No evidence that implicit identification with mental illness predicts recovery.

OBJECTIVES: Recovery from mental illness is multiply-determined, but one factor that has been proposed to influence recovery is the degree to which the person identifies as someone with a mental illness. This study examines the relationship between implicit identification with being mentally unwell and recovery among clients of a community mental health service. A multi-faceted view of recovery was adopted. METHODS: A longitudinal design was used to assess implicit identification with mental illness and its relationship to recovery, including symptom severity, well-being, life satisfaction, and optimism, which were supplemented with ratings by both support workers and the research assistants who conducted the study. Participants were 216 community mental health care clients, with 150 retested at Time 2, and 100 retested at Time 3. RESULTS: Implicit identification with mental illness was correlated with recovery at Time 1 and Time 3, though this relationship did not emerge at Time 2. Cross-lag regression analyses failed to reveal evidence that implicit identification with mental illness predicts subsequent recovery. CONCLUSIONS: The current research suggests that implicit identification with mental illness can be considered a marker of ongoing recovery, but is not predictive of subsequent recovery. Hence, these data suggest that implicit identification with mental illness is unlikely to play an independent role in the recovery process. PRACTITIONER POINTS: Research regarding the mental health consequences of implicit identification focuses on symptomatology. Recovery is more than a reduction in symptoms, however, and thus, a broader conceptualization of recovery was examined. Implicit identification with being mentally unwell was associated with poorer recovery broadly operationalized, but did not predict subsequent recovery.

Implicit attitudes, emotions, and helping intentions of mental health workers toward their clients.

The attitudes of mental health care workers toward their clients may influence the quality of care they provide. There is growing recognition of the role of implicit attitudes in behavior toward people with stigmatized illnesses, such as mental illness, and of the need to measure these separately from explicit attitudes. Seventy-four mental health workers completed implicit and explicit measure of attitudes toward people with mental illness. The participants were also asked about their intention to help people with mental illness and their emotional reactions toward people with a mental illness. The findings show that the implicit attitudes of the health workers toward clients with a mental illness are somewhat negative despite the fact that their explicit attitudes are somewhat positive. Although both implicit and explicit attitudes predicted negative emotions, only implicit attitudes were related to helping intentions. This study highlights the association between implicit attitudes and behavioral intentions and confirms the importance of addressing implicit attitudes in mental health research.

Challenging stereotypes and changing attitudes: Improving quality of care for people with hepatitis C through Positive Speakers programs.

Positive Speakers programs consist of people who are trained to speak publicly about their illness. The focus of these programs, especially with stigmatised illnesses such as hepatitis C (HCV), is to inform others of the speakers' experiences, thereby humanising the illness and reducing ignorance associated with the disease. This qualitative research aimed to understand the perceived impact of Positive Speakers programs on changing audience members' attitudes towards people with HCV. Interviews were conducted with nine Positive Speakers and 16 of their audience members to assess the way in which these sessions were perceived by both speakers and the audience to challenge stereotypes and stigma associated with HCV and promote positive attitude change amongst the audience. Data were analysed using Intergroup Contact Theory to frame the analysis with a focus on whether the program met the optimal conditions to promote attitude change. Findings suggest that there are a number of vital components to this Positive Speakers program which ensures that the program meets the requirements for successful and equitable intergroup contact. This Positive Speakers program thereby helps to deconstruct stereotypes about people with HCV, while simultaneously increasing positive attitudes among audience members with the ultimate aim of improving quality of health care and treatment for people with HCV.

Knowledge and attitudes towards hepatitis C and injecting drug use among mental-health support workers of a community managed organisation.

