Male Service Users Research Articles

Evaluation of a mobile COVID-19 vaccination van outreach service in an outer South London borough.

This study aimed to explore differences in users of a COVID-19 mobile vaccine van service and users of a COVID-19 static vaccination hub, and the impact of changes in national COVID-19 vaccine policy on vaccine uptake. The age distribution of male and female service users in each service was compared. The average number of vaccines administered per hour per week was analysed. Females aged 80-89 represented 51.9% (95% CI 49.5-54.3%) of female vaccine van users compared with 2.8% (95% CI 2.5-3.1%) of female static hub users. The static hub had significantly greater proportions of female service users in all other age brackets.For males, the greatest difference was in those aged 70-79 who represented 29.8% (95% CI 27-32.6%) of vaccine van users and 16.6% (95% CI 16-17.2%) static hub users.Fewer vaccines were administered 2-3weeks before the COVID-19 autumn booster policy change compared with 2-3weeks after; 1.92 versus 6.25 vaccines per hour, respectively (Mann-Whitney U=7, n1=11, n2=8, P<0.01 two-tailed). These findings suggest that a mobile vaccine van service is an effective model for increasing COVID-19 vaccination uptake in elderly residents, particularly after a national policy change.

How do health care services help and hinder recovery after a suicide attempt? A qualitative analysis of Finnish service user perspectives

BackgroundSuicide attempt survivors are at high risk of re-attempts and suicide death. Previous research has shown that service users’ experiences of post-attempt care are related to future treatment engagement and re-attempts. In-depth understanding of how current services meet service users’ needs in the period immediately following a suicide attempt is thus imperative for the development of more effective tertiary prevention practices in real-life health care systems.MethodIn this qualitative study, Finnish suicide attempt survivors’ experiences of and perspectives on mental health services were explored through a semi-structured interview. Participants were seven female and seven male service users interviewed 3–6 months after the index suicide attempt. A conventional content analysis of these service user interviews is presented.ResultsParticipants’ experiences of care ranged from helping to hindering recovery. Seven key aspects of services were described as helpful when present and hindering when absent. These included (1) meeting the service user as worthy of help, (2) supporting the exploration of personal meanings, (3) supporting the exploration of suicidality, (4) psychological continuity and predictability, (5) offering a responsive partnership in navigating recovery, (6) inviting service user involvement in medication decisions, and (7) accounting for service users’ relational context.ConclusionsCurrent health care services are inconsistent in meeting suicide attempt survivors’ subjective needs, leaving clear room for improvement in tertiary suicide prevention. To be perceived as meaningful by service users, services should strive to offer opportunities for both biomedical, psychological, and social interventions, with responsivity to individual needs and preferences. A focus on the social aspects of recovery (e.g., offering support to loved ones affected by the suicidal incident; facilitating peer support and social belonging) was most often found to be lacking in current services.

The gendered drivers of absenteeism in the Nigerian health system.

The ability to deliver primary care in Nigeria is undermined by chronic absenteeism, but an understanding of its drivers is needed if effective responses are to be developed. While there is a small but growing body of relevant research, the gendered dynamics of absenteeism remains largely unexplored. We apply a gendered perspective to understanding absenteeism and propose targeted strategies that appear likely to reduce it. We did so by means of a qualitative study that was part of a larger project examining corruption within the health system in six primary healthcare facilities across rural and urban regions in Enugu State, south-east Nigeria. We conducted 30 in-depth interviews with frontline health workers, healthcare managers and community members of the health facility committee. Six focus group discussions were held with male and female service users. Data were analysed using thematic analysis. Participants described markedly gendered differences in the factors contributing to health worker absenteeism that were related to gender norms. Absence by female health workers was attributed to domestic and caregiving responsibilities, including housekeeping, childcare, cooking, washing and non-commercial farming used to support their families. Male health workers were most often absent to fulfil expectations related to their role as breadwinners, with dual practice and work in other sectors to generate additional income generation as their formal salaries were considered irregular and poor. Demands arising from socio-cultural and religious events affected the attendance of both male and female health workers. Both men and women were subject to sanctions, but managers and facility chairs were more lenient with women when absence was due to caregiving and other domestic responsibilities. In summary, gender roles influence absenteeism amongst primary healthcare workers in Nigeria and thus should be taken into account in developing nuanced responses that take account of the social, economic and cultural factors that underpin these roles.

