pilot study provides encouraging preliminary evidence for the MEP's acceptability and potential effectiveness for improving depression and wellbeing in this group.
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http://dx.doi.org/10.1016/j.evalprogplan.2021.101930DOI Listing
August 2021

Corrigendum: The Effect of COVID-19 on Mental Health and Wellbeing in a Representative Sample of Australian Adults.

Front Psychiatry 2020 21;11:619331. Epub 2021 Jan 21.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.

[This corrects the article DOI: 10.3389/fpsyt.2020.579985.].
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http://dx.doi.org/10.3389/fpsyt.2020.619331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860974PMC
January 2021

Effects of previous exposure to psychotherapeutic strategies on depression and anxiety symptoms during the COVID-19 pandemic.

BJPsych Open 2021 Jan 19;7(1):e38. Epub 2021 Jan 19.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Australian Capital Territory, Australia.

Background: The COVID-19 pandemic has seen an increase in depression and anxiety among those with and without a history of mental illness. Commonly used forms of psychological therapy improve mental health by teaching psychotherapeutic strategies that assist people to better manage their symptoms and cope with life stressors. Minimal research to date has explored their application or value in managing mental health during significant broad-scale public health crises.

Aims: To determine which psychotherapeutic strategies people who have previously received therapy use to manage their distress during the COVID-19 pandemic, and whether the use and perceived helpfulness of these strategies has an effect on symptoms of depression and anxiety.

Method: Data (N = 857) was drawn from multiple waves of a representative longitudinal study of the effects of COVID-19 on the mental health of Australian adults, which includes measures of anxiety, depression and experiences with psychotherapy and psychotherapeutic strategies.

Results: Previous engagement in therapy with psychotherapeutic strategies had a protective effect on depressive but not anxiety symptoms. Common and helpful strategies used by respondents were exercise, mindfulness and breathing exercises. Using mindfulness and perceiving it to be helpful was associated with lower levels of depression and anxiety symptoms. No other strategies were associated with improved mental health.

Conclusions: Prior knowledge of psychotherapeutic strategies may play a role in managing mental health during unprecedented public health events such as a global pandemic. There may be value in promoting these techniques more widely in the community to manage general distress during such times.
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http://dx.doi.org/10.1192/bjo.2020.170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844171PMC
January 2021

The Effect of COVID-19 on Mental Health and Wellbeing in a Representative Sample of Australian Adults.

Front Psychiatry 2020 6;11:579985. Epub 2020 Oct 6.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.

There is minimal knowledge about the impact of large-scale epidemics on community mental health, particularly during the acute phase. This gap in knowledge means we are critically ill-equipped to support communities as they face the unprecedented COVID-19 pandemic. This study aimed to provide data urgently needed to inform government policy and resource allocation now and in other future crises. The study was the first to survey a representative sample from the Australian population at the early acute phase of the COVID-19 pandemic. Depression, anxiety, and psychological wellbeing were measured with well-validated scales (PHQ-9, GAD-7, WHO-5). Using linear regression, we tested for associations between mental health and exposure to COVID-19, impacts of COVID-19 on work and social functioning, and socio-demographic factors. Depression and anxiety symptoms were substantively elevated relative to usual population data, including for individuals with no existing mental health diagnosis. Exposure to COVID-19 had minimal association with mental health outcomes. Recent exposure to the Australian bushfires was also unrelated to depression and anxiety, although bushfire smoke exposure correlated with reduced psychological wellbeing. In contrast, pandemic-induced impairments in work and social functioning were strongly associated with elevated depression and anxiety symptoms, as well as decreased psychological wellbeing. Financial distress due to the pandemic, rather than job loss , was also a key correlate of poorer mental health. These findings suggest that minimizing disruption to work and social functioning, and increasing access to mental health services in the community, are important policy goals to minimize pandemic-related impacts on mental health and wellbeing. Innovative and creative strategies are needed to meet these community needs while continuing to enact vital public health strategies to control the spread of COVID-19.
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http://dx.doi.org/10.3389/fpsyt.2020.579985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573356PMC
October 2020

Consumer-Guided Development of an Engagement-Facilitation Intervention for Increasing Uptake and Adherence for Self-Guided Web-Based Mental Health Programs: Focus Groups and Online Evaluation Survey.

