Informal Support Systems Research Articles

Do GPs want or need formal support following a patient suicide?: a mixed methods study.

Patient suicide can be a devastating event for some general practitioners (GPs). Few guidelines exist to aid or support GPs in the aftermath of patient suicide. To explore GPs views on how they are affected by a patient suicide and the formal support available to them following a patient suicide. Questionnaires and semi-structured interviews. General practices in the northwest of England. About 198 semi-structured interviews were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using descriptive statistics and a framework thematic approach. GPs were aged between 31 and 67 years, 144 (73%) were male and the number of years in practice varied between 8 and 40 years (median = 24 years). GPs were based at 133 (67%) urban and 65 (33%) rural practices, 30 (15%) were single-handed GP practices and 168 (85%) practices had two or more GPs. About 131 (66%) GPs reported being affected by patient suicide through feelings of grief, guilt and self-scrutiny. A greater number of years in practice may have been protective against these effects. About 54 (27%) GPs reported having mostly 'informal' support from peers or colleagues and support was less available to younger and single handed GPs. Our findings suggest that the majority of GPs are affected by patient suicide and most seek informal support from their peers and colleagues. Although many indicated that informal support systems were adequate and provided a protective environment, procedures should be developed to ensure the availability of guidelines for those who may require formal support.

Patients' experiences managing cardiovascular disease and risk factors in prison.

BackgroundDespite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk.MethodsWe conducted in-depth interviews with individuals with CVD-RF who had been recently released from prison (n = 26). These individuals were recruited through community flyers and a primary care clinic in Connecticut. Using a grounded theory approach and the constant comparative method, we inductively generated themes about CVD-RF care in prisons. Data collection and analysis occurred iteratively to refine and unify emerging themes.ResultsFour themes emerged about care in prison: (1) Participants perceive that their CVD-RFs are managed through acute, rather than chronic, care processes; (2) Prison providers’ multiple correctional and medical roles can undermine patient-centered care; (3) Informal support systems can enhance CVD-RF self-management education and skills; and (4) The trade-off between prisoner security and patient autonomy influences opportunities for self-management.ConclusionsPatients develop self-management skills through complex processes that may be compromised by the influence of correctional policies on medical care. Our findings support interventions to engage peers, medical providers, care delivery systems, and correctional staff in cultivating effective self-management strategies tailored to prison settings.

Impact of lifetime evaluated need on mental health service use among African American emerging adults.

This study investigated the association between evaluated need and mental health service use among African-American emerging adults, when controlling for other predictor variables. Secondary analysis of data from the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African-American emerging adults, ages 18 to 29 years (N = 806), was assessed with the Composite International Diagnostic Interview. The sample included females and males with a mean age of 23 years. Evaluated need was determined by endorsement of mood, anxiety, substance use, or impulse control diagnoses. Respondents who reported ever voluntarily using mental health or general medical services to address these problems were considered to have used services. Forty-seven percent of the sample demonstrated an evaluated need for services, whereas a quarter of the sample used services in their lifetime. Respondents who were females, had received religious/spiritual support, and who had an evaluated need for services were significantly more likely to have used services in their lifetime compared with males, those who had not received religious/spiritual support, and those without a need for services. Literature indicates that evaluated need is a strong predictor of mental health service use, yet research examining its impact on service use among African American emerging adults is limited. This study found that along with having an evaluated need, this population was more likely to use services when supported by a religious/spiritual leader. Mental health outreach and education that incorporates the informal support systems identified by African American emerging adults, particularly males, is needed.

Mental illness stigma and engagement in an implementation trial for Cognitive Processing Therapy at a diverse community health center: a qualitative investigation.