Understanding differences in mental health service use by men: an intersectional analysis of routine data

PurposeRates of help-seeking for common mental health problems are lower for men, but less is known about patterns of engagement once they are in contact with services. Previous research has been limited in its ability to understand the intersection between service user characteristics and engagement. This study compared analytic approaches to investigate intersectional associations between sociodemographic and socioeconomic indicators and use of psychological treatment services by men.MethodData from 9,904 male service users attending two psychological treatment services in London were analysed. The association between ethnicity, sexual orientation, religious affiliation and employment status of service users and service use outcomes was explored using multinomial logistic regression and latent class analysis (LCA).ResultsBeing from a minoritised ethnic background, of Muslim faith, being unemployed, and living in the most deprived neighbourhoods were associated with greater risk of not commencing or completing treatment. Seven classes were identified in LCA, with men predominately differentiated by self-reported ethnicity and religion. Compared with the ‘White British, non-religious’ class, the ‘Asian Muslim’ class and the ‘minoritised ethnic, non-religious’ class were at higher risk of disengagement, whilst the ‘Asian, other religion’ class were at higher risk of being referred elsewhere rather than completing initiated treatment.ConclusionsThere were significant inequalities in engagement by men associated with ethnicity, religion and socioeconomic status. Compared with the regression models, further nuance was apparent in LCA regarding the intersection of gender, religion and ethnicity. Identifying groups at greater risk of discontinuation of treatment could inform more personalised pathways through care.

Loneliness, coping practices and masculinities in later life: Findings from a study of older men living alone in England.

While much attention has been given to loneliness as a public health and societal problem less consideration has been given to men's experiences, particularly in later life, and there is a limited evidence based on what works with supporting older men to counteract the impact of loneliness on their mental and social wellbeing. In this paper, we focus on the experiences of older men living alone in the community. Between 2017–2018 72 men residing in England (65–95 years) took part in the study and shared their accounts of experiencing and addressing loneliness on an everyday basis. We generated qualitative data through semi‐structured interviews. Interview data were analysed thematically using the framework analysis approach. We present and discuss findings on the difficulties older men experience in responding to and discussing loneliness and the range of coping practices men applied within their home environments. Three core themes are presented: 1. Maintaining silence around loneliness and distress; 2. Getting on with it versus feeling stuck in loneliness and, 3. Temporary remedies and distractions from loneliness from within the home. Across men's accounts, ‘the home’ is constructed as a space of biographical connections with others as well as a restrictive environment of separation from others. In relation to help‐seeking and efforts to break silence surrounding loneliness, the findings speak to the ways in which masculinities and social expectations attached to male roles complicate older men's varying attempts at help‐seeking and underpin some of their everyday methods of coping with loneliness. The findings reiterate the importance of targeted individual support for older men, particularly for those feeling frozen in loneliness. Facilitators of group‐based support for older men need to recognise the different and potentially conflicting positions older male service users may adopt in relation to help‐seeking that are configured around masculine ideals but in diverging ways.

User involvement in interprofessional team meetings within services for substance use disorders.

