Service-related Barriers Research Articles

Challenges and Barriers to Utilizing Eye Care Services Among Urban Population Globally: A Scoping Review

Objective: Eye health is crucial for overall well-being, relying on eye care services for the prevention and treatment of vision disorders. Increasing blindness rates underscore the need for early detection. Despite known urban-rural disparities in eye care utilization, urban challenges are underexplored. This scoping review summarized and determined the challenges and barriers to utilizing eye care services specifications in urban populations globallyMaterial and Methods: A search was conducted on multiple databases such as Scopus, ScienceDirect, WOS, PubMed, and Google Scholar, covering the period of 2000 to 2023. The criteria were selected based on the PRISMA statements. The search focuses on challenges and barriers in utilizing eye care services.Results: The search identified 464 studies, and 18 were included in the final review. Person-related and service-related barriers can be distinguished from the review. The most common challenges were lack of felt need the eye care services and cost. Person-related barriers were found to be higher compared to service-related barriers among urban populations. Conclusion: The scoping review highlights significant person-related and service-related barriers to utilizing eye care services in urban populations globally. Despite the availability of services, person-related barriers were more pronounced, indicating a critical need for targeted interventions. Addressing these barriers is essential to enhance eye care services and reduce the prevalence of vision disorders in urban settings.

A Systematic Review to Evaluate the Barriers to Breast Cancer Screening in Women with Disability.

Background: Breast cancer (BC) is one of the leading causes of mortality worldwide. There are observed disparities in patients with disability as compared to those without disability, which leads to poor BC screening attendance, thereby worsening disease management. Aim: The aim of this systematic review is to investigate if there are disparities in screening rates in women with disability as compared to those without disability, as well as the different factors that pose barriers to patients with disability for enrolment in BC screening programs. Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed published articles between 2008 and 2023, which assessed different factors that contributed to poor attendance in BC screening programs held across different countries. Detailed study characteristics were obtained, and methodological quality assessment was performed on the individual studies included in this review. Result: A total of fifty-three articles were identified as eligible studies based on the pre-defined inclusion and exclusion criteria. These included 7,252,913 patients diagnosed with BC (913,902 patients with disability/6,339,011 patients without disability). The results revealed there are demographic, clinical, financial, and service-related barriers that contributed to lower screening rates in disabled patients as compared to non-disabled. Patient age is the most common factor, with the highest effect observed for 80 years (vs. 30-44 years) [odds ratio (OR) = 13.93 (95% confidence interval (CI) = 8.27-23.47), p < 0.0001], followed by race/ethnicity for Hispanic (vs. non-Hispanic white) [OR = 9.5 (95%CI = 1.0-91.9), p < 0.05]. Additionally, patients with multiple disabilities had the highest rate of dropouts [OR = 27.4 (95%CI = 21.5-33.3)]. Other factors like education, income, marital status, and insurance coverage were essential barriers in screening programs. Conclusions: This study presents a holistic view of all barriers to poor BC screening attendance in disabled patients, thereby exacerbating health inequalities. A standardized approach to overcome the identified barriers and the need for a tailored guideline, especially for disability groups, is inevitable.

Barriers to the uptake of eye care services: A cross-sectional survey from rural and urban communities.

To explore the barriers to the uptake of eye care services in urban and rural communities in Papua New Guinea. This was a population-based cross-sectional descriptive study and involved multi-stage sampling. Communities were randomly selected from each of the three clusters of Madang District for free eye care outreaches from June to September 2022. A structured questionnaire was used to collect data from the outreach patients. The study excluded attendees who refused to consent. Responses were rated from 1 (not a barrier) to 10 (a very strong barrier). The p-value significance was set at ≤ 0.05. The majority of the 972 participants (60.2%) were from rural communities. The mean age of participants was 40.82 ± 13.14 years. Almost two-thirds of the participants (61.4%) never had an eye examination before this study was conducted. All the participants reported that time constraint, insufficient income, good vision in the fellow eye, not considering their eye conditions as serious issues and cultural beliefs were personal barriers to accessing eye care services. Provider-related challenges included long waiting periods at eye clinics and fear of procedure complications. There were differences in barriers with respect to the participants' demographic clusters. There are major personal- and service-related barriers to eye care services in Madang. These barriers could be overcome through strategic human resource development, health education, school screening programs, and establishing eye care centres in the communities to improve the uptake of eye care services in Madang and more widely across the country.

Barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia: a formative qualitative study

ObjectiveTo assess barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia, in 2021.DesignA grounded theory approach to the qualitative study was conducted between December 2020 and...

Antenatal Care Predicts Neonatal Mortality in Eastern Africa: A Systematic Review and Meta-analysis of Observational Studies

Background Sub-Saharan African countries, especially the Eastern region, present the dismal picture of neonatal mortality (NM) in the globe. The majority of these deaths could be avoided if effective health measures are provided throughout pregnancy and childbirth. Although antenatal care (ANC) is assumed as one of the viable interventions that contribute to neonatal survival, the effect of ANC on NM was not systematically analyzed in Eastern Africa. Thus, the study aimed to determine the pooled effect of ANC on NM in Eastern Africa. Methods PubMed, EMBASE, CINAHL, and HINARI databases were searched using appropriate keywords from January 1, 1990 to February 12, 2021. Independent authors selected eligible articles and extracted data. The risk of a bias assessment tool for nonrandomized studies was used to assess the quality of the study. Comprehensive meta-analysis version 2 was used for meta-analysis. The random-effect model was employed, and the outcome is expressed as a risk ratio with 95% confidence interval (CI). Results In total, 1149 studies were identified through database search, and only 27 studies were included in the meta-analysis. Having at least 1 ANC visit during pregnancy reduced the risk of neonatal death by 42% compared to their counterparts (RR = 0.58, 95% CI [0.47, 0.71]). The pooled prevalence of NM was 8.5% (95% CI [7.3, 9.6]), with NM rate of 46.3/1000 live births. Conclusion The study indicated that NM might be decreased even with a single ANC visit when compared to no visits. Scaling up ANC services through ANC promotion and tackling service-related barriers could potentially reduce NM in Eastern Africa.

\u201cWe are only looking at the tip of the iceberg in infertility\u201d: perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people

IntroductionAboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group.MethodSemi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package.ResultsProviders perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men’s business and women’s business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment.ConclusionThe current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.

Adolescent Mental Health Help-Seeking from Family and Doctors: Applying the Theory of Planned Behaviour to the Northern Ireland Schools and Wellbeing Study

ABSTRACT Background Adolescent mental illness is of increasing concern, with prevalence increasing especially in females in the United Kingdom. While service-related barriers can deter help-seeking, the role of family support and engagement in family activities, and attitudes towards seeking help from a doctor has received little attention. Studies exploring help-seeking from family and medical practitioners have done so without incorporating theories of behaviour change. This study aims to develop a model of adolescent help-seeking using the Theory of Planned Behaviour (TPB). Method A cross-sectional survey of 1639 male and females aged 13–17 years in Northern Ireland. Structural Equation Modelling determined fit for TBP factors, with the addition of gender, experience of mental health issues, and engagement in family activities. Results The Structural Equation Model suggests an adequate description of the relationships between TPB variables [χ 2(639) = 8302.36, p < .001; RMSEA = 0.09; SRMR = 0.06; CFI = 0.92; IFI = 0.92], with significant variance (R 2) of up to 61% (Intentions to Seek Help from Family) and 24% (Intention to Seek Help from Medical Professionals) explained. Males (compared to females) reported a more supportive family life, fewer mental health problems, more trust in doctors, less prosocial behaviour, more confidence discussing mental health with a doctor, and greater intentions to seek family or medical professional help when having emotional/mental health problems. Conclusions When supporting adolescent’s gender, engagement with family and trust in doctors should be considered, especially where they have experienced mental health issues and may be less willing to seek help.

Patient and service-related barriers and facitators to the acceptance and use of interventions to promote communication in health and social care: a realist review

