Objectives: The COVID-19 pandemic poses significant risks to the vulnerable patient population supported by community mental health (CMH) teams in South Australia. This paper describes a plan developed to understand and mitigate these risks. Methods: Public health and psychiatric literature was reviewed and clinicians in CMH teams and infectious disease were consulted. Key risks posed by COVID-19 to CMH patients were identified and mitigation plans were prepared. Results: A public health response plan for CMH teams was developed to support vulnerable individuals and respond to the COVID-19 pandemic. This plan will be reviewed regularly to respond to changes in public health recommendations, research findings and feedback from patients and clinicians. Conclusions: The strategic response plan developed to address risks to vulnerable patients from COVID-19 can assist other CMH services in managing the COVID-19 pandemic.
Background Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics. Method Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults—Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education. Results The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention. Conclusions Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.
BackgroundHealth literacy (HL) has been defined as the degree to which individuals possess the capacity to obtain, process, understand and utilise basic health information. For people with schizophrenia, important aspects of their HL include the ability to understand information about their illness and treatment, taking medications correctly, and interacting with clinicians.Schizophrenia is associated with lower levels of education, which has been found to negatively impact on HL. Further, schizophrenia is often associated with cognitive impairment, but the relationship between HL and cognitive function in this patient population is not known.Studies of HL in people with physical disorders have demonstrated that people with poor HL have poorer outcomes, with greater morbidity and mortality. There has been very little research into HL in schizophrenia, although it may be expected that those with poor HL might have more difficulty managing their illness and interacting with clinical services.MethodsPeople living in the community, and attending public community mental health outpatient clinics in the Northern suburbs of Adelaide, Australia, were invited to participate in the study. They were interviewed by trained research staff, and completed the WAIS VI digit symbol coding (DSC), Verbal Fluency (VF; animal naming), the short version of the Test of Functional Health Literacy in Adults (S-TOFHLA) along with two parts of the Woodcock-Johnson III measuring aural literacy (Part 4; WJ4) and reading literacy (Part 9; WJ9). Of 101 participants, 62 had schizophrenia, while the other 39 had a range of other diagnoses.ResultsThe 62 participants with schizophrenia had a mean age of 41.2 (SD 9.9) years and 61% were male. They had a mean of 11.02 (SD 1.5) years of education. The remaining participants had a mean age of 43.3 (SD 13.4) years, 46% were male, and the mean years of education was 11.3 (SD 2.5).90% of the schizophrenia group were at or below 8th grade (Year 8) level for aural literacy, and 63% were at or below 8th grade (Year 8) for reading literacy.Those with a schizophrenia diagnosis had lower scores on the WJ9 (mean 8.3, SD 4.5) compared with the non-schizophrenia group (mean 11, SD 5.1); t = 2:739; p = 0:007, medium Cohen’s D effect size (D = 0:548). However, there was not a significant difference (t = 1.975, p = .051) in aural literacy between the schizophrenia and non-schizophrenia groups.Using the S-TOFHLA, 81% of the schizophrenia group had adequate HL; 6% were marginal and 13% were inadequate. In contrast, 97% of the non-schizophrenia group had adequate HL. The schizophrenia group had lower mean S-TOFHLA scores (mean 28.6, SD 7.5; compared to mean 31.8, SD 4.8); t = 2.369; p = 0.020, medium Glass’s effect size (G = 0.657).In all subjects, there was a moderate, positive relationship (r = 0.359; p < .05) between education and the TOFHLA score. There was also a positive correlation between the S-TOFHLA score and the aural and reading literacy scoresDiscussionThe majority of people with schizophrenia had ...
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