The present study aimed to describe associations between various types of mental health stigma and help-seeking behaviors among ethnically diverse clients with posttraumatic stress disorder (PTSD) served by an urban community health clinic. The present study draws qualitative data from a parent National Institute of Mental Health Study that aims to identify barriers and facilitators of implementing Cognitive Processing Therapy (CPT) for PTSD. A total of 24 participants from the initial phase of the trial were included in the present study. Mental health stigma emerged as one notable barrier to seeking mental health treatment, as participants described how experiences of environment-level stigma, internalized (self-)stigma and perceived (felt) stigma from their family, friends and previous healthcare providers influenced their decisions to seek care. Despite these barriers to help seeking, many clients also reported that positive interactions with informal and formal support systems, and encouragement from study therapists, helped to combat mental health stigma and facilitate decisions to participate in an implementation trial for CPT. Findings suggest that providers in community health settings may need to attend directly to stigma at the initiation of mental health treatment.

Prostate Cancer Survivorship among African American Men

This article describes how African American prostate cancer survivors negotiate medical systems create guideposts for survival, and strategies for rehabilitation. The intent is to explore the availability and significance of formal and informal psychosocial support systems that are utilized by African American prostate cancer survivors and to better understand the coping and adaptation of survivors and their families. The article will address the role of social support systems, prostate cancer support groups, and self-help groups. Prostate cancer survivorship will be viewed within the larger context of cancer survivorship initiatives in the United States. According to the SEER statistics, 5 year survival by race is 99.6% for White men and 95.9% for African American men. The lower survival rate and higher mortality rate among African American men have resulted in diminished outcomes and poorer quality of life experiences.

Family care-giving and living arrangements of functionally impaired elders in rural China

ABSTRACTChina has seen a rapid decline of the traditional multi-generational household and an increase in rural-to-urban migration, raising concerns about a possible breakdown of the informal support system. Against this background, the paper looks at family care-giving (or the absence thereof) to parents in three different living arrangements: with any child or child-in-law (co-resident); independent with at least one child living in the same community (networked); and without any children in either the household or the community (isolated). It also compares the care-giving arrangements of single elders to those living with a spouse. The sample, which is derived from the comprehensive China Health and Retirement Longitudinal Study (CHARLS), contains data on 887 functionally impaired individuals aged 60 and above. The findings suggest that married parents are mostly cared for by their spouse, even if they co-reside with adult children. Proximity to children is particularly important for single elders, who are more likely to lack a care-giver when living independently. There appears to be a hierarchy in family care responsibilities, where children step in as care-givers only when the spouse is no longer able to fulfil this role. While these findings imply a significant deviation from traditional practices and norms of ‘filial piety’, they can be interpreted as a rational adaptation to the changed economic circumstances in rural China.

A Model Program of Community-Based Supports for Older Adults at Risk of Nursing Facility Placement.

Transitioning an older adult into a nursing facility is a major life event for older adults (care recipients, CRs) and their family caregivers (CGs). This article describes the implementation of a community living program and presents findings on important health and well-being indicators. One hundred ninety-one participants aged 60 and older not eligible for or currently enrolled in Medicaid and meeting four risk domains (functional, health, cognitive/emotional, informal support system) were enrolled for the 10-month program. Two evidence-based interventions were blended into a comprehensive community-based approach to long-term care that included $750 per month for home care services. Measures were conducted at baseline and 6 and 12months. Nine (6%) participants did not complete the program because of nursing facility admission. CRs had fewer physician visits (4.1 vs 7.3, P<.001), emergency department visits (0.3 vs 1.4, P<.001), hospital stays (0.4 vs 0.9, P<.001), and total nights in the hospital (0.8 vs 5.1, P<.001) at 12months than at baseline. Center for Epidemiologic Studies Depression Scale (CES-D) scores also improved significantly (6.8 vs 9.4, P<.001). CGs had improvements in CES-D scores (5.9 vs 3.9, P<.001) and CG burden (14.7 s 12.6, P=.01) from baseline to 12months. This multicomponent program improved the physical and mental health of CGs and CRs at risk of nursing facility placement. Future studies are needed to compare the overall placement rate to determine the success of diverting nursing facility placement in this population of older adults.

Home support workers perceptions of family members of their older clients: a qualitative study.

