Defining continuity of care from the perspectives of mental health service users and professionals: an exploratory, comparative study.

Angela Sweeney,Margaret Whittock,Ferew Lemma,Sarah Clement,Ian Rees Jones,Til Wykes,Tom Burns,Diana Rose,Jocelyn Catty,Jonathon Davies,Ruth Belling,Susan Mclaren

doi:10.1111/hex.12435

Abstract

BackgroundContinuity of care (COC) is central to the organization and delivery of mental health services. Traditional definitions have excluded service users, and this lack of involvement has been linked to poor conceptual clarity surrounding the term. Consequently, very little is known about the differences and similarities in the conceptualization of COC by mental health service users and professionals.ObjectiveTo explore and compare mental health service users’ and professionals’ definitions of COC.MethodsUsing an exploratory, qualitative design, five focus groups with 32 service users each met twice. Data were analysed thematically to generate a service user‐defined model of COC. In a cross‐sectional survey, health and social care professionals (n = 184) defined COC; responses were analysed thematically. Service user and professional definitions were conceptually mapped and compared to identify similarities and differences.ResultsThere was crossover between the service user and professional derived models of COC. Both contained temporal, quality, systemic, staff, hospital and needs‐related elements of COC. Service users prioritized access, information, peer support and avoiding services; health professionals most frequently referred to staff, cross‐sectional and temporal COC. Service users alone identified service avoidance, peer support and day centres as COC elements; professionals alone identified cross‐sectional working.ConclusionsImportant similarities and differences exist in service user and professional conceptualizations of COC. Further research is necessary to explore these differences, prior to integrating service user and professional perspectives in a validated COC framework which could enable the development and evaluation of interventions to improve COC, informing policy and practice.

Highlights

Continuity of care (COC) is central to the organization and delivery of mental health services
Information, peer support and avoiding services; health professionals most frequently referred to staff, crosssectional and temporal COC
Important similarities and differences exist in service user and professional conceptualizations of COC

Summary

Introduction

Continuity of care (COC) is central to the organization and delivery of mental health services. In response to deinstitutionalization and an expanding body of international evidence on service fragmentation, achieving continuity of care (COC) has become a key challenge facing mental health services.[1] COC has a shared intuitive meaning, with overarching definitions emphasizing cohesion, smoothness and connectedness,[2] agreement regarding its specific definition is lacking.[3] COC has been described as ‘a conceptually underdeveloped, vague and overinclusive construct lacking a solid empirical foundation’.3. Poor clarity in the conceptualization and operationalization of COC has been linked to a lack of service user involvement.[5] Historically, COC definitions have been dominated by the perspectives of professionals, and it has typically been assumed that service users and professionals define COC in the same way.[4] This has recently been described as the ‘Professional Paradigm’.6. This should be underpinned by the conceptualizations of both service users and professionals

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Conclusion