BackgroundMore people living into old age with dementia. The complexity of treatment and care, particularly those with multiple health problems, can be experienced as disjointed. As part of an evaluation of a ‘healthcare passport’ for people living with dementia we undertook a realist review of communication tools within health and social care for people living with dementia.AimsTo explore how a ‘healthcare passport’ might work in the ‘real world’ of people living with dementia through a better understanding of the theoretical issues related to, and the contextual issues that facilitate, successful communication.MethodsA realist review was considered the most appropriate methodology to inform the further development and evaluation of the healthcare passport. We undertook a purposive literature search related to communication tools to identify (a) underlying programme theories; (b) published reports and papers on their use in various healthcare settings; (c) evidence on barriers and facliitators of their use.ResultsCommunication tools were noted as a way of improving communication and outcomes through: (1) improvement of service user autonomy; (2) strengthening the therapeutic alliance; and (3) building integrated care. However, while intuitively perceived to of benefit, evidence on their use is limited and key barriers to their acceptance and use include: (1) difficulties in clearly defining purpose, content, ownership and usage; (2) understanding the role of family caregivers; and (3) preparation among healthcare professionsals.ConclusionPatient-held communication tools may be helpful to some people living with dementia but will require considerable preparation and engagement with key stakeholders.

Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers.

Systems of care (SOCs) have the potential to enhance underserved families' access to integrated health and support services. Most scholarship on SOCs has involved school-aged children and adolescents. Thus, research is needed to better understand barriers to, and facilitators of, families' access to services during early childhood. The present study included a community-based participatory approach in understanding services for families of children under age six years with severe emotional and behavioral problems. We analyzed data from two focus groups with caregivers (n = 7) and three focus groups with service providers (n = 22). Our thematic analysis of participants' responses revealed five primary barriers to family service access, including challenges associated with transition planning. In comparison, participants described four primary facilitators of family service access, including providers' adoption of "whole-family" service delivery approaches. Findings indicated areas of convergence and divergence in caregivers' and providers' responses. We discuss limitations and potential implications.

Barriers and facilitators to institutional delivery in rural areas of Chitwan district, Nepal: a qualitative study

BackgroundGiving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery.MethodsSix village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis.ResultsThree main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quality of health services. Factors encouraging an institutional delivery included complications during labour, supportive husbands and mothers-in-law, the availability of an ambulance, having birthing centres nearby, locally sufficient financial incentives and/or material incentives, the 24-h availability of midwives and friendly health service providers. Socio-cultural barriers to institutional deliveries were deeply held beliefs about childbirth being a normal life event, the wish to be cared for by family members, greater freedom of movement at home, a warm environment, the possibility to obtain appropriate “hot” foods, and shyness of young women and their position in the family hierarchy. Accessibility and quality of health services also presented barriers, including lack of road and transportation, insufficient financial incentives, poor infrastructure and equipment at birthing centres and the young age and perceived incompetence of midwives.ConclusionDespite much progress in recent years, this study revealed some important barriers to the utilization of health services. It suggests that a combination of upgrading birthing centres and strengthening the competencies of health personnel while embracing and addressing deeply rooted family values and traditions can improve existing programmes and further increase institutional delivery rates.

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs.

Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.

Determinants of use of health facility for childbirth in rural Hadiya zone, Southern Ethiopia.

BackgroundMaternal mortality remains a major global public health concern despite many international efforts. Facility-based childbirth increases access to appropriate skilled attendance and emergency obstetric care services as the vast majority of obstetric complications occur during delivery. The purpose of the study was to determine the proportion of facility delivery and assess factors influencing utilization of health facility for childbirth.MethodsA cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. Participants who delivered within three years of the survey were selected by stratified random sampling. Trained interviewers administered a pre-tested semi-structured questionnaire. We employed bivariate analysis and logistic regression to identify determinants of facility-based delivery.ResultsData from 751 participants showed that 26.9% of deliveries were attended in health facilities. In bivariate analysis, maternal age, education, husband’s level of education, possession of radio, antenatal care, place of recent ANC attended, planned pregnancy, wealth quintile, parity, birth preparedness and complication readiness, being a model family and distance from the nearest health facility were associated with facility delivery. On multiple logistic regression, age, educational status, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy and place of recent ANC attended were the determinants of facility-based childbirth.ConclusionEfforts to improve institutional deliveries in the region must strengthen initiatives that promote female education, opportunities for wealth creation, female empowerment and increased uptake of family planning among others. Service related barriers and cultural influences on the use of health facility for childbirth require further evaluation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1151-1) contains supplementary material, which is available to authorized users.

A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project

ObjectiveTo assess the barriers to uptake of eye care services among those with avoidable impairment in the population aged ≥40 years in the South Indian state of Andhra Pradesh.DesignCross-sectional study.SettingCommunity...