BackgroundHealth care discourse is replete with references to building partnerships between formal and informal care systems of support, particularly in community and home based health care. Little work has been done to examine the relationship between home health care workers and family caregivers of older clients. The purpose of this study is to examine home support workers’ (HSWs) perceptions of their interactions with their clients’ family members. The goal of this research is to improve client care and better connect formal and informal care systems.MethodsA qualitative study, using in-depth interviews was conducted with 118 home support workers in British Columbia, Canada. Framework analysis was used and a number of strategies were employed to ensure rigor including: memo writing and analysis meetings. Interviews were transcribed verbatim and sent to a professional transcription agency. Nvivo 10 software was used to manage the data.ResultsInteractions between HSWs and family members are characterized in terms both of complementary labour (family members providing informational and instrumental support to HSWs), and disrupted labour (family members creating emotion work and additional instrumental work for HSWs). Two factors, the care plan and empathic awareness, further impact the relationship between HSWs and family caregivers.ConclusionsHSWs and family members work to support one another instrumentally and emotionally through interdependent interactions and empathic awareness. Organizational Care Plans that are too rigid or limited in their scope are key factors constraining interactions.

Spatial pattern of structural ageing in eastern Croatia: evolution and explanations

This article aims to examine the ageing situation and social policy issues in the Osijek-Baranja County of eastern Croatia. Using historical evidence from census data, research suggests that the evolution of the ageing pattern has been mainly determined by such factors as development of the transport system, changes in political-territorial organisation, supply of jobs in the cities, deagrarianisation and a domestic war in the 1990s. The increased importance of urban centres, through planned industrialisation and administrative centralisation, has accelerated and intensified rural-tourban migration. Consequently, the spatial pattern of structural ageing has been substantially affected. A significant variation was found in urban and rural areas and also within sub-regional units. The findings suggest that the evolution of spatial disparities in the ageing pattern is because of unplanned migration; spatial differences in the level of socio-economic development; the influence of tradition, such as higher fertility rates historically in some areas; and suburbanisation, notably around the city of Osijek. The article concludes that ageing is affecting the country’s economic growth and the formal and informal social support systems, including the provision of resources for older citizens in the endangered areas.

Identity development of mothers with mental illness: Contribution and challenge of motherhood

ABSTRACTLimited knowledge exists about the experience of mothers with serious mental illness in developing their maternal identity and the challenges they face in this process. This subject was examined in Israel in a qualitative research with 12 mothers. The results indicated the contribution of the motherhood experience to the development of positive identity and to the management of mental illness. The mothers described tensions between their efforts to maintain their maternal identity during periods of deterioration in their mental health situation, as well as lack of sufficient attention by their formal and informal support systems to these tensions. Mental health professionals need to provide legitimacy to the positive contribution that the motherhood experience may have on the women’s identity, as well as to provide them support with the effects that changes in their mental health situation may have on their sense of maternal identity.

War‐affected children's approach to resettlement: Implications for child and family services

In Canada, the resettlement of thousands of war‐affected children every year poses new challenges to child and family services. Since young people arrive from multiple contexts either alone or accompanied by family or caregiver(s), after having endured significant trauma, stress, and adversity, conventional approaches to service delivery are seldom adequate. Drawing on anthropology of childhood literature, this paper calls for increased inclusion of young people's experiences and perspectives in reconfiguring psychosocial services. Interactive focus groups and in‐depth interviews with youth from war‐affected countries and service providers in Québec uncovered the ways that war alters family and how young people rely on both formal and informal support systems during resettlement. Young people and service providers reflected on inadequacies of current services in meeting the complex needs of youth while service professionals reported being ill‐equipped to support war‐affected youth. This paper posits that perspectives from the anthropology of childhood are critical in liaising between youth and professionals to provide services that build on a socioecological view of development, provide healing, and recognize the diversity of children and families’ kinship ties.

