- Title
- Changing practice: preventive care for chronic disease health risk behaviours in community mental health services
- Creator
- Bartlem, Kate
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- People who have a mental illness have significantly greater mortality rates and a reduced life expectancy when compared to the general population, with a large proportion of excess mortality attributable to a higher prevalence of preventable chronic diseases. One contributor to the greater chronic disease burden is an increased prevalence of modifiable health risk behaviours, when compared to the general population, in particular, tobacco smoking, harmful alcohol consumption, inadequate nutrition, and inadequate physical activity. The provision of preventive care in mental health services is one approach to addressing such health risk behaviours among people with a mental illness, with community mental health services identified as a particularly appropriate setting for such care delivery. Despite this, there are evident gaps in the literature regarding the prevalence of health risk behaviours among people with a mental illness, the prevalence of preventive care provision in community mental health services, and the approaches required to increase the provision of such care in community mental health services. To address these evidence gaps, the broad aims of this thesis were to: 1) Identify the prevalence of, and client characteristics associated with, four chronic disease health risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity) among clients of community mental health services. ; 2) Determine the prevalence of preventive care provision (assessment, brief advice, and referral) in community mental health services for these four health risk behaviours. ; 3) Explore factors that may be associated with the provision of preventive care for these four health risk behaviours. ; 4) Determine the effectiveness of a clinical practice change intervention in increasing community mental health clinicians’ provision of preventive care for these four health risk behaviours across a network of community mental health services. These four aims have been addressed through a series of studies, undertaken within a network of 19 community mental health services in a single local health district in New South Wales, Australia. These studies include: a cross-sectional survey of 558 clients of community mental health services; a cross-sectional survey of 151 community mental health service clinicians; and a multiple baseline intervention trial involving 19 community mental health services, evaluated through weekly surveys of clients of community mental health services over a three year period. The work encompassed in this thesis has contributed to advancing research in this field in a number of ways. Firstly, the findings include evidence among people with a broad range of mental disorders, of a high prevalence of risk for all four health risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity), high interest in improving these behaviours, and high acceptability towards receiving preventive care to address them. Despite the high prevalence of health risk behaviours and high client interest, it was found that the provision of preventive care for these behaviours within community mental health services was sub-optimal, and a number of factors that may be associated with the provision of such care were identified. Finally, the clinical practice change intervention that was undertaken to increase the routine provision of preventive care in community mental health services was found to have limited effectiveness. Overall, this thesis has identified a need to increase the provision of preventive care to address the high prevalence of health risk behaviours among people with a mental illness, and has trialled a novel approach to increasing the provision of such care in community mental health services. Despite the limited effectiveness of the clinical practice change intervention, the findings of this thesis have provided important insight for future interventions. It is suggested that future research consider barriers identified throughout this thesis to better tailor an intervention to the specific context of community mental health services; consider utilising advances in the science of clinical practice change design; and explore alternative models of preventive care provision.
- Subject
- preventive care; mental illness; chronic disease; health behaviour; risk behaviour; health risk behaviour; behaviour change; thesis by publication; mental health; smoking; nutrition; alcohol; physical activity; community mental health services; practice change; implementation research
- Identifier
- http://hdl.handle.net/1959.13/1310083
- Identifier
- uon:21980
- Rights
- Copyright 2015 Kate Bartlem
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT02 | Thesis | 18 MB | Adobe Acrobat PDF | View Details Download |