Background:People with substance use disorders (SUD) and concurrent mental health disorders often need prolonged, coordinated health and welfare services. Interprofessional team meetings are designed to tailor services to users’ needs and should be based on interprofessional collaboration involving the user.Aims:To investigate service users’ experiences with interprofessional team meetings and to identify potential barriers to successful user involvement.Methods:Semi-structured interviews with five male service users aged 27–36 years with concurrent substance use and psychiatric disorders, and observations of team meetings involving both users and relevant professionals. Users were interviewed shortly after commencing treatment and after the team meeting. A phenomenographical approach framed the data analysis.Results:Users described the interprofessional team meetings as less than useful, and perceived that lack of a targeted process and of information hindered their collaboration with professionals. Observations revealed that users were given a subordinate role in the meetings, which largely undermined their involvement. Three categories reflecting lack of information as a core obstacle to user involvement emerged from the data material: (i) unclear role responsibilities and unclear professional role functions, (ii) unclear practices regarding rules and routines, and (iii) absence of user knowledge.Conclusions:User involvement in team meetings may be improved by facilitating adequate information, clarifying role expectations, emphasising user knowledge, increasing professionals’ awareness of the importance of collaboration, and by teaching skills that enhance user involvement.

Social media: A challenge to identity and relational desistance

Society has witnessed a rapid growth in the prevalence and use of social media. The influence and impact of this expansion has sparsely, if at all, been considered within the context of desistance from crime. This article draws upon the narratives of male and female service users subject to community supervision by a Community Rehabilitation Company, collected as part of a doctoral thesis. Evidence demonstrates how social media plays a largely negative role, with some gendered difference on a service user’s identity and relational desistance, alongside individual agency and wider social structures. This enables the article to develop the evidence base of interactionist perspectives of desistance, while also recognising gender.

Service user and healthcare provider perspectives on barriers for men using sexually transmitted infection services in public hospital of Nepal: a qualitative study

ABSTRACT Background In a time of rapid modernization in Nepal, most Nepalese men are engaging in more risky sexual health behaviours. As most of these Nepali men have little factual information or guidance about sexual health or access to health care, it is imperative to explore how and if there remain particular barriers to sexual health service use for sexually transmitted infection (STI) prevention, screening and treatment. Our study explored the perspectives of healthcare providers and Nepalese men as service users who access public hospital in Nepal, regarding the barriers to STI service use. Methods 18 semi-structured interviews were conducted through purposive sampling for healthcare service providers while Nepali male service users between age 25–49 years were interviewed following a convenience sampling. Qualitative thematic analysis, separately for providers and service users was conducted in order to identify varying perspectives regarding barriers to STI service use. Results The main barriers by healthcare providers include low health literacy, poor user-provider interaction, overcrowding in service delivery, and in maintaining confidentiality. Service users mentioned about poor sexual health knowledge and confidentiality remain a concern, while both groups mentioned about fear of infection with STI as a facilitator factor in availing sexual health service screening and treatment. Conclusion Our data identify complexities of delivering sexual health services to Nepali men and barriers to service use. The data suggest that there is a need for greater education regarding STIs and related services, and also consideration of the various cultural factors that influence service use in Nepal.

Exploring the involvement of men who use intimate partner violence in social work education: Student and service user views

There is growing international interest in service user involvement in social work education, but some service user groups are more likely to be included than others. This article explores the possibility of involving male service users who use intimate partner violence in Australian social work education. The article describes focus groups conducted separately with social work students and men who use intimate partner violence, which explored participants’ understandings of lived experience, service user involvement in social work education and the place of men who use intimate partner violence in the social work academy. The findings suggest it may be possible to involve previously excluded service user groups in social work education.

‘Monsters don’t bother me anymore’ forensic mental health service users’ experiences of acceptance and commitment therapy for psychosis

ABSTRACTAcceptance and Commitment Therapy for psychosis (ACTp) is an approach that aims to change the relationship an individual with psychosis has with difficult thoughts, emotions and experiences. It promotes the use of acceptance, defusion, mindfulness and focussing on valued outcomes as opposed to struggling with psychotic experiences. This service evaluation project explored service users’ experiences and meanings of ACTp within a medium secure mental health service. Thematic analysis was used to analyse interviews with 10 male service users. Four main themes emerged from the data: ‘Recovery’, ‘Insight’, ‘Developing Skills’ and ‘Accessibility’. Overall, service users viewed their experience of ACTp positively and identified encouraging therapeutic outcomes. These findings suggest that ACTp is an approach that should be considered a therapeutic option within forensic mental health contexts. These outcomes were compared with previous research findings. Limitations of the study, clinical implications and ideas for future research have been discussed.