JMIR Form Res 2020 Oct 29;4(10):e22528. Epub 2020 Oct 29.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia.

Background: Self-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs.

Objective: This study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e-mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs.

Methods: A total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e-mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods.

Results: Participants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program's content or effectiveness and data security, and normalization of using e-mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence.

Conclusions: EFIs have the potential to improve community uptake of e-mental health programs. They should focus on providing information on the content and effectiveness of e-mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness.
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http://dx.doi.org/10.2196/22528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661236PMC
October 2020

The National Disability Insurance Scheme and people with severe and persistent mental illness/psychosocial disability: A review, analysis and synthesis of published literature.

Aust N Z J Psychiatry 2020 12 28;54(12):1162-1172. Epub 2020 Oct 28.

Centre for Mental Health Research, College of Health and Medicine, Australian National University, Acton, ACT, Australia.

Objectives: The aim of this scoping review was to map and synthesise peer-reviewed literature reporting on the Australian National Disability Insurance Scheme and psychosocial disability.

Method: The review followed the rigorous and systematic protocol of Arksey and O'Malley. Five databases were searched and, using strict inclusion and exclusion criteria, publications were identified for inclusion. Data were extracted from publications, tabulated and graphically presented. A qualitative analysis was also completed.

Results: Twenty-eight publications were included. While a wide range of issues were covered across this literature, only eight publications specifically focused on the National Disability Insurance Scheme. Almost half of publications were only author commentary without analysis of external data. There were no evaluations and a paucity of publications documenting the lived experiences of people with psychosocial disability or their families. Qualitative analysis identified 59 separate themes. These were grouped using a modified strengths, weakness, opportunities and threats framework. While it was acknowledged that the Scheme has the capacity to enrich people's lives and enhance service integration, themes relating to weakness and threats dominated within this literature. These included a variety of existing or predicted problems such as poor integration of a recovery philosophy into the National Disability Insurance Scheme, complex application processes creating barriers to access, concern for those ineligible or not accessing the National Disability Insurance Scheme, the need to ensure National Disability Insurance Scheme plans address specific, changing participant needs and that services will be available to provide required supports.

Conclusion: Given the significant impact of the National Disability Insurance Scheme on the lives of individuals and the wider mental health service system, there continues to be surprisingly limited peer-reviewed literature reporting on experiences and outcomes of the Scheme for people living with psychosocial disability. Future research examining outcomes and shedding light on National Disability Insurance Scheme experiences of people with psychosocial disability and their families are particularly important for ongoing development and evaluation of the Scheme.
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http://dx.doi.org/10.1177/0004867420967747DOI Listing
December 2020

Contextual influences on the impact of a peer worker-led self-stigma program for people with mental health issues: protocol for an interventional implementation science study.

Implement Sci Commun 2020 25;1:26. Epub 2020 Feb 25.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Acton, ACT 2601 Australia.

Background: Despite significant recent reforms, Australia's mental health system faces substantial service and workforce shortages, and progress on the reorientation of services to a recovery focus is also slow. Implementing recovery-focused programs led by mental health peer workers is one way of addressing these issues, but uptake of these programs in Australia is patchy and not well evaluated.This project will investigate the implementation of a peer-led mental health self-stigma program across three diverse settings in an Australian capital city. The project aims to (1) examine the processes and contextual influences on successful implementation of peer work roles and (2) evaluate the impact a peer worker-led program has on individuals and services.

Methods: The project will use an interventional implementation science approach: small-scale, researcher-led implementation of the Honest, Open, Proud program to explore contextual influences, and implementation, service and individual outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to guide investigation of contextual factors. Implementation outcomes (feasibility, fidelity, acceptability, sustainability) and service outcomes (safety, person-centeredness and effectiveness) will be examined in interviews with a range of staff within the services, checklists of adherence to program protocols and analysis of administrative data. Individual quantitative outcomes will include self-stigma, recovery and quality of life, measured at baseline, end of program and follow-up. Qualitative enquiry will focus on experiences with the peer worker and program.Quantitative analyses will comprise change scores on service and individual outcome measures. Where possible, differences between settings and the effects of potential confounds will be tested using multi-level linear models, which will account for clustering of individuals within programs and settings. Qualitative data will be analysed using a framework approach, which is an effective way of combining inductive and deductive coding to test and refine a thematic frame.

