Clients' engagement with assertive outreach services: A comparison of client and staff perceptions of engagement and its impact on later engagement

Gillespie, Morna; Smith, Jo; Meaden, Alan; Jones, Chris; Wane, Julia

doi:10.1080/09638230400006767

Cited by 23 publications

(31 citation statements)

References 4 publications

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“…Qualitative papers received high scores on the CASP analysis [23] and demonstrated robust approaches to study design, data collection and analysis. In contrast, there were short-comings in the design of many of the measures available in the literature, specifically that six of the ten measures were not developed from robust conceptual understandings of engagement [22,[32][33][34][35][36]. Instead, they were based on clinician and researcher perceptions of what engagement might mean.…”

Section: Quality Of Included Papersmentioning

confidence: 99%

“…With regard to published measures of engagement, the interaction and relationship between clinician and patient was considered within some measures, for example, the 'quality of the relationship' [32,34] 'attitudes toward staff' [33], and the 'client's perception of being listened to' [40]. Of note is that items in the measures commonly focused on the patient's actions and perceived attitudes despite the body of evidence detailed above emphasizing the clinician's actions and perceived attitudes.…”

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confidence: 99%

“…Had there been more consideration of patient perspectives in the design process, and had the item development been based on robust empirical and/or theoretical studies of engagement, as done by Macgowan [38] and as recommended by McDowell [39], they may be considered more reliable and valid. Four measures did not explicitly define engagement, the construct at the center of the measure [32,34,35,40]. The lack of a conceptual base and lack of clarity around the construct may limit how much these indicators can be said to be reliable indicators of engagement [22].…”

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“…We would argue that clinicians are not well-positioned to judge this subjective, internal state and that their 'assessment' of a patient's engagement may at best provide only a partial view of engagement and at worst, reflect an inaccurate picture [45]. It could be anticipated that the patient may have a different perspective that should be considered [32,40,57,66]. …”

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confidence: 99%

“…It did not appear to cease once the patient became involved with the service or in a therapy task; instead it was fluid and could further develop, or in fact diminish over time without on-going work and from both parties [10,30,43,44,48,58]. It was said to be maintained through an internal feedback loop, which involved the patient making on-going decisions to remain engaged [58] and through the clinician's way of working [52,57]; this could include periods of intermittent disengagement from services [43].With regard to published measures of engagement, the interaction and relationship between clinician and patient was considered within some measures, for example, the 'quality of the relationship' [32,34] 'attitudes toward staff ' [33], and the 'client's perception of being listened to' [40]. Of note is that items in the measures commonly focused on the patient's actions and perceived attitudes despite the body of evidence detailed above emphasizing the clinician's actions and perceived attitudes.…”

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confidence: 99%

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A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

189

177

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A conceptual review of engagement in healthcare and rehabilitationPurpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement.Method: EBSCO and SCOPUS databases and reference lists were searched for papers that sought to understand or describe the concept of engagement in healthcare or reported the development of a measure of engagement in healthcare. We drew on a Pragmatic Utility approach to concept analysis.Results: Thirty-one articles met the criteria and were included in the review. Engagement appeared to be conceptualized in two inter-connected ways: as a gradual process of connection between the healthcare provider and patient; and as an internal state which may be accompanied by observable behaviors indicating engagement. Conclusion:Our review suggests engagement to be multi-dimensional, comprising both a coconstructed process and a patient state. While engagement is commonly considered a patient behavior, the review findings suggest clinicians play a pivotal role in patient engagement. This review challenges some understandings of engagement and how we work with patients, and highlights conceptual limitations of some measures. Introduction'Patient engagement' is a term increasingly used in rehabilitation and the broader healthcare context [1]. Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge. Levels of engagement have also been associated with lower levels of depression and with higher levels of affect, adherence and attendance [2,4]. In addition, within clinical rehabilitation practice, the 'engaged patient' is perhaps identified as being the 'desirable patient', one who is easy for providers to work with [5]. On the face of it, these findings suggest that patient engagement is both positive and desirable.While the term 'engagement' is increasingly used in clinical practice and research, there has been relatively little critical exploration of what 'engagement' means and the underpinning concept/s the term may represent. Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].It could be argued that it does not matt...

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A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

189

177

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A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment

Tetley¹,

Jinks²,

Huband³

et al. 2011

J Clin Psychol

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This article reports a systematic review of engagement measures for psychosocial therapy. MEDLINE, EMBASE, and PsycINFO databases were searched to identify English-language studies (published 1980 to February 2010) that reported on an instrument/rating scale to measure engagement in psychosocial treatment for mental health difficulties. Forty-seven studies were identified, reporting information on 40 measures of treatment engagement. Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess, they also reveal that there is little consensus in the definition of engagement employed. Few measures are generalizable across treatment settings and clinical populations, and limited information is reported on the indices of reliability and validity. It is concluded that further work is required to develop adequate measures of therapeutic engagement.

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Predicting Initial Client Engagement with Community Mental Health Services by Routinely Measured Data

Roeg

Goor

Garretsen

2014

Community Ment Health J

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Engagement is a determinant of how well a person will respond to professional input. This study investigates whether, in practice, routinely measured data predict initial client engagement with community mental health services. Engagement, problem severity, client characteristics, and duration before the first contact were measured at team entrance with clients (n = 529) of three community mental health teams. Regression analysis was used to predict engagement. Gender, age, referrer, having children, having a partner, and ethnicity showed a minor relationship with engagement. Higher problem severity measured by the team members with the Health of the Nation Outcome Scales, being referred for having psychiatric problems and/or causing severe and long-lasting trouble (as 'assessed' by the often non-professional referrer), and a longer duration between enrollment and the first conversation with a client, were indicative for a lower engagement. The final model explained 19.2 % of the variance in engagement. It can be concluded that initial client engagement with community mental health services can be predicted, in part, by routinely measured data. The findings can be used by community mental healthcare teams to create an awareness system.

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Clients' engagement with assertive outreach services: A comparison of client and staff perceptions of engagement and its impact on later engagement

Cited by 23 publications

References 4 publications

A conceptual review of engagement in healthcare and rehabilitation

A conceptual review of engagement in healthcare and rehabilitation

A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment

Predicting Initial Client Engagement with Community Mental Health Services by Routinely Measured Data

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