Moving on from early intervention for psychosis services: Service user perspectives on the facilitators and barriers of transition.

Early intervention for psychosis services (EIS) has been established worldwide and is offered to individuals experiencing a first episode of psychosis. Engagement with EIS typically lasts for 3 years, after which point, service users are either transferred to primary care or community mental health teams, according to perceived needs. Although UK National Institute for Clinical Excellence (NICE) guidelines recommend transfer of care should be arranged in conjunction with the receiving service, there exists little, if any, practical guidance as to how this should actually be managed. This study aims to investigate the barriers and facilitators of transition from EIS to both primary and secondary care services in the United Kingdom from the perspectives of service users. Fifteen EIS service users who had either been discharged to primary or secondary services were interviewed about their experience of discharge. Data were analysed using interpretive thematic analysis, adopting a critical realist stance. Four themes were identified: feeling ready for discharge; relationships and trust; planning for discharge; life after EIS. This is the first in-depth exploration of a sample of largely male service users' views on transition from EIS to primary and/or secondary care services. We highlight several practical steps that EIS and receiving services can take to facilitate a more optimal discharge and transition experience for EIS service users. Taking into account service pressures, the discharge process should be one that is gradual, allowing time for the service user to both process the news and gradually sever ties with keyworkers.

Predictors of quality of care in mental health supported accommodation services in England: a multiple regression modelling study

BackgroundSpecialist mental health supported accommodation services are a key component to a graduated level of care from hospital to independently living in the community for people with complex, longer term mental health problems. However, they come at a high cost and there has been a lack of research on the quality of these services. The QuEST (Quality and Effectiveness of Supported tenancies) study, a five-year programme of research funded by the National Institute for Health Research, aimed to address this. It included the development of the first standardised quality assessment tool for supported accommodation services, the QuIRC-SA (Quality Indicator for Rehabilitative Care – Supported Accommodation). Using data collected from the QuIRC-SA, we aimed to identify potential service characteristics that were associated with quality of care.MethodsData collected from QuIRC-SAs with 150 individual services in England (28 residential care, 87 supported housing and 35 floating outreach) from four different sources were analysed using multiple regression modelling to investigate associations between service characteristics (local authority area index score, total beds/spaces, staffing intensity, percentage of male service users and service user ability) and areas of quality of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self-Management and Autonomy, Social Interface, Human Rights and Recovery Based Practice).ResultsThe local authority area in which the service is located, the service size (number of beds/places) and the usual expected length of stay were each negatively associated with up to six of the seven QuIRC-SA domains. Staffing intensity was positively associated with two domains (Therapeutic Environment and Treatments and Interventions) and negatively associated with one (Human Rights). The percentage of male service users was positively associated with one domain (Treatments and Interventions) and service user ability was not associated with any of the domains.ConclusionsThis study identified service characteristics associated with quality of care in specialist mental health supported accommodation services that can be used in the design and specification of services.

Gender differences among Veterans with alcohol use disorder nationally in the Veterans Health Administration

Alcohol use among women is increasing relative to men but no study has compared rates and characteristics of women with alcohol use disorder (AUD) to men among Veterans Health Administration (VHA) service users. To compare male and female VHA service users on rates of AUD, and among those with AUD, on sociodemographic characteristics, medical and physical comorbidities, and service and medication use national VHA data from fiscal year (FY) 2012 were used to identify Veterans diagnosed with AUD. Bivariate analyses evaluate gender differences in: sociodemographic characteristics; comorbid medical and psychiatric diagnoses; service use and psychotropic prescription fills. Multivariate stepwise logistic regression was used to identify a parsimonious set of differences. About 13,797 of all 349,430 women served by VHA in FY 2012 (3.94%) were diagnosed with AUD as compared to 331,407 of 5,102,877 men (6.50%) for a risk ratio of 0.608 for AUD among women. Women were younger, more likely to have served in recent Middle East conflicts and had more comorbid psychiatric and substance use diagnoses than men. They filled fewer psychotropic prescriptions (after taking greater number of psychiatric diagnoses in to account), but were more likely to fill a prescription for naltrexone than men. Women had fewer comorbid medical diagnoses than men. Women Veterans with an AUD have higher rates of psychiatric comorbidities than men, highlighting the need for better integration of treatment for AUD and comorbid psychiatric conditions, and suggesting different pathways and potential interventions for AUD in women.