Discussion: Recovery-focused, peer-led programs have the potential to provide a unique contribution to the management of mental health issues. Currently, there is little information to guide successful implementation of these roles. This project will provide important preliminary data on the factors that affect implementation and the impact peer workers can have.

Trial Registration: ANZCTR - Trial Registration ID: ACTRN12619001312134. Registered 26/09/2019.
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http://dx.doi.org/10.1186/s43058-020-00002-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427925PMC
February 2020

Spatial inequities of mental health nurses in rural and remote Australia.

Int J Ment Health Nurs 2021 Feb 17;30(1):167-176. Epub 2020 Aug 17.

Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia.

Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer-grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100 000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100 000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100 000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task-shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer-led, telemedicine and community-based groups.
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http://dx.doi.org/10.1111/inm.12769DOI Listing
February 2021

Spatial inequities of mental health nurses in rural and remote Australia.

Int J Ment Health Nurs 2021 Feb 17;30(1):167-176. Epub 2020 Aug 17.

Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia.

Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer-grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100 000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100 000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100 000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task-shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer-led, telemedicine and community-based groups.
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http://dx.doi.org/10.1111/inm.12769DOI Listing
February 2021

Whose story is it? Mental health consumer and carer views on carer participation in research.

Health Expect 2021 May 28;24 Suppl 1:3-9. Epub 2019 Aug 28.

ACACIA: The ACT Consumer and Carer Mental Health Research Unit, Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.

Background: Mental health carers contribute a unique set of perspectives and lived experiences to research; however, national research ethics guidelines do not specifically address the issues that affect informal carers as participants.

Objective: This study sought to explore Australian mental health consumer and carer views on the ethical conduct of research involving mental health carers.

Design: A public forum (n = 14; consumer = 5, carer = 9) and a subsequent series of interviews (n = 10; consumer = 5, carer = 4, both = 1) were conducted to investigate consumer and carer views on mental health research ethics. Data collection and analysis drew strongly on methodological features of grounded theory.

Results: Conducting research involving carers and consumer-carer relationships raises potential concerns related to story ownership. Lived experience stories have shared and separate elements; thus, it is important to consider potential risks to the privacy of non-participants and of social harm to participants' relationships when conducting research in this space. These risks could be minimized and managed through communication between researchers and participants, and within relationships.

Conclusions: When conducting research involving carers and consumer-carer relationships, researchers may need to facilitate the negotiation of information-sharing boundaries within relationships and the safe and confidential telling of shared stories.
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http://dx.doi.org/10.1111/hex.12954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137495PMC
May 2021

Management or missed opportunity? Mental health care planning in Australian general practice.

Aust J Prim Health 2019 Oct;25(4):332-338

Menzies Centre for Health Policy, Charles Perkins Centre (D17), University of Sydney, NSW 2006, Australia.

General practice care plans are designed to improve the management of chronic illness, facilitating multidisciplinary care and enabling GPs and consumers to work collaboratively. Evidence suggests that they work well for chronic physical illnesses, but it is unclear if they operate as intended for people with mental disorders. The aims of this study were to: (1) compare rates of creation and review of GP care plans for mental disorders and type II diabetes; and (2) examine consumer experiences. Secondary analysis of 109589 recorded encounters from a national cross-sectional study in Australian general practice (2006-16) demonstrated that encounters involving creation of a care plan for depression or anxiety were significantly higher than those for diabetes, bipolar disorder and schizophrenia. Rates of review were commensurate with creation of plans for diabetes, but not for mental disorders. Eighteen people with a GP care plan completed an online survey about their experiences, reporting that care plans facilitated access to allied health professionals, but did not improve the quality of care they received. Findings suggest that care plans are underutilised for people with low prevalence mental disorders, and while they offer financial benefits to consumers, they may not result in ongoing, collaborative care.
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http://dx.doi.org/10.1071/PY18150DOI Listing
October 2019

Evaluation of the Music Engagement Program for people with Alzheimer's disease and dementia: Study protocol for a pilot trial.

Contemp Clin Trials Commun 2019 Sep 19;15:100419. Epub 2019 Jul 19.