OBJECTIVES: People with mental illness are at significantly higher risk of acquiring hepatitis C virus (HCV) compared with the general population. This study assessed knowledge of and attitudes towards people with HCV and people who inject drugs (PWID) among support workers of clients with mental illness. METHODS: Support workers from a community managed organisation (CMO) in Australia were recruited to complete an online cross-sectional survey. The survey collected data about their knowledge of HCV and attitudes towards PWID and people with HCV. RESULTS: Valid responses were received from 117 support workers. Although HCV knowledge was moderate, there were significant knowledge gaps around transmission and treatment of HCV. Higher HCV knowledge was significantly associated with more positive attitudes towards PWID, but not with attitudes towards people with HCV. Participants had more positive attitudes towards people with HCV than towards PWID. Additionally, those with more positive attitudes towards HCV tended to also have more positive attitudes towards PWID. CONCLUSIONS: Given that people with mental illness are at higher risk of acquiring HCV, these results point to the need for education targeted at support workers of clients with mental illness to increase HCV knowledge and promote positive attitudes towards PWID and people with HCV.

Lived Experience as a Protective Factor for Mental Health Workers.

OBJECTIVE: When clients do not seem to be improving, mental health workers have more negative job attitudes, experience higher levels of client-related burnout, and are more interested in leaving the field. Nonetheless, it is unclear whether all mental health workers are equally susceptible to burnout caused by feelings that their clients are not improving. Specifically, people with lived experience of mental illness are intimately familiar with their own recovery challenges and thus may be less susceptible to this source of burnout. METHODS: To test this possibility, mental health providers (N=179) from a nongovernmental community mental health organization in Australia completed a survey assessing their perceptions of client improvement from treatment, their feelings of client-related burnout, and a range of organizational outcomes (job satisfaction, job engagement, workplace well-being, and intentions to resign). RESULTS: Moderated mediation analyses revealed that although mental health providers who felt that their clients were not improving experienced client-related burnout, lived experience served as a buffer. Staff with lived experience were less susceptible to burnout associated with perceptions that their clients were not improving from treatment. Mental health providers with lived experience also reported more positive job attitudes compared with providers without lived experience. CONCLUSIONS: Given the high rates of burnout in the mental health profession, future research should examine why lived experience appears to buffer staff from burnout when they believe that their clients are not improving. This knowledge could aid in the development of interventions to boost resilience, engagement, and longevity in the field.

A community pharmacist delivered adherence support service for dyslipidaemia.

BACKGROUND: Dyslipidaemia is a major risk factor for coronary heart disease. A key issue in management is adherence to therapy. Pharmacists are ideally situated to provide a service to increase medication adherence and optimize health outcomes. This study aimed to evaluate the impact of a community pharmacist-delivered adherence support service on patients' adherence and total cholesterol levels. METHODS: A repeated measures [baseline (t = 1), post-intervention at 3-monthly intervals (t = 2,3,4)], randomized-controlled study in community pharmacies, with patients on chronic lipid-lowering therapy was conducted. Measures used were Brief Medication Questionnaire, Medication Adherence Report Scale, total cholesterol and pharmacist intervention data sheets. A baseline t-test of cholesterol levels between groups was conducted followed by a repeated-measures analysis of variance. RESULTS: Seventeen pharmacists recruited 142 patients (97 completions: 49 control, 48 intervention). Most patients missed either the third or last visit, thus data at t = 3 and 4 were combined. Although the intervention group started with a higher cholesterol level (5.1 vs. 4.8 mmol/l), a difference was observed in the drop in cholesterol levels of the intervention group between t = 2 and 3 (F(1,95) = 8.85, P < 0.01), and between the two groups over the study period (F(2,190) = 4.89, P < 0.05). No changes in medicine adherence scores were observed though there was an improvement in participants' exercise and eating habits. CONCLUSIONS: Patients significantly lowered their cholesterol levels probably as a result of the service delivered by their pharmacists within the short study time frame of ~9 months.

Self-medication Behavior with antibiotics: a national cross-sectional survey in Sri Lanka.

