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Dimensions of Health among Patients in Mental Health Services
Lund University, Sweden.ORCID iD: 0000-0001-9753-0988
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Empirical studies focusing on the subjective experience of health among patients in contact with the mental health services are rare and most questionnaires are based on a medical model that emphasizes objectively observed disease-oriented health indicators. In studies I and II perceptions of the concept of health among patients and nurses in mental health services were explored and described using a phenomenographic approach. The perceptions and description categories that emerged from these studies were transformed into a number of items forming a questionnaire intended to measure subjectively experienced health among patients in mental health services. In study III, a randomly selected sample was used to test the psychometric properties of the new Health Questionnaire. A factor analysis revealed three factors labelled Autonomy, Social Involvement and Comprehensibility. The purpose of study IV was to examine the construct validity of the Health Questionnaire. The hypothesis was that subjectively experienced health would be positively associated to self-esteem, empowerment and quality of life, and negatively associated to psychiatric symptoms, perceived stigmatization experiences and perceived attitudes of devaluation and discrimination. This hypothesis was mainly confirmed insofar that overall health was positively correlated to self-esteem, empowerment and quality of life and negatively correlated to symptoms, attitudes of devaluation and discrimination and rejection experiences. The results of this thesis show that health is more than just an absence of disease and support a focus on health promotion interventions in mental health care.

Place, publisher, year, edition, pages
Lund: Department of Health Sciences, Faculty of Medicine, Lund University , 2007. , 121 p.
Series
Lund University, Faculty of Medicine doctoral dissertation series, ISSN 1652-8220 ; 2007:79
Keyword [en]
Health, Mental health services, Nurse, Patient, Perceptions, Phenomenography, Questionnaire, Reliability, Subjective experience, Validity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-16873ISBN: ISBN: 978-91-85559-57-2 OAI: oai:DiVA.org:hh-16873DiVA: diva2:473982
Public defence
2007-05-25, Hörsal 01, Vårdvetenskapens hus, Baravägen 3, Lund, 13:00 (Swedish)
Opponent
Supervisors
Note

Medicine doktorsexamen

Available from: 2012-01-10 Created: 2012-01-08 Last updated: 2016-02-26Bibliographically approved
List of papers
1. Perceptions of the concept of health among patients in mental health nursing
Open this publication in new window or tab >>Perceptions of the concept of health among patients in mental health nursing
2004 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, Vol. 25, no 7, 723-736 p.Article in journal (Refereed) Published
Abstract [en]

Health has been a central concept in nursing science since the 18th century but the holistic concept of health that includes both the body and the soul, still has to be clarified. The concept of health is often unclear and represents an unreachable ideal state that can be hard to use as a realistic goal in nursing care. The aim of this study was to describe how the patient perceives the concept of health in mental health nursing. Twelve patients with experience of mental health nursing were interviewed and the data were analyzed with a phenomenographic approach. The patients described nine different perceptions that were divided into three descriptive categories: autonomy, meaningfulness, and community. All of these are important to achieve health. There is ambiguity about the possibility to influence the concept of health. Health is described, on the one, hand as a prerequisite to experiencing freedom and finding meaning in life and, on the other hand, it is believed that the search for meaning and the courage to fight and try in spite of the disease is what leads to health. The patients' descriptions are mostly about things that they need in the present time to achieve health, but health as a process with growth and potential for development does not appear that clearly. One conclusion is that mental health nursing must deliver a more process-focused nursing care where the concept of health is visibly used as a goal for all nursing interventions.

Place, publisher, year, edition, pages
Taylor & Francis, 2004
Keyword
Attitude to Health, Mental Health
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:hh:diva-2727 (URN)10.1080/01612840490486791 (DOI)15371139 (PubMedID)2082/3129 (Local ID)2082/3129 (Archive number)2082/3129 (OAI)
Available from: 2009-08-12 Created: 2009-08-12 Last updated: 2016-02-26Bibliographically approved
2. Perceptions of the concept of health among nurses working in mental health services: a phenomenographic study
Open this publication in new window or tab >>Perceptions of the concept of health among nurses working in mental health services: a phenomenographic study
2007 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 16, no 1, 50-56 p.Article in journal (Refereed) Published
Abstract [en]