School of Education, School of Theology, Charles Sturt University, Australia.

Background: Alzheimer's disease and dementia are prevalent conditions globally. People with Alzheimer's disease and dementia commonly experience mental health problems, negative emotional states, and behavioural disturbance. Music therapy has previously been used in this population to improve symptoms of mental health problems; however, there is a paucity of evidence-based programs that also explore positive outcomes such as overall quality of life, social outcomes, as well as the acceptability and sustainability of these programs.

Aims: This project aims to evaluate the effectiveness of the specialised Music Engagement Program (MEP) in improving quality of life, wellbeing, and depression symptoms, in aged-care residents with Alzheimer's disease and dementia. The project also aims to explore how the MEP could be applied and maintained on a broader level throughout the aged-care community.

Methods: The intervention will take place over 8 weeks in an aged-care facility for people living with dementia in Canberra, Australia. Weekly 45-60-min group singing sessions will be led by a music facilitator.

Results: The results of the study will be submitted for publication in relevant academic journals and mental health conferences, disseminated to participants on request, to the residential care facility, and via the lead researcher's website.

Conclusions: This study can provide an indication of the feasibility of the MEP in enhancing the mental health and wellbeing of individuals with Alzheimer's disease and dementia. Further investigation will be required to establish the MEP's ability to be maintained on an ongoing basis with minimal costs and administrative support.

Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12618001690246.
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http://dx.doi.org/10.1016/j.conctc.2019.100419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661543PMC
September 2019

A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial.

JMIR Form Res 2019 Jun 4;3(2):e12550. Epub 2019 Jun 4.

Canberra Health Services, Canberra, Australia.

Background: There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings.

Objective: This exploratory proof-of-concept study aimed to determine if a peer worker-led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness.

Methods: Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service.

Results: Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff.

Conclusions: The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit.
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http://dx.doi.org/10.2196/12550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746099PMC
June 2019

Australian Mental Health Consumer and Carer Perspectives on Ethics in Adult Mental Health Research.

J Empir Res Hum Res Ethics 2019 07 25;14(3):234-242. Epub 2019 Apr 25.

1 The Australian National University, Acton, Australian Capital Territory, Australia.

Barriers to research arise when national ethical guidelines governing the inclusion of consumers in mental health research are implemented at the local level. Equivalent guidelines for research involving carers are not available. A social science investigation of Australian mental health consumer and carer perspectives on research ethics procedures was conducted in two interlinked stages: (a) a discussion forum with consumers, carers, and lived-experience researchers and (b) in-depth interviews with consumers and carers. Data collection and analysis drew strongly on methodological features of grounded theory. Privacy, confidentiality, and stigmatizing ethics procedures were key issues for consumer and carer participants. Recommendations for research practice include the following: considering the impact of information sharing on participants' relationships and adopting individual-focused approaches to managing research risks.
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http://dx.doi.org/10.1177/1556264619844396DOI Listing
July 2019

Mental health research priorities in Australia: a consumer and carer agenda.

Health Res Policy Syst 2018 Dec 12;16(1):119. Epub 2018 Dec 12.

Research School of Psychology, The Australian National University, Acton, Australia.

Background: The perspectives of mental health consumers and carers are increasingly recognised as important to the development and conduct of research. However, research directions are still most commonly developed without consumer and carer input. This project aimed to establish priorities for mental health research driven by the views of consumers and carers in Australia.

Method: The project was conducted in two studies. Firstly, a face-to-face discussion forum held in the Australian Capital Territory (Study 1; n = 25), followed by a national online survey (Study 2; n = 70). Participants in both studies were members of the community who identified as a mental health consumer, carer or both. In Study 1, participants developed topics for mental health research in small group discussions, then voted on which topics, developed across all groups and sorted into thematic areas, were a priority. An online survey was developed from these research topics. Study 2 participants were asked to rate topics on a 5-point priority scale and rank the relative importance of the highest-rated topics.

Results: At the forum, 79 topics were generated and grouped into 14 thematic areas. Votes on priorities were spread across a large number of topics, with the greatest overall support for research relating to integrating care that is sensitive to past experiences of trauma into mental health service delivery (trauma-informed care). Survey responses were similarly spread, with the majority of research topics rated as important by at least 50% of participants and no clear individual priorities for research identified. Amongst items rated as important by approximately 80% of participants, key research areas included the delivery of services, and consumer and carer involvement.