A home-based, nurse-led health program for postoperative patients with early-stage cervical cancer: A randomized controlled trial

PurposeTo investigate the effect of a home-based, nurse-led health program on quality of life and family function for postoperative patients with early-stage cervical cancer. Method226 cervical cancer patients, from two hospitals between December 2012 and April 2014, were randomly divided into intervention and control groups. Patients in the intervention group received an individual home-based, nurse-led health program (family-care team provision, physiological rehabilitation, emotion-release management, informal social support system, and follow-up monitoring), in addition to conventional nursing education. Patients in the control group only received conventional nursing education. The Functional Assessment Cancer Therapy-Cervix, Female Sexual Function Index, and the Family Adaptability and Cohesion Scale were used for assessment before and after the intervention. ResultsAfter the intervention, significant improvements were found for the quality of life total scores (t=−7.650, p=0.000), sexual function scores (t=−6.465, p=0.000), cohesion scores (t=−8.417, p=0.001) and adaptability scores (t=−10.735, p=0.000) in the intervention group. Moreover, proportions of family types were also improved (χ2 = 17.77, p=0.000). However, for the control group, no significant differences were found except for a decrease in sexual function scores (t = −4.035, p=0.000). Significant differences in change scores between groups were also found for quality of life (F=41.980, p=0.000), Sexual function (F=37.380, p=0.000), cohesion (F=15.268, p=0.000) and adaptability (F=16.998, p=0.000). ConclusionA home-based, nurse-led health promotion program improves the quality of life, sexual function and family function in postoperative patients with early-stage cervical cancer.

Do Hispanic and Non-Hispanic Women Survivors of Intimate Partner Violence Differ in Regards to Their Help-Seeking? A Qualitative Study

Socio-cultural and sociopolitical influences on women’s experiences of intimate partner violence (IPV) and their decision-making processes are not well-understood. This study characterizes help-seeking behaviors of Hispanic and non-Hispanic survivors using Liang et al.’s analytical framework and identifies differences in barriers to help-seeking between these cultural groups. Transcripts from two focus groups of non-Hispanic survivors and one focus group of Hispanic survivors were coded to identify similar and dissimilar factors impacting Liang et al.’s three stages of help-seeking. Though several barriers were common, Hispanic participants felt informal support systems were inaccessible and being involved in IPV was shaming. They preferred to not seek help but act to change their circumstances. Non-Hispanic participants described extensive experience with formal systems, but relied on strong self-advocacy skills for effectiveness. These findings highlight the importance of understanding the socio-cultural context in which decision-making processes occur in order to provide the best support to IPV survivors.

The other 23 hours: a qualitative study of fitness provider perspectives on social support for health promotion for adults with mental illness.

Current efforts to reduce the increased risk of premature death from preventable cardiovascular disease among adults with serious mental illness (SMI) through lifestyle change have had limited success. Engaging informal support systems to promote healthy behaviors in everyday life may increase the effectiveness of health promotion interventions targeting this at-risk population. In-depth semistructured interviews were conducted with 10 fitness trainers serving adults with SMI in a health promotion program at community mental health centers to explore their perspectives on the potential of enlisting support from significant others for health behavior change. Trainers reported that the majority of participants had a relative or significant other who influenced their health behaviors, and they saw potential value in involving them in efforts to improve health outcomes by extending support into participants' daily lives. They did not feel qualified to work with families of individuals with mental illness, but they were willing to partner with providers who had experience in this area. Social workers who practice with families could play a critical role on health promotion teams addressing cardiovascular risk in adults with SMI by using their skills and experiences to engage families in supporting a relative through the process of health behavior change.

A synthesis of the theory of silencing the self and the social ecological model: understanding gender, race, and depression in African American women living with HIV infection.

The challenges that face African American women living with HIV are immense. African American women continue to be disproportionately infected and affected by this chronic and life-threatening infection in a complex context of individual experience, interactions with the environment, formal and informal support systems, and cultural belief systems. This article identifies the Theory of Silencing the Self (STS) and a widely known model, the Social Ecological Model (SEM), as a synthesized explanatory framework in helping nurses understand how to address research questions and clinical care that is congruent with the experience of African American women living with HIV infection. In synthesizing the components of these two frameworks, an explanation of the relationship between disempowerment and depression in this population will be uncovered as a key component to making relationships at the individual, family, and community level better. Helping African American women living with HIV infection to explore and address how choosing to be silent across their life systems will advance healthcare adherence as we currently know it to improved self-management of a chronic, gender-specific, culturally-bound experience of depression.

