Psychological aspects of holistic approaches to healthcare: the roles of co-production and ACT for self-management in the care of long-term conditions

Russell, Rachel (2021) Psychological aspects of holistic approaches to healthcare: the roles of co-production and ACT for self-management in the care of long-term conditions. Doctoral thesis, University of East Anglia.

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Abstract

Introduction
It has been argued that care for people with long-term conditions (PLTC) needs to move towards holistic models. Co-production involves service users, professionals, relatives, and communities in the design and delivery of services and has been associated with increased service effectiveness, and improved psychological outcomes. Self-management interventions for PLTC have moved from patient education to psychological interventions. Acceptance and Commitment Therapy (ACT) is a transdiagnostic approach that may have utility for PLTC.

Method
A systematic review was conducted investigating the utilisation and evaluation of coproduction in health and social care services. A systematic review and meta-analysis was conducted investigating the efficacy of ACT for holistic self-management of LTCs, in terms of physical, psychological, and social outcomes in line with a holistic definition of self-management. The reviews were both conducted in line with PRISMA reporting standards and the review protocols were registered with PROSPERO.

Results
The systematic review found 23 reports relating to 11 studies, that were almost exclusively within a mental health context. A range of facilitators and barriers to co-production were identified. Outcome measurement, including psychological outcomes, focused on the output of co-production rather than the process. The systematic review and meta-analysis found 27 reports relating to 21 RCTs of ACT for LTCs (n = 1173). Preliminary evidence was found for the efficacy of ACT for a range of psychological outcomes, with small to moderate effect sizes. Preliminary evidence was found for the efficacy of ACT for holistic self-management for rheumatological conditions, with moderate to large effect sizes. However, issues related to risk of bias and study quality across both reviews, limit possible conclusions.

Conclusions
Both reviews helped to establish the current evidence base in their respective areas. However, there is insufficient evidence to draw firm conclusions and higher quality research is needed.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	25 Nov 2021 09:46
Last Modified:	25 Nov 2021 09:46
URI:	https://ueaeprints.uea.ac.uk/id/eprint/82329
DOI:

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