Background Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. Objective This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. Methods Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants’ smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants’ responses to the second interview. Stage 2 interviews explored participants’ perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. Results People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users’ psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. Conclusions This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations.

Background People with Borderline Personality Disorder (BPD) and their carers/families continue to experience structural stigma when accessing health services. Structural stigma involves societal-level conditions, cultural norms, and organizational policies that inhibit the opportunities, resources, and wellbeing of people living with attributes that are the object of stigma. BPD is a serious mental illness characterized by pervasive psychosocial dysfunction including, problems regulating emotions and suicidality. This scoping review aimed to identify, map, and explore the international literature on structural stigma associated with BPD and its impact on healthcare for consumers with BPD, their carers/families, and health practitioners. Methods A comprehensive search of the literature encompassed MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 28th 2022). The search strategy also included grey literature searches and handsearching the references of included studies. Eligibility criteria included citations relevant to structural stigma associated with BPD and health and crisis care services. Quality appraisal of included citations were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18), the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool, and the AGREE II: advancing guideline development, reporting, and evaluation in health care tool. Thematic Analysis was used to inform data extraction, analysis, interpretation, and synthesis of the data. Results A total of 57 citations were included in the review comprising empirical peer-reviewed articles (n = 55), and reports (n = 2). Studies included quantitative, qualitative, mixed methods, and systematic review designs. Review findings identified several extant macro- and micro-level structural mechanisms, challenges, and barriers contributing to BPD-related stigma in health systems. These structural factors have a substantial impact on health service access and care for BPD. Key themes that emerged from the data comprised: structural stigma and the BPD diagnosis and BPD-related stigma surrounding health and crisis care services. Conclusion Narrative synthesis of the findings provide evidence about the impact of structural stigma on healthcare for BPD. It is anticipated that results of this review will inform future research, policy, and practice to address BPD-related stigma in health systems, as well as approaches for improving the delivery of responsive health services and care for consumers with BPD and their carers/families. Review Registration: Open Science Framework (https://osf.io/bhpg4).

Background Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers’ access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families. Methods This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. Discussion This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. Systematic review registration Open Science Framework (https://osf.io/bhpg4).

Background The rising prevalence of Borderline Personality Disorder (BPD) and suicidality represents substantial health burden worldwide. People with BPD experience high rates of crisis presentations and stigma when accessing health services. Educational interventions designed to modify health practitioners’ attitudes and practice in treating people with BPD may assist in addressing this stigma. The current review aimed to identify and explore existing educational interventions designed to modify health practitioners' attitudes and practice in BPD; and determine what impact educational interventions have on improving health practitioners’ responses towards people with BPD. Methods A comprehensive search of the literature was undertaken in MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 2022). Secondary sources of literature included grey literature searches and handsearching the references of included studies as part of the comprehensive search strategy. The eligibility criteria included peer-reviewed empirical studies examining BPD-related educational interventions aimed at modifying health practitioners’ attitudes and practice in treating people with BPD. Quality appraisal of the included studies were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18) or the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool. Thematic Analysis informed data extraction, analysis, interpretation, and narrative synthesis of the data. Results A total of nine papers containing 991 participants across a diverse range of studies including, quantitative, qualitative, mixed methods, and a systematic review were included in this integrative review. Several BPD-related educational interventions designed to modify health practitioners’ attitudes and practice in BPD exist. Findings suggest that training health practitioners in BPD-related educational interventions can enhance positive attitudes and change practice towards people with BPD; however, more high-quality studies are needed to confirm these conclusions. Conclusions This review collated and summarized findings from studies examining the impact of BPD-related educational interventions on changing health practitioners’ attitudes and practice in treating this population. Results from this review may help inform future research, policy, and practice in stigma-reduction strategies which would improve the delivery of responsive health services and care for people with BPD. Systematic review registration Open Science Framework (https://osf.io/7p6ez/)

BackgroundStructural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD), is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limits consumers’ access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological aetiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers, and their carers/families.MethodsThis scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. DiscussionThis review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices), that manifest and perpetuate stigma experienced by consumers with BPD, and their carers/families. The findings can be used to inform future research, policy and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. Systematic review registration: Open Science Framework (https://osf.io/bhpg4).