Patients' perspectives on their motivations for participating in non-clinical medical teaching and what they gain from their experience: a qualitative study informed by critical theory.

In 2019-2021, we engaged in a project aimed at developing, implementing, and evaluating an educational intervention actively involving patient-teachers in undergraduate medical education at Université Laval, Quebec, Canada. Patient-teachers were invited to participate in small group discussion workshops during which medical students deliberate on legal, ethical, and moral issues arising from medical practice. Patients were expected to bring other perspectives, based on their experience with illness and the healthcare system. Little is still known about patients' perspectives on their participation experience in such context. Informed by critical theory, our qualitative study aims to document,: (i) the motivating factors for patients' participation in our intervention; and (ii) what patients gained from the experience. Data collection was based on 10 semi-structured interviews with patient-teachers. A thematic analysis was conducted using NVivo software. Motivators for participation arose from: (i) perceived consistency between patients' individual characteristics and those of the project, and (ii) conceiving the project as a means to reach individual and social goals. What patients gained mainly refers to (1) the appreciation of a positive, enriching, motivating yet uncomfortable and destabilizing experience; (2) a deconstruction of biases against the medical field and critical thinking about their own experience; (3) new knowledge, with a potential impact on their future interactions with the healthcare system. Results reveal patients as non-neutral thinking and knowing subjects, engaged in the participation experience as active teachers and learners. They also highlight the empowering and emancipatory nature of the learning gained through patients' participation experience. These conclusions prompt us to promote transformative interventional approaches that question the pervasive power issues in medical teaching and value patients' specific knowledge in teaching and learning the Art of Medicine.

When mental health care is stigmatizing: A participative study in schizophrenia.

OBJECTIVES: Mental health care has been identified as a major source of mental illness stigmatization. Detailed information about these stigmatization experiences is thus needed to reduce stigma in mental health practices. The study aimed to (a) identify the most relevant stigmatizing situations in mental health care encountered by users with schizophrenia and their families; (b) characterize the relative importance of these situations in terms of frequency, experienced stigmatization, and associated suffering; and (c) identify contextual and individual factors associated with these experiences. METHOD: An online survey was conducted in France among users and family members to characterize situations of stigmatization in mental health care and identify associated factors. The survey content was first developed from a participative perspective, through a focus group including users. RESULTS: A total of 235 participants were included in the survey: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses, and 80 family members. The results revealed 15 relevant situations with different levels of frequency, stigmatization, and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization, with a higher frequency. Moreover, contextual factors were strongly associated with experienced stigmatization, including recovery-oriented practices (negatively associated) and measures without consent (positively associated). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These situations, as well as associated contextual factors, could be targeted to reduce stigmatization and related suffering in mental health practices. Results strongly underscore the potential of recovery-oriented practice as an instrument to fight stigma in mental health care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Part of the solution yet part of the problem: factors of schizophrenia stigma in mental health professionals.

BACKGROUND: Stigma is highly prejudicial to persons with schizophrenia, their families, the society and the health care system. Mental health professionals (MHP) are considered to be one of the main sources of schizophrenia stigma. OBJECTIVES: The aim of the study was to identify individual and contextual factors associated with stigma in MHP in its three dimensions (stereotypes, prejudices, discrimination, Fiske, 1998). METHODS: An online survey was conducted with specific measures of MHP stigma (stereotypes, prejudices and discrimination). Four categories of potential associated factors were also measured: sociodemographic characteristics, contextual characteristics (e.g., Work setting), individual characteristics (e.g., Profession, Recovery-oriented practices) and theoretical beliefs (e.g., Biological beliefs, Perceived similarities, Continuum versus Categorical beliefs). RESULTS: Responses of 357 MHP were analysed. Factors that were the most strongly associated with MHP stigma were Perceived similarities, Categorical beliefs, Biological beliefs, Recovery-oriented practice and Work setting (independent practice). Conversely, Gender, Specific trainings in stigma or recovery and Cognitive aetiology beliefs showed no association with any of MHP stigma dimension. Remaining factors show associations with a weak effect size. CONCLUSIONS: The survey results suggest that MHP stigma is more influenced by individual factors such as theoretical beliefs and recovery-oriented practices than contextual factors. These original results provide perspectives for reducing stigma in mental health practices.Key pointsMental health professionals (MHP) considering they share similarities with persons with schizophrenia or believing that schizophrenia is not a discrete social category but rather the extreme on a continuum between 'normal' and 'pathologic' reported less stigmatisation.MHP holding higher professional utility beliefs and using recovery-oriented practice reported fewer stereotypes, prejudice and discrimination.Other factors such as age, academic level, contact frequency, familiarity and multidisciplinary practice show associations with a weak effect size.