Depressive Symptoms Among Older Adults Who Do Not Drive: Association With Mobility Resources and Perceived Transportation Barriers.

To examine alternative means of mobility that nondriving older adults rely on and their impact on well-being. Data from the 2011 (T1, N = 6,680) and 2012 (T2, N = 5,413) interview waves of the National Health and Aging Trends Study were used to examine sample characteristics by driving status, use of alternative mobility resources, and perceived transportation-related barriers among ex-drivers and nondrivers, and their association with depressive symptoms. A majority of nondrivers relied on their informal support system and/or paid assistance to drive them to places. About half reported walking/using a wheelchair or scooter. A significant proportion of never drivers also used public transportation and van/shuttle services, whereas a smaller proportion of ex-drivers used them. Nondrivers who walked for transport had lower depressive symptoms than those who did not walk at either T1 or T2, and perception of transportation barriers to visiting friends/family was associated with higher depressive symptoms at T1 only. Older adults' mobility needs should be met through increasing walkability, public and paratransit transportation, supplemental senior transportation, and increasing informal caregivers-transportation providers' ability to aid older adults.

Formal and Informal Support Systems for Single Women and Single Mothers in Malaysia

The aim of this paper is to explore how formal and informal supports were being experienced by single women and single mothers in Malaysia. Closely examining formal and informal support systems reported by single mothers and single women in Malaysia, participants generally reported good and were mainly satisfied with their informal support system. Informal support system comprised of mostly family members and friends. However, formal support system was still lacking and both single women and single mothers were more likely to report an “unfriendly” formal support system. Findings provide important policy and theoretical implications suggesting the need for a more gender-sensitive governmental policy and practice.

The health of female prisoners in Indonesia.

Indonesian law provides prisoners with basic rights, including access to education, health care and nutrition. Yet, structural and institutional limitations, notably overcrowding and under-resourcing, prohibits penal institutions from fulfilling these commitments for female prisoners. The purpose of this paper is to explore their health concerns. Six prisons and one detention centre were researched, comprising: female prisoners (n=69); clinical officers (six); clinic heads (seven); wardens (seven); heads of prisons (seven); and a Directorate representative. Data were collected through observation, focus group discussions, in-depth interviews and a semi-structured questionnaire. Raw data were transcribed and analysed thematically, adopting the General Principles of Grounded Theory. Both "formal" and "informal" health-coping strategies were dependent upon a range of factors which determined access to treatment, medicines and other items procured both inside and outside of the prison, as well as referral services. Informal systems of support existed for women, especially in regard to pregnancy and raising of babies born in detention. Systems that maintain harmony within cell blocks were identified as an important informal coping strategy. This research is important in informing policy and practice. There is a clear need for gender-sensitive legislative frameworks, penal policies and prison rules to ensure women's needs are addressed. The identified coping strategies were considered viable, but do not replace the need for a health system providing women prisoners with levels of care as available in the community, including commensurate budgeting, personnel, access and referral to more specialised external health services.

A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia.

Research on obstetric fistula has paid limited attention to the lived experiences of survivors. This qualitative study explored the evolution of survivors’ perceptions of their social relationships and health since developing this obstetric complication. In-depth interviews were conducted with eight survivors who were selected based on purposive and snowball sampling techniques. Thematic categorization and content analysis was used to analyze the data. The resultant themes included participants’ understanding of factors predisposing to fistula, challenges they encounter, their coping responses, and the meaning of their experiences. First, the participants had a common understanding of the factors that predisposed them to obstetric fistula. They mentioned poor knowledge about pregnancy, early marriage, cultural practices, and a delay in or lack of access to emergency obstetric care. Second, the participants suffered from powerlessness experienced during their childhood and married lives. They also faced prolonged obstructed labor, physical injury, emotional breakdown, depression, erosion of social capital, and loss of healthy years. Third, to control their negative emotions, participants reported isolating themselves, having suicidal thoughts, positive interpretation about the future, and avoidance. To obtain relief from their disease, the women used their family support, sold their properties, and oriented to reality. Fourth, the participants were struggling to keep going, to accept their changed reality, and to change their perspectives on life. In conclusion, obstetric fistula has significant physical, psychosocial, and emotional consequences. The study participants were not passive victims but rather active survivors of these challenges. Adequate support was not provided by their formal or informal support systems. To prevent and manage obstetric fistula successfully, there should be family-based interventions that improve access to and provision of emergency obstetric care. These initiatives should also ensure men’s participation, women’s empowerment, and the utilization of community-based institutions.

