Abstract
BackgroundMost existing conceptual models of residential environments and housing programs were developed over a decade ago or lack comprehensiveness. The attributes to be used to describe housing programs with adequate specification remain unclear including the attributes that mediate service user outcomes. In this study, group concept mapping was used to develop a conceptual model of housing and community-based residential settings for adults with severe mental illness based on stakeholder perceptions and values.MethodsParticipants were selected through purposive sampling and included service users, family members, staff working in residential facilities, mental health workers and managers. Participants (n=221) generated 1,382 statements describing attributes of housing and community-based residential settings for adults with severe mental illness (99% saturation). Thematic content analysis was conducted to analyze the statements and create a list of 140 selected statements. Participants then rated (n=416) and sorted into categories (n=73) the selected statements. Descriptive statistics were computed for each statement relative importance. Multidimensional scaling and hierarchical cluster analysis were used to produce the conceptual model (maps). Stakeholders (n=12) were also involved in the interpretation of the maps.ResultsThe findings show overall concordance between stakeholders in relation to statements perceived importance (rating) and the statements inter-relationships (sorting). The stress value of 0.23 indicates that the two-dimensional solution of the multidimensional scaling analysis fits the data set (goodness of fit). The final conceptualization includes 12 clusters: (1) A balanced and healthy housing system; (2) Quality and management practices (facility/local level); (3) Physical external environment; (4) Services tailored to needs and preferences; (5) Services and interventions provided (linkage); (6) Equality, policies and availability of activities; (7) Organizational structure and staff qualities; (8) Services and interventions (learning skills); (9) Services and interventions (daily living support); (10) Personal space and right to privacy; (11) Physical interior environment; (12) Respect, functioning and atmosphere.ConclusionThe results illustrate the multifaceted and multilevel nature of community-based residential settings through a visual representation. They articulate a number of attributes, clusters and dimensions that could be included in a common conceptual model of community-based residential settings and housing for adults with severe mental illness.
Highlights
Community-based residential settings are widely implemented in Australia, Europe, and North America and constitute a costly key component of a modern mental health service system for adults with severe mental illness [1,2,3]
For the purpose of developing a conceptual model of housing and community-based residential settings we used a form of mapping approach: group concept mapping (GCM)
The results of our analyses show overall concordance in relation to the attributes to be used to describe the array of community-based residential settings, attributes relative importance as well as conceptually
Summary
Community-based residential settings are widely implemented in Australia, Europe, and North America and constitute a costly key component of a modern mental health service system for adults with severe mental illness [1,2,3]. Underlying the problem may be the fact that the field lacks an accepted framework for conceptualizing housing and community-based residential settings for adults with severe mental illness and for unifying decades of evolution in the field. Numerous studies since 1970 have highlighted potential key attributes of housing and community-based residential settings for adults with severe mental illness. These settings have been described in terms of structural characteristics, process of care or both [e.g., Rog and Randolp multisite evaluation [6], PROGRES [14,15,16], UTOPIA-study [17], QuEST programme [18]]. Group concept mapping was used to develop a conceptual model of housing and community-based residential settings for adults with severe mental illness based on stakeholder perceptions and values
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