Measuring practitioners' beliefs, goals, and practices in psychiatric rehabilitation

This article reports on a scale to measure the psychiatric rehabilitation beliefs, goals, and practices of staff who provide services to consumers. The scale's reliability, validity, and factor structure are presented based upon 469 staff members and 191 people in rehabilitation. The scale appears to be a stable measure of staff members' knowledge of modern psychiatric rehabilitation beliefs, goals, and practices as elaborated by the field's leadership. It also appears to provide a valid measure of staff members' actual practice patterns as they relate to the consumer outcomes of empowerment, quality of life, independent living, and competitive employment. Consumers, program administrators, educators, researchers, and practitioners may find the scale useful as a measure of some of the beliefs, goals, and practices that currently define modern psychiatric rehabilitation.     

Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy

ObjectiveZambia suffers from a physician shortage, leaving the provision of care for those with epilepsy to nonphysician health care workers who may not be adequately trained for this task. These individuals are also important community opinion leaders. Our goal in this study was to determine the knowledge, attitudes, beliefs, and practices of these health care workers with respect to epilepsy.MethodsHealth care workers in urban and rural districts of Zambia completed a self-administered, 48-item questionnaire containing items addressing demographics, personal experience with epilepsy, social tolerance, willingness to provide care, epilepsy care knowledge, and estimates of others’ attitudes. Analyses were conducted to assess characteristics associated with more epilepsy care knowledge and social tolerance.ResultsThe response rate was 92% (n = 276). Those who had received both didactic and bedside training (P = 0.02) and more recent graduates (P = 0.007) had greater knowledge. Greater knowledge was associated with more social tolerance (P = 0.005), but having a family member with epilepsy was not (P = 0.61). Health care workers were generally willing to provide care to this patient population, but ∼25% would not allow their child to marry someone with epilepsy and 20% thought people with epilepsy should not marry or hold employment. Respondents reported that people with epilepsy are feared and/or rejected by both their families (75%) and their community (88.8%).ConclusionsKnowledge gaps exist particularly in acute management and recognition of partial epilepsy. More recent graduates were more knowledgeable, suggesting that curriculum changes instituted in 2000 may be improving care. Health care workers expressed both personal and professional reservations about people with epilepsy marrying. In addition to improving diagnosis and treatment skills, educational programs must address underlying attitudes that may worsen existing stigmatizing trends.     

The latent variable model of the psychiatric rehabilitation beliefs, goals, and practices scale

This article determined the latent variable model for the items of the Psychiatric Rehabilitation Beliefs, Goals, and Practices Scale (PRBGP). Five, four, and three factor models were evaluated for best "fit" based upon the responses of 478 IAPSRS members from 39 states. The three factor model achieved an acceptable and the simplest "fit. " The article interprets the three factors or latent variables of the model which were entitled: Consumer-Driven Paradigm, Deficit-Focused, Staff-Directed Paradigm, and Empirical-Based/Consensus-Guideline Practices. The PRBGP's three factor model describes the paradigms and practices that define psychiatric rehabilitation as a sub-specialty in the mental health field.     

A national sample of IAPSRS members' responses to the psychiatric rehabilitation beliefs, goals, and practices scale

This study reports on the convergent-discriminant validity of the Psychiatric Rehabilitation Beliefs, Goals, and Practices Scale (PRBGP) which purports to measure practitioners' knowledge of the current consensus in psychiatric rehabilitation. The sample comprised 478 IAPSRS members who represented practitioners from 39 states. The study found that the PRBGP variance among this sample was primarily associated with the number of 15 leading contributors to the psychiatric rehabilitation literature that these practitioners claimed to have read when education, discipline, role, experience, and agency area were controlled. Experience in the behavioral health field and the administrator role were also significantly related to the PRBGP, but these relationships may have also been a function of informational factors associated with IAPSRS membership. For a combined sample (n = 757), it was also found that the PRBGP is primarily related to the number of leading authors that these practitioners read. The PRGBP appears to measure knowledge of the current consensus on beliefs, goals, and practices in psychiatric rehabilitation, and is not a measure of these other responder characteristics.     

Psychosocial rehabilitation in a public psychiatric hospital

Patients with chronic mental illnesses have complex treatment needs that often pose significant challenges to mental health professionals. This paper describes the implementation of a psychosocial rehabilitation program to meet the treatment needs of patients in a public psychiatric hospital providing long-term care. A core group of professional staff adopted psychosocial rehabilitation principles in order to transform a custodial model of care to a highly interactive educational and skills building program. A model of service delivery was established to address patients' skill deficits and barriers to returning to the community. This article describes the major steps and challenges faced in overcoming obstacles and implementing a psychosocial philosophy of treatment in an inpatient setting. It suggests that it is possible for the public hospital to reinvent itself into an environment that can stimulate recovery and hope.     