A new understanding of the concept of health is needed to meet the goal of mental health nursing, which besides reducing disease is to strengthen the patient's health. The aim of the present study was to describe perceptions of the concept of health among nurses working in mental health services. Twelve Swedish nurses working in mental health services were interviewed and data were analysed with a phenomenographic approach. The nurses expressed 10 perceptions, which constituted three description categories: autonomy, process, and participation. The result showed that health was more than absence of disease. Simultaneously, perceptions were expressed indicating that health was viewed as absence of disease, which implies that the concept is not sufficiently defined. The result emphasizes the need to clarify the concept of health if it is to be used as a goal in mental health nursing and to integrate a clarified definition of health at all hierarchical levels in mental health care services.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2007
Keyword
Health, Nurse, Perception, Phenomenography, Psychiatry, adult, attitude to health, education, female, freedom, health personnel attitude, health status, human, human development, male, mental health, mental health service, middle aged, nurse attitude, nursing methodology research, nursing staff, organization and management, philosophy, psychiatric nursing, psychological aspect, psychological model, qualitative research, questionnaire, self concept, Sweden, trust, Attitude of Health Personnel, Health Knowledge, Attitudes, Practice, Middle Aged, Models, Psychological, Nurse's Role, Nursing Methodology Research, Nursing Staff
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-509 (URN)10.1111/j.1447-0349.2006.00444.x (DOI)000208492900008 ()17229275 (PubMedID)2-s2.0-33846233778 (Scopus ID)2082/849 (Local ID)2082/849 (Archive number)2082/849 (OAI)
Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2017-11-30Bibliographically approved
3. Dimensions and reliability of a questionnaire for the evaluation of subjective experiences of health among patients in mental health services
Open this publication in new window or tab >>Dimensions and reliability of a questionnaire for the evaluation of subjective experiences of health among patients in mental health services
2008 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, Vol. 29, no 1, 51-62 p.Article in journal (Refereed) Published
Abstract [en]

Even though the concept of health and its importance has been widely discussed in health care during recent decades, mental health services have been criticised for adopting a biomedical perspective, which does not sufficiently consider the concept of health. The aim of the present study was to investigate the psychometric properties of the Health Questionnaire, a newly developed questionnaire to measure patients' subjective experience of health in mental health services. A cross sectional study was performed using a sample of 139 outpatients in mental health services. A principal component analysis with varimax rotation was used to test the factor structure of the questionnaire. Cronbach's alpha was employed to test internal consistency and Cohen's Kappa assessed test-retest reliability. The final scale, which contained 22 items, derived from three factors (autonomy, social involvement, and comprehensibility) and showed a good reliability in terms of internal consistency. Test-retest reliability was moderate or better for 17 out of 22 items. The Health Questionnaire may enable further empirical studies on subjectively experienced health in mental health services and serve as a measure of outcome and to monitor quality of care.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2008
Keyword
Health questionnaire, Experiences, Patients, Mental health services
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-1479 (URN)10.1080/01612840701748789 (DOI)18214778 (PubMedID)2-s2.0-38649111314 (Scopus ID)2082/1859 (Local ID)2082/1859 (Archive number)2082/1859 (OAI)
Available from: 2008-06-03 Created: 2008-06-03 Last updated: 2016-02-26Bibliographically approved
4. Construct validity of a health questionnaire intended to measure the subjective experience of health among patients in mental health services
Open this publication in new window or tab >>Construct validity of a health questionnaire intended to measure the subjective experience of health among patients in mental health services
2008 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 15, no 3, 238-245 p.Article in journal (Refereed) Published
Abstract [en]

Mental health services have been lacking systematic health-promoting activities, and health is often perceived as the absence of disease from a biomedical perspective. It is vital to develop methods to assess perceived health among patients in a broader perspective. The aim of the study was to investigate construct validity of a newly developed health questionnaire intended to measure subjectively experienced health among patients in mental health services. A cross-sectional study, including a randomly selected sample of 139 outpatients in contact with the mental health services, was performed in order to explore the relationship between perceived health and self-reported levels of self-esteem, symptoms, empowerment, quality of life and experiences of stigmatization. Self-esteem, symptoms, empowerment and quality of life altogether accounted for 70% of the variation in overall perceived health. Overall perceived health showed positive associations to self-esteem, empowerment and quality of life and negative associations to psychiatric symptoms, discrimination and rejection experiences. The findings suggest that perceived health as measured by the health questionnaire can be a meaningful and valid construct that may be useful for measuring health in clinical mental healthcare practice and in mental health services research.

Place, publisher, year, edition, pages
Chichester, West Sussex: Blackwell Publishing, 2008
Keyword
experience, health, mental health services, patients, questionnaire, validity
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-2079 (URN)10.1111/j.1365-2850.2007.01219.x (DOI)000253630100008 ()18307653 (PubMedID)2-s2.0-40149108471 (Scopus ID)2082/2474 (Local ID)2082/2474 (Archive number)2082/2474 (OAI)
Available from: 2008-10-21 Created: 2008-10-21 Last updated: 2016-02-26Bibliographically approved

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