[Sharing information and respecting confidentiality: Standards for improving the quality of mental health services]. / Partage d'informations et respect de la confidentialité : repères pour améliorer la qualité des services en santé mentale.

Objectives Collaboration between family caregivers and professionals plays a critical role in the recovery of the person living with a mental health disorder. However, collaborative practices between family caregivers and professionals are impeded by issues relating to confidentiality, particularly in connection with bidirectional information sharing between the parties involved. In doing so, these issues affect the quality of mental health services. Method A qualitative study was conducted with 19 family caregivers and 19 mental health professionals from 2 Quebec regions[2] in order to identify issues related to information sharing and confidentiality from their combined perspective. The Photovoice method was used and individuals semi-directed interviews were conducted with the 38 participants. Results Confidentiality and the refusal of the person living with a mental health disorder to consent to share information remains important and current obstacles in mental health practises. The organization of mental health services should ensure better integration of family caregivers into care teams so that they can contribute to the person's recovery and thus receive all the support and information they need to exercise their role. This study shows that family caregivers have different information needs in order to carry out their role and accompany the person living with a mental health disorder, including the need for general and non-confidential information to better support the person. While respecting the fundamental rights and autonomy of the person, who is free to consent or not to sharing information concerning him or her, professionals and family caregivers can still interact and create an alliance that promotes collaboration and recovery. Conclusion This article offers benchmarks to facilitate dialogue among people living with a mental health disorder, family caregivers and professionals, and to support their actions around information-sharing and respect for confidentiality in mental health practises. Ultimately, the intention here is to foster collaborative practices that will help improve the quality of mental health services.

Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study.

OBJECTIVES: Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals' intention to include sex and gender considerations in patient care. DESIGN AND SETTING: In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces. PARTICIPANTS: Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions. INTERVENTION AND COMPARATOR: An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator). OUTCOMES: Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals' intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework. RESULTS: All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was -0.47 (CI -0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was -0.57 (CI -1.09 to -0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care. CONCLUSIONS: CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention. TRIAL REGISTRATION NUMBER: NCT03928132 with ClinicalTrials.gov; Post-results.

"They heard our voice!" patient engagement councils in community-based primary care practices: a participatory action research pilot study.

BACKGROUND: Patient engagement could improve the quality of primary care practices. However, we know little about effective patient engagement strategies. We aimed to assess the acceptability and feasibility of embedding advisory councils of clinicians, managers, patients and caregivers to conduct patient-oriented quality improvement projects in primary care practices. METHODS: Using a participatory action research approach, we conducted our study in two non-academic primary care practices in Quebec City (Canada). Patient-experts (patients trained in research) were involved in study design, council recruitment and meeting facilitation. Advisory councils were each to include patients and/or caregivers, clinicians and managers. Over six meetings, councils would identify quality improvement priorities and plan projects accordingly. We assessed acceptability and feasibility of the councils using non-participant observations, audio-recordings and self-administered questionnaires. We used descriptive analyses, triangulated qualitative data and performed inductive thematic analysis. RESULTS: Between December 2017 and June 2018, two advisory councils were formed, each with 11 patients (36% male, mean age 53.8 years), a nurse and a manager practising as a family physician (25% male, mean age 45 years). The six meetings per practice occurred within the study period with a mean of eight patients per meeting. Councils worked on two projects each: the first council on a new information leaflet about clinic organization and operation, and on communications about local public health programs; the second on methods to further engage patients in the practice, and on improving the appointment scheduling system. Median patient satisfaction was 8/10, and 66.7% perceived councils had an impact on practice operations. They considered involvement of a manager, facilitation by patient-experts, and the fostering of mutual respect as key to this impact. Clinicians and managers liked having patients as facilitators and the respect among members. Limiting factors were difficulty focusing on a single feasible project and time constraints. Managers in both practices were committed to pursuing the councils post-study. CONCLUSION: Our results indicated that embedding advisory councils of clinicians, managers, patients and caregivers to conduct patient-oriented quality improvement projects in primary care practices is both acceptable and feasible. Future research should assess its transferability to other clinical contexts.

How to engage patients in research and quality improvement in community-based primary care settings: protocol for a participatory action research pilot study.