Conclusions: Australian mental health consumers and carers demonstrate a strong understanding of the mental health system and its inadequacies. Although clear specific priorities are difficult to establish, consistent areas of focus are services and the role consumers and carers can play in their improvement. However, for consumer and carer views to be at the forefront of research, it is important to regularly update research agendas and work in partnership across the whole research process.
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http://dx.doi.org/10.1186/s12961-018-0395-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292010PMC
December 2018

Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service.

Contemp Clin Trials 2018 10 9;73:75-80. Epub 2018 Sep 9.

Research Cluster Leader - Muscular and Skeletal Health, School of Health, Medical and Applied Sciences, Central Queensland University, Australia. Electronic address:

Background: Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis.

Objectives: To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting.

Design/methods: In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the 'Access', 'Acceptability' and 'Shared Decision Making' dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology.

Results: Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis.

Conclusions: The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.
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http://dx.doi.org/10.1016/j.cct.2018.09.001DOI Listing
October 2018

"Not an afterthought": Power imbalances in systemic partnerships between health service providers and consumers in a hospital setting.

Health Policy 2018 08 28;122(8):922-928. Epub 2018 Jun 28.

SYNERGY Nursing and Midwifery Research Centre, University of Canberra and ACT Health, The Canberra Hospital, Garran, ACT 2605, Australia. Electronic address:

Contemporary health policies require consumers be involved at all stages of health service planning, implementation, delivery, and evaluation. The extent to which this policy is met, however, varies widely across the sector. One barrier to meeting policy requirements is power imbalances within systemic partnerships between consumers and other health professionals. Between September 2016 and February 2017, interviews were conducted with health care managers, clinicians, and consumers working on partnerships across various health service departments in one hospital. An exploratory, qualitative approach was used. Data were analysed using principles of discursive psychology, which focuses on the way power is constructed through participants' accounts of partnerships. The findings suggest providers have significant power over consumers in partnerships at the systematic level of health services. Managers were responsible for setting the parameters for partnerships, and consumers were seen more as a resource to be used by health services rather than as equal partners to work with. The findings suggest that although contemporary health policies require partnership with consumers, better guidelines are needed to specifically address and challenge power imbalances within these partnerships.
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http://dx.doi.org/10.1016/j.healthpol.2018.06.007DOI Listing
August 2018

Primary care access for mental illness in Australia: Patterns of access to general practice from 2006 to 2016.

PLoS One 2018 1;13(6):e0198400. Epub 2018 Jun 1.

Centre for Mental Health Research, The Australian National University, Canberra, Australia.

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198400PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983527PMC
January 2019

Lived experience researchers partnering with consumers and carers to improve mental health research: Reflections from an Australian initiative.

Int J Ment Health Nurs 2018 Aug 30;27(4):1219-1229. Epub 2018 May 30.

ACACIA: The ACT Consumer and Carer Mental Health Research Unit, Centre for Mental Health Research, The Australian National University, Acton, Australian Capital Territory, Australia.

Consumer and carer involvement in mental health research is a growing and developing field. Whilst there has been policy and in-principle support for such involvement from governments around the world, lived experience researchers conducting academic research in partnership with other consumers and carers remains uncommon.

Acacia: The Australian Capital Territory Consumer and Carer Mental Health Research Unit is based at The Australian National University and employs academic researchers with lived experience to undertake research directly relevant to the needs of mental health consumers and carers with the aim of influencing policy and practice. In this study, we share our experience of developing and conducting research within ACACIA to provide a model for meaningfully engaging mental health consumers and carers throughout the research process.
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http://dx.doi.org/10.1111/inm.12482DOI Listing
August 2018

"Coming from a different place": Partnerships between consumers and health services for system change.

J Clin Nurs 2018 Oct 17;27(19-20):3622-3629. Epub 2018 Jul 17.

SYNERGY Nursing and Midwifery Research Centre, University of Canberra and ACT Health, The Canberra Hospital, Woden, ACT, Australia.