BACKGROUND: Antibiotic self-medication is common in low- and middle-income countries. This study aimed to evaluate the Sri Lankan public's knowledge about and attitudes toward antibiotic use and self-medication, and factors associated with self-medication. METHODS: A national cross-sectional, interviewer-administered, survey of a random household sample (N = 1100) was conducted. Factor analysis of the attitudinal items was conducted to investigate the factors associated with antibiotic self-medication. RESULTS: A response rate of ninety-one percent (n = 998) responded. Knowledge about antibiotics was poor (mean = 12.5; SD = 3.5; (scale 0-27)). Half had previously used an antibiotic once in the past three months. About 11% (108/998) had self-medicated the last time they took antibiotics; mostly obtained from a pharmacy (82%; 89/108). Three attitudinal factors were obtained, explaining 56.1% of the variance. Respondents were less likely to self-medicate if they did not support ease of access to antibiotics from pharmacies (p< 0.001) and situational use of antibiotics (p= 0.001); supported appropriate use of antibiotics (p= 0.003); and had greater knowledge about prescription requirements for antibiotics (p= 0.004). CONCLUSION: There is limited knowledge about, and a high rate of self-medication with antibiotics.Factors contributing to self-medication could be addressed with appropriate public education campaigns, and policy changes.

Perceived inability to help is associated with client-related burnout and negative work outcomes among community mental health workers.

Community mental health is a vital service, but it faces ongoing challenges from its high staff-turnover rates. The current study provides a preliminary test of a novel explanation for employee disengagement in community mental health. It is proposed that providing assistance to clients, while simultaneously feeling that only limited progress is being made, is associated with client-related burnout among community mental health providers, leading to negative work outcomes. Employees (N = 349) from three non-governmental community mental health organisations in Australia completed a survey assessing their perceptions of client improvement from treatment, client-related burnout and a range of organisational outcomes. Analyses revealed that perceptions that clients are not improving was associated with burnout, which in turn is related to lower job satisfaction, decreased job engagement, poorer workplace well-being, and increased turnover intentions. These findings suggest that interventions that highlight positive changes among clients could reinforce the important service provided by community mental health employees and may minimise burnout and negative work outcomes.

Mental health recovery, goal setting and working alliance in an Australian community-managed organisation.

This article examines the relationships between goal setting and achievement, working alliance and recovery in an Australian mental health community-managed organisation. The study gathered data over a 14-month period after the introduction of routine outcome measures. Both goal achievement and the strength of the working alliance were shown to have a positive effect on the personal recovery of the clients in the study. Both working alliance and goal achievement are robustly supportive at whatever point a person is on in the recovery journey. The brief goals card used is a useful adjunct to other tools.

Attitudes of people working in mental health non-governmental organisations in Australia: A comparison with other mental health professionals.

Research suggests that stigma impacts help-seeking behaviour and health outcomes for people affected by mental illness. This study compared the attitudes of Australian non-governmental organisation support workers towards people with mental illness with those of other health professionals. Three hundred and seventy four support workers were randomly allocated to answer questions about one of the six vignettes. Results indicated that non-governmental organisation support workers held more positive attitudes towards people with mental illness than those of general practitioners, psychiatrists and psychologists measured in prior research. These results suggest that non-governmental organisations may be a more positive and comfortable entry and referral point for mental health clients.

A comparative study of consumer participation in mental health pharmacy education.

BACKGROUND: People with mental illness have been recognized as key stakeholders in the development of mental health education. However, few studies have evaluated the impact of people with mental illness as participants in education programs for students studying to become health professionals. OBJECTIVE: To assess the impact of education provided by mental health consumer-educators on the attitudes of pharmacy students toward people with mental illness. METHODS: The study used a 2 group, nonrandomized, clustered, comparative design, with 4 tutorial classes allocated to receive standard pharmacist-led instruction (comparison group), and 5 tutorial classes to receive standard pharmacist-led instruction plus additional input from mental health consumer-educators (intervention group). All pharmacy students (N = 229) enrolled in the third year of a 4 year pharmacy degree program were invited to participate. Consumer-educators receiving ongoing treatment for illnesses including schizophrenia, bipolar disorder, and major depression participated in small-group work, case-study discussions, and role plays with pharmacy students in the intervention group. Pharmacy students' attitudes were assessed using a 39 item survey instrument derived from previously published instruments evaluating social distance, attribution, provision of pharmaceutical services, and stigmatization of people with schizophrenia and severe depression. RESULTS: Paired baseline and follow-up responses were obtained from 117 students in the intervention group and 94 students in the comparison group. Students who received the consumer intervention had decreased social distance scores (F(1209) = 5.30; p = 0.02). Students in the intervention group more strongly disagreed with 26 of 27 nonsocial distance statements that demonstrated a negative attitude toward people with mental illness (F(1209) = 13.58; p < 0.001) and more strongly agreed with all 4 nonsocial distance statements that demonstrated a positive attitude (F(1209) = 7.56; p = 0.014). CONCLUSIONS: Consumer participation in mental health education for pharmacy students improves students' attitudes toward people with mental illness.

