Abstract
Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n = 75) involved with the programme within 14 mental health sites in the Republic of Ireland. Enablers and barriers to engagement were identified at participant, provider, programme and organization level. Motivated participants and engaged clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included readiness among participants, concerns related to stigma and confidentiality, desire to distance oneself from mental health services, a lack of support for programme participation within families, group discomfort, the time and length of the programme, issues with transport, visibility of the programme, and structural supports for clinicians. Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.
Highlights
The distress associated with mental health problems such as schizophrenia or bipolar disorder is well documented from the perspective of the person experiencing it (Crowe et al, 2012; Warwick et al, 2019) as well as from family members’ perspectives (Cleary et al, 2020; Young et al, 2019)
Positive engagement of family members with psychoeducation programmes enhances their knowledge of mental health problems and the supports available, but has been linked with interrupting negative patterns of interaction between the person and family members (Jewell et al, 2009; Miklowitz & Chung, 2016; Rummel-Kluge & Kissling, 2008; Sin et al, 2013; Taylor et al, 2009)
While there was convergence of opinions in some areas, the findings reveal differences of perspectives and emphasis, such as clinical participants emphasis on attendees’ readiness, motivation and willingness to engage, whereas service users and family members emphasized lack of visibility of the programme, failure of services to sustain new initiatives and a desire by service uses to distance themselves from mental health services once discharged
Summary
The distress associated with mental health problems such as schizophrenia or bipolar disorder is well documented from the perspective of the person experiencing it (Crowe et al, 2012; Warwick et al, 2019) as well as from family members’ perspectives (Cleary et al, 2020; Young et al, 2019).A central pillar underpinning evidence-based care for people with such a diagnosis is the provision of psychoeducation. A high percentage of people experiencing psychosis continue to live with or are in regular contact with family members, who provide emotional and practical support but play a significant role in accessing services when someone becomes unwell (Hackethal et al, 2013). In light of this the provision of education to family members is considered best practice (Health Service Executive (HSE), 2019; Institute and for Health and Care Excellence (NICE), 2014).
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