Aims And Objectives: The aim of the current study is to explore whether and how the expectations of consumers to be "representative" influences consumers' ability to contribute to health services partnerships.

Background: Health standards call for services to partner with consumers in service development and governance. While existing research criticises the assumption that individual mental health consumers working with mental health services must be representative of consumers more broadly, research has yet to explore whether this requirement exists for consumers of other health services. Requiring individual consumers to be representative of consumers more broadly marginalises and limits consumer involvement.

Design: A qualitative, exploratory design was employed.

Methods: Consumers (n = 6), clinicians (n = 7) and health managers (n = 5) were interviewed about consumer participation in health services. Data analysis was conducted through the lens of social exchange theory and informed by discursive psychological principles.

Results: The current study extends the existing literature within mental health, finding that consumers of other health services are also held responsible for representing broader communities. Data also suggested that a requirement to be representative would marginalise consumers with a passion to bring about change in health systems.

Conclusions: The findings suggest that organisations might need a culture change so that individual consumers are not expected to be representative of consumers more broadly and that participation be made more accessible for diverse groups of consumers.

Relevance To Clinical Practice: Given the role that nurses might play as allies to consumers within health services, the findings of this study contribute to knowledge about the expectations placed on consumers and the ways that nurses might advocate for better partnerships.
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http://dx.doi.org/10.1111/jocn.14520DOI Listing
October 2018

Health and social care coordination for severe and persistent mental illness in Australia: a mixed methods evaluation of experiences with the Partners in Recovery Program.

Int J Ment Health Syst 2018 3;12:13. Epub 2018 Apr 3.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia.

Background: Care coordination has been identified as a person-centred response to the difficulty in meeting the needs of people with severe and persistent mental illness and complex needs. This study evaluated the processes and outcomes of the Partners in Recovery initiative in the Australian Capital Territory, a program established to improve coordination of health and social care for this population.

Methods: Client, carer and service provider experiences were investigated using a combination of quantitative and qualitative methods. Quantitative data were collected through questionnaires completed by clients ( = 25) and service providers (= 14). Qualitative data comprised open-ended written feedback from the surveys, together with semi-structured interviews with selected clients (= 6), carers ( = 2), and service providers ( = 4). In both study elements, questions focused on dimensions of experience such as communication, continuity and coordination, teamwork and sustainability. Descriptive statistics were calculated for quantitative data; qualitative data were analysed using content analysis.

Results: Clients were satisfied with the program across the majority of experience dimensions, and there was evidence of improved access to coordinated care. Support Facilitators (care coordinators) were central to client and carer reports of the impacts of the program, and to coordination between services through connections built at the individual level. Challenges included difficulties with information continuity, a lack of role clarity for service providers, and uncertainty about the legacy of the program given the absence of formal agreements connecting different services.

Conclusions: The Support Facilitator role was critical to the success of the program. Support Facilitators acted as a source of stability and relational continuity for clients, while also enabling connections with external services through the development of individual level partnerships and personal networks. Systems level coordination was limited by communication difficulties and a lack of formalised infrastructure to support cooperation between services, calling into question the lasting impact of the program for system change.
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http://dx.doi.org/10.1186/s13033-018-0194-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883333PMC
April 2018

An evaluation of a tailored care program for complex and persistent mental health problems: Partners in Recovery program.

Eval Program Plann 2018 06 5;68:99-107. Epub 2018 Mar 5.

Centre for Mental Health Research, Research School of Population Health, The Australian National University, Australia.

Partners in Recovery (PIR) is a nation-wide Australian program designed to improve coordinated care for people with severe and persistent mental health problems. This study evaluated PIR's effectiveness for individual and system-level outcomes. A total of 25 PIR participants (male = 7, female = 15, not stated = 3) provided data for the evaluation of the program across six community mental health service providers in Canberra, Australia. Individual-level measures included quality of life, social inclusion, and perceptions of recovery. System-level individual measures included confidence in the health system, perceptions of organisation of care, and network analyses. Global single-item scores were measured at baseline (retrospectively), midpoint, and endpoint. Scaled scores for quality of life and social inclusion were measured at midpoint and endpoint only. Multi-level fixed effect models demonstrated significant improvements in global quality of life (p = .008), social inclusion (p = .025), perceptions of recovery (p < .001), and confidence in the health system (p = .013) from baseline to endpoint. Mean scaled scores did not improve from midpoint to endpoint. Two network analyses demonstrated the central role of the support facilitator. This study provides preliminary evidence for increasing quality of life, level of social inclusion, and perceptions of recovery for people with severe mental illness and complex needs.
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http://dx.doi.org/10.1016/j.evalprogplan.2018.03.001DOI Listing
June 2018

Exploring the feasibility and acceptability of a recovery-focused group therapy intervention for adults with bipolar disorder: trial protocol.