PLAIN ENGLISH SUMMARY: Making primary care clinics more patient-centered is key to improving patients' experience of care. If patients themselves were engaged in helping define priorities and suggesting quality improvements in the clinic, care would respond better to their needs. However, patient engagement is a new phenomenon, particularly in community based primary care clinics. How to engage patients in quality improvement in these clinics, or what effect this might have, is not well known. The involvement of patients needs to be adapted to the way these clinics function. The aim of this study is to create and evaluate a new model of patient engagement for quality improvement in community based primary care clinics. Patients, primary care professionals and researchers will create advisory councils in two primary care clinics in Quebec City (Canada). In each clinic, the advisory council will include 12 patients or caregivers registered at the clinic, a clinician and a clinic manager. The advisory council will meet every 6 weeks for a total of six meetings. Two patient-experts will facilitate meetings. During meetings, members of the council will list their needs in order of importance. Then they will suggest improvements in line with these needs. We will study if our advisory council model is well adapted to community based primary care settings and meets participants' expectations. At the end of the study we will be able to offer guidance about engaging patients with health professionals in quality improvement in primary care clinics. ABSTRACT: Background Involvement of end-users, including patients, managers and clinicians, in identifying quality improvement and research priorities might improve the relevance of projects and increase their impact. Few patient engagement initiatives have taken place in community based primary care practices (CBPCPs) and best practices for engaging patients in such settings are not well defined. The aim of this pilot study is to develop and assess the feasibility of a new collaborative model of advisory council involving clinicians, managers, patients and caregivers in CBPCP to strengthen their capacity to conduct quality improvement and patient-oriented research projects. Methods We will conduct a participatory action research project in two non-academic CBPCPs in Quebec City (Canada). In each CBPCP, the advisory council will include 12 patients or caregivers, a clinician and a clinic manager. Patients or their caregivers will be identified by clinicians and contacted by patient-experts. They will be eligible if they are registered at the practice, motivated, and available to attend meetings. The council will meet every 6 weeks for a total of six meetings. Two patient-experts will guide council members to identify quality improvement priorities and patient-oriented research questions based on their experience in the clinic. They will then be supported to plan actions to target these priorities. Analysis of meetings will be based on feasibility criteria, notes by non-participant observers in log books, audio-recording of the meetings and questionnaires to evaluate council members' perceptions and the likelihood they would engage in such councils. Discussion The results of this study will  be a model of patient engagement and a discussion of factors to improve the model to fit the needs of primary care patients and professionals. This will lay the foundation for a sustainable structure for long-term patient engagement and contribute to the development of a patient-centered and quality-improvement culture in CBPCPs.

The process of recovery of people with mental illness: the perspectives of patients, family members and care providers: part 1.

BACKGROUND: It is a qualitative design study that examines points of divergence and convergence in the perspectives on recovery of 36 participants or 12 triads. Each triad comprising a patient, a family member/friend, a care provider and documents the procedural, analytic of triangulating perspectives as a means of understanding the recovery process which is illustrated by four case studies. Variations are considered as they relate to individual characteristics, type of participant (patient, family, member/friend and care provider), and mental illness. This paper which is part of a larger study and is based on a qualitative research design documents the process of recovery of people with mental illness: Developing a Model of Recovery in Mental Health: A middle range theory. METHODS: Data were collected in field notes through semi-structured interviews based on three interview guides (one for patients, one for family members/friends, and one for caregivers). Cross analysis and triangulation methods were used to analyse the areas of convergence and divergence on the recovery process of all triads. RESULTS: In general, with the 36 participants united in 12 triads, two themes emerge from the cross-analysis process or triangulation of data sources (12 triads analysis in 12 cases studies). Two themes emerge from the analysis process of the content of 36 interviews with participants: (1) Revealing dynamic context, situating patients in their dynamic context; and (2) Relationship issues in a recovery process, furthering our understanding of such issues. We provide four case studies examples (among 12 cases studies) to illustrate the variations in the way recovery is perceived, interpreted and expressed in relation to the different contexts of interaction. CONCLUSION: The perspectives of the three participants (patients, family members/friends and care providers) suggest that recovery depends on constructing meaning around mental illness experiences and that the process is based on each person's dynamic context (e.g., social network, relationship), life experiences and other social determinants (e.g., symptoms, environment). The findings of this study add to existing knowledge about the determinants of the recovery of persons suffering with a mental illness and significant other utilizing public mental health services in Montreal, Canada.

[Mentally ill and criminalized: testimony of a dual marginalization]. / A la fois malade et criminalisé : témoignage d'une double marginalisation.

Based on two open-ended interviews with people suffering from a mental illness and who have been incarcerated, this article explores their perspectives on both health and justice systems. In their view, there is a divide between the needs of people with mental health problems and the care that is offered. The difficult juncture between needs and services seems to have numerous explanations (prejudice, lack of training of personnel, difficult administrative process, lack of communication between "inside" and "outside"); and the elements that could facilitate this juncture appear to be scarce (mutual help among inmates, community based mental help organizations).