Pharmacists' influences on prescribing: validating a clinical pharmacy services survey in the Western Pacific Region.

BACKGROUND: Hospital pharmacists around the world are becoming increasingly involved in promoting the responsible use of medicines through clinical pharmacy services. This is reflected in the Basel Statements developed by the International Pharmaceutical Federation Hospital Pharmacy Section, particularly the theme 'Influences on Prescribing.' Some countries, particularly in Asia, are currently establishing clinical pharmacy services and would benefit from identification of facilitators. OBJECTIVES: To validate a survey exploring clinical pharmacy services focusing on pharmacists' influences on prescribing, based on Basel Statements 28-31, and the factors that affect their implementation in the Western Pacific Region (WPR). METHODS: Content and face validity of the survey (BS28-31) was established. This resulted in the BS28-31 consisting of 20 questions, which included a Clinical Pharmacy Services Facilitators (CPSF) scale (25 items) to measure respondents' perceptions of facilitators of clinical pharmacy services. The BS28-31 was emailed to hospital pharmacy directors in the WPR. The survey was made available in English, Japanese, Chinese, Vietnamese, Lao, Khmer, French and Mongolian. Principal components and internal consistency analyses were conducted to assess the reliability and construct validity of the CPSF scale. RESULTS: The final survey was sent to a total of 2525 hospital pharmacy directors in the WPR of which 726 were returned from 31 nations yielding a response rate of 29%. Two items in the scale were removed due to low communalities (0.22 and 0.16). The resulting 23 item scale produced a parsimonious two-factor solution, divided into internal (e.g. individual pharmacist traits and pharmacy departmental structure/resources) and environmental facilitators (e.g. government support, patient and physician expectations). This two factor solution explained 51.5% of the variance. In addition, the Cronbach's α for the internal and environmental subscales were 0.94 and 0.78 respectively. CONCLUSION: The BS28-31 survey was found to be a reliable and valid instrument for assessing hospital pharmacy directors' perceptions of clinical pharmacy services regarding pharmacists' influences on prescribing and their facilitators in the WPR.

An international comparison study of pharmacy students' achievement goals and their relationship to assessment type and scores.

OBJECTIVE: To identify pharmacy students' preferred achievement goals in a multi-national undergraduate population, to investigate achievement goal preferences across comparable degree programs, and to identify relationships between achievement goals, academic performance, and assessment type. METHODS: The Achievement Goal Questionnaire was administered to second year students in 4 universities in Australia, New Zealand, England, and Wales. Academic performance was measured using total scores, multiple-choice questions, and written answers (short essay). RESULTS: Four hundred eighty-six second year students participated. Students showed an overall preference for the mastery-approach goal orientation across all sites. The predicted relationships between goal orientation and multiple-choice questions, and written answers scores, were significant. CONCLUSION: This study is the first of its kind to examine pharmacy students' achievement goals at a multi-national level and to differentiate between assessment type and measures of achievement motivation. Students adopting a mastery-approach goal are more likely to gain high scores in assessments that measure understanding and depth of knowledge.

Identifying achievement goals and their relationship to academic achievement in undergraduate pharmacy students.