Health-seeking behaviour of tuberculosis patients and related factors in the central region of Ghana

The health seeking behaviour of TB patients and health service related barriers have been cited to have an influence on the management of the disease in countries with high incidence of TB. Using close and open-ended questionnaires, an assessment of the health seeking behaviour of 302 TB patients selected from 24 DOTS centres in six districts in the Central Region of Ghana was carried out. Under service-related barriers, distance from home to DOTS centre significantly impacted on the management of TB among sufferers (p=0.025). Though not significant, patients acknowledged the good reception by staff at treatment centres with 99.3% of them being comfortable with staff and services provided at centres. Majority (46.7%) of patients perceived TB to be caused by the oral route while only 9.3% knew the causative agent to be bacteria. Compared with males, quite a number of women did not have adequate knowledge on TB (p<0.05). More than half of the respondents sought treatment elsewhere as first point of treatment before reporting to the DOTS centre. Health insurance played an important role in the health seeking behaviour of respondents; 45.9% of TB patients with health insurance visited the health facility as 1st provider whilst 49.4% without health insurance visited prayer camps (p=0.001). Our study has revealed that factors such as staff attitude, distance to treatment centres, gender, employment and education are key factors that affect the health-seeking behaviour of TB patients in the Central Region of Ghana Keywords : Tuberculosis, Health, barriers, Central Region

Health-Seeking behaviour of TB patients and related factors in the Central Region of Ghana

Background: The health seeking behaviour of TB patients and health service related barriers have been cited to have a great impact on the management of the disease in countries with high incidence of TB. Methods & Materials: Using close and open-ended questionnaires, an assessment of the health seeking behaviour of 302 TB patients selected from 24 DOTS centres in six districts in the Central Region of Ghana was carried out. Results: Under service-related barriers, distance from home to DOTS centre significantly impacted on the management of TB among sufferers (p = 0.025). Though not significant, patients acknowledged the good reception by staff at treatment centres with 99.3% of them being comfortable with staff and services provided at centres. Majority (46.7%) of patients perceived TB to be caused by the oral route while only 9.3% knew the causative agent to be bacteria. Compared with males, quite a number of women did not have adequate knowledge on TB (p < 0.05). More than half of the respondents sought treatment elsewhere as first point of treatment before reporting to the DOTS centre. Health insurance played an important role in the health seeking behaviour of respondents; 45.9% of TB patients with health insurance visited the health facility as 1st provider whilst 49.4% without health insurance visited prayer camps (p = 0.001). Conclusion: Our study has revealed that factors such as staff attitude, distance to treatment centres, gender, employment and education are key factors that affect the health-seeking behaviour of TB patients in the Central Region of Ghana.

Views of health service providers on obstacles to tuberculosis control in Ghana

BackgroundAlthough Ghana does not fall into the category of those countries which have a high burden of tuberculosis (TB), the disease does present considerable economic and health limitations to individuals infected with, and affected by, the disease, as well as to the health system in general. Despite this fact, insufficient studies have been done on the key barriers to controlling the disease. This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.MethodsIn-depth interviews were conducted with frontline health workers involved in TB control in the country. Participants were purposively selected from a pool of national and regional, and district and facility level coordinators of the National Tuberculosis Control Programme (NTP). One key informant was also selected from an international non-governmental organisation (NGO) involved in TB-related activities in Ghana. Observations were utilised to complement the study. Data were analysed inductively.ResultsRespondents identified the following as being constraints to TB control: clinical complication, bottlenecks in funding administration, quality of physical infrastructure, competition for attention and funding, unsatisfactory coordination between TB and HIV control programmes, a poor public-private partnership, and weak monitoring and evaluation of interventions.ConclusionsThis paper provides evidence of some key barriers to TB control. The barriers, as reported, were generally health system-based. Although this list of barriers is not exhaustive, it would be useful to take them into account when planning for TB control, thus adopting a more rounded approach to TB management in the country. As well as that, further studies should be done to explore patients’ views on health service-related barriers to TB control.