Mental health-related knowledge,attitudes and practices in two kibbutzim

Abstract. Background: This study explored mental health-related knowledge, attitudes and practices (KAP) in two kibbutzim (collective villages). These kibbutzim share many features, e. g., history, origin of the population, community institutions, and political affiliation. They differ, however, in that one of them keeps fully the collectivist ideology, while the other is undergoing privatization; this is a process that may loosen the solidarity on which the kibbutz movement was conceived. Methods: A brief self-administered questionnaire exploring KAP within the kibbutz context was completed anonymously by 108 members in one kibbutz and 90 in the other. Univariate and multivariate methods of analyses were applied. Results: Mental health literacy was high, 75% endorsed a multifactorial causation of mental disorders, and 79% thought that they were treatable. The definition of what constitutes a mental disorder, however, was limited, 43% for psychosis and 10% for depression. Kibbutz members held contrasting attitudes toward members with mental disorders; while the majority supported their social integration,85% stated that their access to the communes highest offices would be denied. The kibbutz would provide financial support more often to a member with cancer, 94%, than to one with depression, 81%. Attitudes towards outsiders were more negative, 68% stated that the kibbutz would refuse membership to an applicant that recovered from a mental illness. Use of mental health services was high, with a lifetime rate in the total sample of 38%. Conclusion: The mental health KAP among these kibbutz members have not developed in parallel. While the attitudes are mixed at best, knowledge and practice are more positive. Since the kibbutz strives to be an egalitarian society and the members are highly educated, the study of this collective may suggest the possible KAP ceiling in the general society. The privatization process initiated in one of the kibbutzim has not affected the KAP, but the process is too novel to assess its impact.     

When consultants write orders: physicians' attitudes, beliefs, and practices

The process by which a consultation is performed may significantly impact the extent to which the content of the consultation contributes positively to patient care. The practice of consultants writing orders independent of the explicit permission of the consultation requester is a common event. A survey of 211 multispecialty physicians on the medical staff of a large, urban, Northeastern, teaching hospital about their attitudes, beliefs, and practices regarding consultation on the inpatient service reveal that the majority of respondents in all specialties were unaware of departmental or hospital policy regarding the practice of consultant order writing. Significant differences between specialties existed in the perception of the impact of consultant order writing on patient outcomes, in the practice of discussion with the primary attending prior to order writing, and in the documentation practices. The authors discuss such results and their policy implications in light of important medico-legal and ethical principles, and best practice standards.     

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.     

Religious beliefs and practices among 52 psychiatric inpatients in Minnesota

The authors studied the religious beliefs, practices, and experiences of 52 psychiatric inpatients. The rate of belief in the major tenets of faith (God, the Devil, and an afterlife) was uniformly high and in accord with national and local public poll results. Patients with depressive and anxiety disorders tended to score lower than those with other diagnoses on a wide variety of indexes of religion. The authors conclude that religion is an important factor in most patients' lives and that individual inquiry and systematic research into this neglected area are both feasible and important.     

Psychiatric rehabilitation in a French-speaking setting: current practices, future challenges]

This paper aims to assess current interventions in psychiatric rehabilitation in the French-speaking world and to discuss future developments. We review examples of policies and practices in Quebec and Europe and discuss the role and involvement of professionals; namely, the psychiatrists and the nursing staff. We also present different rehabilitation strategies and techniques used in the French-speaking world, such as case management, social-skills training, cognitive therapies for psychotic symptoms, family interventions, and return-to-work interventions. In conclusion, we invite psychiatrists to play a more active role in rehabilitation. We recommend the creation of small, specialized units closely linked to the needs of clients, and we propose to integrate social and medical interventions, rather than opposing them.     

Effects of a psychiatric rotation on psychiatric knowledge and attitudes towards psychiatry in rotating interns

The attitudes of trainees toward Psychiatry affect their career choice and ability to properly identify and manage emotional disorders in their patients. These attitudes are determined by several factors which include preclinical and clinical training among others. We report here a study of the attitude of interns toward psychiatry using the 30 item attitude toward psychiatry (ATP-30) scale. The ATP-30 and a multiple choice questionnaire examination (MCQE) in psychiatry were completed by 96 interns at the beginning and end of their compulsory four week psychiatry rotation. The degree of satisfaction of the trainees was rated in four areas--orientation, teaching/learning experience, overall rating of rotation and relevance of rotation to career choice. There was no significant change in the mean ATP-30 scores (N = 55) during the four week rotation, but the MCQE scores (N = 74) improved significantly (P less than 0.0001). A repeated analysis of variance for the four satisfaction variables by change score in MCQE and change score in ATP-30 did not show any significant main effects or significant interactions between these change scores except with relevance of rotation. Reasons for the absence of changes in the ATP-30 scores during this rotation were explored. The implications of the improved knowledge during this rotation are also discussed. We also conclude that attitudinal change and knowledge are two independent factors which should be assessed independently in trainees.     

Epilepsy in Laos: knowledge, attitudes, and practices in the community

ObjectiveWe evaluated beliefs about, attitudes toward, and stigma associated with epilepsy in four districts of central Laos.MethodFor this study, 83 people with epilepsy, 83 family members, and 166 matched villagers in Vientiane Province were interviewed.ResultsFrom patients to families to villagers, there existed a significantly increasing gradient of misbeliefs. Dubbed locally as “mad pig disease,” epilepsy was viewed as having a supernatural origin by 25–42% of respondents, a life-threatening disease by 60%, a disease transmissible by consumption of pork meat by 10–21%, and a disease transmissible by contact with patients’ saliva by 14.5% of patients and 44% of villagers (P < 0.01). Stigma was high. People thought that they should avoid contact or sharing meals with patients (15% of patients, 62% of family members, P < 0.001), and that persons with epilepsy should not get a job, get married (29 and 42%, P < 0.016), or raise children (33–42%).ConclusionWrong beliefs may lead to stigma and hamper access to or compliance with modern epilepsy treatment. In traditional countries, education is the cornerstone of epilepsy management.