Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis
Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis
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DOI：
10.1192/bjo.2021.93
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发表时间：
2021-06-18
期刊：
影响因子：
5.4
通讯作者：
On behalf of the DIAMONDS Research team
中科院分区：
文献类型：
--
作者：
Carswell C;Brown J;Balogun A;Taylor J;Coventry P;Kitchen C;Kellar I;Peckham E;Bellass S;Alderson S;Lister J;Holt R;Hewitt C;Jacobs R;Shiers D;Boehnke J;Ajjan R;Siddiqi N;On behalf of the DIAMONDS Research team
系统地回顾和综合关于重度精神障碍成人自我管理决定因素的定性证据。目的是利用本综述的发现为重度精神障碍患者和长期精神障碍患者设计有效的自我管理策略提供信息。患有严重精神疾病（SMI）的人的预期寿命减少了大约15-20年，这主要是由于糖尿病和心脏病等长期身体状况的高发。重度精神障碍患者在试图管理自己的身体健康时面临许多挑战。对于重度精神分裂症患者的长期病情（LTCs），自我管理的决定因素——管理情感和实际问题——知之甚少。包括CINAHL和MEDLINE在内的六个数据库进行了检索，以确定定性研究，探讨人们对重度精神分裂症成人（伴或不伴LTCs）自我管理决定因素的看法。根据美国糖尿病教育者自我护理行为（AADE7）定义自我管理。根据能力、机会、动机和行为（COM-B）框架定义决定因素。根据数据的丰富度（使用Ames等人（2017）的数据丰富度量表进行评估），有目的地对符合条件的研究进行抽样合成，并进行主题合成。该综合报告包括26篇文章。7项研究关注LTCs的自我管理，其余文章探讨SMI的自我管理。从综合中确定了6个分析主题和28个副主题。主题包括：重度精神疾病的额外负担；患有合并症；关于自我管理的信念和态度；在自我管理方面得到他人的支持；社会和环境因素；常规，结构和计划。自我管理能力与人们对从医疗保健专业人员、家人和朋友那里获得的SMI和LTC支持的看法有关。自我管理的机会通常是在社会和环境因素的范围内表示的。自我管理动机受信念和态度的影响，同时与重度自我伤害的负担密切相关。综合报告确定的主题表明，自我管理的能力、机会和动机可能受到重度精神病人经历的负面影响，而社会和专业支持、获得资源的改善以及更多地参与护理可以促进自我管理。对重度精神障碍患者和长期精神障碍患者的支持规划需要考虑到这些经历，并适应这一人群的独特需求。
To systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs. People living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI. Six databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised. Twenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI. The themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.