BMJ Open 2018 01 31;8(1):e019203. Epub 2018 Jan 31.

Centre for Mental Health Research, Australian National University, Canberra, Australia.

Introduction: Improving accessible, acceptable recovery-oriented service provision for people with bipolar disorder (BD) is an important priority. Mindfulness and acceptance-based cognitive and behavioural therapies (or 'third -wave' CBT) may prove fruitful due to the considerable overlap between these approaches and key features of personal recovery. Groups also confer therapeutic benefits consistent with personal recovery and may improve recovery-oriented service provision by adding another modality for accessing support. The primary objective of this trial is to explore the feasibility and acceptability of a new recovery-focused group therapy (RfGT) intervention for adults with BD. This is the first published feasibility assessment of a time-limited RfGTrecovery-focused group therapy intervention for BD.

Methods/ Analysis: This protocol describes an open feasibility study, utilising a pre-treatment design versus post- treatment design and nested qualitative evaluation. Participants will be recruited from the Central Coast region of New South Wales, Australia, from primary care providers, specialist mental health services, non-government organisations and via self-referral. The primary outcomes are feasibility and acceptability as indexed by recruitment, retention, intervention adherence, adverse events (if any) and detailed consumer feedback. Clinical outcomes and process measures will be assessed to inform future research. Primary outcome data will utiliseuse descriptive statistics (eg, summarizingsummarising recruitment, demographics, attendance, attrition and intervention adherence). Secondary outcomes will be assessed using repeated-measures analysis of covariance across all time points (including change, effect size and variability).

Ethics And Dissemination: Ethical approval has been granted by the Northern Sydney Local Health District HREChuman research ethics committee (HREC) (HREC/16/HAWKE/69) and The University of Newcastle HREC (H-2016-0107). The Ffindings will be used to improve the intervention per user needs and preferences, and inform what amendments and/or information are required before a follow-on trial would be possible. This study contributes to a growing body of innovative, recovery-oriented innovations of psychological treatments for adults with BD.

Trial Registration Number: ACTRN12616000887471; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2017-019203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829875PMC
January 2018

A Peer-Led Electronic Mental Health Recovery App in an Adult Mental Health Service: Study Protocol for a Pilot Trial.

JMIR Res Protoc 2017 Dec 7;6(12):e248. Epub 2017 Dec 7.

Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia.

Background: There is growing demand for peer workers (people who use their own lived experience to support others in their recovery) to work alongside consumers to improve outcomes and recovery. Augmenting the workforce with peer workers has strong capacity to enhance mental health and recovery outcomes and make a positive contribution to the workforce within mental health systems and to the peer workers themselves. Technology-based applications are highly engaging and desirable methods of service delivery.

Objective: This project is an exploratory proof-of-concept study, which aims to determine if a peer worker-led electronic mental (e-mental) health recovery program is a feasible, acceptable, and effective adjunct to usual treatment for people with moderate to severe mental illness.

Methods: The study design comprises a recovery app intervention delivered by a peer worker to individual consumers at an adult mental health service. Evaluation measures will be conducted at post-intervention. To further inform the acceptability and feasibility of the model, consumers will be invited to participate in a focus group to discuss the program. The peer worker, peer supervisor, and key staff at the mental health service will also be individually interviewed to further evaluate the feasibility of the program within the health service and further inform its future development.

Results: The program will be delivered over a period of approximately 4 months, commencing June 2017.

Conclusions: If the peer worker-led recovery app is found to be feasible, acceptable, and effective, it could be used to improve recovery in mental health service consumers.
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http://dx.doi.org/10.2196/resprot.8795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740261PMC
December 2017

A Peer-Led Electronic Mental Health Recovery App in an Adult Mental Health Service: Study Protocol for a Pilot Trial.