Small but Mighty: Perspectives of Rural Mental Health Counselors

Limited research is available on the experiences of rural mental health counselors. The following is a phenomenological study grounded in critical theory. Four practicing licensed professional counselors currently working in rural settings in the Midwest region of the United States were interviewed to elicit stories regarding rural counseling, supervision and professional development experiences. The participants' responses included the following themes: (a) need for flexibility, (b) resource availability, (c) isolation, (d) ethical dilemmas and (e) finding meaning in one's work. The results contribute to a small but growing body of research about rural counselors, who are often misunderstood in the context of mental health.Keywords: rural counseling, rural mental health, ethical dilemmas, phenomenological, professional developmentNo common culture for the rural United States is absolute. Rural communities range according to geographic location, diversity of inhabitants, social and economic factors, problems and resources available (Bushy & Carty, 1994). As such, counselors-in-training often lack critical background information to competently and ethically serve traditionally underserved clientele (Smalley et al., 2010); in addition, counselors often lack the professionalism necessary for dealing with the profusion of unique issues in rural settings. Authors have documented studies related to rural school counseling, rural marriage and family therapy, rural mental health practitioners, rural clinical psychology, and rural healthcare and education (Bambling et al., 2007; Boyd et al, 2007; Curtin & Hargrove, 2010; Curtis, Waters, & Brindis, 2011; Ellis, Konrad, Thomas, & Morrissey, 2009; Endacott et al, 2006; Hartley, Loux, Gale, Lambert, & Yousefian, 2010; Lockhart, 2006; McCord et al., 2011; Morris, 2006; Murry, Heflinger, Suiter, & Brody, 2011; Owens, Richerson, Murphy, Jageleweski, & Rossi, 2007; Smalley et al., 2010). There is a noticeable gap in the literature, however, related to rural mental health counseling experiences.The many definitions of rural reflect the complexity and dynamism of this elusive concept. In one scenario, population density may be the focus of the definition, whereas in other cases, geographic isolation may take precedence. For example, the U.S. Census Bureau (2013) uses the urban-rural classification system to distinguish between two types of urban areas: (a) urban communities of 50,000 or more people and (b) urban clusters of between 2,500 and 50,000 people. Rural thereby encompasses all population, housing and territory not included within an urban area (U.S. Census Bureau, 2013). However, the U.S. Department of Agriculture uses a regional-economic concept as defined by the Office of Management and Budget, which distinguishes metropolitan areas as broad labor-market areas that include (a) central counties with one or more urbanized areas (densely populated areas with more than 50,000 people), and (b) outlying counties that are economically tied to the core counties as evidenced by labor-force commuting (U.S. Department of Agriculture, 2013). Nonmetropolitan areas are therefore those outside these metropolitan areas (U.S. Department of Agriculture, 2013). For the purposes of this article, rural is defined according to the Office of Management and Budget geographic isolation definition, with rural counties constituting those with fewer than 50,000 people as well as counties not economically tied to densely populated counties.Bushy and Carty (1994) authored one of two articles specifically devoted to rural mental health counseling. The authors provided a solid foundation of rural mental health considerations, outlining the availability, accessibility and acceptability of services. The authors also described rural culture and its intersection with mental health, stating that utilization patterns are typically characterized by informal support systems versus social services. …