Changing Barriers to Use of Eye Care Services in Timor-Leste: 2005 to 2010

ABSTRACTPurpose: To determine barriers to seeking eye care services in Timor-Leste in 2010, and compare this to similar analyses undertaken 5 years previously.Methods: An interview-based questionnaire used in a 2005 survey was re-administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years in Timor-Leste in 2010.Results: The participation rate for the 2010 survey was 89.5% (n = 2014). The sex-age-domicile-adjusted prevalence of a history of at least one previous or current ophthalmic problem in the population aged ≥40 years was 92.6% (95% confidence interval [CI], 91.4–93.7%). Of these, 75.4% (95% CI 73.4–77.3%) had not consulted a care provider. In multivariate analysis, rural domicile, illiteracy and subsistence farming were associated with having not sought care for an eye problem. The most frequently cited reasons were “service too far away” (36.3%), “no time/other priorities” (21.7%) and “unaware of eye care service” (20.7%). More people reported a history of an eye problem in 2010 than in 2005, but the proportion seeking care was no different. Social barriers became more prevalent for urban dwellers in 2010, while attitudinal barriers decreased. For rural residents, social and service-related barriers increased and awareness and attitudinal barriers decreased.Conclusion: Barriers to eye health service use in Timor-Leste are not universal or static. Monitoring the extent and nature of barriers, as well as the prevalence and causes of vision impairment, will help plan appropriate interventions for vulnerable groups.

Attitudes to deceased organ donation and registration as a donor among minority ethnic groups in North America and the UK: a synthesis of quantitative and qualitative research

Objectives. A systematic review and synthesis of quantitative and qualitative research were undertaken to examine attitudes to deceased donation and registration as an organ donor among ethnic minorities in the UK and North America. Design. A systematic search and assessments of relevance and quality were conducted. Parallel syntheses were then undertaken of 14 quantitative and 12 qualitative papers followed by their integration. The synthesis was organised around five barriers that emerged as key issues: (1) knowledge regarding deceased donation and registration as a donor; (2) discussion of donation/registration with family members; (3) faith and cultural beliefs; (4) bodily concerns including disfigurement and intactness; and (5) trust in doctors and the health care system. Results. In all countries, knowledge of organ donation and registration remained low despite public campaigns, with African-Americans and Black African and Black Caribbean populations in the UK often regarding organ donation as a ‘white’ issue. Each of the four attitudinal barriers was also more prevalent among ethnic minorities compared with the majority population. However, the significance of trust and uncertainties regarding religion/faith differed between groups, reflecting salient aspects of ethnic identity and experiences. Differences were also identified within ethnic groups associated with age and generation, although respect for the views of elders often influenced younger peoples' willingness to donate. Conclusion. There is a need for a more nuanced understanding of ethnicity and of variations in attitudes associated with country of origin, age/generation, socio-economic status and area of residence, to inform public campaigns and promote sensitive discussions with bereaved ethnic minority families. The traditional focus on knowledge and attitudes also requires to be complemented by a greater emphasis on organisational and service-related barriers and changes required to enhance ethnic minorities' access to registration as a donor and consent to deceased donation.

Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation

There is general agreement in Australia and other Western resettlement countries that many refugee adolescents with social, behavioural, and mental health problems are not accessing mental health care. There is, however, a paucity of research on refugee adolescent mental health service utilisation and help-seeking. Most research to date has centred on adolescents in the general population, and even then is still very limited. This paper presents the findings of 13 focus groups held with 85 refugee adolescents aged 13–17 years from Afghanistan, Bosnia, Iran, Iraq, Liberia, Serbia, and Sudan. The study was part of a wider investigation of mental health service utilisation by refugee parents of children aged 4–17 years, and by adolescents aged 13–17 years. With respect to adolescents, the focus group findings indicate that most are very reluctant to venture beyond their close friendship networks for help with their psychosocial problems due to a range of individual, cultural, and service-related barriers. Implications for mental health policymakers, service planners, and service providers are discussed.

Involving Families in the Care of Persons with Schizophrenia and Other Serious Mental Illnesses: History, Evidence, and Recommendations

Families of individuals with schizophrenia and other serious mental illnesses often provide considerable support to their ill relatives, yet many remain unaware of or unable to access resources and information to help them effectively manage their caregiver role. Consequently, family members may experience burden and subsequent distress. There is substantial evidence to suggest that participation in family services and family involvement in a consumer's clinical care can minimize family burden, leading to better outcomes for the consumer and the family. Unfortunately, few families have contact with their relatives' treatment teams, and even less participate in formal support or educational programs. There are a number of consumer-, family-, provider-, and service-related barriers, which may inhibit family involvement. However, many of these barriers can be overcome when a more individualized, tailored approach to working with families is used. The current paper provides an overview of the impact of mental...