JMIR Res Protoc 2017 Dec 7;6(12):e248. Epub 2017 Dec 7.

Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia.

Background: There is growing demand for peer workers (people who use their own lived experience to support others in their recovery) to work alongside consumers to improve outcomes and recovery. Augmenting the workforce with peer workers has strong capacity to enhance mental health and recovery outcomes and make a positive contribution to the workforce within mental health systems and to the peer workers themselves. Technology-based applications are highly engaging and desirable methods of service delivery.

Objective: This project is an exploratory proof-of-concept study, which aims to determine if a peer worker-led electronic mental (e-mental) health recovery program is a feasible, acceptable, and effective adjunct to usual treatment for people with moderate to severe mental illness.

Methods: The study design comprises a recovery app intervention delivered by a peer worker to individual consumers at an adult mental health service. Evaluation measures will be conducted at post-intervention. To further inform the acceptability and feasibility of the model, consumers will be invited to participate in a focus group to discuss the program. The peer worker, peer supervisor, and key staff at the mental health service will also be individually interviewed to further evaluate the feasibility of the program within the health service and further inform its future development.

Results: The program will be delivered over a period of approximately 4 months, commencing June 2017.

Conclusions: If the peer worker-led recovery app is found to be feasible, acceptable, and effective, it could be used to improve recovery in mental health service consumers.
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http://dx.doi.org/10.2196/resprot.8795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740261PMC
December 2017

Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement.

J Adv Nurs 2018 Mar 25;74(3):564-578. Epub 2017 Oct 25.

National Institute for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia.

Aim: To develop a conceptual model that provides a comprehensive understanding of the structures and processes underpinning patient enablement and satisfaction in general practice nurse consultations.

Background: Current evidence regarding patient satisfaction and enablement arising from general practice nursing care is either quantitative or qualitative. To date, no studies have integrated the results of mixed methods research to provide a deeper understanding of processes that facilitate their achievement.

Design: A concurrent mixed methods study.

Methods: Our 2013-2014 concurrent mixed methods study comprised a quantitative study that analysed variables identified in interviews with general practice nurses, patients and practice managers with data from a cross-sectional survey of 678 patients receiving nursing care in 21 general practices; and a qualitative study that used a grounded theory approach to in-depth interviews with nurses and patients from these same practices. Using joint displays, we compared and integrated the results of the multilevel analyses and the grounded theory model derived from these studies.

Findings: We conceptualized a model-'developing a positive patient experience with nurses in general practice'-in which time, continuity of care, nursing scope of practice and autonomy, and patients' health conditions provide platforms for the processes of triggering healthcare partnerships and tailoring care in nurse consultations.

Conclusion: This model builds on previous evidence describing processes and characteristics that optimize the quality of care in general practice nurse consultations. It provides a practical tool to inform education and training for general practice nurses and other clinicians.
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http://dx.doi.org/10.1111/jan.13461DOI Listing
March 2018

Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia.

BMC Fam Pract 2017 Jan 10;18(1). Epub 2017 Jan 10.

Ochre Health Medical Centre, Cnr Allawoona Street & Ginninderra Drive, Bruce, ACT 2617, Australia.

Background: The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint. The objective of this study was to explore consumers' and providers' concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people's experiences.

Methods: A qualitative pilot study was undertaken at one Australian multidisciplinary primary health care centre. Semi-structured interviews were conducted with consumers (N = 19) and staff (N = 10). Data were analysed using a framework analysis approach.

Results: Consumers' experience of integrated care tended to be implicit in their descriptions of primary healthcare experiences more broadly. Experiences related to the typologies involved clinical and functional integration, such as continuity of providers and the usefulness of shared information. Staff focused on clinical level integration, but also talked about a cultural shift that demonstrated normative, professional and functional integration.

Conclusions: Existing frameworks for integration have been heavily influenced by the provider and organisational perspectives. They are useful for conceptualising integration from a professional perspective, but are less relevant for consumers' experiences. Consumers of integrated primary health care may be more focussed on relational aspects of care and outcomes of care.
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http://dx.doi.org/10.1186/s12875-016-0575-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225665PMC
January 2017