OBJECTIVES: To compare the achievement goal orientations of first-year with those of third-year undergraduate Australian pharmacy students and to examine the relationship of goal orientations to academic achievement. METHODS: The Achievement Goal Questionnaire was administered to first-year and third-year students during class time. Students' grades were obtained from course coordinators. RESULTS: More first-year students adopted performance-approach and mastery-approach goals than did third-year students. Performance-approach goals were positively correlated with academic achievement in the first year. Chinese Australian students scored the highest in adopting performance-approach goals. Vietnamese Australian students adopted mastery-avoidance goals more than other ethnicities. First-year students were more strongly performance approach goal-oriented than third-year students. CONCLUSION: Adopting performance-approach goals was positively correlated with academic achievement, while adopting avoidance goals was not. Ethnicity has an effect on the adoption of achievement goals and academic achievement.

Investigating the relationship between pharmacy students' achievement goal orientations and preferred teacher qualities.

OBJECTIVE: To investigate the relationships between pharmacy students' preferred teacher qualities and their academic achievement goal orientations. METHODS: Participants completed an achievement goal questionnaire and a build-a-teacher task. For the latter, students were given a $20 hypothetical budget to purchase amounts of 9 widely valued teachers' qualities. RESULTS: Three hundred sixty-six students participated. Students spent most of their budget on the traits of enthusiasm, expertise, and clear presentation style, and the least amount of money on interactive teaching, reasonable workload, warm personality, and intellectually challenging. In relation to achievement goals, negative associations were found between avoidance goals and preferences for teachers who encourage rigorous thinking and self-direction. CONCLUSION: These novel findings provide a richer profile of the ways students respond to their learning environment. Understanding the relationships between teachers' characteristics and pharmacy students' achievement goal orientations will contribute to improving the quality of pharmacy learning and teaching environments.

An international validation study of two achievement goal measures in a pharmacy education context.

BACKGROUND: Achievement goal theory helps us understand what motivates students to participate in educational activities. However, measuring achievement goals in a precise manner is problematic. Elliot and McGregor's Achievement Goal Questionnaire (AGQ) and Elliot and Murayama's revised Achievement Goal Questionnaire (AGQ-R) are widely used to assess students' achievement goals. Both instruments were developed and validated using undergraduate psychology students in the USA. METHODS: In this study, our aims were to first of all, assess the construct validity of both questionnaires using a cohort of Australian pharmacy students and, subsequently, to test the generalizability and replicability of these tools more widely in schools of pharmacy in other English-speaking countries. The AGQ and the AGQ-R were administered during tutorial class time. Confirmatory factor analysis procedures, using AMOS 19 software, were performed to determine model fit. RESULTS: In contrast to the scale developers' findings, confirmatory factor analysis supported a superior model fit for the AGQ compared with the AGQ-R, in all countries under study. CONCLUSION: Validating measures of achievement goal motivation for use in pharmacy education is necessary and has implications for future research. Based on these results, the AGQ will be used to conduct future cross-sectional and longitudinal analyses of the achievement goals of undergraduate pharmacy students from these countries.

Pharmacy students' approaches to learning in undergraduate and graduate entry programs.

OBJECTIVES: To compare longitudinal data with previous cross-sectional data regarding Australian undergraduate pharmacy students' approaches to learning, and explore the differences in approaches to learning between undergraduate and postgraduate cohorts. METHODS: Longitudinal, repeated measures design using a validated self-report survey instrument were used to gather data. RESULTS: Undergraduate students' preferences for meaning directed, undirected, and reproduction-directed approaches to learning displayed the same pattern across the 2 studies; however, application-directed scores increased significantly in the second half of the undergraduate degree program. Commencing postgraduate students' approaches to learning were similar to finishing undergraduate students, and this group was significantly more oriented towards meaning-directed learning compared to undergraduate students. CONCLUSIONS: Pharmacy students' maturation in approach to their learning was evident and this bodes well for pharmacists' engaging in life-long learning and capacity to work in increasingly complex health settings.