Sensory strategies in adult mental health: A qualitative exploration of staff perspectives following the introduction of a sensory room on a male adult acute ward.

In recent years, there has been growing interest in the use of sensory techniques to help with emotional regulation in adult mental health populations. This is against a backdrop of international policies aimed at reducing restrictive interventions and improving the effectiveness of de-escalation techniques. A sensory room was designed and implemented on a male adult acute psychiatric ward. Staff perspectives were sought to evaluate the effectiveness of the room in managing emotional distress by exploring staff awareness of a broader range of de-escalation strategies and by exploring what effect the room had on staff behaviours with respect to sensory interventions. A series of semi-structured interviews were carried out, analysed, and grouped into themes. Three themes emerged as follows: enhancing de-escalation, sensory interventions, and impact on staff. Findings showed that increased awareness of sensory processing and use of sensory strategies such as the sensory room were perceived by staff to have a positive impact on reducing distress with male service users. Staff use of the room was also discovered to have benefits that included staff attending to their own emotional needs and the use of the room supporting reflective learning during critical incident debriefing.

Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists

Optimising quality of life (QOL) for service users in a forensic hospital is an important treatment objective. The factors which contribute to QOL in this setting are currently unclear. The aim of this study was to analyse the predictors of QOL amongst service users within an inpatient forensic mental health hospital. This study is a naturalistic, cross-sectional, observational study. Fifty-two male service users with schizophrenia or schizoaffective disorder participated in the study. QOL was measured using the World Health Organisation QOL Bref. We used the Engagement in Meaningful Activity Survey (EMAS), ward atmosphere was measured using the Essen Climate Evaluation Schema (EssenCES), occupational functioning was assessed using the Social and Occupational Functioning Scale (SOFAS). We also collected level of ward security, length of stay and community leave data. Stepwise regression showed that meaningful activity, level of ward security, and therapeutic hold on the EssenCES significantly predicted QOL on a range of specific QOL domains. These variables accounted for 40% of the variance for total QOL score. Engagement in meaningful activity added the largest contribution to total QOL score accounting for 30% of the variance. This study shows that provision of meaningful activities, level of ward security and therapeutic hold may contribute to QOL amongst forensic mental health inpatients.

Perspectives of cannabis use in the life experience of men with schizophrenia.

Substance use amongst people with schizophrenia is well-established: up to 50% report using illicit substances. The occurrence of both conditions can also induce people to disengage from mental health services. The research question sought to understand, from the perspective of both service users and clinicians, cannabis use within the experience of people with schizophrenia. The transcripts of the seven participants and the two focus groups were analysed using interpretative phenomenological analysis. Service Users and Clinicians were recruited from Assertive outreach community-based teams. seven male service users who described their ethnic identity as 'black', diagnosed with schizophrenia and a history of treatment disengagement and 12 clinicians who worked with this client group. The two component study involved semi-structured interviews with the Service Users and two focus groups with the Clinicians. Service Users perceived cannabis use as a means by which they could 'reestablish their identity' that had been damaged and the social consequences of diagnosis. Clinicians similarly perceived drugs, cannabis in particular, as a significant part of the service users' life. This study provides greater depth to understanding cannabis use within the experience of people with a diagnosis of schizophrenia.

