The Impact of Stakeholder Preferences on Service User Adherence to Treatments for Schizophrenia and Metabolic Comorbidities

Abstract

ObjectiveTo determine how stakeholder opinions of treatments influence service user decisions to adhere to courses of actions necessary to treat metabolic conditions.MethodsQualitative open-ended interviews were conducted with 20 service providers, 25 service users, and 9 caregivers. Grounded theory was used to generate an understanding that linked preferences of care with adherence to follow-up treatments.ResultsParticipants spoke about several considerations when discussing adherence: Resource limitations were the predominant consideration. Social considerations such as stigma and support surfaced in caregiver and service-user interviews. The influence of symptoms, especially their absence could reduce adherence, and organizational considerations related to the opinions they had about the qualifications of professionals.DiscussionA rational patient model partially organizes our findings, but emotional components related to stigma and the opinion of service providers do not fit well into such a model. If service providers do not consider components of the decision making process which fall outside of the rational patient model, they may incorrectly be leveraging suboptimal values to bring about adherence to treatment plans. Being sensitive to the values of service users and their caregivers may allow service providers to better act on points that may bring about change in non-compliant service users with schizophrenia and metabolic comorbidities.

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

“…Principles of beneficence often drive the dynamics of healthcare provisions in Asia. This may lead service users to defer medical decisions to their doctor (Pathare, Shields, Nardodkar, Narasimhan, & Bunders, ; Poremski et al, ). Efforts to introduce advance psychiatric directives may therefore be impeded by low uptake, as in the case of medical directives (Tay et al, ).…”

Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research

“…the more you know what's going on with you, that's a big part of my staying healthy. (Graham et al, 2014, p. 5) The second subtheme for informational support needs was the need for sharing information (Doherty & MacGeorge, 2013;Poremski et al, 2016;Rastad et al, 2014;Zou et al, 2014), which included listening to peers (O'Connor et al, 2008;Poremski et al, 2016) and exchanging information (Doherty & MacGeorge, 2013;Rastad et al, 2014;Zou et al, 2014) and ideas on how to cope with the illness (Rastad et al, 2014). By sharing information with peers, they discovered similarities, found understanding, and therefore felt less strange (Doherty & MacGeorge, 2013) and lonely (Zou et al, 2014).…”

“…Participants stated difficulties in understanding and recalling information (Aref-Adib et al, 2016), thinking logically, making decisions (Fisher et al, 2017), being proactive (Doherty & MacGeorge, 2013;Fisher et al, 2017), making one's voice heard (Fisher et al, 2017;Topor et al, 2006), and expressing oneself (Aref-Adib et al, 2016;Hernandez & Barrio, 2017;Rusner et al, 2010). These difficulties were related to a lack of confidence, learning disabilities (Aref-Adib et al, 2016), unawareness of current symptoms (Chronister et al, 2015;Doherty & MacGeorge, 2013;Whitley & Campbell, 2014;Zou et al, 2013), a fear of what might happen (Ouwehand et al, 2014;Poremski et al, 2016;Rusner et al, 2010;Zou et al, 2013), or being overwhelmed (Aref-Adib et al, 2016;Chronister et al, 2015;Fisher et al, 2017;O'Connor et al, 2008;Ouwehand et al, 2014;Rusner et al, 2010). Four subthemes for the need for guidance emerged from the data.…”

“…Conclusions drawn in the research report do appear to flow from the analysis or interpretation of the data. (Cruce et al, 2012) Coping with symptoms, and relapse prevention (Chronister et al, 2015;Luciano et al, 2014); getting to and sticking to a regular schedule, stabilizing daily structure, and routines (Cruce et al, 2012;Doherty & MacGeorge, 2013) Coping with symptoms in general (Chronister et al, 2015;Cruce et al, 2012;Doherty & MacGeorge, 2013;Fisher et al, 2017;Poremski et al, 2016;Rusner et al, 2010;Thomas & Rickwood, 2016;Todd et al, 2012;Topor et al, 2006;Whitley & Campbell, 2014;Zou, Li, Nolan, Wang, & Hu, 2013), keeping up awareness (Poremski et al, 2016) Substance abuse Alcohol and drugs, and how to remain sober (Thomas & Rickwood 2016) Coping with craving (Whitley & Campbell, 2014) Understanding difficulties in periods of misuse (Cruce et al, 2012) Staying clean…”

Identifying values and preferences around the choice of analgesia for patients with acute trauma pain in emergency and prehospital settings: using group concept mapping methodology

“…These reviews are based on studies of different designs including cross-sectional interviews, surveys and randomised controlled trials. Qualitative open-ended interviews, on the other hand, have also been conducted to investigate different stakeholders’ values and preferences,11 and another systematic review has included only qualitative studies to investigate patients’ values and preferences 12. Still, the area of values and preferences is underexplored, and the methodology on how to assess this criterion to substantiate recommendations within GRADE is not yet fully developed 13…”