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Articles   |    
Service Users’ Perceptions About Their Hospital Admission Elicited by Service User–Researchers or by Clinicians
Brian O'Donoghue, M.Sc., M.R.C.Psych.; Eric Roche, M.B., M.R.C.Psych.; Veronica F. Ranieri, M.A., M.Sc.; Stephen Shannon, B.A., M.Sc.; Ciaran Crummey, Ph.D.; Johanna Murray, M.B.; Damian G. Smith, M.B., M.R.C.Psych.; Kieran O'Loughlin, M.B., M.R.C.Psych.; John P. Lyne, M.Sc., M.R.C.Psych.; Kevin Madigan, R.P.N., M.Sc.; Larkin Feeney, M.Sc., M.R.C.Psych.
Psychiatric Services 2013; doi: 10.1176/appi.ps.001912012
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Dr. O’Donoghue, Dr. Roche, Mr. Madigan, and Dr. Feeney are affiliated with the Cluain Mhuire Mental Health Service, Newtownpark Ave., Blackrock, Co. Dublin, Ireland (e-mail: briannoelodonoghue@gmail.com).
Ms. Ranieri, Mr. Shannon, and Dr. Crummey are with SOURCE (Source of User Research, Collaboration and Expertise), Dublin.
Dr. Murray is with the Department of Medicine, Royal College of Surgeons, Dublin.
Dr. Smith is with the Department of Forensic Psychiatry, Central Mental Hospital, Dublin.
Dr. O’Loughlin and Dr. Lyne are with the Department of Psychiatry, St. Vincent's University Hospital, Dublin.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Service users may express positive, ambivalent, or negative views of their hospital admission. The objective of this study was to determine whether the background of the interviewer—service user–researcher or clinician—influences the information elicited. The primary outcome was the level of perceived coercion on admission, and secondary outcomes were perceived pressures on admission, procedural justice, perceived necessity for admission, satisfaction with services, and willingness to consent to participate in the study.

Methods  Participants voluntarily and involuntarily admitted to three hospitals in Ireland were randomly allocated to be interviewed at hospital discharge by either a service user–researcher or a clinician. Interviewers used the MacArthur Admission Experience Survey and the Client Satisfaction Questionnaire.

Results  A total of 161 participants were interviewed. No differences by interviewer status or by admission status (involuntary or voluntary) were found in levels of perceived coercion, perceived pressures, procedural justice, perceived necessity, or satisfaction with services. Service users were more likely to decline to participate if their consent was sought by a service user–researcher (24% versus 8%, p=.003).

Conclusions  Most interviewees gave positive accounts of their admission regardless of interviewer status. The findings indicate that clinicians and researchers can be more confident that service users’ positive accounts of admissions are not attributable to a response bias. Researchers can also feel more confident in directly comparing the results of studies undertaken by clinicians and by service user–researchers.

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Table 1Characteristics of 161 service users interviewed before hospital discharge by service user–researchers or by clinicians
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a Data on use of restraint available for 152 participants; use of seclusion, 151 participants; use of medication without consent, 149 participants

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b Global Assessment of Functioning. Possible scores range from 0 to 100, with higher scores indicating better interviewer-rated global functioning.

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c Measured with the Birchwood Insight Scale. Possible scores range from 0 to 12, with higher scores indicating good insight.

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d Measured with the Scale for the Assessment of Positive Symptoms only for participants with a diagnosis of a psychotic disorder (N=75). Interviewer-rated possible scores range from 0 to 20, with higher scores indicating more severe positive psychotic symptoms.

Table Footer Note

e Measured with the Scale for the Assessment of Negative Symptoms only for participants with a diagnosis of a psychotic disorder (N=75). Interviewer-rated possible scores range from 0 to 25, with higher scores indicating more severe negative symptoms.

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f Measured with the 21-item, self-report Beck Depression Inventory. Possible scores range from 0 to 63, with higher scores indicating more severe depressive symptoms.

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Table 2Information about service users’ views of their hospital admission elicited during interviews before hospital discharge with service user–researchers or clinicians
Table Footer Note

a Measured with the MacArthur Admission Experience Survey (MacArthur AES) perceived coercion scale. Possible scores range from 0 to 5, with higher scores indicating higher levels of perceived coercion.

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b Measured with the MacArthur AES perceived pressures scale. Possible scores range from 0 to 4, with higher scores indicating higher levels of perceived pressures.

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c Measured with the MacArthur AES procedural justice scale. Possible scores range from 1 to 4, with higher scores indicating lower levels of perceived procedural justice.

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d Measured with the self-report Client Satisfaction Questionnaire (CSQ-8). Possible scores range from 8 to 32, with higher scores indicating higher levels of satisfaction.

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