Treatment challenges for alcohol service users in Kampala, Uganda

Kalema, D., Vanderplasschen, W., Vindevogel, S., Baguma, P., &amp; Derluyn, I. (2017). Treatment challenges for alcohol service users in Kampala, Uganda. The International Journal Of Alcohol And Drug Research, 6(1), 27-35. doi:http://dx.doi.org/10.7895/ijadr.v6i1.240Background and Aims: Enhancing treatment participation of persons with substance use disorders is a challenge worldwide. Obstacles keeping people from entering or continuing treatment are well documented in Western countries, but such knowledge is scarce in majority countries that face particular challenges when implementing alcohol policies. This study aimed at identifying factors challenging treatment participation in Uganda, a Sub-Saharan country with a considerable alcohol problem.Methods: Data were collected during 30 in-depth, qualitative interviews on treatment challenges with 20 service providers and 10 male service users, who were recruited at one public and one private alcohol treatment center in the Ugandan capital city, Kampala. Men comprise about 90% of the total number of service users in these centers. Interview data were analyzed thematically, using Nvivo software, and were categorized around three levels of treatment challenges: societal, institutional, and personal challenges.Findings: Interview findings showed several treatment challenges relating to institutional aspects like inadequate human resources, overall insufficiency of services, and the treatment philosophy of available services. Respondents identified stigma and cultural interference as important challenges at the societal level, while limited awareness about addiction and denial of problems can be situated at the individual level.Conclusions: Institutional, societal, and personal challenges keep persons with AUD from participating in alcohol treatment in public and private services in Uganda. Alcohol regulation, sensitization, and prevention are needed to raise awareness at the societal and individual level, while appropriate training and additional financial resources may help to overcome institutional challenges.

Feasibility and acceptability of brief cognitive remediation targeting metacognition in acute inpatients with psychosis: a case series

ABSTRACTCognitive remediation (CR) is an intensive intervention targeting cognitive impairment with the aim of improving functioning in people with psychotic disorders. Shorter forms of CR based on metacognition and targeting awareness of cognitive problems may be more appropriate for acute inpatient settings where time is limited. The objective of the study was to evaluate the feasibility and acceptability of a new brief course of CR targeting cognitive and metacognitive difficulties within an acute inpatient psychiatric setting. Thirteen male service users with psychosis received a three-week course of CR. Participants were assessed at baseline and post-treatment on cognitive measures, subjective cognitive complaints, functional impairment, and symptom severity. Feasibility was assessed based on engagement, attendance, and attrition. Acceptability was evaluated through treatment satisfaction. Eight participants completed therapy, with 81% session attendance. Therapy was considered acceptable, with the majority of participants considering it satisfactory. Potential benefit analysis showed a significant post-treatment improvement in global cognition and memory. Subjective cognitive complaints did not change over time. It was concluded that it is feasible to deliver brief CR in an acute inpatient setting. Context of delivery and engagement are challenges for optimal therapy implementation. CR protocol adaptations made to promote metacognitive competencies may compensate for lack of intensive practice.

An initial evaluation of the Global Review Form as an approach to measuring individual change

Background: Routine assessment of individual change in forensic mental health services is increasingly recognised as important. However, existing tools have been criticised and their periodic use make them unsuited to directly measure the impact of interventions. This paper describes the initial evaluation of the Global Review Form (GRF) as a framework for measuring change over time. Specifically, measurement properties, feasibility and usefulness in routine practice are examined. Method: 28 male service users in three distinct areas of an adult secure service (low secure, locked rehabilitation and high relational support housing) were rated over a 20-week period by their multidisciplinary teams. Findings: The GRF showed promising construct validity and appropriate stability and sensitivity to change across time. It enabled measurement and understanding of individual change over time. Staff feedback suggested the GRF is a useable and practical outcome measuring tool. Conclusions: The GRF shows promise for use as a routine outcome monitoring tool within forensic mental health services.

Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study

AimsTo explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes.DesignIn-depth interviews.SettingBristol, UK.Participants24 current and...